Good management in nursing

Good Management in Nursing

Good Management in Nursing Good Management in Nursing Activity aids for use in healthcare For an improved quality of work in nursing
With changes in the population and the rise in the number of elderly Together with practitioners from hospitals and both inpatient and people resulting in a rising number of chronically ill and multimorbid outpatient health care facilities, practical guides such as this have individuals, the subject of ‘health care' has increased in significance been developed to provide incentives and encouragement by allowing for both the individual and society. This higher level of importance, an exchange of knowledge for everyday working life, thus contributing the new challenges and the rising demands on nursing mean that to improving working conditions. To create a close connection to and answers are needed on what form nursing should take in the future. allow for a constant exchange with actual health care practices, the The working conditions in the nursing industry are characterised by authors alternated during the course of the project between conduct- elevated physical and mental stress, time pressure, awkward working ing workshops with the support of care facilities and conducting evalu- hours, high numbers of personnel absent through illness and person- ation phases. The process was less about generating new knowledge nel rapidly leaving the profession. These stresses on the personnel and much more about transforming theoretical and practical knowl- also directly affect the quality of the work, thus also affecting those in edge that was already available into a form more useful for nursing facilities. It was important for everyone involved to look at material While the challenges in nursing require a solution as part of a larger and aspects within the thematic fields that had potential for improve- society and must not be tackled alone, those who practise nursing ment or change on an operational level. should and must recognise and take advantage of the organisational Six practical guides are the result – guides that provide practical rec- freedom they have to overcome current and future challenges. ommendations and encouragement for nursing practices, clarify the Following up the holistic approach of the memorandum ‘For a new reasons for doing so, demonstrate the circumstances, show examples quality of working in health care', the Institute of Work and Technology of good practice and act as a provider of incentives and ideas, ena- in Gelsenkirchen has been developing six topics together with its part- bling new paths in nursing to be laid and, if needed, to be taken. ners as part of the project ‘practical guides for nursing'. These fields represent the most significant stresses for employees: 1. Time pressure in nursing, ­. Communication and interaction, ­4. Compatibility of family life and profession, ­5. Nursing individuals afflicted with dementia, ­6. The debureaucratisation of nursing. Foreword
1 Professional, personal, successful
Management in nursing 2 Good employment decisions pay dividends
Recognising and obtaining new valuable personnel 3 Making a good start
Successfully organising the induction of new management personnel 4 Learning to praise performance
Appreciation is motivation! 5 The right word at the right time
Constructive criticism 29 6 Managing conversations
Successfully structuring discussions 7 Recognising potential, developing skills
The employee development interview 8 To err is human
Guidelines for a culture of handling mistakes productively 9 Management task: Laying off employees
Structuring and carrying out discussions where personnel are to be released in a fair manner 47 10 Literature
Good management in nursing "Management makes all the difference" – while that might ment of this practical guide by expressing their experi-at first sound like a truism, it holds true without a doubt ences, providing examples of good practice, offering frank today, with nursing institutions being no exception. This feedback on the articles and contributing a great deal of practical guide is intended to present the current expertise further valuable information. on this subject in a concise and precise manner and also provide sustainable recommendations for use in practice in the face of increasingly unclear and obtuse literature on the subject. The fields covered were selected as part of the INQA Project "Practical Guides for Nursing" together with the participating institutions. We offer our sincerest thanks to the institutions that took part in the develop-

Professional, personal, successful Good management in nursing 1 Professional, personal, successful Management in nursing
"Management" is not an abstract concept. Managing per- 4. Social and communicative skills verstanden als die
sonnel is all about reaching complex work targets together Fähigkeit, sich mit anderen zusaunderstood to be the on the basis of a dynamic relationship between people. ability to work together and interact with others, to co- As such, the following information on good management operate in a creative way and communicate with them. practice is very well established. It has been derived from many years of intensive collaboration with a wide range When taken in the context of a nursing institution, the of management personnel from inpatient and outpatient following aspects that define a successful manager can be nursing institutions, hospitals and clinics as part of quality derived from this model: development projects, workshops and training sessions and has been corroborated by precise interviews con- Personnel management skills are demonstrated by man-
ducted with "successful" management personnel. The question of what makes a successful manager gives rise to – ­ setting priorities in a precise manner and selecting a concrete set of skills, which will be expanded upon with tasks that need to be carried out carefully. Making use a focus on the following core subjects: of a small number of targets that are of high impor-tance, so as to have something for him or herself to 1. ­Personnel management skills understood to be the
concentrate on and achieve results. ability to be both clever and critical about oneself, – ­ having developed a positive attitude when dealing with productive attitudes, principles and ideals. personnel: "making out the best of ordinary people". – ­ not hiding behind external regulations, rather represent 2. Action skills understood to be the ability to be able to
their own, unambiguous position. make use of all skills, knowledge, results from social – ­ having developed a consistent, client-oriented attitude interaction, personal values and ideals in a highly and expressing this in a credible manner. determined and active manner. – ­ appraising the current quality of the current service provided in a realistic fashion (without embellishing 3. Professional and methodical skills understood to be
it or perceiving the current situation to be perfectly the ability to overcome difficult problems in a creative way with professional and methodical knowledge to hand.

Professional, personal, successful Action skills are demonstrated by managers
– ­ end the working relationship with personnel if it is clear – ­ having clear impressions of the direction they want to that the relationship is not working. take and a strong vision based on his or her own princi-ples of the form that the service should take. Social and communicative skills are demonstrated by
– ­ working actively with fixed, well-thought through tar- gets that are supported by the personnel. – ­ seeking to actively discuss changes with their col- – ­ "putting the pedal to the metal" (providing resources, leagues and support them in dealing with changes. creating basic conditions, supporting personnel etc.) – ­ checking the appropriateness of their management when the decision is made that something in particular style by discussing it with personnel and nurturing a needs to be done. open feedback culture. – ­ checking precisely to what extent and with what kind – ­ being generally always ready to form open relationships of expenditure and effort externally imposed require- with the personnel founded on continuity. ments are to be implemented in the institution. The – ­ recognising and taking into consideration individual personnel perceive management to be primarily occu- skills and resources that personnel possess. pied with the task of creating ideal basic conditions so – ­ appreciating his or her colleagues in all their diversity. as to allow the personnel to concentrate on the "core – ­ being available for personnel to speak to when they are having problems (not always work-related). – ­ having perseverance in pursuing targets. They do not – ­ not acting as though they were self-important or dis- allow themselves to be demotivated or impeded by tancing themselves using the hierarchy. resistance or setbacks. – ­ checking the effectiveness of changes made. Specialist and methodological skills are demonstrated by
– ­ expect, support and demand a good level of perform- ance from the personnel. – ­ being able to realistically recognise the strengths and weakness of their own working environment (ward, group, team). – ­ working with concrete, easy-to-understand data and – ­ carefully thinking about the tools that they want to use and not being impressed by short-term fads. – ­ making intensive use of available tools and actively searching for new fields of application. – ­ quantifying goals whenever this is possible and useful. – ­ ensuring that responsibility is being taken seriously in a reliable manner and that agreements or tasks are being carried out to the letter. Good management in nursing Practical example: Luisenhospital in Aachen
An interview with senior nurse Ms. Mauer
Question: How do you go about making impor-
openly about it. However, I don't do so in an What does "appreciation" mean for you? tant decisions? accusing tone, rather I try to create incentives, I try to approach my personnel with an Ms. Mauer: As a senior nurse, it is impor-
