Although nursing management is a process that needs long-term clinical accumulation, if there are some masters' guidance, we can certainly avoid some detours.
In the process of my own management, I have the honor to read three books about how to improve the nursing management ability by using limited resources, and systematically apply them in the work scene to improve the nursing quality of departments, and recommend them to everyone. Now I recommend them to everyone. You can choose to read according to your own situation.
1, Essentials of Nursing Management Cases: Jump out of daily chores and understand nursing management theory.
When I read this book at the beginning of the year, I thought that the case book must be about clinical stories, and then what to do under the guidance. However, this book broke my previous understanding of case books. Before the actual operation, the related theoretical knowledge of nursing and management was explained. In fact, it taught nursing managers not to be trapped by clinical trivial matters, learned to use scientific management theory to guide the management framework, integrated the methodology involved in nursing work, broadened their horizons and improved their nursing management ability.
The 44 clinical nursing management stories in the book are close to clinic, close to patients and close to demonstration. Running through the main line are the four principles of management (system, humanism, dynamics and efficiency); Five basic functions of nursing management (planning, organization and management, leadership, human resources, control, etc. ); At present, the hot and difficult issues of nursing in China (post, performance, culture, crisis, information, innovative management).
Each chapter briefly outlines the definition of management, and then tells stories and asks questions. With the help of related knowledge links, the problems are analyzed and interpreted, and then extended and expanded.
Case 22 is nurse scheduling, which belongs to the chapter of nursing human resource management. The topic is "headache on duty during the Spring Festival", and everyone is very concerned. By telling the story of neurosurgery scheduling in a private hospital during the Spring Festival, we are faced with:
1. Bed utilization rate100%;
2. Young nurses account for 50%;
3. More than 30 first-class nursing patients;
4. Three shifts;
5. Old nurses ask for leave during the Spring Festival, new nurses are afraid of being on duty, and they also ask for leave during the Spring Festival, or threaten to resign;
In view of this situation, three management problems are put forward:
1. What is the average daily nursing time for each patient in this ward? How many people are equivalent to full-time employees?
2. Should the nursing department formulate the scheduling regulations during the Spring Festival? Should we take care of the old nurse or the new nurse?
3. How does the nursing department evaluate whether the head nurse's shift arrangement is reasonable?
On the knowledge link, the common nursing work mode, scheduling principle, influencing factors, nurse scheduling cycle and scheduling type are described.
In the case analysis, three management questions were answered, such as self-scheduling after screening three scheduling schemes, emphasizing the guidance of the head nurse and the final audit and coordination.
In the part of experience sharing, not only the different scheduling modes such as three-shift system, two-shift system, fixed scheduling and flexible scheduling are expounded respectively; It also provides a new perspective reference for nursing managers in the nurse scheduling decision support system.
Through the study of this book and subsequent clinical practice, individuals have made great achievements in the following five stages: the principle of integration and separation, the principle of relative closure, feedback mechanism, training, the flexible principle of dynamic principle, contingency management, informal organization, team building, the relationship between system and humanization, situational leadership, flexible scheduling, motivation, career planning, three-point control, nursing quality control indicators, nursing adverse event management and nursing implementation.
20 16 systematically practiced the learning content of this book, and the practical experience was written into a series of management articles and shared.
However, every time you reread this book, you will still have new feelings when you encounter related management confusion, just like every time you come to the seaside, you will always find new shells.
This is a rare good book, which is worth reading repeatedly by nursing managers.
2. Case analysis and prevention of abnormal clinical nursing events: systematically straighten out nursing safety management.
In recent years, the concept of patient safety management has been widely accepted by clinical workers. The existing research results show that patients' safety problems are usually caused by a variety of interlocking factors.
In this context, our hospital has also carried out nursing safety activities, and the management of nursing adverse events has entered the daily affairs of head nurses. However, there are still many doubts about how to create a non-punitive environment, encourage nurses to report actively, analyze the root causes of adverse events, and learn from mistakes.
This book has fourteen chapters. Except the first chapter describes the classification, reporting system and case analysis method of nursing abnormal events, the remaining thirteen chapters systematically collect 194 cases, involving the following two categories and thirteen aspects:
1. Identification, falling, medication errors, burns and injuries;
2. Blood transfusion, surgery, restrictions, pipelines, medical equipment and facilities, hospital physical environment and other nursing abnormalities;
Each chapter first describes the nursing system, principles and consequences caused by mistakes involved in this chapter. In each case, the incident is described first, then classified, and then the direct cause and other causes are systematically analyzed, and corrective measures are put forward, and preventive measures are extended, and relevant systems and norms are marked to clarify the source.
