Stop skirmishes with nurses over patient ed

Implement programs, introduce new materials

Q: Once you have implemented an education program, teaching sheet, or documentation form, how do you get nurses to do what you want? How can you stop arguing with nurses and build a strong working relationship?

A: The secret is to work with staff when creating a program, teaching sheet, or form. "You’ll have a lot less wrangling when it comes time to implement a program because staff will have been instrumental in creating it," says Patricia Mathews, RN, MHA, president of Mathews Associates, a health care consulting firm in Chambersburg, PA.

Getting staff input doesn’t have to be complicated. Just work the halls, and ask staff for suggestions when you’re creating a new teaching sheet or documentation form, advises Mathews.

Patient education managers who involve staff in the development of a program or form set a good example. After all, they want staff to partner with patients, helping them determine how to comply with a difficult diet or medication regimen. Therefore, patient education managers should partner with staff when developing patient education programs. "We should listen to staff concerns and negotiate an approach that will meet their needs and our needs as managers," says health care consultant, Barbara Hebert Snyder, MPH, CHES, president of the Cleveland-based Making Change.

Make staff accountable

But while cooperation will improve by getting staff buy-in before a project has been implemented, it doesn’t completely solve the problem. Some sort of accountability must be built in, says Mathews. "The patient education manager isn’t the one to hold staff accountable for patient education or documentation. But we must work with the unit managers to make sure they hold staff accountable," she explains.

Make sure that all patient care staff who educate patients have their duties defined in their job description and that it is part of their performance appraisal. "If patient education requirements aren’t clearly spelled out, then they won’t be given value," says Sandra Cornett, RN, PhD, patient education coordinator at The Ohio State University Medical Center in Columbus.

Standards implemented by the Oakbrook Terrace, IL-based Joint Commission on Accreditation of Healthcare Organizations can be used as leverage if there are any difficulties building patient education into job descriptions and performance appraisal. The Joint Commission requires patient care staff to be competent in teaching patients and families, says Cornett.

Chart audits are a good way to monitor patient education and uncover problems on units, says Denise Thornton, RN, MSN, CDE, patient education coordinator at Methodist Hospitals of Memphis (TN). "We monitor how records are completed and report back to each specific nursing unit," she explains.

Also, patient education indicators are monitored throughout the health care system, and each hospital periodically receives a report card on how the facility is doing as a whole. One indicator is the documentation of patient education. Another is interdisciplinary teaching when appropriate to the lesson plan. Each hospital strives for a score of 91% to 100% compliance. The numbers match Joint Commission requirements, says Thornton.

Educate staff time and again

Provide plenty of staff education so everyone understands what is expected, advises Cornett. Include training on the use of materials and methods of documentation in staff orientation. Also, reinforce learning and provide periodic updates with inservices.

Staff education is particularly important when a new program or form is being implemented, says Thornton. "We go from floor to floor to our nursing units to provide education. We offer the inservices at different times, so all shifts have the opportunity to attend," she says. In addition, if a new form is being implemented, a poster display is left on each floor with instructions and an example of a completed form.

Education is key, agrees Magdalyn Patyk, MS, RN, patient education coordinator at Northwestern Memorial Hospital in Chicago. Many times staff don’t use new documentation forms or teaching sheets because they really don’t understand how to use them. For example, staff at a cardiac step-down unit at the hospital kept ordering the old documentation tool, so Patyk took the new form to the unit and spent about 20 minutes explaining to staff how to use the form. "When you hear that staff made negative comments about a form, go talk with them," advises Patyk.

Encourage communication

Finding a way to communicate with staff is important. Patyk sends out surveys to elicit staff comments about forms and programs that are being implemented.

Another good way to communicate is through patient education liaisons, says Mathews. Have a contact on every unit who other staff members can talk to about patient education concerns. Then meet with the liaisons on a regular basis. When Mathews was a patient education manager, she would invite all the liaisons to lunch. She would show them new materials such as an asthma booklet so they could pass the information on to the rest of the hospital staff. Liaisons would then explain staff concerns, such as the need for an easier medication teaching sheet. Liaisons would change periodically, so many of the staff had a chance to participate in the process.

The more staff you involve in patient education activities, the easier it is to get them to cooperate. Have them review materials or be part of a chart auditing team, advises Cornett. However, be sure to reward the people who go beyond what is expected. Give them a free lunch certificate, or publish their names in the hospitalwide newsletter, she says.