Here are some tips to help keep nurses focused on why they chose nursing as a career—because providing great patient care is fulfilling, rewarding work.
Give them the gift of great leadership. Most RNs leave their job because of their relationship with their supervisor. The best thing you can do for your nursing staff and your organization is to invest in leadership training. Well-trained leaders have the ability to inspire and bring out the best in their staff. They help create the kind of environment that attracts and retains great talent.
Work on the assumption that your nurses want to do a good job. When nurses aren’t performing, it’s almost always because they don’t have the tools they need.
Don’t be too removed from the nurses in their everyday work environment. If you want to really solve problems, solicit the advice and direction of the front-line nurses who do the job every day. Walk up to them and ask very specific questions: Is there anything we can do better? Do you have the tools and equipment you need to do the job? Then, do everything in your power to give them what they need.
Embrace a “can do” attitude and empower your nurses to do the same. Nurses want to provide great patient care. They will often do whatever it takes to make that happen.
Give nurses consistency. This is best done by hardwiring your nursing culture with key behaviors. When checking their schedules, nurses not only look for when they work, but who they work with. What if everyone on your nursing staff were equally well trained? This may seem like an impossible notion, but not when you hardwire the right behaviors, tools, and techniques and align your focus with the entire nursing staff. Do this and the shift will run smoothly no matter who is working.
Deal with your low performers and understand the impact they have on your nursing team. Great nurses want to work with other great nurses and are extremely frustrated by low performers. Don’t be afraid to let disruptive people go. If you don’t, these low performers will affect your high performers, causing them to leave the organization, channel their positive energies into outside interests, or pace themselves and slow down.
Understand the connection between employee satisfaction and the bottom line. Remember, satisfied employees are always better performers. When employees feel appreciated and recognized by their leaders, they seek out opportunities to do good things for the company and its customers. They think like owners, not renters.
Find and recognize the heroes. Know who your great nurses are and celebrate them every day. Share stories of nurses who go above and beyond any time you get the chance.
Quint Studer is a health care management educator.
Dr George Magee, a rural doctor from Burns Lake, BC, was recently awarded a 2005 British Columbia Community Achievement Award. In addition to providing advanced scope GP care to the community for 35 years, he has played an important role in many community projects and activities. As an active Rotarian, he helped complete important recreation facilities. He was the driving force behind the establishment of the Rod Reid Nature Trail, donating much of the land for the trail system.
Now retired, he continues to be passionate about his profession—especially the recruitment of doctors for rural service—and remains active with the Society of Rural Physicians. He is also a member of the University of Northern British Columbia’s Medical Endowment Fundraising Committee.
Patients First: The Story of Family Medicine in Canada. By Stan Solomon and Peter Taylor. Toronto: Key Porter Books, 2004. ISBN 1-55263-605-4. Hardcover, 112 pages. $49.95.
Patients First is an enlightening book about the history of the College of Family Physicians of Canada (CFPC) from its inception back in 1954 to the College’s 50th anniversary in 2004. It is an enjoyable read that looks at the challenges and changes in family medicine in Canada, along with a brief look at the context of major medical and political events over this time.
The book is divided into chronological decades and takes us back to 1954 in Vancouver, when a small group of general practitioners met to discuss “the future of Canadian family practice.” The College of General Practice of Canada first came about as GPs “came to feel like second-class citizens in the medical hierarchy.” As medical schools and hospital-based residency programs moved toward more and more specialization, there was a great fear of the demise of general practice. The book goes on to state “there would not only be a shortage of family doctors in the future but those who did chose that field would never have the education and research resources to keep up with the demands of modern medicine.” These quotes from Patients First serve to remind us that despite the accelerated pace of change in medical practice over the past 50 years, the challenges faced by general and family practice have in many ways changed so little.
As the College went on to change its name to the College of Family Physicians of Canada to recognize the role of the GP/FP in caring for patients and their families in the context of their communities, this book takes us through the “Swinging Sixties,” the “Super Seventies,” and the “Exciting Eighties” when family practice residencies truly came of age as an accepted discipline in medicine. It then takes us through the “Nervous Nineties” and into the “New Millennium” as we are shown the significant role family physicians play and the challenges they face in caring for the people of Canada in the modern world of global travel and rapid expansion of technology. It challenges governments of today to recognize that “one of the best investments this nation could make would be to ensure that every Canadian has the opportunity to have his or her own family physician—the doctor who puts patients first.”
—Cathy Clelland, MD
The recent publicity concerning the case of Terri Schiavo, the Florida woman who died after her feeding tube was removed, has heightened the public’s awareness and concern over an individual’s right to express wishes about refusing life support.
In British Columbia, the Health Care (Consent) and Care Facility (Admission) Act says that a capable adult, 19 years and older, can give or refuse consent on any grounds, even if the refusal will result in death. However, complications can arise when a person becomes incapable of communicating his or her wishes through a debilitating health condition such as a stroke, dementia, or an accident.
In advance of incapability, adults in BC can write a representation agreement that names their choice of legal decision-maker (representative) if he or she is incapable, and gives the representative the authority to refuse treatment on their behalf.
