Nursing

Discussion Post 1

Think about your current or former workplace. Are you aware of any specific actions that were taken to protect employees from workplace violence? What more could you suggest? Do you have policies in place to protect nurses against workplace violence?  Have you witnessed workplace violence and if so how did management handle the situation?

Sarah Hagen wrote:

At my current place of employment, we are supposed to have zero tolerance for bullying. I have actually not witnessed bullying at my current employer at all. We have a very good team that fosters communication and care. The violence that I have witnessed is solely that from the patients. I have seen patients hit, kick, spit, bite, and throw urine. I have seen many patients yell and threaten the staff members. I have also seen patients state racial slurs at the staff members. We do watch a video for active shooter training, and another video for bullying within the chain. Yet there is nothing on nurses to protect from patients that could hurt them. I suggest there should be more to protect nurses from being injured by their patients, and what nurses can do in these situations. I think nurses are still a long way from having the protections that they should at the bedside. Possibly implementing a UKERU class for the entire staff to know how to deal with aggressive patients. We do not have any policies in place to protect the nurse from patients - since we do not anticipate psych patients or other high-risk areas. I work the night shift so I actually rarely see management, yet when patients are a danger to themselves we are allowed to send them out. We do the best we can to calm the patients and call the doctors if need be. If a patient does not truly belong in our rehab we will send them somewhere better fitting for them, ideally in a few days.

Dylan wrote:

In the Emergency Department I currently work at there are very few instances of violence, mainly from combative intoxicated patients or psych. At one of the previous Emergency Departments there was violence almost daily from combative psychs, intoxicated patients, and aggravated patients and family members. We had signs posted saying violence would not be tolerated, and we had multiple security guards in the department at the entrance at all times. At one point, management requested a plainclothes police officer present in the waiting room during peak hours, and it lasted for a few weeks before they cancelled saying it wasn't being utilized. Most of the violence happened in the actual department and not in the waiting room. The current department I work in does not have security presence as there's very low occurrences, we have panic buttons on all keyboards, and we carry voceras so we can reach police and request their presence whenever necessary. 

Discussion 2

How could you use the Nursing Process to address a staff member’s performance shortcomings? Is it important to be visible on the units to be able to properly evaluate employees? Should you wait to the annual evaluation to address an employee'ss short comings?

Lisa wrote:

The Nursing Process is a fabulous tool to address a staff member's performance shortcomings.  To start off you assess the staff's performance.  Next, you diagnose the problem.  What is their shortcoming?  Then you identify outcomes with the employee.  What is the goal?  Then you make a plan to reach that goal with the staff member.  Next, you and the staff member implement the plan.  They receive the education, follow a preceptor, get a certification, and perform a checklist to accomplish their goal.  Then you will reevaluate their performance.  How has the plan helped them reach the desired outcome?

I feel management being an active part of the unit should be a requirement.  This would allow for great oversight, ensure that policies and procedures are being fully followed, highlights the areas needing to be addressed or changed, and overall, it shows the attitudes and teamwork your employees have.  A manager cannot effectively manage by hearsay, they must actively observe the care being provided to guarantee patient-centered care. 

 Staff shortcomings should be addressed immediately.  Waiting till their annual evaluation places patients at risk for serious injury, decreases patient satisfaction, places the nurses license at risk, and creates an unsafe work environment.  

Dylan wrote

The nursing process could be used to assess the situation, diagnose what the problem is, plan how to fix the problem, implement the solution, and evaluate the effectiveness. It is very important to be visible on your unit, as you will be better able to determine any issues the unit may be having. By being visible on the unit you are showing your staff that you are present and open to helping them when necessary. Without that, your staff will potentially come to resent you for "hiding in the office" away from them and believe you are disconnected from what's actually happening in the unit. If there is an issue with an employee it should be addressed informally at first, and then escalated from there with further instances. It would negatively impact the employee in question if an issue was failed to be addressed and then punished during an eval, when they might not have known they were doing something wrong in the first place. Managers should not only lead, but also mentor their employees to perform their best and improve their practice.