Staff education crucial for buy-in
Include both how-tos and why-tos
As St. Thomas Hospital in Nashville, TN, was aggressively reorganizing its separate case management efforts into an integrated system, leaders realized that the new system first must gain staff approval.
"Staff education is a crucial key. You must have a lot of staff education not only on the how-tos, but the why-tos as well," says Susan M. Coles, RN, MSN, OCN, clinical nurse specialist and case manager for the hospital's surgical patient care units. Coles is one of the originators of the revised case management program, which is in the fine-tuning stage. Coles and her colleagues now are focusing on educating staff about case management.
"One problem we discovered when we started working with the pilot program is that we started out with an education process of how to use the document, and we didn't get a lot of good buy-in. What we found out was that you can't just tell staff how to use the tools, you have got to tell them why they need to use the tools," explains Coles.
Educating staff requires highlighting the benefits of the program, adds Coles. "They have to understand why it is being used and how it will streamline everything that they are doing and make more sense in what they are doing," she explains.
Staff at St. Thomas participated in a month-long educational program, says Coles. "We had a big blitz of education with all staff every day for one month. Programs typically lasted about four hours, but not all staff had to attend every day."
All staff -- staff nurses, respiratory therapists, dietary staff, social services, and pastoral care -- were included. The agenda for the educational series focused on "how to meet outcomes and how to change from task-oriented to outcomes-focused functions," explains Coles.
"Probably the biggest problem we are having now is getting the old nurse out of the old mold of what we all learned in nursing school, which is that charting must be done in longhand and that we need a 90-page narrative on every patient every time we walk in the room and assess him," Coles observes.
Therefore, staff training should emphasize that the pathways are a streamlining tool and staff do not have to document certain assessments because "they have already indicated that the patient is meeting the standard of care and is alert and oriented, for example, either in the care map or in the documentation check list."
St. Thomas eventually will make pathway documentation part of its nursing competency evaluation, notes Coles. *
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