Making and registering a representation agreement (sometimes referred to as “BC’s living will”) ensures that wishes about refusing life support are legally binding. The law requires the representative to make decisions according to the adult’s wishes. A representation agreement can cover financial, legal, and personal care matters as well as health care.
In the absence of a representation agreement, the Health Care Consent Act sets out a list of persons who may be selected as a temporary substitute decision-maker (TSDM). The TSDM is chosen from a hierarchical family-based list; this person does not have binding authority to refuse life support. There are other decisions that are outside the authority of a TSDM, such as decisions about electroconvulsive therapy. In November 2003, the BCMA’s Council on Health Promotion issued a press release encouraging the public to make and register representation agreements.
The Representation Agreement Resource Centre (RARC) is a provincial non-profit organization dedicated to providing information and assistance to the public in writing and registering representation agreements.
The RARC has a free information package on representation agreements including a worksheet to help adults through the steps of appointing their representative, writing an agreement, and making it a legal document. The RARC can refer people to a lawyer or to one of its legal clinics. A lawyer’s signature is required to ensure the representative has binding authority to refuse life support on the adult’s behalf. The RARC has self-help kits for agreements that do not require a lawyer’s signature.
The material also stresses the importance of discussing wishes with those being appointed. Adults can appoint a spouse, a family member, or a friend. It’s a good idea to name more than one person so there is a “backup” in case something happens to the representative.
After making a representation agreement, it can be registered with the Nidus eRegistry (nidus is Latin for nest). Nidus is a centralized registry for representation agreements. Registration allows the adult’s wishes to be available when needed. This may be especially useful in an emergency. The Health Care Consent Act says that in an emergency, a health care provider must not treat if he or she has reason to believe an incapable adult expressed an instruction or wish while capable to refuse treatment for the situation at hand.
The best advice for patients is to make arrangements before they become incapable. Like a will, everyone needs her or his own representation agreement. It saves delay and expense, eases the burden on family and friends, and avoids the need for court or government involvement in one’s personal and private affairs.
Representation Agreement Resource Centre, 411 Dunsmuir Street, Vancouver, BC V6B 1X4; 604 408-7414; www.rarc.ca
—Joanne Taylor, Executive Director, Representation Agreement Resource Centre
Tickets to a play, a romantic getaway, a trip on VIA Rail, seats at the symphony, Aboriginal art—those are just some of the things to choose from at the Parent Support Services (PSS) 9th Internet Auction.
Any time between 1 June to 30 June, day or night, anywhere in the province, you can visit www.gobid.ca to see what is being offered and buy a birthday gift or getaway. The auction site supports numerous charities, which change monthly.
The mission of Parent Support Services is to prevent child abuse and promote healthy family relationships. The parents in Parent Support Circles come voluntarily to improve their parenting skills and receive the support that they need and want from trained facilitators and their peers.
A Canadian survey conducted in September revealed that more than a quarter of respondents would be uncomfortable hugging, kissing, or getting into the same swimming pool as someone with psoriasis. In terms of psychological aspects, psoriasis ranked close to depression as having a profound impact on the lives of its sufferers.
The Psoriasis Education Program (PEP) has released the first issue of PEP Talk, a publication for people affected by psoriasis. Featuring patient testimonials, advice from Canadian dermatologists, and survey results, the newsletter is targeted to people with psoriasis, their families, and the health care professionals who treat them. The publication is available through the Psoriasis Education Program and can be found on the web at www.psoriasisinfo.ca.
The Society of General Practitioners of BC (SGP) has launched a new initiative to help members bill effectively for uninsured services. A key component of the initiative is the creation of the Full Service Family Practice (FSFP) logo that will be included in the package of billing materials made available to members. The purpose of the logo is to highlight physicians who are providing comprehensive longitudinal care and foster a renewed sense of pride in what family physicians do. The SGP hopes that the uninsured services package will be the first of many value-added services made available to SGP members, and the logo will be a central theme throughout. The uninsured services package, which includes waiting and exam room posters, tick-off billing sheets, off-work certificates, and a logo appliqué for the office door, will be made available to SGP members only at an initial cost of $85. Reorders of printed materials will be direct from the printing company through an online order process. Uninsured services are seen as an important income stream for GPs and may encourage many GPs to continue in FSFP, as it could add significant value to their businesses in a variety of ways.
Information on the FSFP package can be obtained by contacting the SGP office; contact Dr Cathy Clelland at 604 638-2942, e-mail firstname.lastname@example.org, or Ms Estelle Doull at 604 638-2943, e-mail email@example.com.
The FSFP uninsured services billing package was developed by the Future of General Practice Committee with special support from Dr Jeff Purkis and the GPs from White Rock.
—Cathy Clelland, MD
Above is the information needed to cite this article in your paper or presentation. The International Committee
of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally
accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.
About the ICMJE and citation styles
The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.
An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.
BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:
- Only the first three authors are listed, followed by "et al."
- There is no period after the journal name.
- Page numbers are not abbreviated.
For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org