What a Nurse wants

What is your age?

There were 73 people responding. That’s over 750 years of experience talking!!

1.Good Communication – clear, concise 2.Listens 3.Collaboration/Teamwork 4.Value our assessment skills 5.Respect our experience 6.Willing to teach/advise in a constructive, supportive way 7.Available 8.Approachable

1. Not listening 2. Lack of respect – esp. in front of patient 3. Ignore experience 4. Lack of teamwork 5. Not receptive to suggestions 6. Unclear expectations 7. Bullying

"Disruptive behavior" is defined as any inappropriate behavior, confrontation or conflict. Disruptive behavior occurs in many forms including passive-aggressive behavior, subversive behavior, verbal abuse, or physical or sexual harassment.

Hawkeye – The perfect doctor??

 Greater than 50 percent of nurses say that they have been subjected to verbal abuse on the job  Over 90% report that they have witnessed disruptive behavior The Joint Commission, Healthcare at the crossroads: Strategies for addressing the evolving nursing crisis

◦ Link between effective team work and patient safety ◦ Recipients of disrespectful behavior may have a strong emotional response that can impair their ability to think clearly and may increase errors in decision making ◦ Hostile work environment causes low morale, burnout, ineffective teamwork

Nurses may avoid “speaking up” because:  Desire to maintain positive interpersonal relations/ harmonious work environment  Avoid conflict  Lack of confidence in their own knowledge  Conform to the “definition” of a good nurse  Cultural background  Avoid peer censure Garon, M. (2012).

 Fetal monitoring interpretation  Management of Pitocin Simpson, K. R., James, D. C., & Knox, G. E. (2006)

Pressure to pushing the pit ◦ “’they’ like that pit pushed and you’d better push it and go, go, go otherwise they’ll be hot, really mad.” ◦ “ I would be petrified if at 7 AM ‘they’ walked in an I didn’t have the pit going. They’d yell at me and that’s just added stress.” Workflow:  “If we are swamped I may not turn the pit up because it’s not safe.” Managing pit:  “If she was 1 cm an hour ago and now she’s 3, these contractions must be adequate or she wouldn’t be making progress.” Simpson, K. R., James, D. C., & Knox, G. E. (2006)

 Fetal monitoring: “ When I have a bad strip, I poll everybody. Should I call him (the physician)… because it is 3 AM. You debate whether or not to call.”  New nurses: “Some of the doctors just hate working with the new nurses. They (the nurses) need to prove themselves and it takes a long time… Simpson, K. R., James, D. C., & Knox, G. E. (2006)

 Creating a culture of respect is part of the larger challenge of creating a culture of safety.  Establishment of a relationship may be a precursor to effective communication. Robinson et al. (2010)

 Interpersonal responsibility  Person-centeredness  Support of co-workers  Friendliness  Openness in personal relationships  Creativity  Credibility  Interpersonal trust  Resiliency Leape (2012)

Hmmm – Relationships…

 Narrative vs just the facts  Vague descriptions vs specifics  Common language

 SBAR  Assertive communication  Transparent thinking

 Communication issues have been shown to influence nurses’ job satisfaction and retention, and are a key factor in the development of a healthy workplace.

 Individual self assessment  Are you part of the solution or part of the problem?  Collective self assessment  What is the culture on your unit?  Interdisciplinary team training and debriefing

So, is there such a thing as a perfect doctor??