Communication and Coaching: A Nurses Guide to Creating a Harmonious Atmosphere

Communication & Coaching: A Nurse’s Guide to Creating a

Harmonious AtmosphereHARMONY UNIVERSITYThe Provider Unit of

Harmony Healthcare International, Inc. (HHI)

Presented by:

Beckie Dow, RN, RAC-MTDirector of MDS/Nursing Program

Development

Speaker Bio

Over 20 Years Experience in Long-term CareClinical and Reimbursement Accuracy in AssessmentsQuality Assurance ActivitiesInterrelation between MDS, Care Planning, QA, and Clinical Excellence at the BedsideAANAC Master Teacher

Copyright © 2013 All Rights Reserved 2Harmony Healthcare International, Inc.

Communication & Coaching: A Nurse’s Guide to Creating a Harmonious Atmosphere

Disclosures: The planners and presenters of this educational activity have no relationship with commercial entities or conflicts of interest to disclosePlanners:

Elisa Bovee, MS, OTR/LDiane Buckley, BSN, RN, RAC-CTBeckie Dow, RN, RAC-MTKeri Hart, MS CCC, SLP, RAC-CTKristen Mastrangelo, OTR/L, MBA, NHAChristine Twombly, RNC, RAC-MT, LHRM

Presenter:Beckie Dow, RN, RAC-MT


Communication & Coaching: A Nurse’s Guide to Creating a Harmonious Atmosphere

Disclosure

Speaker: Beckie Dow, RN, RAC-MT Director of

MDS/Nursing Program Development

The speaker has no relevant financial relationships to disclose

The speaker has no relevant nonfinancial relationships to disclose

4Harmony Healthcare International, Inc.Copyright © 2013 All Rights Reserved

Communication & Coaching: A Nurse’s Guide to Creating a Harmonious AtmosphereCriteria for Successful Completion

Complete Sign-in and Sign-Out on Attendance FormAttendance for entire sessionCompletion and submission of speaker evaluation form.


Program Objectives

The learner will be able to discuss the positive impact of clear communication to address areas of improvement on staff members and customersThe learner will be able to articulate the positive impact of a cohesive clinical team to promote staff and customer satisfactionThe learner will be able to list three techniques to better communicate with a cognitively impaired elder


Program Objectives

The learner will be able to give examples of workplace bullying, and offer techniques to eliminate bullying in the workplaceThe learner will be able to describe how proactive communication with co-workers and employees can stop the cycle of miscommunication and create a more harmonious workplace for staff and customers


“I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel”

-Maya AngelouCopyright © 2013 All Rights Reserved 8Harmony Healthcare International, Inc.

Frustrated Employees Say…

“Management doesn’t care about us”“They never get rid of bad employees; they just get away with everything”“We always have to deal with the fallout, and they get to go home”“If I speak up and then nothing changes, why should I even bother?”


Frustrated Employees Say…

Your front-line staff spends the most time with your customersThey are, essentially, the face of your organizationEffective communication with your staff can increase employee satisfaction, which will influence customer satisfaction


Communicating Well…



Good communication is a powerful tool that can help you to:

Connect with othersExpress what you really meanNavigate challenging situationsBuild better relationshipsEarn the respect and loyalty of your team



The way you listen, look, move, and react influences the listenerIt shows whether or not you care, if you are being truthful, and how well you are listeningAs a manager or caregiver, your staff and patients will often base their opinion of you on how they feel after they interact with you



When non-verbal communication supports verbal communication you will increase trust, clarity, and rapportWhen non-verbal communication does not support verbal communication you will generate tension, mistrust, and confusion



Be sensitive to someone’s physical response to your communicationThis non-verbal communication can offer you valuable clues as to their true response to your wordsBe aware of the non-verbal communication you are displaying, so others do not misinterpret your meaning



