Expert's Corner: By Karen Murphy
R.N.,C. MHSA President, Adept Resources

Who is Right?

 

Agencies work diligently each day to develop consistent, reliable and efficient processes to attain and maintain compliance with various standards. This is an ongoing process because agencies continuously seek to improve performance, cut costs and comply with new standards.

 

Several times each week I receive telephone inquiries: "Will this new agency procedure comply with regulations?" "Why is my DPS insisting that our procedure is not appropriate?" "Is the 2 step PPD required or recommended?"

These inquiries are the result of disagreements between agency management staff members. When I answer these inquiries, I know that someone or everyone wants to be "right". This is an error in approach....and my biggest concern.

Agency management teams need to be cohesive. A Manager may need information from the chief nurse to make and support decisions. I have listened to many Managers relate that when they ask their nurse a question, the nurse seems angry that the manager is "questioning" the nurse's response.

This is inappropriate. When I was a student nurse, I remember my nursing instructor telling her students that "questioning a medical order" is different than "asking a question about the medical order". I remember this lesson from decades ago because I frequently have many questions. I needed to develop a communication strategy that would allow me to learn without distancing the source of the information.

Managers should seek information from the agency's human assets. Avoid questions like "Why are you doing that?" This question may be perceived as challenging the nurse's knowledge. So then, the answer is "because we are required to!?" This is not a learning experience for the Manager. It is an information hoarding opportunity for the nurse. I frequently suggest that Managers who are seeking information from agency nurses state that they are seeking information to develop a foundational understanding of the subject matter. " I need your help to understand this. Can you explain this to me?" The nurse becomes an information resource. This strategy enables the Manager to collect information freely and move forward in understanding and development.

Breaking the information deadlock is important to the Manager, the agency and the nurse. Sharing information is a necessary job requirement for staff members at all levels. I frequently discover that the "requirements" that the nurse is referring to may not really be requirements that the agency must attend to.

Most of the time the nurses are experienced home care nurses. They are making recommendations based on their experience, not their knowledge of regulations. The nurses are relating procedures from their experience in home care....at a certified agency, or a LTHHCP, Hospice, CHAPS or JCAHO accredited agency. Since their recommendations are based on experience, the nurses may not understand that they are recommending compliance with a standard that is not required for this agency.

When this happens, the nurse becomes defensive and the Manager becomes more unsure of the nurse's knowledge. Subsequent inquiries are met with challenging responses. The information necessary for ongoing development is caught in an ego web.

Asking questions about recommendations is necessary and appropriate. Usually, the Manager calls me because the manager cannot get information from the nurse. When I explain the standards that the particular agency must meet and why the nurse's recommendation may be more that the agency needs, the Manager receives the information needed to build a foundation of understanding and make good decisions. But, the manager now questions the nurse's recommendations.

Within minutes, the nurse calls to question my response. This is a great learning opportunity. I explain the differences between LHCSA requirements and CHHAs, LTHHCP, CHAPS, JCAHO and other standards that the nurse is recommending. The nurse concludes the telephone call with an understanding of the source of the standards and if and how the agency can attain compliance.

The operation of the agency is fraught with regulatory requirements. Managers and nurses should build quality standards and improve performance. But knowledge of "what we have to do" and "what we would like to do" is essential. Management teams MUST share knowledge and experience. The team must be able to answer questions: "Is that a Department of Health regulation?", "Does JCAHO require us to do that?" In this manner, the team is always growing in understanding.

Managers need to access the information resources of their nurses without "questioning the nurse." Nurses MUST understand that their managers are paying them for their experience, expertise and knowledge. Sharing information is a job requirement not a courtesy.

We can and should learn every day. Establish functional communication paths. Require advisors to cite sources of information. Make decisions based on facts. Leave the ego home.

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