Redefining the Communication Culture in your Unit: Perils, Pitfalls &
Opportunities…………….
Lori Gunther, MSDirector, NICU Initiatives, March of Dimes
Laura MillerNICU Initiatives FCC Workshops
Copyright © 2015 by March of Dimes Foundation. All Rights Reserved
Objectives
As a result of this training, participants will be able to:
● Examine various forms of communication used in hospitals; and explore strategies for establishing consistent messaging to staff as leaders and families
● Identify differences and commonalities related to a multigenerational workforce; and explore strategies to provide the needed support for each subset
● Identify ways to cultivate healthy connections staff-to-staff, and staff-to-families, without jeopardizing professional integrity or overstepping boundaries
Behaviors Drive Staff Engagement
Hospital Expectations
As a Grady employee, you are expected to always be mindful of your surroundings and environment:
• Step aside for people exiting the elevator, board after. Once on the elevator, make a great first impression. Smile and speak to fellow passengers. “How is everyone today?”
• Refrain from discussing patient issues, personnel concerns or hospital business
• Refrain from holding a conversation on your personal cell phone
• Patients being transported should have priority.
• Use Words such as, “Hold the elevator please”, “Please press the 11th floor”, “After You”, “It’s my pleasure” or “Consider it done”.
In one word describe your image of a nurse.
Efficient
Competent
Professional
Responsible
Caring
Nurturing
Empathetic
Sensitive
Patient
Overworked
Chaotic
Overstressed
Underestimated
Underrated
Underpaid
Disillusioned
Indifferent
Oppressed
Porter, Porter & Lower
Optimal Patient Outcomes
Healthy Work
Environment
Clinical Excellence
Skilled Communication
Leadership
Meaningful Recognition
True Collaboration
Effective Decision making
Healthy Work
Environment
Shirey (ed.) (2006)
Root of the Problem: We all Communicate Differently
Houston we have a problem:
• When you first hear of the problem what is immediate reaction?
• Do you seek help from others?• If so, from whom?
• Do you launch into immediate action?
• Or do you take a moment to formulate a plan?
The Importance of Communication
Many studies show that communication, collaboration, and teamwork are lacking in health care, leading to medical errors:
• Broken rules• Mistakes• Lack of support• Incompetence• Poor teamwork• Disrespect• Micromanagement
(O'Daniel and Rosenstein 2008 & Maxfield et al. 2005)
Today’s Health Care Environment
“The richness of the current workplace diversity has numerous benefits, but it also poses unique communication and collaboration challenges. The generational cohorts have various approaches and attitudes toward their work ethics, values, technology and work-life balance.”
Marie-Elena Barry, MSN, RN
Multigenerational Workforce
25%
5%
38%
32%
FOR THE FIRST TIME IN HISTORY, WE HAVE FOUR GENERATIONS IN THE WORKFORCE.
Traditionalists (1922-1949) Ages: 66-93
Baby Boomers (1950-1964) Ages: 51-65
Generation X (1965-1979) Ages: 36-50
Generation Y (1980-1997) Ages: 18-35
POLL: What is the age of our audience today?
Demographic question1. Gen Y (25-35):2. Gen X (36-50):3. Boomers (51-65):4. Traditionalists (66
and older):
Communication Characteristics
Traditionalists
66 and older
• Formal
• Memo
• Thorough
Baby Boomer
51-65
• In-person
• Telephone
• Social
Gen X
36-50
• Direct
• Immediate
• Openly speak up
Gen Y
18-35
• Limited in-person
• Text / SM
• Multi-taskers
• Hard work ethic
• Respect authority
• Workaholics
• Question authority
• Work-Life balance
• Self-reliant
• Entrepre-nurial
• Looking for meaning
• Dedicated
• Goal-oriented
Leading a Multigenerational Staff
The significant segment of the nursing workforce is nearing retirement age.
• According to a 2013 survey conducted by the National Council of State Boards of Nursing and The Forum of State Nursing Workforce Centers, 55% of the RN workforce is age 50 or older.
• The Health Resources and Services Administration projects that more than 1 million registered nurses will reach retirement age within the next 10 to 15 years.