trigger developments. I have had positive appreciative attitude. I find it important that tant for me to approach decisions in a struc- experiences in this respect. This means in the I be genuinely interested in the personnel. I tured manner and, whenever it's useful and long-term that personnel feel less inhibited to don't mean telling private stories here. For possible, to gather feedback their application talk about where their knowledge and skills me, appreciating personnel means being in practice. For example, we recently had a are lacking. It is important that the responsi- interested in their potential, seriously listen- new infusion system introduced. I started by bility for their actions remains with them. ing to their opinions on professional subjects demonstrating the system during the ward and supporting personnel in their further management meeting. I then asked the per- Any manager would wish for personnel that development. This approach also helps to sonnel to collect arguments for and against. can work as independently as possible and take increase the level of trust, to have personal Next, the personnel were able to discuss the responsibility for their own actions. What experi- topics discussed and it also enables us to get reasons for and against. I avoid getting too ences have you gained in this field in your time to know one another. This is my management involved in discussions such as these, as I as a manager? style. My experience with this approach has would to really find out more about the argu- You can't just throw all of your personnel been positive so far. ments that the personnel put forward. How- "into one basket". Good management means ever, I also find it important to place a limit having to adjust to individual personnel. Do you deal with everything by yourself or are on discussions, because eventually all of the Generally speaking, I find it important that the there times where you rely on support from arguments will have been expressed. Then it's personnel are able to apply their potential so time for the decision. that they can work as independently as pos- I've learnt to get support through training sible. If this works, I can move on to the next or advice from colleagues if I'm stuck with a How do you organise your relationships to your step and hand over more responsibility. But problem. I always need to reflect on things personnel? this also works in the other direction – if it and call in an outside perspective on the way I draw a clear line between professional doesn't work, or if personnel are being asked and private relationships. I don't know if this too much of or are unable or unwilling to ac- is really necessary, but it helps me to build cept responsibility, I need to take a step back. Can you tell us another "secret for success"? relationships that have a healthy, profes- Continuity is important. Work with a plan. sional distance. This might irritate a few of What skills should a good manager bring to Have perseverance and implement things my personnel, but the longer they know me, that you consider important in a consistent the easier it is for them to accept this type of The ability to view things objectively and manner. This makes you predictable for per- relationship or even to appreciate it. fairly and to be open-minded about employ- sonnel. Nothing is worse than constantly hav- ees' arguments. The ability to avoid allowing ing to start things anew and not completing What do you do when you recognise deficits in yourself to be put under pressure and thus anything. This kind of situation undermines your personnel? have control over your own emotional state. the employees' motivation considerably. I find it important to be open and honest After all, a manager who lets themselves be in communication. It's particularly when I put under pressure also allows themselves recognise deficits in an employee's perform- to be controlled by their emotions. This often ance that I feel the need to approach them leads to them acting recklessly, kicking off too early or just simply "losing their head". Good employment decisions pay dividends Good management in nursing 2 Good employment decisions Recognising and recruiting new, valuable personnel Ms. Werner is a manager in an old peoples' home and is Poor decisions in selecting person- seeking a qualified nurse. An advertisement placed in local newspapers and magazines leads to an influx of applica- nel have direct and negative effects tions. Three applicants largely meet the requirements and are invited to an interview. Ms. Werner sets 45 minutes on the well-being of the patients and aside for each interview. Once the interviews are complete, residents, the quality of cooperation in Ms. Werner decides upon one applicant – Ms. Engel. She gives the impression of being very open-minded and the team and cost time and money. friendly. There are a few issues that need to be cleared up, but Ms. Werner is happy that Ms. Engel is available at such short notice. It wouldn't be the first time for her that an applicant has suddenly decided that they don't want the position. This means that the problems with the What you should know
personnel rota are solved for now. Any other issues will be The selection process should be structured in such a way tackled during the trial period. During the trial period, it that allows the suitability of the applicants to be assessed turns out that Ms. Engel demonstrates considerable defi- in a reliable fashion. Poor decisions in selecting personnel ciencies in her nursing planning and is unable to organise have direct and negative effects on the well-being of the her work sufficiently well. Ms. Werner is surprised. She patients and residents, the quality of cooperation in the hadn't expected this. The provision of support also fails to team and cost time and money. Interviews conducted in a bring success as she had hoped. Ms. Engel's contract is spontaneous fashion or an "unmistakable" impression of terminated at the end of the trial period. This means that people are not usually sufficient for making decisions in the primary nurse position is vacant once again. selecting personnel that are sustainable in the long term. This example is not an isolated case. That positions in The core element of most selection procedures is a tra- nursing are not filled by appropriate personnel is some- ditional-style interview with the applicant. During this in- thing that occurs repeatedly. It is more important to make terview, it is important to avoid using popular but clichéd informed decisions related to personnel with a view upon questions ("What do you think are your greatest strengths the current situation and the possible continued develop- and weaknesses?") and concentrate more on gaining a ment of the institution. more specific perspective of the applicant's potential. Good employment decisions pay dividends How you can go about this
– ­ Use the applicant interview to assess the skills! You – ­ Create a profile that clearly defines the requirements of can create a vague outline of the interview. This outline the position to be filled! It should not only contain pro- should contain questions that allow the skills to be fessional requirements (knowledge of expert standards, assessed to "come to the forefront"! These questions ability to plan nursing etc.) but also desired fundamen- allow you to ask the applicant to talk about situations tal skills not specific to the profession (such as com- they have been in, where, for example, communication munication skills, teamwork skills, client focus etc.). skills were demanded, and to describe their own behav- It's only on this kind of basis that informed decisions iour or approach. You can derive the questions directly from the definitions that you have produced yourself! – ­ Concentrate on a small number of requirements that are critical to success! A few examples of questions for determining skills
– ­ Define, for example, what you exactly mean when you Communication skills:
say "communication skills"! What makes a good com- "Tell me about a situation where you were clearly able municator in nursing? to listen well and respond well to the person you were speaking to!" Example: "Communication skills"
"Tell me about discussion you had with a person you – ­ Is open-minded and sympathetic towards others, found rather unpleasant. How did you act personally but retains a certain distance when talking to this person?" – ­ Retains a positive and controlled demeanour in all situations throughout the day – even in diffi- Willingness to learn:
cult and conflict-ridden situations "Tell me about something you did that was new for – ­ Is able to create and expand upon contacts you, that really challenged you and forced you to learn – ­ Exhibits appreciation of those he or she is speak- "Each of us has had situations in their career that haven't not gone so well. Tell me about a situation that – ­ Is a good listener and is responsive towards you've had like this. What did you learn from it?" those he or she is speaking to Questions like these allow you to "drill" the applicant – ­ Make sure you have a fixed standard for evaluating the – meant positively, of course. They allow you to precisely selection process! It is not enough to make decisions evaluate the level of experience that the applicant pos- based on details of skills that may or may not be avail- sesses. It will also become clear very quickly to what able as mentioned in the written application. extent the person being asked has actually experienced situations such as these and their approach in overcom-ing them. Make detailed notes during the interviews about the answers that each applicant gives and assess them in a methodical and systematic fashion! An evaluation scale will help you during the assessment process: Good management in nursing The evaluation scale (1–7) contains assessment criteria Practical example
that allow the answers to be assessed. Johanniter-Stift Gelsenkirchen
(1) = unconvincing
