As a nurse, this runs counter to much of the thinking that I have always been taught.  We often get caught up in making our plan better and better but at the same time, the implementation gets pushed back further and further.  One person at the event was even heard to remark that ‘perfection and procrastination are first cousins’. This goes along with a quotation from General George Patton – “A good plan, violently executed now, is better than a perfect plan next week”.

Maybe we should check our thoughts on getting everything ‘exact’ (an implemented weeks from now) and work on ‘real good’ with an implementation time much sooner.  The Intelligent Nurse knows when good enough is truly good enough.  After all, a plan that is not implemented is only a dream!

I have often felt that nurses are their organization’s best or worst marketing.  A kind word spoken at the right time or a small, heartfelt, action can make the patient or their family think that this is the best health care provider in the world.  Just as easily, a sarcastic comment or a reference to how the hospital is trying to save money by skimping on supplies (people, equipment, etc.) can cement a negative thought about that same institution that will last for decades.

Are these comments (positive or negative) made with any real intent in mind? Often they show the mood of the nurse at a particular time.  Some people give a first impression that is very negative to the patient. Never mind that the nurse in question is an excellent care giver, the impression with the patient and family is often set in the first interaction with that nurse. If the impression is negative it will last forever. If positive, it will last just as long.

Another thing to remember is that nurses are the most trusted profession. This comes from a Gallup Poll. Nurses have been the most trusted profession for 7 years in a row! Is it any wonder that when a nurse makes negative comments about their work place, environment, equipment or hospital quality that patients believe it? My first question is: do nurses realize the power of their words??????

To this end, I have decided to start a program called “The Intelligent Nurse “. Not that nurses are not smart but to teach nurses and others the far-reaching effects of their words and actions.  Nursing today is more than taking temperatures! We need to realize that nursing can have an effect on the bottom line of our employers. Our employers need to realize that all members of the nursing department (CNA, LPN, RN, ARNP) have a direct and measurable effect on the many variables that affect the health of the institution.

I have made the first inroads to this program and hope to have it finished in the next month. At that time I will bring the program public and start pushing it on the social media sites and to individual health care organizations.

One may think of this as discharge planning. What condition do you want your patient in when the time arrives for discharge.  This is a pretty short-term vision – correcting whatever brought them into the hospital.  What about the days and months in the future.  Can you define a vision for this patient over the next 6 months, 1 year or 5 years? It isn’t a complex process. Better nutrition, smoking cessation, better diabetes control and stress relief are a few things that come to mind. These items will contribute to a better overall state of health for just about anyone.

Next you have to communicate this vision to your patient.  As a leader, you may need to explain the significance of the vision that you have for them.  Explain the benefits in terms that your patient can understand. Point them to the resources that they may need to accomplish the vision.  Encourage them to write the vision down as goals that are easily quantified or measured.

How about the nurse outside of the hospital?  The office nurse is in an excellent place to give a healthy vision for their patients.  More importantly, a vision communicated when the patient is not hospitalized may actually be accepted better than when the patient is in the acute phase of an illness.

What about the second week (or month or year) the person stays in that position? How can the organization measure the worth of that leader long after the promotion has taken place? Should a person stay in a position just because they haven’t made any big mistakes or should they have to prove their continued existence?

There are ways  to measure the ongoing effectiveness of the nurse who once promoted to a leadership post such as nurse manager.  Sure, upper level management will look at “the numbers”.  Managing overtime cost, supply cost and looking at the promptness of completing required paperwork is one way to easily measure the work performed. But this primarily looks at the management side of a leader. We can look at the measure of leadership in concrete numbers such as the number of request to transfer into a unit, the number of request to transfer out of a unit and the number of subordinates who are promoted into leadership positions. I’m sure that you can think of other indicators that could be used with a little effort.

The next question then becomes what to do with a person in a leadership position who has lost their effectiveness as a leader? counseling and update training come to my mind long before the usual knee jerk reaction of bouncing someone out of their job.

 Have you ever seen anyone in a leadership position that has outlasted their skills?

The role of the nurse practitioner is set to explode. Pedeatric, family practice or geriatric nurse practitioners are set to become very busy practitioners indeed. Many news articles have been published concerning the  lack of family practice physicians when the healthcare changes occur. Some of this physician shortage stems from the limited number of slots available in medical schools. Other parts of the shortage is attributable to the limited number of residency slots available.  Even if these problems could magically disappear there is still the time frame that it takes to train a physician to the point where they are functional (6-8 years for undergraduate and medical school plus 3 years residency).

When you compare the number of nursing schools (640 at the BSN level or higher) to the number of medical schools (131 MD and 25 DO) you can see which area can best support a surge of people to go onto advanced training and then into direct patient care! If you add the number of nurses who are already practicing and choose to put in the extra time to become a nurse practitioner, nursing really stands out. Yes, it does take additional schooling but the rewards are well worth the effort.

If you are growing tired with your current nursing job and want to expand your professional field, consider becoming a nurse practitioner. When you talk with others who may be considering a career in nursing, talk to them about the many fields available within the generic work field of nursing.  This is truly a golden time to be a nurse.

