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Why is nursing not able to keep its graduates in the profession?

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This month I want to focus on why nursing is no longer attracting people to remain in the industry. Well, I believe the publicity nurses are receiving may not be doing them any favours. Why? Well, why would you go into a career that is telling you it is underpaid, over worked and burnt out and while all of this is true, it is hardly a good advertisement for a good career option is it? 

All we hear in the news and on Facebook is all the negative things around nursing. There is nothing that tells people about the good things a career in nursing offers. The job satisfaction of seeing people get well, the amazing progress health science is making in health of all, how rewarding it is to be thanked for the loving care you have given them, the gratitude of those receiving care…. The list can go on.

I know I am a bit of a Pollyanna but there are so many good things about being a nurse. However, if we read facebook forums listen to the media and unions that is not the message that is getting out. Maybe if we started focusing on all the great things a career in nursing can offer, then maybe not only will people be attracted to profession but will also change the energy that is currently infesting the industry. The more people that find the positives about nursing, the more people will be available to fill the gaps in numbers and want to stay nursing.

Nursing has so many options. They are not all in the public sector where most of the negative comments seem to be coming from.  However, I do believe that an extended period of public sector nursing does give nurses the skills to branch out into other areas. 

I talk to a lot of people around the country for Care Training Online. At times they have empty beds and their owners put pressure on them to get them filled, and I understand how important it is to keep the business running. What I tell them, is what you focus on, the energy will follow. So, if you are focusing on the empty beds being empty then they will remain so, but if you focus on getting them filled, then they begin to fill. Doing nothing and expecting people to come to you, just doesn’t work.  Negative energy creates negative outcomes. You would be surprised how many people begin to fill their beds after they get to understand this principle. 

The thing is, you must never give up talking up your facility or your profession. Yes, I know at times, it can get you down and you don’t feel like you’re making any progress but you just keep pushing on it will eventually change.  I wouldn’t have a business if I didn’t keep calling people and talking to them about Care Training Online. New manager and owners come and go all the time. If I don’t keep up talking to your potential customers, they don’t know what is available for them.- they won’t know they have something that may be a better option for them.. 

So, my message to you this month is GET OUT AND GET SEEN. Be the squeaky wheel that gets oiled and DON’T GIVE UP. I’ll conclude with one of Winston Churchill’s famous quotes:

“Success is not final, failure is not fatal, it is the courage to continue that counts.”

“If you’re going through hell, keep going.”

“Everyone has his day, and some days last longer than others. 

So never give up.  Success will come if you keep going and focus on the good things about nursing, about your facility about life.

The art of delegation and direction

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I’ve recently been contacted by a company who is reviewing their RN understanding of delegation and direction especially when working with unregulated staff. I thought I would discuss this topic today because it is something, Registered Nurses need to be mindful of and our responsibilities around this. I wonder how many of us have been on to the NZNC to review what our responsibilities are around delegation and direction?

The NZ Nursing Council describes delegation and direction as follows:

  • Delegation is the transfer of responsibility for the performance of an activity from one person to another with the former retaining accountability for the outcome.
  • Direction is the active process of guiding, monitoring and evaluating the nursing activities performed by another.

While it might be easy to delegate a responsibility, how do you really know the level of knowledge of the person you are delegating to? We are all good at assuming that a person knows, BUT how do we know? Have you monitored or evaluated the person to ensure they have the knowledge and skill to do the job because ultimately you are responsible for the care being delivered? This 3 min video explains it really well

The problem I see is with the amount of paperwork and the physical workload that is now the responsibility of the Registered Nurse. It can become very easy to delegate a job assuming the person knows what to do but lacking the time to monitor and evaluate the caregiver/support worker. 

I can see how easily this can happen as I constantly see on the ‘Facebook platform New Zealand Please Hear Our Voice’, the stress that nurses are under with their workload. Many people work long hours, do not take breaks and get burnt out, so how are you going to give direction to the person you are delegating the task too? It can be tricky.

Even if a person has a Level 2, 3 or 4 qualification, can you be assured they are competent at carrying out the delegated task? Unfortunately, you can’t. So how are you going to ensure the person has the specific training?

One way to get them to do targeted training for the task or tasks they are going to do, online. For instance, if you are dealing with someone in the community who has a tracheostomy, get them to show proof of understanding tracheostomies online. The same goes for any ostomy, including PEG feeding. I know for instance, that on Care Training Online, I have a training module that comprehensively covers these topics. It’s not an NZQA Unit Standard, it’s practical training and understanding of the topic.

So, targeted training is one thing but how are you going to monitor and evaluate their competence so that you are assured they know what they are doing. So here lies the problem. Unfortunately, there’s no other way but to actively assess them doing the job because ultimately, you, the Registered Nurse, is responsible for the care they are delivering.