In the 29th case-medication error caused by inconsistency between handwritten doctor's orders and computer doctor's orders, several key points of the incident were mentioned:
1. The doctor mistakenly entered the "prednisone" computer with handwritten orders as "hydrocortisone";
2. "Hydrocortisone" has been used before;
3. On the first day, the nurse in charge of the class did not find any problems with the doctor's advice, and the handwritten doctor's advice checked by the clinical nurse on the first day was correct. No problems were found on the first day, so that the treatment list, patrol card and bottle label printed the next day were all wrong;
4. The nurse who takes medicine the next day is the nurse on the first day. She did not carefully check the treatment list, patrol card and bottle label, and still added the medicine according to the handwritten doctor's order "Hydrocortisone" checked on the first day. There is nothing wrong with the infusion of drugs, and the next day, the general inspection found no doctor's advice problems, so that the treatment list, patrol card and bottle label printed on the third day were all wrong;
5. On the third day, the nurse added medicine to the patient according to the treatment list, the patrol card and the label of the medicine bottle, and the medicine input was wrong. On the third day, I found the doctor's advice, so that the printed treatment list, patrol card and bottle label were all wrong;
In the event classification, it belongs to preventable clinical nursing adverse events;
According to the analysis of event J, it is found that the direct cause is:
Doctor 1 mistakenly entered the handwritten "prednisone" into the computer as "hydrocortisone";
Other reasons include:
2 dressing change is not notified.
3. The nurses in the main class failed to perform their inspection duties when dealing with doctor's orders.
4. Nurses failed to effectively implement the daily general inspection system, and did not strictly implement the "three inspections and seven pairs" when dispensing medicines;
It is worth noting that, when analyzing the causes, the direct cause 1 mentioned the system of doctor's advice and instruction execution in the Nursing Management Work Standard (Fourth Edition); 2. The intravenous drug (liquid) infusion system is mentioned in the Standard for Nursing Management of Safe Drug Use System (fourth edition). The fourth edition of Nursing Management Standard mentioned the inspection system of the fourth edition. 5 mentioned "three checks and seven pairs"; There are reasons to check and systems to follow;
Regarding the corrective measures, we have dealt with the patient's situation (stopping medication, evaluating drug hazards, communicating and explaining, reporting, etc.). ), the event itself (organizing discussion and recording), training (doctors and nurses) and drug management (labeling and managing "sounds" and "looks" drugs).
Finally, from the preventive measures to prevent this behavior from happening again:
1, stop using handwritten doctor's advice and directly input it into the computer;
2. Implement doctors' professional quality, nurses' professional training, system assessment and professional ethics in training;
3, high-risk drugs, sounds like, looks like, a variety of drug label management;
For the cases involved in the book, our department organizes learning at the daily morning meeting, such as case analysis and identification incident prevention: the nursing students almost gave 30 beds of patient fluid to 25 beds of patients, and the drug insurance was input by another person with the same pronunciation and different words, so as to reduce the identification errors of anonymous patients in the body and emergency room;
Medication error: ceftriaxone sodium was mistakenly sent into cefotaxime, and the wrong bottle was attached, which led to medication error, and aminophylline was repeatedly given without signature after infusion; The nurse didn't check the dosage of intramuscular injection of drugs, which led to 1.5 times more drugs, and the expired liquid medicine was mistakenly input into the child's body;
Medical facilities and equipment: venous indwelling needle cannula was taken out by operation, and the speed of injection pump was abnormal;
Case analysis and prevention of bad communication events: bad words hurt people, advice is better than instructions, family members are impatient, patients are angry, unsuccessful venipuncture of nursing students causes family members' dissatisfaction, improper language causes disputes, inadequate notification causes family members to ask for bed reduction, waiting for dressing change for too long causes nurse-patient friction, and children with viral myocarditis repeatedly cry and suddenly stop breathing and heartbeat;
Every month, when there are adverse nursing events reported in the department, I always look through the books and get a more systematic management method from time to time. Every year, when departments report nursing adverse events, about 80% of the cases I sorted out are medication errors, equipment failures, poor communication and so on. And summarize and analyze the management in the book to find out the improvement space of safety management. In this regard, the nursing staff of the department will talk about the case feelings after studying in groups.