Johanniter-Stift Gelsenkirchen has introduced a – ­ the way described that the situation was overcome three-stage selection process. After the interview contradicts how we would expect it to be (stage 1), selected applicants spend a whole day in – ­ the application has demonstrated hardly any apparent the institutions and are assigned a concrete task, skills with regards to the requirements e.g. to produce a nursing plan for one resident within the institution. Seeing the applicant actually (4) = well expressed with potential for development
in action shows clearly whether he or she would be – ­ the way described that the situation was overcome fits able to complete such a complex task using their how we would expect it to be professional and personal skills. – ­ the applicant demonstrates good performance, but During the observation period, the applicants experience in handling difficult situations is missing are supported by management personnel from the nursing team and are observed on how well they (7) = excellently expressed
match the requirement profile. Once the observa- – ­ the applicant possesses skills that are extremely well- tion period is over, the results from the interview developed and have been well-tested in practice and the observation period are evaluated among the management personnel involved and compared. A An overall assessment provides a summary of all of the final discussion (stage ) allows the results to be individual evaluations, gathered from the various ques- discussed with the applicants. The procedure used tions related to the applicant's skills. This allows a skill by Johanniter-Stift that integrates an interview and profile to be produced for each applicant and enables practical test is worth the extra effort involved. It comparison. In turn, this allows for selection decisions to allows poor decisions regarding personnel to be be made based on solid information. However, the selec- considerably reduced. New personnel now hardly tion process does not necessarily have to be based solely ever leave the institution after the trial period. Even on an interview. if deficits in skills and gaps in knowledge do become apparent, necessary development measures can be integrated quickly into the induction plan, adapted precisely to each new recruit. Making a good start Good management in nursing 3 Making a good start Successfully organising the induction of new management personnel In nursing, the assignment of a new manager often fails for her. Ms. Horten felt as though she was being treated within a year. The negative repercussions for all involved unfairly and regretted changing position. She asked what are difficult to avoid – the institution has to refill the posi- kind of perspectives she had. This is a story of a change of tion, the self-confidence and possibly career prospects position "gone wrong". An isolated case? Certainly not! of the failed manager are dented and personnel become insecure. An example: the home management team spoke of a "breath of fresh air" during an interview that they hoped the new living area manager, Ms. Horten, would provide. A number of "veteran" living area managers were not up-to-date with modern nursing. As such, Ms. Horten started out with a great deal of enthusiasm and drive and was looking to implement new concepts quickly. She was certain that the home directors would support her every step of the way. Four months along the line, and she's just about to throw in the towel. The reason – she was far too quick to concentrate on everything that could be done differently. The other living area managers felt as though they were being placed under pressure by this and that the work they were doing was being devalued. The person-nel within her living area began with high expectations of their new manager. The somewhat neglected living area would finally be seen in a more positive light. However, they too felt somewhat devalued by the sheer speed of the changes. As Ms. Horten also made two obvious mistakes, they also began to lose trust in her. Ms. Horten's working day became ever more difficult. She felt increasingly isolated. The home directors were also becoming increasingly withdrawn in their support Making a good start What you should know
able the poor quality of the nursing to be improved. Why do so many changes in management fail in nursing? She wastes no time in having necessary changes intro- They fail because duced. However – the three measures with the highest – ­ Institutions still equate "clearly exhibited professional- priority had already been suggested by the living area ism" with "ability to manage" when filling management manager working under the previous senior nurse but positions internally. This means that management po- was simply unable to have them accepted. Ms. Miller is sitions are filled internally by the best qualified nurse. successful in a short period of time and takes the credit – ­ When filling management positions internally, institu- for the success. The living area managers tag along. tions are usually happy to find someone who will actu- Nonetheless, they see "mixed feelings" of hope, com- ally take "the job". They usually neglect to check that petition and the realisation of their own past failures requirements are fulfilled. – ­ Institutions often do not engage in career planning or talent management and are thus only able to react on How you can go about this (as an institution)
a short-term basis when filling management positions – ­ Make an active effort to support your new managers! that have become vacant. – ­ Institutions rely too heavily on satisfying formal re- Example: Sozialholding Mülheim
quirements. The new living area manager is considered Sozialholding Mülheim supports several inpatient to be suitable because he or she has completed a nursing institutions and one outpatient nursing qualification as a living area manager. institution. As part of an effort to develop the serv- – ­ The new manager does not possess the required skills ice provided, new management structures were and abilities needed to work successfully. The institu- introduced. Management positions that had been tion making the decision has "sensed" that there are made vacant or just created were to be filled inter- deficits in the applicant selection procedure but has nally as far as was possible. To clarify whether per- not actively discussed them. These deficits become sonnel from the institution were ready and willing visible during the first few months or weeks, but cannot to accept the responsibility of management, inter- be compensated for in the short term by providing ested personnel were invited to a briefing session. supervision or training. There was a surprisingly large response. To begin – ­ Superiors do not clearly express their expectations. It is with, the institution management provided infor- silently assumed that the new manager will "figure out mation on other planned developments and the what it's all about". On the other side of the fence, new opportunities that arose from these developments managers often neglect to find out about the expecta- to assume management positions in nursing. The tions of their superiors, colleagues and personnel. personnel were then given the opportunity to give They don't do this, because they are afraid of appearing short presentations on problems presented in insecure and would rather "roll up their sleeves and get advance to demonstrate their own knowledge and experience. The style of the presentation allowed – ­ The new manager does not have sufficient background early hints to be given on the management poten- knowledge of the reasons why the change was made tial available internally. or does not take these reasons into consideration. An example: Ms. Miller was employed as the new senior – ­ Proceed carefully when (re)filling management posi- nurse in an inpatient nursing institution, so as to en- tions. Create a detailed profile demonstrating expected Good management in nursing qualities related to the position and a profile detailing team! Get a picture of the situation for yourself before absolute requirements focused on the applicant! getting started! Use different sources and perspectives, – ­ Explain what is expected to the new manager! Take the for example external inspection reports or the results specific basic conditions into consideration that the of audits or employee/client surveys. Study the facts at new manager will encounter! Remember to bring the management style of the outgoing ward management – ­ Find out about the strengths and resources that you into the discussion during the selection process. can build upon and make use of them! Which proc- – ­ Let the new manager know what you expect and find esses run particularly well and smoothly? Which out the extent to which the manager can and wants to strengths and skills do the personnel have? Who works fulfil these expectations! with whom and do these collaborations provide good – ­ Ensure that the new manager is carefully supported results? Which innovations have been successfully during the induction process! implemented in the last few years? Proceeding systematically allows you to create the neces- How you can go about this (as a new manager)
