Montana Pulse - November 2020

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Page 16 Montana Nurses Association Pulse November, December 2020, January 2021 State Wide Nursing News WORKPLACE FRATERNIZATION NURSING ADMINISTRATOR/ LEADER ROLE You were (or will be) hired to do a nursing administrator/ leadership job! That means that you are trusted and considered competent to make difficult, logical, fair, and progressive decisions. You might have a board of trustees (or other advisory people) to make decisions. Because you are the nursing administrator/ leader, you (especially you) are legally accountable for Carolyn Taylor Ed.D, MN, RN your decision-making role and behavior for the welfare of patients and nursing staff. The most effective and accurate decisions on your part are (or will be) an outgrowth of your leadership knowledge and intellectual skills (cognitive domain), your leadership ability and function skills (psychomotor domain), and your selected attention skills (affective/feeling domain). Therefore, it is imperative to understand, perform leadership, and relate to the psychology of human behavior. Understanding fraternization and its implications are to understand human behavior. It is this awareness that helps to identify nursing professional prowess. Fraternization is when coworkers act socially with each other or are inappropriately friendly with each other in the work situation; therefore, disrupting job expectations. It is common for frequent interactions with coworkers to lend themselves naturally to friendly relationships. After all, getting along with coworkers increases work morale. The very practice of nursing encourages work fraternization. Also, after-hour romantic relationships are easily a part of the work setting—with good or bad results. Conversations with nurses to explain how romantic or other social relationships can negatively impact work can be a part of orientation and in-service content. Nursing leadership objectivity requires no influence by personal feelings or opinions as to the facts regarding work fraternization. Therefore, the big objective questions for a nurse administrator/leader are-- 1. How is it made abundantly clear to nursing staff about the boundaries to mitigate potential fraternization problems? 2. What are the ways to help nurses remain focused on nursing process tasks during their work time and as indicated by their job descriptions? TEACHING AND LEGAL ENFORCEMENT OF FRATERNIZATION The work policy should state that the facility/ organization supports positive work relationships in the common interest of quality nursing care and the meeting of job description expectations. However, there is non-acceptance of inappropriate fraternization and consequences for obvious infractions. A copy of this policy is provided to each nursing employee. The policy will help mitigate potential fraternization problems. Policies are written and distributed as standard operating procedures (SOP) of the organization. A job description is separate from a policy statement. Job descriptions follow the Benjamin Bloom Taxonomy (online)—each positive expectation started with an action verb and related to one of the three domains of cognitive, psychomotor, and affective/feelings. Job descriptions are the positive statements that are the internal guidance systems of the facility/organization. Reprimand for disruptive employee fraternization should be progressive. First, start with a verbal warning or private discussion. The second time fraternization occurs, present the employee with a written notification. The third time (the final time), give a written statement of transfer or job termination. Something like—three strikes and you are out concept. Be sure that the policy clearly states the progression of employee fraternization warnings and the outcome of persistent non-compliance. Always have legal documents (including original facility/organization policies) signed and dated by both the nursing administrator/leader and the employee. WORK VS. PUBLIC BEHAVIOR—A NURSING LEADER CHOICE Nursing administrative/leadership behavior means that you are aware of and CHOOSE the professional conversation and action that you share in the workplace with the nursing staff. There are three behaviors--“public/social behavior,” “private behavior,” and the “work behavior.” You, as a nursing administrator/leader, must decide how to communicate to the nursing staff to keep these three behaviors under control. The public/social behavior and private behavior most often will not successfully get nursing accomplished in the manner designated by the job description. It also means that every nurse must learn there is a time and place that legitimately supports the changing of the communication climate from work behavior to private, public, or social behavior. The separation of these three behaviors represented by nursing leadership communication (words and actions) will help assure more meaningful attention to successful professional work behaviors. Family and friends will benefit when the work behavior stays at work. Patients benefit when work behaviors occur on the job. Knowing and practicing outstanding leadership behavior helps control the on-the-job social behavior of fraternizing and maximizes positive work behavior on the job. The consequences of sharing personal (private) information are not always or not all bad. Sharing selected unique commonalities may be a good thing if you try to establish a close working relationship with another person. However, maintaining a nursing administrative/leadership role and positive influence with nursing staff requires some restraint. The problems of excessive personal or private sharing by a nurse administrator/leader with any nursing employee can lead to possible attempts of nurse employee manipulation, blackmail, or misrepresentation of the shared comments to others in an untoward manner. Before sharing your personal or private information as a nurse administrator/leader, the question you should ask yourself: “How could this information be misconstrued, misused, or how could it be used against me as a nurse administrator/leader?” If this concern appears to represent paranoid thought— so be it for your good! Believe it or not—not all of your cohorts and subordinates have your best