There is no end to learning. Only by learning and reusing, using and learning, can we continuously improve the ability of clinical nursing safety management. This is the biggest feeling brought to me by Analysis and Prevention of Abnormal Events in Clinical Nursing.
3. Nursing samples: the best practice of holistic nursing
Before reading the Nursing Sample, I have been thinking about how to improve the quality of nursing service and how the "functional" nursing model will change to the "responsible" nursing service model with patient as the center under the limited nursing resources, such as geography and human resources. The practice of Yuxi People's Hospital in Yunnan Province-"nursing samples" provided me with the best practical ideas.
The book consists of seven aspects: 1, nursing examination: nursing answer sheets in the top three exams; 2, thinking turn: from shampoo to brainwashing; 3. Scheduling opens the way: from functional system to responsibility system; 4. Basis of reform: from human resources to support system; 5. Nursing landing: from hierarchical training to quality supervision: 6. Long-term mechanism: from post management to performance change; 7. Nursing starts again: from "a bed" to forcing a doctor. In the narrative of seven chapters, this hospital, which is located in the frontier of plateau, has been deeply analyzed for three reasons that the level of high-quality nursing service ranks among the first phalanx in China by using limited resources:
1. The leaders of the hospital realized that the development of high-quality nursing service was promoted to the strategic height of the hospital and became a veritable "number one" project.
2. Hospital administrators try their best to understand the connotation of high-quality nursing service and find out the direction of nursing reform: starting from the shift arrangement reform. Implement flat nurses to be responsible for patients and pay close attention to the implementation of post management;
3. Good execution of hospital nursing team.
In the fifth chapter of the book, "Nursing Landing: From Graded Training to Quality Supervision", I was deeply impressed by a passage with the subtitle of "Turning to Use-Oriented".
This section describes the challenges and changes experienced by Liu Zhaoxian, the head nurse of the hospital, as a full-time training supervisor.
Under the "user-oriented" training concept put forward by the nursing department, we can get rid of the disadvantages of paying attention to theoretical explanation and the disconnection between nursing teaching and clinical practice, and train according to the actual needs of nursing posts and work.
Under the guidance of this concept, "user-oriented" training has shifted from classroom simulation to practical demonstration and explanation at bedside, and the training content is mainly based on workflow. On 20 1 1 year, the nursing department organized nurses in the whole hospital to carry out training on the overall nursing process of the six specialized diseases responsibility system. Simulate the daily work of patients and nurses for training, and tactically choose the clinical nursing path of single disease.
Liu Zhaoxian first selected 2~3 diseases from a department, worked out detailed operating procedures one by one, and then gradually expanded the scope of coverage departments, with a view to covering 5~ 10 common diseases in each department.
Taking the common high-quality nursing path of cerebral infarction in neurology as an example. During the whole stage from admission to discharge, nurses should evaluate the patient's condition, what treatment measures should be implemented, what health education should inform patients, what life care services should be completed and what rehabilitation guidance projects should be carried out, all of which are listed in detail. Nurses check the completed projects with memos against this high-quality nursing path table.
According to the characteristics of the disease, the single-disease clinical nursing path helps young nurses to get familiar with the work content quickly through mandatory repetitive processes, which avoids the possibility of missing the work content and links by human negligence and points out the direction for nurses to further improve their professional skills. This idea of providing content guidance through process refinement and nurse training has also inspired imitation and innovation in various departments.
Later, according to the actual diagnosis and treatment level of the department, I took the emergency service flow of acute trauma, pesticide poisoning, emergency delivery, acute myocardial infarction, acute stroke, acute craniocerebral injury, high-risk pregnant women and high-risk newborns mentioned in the evaluation standard of the Second Hospital as a model for the exercise, and conducted the exercise according to the emergency service flow of these major diseases in our city. After every exercise, I make comments, sum up every year and find out the gap. This is for our medical care.
As Chen Xiaohong, the evaluation center of medical institutions of China Hospital Association, said, the book "Nursing Samples" recorded and deeply analyzed the process of high-quality nursing reform in Yuxi People's Hospital, with both experiences and lessons, which is why its nursing reform case is more meaningful.
The Spring Festival is coming. Nursing managers on duty and off duty, if interested in the books mentioned in this article, may wish to read a book quietly in the next holiday, follow the footsteps of teachers, taste the fragrance of nursing management, and forge ahead in practice and walk hand in hand in the new year!