It’s a very tricky situation but the one thing you must do at all costs, is protect not only your good name but your Practicing Certificate as well. You must not compromise yourself in any way. While I cannot tell you how to do this, as each organisation is different, I can tell you that you have to be proactive and find a suitable way for you to delegate and direct safely so you can be confident the person delegated is delivering safe care.

Who pays for your education?

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This can be a hotly debated topic. Is it you personally or should your employer pay for it?  Well, I guess it boils down to this – whose practicing certificate is it? Yours or your employers? 

So, what is your employer’s role around your practicing certificate?

Well, they need to make sure it is current and renewed each year.  The employer also has to check that the medical practitioner, physiotherapist or occupation therapist or any other allied health professional has a current practicing certificate too, not just yours.  Is your employer responsible for paying for the allied health professional’s educations?  No, they aren’t. The individual is responsible for ensuring they keep up to date with their education hours. 

So, the question is, does an allied health professional get anything more than you do to be able to come in and attend to residents or clients.  They get remunerated for it just like you. While it may not be a weekly wage, their services are still paid for by your employer, but your employer does not pay for them to go to educational updates.

So that comes down to you as a RN or EN. Who should pay for your education – you or your employer? I guess this is a question you have to ask yourself. Do you give anything more to your employer than an allied health professional? You may argue you do, but you see, your employer’s ability to provide the service is dependent not only on you, but also the caregivers and the allied health professions they contract in to service their clients or residents.

Why am I bringing this up again? Well, many RNs and ENs have an expectation that their employer will pay for their education hours, and if they won’t, they don’t attend. Now if your employer does pay for you to attend education updates in the form of paid days off, course fees etc, be grateful because they don’t have to. If you don’t have a current practicing certificate because your education hours are insufficient, that is your issue – you can’t practice.

So why then am I discussing this? Well, in some cases there is not much loyalty or gratitude paid to a generous employer. Loyalty is not something high on the values of some people. Money is and some people will think nothing of jumping ship to a get a higher paid position rather than give back to a generous employer. Your employer should expect something in return for being generous and giving you a day off and paying for your education. Do you give back to them or is your expectation that it is their responsibility to keep you employed when tomorrow you could hand in your notice and not look back.

When you next see an educational session you would like to attend, think first of how you can contribute to paying for it. Maybe you discuss a partnership with your employer? Maybe you take some annual leave or lieu days to attend so they are not paying both your wages and for someone to replace you. If they do want to pay for your fee to attend and your wages, then be grateful and show them some loyalty. Give back to them and be considerate to your employer. Work together because in the end, you are the one that keeps the knowledge you attain. Sure, your employer will benefit while you are there but if you leave, you walk out with that knowledge.  It is not left behind.

Now I am not saying which is right. I have been the recipient of having an employer pay for courses for me for which I was very grateful, but I have also been an employer who had to look at the budget to see if staff could be paid for to do course and this can be quite a dilemma. So spare a thought for your employer who is trying to balance the books and if they graciously pay for you to do training, be grateful and give back to them with your loyalty.

Food for thought isn’t it?

A new era of training is emerging

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Covid-19 has forced many people to embrace other methods of training and communicating. The face to face classroom is no longer the only way to learn. Many businesses are now resetting their methods of training as we have seen with the universities. However, some people are resistant to change and want to keep the status quo. It is a bit like the swing away from cheques to online or mobile phone banking. Some just will not do it. 

However we all know that now some banks are no longer accepting cheques and when we do receive a cheque it is not an easy option to bank it. Is training going to go the same way? I believe it will and whether we like it or not, it is the way of the future.

Zoom meetings and training have mushroomed over recent months, with many people using zoom in a variety of ways to communicate, be it for training, running meetings or for catch ups with families and friends. 

So, what are the advantages of online training as opposed to face to face training?

  • Can be done anywhere anytime
  • All learners get the same information
  • No travel required
  • Annual leave is left untouched
  • Staff don’t need to be replaced to let one staff member off to attend training
  • Easier to get multiple members of staff trained at the same time

So, what are the disadvantages online training

  • Option for discussion is reduced but not impossible
  • Unable to network with people from other facilities
  • Less cost effective as may only send one person instead of many
  • Cost of travel, time off and replacement of staff to attend

The feedback we got from the online learners at the clinical update has been very positive. Being able to attend Online Real Time and the Recorded options for the Clinical Update ticked all the advantages listed. I have found also that people using Care Training Online get positive result. I know it takes a shift in mind set to go online as opposed to face to face learning. We all don’t like change that much as I said, but once we get past that block it is easy. I remember when I first started using a projector for training. It really scared me but now it is dead easy and I wouldn’t be without it. When I started using Zoom I messed it up but now I really like it. We just have to practice, be bold and try something new.