Non-verbal communication can be modified and controlled…to a pointEven the best communicators do not fully eliminate all non-verbal communicationBy managing your staff effectively, you will decrease your own frustration and be able to communicate better


Communication Ability for the patient with Dementia

Dementia can gradually diminish a patient’s ability to communicatePatients with Dementia have increased difficulty expressing their thoughts and emotions—and more difficulty understanding them in othersThe ability to communicate is a basic need


Communication Is…

Sending and receiving messagesHow we relate to one anotherAn important part of our relationshipsA way to express who we areMore than talking or listeningAbout attitude, tone of voice, facial expression, and body language


Changes in Communication

Difficulty finding the right wordsUsing familiar words repeatedlyInventing new words to describe familiar thingsEasily losing train of thoughtDifficulty organizing words logically


Changes in Communication

Reverting to speaking a native languageUsing curse wordsSpeaking less oftenRelying on gestures rather than speaking


Help The Patient Communicate



Be Patient and Supportive. Let the person know you are listening and trying to understand what is being said.Show Your Interest. Keep good eye contact and show the person you care about what he or she is saying.



Offer Comfort and Reassurance. If the patient is having trouble communicating, let them know it is OK.Encourage. Have the patient continue to try to explain his or her thoughts.Give the Patient Time. Let the patient think about and describe what he or she wants.



Don’t Interrupt. Gently stop a rambling thought in a respectful manner.Avoid Criticizing or Correcting. Don’t tell the person that they are incorrect. Try to find the meaning in what they are saying.Avoid Arguing. If the patient says something you disagree with, let it go.



Offer a Guess. If the patient uses the wrong word or cannot find a word, try guessing the right one. If you understand what they mean you may not have to give the exact word.Be Careful Not to Cause FrustrationEncourage Non-Verbal Communication. Pointing or gesturing to clarify what is being said.



Limit Distractions. Find a quiet place. The surroundings should always support a person’s ability to focus on his or her feelings.Focus on Feelings, not Facts. Sometimes the emotion being expressed is more important than what is said. Look for the feelings behind the words. Tone of voice and actions may provide clues.


A Challenge For You:

Consider the following scenario:A confused resident approaches the

nursing station. “I would like my hair done today,” she requests.

The nurse replies, “No, you can’t get your hair done. The hairdresser is only here on Tuesday and Thursday.”


A Challenge For You…

Avoid the following words for 24 hours:

NoDon’t Can’tWon’tNot


What is “Customer Service?”

An expression of human decency which creates mutual benefit for the customer and service provider

A series of activities that enhances the customers feeling that the product or service meets their expectations


What is “Customer Service?”

Creating an atmosphere of trust and loyaltySacrifice and servingDoing what you say you will doPutting customers needs firstTreating others with dignity


First Impressions…



Residents and family members have the opportunity to observe you and how you interact with all residents.

What kind of impression are you making?



People generally form a first impression of you in 3-5 secondsThis first impression will influence how residents and family members perceive you will provide careA poor first impression is often difficult to change



What influences a first impression?

Your facial expressionYour appearance and attireYour postureYour speech and inflectionThe overall attitude you display



Identify your role--let the patient and family member know what you are responsible for, and direct them to the person responsible for their other requestsDon’t try to do what you do not have the capability or authority to do, because if you fail, the patient will feel more insecure


Ownership of a Task

Not Acceptable

She is not my assignmentHer nurse is on breakShe is not here. Call back tomorrow

Acceptable

I am happy to help youI can assist youI will give her a message that you wish to speak to her. What is your name and contact information?


Ownership of a Task

How you respond to an initial request sets the tone for the remainder of the interactionAt times, customers will approach you in an angry way even if you don’t deserve itIt is important to always respond kindly and courteously to a request or complaint


Communication and Meeting Government Initiatives

Two themes are common in today’s debate about the long-term care industry:

Many patients receive, or are at risk for receiving, sub-standard level of careLong-term care employees may be dissatisfied with work environment or job duties which will affect residents


Communication and Meeting Government Initiatives

Employee turnover is a serious concern for all levels of the health care industryRetention of valuable employees is essential for patient satisfaction and financial stabilityIncreased governmental attention to “quality care” in healthcareHigher customer expectations


What is “Quality Care”?

