Effective Management Style
Most Effective Management Style Witnessed
By Donna Setterholm MA, BSN, RN 06/26/2018
During the month of May this year, I experienced the most effective management style on a medical nursing unit at a large Midwestern academic teaching hospital in MN. Working as an “at the elbow” trainer for the Epic electronic medical records conversion project, I witnessed excellent team work, professional & mature attitudes, and genuinely positive, happy nurses. With decades of experience in many different hospital settings, in several states, I have never seen such cohesive, supportive, and proficient nursing care for patients. The nursing staff calmly exhibited respect for each other and unit pride. The unit I am referring to is managed by Quinn P. Bissonettte, MA in Nursing, RN. It is a busy gastroenterology and hepatology unit.
Upon asking Quinn what his formula was for nurse job satisfaction and team work, he actually presented the formula “C/Nulla” – Latin, translating in essence to “C” meaning 100% and “Nulla” meaning no (excuses) which is closer to being a concise emblem representing the ideas rather than a formula since 100/0=infinity. Each staff member is 100% accountable for the nursing care provided on the unit and the ability to function well at 100%, no exceptions. They are responsible for 100% of their own success and the success of the team. On average, only five seconds passed before someone got up to answer a call light or alarm. And they responded to all patients, not just their assigned ones. Quinn calls his unit a “No fly zone,” a non-standard meaning for “no one flies under the radar”. Fly high and answer lights & alarms ASAP. Consequently, the unit was rather quiet as patients received their needs in a timely manner and alarms were silenced quickly.
After asking Quinn, “What do you do with Prima Donnas or drama queens?” he pointed to a button above his desk that read, ‘Ditch the Drama’. While counseling individual staff members, he assures them that they are 100% accountable for their happiness, no excuses. I asked him where he got his formula. He said, “It is ours,” and the ditching the drama is based upon the book, Reality Based Leadership by Cy Wakeman. Many people read management books, but few put the lessons into practice. I witnessed this nursing unit functioning in such a way that proved the teachings work.
Upon sharing “C/Nulla” concept with some colleagues, the question, “What is the staff to patient ratio on that unit?” Adequate staffing based upon the acuity of patients is the most fundamental source of job satisfaction. The unit in discussion uses technology to make evidence-based staffing assignments. They use the Quadra Med acuity system. Patient acuity is generated through RN input into the electronic system which classifies the patient according to care needs. Quadra Med then populates a recommended number to staff the unit. Staffing decisions are made based upon that number and assignments are then completed. (The following link provides an explanation of the Quadra Med system). The purpose of the system is to:
http://www.portal.quadramed.com/webinars/acuityplus/SSheet_AcuityPlus_4pg.pdf
- Effectively allocate nursing staff to safely meet patient care requirements
- Understand the complexity of patients to appropriately utilize RNs
- Generate information for budgeting and strategic planning
- Enable unit-to-unit and facility-to-facility benchmarking
- Quantify the impact of nursing care on patient outcomes
- Provide these benefits:
- Easy, efficient and accurate patient classification
- Accurate and effective forecasting
- Enhanced analysis of patient care requirements
Nurses are held accountable by their nursing management for accuracy and must operate the system within a +1 to -1 percent classification recommendation as audited, or the staff may lose the ability to manage the tool. In other words, don’t blow the opportunity to make it work correctly by padding or cheating the system. This staffing system is excellent. The nurses were busy throughout their shifts, but not overloaded or unduly stressed. Patients received the care needed, and the teaching required for home release, with fewer mistakes.
This large Midwestern hospital has several nurse support systems in place to prevent hospital acquired infections and handle situations that increase the nurses’ time away from their classified assignments (ICU exception). These systems are:
- Infusion team – initiates and cares for all IV sites and administers/manages all blood products except albumin
- Foley catheter team – inserts and cares for Foley catheters
- Phlebotomy team – draws all blood for lab studies
- Office of Decedent Affairs (ODA) – handles family, funeral home, coroner, chaplains, notifications and documentation.
- Rapid Response Team – provides stat consultation to evaluate patient deterioration
The incidence of hospital acquired infections has been greatly reduced because of these support teams. Procedural sterility is enhanced by expert, regularly experienced teams with dedicated time to accomplish tasks. They also use the MEWS (Medical Early Warning System) tool for detecting possible sepsis based upon VS, O2 saturation, and urine output. All patients are monitored via this computerized system by an Epic calculation. All patients admitted from a nursing home or assisted living facility are immediately placed in isolation for MRSA until their lab results come back negative (usually within 24 hours). After a C-Diff isolated patient room is cleaned by housekeeping, it is sterilized by a Xenex Robot which emits ultra-violet light (strobing) for a prescribed amount of time. Hence, hospital acquired infections are seldom experienced at this hospital.
Positive philosophical influence from Quinn is observed in many areas of the unit. “Just Do It” signs hang from the ceiling in the staff conference room. Different notes of wisdom are placed on his office door when he leaves for the weekend, such as, “There are things in life that will either build you up or tear you down – you decide.” The staff restroom has a board for writing 2018 unit goals. All comments from staff members written on that board were action oriented. Examples: Create a great orientation program, keep up “No Fly Zone”, more CMSRN nurses (Certified Medical Surgical RN), continue to be the place everyone wants to work or float to because we are friendly, keep “rocking” classification, continue to be the best, make it to rounds, maintain patient satisfaction scores, and keep patients active and moving.
While interviewing several staff nurses, they indicated they knew that leaving the unit to work elsewhere would be difficult. Many have friends who work in other hospitals and have heard about the work conditions elsewhere. Their only reasons for choosing to leave would be spouse relocation needs or going on an adventure or wanting a different nursing experience. None of the nurses would leave that unit because they were unhappy with the unit or their manager. Hopefully these nurses will propagate the philosophies learned. If I ended my career today after witnessing this unit I call Nirvana, I can rest assured there is HOPE for better health care systems and reasonable working conditions for the professionals.
(Post script 2022: It is with real sadness that I report that Quinn Bissonnette passed away from a lumber accident. A tree fell on him while obtaining wood. A real loss for the nursing profession!)