Nurse Job Satisfaction Blog

Help Employees to Thrive by Minimizing Incivility

A thriving, motivated staff is critical to the delivery of high quality healthcare because a thriving nursing organization will go the extra mile for patients and achieve better outcomes.  As the latest post in a series on this topic, I will focus my comments on how managers can create a culture that supports a thriving organization.

As a reminder, the research by the Harvard Business Review described four mechanisms that, when applied together, create a culture of vitality, enthusiasm, and learning that define a thriving organization:

1. Providing decision making discretion
2. Sharing information
3. Minimizing incivility
4. Offering performance feedback

I’ll cover item #3, Minimizing Incivility, in this post.

According to the Thunderbird School of Global Management, one of the most respected graduate management programs and a partner to Harvard in their study, incivility in the workplace has a direct impact on employee performance.  The research showed a half to a third of people who experience incivility in their workplace deliberatley decreased their output and/or quality of their work. 

This makes intuitive sense:  Individuals with toxic behavior poison their workplace and diminish the satisfaction and motivation of their colleagues.  (Images of the classic movie Office Space spring to mind, where jerks rule the roost and the rest toil miserably or plot to improve their condition, with dramatic results.)  

The nursing profession is particularly challenging in this area because toxic behavior can come from not only colleagues in the workplace (the focus of the Harvard and Thunderbird research) but also (and sometimes predominantly) from patients and their families. Abuse from patients and their families can be both verbal and physical, so healthcare managers must have the means to mitigate opportunities for abuse and provide the tools to help the nursing staff process and recover from incivility.

That means the focus has to be dual:  Foster a supportive, collegial culture among caregivers, and put in place measures to manage patients and families when circumstances become pressurized.  In the first case, the greatest impact can be made at the hiring point - organizations that are most succesful at building the right culture of civility take it into account when evaluating applicants, sometimes passing on highly qualified ones who don't match the culture.  In the second case, training becomes critical to effectively handling patients and families who are distraught or upset.  Communication and conflict resolution skills training top the list and are available online and in seminars. 

In an environment as dynamic as a healthcare facility, it's unlikely that nurses can completely avoid incivility, so they must be given the oportunity to recharge after the emotional drain of a confrontational incident.  That means time off.  Healthy work environments give nurses enough time to effectively manage their work/life balance.  The best way to achieve this while meeting the operational goals of the facility is to use nurse scheduling software to asssure that staff get enough time off while maintaining the proper care levels.

In the end, minimizing incivility can reap rewards in quality of care because culture is contagious.  Those organizations that can bring staff in that identify with the culture will assure a stable and high level of care quality over the long term, along with all of the other benefits of a thriving organization. 

 

Nurse Scheduling Software Enables Information Sharing

A thriving, motivated staff is critical to the delivery of high quality healthcare because the elements of a thriving organization are also the key components of an effective nursing staff that goes the extra mile to treat patients.  As the latest post in a series on this topic, I will focus my comments on how managers can create a culture that supports a thriving organization. 

The research by the Harvard Business Review described four mechanisms that, when applied together, create a culture of vitality, enthusiasm, and learning that define a thriving organization:

1. Providing decision making discretion
2. Sharing information
3. Minimizing incivility
4. Offering performance feedback

I’ll cover item 2, Sharing Information, in this post. 

Nobody likes to work in an information vacuum, without an understanding of how their work affects the greater goals of the team or organization.  The daily grind of work, some of it challenging, some of it boring, lacks meaning and causes the employee to lose motivation and vitality.  Poor vitality diminishes the energy to pursue learning opportunities which leads to a stagnant worker who fails to thrive. 

