Healthy Workforce

Helping Selfish Nurses to Step Up

Reminding your team that the mission comes first

Sean hates to follow Audrey because he knows nothing will be done with their patients during her shift, and she’ll give him excuse after excuse. “I was so busy” is a refrain she repeats like a broken record, although Sean knows for a fact that she spends a lot of her time on her phone, playing games and posting on Facebook. Not only is he suffering, the patients are too.

 

I once worked with a nurse whose primary goal during a 12-hour shift was to NOT get an admission. She would do everything she could to delay transferring or discharging her patient until 30 minutes before the end of her shift.

Whenever I was in charge, I constantly reminded her that she needed to move her patients so that she could admit a postoperative patient who was waiting for the bed, but she gave me every excuse in the world for not doing it.

One day, after a litany of her evasions and rationalizations, I walked up to the receiving unit and found that the bed had been ready for hours and the receiving nurse had never gotten a call.

UGH! It’s still infuriating to think about all the time and energy I spent trying to coax her into doing her job — and how much time it wasted for patients in the recovery room who were waiting for beds and the chance to see their families.

Putting Mission First

A while back, I read an article by Michael Useem in Harvard Business Review about lessons we can learn from the military about teamwork. This particular passage really struck me:

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“After dinner at the Quantico officers’ club, a Marine general explains to the MBA students that in combat a commander must unequivocally commit to two objectives: (1) Accomplish the mission, and (2) Bring all your people back from the battlefield, whatever their condition. Mission first, then team, then self.”

When I read this, I had an “ah-ha” moment. Healthcare organizations have a mission, and nurses are part of a team. What nurses who act selfishly get backwards is the order of priority. They make decisions based on what is best for THEM — not the patients and not the team.

The first step to getting them back on track is to define the organization’s common mission.

Most hospitals have a mission statement that is framed and hung on the premises and appears on their website and in their literature. The mission statement provides a big picture moral compass that guides decision-making.

Why not create a such mission statement for your own unit or department? Define your unit’s purpose and identify specific steps to achieve that goal.

#1: Patient Care

Nursing is a service profession. Taking care of patients is our mission. When I was a bedside nurse, the coordinator apologized whenever she had to give me an admission. While I admit I cringed internally (just a little bit) when I got a new patient, especially if I had just gotten caught up, I always told her, “That’s what I’m here for: to get admissions.”

As nurses, our mission should always be providing extraordinary care to patients and their families. We all know that, but sometimes in the hustle and bustle of a hectic shift, we forget. Patient care is why we are here.

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#2: The Team

Supporting the team comes next. Nurses sometimes get myopic when it comes to their work. They focus on their patient load and their schedule, and fail to see how their actions (or inaction) may have a ripple effect on everyone else.

When I was a clinical instructor taking a group of students onto a unit for their clinical rotations, I gave them an important instruction on Day One.

Before they were allowed to sit down, they first had to check with every other student to see if anyone needed help. Then, they had to check with every nurse on the unit, and after that, with the support staff. Only when they had offered to help everyone on the unit could they take a break.

While you probably can’t be quite that exacting with the nurses on a busy unit, it’s important to make clear that the team only thrives when all members are supporting one another and rowing together in the same direction.

Developing a culture of kindness and support on your unit will not only make operations run more efficiently, it will produce a happier, healthier workplace that nurses will want to return to day after day.

A Note for Managers

Effective leadership plays an important role in team cohesion. Managers must know how to take care of their people. If a team member is having issues at home or is ill, the manager should intervene with appropriate support.

However, if a team member is so stubbornly self-centered that they threaten the mission, the manager must reprimand or replace that nurse.

In order to have a successful nursing team, everyone needs to share a common understanding of the priorities: mission, then team, then self. Whether on the battlefield or on the unit, that is how victory is achieved.


RENEE THOMPSON, RN, DNP, CMSRN, is the CEO and founder of the Healthy Workforce Institute (healthyworkforceinstitute.com).


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