Feature
What you need to know about running a shift Andrew Frazer explains the techniques junior nurses should learn in order to manage shifts in urgent care settings safely and effectively Correspondence [email protected] Andrew Frazer is assistant executive director of nursing of Hamad Medical Corporation, at the emergency department, Hamad General Hospital, Doha, Qatar Date of submission October 31 2014 Date of acceptance November 4 2014 Author guidelines rcnpublishing.com/r/en-authorguidelines
Abstract Many junior emergency department nurses are given no formal training in management before they are asked to take charge of shifts. Nurses learn by observing senior staff, but when they first take charge of a busy shift they can be uncertain about what tasks to prioritise and how to manage team members. This article describes some of the techniques they can learn and the observations they should make to run shifts successfully. Keywords Nursing management, charge nurse, knowledge, human factors NURSES ARE good at many things, including caring for patients and relatives, dealing with competing priorities, and communicating with a range of clinical and non-clinical colleagues. However, in the author’s experience they often lack training in, or perhaps do not give much thought to, managing shifts. Rather than focusing on leadership strategies, the differences between leadership and management, or organisational theories, this article offers some practical advice about how to manage a busy shift in an emergency department (ED). The techniques described can be applied to other healthcare settings.
Techniques Staff Think about the staff members who are on the shift. Knowing your team is important and, as a band 6 or 7 nurse, you should be aware of team members’ strengths and weaknesses, and assign them their roles accordingly. 14 December 2014 | Volume 22 | Number 8
Shifts on which there are ‘strong’ team members in all roles can almost run themselves, but those in which there are several new staff must be managed closely. In such cases, ask the more experienced nurses to support those with less competence and monitor areas in which the team is weak. Mobility As a shift leader, you should visit each area of the department at least once an hour. This will help you to identify potential problems before they develop. For example, if you notice that a patient is in pain, make sure he or she is given analgesia; if you spot relatives who are frustrated because they have been given too little information, make sure they receive it. By looking at each area with a critical eye, you can manage shifts calmly and avoid the need for crisis management. If you wait until problems arise instead of anticipating and preventing them, shifts become more difficult. Critical observation Every action and decision you make should be guided by the answer to one fundamental question: would I be happy to receive the care the patients are receiving? If the answer is no, the care must be changed. You may be powerless to solve some problems, such as a crowded department and long waiting times, but where these situations arise you can ensure that all patients understand why they are waiting, that they are as comfortable as possible and that no one is in pain. Or, if you notice that a patient’s condition is likely to deteriorate if he or she is not seen quickly, you can ask the senior doctor to divert medical resources to the assessment of patients who are waiting. EMERGENCY NURSE
Downloaded from RCNi.com by ${individualUser.displayName} on Dec 09, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
iStock
‘My request is that you talk to the doctor in charge and ask him or her to divert a doctor temporarily from the treatment area.’ Such a statement outlines your expectations, reasoning and directions clearly. Follow up If you ask team members to carry out tasks, do not assume that they will do so correctly, especially if the tasks are complicated. Even the clearest of messages can be misunderstood, particularly in situations where staff members speak a variety of languages (Shen et al 2012). About 20 minutes after you have asked a team member to undertake a task, you should return to make sure it is being carried out as planned. In such situations it is better to discover and deal with a problem immediately than to wait until the end of a shift when the problem may have grown worse.
Shifts with ‘strong’ team members can almost run themselves
As the shift leader, you will not necessarily solve these problems yourself, but you may point them out to your team. Communication Part of your job is to prioritise, and one of your most important roles is communicating with patients and explaining their viewpoints to your team. Busy nursing environments can be stressful places to work and, as stress levels rise, communication between nurses can deteriorate. How you communicate priorities to staff is therefore important. Shouting at your team is an example of poor leadership; instead, you should use the Situation, Background, Assessment and Recommendation (SBAR) tool (Eberhardt 2014) or a similar communication technique to help you get across what you want to say. If the ED is overcrowded and there are too few doctors on call, you could speak to the senior doctor about re-allocating staff. In some circumstances, however, you may ask a junior team member to make the request, in which case you should tell them this: ‘There is a two-hour wait for assessment at the front desk and there is only one doctor available. ‘My assessment is that we can reduce waits to manageable levels if we bring a doctor from one of the other areas. EMERGENCY NURSE
Value team members All staff members are important to the delivery of patient care and all deserve respect. Remember that you rely on the clerk at the front desk as much as you do on nursing assistants, for example. If their work is good, praise them; if their work is poor, tell them that excellence is the minimum standard expected of them in emergency care and explain how they should do things differently next time. If significant errors occur, you should write an incident report as soon as you can and, if a mistake has serious repercussions, talk about it to a senior member of staff. No one will complain about being informed about a problem you cannot solve yourself.
Conclusion Managing shifts may look easy when described in writing but, in practice, every shift is different from the previous one and every day brings a new problem to solve. This is one of the reasons why emergency care can be so exciting and rewarding; another is the satisfaction of knowing at the end of each shift that you have done your best for patients and staff.
Online archive References Eberhardt S (2014) Improve handoff communication with SBAR. Nursing. 44, 11, 17-20. Shen J, Xu Y, Bolstad A et al (2012) Effects of a short-term linguistic class on communication competence of international nurses: implications for practice, policy, and research. Nursing Economics. 30, 1, 21-28.