sary conditions to create a coherent "programme" that – ­ Speak to your superiors, fellow managers, personnel etc. and make sure you are aware of their expectations. This doesn't mean that you should create tasks for personnel to perform that are carbon copies of these expectations, rather it should provide you with infor-mation on the perspectives that your actions will be viewed from. Remember to take the (supposed) unex-pressed expectations into consideration! – ­ Identify key persons and form relationships actively and appropriately. Key persons may be, for example, predecessors that may have provisionally taken on management duties during the transitional process. Show an interest in their experience! How does your predecessor assess the situation? What does he/she see as important for the work? – ­ Proceed carefully when taking on the management of "problem children" – groups or teams frequently making mistakes, where complaints or negative in-cidents dominate or where the personnel turnover is particularly high. This is sometimes the case. There is a considerable danger in groups such as these of being practically "ground down" between high expectations on one side and high levels of frustration on the other. – ­ Think before you act! Give yourself time and find out about current issues within the institution, group or Making a good start will satisfy superiors, personnel and other groups involved miliar among her new ward management colleagues. Her and provides a good start to long-term management suc- relationship to her former colleagues has also changed. cess. A programme like this should: Ms. Werner quickly begins to miss the relaxed and natural – ­ be adapted to the unique conditions in each institution. style of interaction. Furthermore – her former colleagues This makes it credible and boosts confidence. behave differently. Discussions in the office sometimes – ­ be ambitious and set challenging goals. This makes it come to a pause whenever she enters. She also has motivating and provides a clear direction. It's teams mixed feelings about humorous comments made such as that produce "poor results" that particularly expect "Should we call you Ms. Werner now?" Somehow she feels a coherent programme that make it possible to "get like an outsider. things really moving forward". – ­ make it clear that it will preserve fundamental achieve- What you should know
ments made in the past. This shows a level of apprecia- At first glance, the switch from the team to superior posi- tion and respect. So – don't just say what you want to tion seems simple and comfortable. The "internal climb- change. Remember to also say what you really want to er" knows the personnel, procedures and peculiarities of the institution. However, the fact this switch is often demanding and prone to problems is often not viewed Special case – internal assignments
with enough importance. Nursing teams often form a cul- Ms. Werner was a nurse on a surgery ward for many ture whereby equality and mutual solidarity dominate and years. After the former ward manager left the position, differences in rank are of less importance or completely ig- she took over the management. Since then, everything nored. If one of the team members switches to the role of has been very different. She feels very insecure and unfa- a superior, the difference in rank can no longer be denied. Good management in nursing The task of the new superior is now to enact the change in Practice example
hierarchy in the form of a new behavioural and communi-cative style. This is not a unique activity. "Internal climb- Successful development of new management per-
ers" often speak of isolation in their new role. sonnel: Hohenhonnef GmbH
Hohenhonnef GmbH supports institutions that
How you can support new managers coming from the
specialise in care for the disabled and has pledged team when switching to their new position
to offer its own personnel interesting career oppor- – ­ Explain what the switch to the management position is tunities. For example, personnel with management potential are given particular duties, are trained to – ­ Have faith in the ability of the new manager to make become internal experts on particular subjects or the switch under his or her own steam! have the opportunity to assume certain manage- – ­ Assume that the switch will take time and recognise ment duties (moderating working groups, meetings that irritations and "mini-crises" are bound to crop up etc.) This kind of approach allows personnel to learn once in a while! to perceive activities from new perspectives beyond – ­ In cases such as these, don't begin to doubt the ability the team level and trains them to organise process- of your new manager to manage! es as appropriate. This makes switching to a formal – ­ Observe the hierarchy from the very beginning! This management position easier. means that you should never go over the new manag-er's head, even if you need to speak to team members regarding what appear to be minor issues! How you can make the switch as a new manager
– ­ Make sure that you are aware that the familiarity and
feeling of belonging as you have always known it will be gone once you switch position! – ­ Give your team time to get to know you in the new – ­ Give yourself time to decide how to settle into the new position! Don't overburden yourself! Beliefs such as "a good manager needs to have everything under control from day one" are more discouraging than encourag-ing. – ­ Create distance to your team step by step without descending into ridiculous, bossy behaviour. – ­ Make an active effort to feel like you belong among managers of the same rank! Talk about your experi-ences on this level with each other! – ­ Let your team know you want to work together with them in your position as manager! Learning to praise performance Good management in nursing 4 Learning to praise performance Appreciation is motivation!
Many nursing structures and services are only able to recognition) as being balanced. If the institution is fair work because personnel are fully committed and often and generous in their treatment of its personnel, the apply more effort than is actually demanded of them. It's personnel will behave in the same way. For example, fully understandable that they would like this additional personnel will voluntarily take on unpleasant tasks and commitment to be clearly recognised. However, giving will be ready to put up with short-term personal strains, active praise is not at all as easy as it first sounds. Most challenges and difficulties. A few examples: managers recognise that praise and recognition must be · Personnel do overtime and help to overcome staffing as reserved, "authentic" and substantial so as to avoid de- bottlenecks arising from sickness leave scending to ridiculous rituals. It is clear, however that not · An employee is ready to learn about doing a new task everyone can make their own laudable intentions reality · An employee is ready to tackle their own behavioural and give personnel recognition that they can perceive. deficits and participate in an appropriate training course What you should know
· ­an employee with poor knowledge of English, for Praise and recognition are more than just being nice. The example, who has so far not expressed herself in team fact that recognition and praise themselves have an influ- discussions, expresses her readiness to prepare to give ence is often overseen, and they are often conspicuous by some professional input during the next meeting. On the other hand, unfair treatment leads to personnel 1. ­There is ample evidence to show that a lack of recogni- attempting to recreate the lost balance, for example, by tion together with a high readiness on the part of the "reducing" their level of commitment to an "appropri- employee to invest a great deal of energy in the work ate level". Many managers do not perceive these links or present a real risk to health. underestimate the subject for various reasons: 2. Results of fairness tests show that personnel feeling that they are being treated fairly perform better, get in- – ­ They set such high standards for the work and behav- volved more actively, identify better with the institution iour of the personnel that they apparently do not find and develop more trust in it than personnel that feel as any opportunity to give praise – after all, most of the though they are being treated unfairly. Personnel feel personnel act below the standard demanded. as though they are being treated "fairly" if they perceive – ­ They are of the opinion that personnel are fulfilling the the relationship of "giving" (e.g. working, performance, duties established in their contracts and receive an ap- commitment) and "receiving" (e.g. wages, status, propriate wage for it. "Why should I praise someone for something that I'm justified in expected from them?" Learning to praise performance – they see outstanding performance by personnel, but do – ­ Give praise right away when you notice something not give praise, because they are already mentally one praiseworthy! Putting it off will lead to you forgetting it! Giving praise immediately and directly allows you to – ­ They have acknowledged personnel for good perform- make use of the your current emotional presence! Per- ance. The personnel have not reacted as the manager haps you've just had "a load taken off your shoulders" wanted or expected. Instead of joy and gratitude, the as your employee expresses his or her willingness to praise is simply met with a silent acceptance. Insecurity carry out an important (and unpleasant) job? Your or disappointment on the part of the manager can be praise is more convincing when it is expressed from the result of a misunderstanding like this. your own relief or even enthusiasm. If you put off the – ­ They suspect praise and recognition to generally be a praise until the next meeting, it's often not as in-keep- form of manipulation and don't want to walk down this ing with the mood! path. "Whenever I was praised by my own superior, I – ­ You should only ever criticise in private, but you can knew that they wanted something from me!". As such, give praise any time you want! they just pass on praise completely. – ­ Be specific in your praise! Pre-fab praise ("great job!") – ­ They view praise and recognition in terms of fairness of doesn't make much of an impression! distribution. If I praise A for something he did, then I also – ­ Express your praise personally! Assigned praise doesn't have to praise B for something that he did too, or else I'm not being fair. This creates expectations – jealousy and – ­ Avoid all forms of "manipulative adulation"! If you distrust are the result. So they prefer to leave it altogether. expect something from an employee, discuss it openly! – ­ They actually can't find the time to acknowledge – ­ Make sure that you are aware that you are not alone personnel for good performance, because "problem in the way you make use of praise. You're building the cases" are taking so much of their time. They're happy foundations for a culture of mutual recognition! that all of the others are not "causing any trouble" and don't need their attention. – ­ They're of the opinion that praise and recognition have no place in modern nursing. Independent personnel that want to make use of their potential in their work and actively take control of their own development do not need praise or recognition. – ­ Similarly, they're of the opinion that an employee in need of praise and recognition is a sign of poor ma-turity. Really mature people do not need this kind of confirmation from others. How you can go about this
