Developing health service staff.

Professional nurses frequently view continuing education and staff development narrowly, as in the form of an annual offsite seminar. Staff development is a year around, planned program, adequately funded and creatively administered. Development needs can be identified during annual performance appraisals and strategies to meet the needs written into a formal plan. These strategies might include a variety of educational and vocational opportunities within the organization and in the community. An effective development program should lead to more staff with a wider repertoire of skills and a new vision of their role and responsibility. The nurse manager should see these changes reflected in a more effective and efficient health service and in personal accolades from the organization.

When the manager encounters "We can't do it!".

This article has described the importance of increasing staff feelings of self-worth, of promoting feelings of personal power, involving staff actively in practice issues, of increasing staff knowledge of the health care and agency system, and of setting limits on negative discussion in a group. When nurses feel power in the health care system, it not only has the benefit of increasing job satisfaction but increases positive responses on the job. On the other hand, nursing staff who are unable to conquer the feeling of powerlessness may respond to assignments with statements signifying the subjective state experienced: "We can't do it!" Such staff are unlikely to experience personal and professional rewards and may ultimately leave the health care field. This negative process may be blocked by the manager who assists staff to develop feelings of worth, professional autonomy, and control and who can appropriately handle negative feelings expressed in a group.

Positive and negative criticism: strategies for professional growth.

Criticism is a common experience in critical care for both the novice and experienced nurse. Assisting staff to react positively to criticism presents a challenge to the critical care nurse manager and an opportunity to turn what frequently is a negative situation into a phenomenon that builds morale and relationships. Whether criticism is being given or received, it is up to the nurse manager to facilitate positive relationships in the critical care environment.

Cost-effective caring.

Cost containment is the key issue in healthcare systems and a key concept that nurses must grasp in this time of shrinking budgets and growing demand for health care. As healthcare budgets come under increasing scrutiny, nurses must prove their cost-effectiveness. To ensure the maintenance of quality care, national nurses' associations have a strong role to play in supporting research efforts into nursing's real worth (not only in cost terms) and gathering and disseminating this information to demonstrate the value of quality nursing. To get nurses worldwide to campaign for cost-effectiveness, ICN will focus on "Quality, Costs and Nursing" in its celebration of International Nurses' Day in 1993.

Communication techniques.

OR managers become aware of vast amounts of information while carrying out job functions. It is important to use the information carefully and to select what information to share, when to share it, and with whom it should be shared. Appropriate communication can promote efficiency as well as job satisfaction.

Reducing and managing restraints in long-term-care facilities.

OBJECTIVE: To evaluate a management system designed to improve staff adherence to a federal regulation that stated restrained residents should be released, exercised, and repositioned every 2 hours. DESIGN: A delayed intervention, controlled, cross-over design with three phases. During phase one, baseline, the length of intervals that residents remained in restraints was monitored. The intervention was implemented at site A in Phase two while site B remained in baseline. During Phase three, the intervention was replicated at site B. SETTING: Two long-term care proprietary nursing facilities. PATIENTS: Sixty-three physically restrained residents in the two facilities. INTERVENTION: The intervention was a system of restraint release using colored pads corresponding to specific hours. The management rule was that the resident should be on a different colored pad every 2 hours. Staff had to lift residents to place the pad, and the colors made the system easy for supervisors to check. MAIN OUTCOME MEASURES: Checks by research personnel by black light and invisible ink, to detect movement of the knot tying the restraints. RESULTS: During the baseline phase, the majority of residents at both sites were inappropriately restrained longer than 2 hours (site A: 54.1%; site B: 60.1%). The percentage of residents restrained over 2 hours was significantly reduced during the intervention phase to 13.9% (site A) and 19.4% (site B). Three weeks after the end of the intervention, inappropriate use of restraints remained low, 14.2%, but rose to 47.7% after another 3 weeks. CONCLUSION: The management system is an effective way to increase the consistency with which nursing-home staff release and reposition restrained residents.

Clinical supervision in psychiatric nursing: using the process record.

This paper explores the need for more creative supervision in mental health nursing, to meet the challenges of case-load management and the psychotherapeutic approach to care. One method, the process record, is explored in detail and its role in the supervisory relationship is discussed.

Achieving excellence: the nurse manager's challenge.

We must develop the idea that excellence is constant reshaping and self discovery. Gardner (1961) points out that, "... free men must set their own difficult goals and be their own hard task masters" (p. 160). We must move to self-supervising models of excellence. We must do this for the nursing profession and we must each do this for the people on our units and for ourselves. We must set a standard that strives for the very highest achievement in every part of our life. As Captain Kirk described, "I had ambition not only to go farther than any man had ever been before but as far as it was possible for man to go" (Gardner, 1961, p. 140). Developing a patient care unit of excellence means that we do not just try to compete with another unit and do better. Excellence means that we chart new ground and become a pacesetter in developing new models that create exceptional levels of quality at a value and cost that people are willing to pay.

Impaired nursing: the role of the nurse manager.

Impaired nursing practice is a professional and personal problem. As a result of increasing substance abuse and in response to changing theories and attitudes, nurse managers must be better educated on this topic.

Supervision of home health paraprofessionals. A quality of care issue.

A new tool has been developed to assist community health nurses in the supervision of care provided by home care aides, the providers of personal care and the extension of skilled services.