So, give online a go. With some encouragement from you for your staff, it could save you not only a lot of time but also a lot of money too. On top of that that  your residents will get great care. What a bonus.

It’s the little things that count.

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Having just spent time in hospital with a fractured pelvis, I am reminded again of the little things that make recovery easier. While I can’t fault the care, it is the little niceties that make it more bearable. I’m talking about somewhere to put your little bits of rubbish that accumulate around you.  Easily solved by putting a rubbish bag attached to your nightingale. Like pain relief being given on time so you can at least be more comfortable. When receiving care, have it all completed before the nurse goes on to the next person. Having to sit and wait to have your morning cares does not make the morning start well.

I have to say I am very impressed with the new grads too. The standard of care they delivered was exceptional. They were well organised in their day too which was very pleasing to see.

However, a lot has happened in a week hasn’t it with the World Wide Pandemic being declared. But again, it is the little things that count – like handwashing. Being sloppy around this very basic of practices is what can cause the harm. For those using Care Training Online, I have posted some updated videos on Virus’, what they are and how to combat them on the Infection Control topic.  I have also updated some videos on the Pandemic planning topic as well.

Back to the little things again. It is these that will keep you all safe. The gold standard for hand hygiene is soap and water. While many think that hand sanitisers will protect them, some pointers to remember are:

  1. Not all hand sanitisers are equal. They need to be at least 60% alcohol to be effective
  2. Hands need to be clean in the first place for hand sanitisers to work
  3. Even if using hand sanitiser, if you pick up the container, you are contaminating it as is everyone else who picks it up so it less likely to be effective.  On top of this hands needs to be washed frequently with warm water and soap as well, so soap and water is the best defence against cross infections.

So, nothing beats hand washing with soap and warm water, not cold water.  This article will explain more.

So how are you going to prevent the virus from getting into the facility or your home in the first place? Have some form of soap and water hand washing at your door. While warm water may be a bit difficult to provide in these circumstances, I am reminded of Ignaz Semmelweis, the father of Infection Control, who prevented postpartum woman from dying by having buckets of water and chlorinated lime in the wards. All his medical students had to wash their hands before they examined any women in labour and dropped the death rate to as little as .85%.  It worked in the 1800s, and it still works today so let us not be resistant to the importance of using soap and water and when not available, use hand sanitiser with a high alcohol content. 

Learning Styles Across Cultures

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I came across an article in a Training & Development Magazine. It is written by Sean O’Tool who works with Australia’s largest employer of Aboriginal people and it is about understanding the difference between traditional culture learning and mainstream western culture learning. He received a Churchill Scholarship to investigate best practices of teaching indigenous people in New Zealand, Canada and USA. 

Indigenous people around the world share many common learning styles which can be in conflict with the way most of our teaching is done in western culture where we use the expert-novice model. Those of us who work with many ethnicities, know that not every body learns the same way and unless we look at providing a variety of learning options, teaching staff to provide the care the way we expect them to will result in varying results.  “A common learning style for indigenous people is to see a demonstration and go away and practice privately until they master the skill” he says.  How many times do we actually nurture or respect this way of learning?

In the article there is a comparative table of the learning styles of indigenous and non-indigenous people. It was developed by the Aboriginal Human Resource Council of Canada (2007).  I hope you find it interesting

TRADITIONAL CULTURE             MAINSTREAM WESTERN CULTURE
Community is the foremost of all values Individualism is the foremost value
The future tense is dominant Tradition of printing and literacy
The world is understood mythically The present is the dominant tense
Goals are met with patience   The world is understood scientifically
Ownership is often communal  Goals are met with aggressive effort
Gifts are regarded as social glue   Ownership is reward for hard work
Work is often motivated by group need Gifts are regarded as holiday issues
Aging is a source of wisdom  Work is motivated by ambition
Eye contact is thought over-assertive Aging is decay and loss
Silences are acceptable anywhere Eye contact is part of conversation
Assertiveness is non-communal  Silences are a waste of time
Listening skills are prized Assertiveness is a basic social skill
Soft spoken words carry farthest Communication skills are prized
Nodding signifies understanding Emphasis carries the day
Handshake is soft, signalling no threat Nodding signifies agreement
Collective decisions are consensual   Handshake is firm, assertive
A faith in harmony with nature Collective decisions are put to a vote
Family is extended family A faith in scientific control of nature
Responds to praise of the group  Family is nuclear family
Responds to praise of the individual