– ­ Recognition and praise must be carried out in an
informed and individual manner. Turn your full atten-tion actively towards the employee. During our daily routine, it is often not easy to observe personnel as attentively as it is to observe data, figures, vital signs, current problems etc. Good management in nursing Practical example
Appreciation – recognition – encouragement: Christinenstift in Nideggen (Eifel)
1. Everyone is important
2. Feedback counts
Personnel are shown in clear and easy-to-understand terms how Observations of the nursing made as part of nursing rounds important, valuable and essential their contribution is to the are shared and evaluated in discussions intended for reflection work of the institution. Personnel are also informed extensively and encouragement. The employee finds out for him or herself about current developments. This affects observations from through the expressed appreciation that his or her own work is nursing consultations as well as the consequences of excellent being observed and that their superiors are taking the time to do nursing care on long-term human resource policy. This open and this. This not only encourages professional improvements but participatory policy of information allows personnel to recognise also improves the relationship between personnel and manag- the link between their own efforts and the results achieved. ers. In the long-term, it also encourages personnel to get "their" feedback on a regular basis. 3. Encourage interest and enthusiasm
Whenever personnel overcome difficult situations or show stamina, they are given small rewards. But it's not about the material value of these bonuses. Their power arises from the fact that their superiors are showing that they recognise their performance and that they can appreciate and recognise the value and contribution of the employee. 4. Strengthen teamwork
The nursing teams are well-versed in openly discussing individ-ual "strengths" and "weaknesses" with one another. During an intensive team development process, the nursing teams learned how to tackle and solve problems and conflicts independently. Since then, they have also been able to observe each other's performance weaknesses and mistakes or the risks of making mistakes are discussed openly within the team. 5. Always guarantee equipment that help ease the work
Nursing trolleys for all resident groups were procured after the personnel suggested it – there is one document box per resident group and there is the possibility of making detailed notes at the trolley. A bumbag with pens, telephone, medication cabinet keys if necessary ensures that all personnel have all of the necessary materials ready to hand. The right word at the right time Good management in nursing 5 The right word at the right time Constructive criticism
Especially for managers looking to adopt a cooperative fect the employee and offend them. At the other extreme, management style, criticism discussions are a complex approaching an employee tactfully with a eye firmly on subject. Many managers go out of their way to avoid criti- the possible effects of the discussion on the discussion cal discussions and confrontations with their personnel. partner can turn into ambiguous, evasive "beating around They are afraid that they will react negatively, push the the bush", which only serves to confuse the employee and blame onto someone else, react angrily or only appear leaves them unclear as to what to do. superficially to accept the criticism. They are also often worried about the general working climate in the institu-tion. Nonetheless, deficits in the way work is done or inappropriate behaviour can be disruptive to work proc-esses, which can make working together difficult or even have negative repercussions for residents and patients. This makes criticism discussions a management task that cannot be delegated to someone else. What you should know
Critical discussions with personnel hide a number of
pitfalls. Critical discussions gone wrong can actually cause
long-term problems within the working environment and
the relationships between those involved. Conducting
critical discussions involves a delicate balancing act. On
the one hand, personnel need to be confronted clearly and
openly with points of criticism. On the other, the employee
being criticised must always be treated with due tact,
respect and politeness. It is easy to lose this balance in
either direction. In one extreme case, an open discussion
can turn into a merciless and direct attack, which can af-
The right word at the right time The doors of change only ever open from inside. Offended people lock these doors. How you can go about this
When conducting the critical discussion
If your discussion is aimed at "jolting" the employee with
When preparing a critical discussion
your criticism and triggering off a learning process, then – ­ Keep in mind that expressing criticism is part of you should do everything you can to strengthen the moti- responsible management and that it is part of your vational effect of the criticism and leave out anything that everyday job. This helps you remember that the situa- might weaken it! After all, the doors of change only ever tion doesn't always have to be at breaking point before open from inside. Offended people lock these doors. you are forced to express criticism. – ­ Take personal responsibility for the criticism! Express- – ­ Make sure you know your intentions behind wanting to ing criticism is risky, as it is possible that the employee conduct the critical discussion. Do you want to make will be offended by your criticism, especially if the them aware of mistakes and agree upon ways that points of criticism are closely related to the self-esteem the employee can avoid these mistakes in the future? of the employee. Do not make references to other indi- Or are you just trying to show "who's the boss here"? viduals or anonymous entities! This kind of "self-evaluation" before the discussion is – ­ Criticise specific behaviour, not the person as a whole! something you should never pass on. People being criticised for the way they are feel injured and occupy themselves with retaining or restoring their personal integrity. Good management in nursing – Concentrate on the most fundamental issues and set but will occupy him or herself with the question of how focuses! Generalised statements only serve to demo- he or she can compensate for the loss of face in re- tivate. It's only in healthy doses that criticism can be spect to the team. moulded into something positive. – Do not represent interpretations as facts! "You're not – Avoid irrelevant generalisations such as "always", at all interested in learning IT skills. All you want is your "never", "all" etc. People accused of "always" avoiding peace and quiet!" conflicts will either become resigned and non-respon- – Remain calm, objective and polite! A sharp tone of sive or remember at least one situation where they voice, a sense of acrimony, impolite overbearing and did manage to deal with a conflict. In either case, the abusive remarks either cause the employee to adopt a examination is not constructive in nature. strong defensive stance or lead to obedience or subser- – Be precise and specific in your arguments! What vience out of fear. Nothing is learned from either case. precisely did you observe? In which situations did the problematic behaviour occur? What were the conse-quences for the objective results of the collaboration? – Never criticise personnel in front of the entire team! This embarrasses the employee. The employee will then generally not try to deal with the criticism at hand, Managing conversations Good management in nursing 6 Managing conversations Successfully structuring discussions Team discussions, departmental conferences, cross-de- Personnel often com- partment discussions – this is a familiar routine for man-agers and nursing staff. The daily routine of the discussion rounds should, however, not hide the fact that: 1. This plain of unproductive discussion is important for assigning tasks that need to be carried out, sorting out problems, determining work fo-cuses etc. 2. Communication in the nursing team can ap- discussions with end- pear to be awkward and sometimes even troublesome, if for example there are difficulties that remain unexpressed among personnel or if there are even "gang wars". This less talk and few re- kind of situation can cause entire teams to descend into a resigned inflexibility. In this case, even the best discussion moderator will be put severely to the test. Seen from this perspective, discussions are an accurate reflection of the culture within the institution, but discussions also have great potential in influencing this culture. Personnel often complain of unproductive discussions with endless talk and few results. They might feel like they are just there for the sake of it, and let the time pass with the feeling that The personnel taking part can indeed influence more in a they are having to nod in agreement to decisions already positive fashion than previously thought. Nonetheless, the made elsewhere. Discussions should thus be structured in quality of a discussion is in no small measure dependent such a way that quality results can be achieved within the on the type of discussion management. These days, there time given with the involvement of a high number of the is a wide variety of literature on the subject of "discussion personnel. This enables them to play a considerable role management". Implementing suggestions into the daily in the success of the institution and encourage employee routine is not always easy – but it's always worth thinking commitment and satisfaction. about the available potential for improvement. Managing conversations What you should know
How you can go about this
1. ­It seems to be obvious. Seating arrangements nega-
