Nursing

Lift retention rates with CRM: Communication is the key

Nurse Leader Weekly, December 5, 2005

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If the aviation industry allowed for a 5% error rate to occur, 137 planes would crash daily, Linda Kosnik, RN, MSN, CS, chief nursing officer (CNO) at Overlook Hospital, a branch of Atlantic Health System in Summit, NJ, explained to the audience of a 2004 HCPro, Inc., audioconference.

The audioconference, "Improve Your Nurse Retention Now: Practical and Innovative Strategies for Increasing Staff Morale and Empowerment," identified crew resource management (CRM)-the collaborative communication system used by pilots and flight staff to ensure passenger safety-as a key strategy for improving patient safety and enhancing staff collaboration and satisfaction-and ultimately leading to the retention of much-needed staff.

Why is retention a main focus? According to cospeaker Trish O'Keefe, RN, MSN, CNA, CNO at Morristown (NJ) Memorial Hospital, a branch of Atlantic Health System, hiring new staff costs organizations approximately $40,000 a year. And when it comes to patient safety and care, evidence shows that retaining trained nurses decreases lengths of stay, infection and mortality rates, and pressure ulcer occurrences, says O'Keefe.

To aid in the retention of nurses and staff, organizations should implement a collaborative governance model, suggests O'Keefe. Doing so will promote teambuilding and empower staff, she says.

CRM for team building

CRM enhances collaboration, builds teams, and leads to staff satisfaction, says Kosnik. Under the CRM model, all team members are not only able to speak freely, but are expected to do so.

For instance, when staff involved in wrong-site surgery events are questioned, they often state that at one point or another they thought that the surgeon may have been dealing with the wrong site, but they did not feel comfortable speaking up, says Kosnik.

In healthcare, the traditional approach is to stay quiet because the surgeon is in charge, says Kosnik. This practice is not only unsafe to patients and toxic for staff, but it is also unfair to the surgeon who executes the grave mistake, she says.

CRM decreases the possibility of such mistakes because it requires a complex matrix of team monitoring, crosschecks, workload management, vigilance, and automation management, says Kosnik. If care team members were expected to implement these practices and felt comfortable expressing their concerns, patient safety and staff satisfaction would vastly improve, she says.

The building blocks for CRM include

  • backup systems
  • team communication and coordination
  • adequate briefings; availability and use of resources
  • leadership and adequate supervision
  • knowledge of systems
  • personal readiness
  • planning
  • correction of known problems and issues
  • management support

'De-siloing' of healthcare

Another area that causes stress to staff is interdepartmental communication, says Kosnik. As healthcare has grown and become more specialized, departments now function singularly, or as "silos" that don't share information with each other, she says.

Trying to communicate across these silos often frustrates staff, and that is when the blame game begins. "We often are willing to blame others because we don't have a relationship with them," Kosnik says. CRM promotes relationships.

To de-silo your organization and improve communication and collaboration among staff, Kosnik suggests

  • determining the stressors that affect multiple units
  • empowering staff to come up with solutions for these stressors as they occur
  • teaching staff to share information and resources

Source: This article is adapted from The Staff Educator (November 2005), published by HCPro, Inc.



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