Reference no: EM133860933

CASE

Managing Nurse and Leadership Relationships

Amanda M. Carlson

You are a Nurse Manager on the intensive care unit (ICU) floor at a hospital in California. Leadership has approached you and informed you that your department has a high rate of supply waste. Your assignment is to identify why the nurses are wasting supplies. In addition, it is your job to implement and enforce new policies to reduce waste and save money. Over the next month, you observe the nurses and see they are taking excess supplies into patient rooms. When the hospital discharges the patients, the nurses dispose of any unused supplies left in the room to reduce contamination with the next patient.

You believe you have identified the problem, so at the next ICU staff meeting, you bring the matter up to the nurses. You tell the nurses that due to new hospital policies, nurses can only take what they need, when they need it, to the patient rooms. The nurses hesitate before one speaks up. He lets you know they understand supplies are costly and not wasting them is important for saving money. However, they feel like they have had to resort to taking more than they need at the time for two major reasons: 1) the nurses feel they are wasting valuable time by running to the supply room to get a single item at a time instead of taking more, reducing the time spent going back and forth for supplies and spending more time caring for the patient, and 2) for the past six months, turnover in the ICU has been high, meaning the nurses have more patients than normal. When they spend time going for supplies, they are away from the patients and have noticed an increase in preventable patient accidents.

The nursing team shares this as a source of frustration. They feel leadership continually asks them to make changes that support the bottom line without paying attention to how these changes affect patient care and the sacrifices these changes force on the nursing staff. They feel if leadership paid attention to and addressed the root issues of unsafe working conditions, outdated equipment, and offered more enticing benefits for overtime and extra shifts, nursing turnover would decrease, leading to reducing wasted supplies.

You let the team know you appreciate them bringing these matters forward and ask them what they feel would be good solutions for taking care of these issues. A brainstorming session brings up the following:

Poor working conditions: Due to understaffing, the nurses are taking care of three patients at a time instead of two. This has led to more patient accidents. The solution they see is identifying the patients at the highest risk and ensuring the nurses taking care of them do not have more than two patients to ensure they can monitor them regularly. They also suggest creating strategically-placed supply carts around the floor to lessen the time they have to walk to the supply closet. This strategy will also reduce waste because they do not have to take more than necessary into the patient rooms.

Outdated equipment: The patient beds are outdated because they are not automated, which means the nurses are pushing a total of 400-600 pounds on their own when transporting patients. This has led to staff injuries, further contributing to the understaffing issue. The nurses believe if the hospital were to invest in newer beds that are automated, lighter, and easier to move, the number of injuries would decrease, and they would have proper and safe nurse-to-patient ratios.

Better rewards for overtime and extra shifts: The leadership team recently implemented a new rewards system that no longer pays for overtime. Instead, they reward nurses with points for overtime hours worked to be used to purchase items on the online company store. The staff feels like there is now less of an incentive to come in for extra shifts because they no longer receive the overtime pay. They suggest bringing back the overtime pay.

1. What processes can you help implement so the leadership team hears the nurses' voices?

2. What techniques can be utilized to solve workplace problems?

3. How can you and leadership monitor progress to ensure that financial, clinical, and human problems improve? What metrics could they utilize?

4. How could you and leadership share outcomes learned with other managers or floors?