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How ‘Peter Says Lion Eats Snails’ Helps Rehab Nurses

Written by: James Farrell, RN, MBA on Sunday, March 29, 2015 Posted in: Inpatient Rehab

From the lowest priority to the highest: Part 3

In the absence of obvious issues that require immediate redress, where does the nurse leader go with the data? How should the nurse leader prioritize? Using the acronym ‘Peter Says Lion Eats Snails’ (PSLES), the nurse leader can look for areas of prioritization. As the reader may recall, this is the same acronym used to memorize Maslow’s hierarchy of needs. In this case the concept is the same, we move from lowest priority to highest, but the words are different.

For the lowest level and the greatest priority, the nurse leader should focus on people. When we talk about people as a priority, there are two issues of greatest concern: is your unit adequately staffed to be able to handle the census of the unit? If not, hiring has to be the first task for the nurse leader; and, is your unit staffed adequately, but the patient census falls below 60% on a regular basis? If that is the case, working with marketing to find ways to bring in the right patients for the beds has to take priority. If you do not have a marketing department, you may want to consider marketing your own rehabilitation unit or rehabilitation hospital through your own resources. You can host wellness days or promote rehabilitation awareness week (third week of September). You can have open houses in the evening with drawings and free health screenings. Whatever you do though, having the right number of staff for the right number of patients is the foundation for a successful rehabilitation unit or hospital.

The second level or the second area of focus is safety. When we talk about safety (aside from sentinel events) we are talking about issues that are not immediately clear, but put your patients or staff at risk. At this level, you need to look at your policies and equipment. Does your staff have the right equipment to safely do their job? Do the policies guide the staff using current accepted standards of practice? Chances are, if the policies have not been updated in the last three years, they are outdated and not following evidence-based practice. In addition, if your unit does not have equipment to assist the staff members in safely transferring patients; your staff is at significant risk for injury.

The third level or area of focus is leadership. There is a church saying “when it’s foggy in the pulpit it’s cloudy in the pew.” This refers to the criticality of good leadership, in any organization. Good leaders inspire people to achieve more collectively than they can do individually. Poor leadership is correlated with poor morale and sub-par work performance. The problem in many healthcare organizations is that nurse leaders are often chosen from the staff based on the greatest seniority or best clinical skills. The faulty logic behind this is that seniority and good clinical skills make good nursing leaders. What is forgotten is that nursing leadership is a different skill set than the bedside clinical skills of the nurse. In addition, seniority does not instill leadership via osmosis. Leadership requires training that is often overlooked. If the leaders on the unit or in a rehabilitation hospital have not received any kind of training in leadership, then it is a priority to give them some. Book clubs or hospital educational resources often are overlooked and can be a great asset in helping to train nurse leaders.

The fourth level or area of focus is experts. Assuming that the unit or hospital is doing well in the other areas (people, safety, and leadership) it is time to determine who the experts are and how their expertise can be used. For example, you may have a nurse who has been, or is willing to go to wound classes. You can use that expertise to establish wound protocols and build a wound team to train the rest of the staff on evidence-based wound care. You may also have someone who has expertise in diabetic care and management. An educational plan can be established to help the unlicensed staff understand how to look for signs of hypo/hyperglycemia.

The last level or area of focus is strategic initiatives. With strategic initiatives, the goal is to look at new ideas or programs to differentiate your hospital or unit from other like units or programs. For example, if you do not have bedside dialysis, you can work with local dialysis clinics to set up a contract to provide bedside dialysis to your patients. The savings to your hospital and the advantage to your patients of not being transported three times per week can give you a competitive edge. You can also create a wheelchair seating clinic with a local vendor to work with people who are wheelchair- dependent to get the right seating and wheelchair to prevent skin breakdown. Any kind of program that differentiates your unit/hospital from similar programs in your area can be a great way to add extra value to your patients and differentiate yourself from the competition.

While these are just some of the steps and areas of focus, by knowing how to look at your data and knowing how to prioritize, you can help increase the quality of the patient care on your unit and the satisfaction of your staff.

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