Nursing Communication and the Hierarchy of Resiliency

January, 2018

I frequently have conversations with nurse executives who are uncomfortable making technology decisions on behalf of their nursing staff. They live in the all-consuming world of nursing operations, staffing, and patient satisfaction. I find that nurse executives, as a matter of expediency, surrender their decision-making power regarding technology to IT. These executives desire to be informed but don’t always feel they have the required technical expertise to be a driver in the process.

I recall one conversation in which I was talking with a CNO about mobile communication solutions in nursing practice. She said to me, “It’s a mobile phone. I don’t have time to deal with phones when I’m dealing with things like patient-family satisfaction, burned-out nurses, and short staffing.”

She was overwhelmed with the problem of nursing staff turnover, and didn’t want to talk about communication and smartphones. I was concerned she was missing the bigger picture.

“If you leave the decision making for a communication solution to IT,” I said, “the clinical details – and your nurse adoption of the technology – could suffer. Investing in solutions your nursing staff will not use effectively is a worn out theme you don’t want to repeat.”

She nodded, inviting me to continue.

“Let’s break down what happens when you’re short of staff,” I said. “You need systems or technology or processes to fill the gaps people would normally fill. You need streamlined protocols that make it very easy for nurses to do their work. When nurses are more efficient and more able to focus on patient care, it in turn reflects well for the patient, who feels well-taken care of.”

She agreed.

“Let’s talk about a mobile phone,” I said. “I realize to you it seems like an everyday device. But the truth of the matter is, when you use the capabilities of a smartphone to provide a nurse with the right information to be used in the right place, at the right time, it can dramatically affect everything we just talked about.”

We ended up having a long conversation about a whole gamut of clinical workflow and communication challenges, and how much more time nurses can devote to patient care when they can communicate effectively and find information and resources quickly.

The Path to Nurse Self-Actualization

Nurses will put up with a great deal of chaos in their work environment. But chaos breeds fatigue, and together chaos and fatigue are part of a whole picture that can wear down a nurse’s capacity for compassion. Think about the experience of a busy, chaotic day with multiple urgent tasks at hand. The simple act of needing to make an important phone call but not having the necessary phone number can complicate a nurse’s work to the point of total frustration. Frustration can chip away at patience, tolerance, and the nurse’s ability to cope with larger issues at hand.

I think of nurse resiliency and technology adoption in healthcare in terms of a hierarchy, much like Maslow’s hierarchy of needs.

At the top of the pyramid is what I call a climate of respect, where nurses feel a sense of control and support. When you solve for the first three areas of need in the hierarchy starting from the bottom, you have a greater chance of solving for higher level self-actualization needs. You won’t solve those top two unless you solve the bottom three.

Here’s what the hierarchy looks like, beginning with the foundation:

Level 1: Physiological needs

First and foremost, solve for the work environment. This means physical well-being, communication, and workflow.

At the most fundamental level, nurses need to be able to take sufficient breaks. Like so many nurses I know, I’ve worked hundreds of 12-hour shifts where I didn’t drink anything because I knew I wouldn’t have time to go to the bathroom.

Nurses also need time for regular nutritious meals, rather than eating vending machine snacks on the go. They need to be able to stop and catch their breath.

Burnout can become more intense and more frequent, and the job of being a nurse more difficult, when the work environment doesn’t allow for the basic human requirements for food, water, and rest. Strengthen processes, and equip nurses with tools that help them communicate and collaborate more effectively.

Using more effective tools can streamline clinical workflow. Equipping nurses with technologies that enhance practice helps reclaim time they used to waste on inefficient approaches to communicating with physicians, locating people and resources, getting critical test results, and more.

With better efficiency, nurses can reclaim time for basic human needs like rest and meals, and more energy for patient care.

Level 2: Safety needs

We all have a basic need to feel safe. If this need is not met, nothing else works.

Equip nurses with tools that provide a way to call for immediate help when their physical safety is threatened. Ensure adequate staffing. Solve for the constant drone of alarms and alerts. Create processes or protocols that make bullying unacceptable and allow nurses to resist bullying without fear of retaliation.

To nurses, safety also means having an executive team who supports their needs. Make sure they understand you do. Nurses can never be fully self-actualized until they’re okay with their work environment.

Level 3: Belonging needs

Let nurses know you value what they think and how they feel. Validate their education and experience by seeking their expert clinical contribution to policy, practice, and purpose.

If your hospital doesn’t have a shared governance model, consider implementing one. Regardless, be sure to solicit input from nurses, who are the ones at the front line of patient care.

At Vocera®, we have more than 40 nurses who work with our customers to ensure their nurses are fully involved with designing, implementing, and deploying our technology solutions in their hospitals. We develop and sustain solutions that give nurses tools to support clinical workflow and provide useful data to demonstrate successful outcomes.

Level 4: Esteem needs

Enable nurses to have better patient outcomes, which leads them to feel a sense of accomplishment. Create an environment where nurses can spend more time with patients in the practice of nursing, not running around looking for people, products, or protocols.

Give nurses the power to make decisions about tools and policies that affect their practice. Involve them in selecting the technology they will use for patient care. When nurses integrate their practice knowledge with expectations for technology, it’s more likely to meet their needs and they are more likely to embrace its use, leading to better outcomes for patients.

Enthusiastically recognize nurses who provide extraordinary patient care. Equip nurse leaders with tools that foster purposeful rounding with features that make it easy to capture patient recognition of staff and share it across your organization.

Level 5: Self-actualization – climate of respect

Having established a solid foundation, nurse executives now have the basis for creating an environment where nurses can feel energized by their work, which leads to more focused patient care. Nurse executives can be more creative with staffing and address issues that lead to fatigue and burnout.

Allow nurses some control over their scheduling. Think outside the box with the focus not on how to smooth everything over so our nurses can stay in a 12-hour shift, but rather on how to creatively meet staff members’ individual needs. You might have one nurse who wants to go back to school to earn an advanced degree and can only work weekends. You might have another who needs to be home with his or her family on the weekends and can only work week days. Find ways to create partnerships.

When you give nurses the power to be creative about their work environment and to have input into determining how to solve problems, they feel more supported – and this fuels resiliency.

Support nurses (and patients and families) who have met their emotional limit. Introduce a program like the Code Lavender® program to support nurses whose patients are critically ill.

Building Resiliency and Retention

HealthLeaders Media recently released a report called Nursing Excellence: Leadership Development, Culture, and Retention. The report reveals double-digit nurse turnover rates, considers the role of fatigue in burnout, and looks at tactics nursing leaders have used to improve retention.

Themes in the foreword and throughout the report emphasize the need to create a positive, supportive environment. This concept is not unlike the climate of respect at the top of the Nursing Hierarchy of Resiliency. My hope is that you, as a nursing executive, will find the hierarchy a straightforward way to conceptualize how to get there.