Sharing information helps team members see how the team is functioning and achieving its goals and gives insight into methods that the individual can employ to be more effective in support of the team goals.  In the healthcare setting, there are vast opportunities to share information to improve organizational vitality:

• Leaders who encounter successful approaches to problems in one segment of the facility recognize the achievement and share the lessons across the organization.  I’ve seen an example where new bedside techniques to engage patients were yielding higher satisfaction scores in one unit of a large hospital and they were picked up by nursing leadership and rolled out across the facility.  The increased morale of the “inventors” and the effect of the example on the rest of the nursing population were dramatic.  It soon spurred a steady flow of improvement ideas from within the nursing corps.
• Professionals contributing to a knowledge base of information that address thorny problems.  Examples are forums that enable sharing of anecdotes, experiences, and ideas that are reachable by peers.
• Clear communication of management metrics and how an individual’s performance affects the achievement of the goals.  The HBR article used a great example of a food service company that had successfully communicated to a busboy how a metric about “number of meals sent back to the kitchen”, affected company performance.  In the era of ACO, opportunities abound to connect daily staff activities to the metrics that drive the ACO scores. 

But what effective means do we have to share information?  We all know that getting information via email is iffy at best.   At Schedulist, we believe that the scheduling platform represents the best opportunity to reach staff because they frequently turn their attention to the nurse scheduling software.   That’s why we put collaboration tools into our platform to foster the sharing of information.  Schedulist users can correspond via messages, surveys, task collaboration, social networking, and forums, all in the name of creating a tight, professional community within the facility.  This supports the vitality and culture of learning that perpetuates a thriving healthcare workforce that constantly improves care quality.

Enable Decision Making Discretion with Nurse Scheduling Software

A thriving, motivated staff is critical to the delivery of high quality healthcare because the elements of a thriving organization are also the hallmarks of an effective nursing staff that goes the extra mile to treat patients.  As a continuation of my last post I will focus my comments on how managers can create a culture that supports a thriving organization. 

The research by the Harvard Business Review described four mechanisms that, when applied together, create a culture of vitality, enthusiasm, and learning that define a thriving organization:

1. Providing decision making discretion
2. Sharing information
3. Minimizing incivility
4. Offering performance feedback

I’ll cover item 1, Providing Decision Making Discretion, in this post. 

Employees, in general, are energized by the ability to make decisions that affect their work.  It enhances their sense of self-worth and adds to the pride that goes into daily activities. In a high stakes healthcare workplace where the wellbeing of patients is at stake and costly legal action awaits those who make mistakes, tradition has limited the trickle down of decision making discretion.  The disconnect in healthcare (and many other industries) lies in the fact that the customer interface is principally handled by the lower levels of the organization.  Nurses are the ones who face patients with needs, requests, and complaints all day but have limited authority to make decisions to improve the situation for the patient.   This may mitigate risk, but it drives down patient satisfaction which will become increasingly important in the age of the ACO.  Naturally, there are limits to how much this can change when it comes to making care decisions but that makes it all the more important to find the ways that nurses can exercise autonomy and discretion in their workplace.  These areas, although they are away from the patient interface, can positively affect patient care because higher morale leads to more attentive and alert patient care.

One clear area where there’s room to grow is the nurse scheduling process.  Too often, manual or top-down scheduling processes give little weight to the input of the staff which is both inefficient and damaging to morale.   This is magnified by the fact that the single most important job satisfaction driver for nurses is the quality of their schedule.  By implementing cloud based nurse scheduling software, healthcare organizations can quickly and inexpensively engage their staff in the scheduling process and give nurses a high level of decision making discretion over their most valued job satisfaction driver.  This removes inefficiencies while it delivers the morale boosting autonomy that nurses crave. 

This may sound like a dangerous loss of control of management in the facility, but if the nurse scheduling software is rules based, a high level of autonomy can be achieved while adhering to the care guidelines and staffing rules.  As long as the system holds the organization to critical guidelines like care levels, qualifications, fairness principles, and safety practices, the nursing staff can be much more efficient in managing the daily staffing challenges.  In doing so, they exercise autonomy and discretion in arranging covers, managing leaves, and flexing up or down, thereby driving up morale and exhibiting the attributes of a thriving organization. A big dividend is the time savings for nurse managers who would otherwise spend their time chasing down staff members to fill shifts. 

In the end, thanks to rules-based nurse scheduling software, nursing teams are able to thrive because they have autonomy and discretion in managing the most important factor in their working lives, their work-life balance.  