Each person may define quality care differently, based on personality, values, culture, etc.Common themes:

Treat patients with dignity and respectPatient involvement in decisionsControl of ones own lifePhysical and emotional needs met


The CMS Nursing Home Action Plan: A Three Part Aim


The CMS Nursing Home Action Plan: Five Approaches

Enhance consumer engagement Strengthen survey processes, standards, and enforcement Promote quality improvementCreate strategic approaches through partnershipsAdvance quality through innovation and demonstration


The Regulatory Aspects of Communitation--F280

“The care plan must be prepared by an interdisciplinary team that includes the attending physician, an R.N. with responsibility for the resident, and other appropriate staff in disciplines as determined by the resident’s needs, and, to the extent practicable, the participation of the resident, the resident’s family, or the resident’s legal representative [42CFR483.20(k)(2)]”


A Bottom-Up Approach to Communication

Valuing direct caregivers input in patient care policy decisionsCare planning becoming more relevant to the patientCare plan more closely represents patients status and is better individualized to the patient



Encouraging input from front-line staff may increase their acceptance of policy change…or at least their understandingFeeling valued increases employee satisfaction and retentionOpens up dialog about other topics



Truthfulness with employees is a key aspect of caring for employeesTelling employees what they need to hear, which may not be what they want to hear, is a necessary first stepThis may cause the manager discomfort at first, but is a skill that needs to be practicedBe ASSERTIVE!


Assertiveness

“Disposed to or characterized by bold

or confident statements or behavior”

--Merriam Webster dictionary


Assertiveness

Assertiveness is not forcing others to do what they do not want to doAssertiveness is clearly pointing the way for the team to go, and inviting others to take that journey with youAnyone can force compliance, but a manager encourages commitment


Assertiveness

Assertiveness is…

Clearly communicating expectationsFollowing upCoaching and encouragingHaving the same standard for everyone

Assertiveness is not…

BullyingManipulatingIntimidatingForcing complianceThreatening


Assertiveness

Many managers struggle with employee behavior that is not in line with the organizations visionIt is up to the manager to set clear expectations regarding behavior and follow upThe clearer expectations are, the easier it is to address problem behavior


Effective Communication

An effective manager will:Set clear boundaries and expectationsPractice accountabilityHonor your staff’s rightsChoose your battles carefullyDeal with problem behavior swiftly and fairly


Boundaries and Expectations

Managers who do not clearly define boundaries and expectations are just asking for troubleDon’t expect your employees to be mind readersCommunicate what you expect—and what will not be tolerated


Accountability

Managers must hold staff accountable when they do not meet expectationsIt can be uncomfortable for some people to have this type of confrontationThese behaviors will rarely resolve on their own, without coaching or discipline


Accountability

Remember—it is your job as a manager to consistently hold staff accountableHolding those who engage in bad behavior accountable will create respect with other employeesHaving the same standard for all creates an atmosphere of trust


Honor Staff Rights

Staff members should be able to expect that they will be treated fairly at work and have an appeals process available to themStaff should also be able to expect equity in how they are treated and spoken to by peers and managers


Choose Your Battles

Some areas are not available for debate, such as patients rights, regulatory mandates, etc.Other areas may be more flexible and may provide an opportunity for collaboration on a small topic that makes a big difference


Choose Your Battles

Psychology Today says there are four things that motivate employees

Desire for compensation and material thingsNeed to bond with others and feel they belongNeed to make sense of the environmentDesire to defend their accomplishments


Performance Evaluations

The cost of employees who do not perform as we expect them to is hard to quantifyConsider time, money, lost productivity, and lower moraleThe most effective management technique is preventing performance problems proactively and addressing issues quickly and decisively



