Risk Management & Legal Responsibilities of the Nurse Leader

1) I wasn’t really sure what Risk Management meant. I know I’ve heard of it before though.

2) After this unit’s learning, I realized how important Risk Management is. There is a saying that says, “To be human is to error.” To apply this to the patient-care setting, most all nurses render care with their best intentions in mind, but even with these good intents, errors still occur.  Risk Management realizes that nurses cannot predict the future and what will happen with a patient. It is never the intention of the nurse to cause injury, neglect or harm the patient. This being said, Risk Management is in operation to ensure better safety measures are implemented in order to keep patients safe and protect staff members.

Risk Managers look at domains and areas of risk. These include: finance, operational/clinical, human capital, legal/regulatory, technology, and natural disasters/hazards. For example, for financial risks, liability insurance is bought to cover the company’s risks. For human capital risks, research can be done to gather data on what part of the shift nurses tend to make the most mistakes.  This way appropriate interventions can be made to limit or prevent the risks from occurring (i.e. Risk Mitigation).

An important role hospital staff can play is filling out “Incident Reports” to help track and view trends of various events, complaints, grievances, serious safety issues, or sentinel events.  It is important to document only the facts of the event, remembering the Who, What, When, and Where information. Because Incidents Reports are protected pieces of information, a nurse must never refer to it in her nursing notes. If the nurse does, it can be “discovered” by the court during depositions and cases.

When an event occurs, it is necessary to ask the initial question, “What is the standard of care?” Then, risk management will research to see if what actually happened was a breach in the standard of care, and if that breach caused the patient injury or damage.

Risk management is so important because it aims at getting serious safety events down to zero. Across the U.S. medication errors, falls, and patient care/treatment are high volume nursing event types. If we all can decrease injuries and errors by 40%, 60,000 patient lives can be saved.

3) I enjoyed the discussion about the 27-year old intoxicated and aggressive patient getting serious burns on his body, and how the nurse leader would go about resolving the event. It was interesting to see my team member’s ideas on how to fix the problem in the future. I had forgotten that a 1:1 psych sitter could have immediately helped prevent the burns from occurring, due to rapidly putting out the fire and noticing the patient movement. As an ER nurse myself, this type of patient is quite common, and it was eye-opening to see the results of what could happen if I were not diligent.

The scholarly article I looked up on the topic ‘Risk Management in Nursing Leadership’ was interesting. Failure Mode Effects Analysis (FMEA) is a systematic method, developed by the U.S. military, for evaluating parts of processes in need of change (Reams, 2011). Nurse leaders can use this method to make the delivery of healthcare safer for patients. It is an 8-step process which allows for thoroughness and questioning what may not be right. The first step involves identifying a system and a process within it that’s likely to cause harm to a patient.  A multi-disciplinary team will break the process a part and analyze each part of it using a flow chart. Problems that need fixing will be identified and assigned a severity score (how mild-catastrophic the patient outcome will be) and probability score (likelihood of error occurring). These scores will be multiplied together and then ranked in order. A score of 16 would be considered a severe threat to patients, whereas a score of 6 would not be as big a concern. Items with a higher score would be given higher priority to address and fix the process. FMEA is a straightforward process that can decrease and stop harmful incidents from occurring if conducted appropriately by the nurse manager and multidisciplinary team (Reams, 2011).

4) I plan to always be honest and forthright with my patients. I will continue to document Incident Reports if they occur. I realize involving Risk Management is helpful in preventing errors to patients in the future. We are all human—unintended mistakes happen.

5) I enjoyed this unit. It really struck me how important the role of Risk Management is in limiting risks. I realize how important all the skills certifications are (i.e. applying restraints, etc) now. It ensures competency while also limits potential risks to patients.  

Reference

Reams, J. (2011 May). Making FMEA work for you. Nursing Management, 18-20. doi: 10.1097/01.NUMA.0000396500.05462.6e

Motivation Reflective Journal

1) I expected to learn about motivating employees to perform well on the job.

2) I actually learned in this unit how to retain employees and encourage their best work through motivating them. The basic formula is this: as a manager you are to find out what your employees want and find a way to give it to them. There are many different ways to motivate employees. The obvious answer is money. All employees love a pay-raise. Although, money has not been shown to be a long-term motivator. The best ways to motivate employees can be through personalized notes, public and private recognition, gift baskets, movie tickets, or assigning them to be in charge of short-term projects (shows you trust them). Employees will know if gifts and recognition are genuine or not. It is important to truly get to know your employees in a personal way, so when the recognition is given, they will appreciate it more.

With consistent praise and recognition, employees will be more willing to stay at a company and perform their best work. They will love coming to work—which creates an positive work environment. Also, they will admire you as their manager for taking a personal interest in them and their efforts.

3) For the team discussion, I enjoyed creating a 7-Step Plan for motivating employees. It seemed difficult at first, since the employees seemed to already have all the financial incentive they could possibly desire. It makes sense to me that creating an uplifting and positive work environment, where employees feel included, needed, and rewarded, would be what would retain them. If they enjoy and love coming to work, they are more likely to stay as a long-term employee. This is what I kept in mind while creating my plan.

4) I plan to refer back to these websites when I am in a leadership role in the future. By using these ideas, and the ones presented in the lecture, I can be a better motivator for my employees.