Before the discussion
tively affecting communication, missing or defective – ­ Make sure you know which subjects need to be covered media, disruptions by ringing mobile phones or partici- to what extent and in which form. Is it perhaps pos- pants being called out are anything but conducive to sible to bring the subject over in another, simpler way? constructive and productive discussions – nonetheless, Perhaps a circular would suffice? Or a note about new they are still part of everyday discussions in many insti- information in the handbook? tutions. Does this sound familiar? The discussion has – ­ Agree upon a few fundamental "discussion rules" and just begun. The first agenda point is being discussed. ensure that these rules are consistently adhered to in Then Ms. Miller is called out "because of an urgent issue". It's impossible to discuss this point properly – ­ Define precise discussion goals in advance as far as without Ms. Miller. Time passes. There are still three is possible! These goals should be reached, visualised important topics to discuss. As Ms. Miller comes back, and finally agreed upon with the participants by the end ten minutes have passed. The team tries hard to pick of the discussion at the latest. up where they left. Or they just pick up their ringing mobile, with participants accepting calls "because Examples of discussion goals
there's no way around it, unfortunately, because it's By the end of the discussion … really important". Or the new flip chart – without any – ­ we will have decided whether we want to carry paper. Or the nice new discussion room. Sadly, the out an internal training course on "basal stimu- tables are arranged in such a way that six participants are sitting next to each other and can't see each other. – ­ we will have developed ideas on how we can Exceptions to the rule? This all happens more often use the nursing rounds more intensively to than you'd think. provide specific feedback for the personnel. – ­ we will have developed ideas on how we can 2. There's hardly enough time for discussions to cover use the nursing rounds more intensively to everything needed. Discussions are often "crammed" provide specific feedback for the personnel. with topics to be discussed, so that it is clear from – ­ we will have gained feedback from the team (ap- the outset that there is no way that everything can be proval, worries, open questions) on the planned discussed. At the end of the discussion, everyone is introduction of the new infusion therapy. frustrated because "yet again, we haven't managed to – ­ we will have established which personnel shall cover a lot of what we wanted." be switching to the newly-opened living area. . ­The subject is specified. It is actively discussed. It isn't possible to recognise a main central theme. The – ­ all personnel will have been informed of the new nurs- discussion is going "all over the map". It was actu- ing guidelines that they have to consider. ally supposed to be about the new infusion device. As – ­ As soon as the discussion goals are clear, it will be pos- the discussion leader brings the group "back to the sible to create a sustainable time plan for the subjects subject", half the time for the discussion has already in need of discussion. For example, this makes all the passed. There is no result in sight. difference whether you want to begin by establishing Good management in nursing the general feeling of the personnel on a sensitive sub- – Check whether you can get your personnel to involved by ject or reach a decision right away. The decision proc- having them provide brief input on the subject! ess will generally need to be discussed at more length – Ensure that the participants have the most important and so you will also need more time. documents to hand during the discussion! – The discussion goals demonstrate whether you as a – Always avoid triggering open discussions on a subject manager act generally speaking in a systematic and when you have already made a decision on the subject in well-thought through manner. Acting systematically private! This only serves to dent the trust people have in means that you spread certain subjects across several you and your credibility. discussions with the team. For example, you would be-gin by evaluating the general impression of the team of After the discussion
a new procedure, then gather suggestions for changes – Keep to the agreements made at all times! Be a role and finally plan the decision and implement it. model and carry out the duties that you have personally – Discussion goals are also excellently suited to control- taken on in a reliable manner! Keep promises that you ling the discussion process. If the goal consists of developing ideas, you can interrupt heated arguments, – Make sure that personnel are also keeping to agreements whereby ideas and being attacked and defended, firmly and keeping their promises! If personnel are not keeping and persuasively by reminding everyone of the goal. to their agreed duties, you must not simply let it pass or – Set the order of the subjects according to their impor- gloss over it! Otherwise, all you are doing is contributing tance! The subject of particular importance should at to the establishment of a culture of "consequenceless- ness" – "whether we do something or don't do some-thing, it doesn't matter – nobody will notice anyway!" Recognising potential, developing skills Good management in nursing 7 Recognising potential, developing skills The employee development interview The employee development discussion is among the most term performance and service provision for institutions important instruments in management and personnel from personnel if this is made an urgent and ongoing development. The primary goal of this instrument is to task. However, subjects of more overriding importance, agree upon and evaluate steps with regards to support and development for each employee. The employee devel- – ­ regular feedback on individual performance, opment discussion is carried out regularly (usually once a – ­ applying and making use of skills and abilities con- year) in private between the nursing manager and one of structively within the institution. – ­ Discussing performance and skill deficits, triggering development processes for the individual and provid- What you should know
ing support in their implementation The nursing environment has changed in recent years just rapidly descend to being an "aside" in the process of as much as the people that work there. The professional routine communication. demands in nursing professions are constantly rising. This particularly affects the ability to structure relation- The employee development interview can be viewed as ships with residents, patients and relatives so that they a "time out" from daily business and allow the manager are productive. A responsible working style, independent and employee to leave the playing field to view the ongo- organisation and a willingness to work together are also ing and future goings-on together from the stands. The essential key skills. The fundamental attitudes and values enclosed nature of the one-on-one interview makes quality of nursing also change over time. The desire for personal communication possible, which can lead to a deeper development, good career perspectives and high expecta- mutual understanding. Managers often see employee dis- tions for an attractive working environment affect them cussions as an unpleasant task. They feel internal resist- as do the motives of carrying out useful work for other ance towards speaking openly with the employee about people and having job security. work performance, strengths and weaknesses or towards Viewing nursing institutions as "learning organisations" exposing themselves to the open feedback provided by the reveals that there is a need to define the basic organisa- employee on the manager's management style. Personnel tional conditions as well as changes and developments too sometimes fail to see the opportunities that they are together with the personnel, which means finding ways for provided with. They are aware that their relationship to both sides to benefit. It is only possible to secure long- their superior is affected by the hierarchy and is thus not Recognising potential, developing skills on equal terms. This can lead to personnel feeling inhib- 1. ­ Let the employee know what the development inter-
ited in talking about things openly or expressing opinions view is all about, what it will involve and what the to the contrary. They "adapt" their behaviour or act "stra- tegically" and are actively involved in "impression man- 2. ­ Prepare each individual discussion carefully. Look back
agement", whereby they try hard to present themselves over the time that has passed. Take a look at the agree- and their performance in a positive light. ments made during the development interview and evaluate how far they are in their implementation. How you can go about this
3. ­ Allow for enough time in carrying out the discussions.
Turn the employee development interview into a suc- 4. ­ Ensure that you can carry out the discussion without
cessful management tool that takes centre stage in your any kind of disruption from outside. 5. ­ Clearly justify your assessment of the employee's
work, performance etc. Get to the point and avoid beating around the bush. 6. ­ Make sure the conversation runs both ways. If the con-
versation is intended to bring about a change in the employee's behaviour, it is important that he or she is also able to express his or her own impressions and feelings in detail. Listen attentively and be responsive to the arguments and questions that the employee puts across. 7. ­ When expressing criticism, always do so in healthy
doses and link it with offers of support. Too much criticism is discouraging. 8. ­ Concentrate on and limit yourself to the employee's
working behaviour. The personality of the employee is a taboo subject. Good management in nursing 9. ­ Conduct discussions as openly as possible. This
means avoiding manipulative behaviour so as to avoid damaging the relationship of trust. 10. Make notes on the agreements made.