Communicating with a Multigenerational Staff
• One size does not fit all• Learn to speak multiple languages • Find commonalities between you and your staff• Remain above the fray and maintain your integrity
and professionalism
Difficult Conversations with Staff
Stone's 5-Step Process:
1) Sort out the three necessary conversations 2) Determine the benefits, if any, of a confrontation 3) Start from the third story4) Explore their story and yours while avoiding blame5) Begin problem-solving
(Stone et al. 2010)
First Steps - Stone
• Sort out what happened. Be open to the fact that you may not know the whole story. Obtain the facts from as many sources as possible.
• Understand your emotions within the issue.
• Identify what is at stake for you by determining what impact this situation may have on you.
(Stone et al. 2010)
Potential Barriers to Problem-solving
(Ury 1993)
Ury’s Model of Negotiation
• These barriers include your reaction, their emotion, their position, their dissatisfaction, and their power.
• A manager or coworker cannot defuse emotions until his or her own are under control.
Five Strategies - Ury
(Ury 1993)
• Go to the balcony for perspective• Acknowledge their viewpoint and show respect• Ask questions and reframe the problem• Bridge the gap between your interests and theirs• Still resisting? Bring them back to negotiations again
“A successful negotiator will always ask for more than is needed, so that less important items can be given up. In this manner, the negotiator appears to be grantingsome wins to the opponent, while protecting what is truly important to him or her.”
Communicating the Art of Professionalism
Heart and Soul of Medical Care
Professionalism mean safe care
Professional boundary
The framework that we operate within that makes our work relationships professional and safe and set the limits for the services we deliver.
Professional ethics
Behavioral standards for a person operating within a certain profession.
Communication via the web (aka Facebook)
Question: What are other units doing related to social media and parents/families who friend request them (or vice versa)?
Our hospital has taken the understandable stance that nurses should not "friend" patients or families as it is a conflict of interest and it may potentially put the staff and family both in difficult situations.
However, this is especially very challenging for nurses because we DO become "friends" and develop close caring relationships when supporting them day after day.
Therapeutic Relationship
Over-InvolvementUnder-Involvement
Continuum of Professional Behavior
Adapted from the National Council of State Boards of Nursing
Therapeutic Relationship
Utilize the hospital’s social media to connect with families
Over-Involvement
“Friend” families or staff
Post about work
Keep pictures in phone
Under-Involvement
Distancing to an extreme: Not attending NICU reunion
Not saying “hello” to graduate families who return
Continuum of Professional Behavior
Practical Guidance
https://www.ncsbn.org/Social_Media.pdf
Helping Staff Communicate with Families
● How do we help our staff have tough conversations?
● When do you think your staff feel the most challenged?
When Bad News Has to be Delivered
SPIKES breaks down the delivery of bad news into steps, rather than making it one big run-on conversation that can be confusing and difficult to process.
Baile, W.F., Buckman R., et al. 2000
SPIKES Definition
S: Setting. Pick a private location.
P: Perception. Find out how the parents view the medical situation.
I: Invitation. Ask whether the parents are ready/want to know the information you are about to give them.
K: Knowledge. Warn before dropping bad news.
E: Empathy. Respond to the patient’s emotions.
S: Strategy/Summary. Once they know, include parents in treatment decisions.
Baile, W.F., Buckman R., et al. 2000
References
● Cooper, F. (2012). Boundaries in Social Work and Social Care. Jessica Kingsley Publishers; Philadelphia.
● Crawford, D. (2008). We Need to Talk. Society for Human Resource Management.
● O’Daniel, M., Rosenstein, A. (2013). Professional Communication and Team Collaboration. Patient Safety and Quality: Evidence-Based Handbook for Nurses; Rockville MD
● Sherman, R. (May 31, 2006). Leading a Multi-generational Nursing Workforce: Issues, Challenges and Strageties. OJIN; The Online Journal of Issues in Nursing. Vol. 11, No. 2, Manuscript 2.
● Stone, D. et al. (2010). Difficult Conversations: How to Discuss What Matters Most; NY Penguin Books
● Ury, W. (1993). Getting Past No: Negotiating Your Way from Confrontation to Cooperation; NY Bantum Books
