Simple Test of Consistency

I was talking with a OB unit about their number one key driver--pain management. We were talking about how they discuss pain mitigation options with patients before the pain arrives. One nurse spoke of how she connected with her patients right when they get admitted. She talks about the various options and the time-line for their effectiveness. She told them about the need to be proactive. As she rounded, if she saw a patient who was struggling with the pain and it was still relatively early in the process, she would discuss their options again, even perhaps encouraging them to consider something, given that there was still quite a ways to go before it was all over. All in all, it seemed a very thorough and compassionate approach.

I turned to the crowd and asked how universal, how consistent, this communication was between all the nurses on the floor and all the patients. The nurse manager nodded confidently at the same time one charge nurse shook her head. Another shrugged her shoulders.

When I asked about this rather divergent response, the manager said, "Well, it is what we should be doing." Fair enough. Clearly one person thinks that it isn't be done. When asked, the shoulder-shrugger said, "I really don't know what other shifts are doing. I think my shift does a good job with this, but I suspect that not all shifts are."

Too often, I think that managers rely on the assumption of should and do not actually follow through with what is happening on their floor. But if you want to know what your nurses (or techs or orderlies or registration staff) is doing, you might ask them.