11. ­Be reliable in keeping the promises you have made
during the discussion. 12. ­Use the results and agreements achieved during the
discussion to enhance your general management. This brings this tool to life and prevents it ending up as an "isolated one-off discussion"! Possible basis questions for the employee development interview
Look back at the past work period
Looking to the future
– What is the focus of the tasks that the employee has – Work goals: what goals should the employee be performed up until now? looking to achieve in the near future? – Are fields of responsibility and duties clearly de- – Personal development goals: what personal devel- opment goals is the employee looking to pursue? – Which support or training programmes has the em- – Skill development (future working time): which skills ployee taken part in? Which of these programmes need to be further developed (strengths) or devel- have had a positive effect on the daily routine and oped (development fields) in order for the employee which ones haven't? to be able to achieve good results in reaching his or – How satisfied are you with the performance, the way her work and personal development goals? the employee has completed tasks up until now? – Which support programmes should the employee What was positive, what was negative? What went well? What didn't go so well? – What qualifications, skills, abilities does the em- ployee have that he or she is not using or only using to a limited capacity? Recognising potential, developing skills Feedback for the managers
Resilience (1 – 7)
The employee development interview is not a one-way street. Ask the employee for feedback on the management style! Ask if informa- demonstrated to an (too) low
demonstrated to a good extent
demonstrated to an (too) high
tion has been brought over well, if meetings have been conducted well and, in both cases, how well. It is also possible to ask about the – Strengths and skills present – Possesses organisa- – Adheres to unrealistic plans quality of job delegation, decisiveness as well can no longer be brought to tion skills in the event of – Takes long-term stresses as involvement in decisions. Other possible bear under social, mental disagreements, difficulties, upon colleagues and per- or physical stress, even in resistance and under stress sonnel for granted subjects to discuss may be how monitoring for a manageable period of – Applies disproportion- is carried out, feedback on performance and ate amounts of energy at behaviour, personnel support etc. – Adheres to original plans the cost of his or her own under complicated condi- mental or physical health Evaluating and assessing during the devel-
tions such as these. – Feels challenged and opment interview
enlivened by elevated The quality of feedback during an employee development interview is largely dependent – Is able to recognise, ex- on the careful definition of the underlying press and actively "coun- criteria used for assessment purposes. In this teract" own limits (e.g. by requesting assistance). way, superficial judgements and misunder- – Use his or her behaviour standings can be avoided. Both the criteria to encourage others to (resilience, teamwork skills, willingness to face difficult situations and cooperate etc.) and the scale should be clearly accept these difficulties as challenges for the benefit of personal, group or depart-mental development. Good management in nursing Here the skills to be assessed are specified in 1. Measures in the workplace
terms of how they are demonstrated to a too low, good or excessive/too high extent. The – Instructions/feedback from superiors, ex- – Expand professional knowledge manager and employee undertake evaluations perts, qualified colleagues – Reflect upon and develop behaviour independently from each other while prepar- – Delegation of specific tasks, extending duties – Experience in completing tasks independently ing for the employee development interview – Participation in projects, project management – Experience in project work or project manage- (self-assessment and assessment of the other). This highly detailed operationalisation – Develop teamwork skills allow the two to understand what the other is – Expand horizons – Participation/collaboration in cross-depart- – Expand knowledge in practical situations mental working groups – Develop problem-solving skills Agreement of support and development
– Develop teamwork skills measures
– Participation/collaboration in quality circles – Develop an awareness for working processes Allow the list of possible development meas- – Continue to develop the quality of the work ures below to serve as some inspiration: – Learn to work independently in a team – Learn to provide long-term solutions for – Taking on (to a limited extent) management – Learn about the management situation duties (e.g. heading discussions) – Expand horizons – Acting as a speaking during internal seminars – Develop didactic skills – Enhance knowledge of a specialist field – Expand on communication skills – Develop presentational skills 2. Measures outside of the workplace
– Stays in other institutions, with other sup- – Talk about experiences porting organisations, in other fields – Expand horizons – Find out about new practices and methods – Colleagues consulting (intervision) outside – Develop problem-solving skills of the employee's own institution – Reflect on the employee's own role/own – Visits to seminars, tutorials, course – Gain and expand upon knowledge – Learn in terms of behaviour – Learn by discussing with other participants – Participation in external working groups – Expand upon specialist knowledge – Expand horizons – Strengthen the sense of identification with – Represent the institution Good management in nursing 8 To err is human Guidelines for a culture of handling mistakes productively Nursing (whichever form of organisation is used) is Human error in health care
fundamentally influenced by the security, health and well-being of the people that place their trust in it. Mistakes P. Deitinger and Chr. Nardella (Istituto Superiore in this respect can lead to (severe) harm to people. It is Prevenzione e Sicurezza sul Lavoro) have devel- nonetheless clear that mistakes in a complex working en- oped some important information on the causes of vironment (hospitals, nursing homes) cannot be avoided. mistakes and error probability as part of a scientific study. There is no such According to the study, mistakes arising from forgetfulness or a lack of care are typical of person-nel having already achieved a high working routine and carrying out a wide variety of "skill-based" activities. This situation can contribute to mistakes in execution (i.e. incorrect manual implementation despite appropriate intentions). Mistakes arising from insufficient planning (knowledge mistakes) are highly likely to be made by personnel with low work experience. For mistakes affecting the adher- What you should know
ence to or application of regulations (rule mistakes), DIN EN ISO defines a mistake quite simply as being "the however, it has been determined that the relation- failure to fulfil a requirement". Error management con- ship to the employee's experience corresponds to a siders mistakes to be "unintentional, undesired actions bell curve. In this case, the probability of a mistake that may or may not be carried out consciously or uncon- grows as work experience increases during the first sciously." This differentiates mistakes from intentional phase, before it begins to decrease again. deviations from norms (such as sabotage). In general, the following rules apply: – ­ There is no such thing as a zero-defect system. – ­ Each and every person is a permanent potential source of danger for his or her environment. – ­ Mistakes generally do not occur suddenly but are the result of a chain of events and consequences. Modern error management demonstrates its qualities by The buck is constantly being passed around and the team – ­ making it possible to learn from mistakes made and atmosphere is damaged. If personnel break silence and thus reducing the probability of future repetitions of report problems, they are quickly seen as being as a "trai- this mistake as far as is possible. tor". This means that mistakes aren't learned from, which, – ­ taking all necessary measures to prevent mistakes be- in turn, makes it more likely that they will be repeated. Near-misses are also not discussed or talked about. This prevents useful error prevention measures from taking Exclusively following a "zero-defect principle" can result effect and new mistakes are made. The personnel become in damaging "mistake loops". For example, a particularly worried – their work increasingly focuses on avoiding demanding set of guidelines can lead to the discrepancy mistakes. The will and courage to try out new things between expectation and reality being demonstrated in diminishes, because trying something new means ventur- mistakes not being tolerated. Personnel making mistakes ing into the "unsafe zone". In the long-term, this causes are made accountable. In the event of an error, people try the institution's ability to innovate to suffer. An external to play the blame game. Consequently, personnel make quality audit reveals the deficits present in the institution. more of an effort to embellish their own acts, cover up The managers feel deceived and are determined to keep a mistakes or deny them. Those bringing good news and closer eye on things. A culture of distrust results. A proper reporting success are the ones receiving the recognition. "error management culture" is the result of a balance Good management in nursing between error tolerance and error prevention. "Error toler- 5. ­ Encourage a culture in which open communication
ance" is defined by a tolerant attitude towards mistakes and mutual validation are possible. Personnel should whereby understanding and a ready to assist are ex- be given the opportunity to give and receive real pressed if something does not work, if mistakes are made feedback in real time and not be shy about expressing or problems are discovered. This does not mean taking criticism towards managers. mistakes for granted as something unimportant. Mistakes 6. ­ Ensure that personnel are checking precisely whether
should continue to be avoided and everything possible what you are saying matches what they are doing. is done to ensure that they are discovered or mitigated Show-off speeches about "productive error manage- in some way. However, when they occur, they should not ment cultures" will be exposed if they have little to do lead to sanctions being issued, rather to a willingness to with what the employee is doing. help and provide support on the part of managers, col- 7. ­ Carry out an evaluation of the mistake and do not seek
leagues and/or other groups. Nursing personnel reporting their own personal inadequacies, mistakes or problems to 8. ­ Be consistent in directing your efforts at avoiding
the whole team or group are not lectured or sanctioned, future mistakes instead of assigning blame! rather they are triggering a support mechanism. 9. ­ Make sure you are aware of the difference between
responsibility and blame. Let the employee making the Wie Sie vorgehen können
mistake take the responsibility but don't start assign- 1. ­ Make it clear to your personnel how you want to go
about dealing with mistakes, how you want them to be 10. Admit to your own mistakes!
corrected, how you act yourself under these circum-
stances and what you expect from your personnel!