Happiness Is: Thriving With Nurse Scheduling Software

I'm always on the lookout for new research to inform our discussion about nurse job satisfaction.  I received a late Christmas present when the Harvard Business Review showcased "The Value of Happiness" as their cover story.  As I picked up the issue at the newsstand I was giddy with anticipation about what it held in store, and I was not disappointed.

The issue took the topic of happiness from its effects on the well being of nations all the way to the fulfillment of individuals. Along the way, it stopped to cover the methods for researching happiness and, to my delight, how happiness drives employee performance. 

The research on company performance, performed by the University of Michigan's Ross School of Business, redefined happy employees as thriving employees. Thriving employees and organizations are defined as those that are not only satisfied and motivated, but also "engaged in creating the future- the company's and their own". 

Thriving organizations carry two notable traits:

1. Vitality:  The sense of being alive and energized.  Organizations have the ability to take action to generate vitality by freeing their employees to perform work that makes a difference.  Sound familiar, nurses?  It's hard to think of a making a greater difference than healing the sick, so the best that management can do is clear the way for you to do just that.  However, there are frequent obstacles to providing care, such as administrative duties like schedule management. 
2. Learning:  The growth that comes from new knowledge and skills.  Creating a culture of learning can be a virtuous cycle, according to the article, because individuals who develop their skills are likely to believe in their potential for future growth. In a healthcare facility, management must provide opportunities for learning as well as the time to learn. 

Both of these are complementary to each other.  Learning fuels passion and passion keeps the individual from burning out. From our vantage point, Schedulist has a role to play in supporting a thriving culture by freeing nurses to focus on patient care and giving them the time to spend on their own development.

Over the next several weeks, I will to expand upon the key points in the research and apply them to the healthcare setting.  As a preview, the research identified these strategies for organizations to follow to help employees thrive:

1. Empower to make decisions
2. Share information
3. Minimize incivility
4. Offer performance feedback

I'm excited to explore these topics with you.  Tune in and follow!

 

Using Nurse Scheduling Software for a Quick IT Win

The current era in Healthcare IT is going to go down as one of the most challenging of all time.  With the task to implement EMR to the point of meaningful use and support the adoption of ICD-10 in the same time frame, IT and clinical staff are attempting to achieve two long term and transformative projects at once.  Simple logic would lead one to conclude that clearing the decks for these projects alone is the only prudent plan, but the principles of organizational behavior and project management tell us otherwise.

Long term projects are inherently risky because they consume enormous resources over an extended period and reveal very little progress until the project is complete.  This results in loss of interest and support from users and a failure to adopt.  In order to achieve momentum, project managers face the challenge of maintaining organizational awareness of the progress of the project and the incentives to the organization for completing it.  This is a stiff challenge with an already overworked staff, but the risk can be mitigated by incorporating smaller projects into the pipeline that deliver quick wins.

A nurse scheduling software project is ideal for this purpose because:

1. It delivers tangible value to the staff, like better control of their schedule and more time to care for patients.
2. It delivers hard dollar savings to the facility, like optimized staffing vs demand and reduced agency and prn usage.
3. It takes a matter of weeks to deploy and only one cycle to deliver positive ROI.

Its short implementation cycle and close ROI horizon make it the ideal quick win project, and it complements the heavier projects by finding more time for staff to support the new initiatives.  In the age of Accountable Care, this is invaluable in avoiding nurse burnout and turnover that leads to higher mortality and medical errors.

 

Nurse Scheduling Software: Controlling Job Satisfaction Levers

I've talked alot about nurse job satisfaction in these pages and frequently the talk has turned to the concept of mandatory overtime and how devastating it is to nurse morale and job satisfaction.  Mandatory overtime occurs, in it's worst form, at the end of a shift when the charge nurse catches an RN on the way to her car and tells her she has to stay on.  Strikes were born on such practices.

I came across an article from earlier in the year that showed the flip side of this issue - not enough overtime.  There was a study by the Journal of Nursing that showed that allowing nurses to pick up the overtime they wanted resulted in a positive impact on the retention of those nurses.  The study analyzed data from 1,653 newly registered nurses working in hospitals in January of 2006 and 2007.