(http://www.choosewhat.com/starticles/how-motivate-your-employees)

(https://hbr.org/2011/01/managing-employees-in-their-tw)

(http://www.inc.com/guides/hr/20776.html)

5) I enjoyed learning about motivation. Sadly, I could relate to the Gallup Employee Opinion Survey. I feel like there was so much going on in the Emergency Room that it was easy to be forgotten for all you contribute during your shift. If our manager presented more employee recognition, especially verbally and personally, I think there would be increased employee retention and less turnover.

I also really liked the idea of a gift basket given to employees. When hiring them, the manager can present them with a form that states, “My favorite [color, candy bar, drink, actor, movie, dessert, car, etc] is ________.” Then the gift basket can be compiled for them and given to them later for a job well-done. That would mean tons to me! 

Conflict Resolution Reflective Journal

1) I expected to learn about different communication styles and how to resolve conflict before beginning this unit.

2) This week I learned about different communication styles, resolving conflict effectively, and how to collectively bargain.

“Assertive communication is the ability to express positive and negative ideas and feelings in an open, honest, and direct way” (Hopkins, 2005). The assertive style of communication involves being direct, honest, accepting, responsible, and spontaneous.  The advantages of communicating assertively is it helps us feel good about ourselves and others, it helps us achieve our goals, it reduces anxiety, and protects us from being taken advantage of by others (Hopkins, 2005). Lastly, assertive communication enables us to express, both verbally and non-verbally, a wide range of feelings and thoughts that are both positive and negative.

Assertive communication is not aggressive communication. The two types of aggressive communication are direct and indirect. Direct aggression is described as bossy, arrogant, over-bearing, intolerant, and opinionated (Hopkins, 2005). Indirect aggression is seen as sarcastic, deceiving, ambiguous, insinuating, manipulative, and guilt-inducing (Hopkins, 2005).  

Non-verbal communication is very powerful. How a person stands, holds themselves, how they gesture, their tone of voice, voice inflection, closeness, eye contact made, and facial expressions all convey unspoken messages (Segal, et al., 2015). It is important to determine if these non-verbal messages are congruent with the actual words being spoken.

Along with communication comes effective listening. Most people think they listen better than they actually do. “Effective listening is actively absorbing the information given to you by a speaker, showing that you are listening and interested, and providing feedback to the speaker so that he or she knows that the message was received” (Wright State University, n.d.).  Reflecting upon what a person has said, and probing for more information are signs of an active listener.

Conflict is experienced when two people have opposing views and they collide. It is important to find a resolution for conflict so feelings do not go unresolved and fester. Resolving a conflict is a healthy thing and can actually strengthen relationships. It is important to manage stress quickly while remaining alert and calm. Controlling your emotions and behavior is also essential. Being centered and aware of how you feel helps you communicate your needs better. It is important to pay attention to the feelings being expressed by the other individual, and then be aware of and respectful of differences. Sometimes it is necessary to agree to disagree. Most often, though, when following the above steps, conflict can be resolved quite well.

Lastly, I learned about unions and collective bargaining. A union is an organization that is outside of where you work that has an interest in your work and represents, you, the worker (Lecture, Part 2). Unions care less about management and the hospital, they mainly care about the employee and their rights. Even if not all employees are in favor of a union, if the in favor percentage is above 50%, then the union is established. A union representative is determined. Union dues are paid monthly, whether the employee wants to pay it or not. The representative bargains with the employer for certain rights for the employees. Things such as increased pay, more vacation time, longer lunch breaks, or more insurance coverage are items that can be bargained for. If an employer refuses to negotiate, strikes result. It is important to note too that it can be very costly. The more time employees are out of work on strike, and the actual amounts negotiated, can end up being less than expected---more of a net loss than a net gain. Some unions have had a history of throwing rocks at and barricading entrances to organizations, if employees are not in support of them. This makes it unsafe for employees, and the sometimes have to be bussed in to work for their own safety. Unions seems to be great since they are there to protect the employee, but ultimately, the union itself has to be paid money as well. That money comes from the employees’ pockets.

3) I enjoyed the team activities. The Haji Kamal- World Warfighter online game was interesting. It took understanding what was said verbally and non-verbally to be able to win the game. Discerning what another individual is thinking is not easy. But, looking for the verbal/non-verbal cues is advantageous.

I enjoyed the collective bargaining assignment and discussion. This was difficult at first because the material presented was difficult to understand—it could have been presented more clearly. But, it was fun to practice what it would be like to be a union representative and bargain with an employer for your fellow employees.

4) I plan to utilize the information I have learned by practicing assertive communication in my personal and professional life. As a nurse, there are many times conflicts arise in the workplace. I plan to be more aware of the non-verbal messages I am sending to my patients, as well as being open, honest, and direct in my communication. This can build better relationships of trust with my patients (and those close to me in my personal life).

5) I enjoyed learning this material. It was a large amount of workload, but I felt it was helpful in teaching me better communication skills and conflict resolution techniques. I personally enjoyed learning about being centered, aware of my emotions, and reducing my stress quickly, in order to more effective resolve conflicts.

Reference

Hopkins, L. (2005). Assertive communication- 6 tips for effective use. Retrieved from http://ezinearticles.com/?Assertive-Communication---6-Tips-For-Effective-Use&id=10259

Segal, J., Smith, M., Boose, G., & Jaffe, J. (2015 February). Nonverbal communication: Improving your nonverbal skills and reading body language. Retrieved from http://www.helpguide.org/articles/relationships/nonverbal-communication.htm

Wright State University (n.d.). Listening effectively. Retrieved from http://www.wright.edu/~scott.williams/skills/listening.htm