For related information, visit our online archive and search using the keywords Conflict of interest None declared
December 2014 | Volume 22 | Number 8 15
Downloaded from RCNi.com by ${individualUser.displayName} on Dec 09, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
What you need to know about running a shift Andrew Frazer explains the techniques junior nurses should learn in order to manage shifts in urgent care settings safely and effectively Correspondence [email protected] Andrew Frazer is assistant executive director of nursing of Hamad Medical Corporation, at the emergency department, Hamad General Hospital, Doha, Qatar Date of submission October 31 2014 Date of acceptance November 4 2014 Author guidelines rcnpublishing.com/r/en-authorguidelines
Abstract Many junior emergency department nurses are given no formal training in management before they are asked to take charge of shifts. Nurses learn by observing senior staff, but when they first take charge of a busy shift they can be uncertain about what tasks to prioritise and how to manage team members. This article describes some of the techniques they can learn and the observations they should make to run shifts successfully. Keywords Nursing management, charge nurse, knowledge, human factors NURSES ARE good at many things, including caring for patients and relatives, dealing with competing priorities, and communicating with a range of clinical and non-clinical colleagues. However, in the author’s experience they often lack training in, or perhaps do not give much thought to, managing shifts. Rather than focusing on leadership strategies, the differences between leadership and management, or organisational theories, this article offers some practical advice about how to manage a busy shift in an emergency department (ED). The techniques described can be applied to other healthcare settings.
Techniques Staff Think about the staff members who are on the shift. Knowing your team is important and, as a band 6 or 7 nurse, you should be aware of team members’ strengths and weaknesses, and assign them their roles accordingly. 14 December 2014 | Volume 22 | Number 8
Shifts on which there are ‘strong’ team members in all roles can almost run themselves, but those in which there are several new staff must be managed closely. In such cases, ask the more experienced nurses to support those with less competence and monitor areas in which the team is weak. Mobility As a shift leader, you should visit each area of the department at least once an hour. This will help you to identify potential problems before they develop. For example, if you notice that a patient is in pain, make sure he or she is given analgesia; if you spot relatives who are frustrated because they have been given too little information, make sure they receive it. By looking at each area with a critical eye, you can manage shifts calmly and avoid the need for crisis management. If you wait until problems arise instead of anticipating and preventing them, shifts become more difficult. Critical observation Every action and decision you make should be guided by the answer to one fundamental question: would I be happy to receive the care the patients are receiving? If the answer is no, the care must be changed. You may be powerless to solve some problems, such as a crowded department and long waiting times, but where these situations arise you can ensure that all patients understand why they are waiting, that they are as comfortable as possible and that no one is in pain. Or, if you notice that a patient’s condition is likely to deteriorate if he or she is not seen quickly, you can ask the senior doctor to divert medical resources to the assessment of patients who are waiting. EMERGENCY NURSE
Downloaded from RCNi.com by ${individualUser.displayName} on Dec 09, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
iStock
‘My request is that you talk to the doctor in charge and ask him or her to divert a doctor temporarily from the treatment area.’ Such a statement outlines your expectations, reasoning and directions clearly. Follow up If you ask team members to carry out tasks, do not assume that they will do so correctly, especially if the tasks are complicated. Even the clearest of messages can be misunderstood, particularly in situations where staff members speak a variety of languages (Shen et al 2012). About 20 minutes after you have asked a team member to undertake a task, you should return to make sure it is being carried out as planned. In such situations it is better to discover and deal with a problem immediately than to wait until the end of a shift when the problem may have grown worse.
Shifts with ‘strong’ team members can almost run themselves
As the shift leader, you will not necessarily solve these problems yourself, but you may point them out to your team. Communication Part of your job is to prioritise, and one of your most important roles is communicating with patients and explaining their viewpoints to your team. Busy nursing environments can be stressful places to work and, as stress levels rise, communication between nurses can deteriorate. How you communicate priorities to staff is therefore important. Shouting at your team is an example of poor leadership; instead, you should use the Situation, Background, Assessment and Recommendation (SBAR) tool (Eberhardt 2014) or a similar communication technique to help you get across what you want to say. If the ED is overcrowded and there are too few doctors on call, you could speak to the senior doctor about re-allocating staff. In some circumstances, however, you may ask a junior team member to make the request, in which case you should tell them this: ‘There is a two-hour wait for assessment at the front desk and there is only one doctor available. ‘My assessment is that we can reduce waits to manageable levels if we bring a doctor from one of the other areas. EMERGENCY NURSE
Value team members All staff members are important to the delivery of patient care and all deserve respect. Remember that you rely on the clerk at the front desk as much as you do on nursing assistants, for example. If their work is good, praise them; if their work is poor, tell them that excellence is the minimum standard expected of them in emergency care and explain how they should do things differently next time. If significant errors occur, you should write an incident report as soon as you can and, if a mistake has serious repercussions, talk about it to a senior member of staff. No one will complain about being informed about a problem you cannot solve yourself.
Conclusion Managing shifts may look easy when described in writing but, in practice, every shift is different from the previous one and every day brings a new problem to solve. This is one of the reasons why emergency care can be so exciting and rewarding; another is the satisfaction of knowing at the end of each shift that you have done your best for patients and staff.
Online archive References Eberhardt S (2014) Improve handoff communication with SBAR. Nursing. 44, 11, 17-20. Shen J, Xu Y, Bolstad A et al (2012) Effects of a short-term linguistic class on communication competence of international nurses: implications for practice, policy, and research. Nursing Economics. 30, 1, 21-28.
For related information, visit our online archive and search using the keywords Conflict of interest None declared
December 2014 | Volume 22 | Number 8 15
Downloaded from RCNi.com by ${individualUser.displayName} on Dec 09, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