Have you taken steps to advance yourself professionally? Not just taking the CEU courses that you have to have for license renewal but something to really broaden yourself professionally.

I was one of the speakers at this event. The new skills learned and the relationships formed in the past year preparing for my presentation were beyond anything I could have imagined. Take a step or two out of your comfort zone and bring your nursing to a higher level. The opportunities are out there, it is up to you to pursue them.

Teaching methods vary greatly. Think back to some of the classes you have taken in the past.  Think of the instructors that held your interest. What was it that held your interest?  Was it the instructors voice, their enthusiasm for the subject or something else?  Think of those points that helped you to learn. Now think of your teaching style.

First, you must have a true desire for your patient to learn the subject.  It is very easy to detect a lack of teaching desire. When the patient does not see the enthusiasm for the subject in the instructor, they automatically think that the subject must not be important.  This type of teaching ends up being wasted.  Wasted time for you and wasted opportunity for the patient to improve their level of wellness. Ineffective teaching results in a loss for everyone involved. Worse yet, the patient now runs a greater risk of having to seek medical attention in the future.

So show some interest in what you are doing. Add some of those teaching skills that your most memorable instructors in the past used. Don’t be afraid to use some salesmanship in your teaching style.  You don’t have to yell like Billy Mays selling OxyClean but give your patient some reasons to learn and practice the  material you are teaching.

The first engagement is speaking for the 2010 Conference of the National Alliance of Certified Legal Nurse Consultants. The next talk will be with the Society of Gynecologic Nurse Oncologist for their 27th annual symposium. I hope that this is the start of my being able to give back to the nursing community some of the information that I have learned over the past 37 years. To that end, I have started to learn the business of speaking and started a speaking website (www.donaldwood.com). I am hoping to have this business encourage nurses to become better through learning communications, creative thinking, problem solving and other leadership skills.

What have you done to better nursing lately? Have you spoken to someone about becoming a nurse? Have you explained to your patients your role in their healthcare? Do you have a good idea what your role in healthcare is? As we personally progress in our nursing careers we should strive to know our reason for being a nurse and be able to articulate this to others.

If you are the type to keep that attitude with you during the day, don’t expect things to get better anytime soon.  Those around you will feed off of your attitude and return the same to you. Your attitude affects all of your actions during the day.  The way you look at people, the way you respond to questions, your body language – it is all connected and on display for others to see. In return, they will often offer the same attitude back to you.  People often mirror those around them. Hopefully you will be around someone with a positive attitude that will mellow your attitude and reflect back a better person.  After all, you must keep everything in perspective.

Perspective means not taking your poor attitude into the patient who has just been told that they will need immediate surgery. The patient who must stay in the hospital for further treatment and will miss their child’s school play does not need to hear how you had to jump-start your car. The patient who is trying to decide between cancer treatments does not need to hear (verbally or non-verbally) about your bad day.  Your day pales in comparison to what your patients are often going through. 

The same goes for the family or support members with your patient.  I remember discussing with my wife about implementing a do not resuscitate order for her father when he was in the hospital.  The absolute last thing I would want to hear is a nurse complaining about how her lunch period was short or that she did not get an afternoon break. With the high acuity of patients in todays hospitals, a dead battery is probably way down on the list of things that patients or family consider as an item of major importance.

Don’t ever forget who you are going to work for.  You don’t work for the corporate structure or the CEO/CNO/nurse manager. They You may receive your pay from them but we should always remember that we work for the patient.  If we can’t keep that perspective we should probably start looking for another job.

Except for the simplest of changes, advanced planning is a must.  This is the time to sit down with as many of the affected parties as possible to set out a time line for the process.  Look for unintended impacts that this change may incur (often called the Law of Unintended Consequences). Are other departments affected? Will this change have a different effect based on time (night shift), day of week (weekends), or environment (electric outage due to storms).  This is the period to ask all the ’what if’ questions so suitable answers are available.  The whole idea is to decrease the number of surprises that crop up.  Some of the surprises could surface early in the implementation stage while others may rise in the coming months. 

The planning period is also the time to decide just how to roll out the change process.  Will everything happen at one time or can a phased approach be used? Both styles have their ups and downs and often the final decision is out of your hands. If you will be using a phased approach ( implemented by incremental stages), don’t prolong the change process too much.

The closely supervise the implementation of the change process.  Though you may have closely studied all the things that can go wrong, reality often raises its ugly head and a totally unexpected problem could arise. By closely supervising this part of the change process you can find the problems early and apply corrective measures before the problem grows into a major headache. Be sure to pass on to others involved with the change what occurred and how to handle it. It would be a great idea to have a daily meeting with those involved with the implementation to share thoughts and occurences from the day. The old military adage that no plan survives first contact with the enemy is true of all plans. If a best practice is found then adjust the implementation plan to capitalize on it.

Finally, the change has been implemented!  Often the process is not as painful as first thought. The low-level of discomfort is often directly attributable to good leadership skills.  Reviewing the change, assessing impacts, good communication and a well thought out plan will allow the leader to bring even an uninvited change to a successful completion.