The mission? Reduce HAPUs

I appreciate the author's acknowledgement of the difficulties her facility faced when attempting to reduce hospital-acquired pressure ulcers (HAPUs) in "Zero HAPUs: Reaching for the Moon" by Toni C. Clark, MHA, RN, CMSRN, which appeared in the March issue. As a former critical care nurse and now the director of a surgical unit, I'm facing patients with more comorbidities and less mobility, but aim to likewise initiate a program to reduce HAPUs. I'd like to add a different perspective by suggesting that nurse leaders incorporate this important aspect as a subpart of their organization's mission, which would become an automatic expectation for all new staff. Any initiative has the danger of push-back, and nurses may view it as yet another task to be completed. However, by incorporating the focus on patient care to include the aim of reducing HAPUs, it will more effectively become part of the organization's culture.

Finance for nurse managers

It's helpful for new nurse managers to expose themselves to the business side of nursing. Much of what's taught in undergraduate programs is care of patients at the bedside with some leadership education. As I move forward in my career as a graduate student and nurse manager, it's becoming more important to look at the financial responsibilities associated with nursing leadership. The March article "Do You Speak Finance?" by Rick Muller, PhD, and Margo Karsten, PhD, MSN, RN, provided an overview of the finance terms that nurse managers need to know. It's true that finance is another language that must become imbedded into our everyday practice to help shape healthcare and manage resources. Most nurses aren't aware of how patients pay for their healthcare services and that payment depends on the contractual discounts of Medicare, Medicaid, and insurance companies. Although it's important for leaders to pay attention to market share and payor mix trends, this isn't a perspective that's shared by direct care nurses, who want to care for their patients in the best and safest way possible and not worry about the financial aspect of healthcare.

As a new manager, it's difficult to understand and even more difficult to explain to staff members why they can't have a resource nurse or why they can't work overtime. Explaining hours per patient day (HPPD) has helped charge nurses gain a better understanding of the importance of flex staffing, but when it's busy on the unit, it's hard to rationalize this concept. Other financial metrics should be taken into account, not just HPPD. It has been suggested that a variety of additional information, along with midnight census, should be used to calculate HPPD. Some of this includes adding hours for short stay patients and inpatients or using multiple census reports, including noon census. This might involve having exact admission and discharge times to calculate additional patient hours.

It's important for nurse leaders, CNOs, and CFOs to look at more than the numbers that are generated by organizational systems. Many decisions about staffing are based on productivity, which doesn't always take into account what's happening on the unit at the bedside. There needs to be further identification of additional information for finance metrics, such as contact census, noon census, and acuity. Although most leadership allows managers and charge nurses to staff to what's needed on a specific day or shift, when the financial numbers are generated at the end of a pay period, there's still accountability for variances in the budget.

Understanding conflict management

Thank you for publishing the article "Keeping the Peace: Conflict Management Strategies for Nurse Managers" by Mary L. Johansen, PhD, RN, NE-BC, in the February issue. I'm currently pursuing my MSN in administration and enrolled in a course on leadership in a complex healthcare system. One of the topics we've discussed is conflict. My nurse manager provided me with this article to use as a resource, and I found it to be useful as a graduate student and staff nurse.

Conflict is everywhere; it's inevitable. It occurs in the work environment, at home, and in social settings. Conflict is part of life-how we manage and resolve it is important. I agree that as a future manager/leader, I must be able to handle conflicts efficiently and effectively. The problem is that many people tend to avoid conflict due to fear of how the other person or group will react. In my experience, people tend to avoid conflicts or accommodate to prevent tension. However, if conflict isn't resolved in a positive way, there can be no progress.

Collaborative approaches to conflict management require us to engage in the moment of dialogue in profound and meaningful ways. The two case studies presented in this article exemplify true reflections of conflict that nurses and nurse managers face. The sample conflict management resolution action plan presented an excellent demonstration of the five different management styles implemented to resolve the conflicts described in the case studies. Research supports that there's no single approach for conflict resolution; it's the responsibility of the person or group to be aware of the problem and select the most effective strategies depending on the nature of the conflict. I agree that participating in professional development and coaching programs on conflict resolution will help develop the skills to effectively manage conflict. This article provided me with invaluable recommendations about strategies and approaches to conflict management that I can implement in my work, education, and personal life.

Gi Morrell-Stinson, BSN, RN, CCRN

Graduate Student University of Texas at Arlington

Aileen Bolliger, BSN, RN, CPN

Mary Abraham, BBA, BSN, RN

Graduate Student The University of Texas at Arlington