Performance Evaluations will enable the manager to:

Examine each employee as an individualEvaluate strengths and weaknessesReward employees who perform wellProvide continuous feedbackBe better aware of the needs of your staff




Reduce legal risk by ensuring that each employee feels they are treated fairlyIdentify and deal with problem behaviorsCreate valuable employeesLay the foundation for formalized discipline and/or termination




Provide legal protection for the employer in the form of documentation that supports repeated attempts to correct behaviorProvide a consistent and objective framework for all employees, so that no one employee feels “singled out”


Performance EvaluationsPerformance Objectives

Performance objectives identify what you expect from the employee and give the employee something to strive forJob Requirements are what you want the employee to accomplish and how you want the job performed

Result requirementsBehavior requirement


Performance EvaluationsPerformance Objectives

Developmental Goals are individualized for each employeeThese goals should directly relate to the employees job to prevent spending time and assets on developing a skill that does not benefit your companyOnly a few goals are needed to be effective


Performance EvaluationsObserve and Document

Be mindful of employee performance throughout the year, not just in the weeks leading up to their performance evaluationHaving an entire years worth of documentation about performance will paint a fairer picture of performance


Performance EvaluationsKeep in Touch

The annual evaluation should not be the only opportunity for feedbackSix months—checking in halfwayBrief review of progress to goals thus far in the yearProvide an opportunity for the employee to give feedback


Performance EvaluationsThe Annual Evaluation

Preparation is key in giving an effective performance evaluationUse objective data—numbers, factsUse subjective data—customer complaints or complimentsDraw conclusions and summarize your conclusions on the Evaluation Document


Pitfalls of the Evaluation…

The “Blame Game” when things go wrongFirst impressions clouding future performanceLiking those who like youJudging an employee based on one aspect of their performance


Pitfalls of the Evaluation…

Calling everyone “average”Placing more weight on recent eventsStereotyping employeesReviewing based on fear—softening the evaluationAvoiding the evaluation


Progressive Discipline

Benefits of Progressive Discipline:Allows managers to intervene and correct employee behavior at the first sign of troubleEnhances communication between manager and employeeHelps managers achieve higher performance from employeeImproves employee morale and retention by demonstrating rewards for good behavior and consequences for bad behavior



Benefits of Progressive Discipline:Avoids expensive replacement costsEnsures consistency and fairness in dealing with employee problems andLays the ground work for fair, legally- defensible employment termination for termination of employees who cannot or will not improve.



Steps of Progressive Discipline:CoachingVerbal WarningWritten WarningTermination

The disciplinary response should be appropriate and proportionate to the employee’s conduct


Coaching

At the first sign of an issue, sit down with the employee to discuss the issue“What can you tell me about…”Allow the employee time to explainGive the employee your perspective and offer guidance on correcting the issue


Coaching

Plan your coaching sessionsThe goal is to correct the issue and lead the employee on the path of improvementDon’t be emotional or threaten further actionStay positive and encourage the employee that you have confidence they can correct this issue


Coaching

Clearly explain what the issue is and what negative effect the issue is having on the companyThe purpose of this meeting is to discover the underlying issue and find a resolution that works for allClearly outline what will be expected for future behavior


Coaching

Follow up with the employee even if the problem is resolvedAfter 2-3 face-to-face coaching sessions with no resolution to the problem the discipline will progress to the next step


Verbal Warning

A verbal warning serves as notice to the employee that this issue is serious and must be correctedA verbal warning is a written warning that has no signaturesThe employee is placed on notice that if the issue is not resolved it will lead to further disciplinary action, up to and including termination of employment


Verbal Warning

If you have not already done so, contact your Human Resources (HR) departmentThey are experts and can provide guidanceKeep a written record of your conversations with the employee, including the coaching sessions


Verbal Warning

Be specific about deadlines for improvement, along with a timeframe for the next meetingExample: “You are expected to be on time for work each day, which means no later than 8:05 am. In two weeks we will meet again to follow up on your performance.”