The study makes it clear that defining cause and effect in an issue as complex as turnover is a long shot, but the concept of "voluntary overtime" makes sense. Implicit in allowing nurses to take voluntary overtime is the notion that they are reducing one type of stress (financial) while increasing another within their tolerance (fatigue, work/life balance).  In addition, the sample was all new RNs who demographically suffer from the highest turnover.  Not coincidentally, they also tend to have more flexibility in taking overtime, which adds to the calculus of the positive impact of voluntary overtime.

This strikes me as a great application opportunity for nurse scheduling software.  By allowing nurses the option to work overtime while providing actionable data to avoid conditions of mandatory overtime, nurse scheduling software can magnify its leverage on morale and job satisfaction.

Such a system would need to control overtime with rules based restrictions so that nurses can have it if they want it while at the same time having logic and communication tools that raise coverage issues soon enough to allow schedulers to react without forcing mandatory overtime.  For those facilities with this problem, the adoption of a robust scheduling system should be high on the list of improvements this year.

 

 

 

 

Hospital Staff Scheduling Alert: Ho Ho Hold a Strike

The December 22nd walkout by nurses in the San Francisco Bay Area gives us another example of the consequences of a breakdown of nurse job satisfaction.  Following a record setting walkout in September, this strike called attention to staffing levels, patient safety, and benefits for nurses at Sutter Health  facilities.  It looks like this one went down more smoothly than the September walkout that resulted in one patient death from a replacement nurse medical error. This time, the stricken facilities were able to hire replacement nurses and avoid tragedy.

Regardless of the outcome, these episodes leave onother scar on the relationship between nurses and their employers.  We believe that nurse scheduling software has the potential to rebuild connections between staff and management and avoid breakdowns in the future.  Here's how:

1. Build a forum to promote communication in "peacetime".  Scheduling is not only vitally important to nurses on its own merits, but the process of scheduling demands the participation of staff on a regular basis.  Using the scheduling process as an opportunity to collaborate creates common ownership of the staffing challenge and presents opportunities to build links between staff and management beyond just scheduling.  Improving these networks surfaces issues sooner and enables accomodation before each side is forced to go to its corner and lawyer up.
2. Optimize and staff to agreed staffing levels.  Good scheduling software promotes collaboration as well as optimization so that cost constraints are balanced with patient safety concerns.  Managing to metrics in both these categories keeps the team on the rails and reduces the likelihood of a disconnect on these key issues.
3. Create an atmosphere of fairness.   From time to time, taking humans out of the equation diffuses contentious issues.  Using a powerful software tool to embody important rules allows all the parties involved to remain objecive about the issues at hand and reach compromises more effectively. 

For patients, these stakes are high.  In New York State (where another strike is planned at a handful of hopsitals)  a study for the National Bureau of Economic Research, found that patient mortality was 19.4 percent higher during a strike, or that there was about one extra death for every 280 patients admitted, and that they were 6.5 percent more likely to be readmitted within 30 days.

Keeping ahead of the curve through engagement is the most effective (and lowest cost, btw) way to avoid breakdowns betwen management and staff.  Nurse scheduling software, used properly, can be powerful tool to keep the organization on track and improve quality of care.

Circadian Rhythms and Nurse Scheduling Software

I was reminded today, by a friend who knows that we devleop nurse scheduling software, that nurses value predictability in their schedule more than almost anything else.  That makes sense - nurses can't predict the types of patients they'll have but if they can have predictable shifts they can maintain a better balance between work and personal life. 

Naturally, predictability allows nurses to plan their personal lives better, giving them a richer experience off the job and adding to a sense of balance and happiness. Hospital staff scheduling practices, especially manual ones, are notorious for rapid changes in shift work and mandatory overtime that devastate personal time, so predictability can be elusive.  The proper automation of this process can implement controls that keep staff on a predictable pattern because planners can see farther into the future and avoid the surprises that lead to morale-crushing schedule changes.

