Skill sets are changing for managers in ICUs as managed care advances
Bone up on your business acumen
ICU managers who want to survive the current evolution of health care — and perhaps even prosper from it — need to begin developing new skill sets, experts tell Critical Care Management.The time when a strong clinical focus carried the day are gone. Today’s successful managers need the nursing skills of a Florence Nightingale, the business acumen of a Donald Trumpp, and the communication skills of a Ronald Reagan (since poor Reagan has Alzheimers’ why not use another example?), according to three experts queried by CCM.
The principal skills they pointed to were:
1. Develop business savvy.
"There’s a certain point at which a manager has to stop thinking like a nurse," says Gladys Campbell, RN, MSN, president of the American Association of Critical Care Nurses (AACN), and director of critical and acute care patient services at the National Institutes of Health Clinical Center in Bethesda, MD. "I say that cautiously. Nurses have a particular way of approaching things, and I think you have to be able to switch your head set and think like a business player, to talk and respond in ways that you can be heard and understood and which gives you credibility when talking with CEOs and CFOs."
One of the most beneficial areas to focus on is controlling supplies and product prices, adds Suzanne White, RN, MN, FAAN, FCCM, CNAA, a consultant with Ernst & Young in Atlanta, and former president of the AACN. Reimbursement and cost concerns are key elements to critical care. "If you can develop better skills in product evaluation and contract negotiations, that can make a big difference in the future of critical care," she says.
2. Learn new interpersonal skills.
Not that long ago ICUs were the realm of registered nurses. No longer. ICUs have already grown more diverse, and that will continue, says Suzette Cardin, RN, DNSc, CNAA, director of the Cardiac Care Unit/Observation Care Unit at theUniversity of California-Los Angeles Medical Center.
"We’re working with different types of people these days. It’s not just all nurses. We’re also working with a lot of professional staff and a lot of unlicensed people. And it requires a whole new set of skills — and these are people skills — to balance the variety of personalities that you see today."
Focus on diversity
How great of a challenge you face preparing for this may depend on where you are, she adds. "Here in Southern California we freely discuss cultural diversity, how we all should have a diverse staff, and what impact that has. But in some areas of the country where the diversity isn’t as great, they just don’t know what to do when different types of people show up on their doorstep."Campbell adds that nurse managers can expect to spend a tremendous amount of time just counseling staff, "whether it’s helping people make sense of the day-to-day challenges of dealing with very sick patients, and sometimes aggressive members of the health care team, whether it’s trying to keep the right balance of their personal lives because nursing can be very draining personally, or whether it’s helping people develop career paths that make sense to them. You have to know how to respond to you staff."
3. Look beyond the ICU walls.
Chances are, you no longer work just at a hospital, but at a "health system." The focus of health care is expanding and ICU managers need to look "beyond their walls," says White. Tomorrow’s ICU manager may find himself or herself managing ancillary services such as nutrition, housekeeping, or telemetry, and they may also find themselves with a role in outpatient care and home critical care, she adds. Allow your view to expand beyond the traditional ICU confines and to follow the continuum of care, she advises.
4. Communicate a vision.
Nurse managers "have to be explicitly clear about what nursing is," says Campbell. "Nurses are doing a great job of being what has been called the institutional queen,’ meaning running around making systems and institutions work. And they do a great job of supporting the practice of medicine. But many nurses do a very poor job of practicing nursing, and some nurses have forgotten what that actually is. That puts our profession, and our patients, in great danger. Nurse managers have to know what nursing is. They have to be able to go out there and articulate it every single day in a multitude of ways to administrators, CFOs, to their staff, and their patients and families."
5. Focus on the patient.
When the federal government began intervening in health care to remove treatment limits enforced by manager care companies, "it should have been a real wake-up call about where we’re headed and what the response to managed care will be," says Campbell. "I think the response is going to come from the consumer, and the smartest thing health care providers can do is to link themselves very tightly to consumers, to patients and families, to what they care for and want, and to position themselves to be able to speak for patients and their families."
That patient focus extends to a key ethical concern — end-of-life decisions, Campbell adds.
"Jack Kevorkian exists today because the critical care team has not done a good job with end-of-life decision making, and patients and families don’t trust us," says Campbell. "They don’t trust that we’re going to honor their desires — either their desire that we do everything or that we let them be comfortable and withhold or withdraw treatment."
Despite the myriad changes taking place, Campbell remains optimistic about the ability of ICU managers and staff to adapt. "Critical care practitioners are often adrenaline junkies. We’re good at assessing situations and making quick decisions. Even if those decisions are wrong, we have confidence in our ability to reassess the situation and figure out what the next thing is that we should do. And the same is true for our changing environment. We’re very adaptable, responsible creatures, comfortable with rapid change."
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