2. ­ Show them that you would prefer that people learn
from their mistakes rather than have a situation where nobody does anything wrong because nobody is doing anything. 3. ­ Support your personnel in analysing mistakes and
help them to take appropriate action. This helps you to ensure that personnel improve their self-assessment skills and have more control over themselves. Learn-ing from mistakes increases self-awareness and the ability to have more control over oneself. 4. ­ Learning from mistakes is only possible if mistakes
and near-missed are discussed openly. Reward per-sonnel that talk openly about mistakes! Nobody likes to talk about mistakes or near-misses. For this reason, you should conduct discussions so that personnel feel rewarded for their openness! After all, it always takes effort and courage to discuss one's own mistakes openly. It never goes quite the way you want? Good management in nursing 9 Management task: Laying off employees Structuring and carrying out discussions where personnel are to be released
in a fair manner Give the employee the opportunity to express Regardless of the reason for releasing an employee – being released from a job is usually a personal catastrophe for the employee in question. Their personal his or her feelings. Stay plans are thrown into question, a lack of (material) security arises, their position among their circle of friends is thrown within emotional reach into disarray, important relationships to work colleagues may be cut off etc. Releas-ing someone also expresses a clear "no" of your employee. – the message that someone is no longer needed. These are facts that managers are generally also aware of when having to inform someone that their contract is being terminated. So it's no wonder that most would rather avoid this management task like the plague. This makes it all the more important to prepare appropriately for eventualities during the discussion at hand. It never goes quite the way you want? What you should know
ferring to hide behind the decisions and judgements of Generally speaking, the news that an employee is to be others. They "beat around the bush" or avoid getting into released triggers strong emotions within the employee. discussions with the employee being released, as they The level of self-esteem often sinks dramatically. Many are suffering from their own feelings of guilt. Managers institutions give little consideration to the subject of "re- might use this discussion to really "get down to brass leasing personnel". One reason for this is that the proc- tacks", leading to the employee unnecessarily becom- ess is considered to be an unpleasant duty that should ing all the more offended by the way the termination is be just over and done with. Another is that the scope of being brought over. The termination process is then not the long-term consequences of a contract termination only considered to be unfair and offensive by the person are not recognised. As such, these discussions are often affected. Even if terminations are an exceptional incident insufficiently planned and result in unprofessional behav- and are not part of daily routine, they should be prepared iour: managers attempt to delegate the task to someone in systematic fashion. Preparing well for terminations from the human resources department; managers may does not just take the person leaving into consideration, indeed inform the employee in question personally, but but also those remaining and those that will be joining refuse to take responsibility for the decision, instead pre- the institution. Good management in nursing How you can go about this
The discussion
– ­ Call the reason for the discussion "ending the con-
Preparation
tract"! Avoid small talk, talking about niceties or mean- – ­ Prepare the termination discussion carefully. Check precisely whether your legal obligations are being – ­ Bring the message across early on. Make the message clear that you are ending the working relationship! – ­ Explain the reasons for releasing the employee so that – ­ Justify your decision in clear and succinct terms! he or she can really understand them. – ­ Give your employee the opportunity to present his or – ­ Make sure that you do not select expressions that at- her point of view without getting into endless discus- tack the employee personally or his/her self-esteem. sions or regurgitating arguments that have long been – ­ Select a suitable location for issuing the termination (your own office, discussion room etc.) – ­ Give the employee the opportunity to express his or her – ­ Take the affected employee's possible reactions into feelings. Stay within emotional reach of your employee. consideration. Is there a danger that the employee Show the employee that you can fully understand his or may react in an emotional, uncontrolled manner? Or her reaction. Do not confuse being emotionally within is it more likely that the employee will remain silent in reach with "getting soft". acknowledging the message? – ­ Have no doubt in the fact that your decision is final. – ­ Make sure you are ready for any emotional reactions on – ­ Avoid making concessions that you know you cannot the part of the employee. Make sure you are aware that or don't want to keep! reactions like these "are perfectly OK" in this discus- – ­ Depending on the reaction of the employee (crying, sion. Avoid lecturing or moralising! anger, screaming etc.) offer to postpone the discussion for a while. Literature notes Good management in nursing Benien, K.: Schwierige Gespräche führen. rororo 200. Osterloh, M.: Investition Vertrauen. Gabler 2007. Deitinger, P.; Nardella, Chr.: Unpublished manuscript of the Istituto Schneider, Th.; Weber, M.: Das Mitarbeitergespräch. mtt Werkstattreihe 2004. Superiore Prevenzione e Sicurezza sul Lavoro (2007). Schreyögg, A.: Fehlerkultur, Fehlermanagement und ihre Bedeutung für Erpenbeck, J.; Heyse, V.; Max, H.: Kompetenzen erkennen, bilanzieren und Maßnahmen der Personalentwicklung in Kliniken. OSC /2007. entwickeln. Waxmann 2004. Seifert, J.: Visualisieren. Präsentieren. Moderieren. Gabal 2007. Fischer, P.: Neu auf dem Chefsessel. Redline Wirtschaft, 7th edition 2002. Struß, E.: Müssen wir dich jetzt siezen? Carl-Auer Verlag 2007. Hartmann, M.; Funk, R.; Arnold, Chr.: Gekonnt moderieren. Beltz 2001. INQA Handlungshilfe "Leitfaden Personalgespräch". Available to order free-of-
charge at: www.inqa-pflege.de > Publikationen; Sammelmappe: Handlungshil-
de. Free download at: www.inqa-pflege > Wissen > Führung.
Kanning, U.-P. (Hrsg.): Förderung sozialer Kompetenzen in der Personalent-
wicklung. Hogrefe 2007.
Knoblauch, J.; Kurz, J.: Die besten Mitarbeiter finden und halten. Campus 2007.
Lorenz, M.; Rohrschneider, U.: Praxishandbuch für Personalreferenten.
Campus 2007.
Mistele, P.; Tolle, A.: Zur Konstruktion von Lernräumen in Hochleistungs-
systemen. OSC /2007.
Mitarbeiterorientiertes Führen und soziale Unterstützung am Arbeitsplatz.
Available to order free-of-charge at: http://www.inqa.de/Inqa/Navigation/
publikationen,did=560.html
Nagel, R. et al.: Das Mitarbeitergespräch als Führungsinstrument.
Klett-Cotta 1999
Möller, H. et. al.: Die Einführung von Mitarbeitergesprächen an österreichischen
Universitäten in OSC, Number 4/2006.
Good management in nursing
Specialist advisors and editors: Stephan Schwarzwälder, BAuA Dresden Initiative "Healthy Care" of the New Quality of Work Initiative (INQA)
c/o Bundesanstalt für Arbeitsschutz und Arbeitsmedizin, Dresden
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Authors:
Jochen Schneider
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Text editing: KonText – Oster&Fiedler, Hattingen Design: Rainer Midlaszewski, Bochum Photo: FOX-Fotoagentur – Uwe Völkner, Lindlar/Köln Photo pages 24, 25 und 4: Dirk Kerkmann, Oberhausen Production and printing: DruckVerlag Kettler, Bönen This brochure has been produced in the INQA-project: "Handlungshilfen für die Pflegepraxis". Project management: Christa Schalk and Christoph Bräutigam, Institut für Arbeit und Technik, Gelsenkirchen Reproduction, also extracts, only with the prior consent of the New Quality of Work Initiative (INQA) 1st edition Berlin/Dresden 2009 ISBN: 97--261- Agency of the "Initiative Neue Qualität der Arbeit" ­
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Source: http://www.euro-eoc.eu/docs/de/22/good-management-in-nursing,property=pdf,bereich=inqa,sprache=de,rwb=true.pdf