Less obvious is the role that predictability plays in addressing the importance of biochemistry in the morale and satisfaction of the nursing staff.  Switching back and forth between night and day shifts strains the body's ability to adapt to night and day, triggering fatigue.  Believe it or not, the proper use of nurse scheduling software can take into account the circadian rhythms (or body clock) of the nursing staff.  It's common knowledge that depression and anxiety can be made worse by poor sleep patterns and fatigue so if the schedulers have a method to support the establishment of a healthy shift rotation, these issues can be minimized. 

Good nurse scheduling software enables schedulers to control the rotation in an automated way because automation is much more reliable in establishing patterns that respect circadian rhythms than a manual process.  Believe it or not, there are research based standards from the National Institute of Health  that call for a transition period between day and night shifts.  Good, rules based nurse scheduling software can help with this but only the most advanced will employ the NIH standards.

In summary, it's important to maintain predictability in your staff scheduling system for both planning and health reasons because these are major drivers of nurse job satisfaction and morale.

 

A Nurse Scheduling Software Question: Which of the "Big 3" holidays would you rather work?

OK, place your votes here!  One of the challenges for nurse scheduling software is giving nurses their schedule preference.  We'd like to take a quick pulse about which holiday, Thanksgiving, Christmas, or New Year's Day you'd work if you had to pick one.  Assume it's the day shift so you would have Christmas Eve, New Year's Eve, and "Black Friday" off.  No fair saying "none"! 

So, which one would you take?  Answer in the comments section below and tell us why if you have time.

 

Nurse Scheduling Software - The Unsung Hero for Quality of Care

There's an abundance of evidence that high turnover in a facility's nursing staff contributes to medical errors and, ultimately, increased patient length of stay and mortality.  There are many ways to look at it but all arrive at one simple fact:  Hospitals and post-acute facilities must take better care of their nurses so that they can take better care of us. 

This is one of my favorite studies, performed by the VHA (albeit some time ago), that shows the sensitivities between turnover vs length of stay and mortality:

Every facility strives to improve Quality of Care but there are so many levers to affect it that many important ones are often overlooked.  One of these is the use of nurse scheduling software. 

If you think about it, it makes sense.  Nurse scheduling software, at its most basic level, helps the facility assure that the people with the right skills are available to treat the expected number of patients.   This task alone, done well, reduces the likelihood that shifts will be short-staffed or poorly qualified.  That's a comfort to all us patients, but it's also a comfort to the nurses because they are less likely to be stressed, become burned out, and quit.

At a different level, nurse scheduling software can do more for nurse job satisfaction than just making sure the nurses don't work too much overtime or work with underqualified colleagues.  Nurse job satisfaction is driven by the achievement of work life balance and by working in a positive environment.  Just check out the list of best places to work in healthcare, and you'll see these drivers supported by all of the providers on the list.  The right nurse scheduling software can facilitate these satisfaction drivers (and satisfaction reduces turnover) by

1. Giving staff their schedule preference as much as possible
2. Giving them tools to enhance their autonomy to achieve work-life balance
3. Facilitating collaboration and the building of communities in the facility (see my last post on this) 

Impacting job satisfaction is done most efficiently at the points in the facility's workflow where everyone interacts most frequently and, somewhat surprisingly, the scheduling process is the highest traffic point.  Staff and management need to take part in the scheduling process on a fairly frequent basis to keep it on track.  Each one of these interactions is an opportunity to make an impression on staff and each opportunity should be used to build loyalty to the facility.  That means that the nurse scheduling software should support a forum for management to test ideas and engage staff, and where staff can connect to build communities and enhance their work experience.

With all of the energy put toward the imperatives of ACO's, EMR, and the rest of the alphabet soup programs that exist in the name of improving Quality of Care and cost, it's important to keep in mind that these can negatively impact quality by stressing and burning out the nursing staff, causing turnover.  Hospitals and post acute facilities must  prioritize focus on other activities that can impact quality at a number of levels including nurse job satisfaction.  Nurse scheduling software should be at the top of their list.