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Hours and Nurses and Patient Days, Oh My!

Part two in a two-part blog series
04/20/17

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Melanie Bell, MSN, RN, CNEP, Senior Workforce Director

The increased pressure on nursing leadership to manage budget and productivity continues to add to the sometimes overwhelming mountain of responsibilities of this group of former caregivers. I think it’s often forgotten that nurse leaders are just that: nurses. Nowhere in our education on pharmacology, pathophysiology and anatomy did they sneak in studying the ins and outs of productivity. And yet it has arguably become one of the most critical aspects of a nursing leadership position outside of quality of care.

The result is nurses feeling like Dorothy from The Wizard of Oz when they move from the bedside to leadership. While they are definitely “not in Kansas anymore," there are tips new nurse leaders can utilize to navigate the yellow brick road of nursing leadership!

Making the munchkins happy

Although I wish it was as easy as landing a house on the Wicked Witch of the East, keeping your staff engaged and satisfied as you work toward operational excellence is achievable.

First, involve your staff in each step of the journey. It’s important for them to understand that efficient and effective use of their time is an essential component to providing consistent, high-quality patient care at a sustainable cost. Convey this in a brief education session on productivity and its impact on hospital financials. For related content, click here to read my previous blog.

Second, if you already have a shared governance structure, use it. If you don’t, form a staffing guidance committee to help you define a realistic staffing plan. Share what the goals are for the project and have this group assist you in determining how resources are allocated to best meet the needs of the department and stay within budget. Be sure to include a cross section of the staff, different roles and all shifts. Encourage them to think outside the box with regard to skill mix, scheduling and roles.

Third, make sure you are communicating frequently with all individuals who are making staffing decisions on a regular basis, including charge nurses, house supervisors, etc. While you probably shoulder responsibility for your department’s budgetary success, these are the people who will dramatically impact your ability to do so. Make sure you are all in alignment on expectations and guidelines.

Finding your scarecrow, tin man and lion

You are going to need lots of friends and resources on this journey and they need to have a varied set of skills and strengths. Identify a professional mentor that may or may not be within your direct reporting structure. Some great ways to approach this search are outlined in this article.

A mentor is often someone who you will maintain a long term relationship with, so you need to genuinely like, trust and respect this individual. They can act as your sounding board, provide insight from their experience, and potentially be an unbiased listener that can provide you with neutral guidance. You will also need some peers who you like and trust as well; people who have strengths that are different from yours so that you can rely on each other for assistance as you navigate the different challenges of your new role. These are also great people to share articles, books and best practice with. Create a culture where you help to drive each other toward excellence.

Pulling the curtain on the wizard

Financial and operational reports often come to us as disembodied data that has minimal context and can be difficult to interpret. Or we may not get regular and consistent reporting at all. Take the time to research what data points are available within your organization, how you access them, where the source data comes from and if they can be customized.

Reach out to your finance, decision support, or nursing operations team based on the roles in your facility and see if they offer any introductory training or one-on-one reviews of the systems. Find someone who is able to answer questions for you and keep them on speed dial! Also, check your learning management system or even You Tube for courses on Excel to enhance your confidence in creating your own reports and graphs. I highly recommend that you be able to write simple formulas, create a pivot table, do a LOOKUP and create graphs. Videos that can get you started can be found here and here.

Taking the hot air balloon to excellence

Have all of the support, training and resources you need? Well, you are ready to jump in your hot air balloon and start rising. Just remember though, you won’t rise without continuing to add heat as needed. Set aside time on your calendar each week to read an article, research an idea or learn something new. It’s very easy at any point in your career to sink into a heads-down mentality that focuses on the everyday operations, putting out fires and just keeping it all together. Make sure that you are creating the opportunity to seek out chances to be heads up, find ways to prevent the fires and savor the view.

Remember to save Toto!

As a new nurse leader, your new scope of responsibility can often be overwhelming. The dramatic change extends to working hours, relationships and communication. One of the most important things to do during your first few years in leadership is to find ways to maintain this balance and remember why you started this journey to begin with. The reason most of us move into leadership is because we recognize the ability to impact more than the patients that we care for each shift.

Our first and biggest responsibility remains the health and safety of our patients. That being said, make sure you also acknowledge that the desire to influence the future of our profession was likely a contributing factor for you as well. Regardless of your years of experience or level within an organization, you must be sure that you are role modeling leadership in a way that encourages others to pursue it. Allowing your staff to see you balancing quality of life, enjoying your work and appreciating the rewards that you experience as a result will create the next generation of aspiring nurse leaders.

About the author. Melanie Bell is an experienced nursing administrator with a background in labor and process optimization in the acute care setting. Prior to her career as a registered nurse, she was a business and financial analyst, working as a liaison between finance and IT. Utilizing her unique experience in the clinical and business settings, Bell has managed nursing operations through rapid expansion and new facility openings. In her current role, she leads technology and operations for Vizient’s Workforce Optimization team and is responsible for Contract Labor Optimizer.

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