interest in mind all of the time! Furthermore, the personal and private sharing (inappropriate fraternization) between nursing employees during work hours is time-consuming, distracting, and non-productive for getting the nursing assignments done. BENEFICIAL UNCERTAINTY (WATCHFUL UNEXPECTED EYES) When trying to curtail inappropriate fraternization among employees, being close to employees at unexpected moments will tell you if a nursing employee is on task. Your presence as an unpredictable nursing administrator/leader watching job performance is called BENEFICIAL UNCERTAINTY. In other words, they (nursing staff) never know for sure when a nursing administrator/leader will unexpectedly be present or show up! Interesting—social communication and inappropriate fraternization often increase when the nursing administrator/leader leaves for the day! Have you ever noticed or have times when there is a shift from nursing behaviors to unacceptable fraternization behaviors? Time to pay unexpected attention--and watch behavior improve! VERBAL NON-JUDGEMENTAL RECOGNITION OF FRATERNIZATION If you notice a fraternizing behavior that deviates an employee from expected work performance, merely draw verbal attention to your observation of inappropriate fraternization without drawing judgment on the observed fraternization. Draw attention to the unacceptable fraternizing behavior by simply saying what you observe without judging the behavior. Then, listen to the personal judgment he/she places on their fraternizing behavior. You, as a nurse administrator/ leader, allow the nurse to verbally or non-verbally admit that “Oh, I am caught.” The improper fraternization is, then, usually curtailed in the future. Your nonjudgmental verbal recognition and the perpetrator’s response (verbal or non-verbal) to the nurse administrator/ leader’s recognized fraternization will often refocus the perpetrator’s attention back to their expected nursing assignment. CURTAILING FRATERNIZATION THROUGH VERBAL COMMUNICATION—COGNITIVE ENGAGEMENT Asking questions as a nurse administrator/leader is a thoughtful process. No more “off the cuff” conversations! Choose your communication wisely! Encourage verbal assessment and evaluation of healthcare situations to keep nurses on-track. Cognitive stimulation can help replace fraternization behaviors and encourage the elevation of nursing cognition. Use open-ended questions to stimulate intellectual thought and conversation rather than close-ended questions. Open-ended questions related to a specific job might include: (Cannot be answered by “Yes” or “No.”) 1. Sally, tell me how that procedure is helping Mr. Dobbs. (or) 2. How is working closely with nurse Jones helping you understand the computer charting? Closed-ended questions (examples) related to a specific job might be: (Requires an answer of “Yes” or “No.”) 1. Sally, is that procedure helping Mr. Dobbs? (or) 2. Is working closely with nurse Jones helping you to understand the computer charting better? Always calculate your words and behavior wisely— be an example of non-fraternization. You, as a nurse administrator/leader, are to be an example of correctness in all nursing situations. Your restraint and professionalism are why you have nursing leadership responsibility. Know WHY you do what you do---don’t just DO! Welcome to the covert behaviors of leadership!! Remember, you were (or will be) hired as a nurse administrator/leader because you are special. Prove it! That most often means you know the difference between acceptable and unacceptable nurse administrator/leadership behaviors. You know fraternization when you see and experience it! The nurse administrator/leader is the procurer of nonfraternizing work behaviors. TRUE LEADERSHIP POWER COMES IN THE SECRET ABILITY TO RECOGNIZE AND CHANGE UNNECESSARY JOB FRATERNIZATION INTO PRODUCTIVE JOB-RELATED BEHAVIORS.
November, December 2020, January 2021 Montana Nurses Association Pulse Page 17 Sylvia J. Galloway, RN Reprinted with permission from Arizona Nurse May 2020 The population of hospitalized patients aged 65 years and older often experience less than optimal outcomes as a result of inadequate nutrition. A significant number of patients are not sitting in chairs for meals, which leads to impaired digestion and malnutrition. The purpose of this quality improvement project was to educate patients and staff on the benefits and detriments of position during mealtime. A literature search was conducted, with few articles being found. As a result of this search, a deduction was made that the lack of literature proves more attention needs to be given to this matter. Patients and hospital staff were involved in order to focus on awareness and education within the hospital setting. Patients were encouraged to be proactive in their care and recovery. To determine the impact this has on nutritional intake, a select group of mealtime percentages at a rural hospital in the southwest was recorded and analyzed, utilizing a qualitative review of chart audits. Results served to provide awareness of the importance of the relationship between nutrition and position. The significance of this project included better patient outcomes, less need for skilled nursing facilities upon discharge, fewer hospital readmissions, and improved patient satisfaction. Rationale The intent of this quality improvement project was to improve nutritional intake. Two key factors contribute to patient recovery and rehabilitation: nutrition and functional mobility (Resnick & Gershowitz, 2013). The problem of patients becoming malnourished while in the hospital has been identified. The project included education for patients and staff in order to work collaboratively to encourage patients to sit in chairs for meals. Proper position facilitates eating and increases the percentage of meal consumed. As a result, patients experienced better outcomes. Evidence Nutritional status directly influences factors that contribute to functional disability (Cederholm et al., 2014). Functional disability may lead to malnourishment (Cederholm et al., 2014). Loss of lean body mass accelerates during bed-rest, putting the hospitalized patient at risk for malnutrition (Tappenden et al., 2013). Muscle strength decreases by five percent a day when hospitalized patients are inactive (Resnick & Gershowitz, 2013). Patients are more likely to need skilled nursing facility placement after discharge when they are not properly nourished or assisted out of bed (PBS, 2016). Addressing the problem of hospital malnutrition has the potential to improve clinical outcomes and quality of care, at the same time reducing costs (Tappenden et al., 2013). Internal data within the rural hospital in the southwest for linking nutrition to patient position was unavailable. Patient Position and Nutrition PDSA Framework Plan • Design and facilitate an educational program at a rural hospital in the southwest that educates patients and staff on the importance of getting hospitalized patients aged 65 years and older out of bed for meals when diagnosis, condition, and willingness permits. • This will produce statistical evidence that patients sitting in chairs for meals will experience greater percentages of nutritional intake. Steps to execute • Surveys will be distributed to nursing staff at a rural hospital in the southwest to determine reasons patients are not getting out of bed for meals. • Information gained from the survey will be used to improve modifiable barriers. • Educational material for staff will be distributed at staff meetings and at shift huddles. • Laminated cards educating the patient as to the importance of getting out of bed for meals will be included as part of the patient information packet in each hospital room. Nursing will review the cards with patients. Do • Reflective chart audits will compare percentages of meals consumed at breakfast, when most patients are in bed and at lunch when most patients are in chairs. • Chart audits will occur over a period of one week • Key participants will make observations and identify barriers to getting patients out of bed for meals to determine if the plan should be modified. Study • Results of the chart audits will be analyzed to determine if meal consumption increases or does not increase when patients are assisted to chairs for meals. • Meal percentages will be compared to the goal of a 25% increase in meal consumption per meal when sitting in a chair. • Results will be recorded and a determination made as to what was learned and whether the goal was met. Act • After a study of the results, a conclusion will be made as to whether the project was a success and if it did not work, what can be modified to improve the results. • At this time, a decision will be made to determine whether the plan is beneficial and should be expanded throughout the hospital inpatient units at a rural hospital in the southwest. Goals • By the conclusion of this project, 50% of the selected hospitalized patients aged 65 years and older at a rural hospital in the southwest whose diagnosis and condition permits will be assisted into a chair for meals. • By the conclusion of this project, the selected hospitalized patients aged 65 years and older at a rural hospital in the southwest whose diagnosis and condition permits will increase their nutritional intake percentage by 25% per meal over the course of one week, evidenced by data collection analysis. Conclusion The plan included meeting with stakeholders and addressing possible barriers. Education materials were designed including laminated cards in patient rooms, which identified the benefits of spending less time in bed. Interdisciplinary team members worked together to ensure that selected patients were assisted out of bed for lunch. Breakfast was utilized as a comparison variable. The focus was to compare meal percentages eaten in bed and in chairs. The expectation was that meal percentages of patients who are sitting in chairs for meals would increase. Percentages were collected and analyzed with the assistance of the dietary department. With the implementation of this project, success was determined based on an increase of patients sitting in chairs for meals and subsequent increase in nutritional intake. References available upon request Sylvia J. Galloway, MSN, RN Montana Healthcare Mutual Aid System (MHMAS) is the Emergency System for the Advance Registration of Volunteer Health Professionals for the state of Montana. MHMAS is a secure, web-based online registration system used to register, verify, and credential volunteer health care professionals before a major disaster or public health emergency occurs. MHMAS is a secure, web-based online registration system used to register all levels of medical professionals to be needed to respond to a medical and/or public health emergency. PICO In selected hospitalized patients aged 65 and older at a rural hospital in the southwest whose diagnosis and condition permits, (P) how does sitting upright in a chair for meals (I) compared to lying or sitting in a bed for meals (C) affect the percentage of meals consumed (O) within a period of one week (T)? Problem Statement A significant number of hospitalized patients aged 65 years and older are not sitting in chairs for meals. As a result, there is a decrease in meal consumption, leading to malnutrition, ineffective digestion, decreased functional mobility and an increase in hospital readmissions. Once you register you are under no obligation to respond to a request, you decide when and where you would like to respond. MHMAS does ask for personal information (e.g., SSN, DOB) this is needed so we can conduct a background check once a request is made for medical professionals. If you would like to register, please follow the link below. Register Here @ https://mhmas.org/ Significance to Nursing Nursing is responsible for ensuring safety and providing care to patients. One element influencing health outcomes is nutritional status. Hospitalized patients generally eat less than 50 percent of their meals (Robert, Chaboyer, & Desbrow, 2015). Nutritional status is correlated with intake, which is directly under the control of nurses and interdisciplinary team members including subordinate staff. Positioning is one element that affects intake. Nursing can impact health outcomes by optimizing mealtime positioning. A significant number of hospitalized patients, whose diagnosis and condition permits, are not sitting in chairs for meals. When permitted, the most beneficial position for eating is in an upright, sitting position.
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