WHILE SHERYL WILLIAMS, MD, medical director of quality at BSA Hospital in Amarillo, Texas, is thrilled that her health system was able to hire dozens of new nurse graduates this spring, she knows how much time and education it will take to build those nurses’ skills.
That includes a lot of inculturation time for nurses to appreciate how important every step of processes designed for safety—around dispensing medications, for instance—is critically important and how any shortcuts can produce errors.
“Bringing that lesson home is very important,” Dr. Williams says. “Safety needs to be hardwired in new nurses, and hospitalists won’t pressure a nurse to do something quickly. We’re going to pressure them to do something right.”
“Safety needs to be hardwired in new nurses.”
Sheryl Williams, MD
BSA Hospital
But how comfortable are hospitalists giving nurses feedback, particularly new ones on the job? As medical director of the hospitalist program at OSF HealthCare Saint Francis Medical Center in Peoria, Ill., Jeremiah Anders, MD, says nursing leaders have come to him to raise issues from their staff about a hospitalist—when it’s clear that no one has yet raised that issue with the physician in question.
“The problem is when you escalate something many levels up without first addressing it with the person at the time,” says Dr. Anders. “That’s where you have to start and give people a chance to make something right.”
He finds, however, that hospitalists likewise shy away from delivering direct feedback to a nurse they’re working with. “Hospitalists have a very short memory,” he says. “When something doesn’t go the way it should, they tend to move on and not provide the necessary education.”
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Moreover, Dr. Anders himself finds it challenging to give feedback to young nurses. That may be a generational difference, or it may just be the reaction of anyone starting out whose confidence in their own skills is shaky.
“No one—a plumber, an electrician, a grocery store manager—likes to be told they need to do more work or do something differently.” But while he couches any comments he makes in the vein of “here’s what I think needs to be done,” they often aren’t taken that way.
“I think comments from physicians are perceived as being rude or condescending,” says Dr. Anders. Because so many travel nurses and new hires are now in his hospital, he encourages members of his group to at least bring any issues to him so he can discuss those with nurse managers. “That way,” Dr. Anders says, “new nurses will be hearing it from a peer.”
Phyllis Maguire is Executive Editor of Today’s Hospitalist.