Verbal Warning

After 2-3 verbal warnings the discipline will progress to the next stepThe employee will be aware of the consequences of their actions should they choose not to changeBy this time, you have had 2-3 coaching sessions and 2-3 verbal warnings


Written Warning

All interactions up until this point should be documented in the employee fileDo not document after the factKeep your HR department informed of the progressionWritten warnings are serious


Written Warning

As with the verbal warning, give specific details of what aspect of the employees behavior must changeProvide a timeframe for follow upInclude language stating that if the issue is not resolved further disciplinary action will be takenThis action may be up to and including termination


Written Warning

The written warning should be signed and dated by the employee and managerIf the employee refuses to sign, write “Refused to Sign” on the documentA separate Performance plan may be written to outline goals and timeframe for improvement of the employeeThis is helpful when dealing with multiple issues


Written Warning

Continue to coach the employee, and stick to the timeframe for improvement outlined in the written warningIf the issue remains unresolved, issue a second written warning that contains a specific timeframe for improvement


Written Warning

At the end of the established timeframe for improvement issue a Final Written WarningA Final Written Warning is open-endedExample: “You are expected to be on time for work, which means no later than 8:05 am. If you are late even one more day your employment will be terminated.”



Progressive discipline is not intended to punish or demoralizeProgressive discipline is intended to be fairProgressive discipline invests the employee in the improvement strategyThis increases the likelihood of follow through and employee improvement



Progressive Discipline can improve morale and foster feelings of employee loyaltyTreating employees fairly and with respectEnhances communicationAvoids expensive replacement costsLay the groundwork for a fair, defensible employment termination for employees who cannot or will not improve


Why Progressive Discipline is Difficult for Some Managers

Don’t want to be a “bad guy”It is uncomfortable to confront othersDon’t want to deal with an angry, hurt, or critical employeeFear of conflictDesire to be likedFear of retaliation


Why Progressive Discipline is Difficult for Some Managers

Reasons to “do it anyway”:Helps employees improveGives you the personal satisfaction that you have done all you could as a manager to help this person improveGives legal footing that a termination was just and fairPromotes morale of team as conflicts are dealt with fairly and equitably



The goal of the Progressive Discipline

process is for the employee to change their

behavior to meet your company’s standards.


Termination

Termination of employment is not simply a disciplinary measureTermination is a representation of the failure of the disciplinary processThe behavior of the employee has not changed, despite numerous warningsOr, the initial offense was egregious (stealing, workplace violence)


Termination

Have the termination document prepared before the meetingBe brief when disclosing the contents of the document to the employeeHave the employee sign the documentStand up to signal the meeting is over


Workplace Bullying

Workplace bullying might be becoming more prevalent—or we may be identifying it more oftenBullying can lead to decreased productivity and decreased moraleA good environment for patients, staff, and guests must be bully-free


Workplace Bullying

Bullying: The use of persistent aggressive or unreasonable behavior against a coworker or subordinateCan be covert or overtMay be difficult to identify because the bully may stay within established rules and policies of the organizationNo universally accepted definition


Workplace Bullying Statistics

13% of workers state they are currently being bullied24% of workers say they have been bullied in the past12% have witnessed workplace bullying49% of workers affected by workplace bullying

Source: 2007 WBI-Zogby Survey


Dealing With Workplace Bullying

First step is to have a no-tolerance policy for bullying—positive workplace culture starts from the top!Consider progressive discipline for the bullying individualInvestigate complaints of bullying per your facility procedureTake all complaints seriously


Final Thoughts

Patients, staff, visitors, and customers always want to be treated with dignity People respond more positively when they feel they are heard and were dealt with honestlyGood communication is not a luxury—it is a necessity to providing good care


Questions/Answers

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