According to the U.S. Office of Personnel Management, “an employee knows a threat, intimidation or other disruptive behavior when he or she experiences it — definitions are not necessary.”¹

However, these types of behaviors can exhibit themselves in ways that can be defined.  For example, the Agency for Healthcare Research and Quality identifies disruptive behavior as any behavior that shows disrespect for others including any interpersonal interaction that impede the delivery of patient care.²

Professionalism in Healthcare

In contrast, professionalism is defined as the skill, good judgment, and polite behavior that are expected from a person who is trained to do a job well.³  Professionalism is behavior that should be exhibited by all clinicians working in healthcare. This is a basic principled practice and all clinicians should hold themselves and one another accountable to adhere to the highest standard of conduct at all times.

The correlations that are made between disruptive/intimidating behavior and patient safety are well-documented.  However, the strategic challenges come with identifying, reporting and managing this undesirable behavior.

Recognizing Disruptive Behavior

Disruptive and/or intimidating behavior can manifest itself in different forms.  When we hear these words, we typically think of overt actions that are unquestionable, such as verbal outbursts, throwing instruments during procedures, and physical threats.  On the other hand,  disruptive and/or intimidating behavior can also manifest itself in the form of passive activity, which can have an equally compromising effect on patient safety.   Intimidating and disruptive behaviors are often manifested by health care professionals in positions of power.⁴

Activities such as refusing to perform assigned tasks or quietly exhibiting uncooperative attitudes during routine activities are a few examples of passive activity.

The Joint Commission identifies these types of behaviors as⁵:

• reluctance or refusal to answer questions
• failure to return phone calls or pages
• condescending language or voice intonation
• impatience with questions

A presence of the hierarchical structure in combination with  intimidating/disruptive behavior can create significant barriers to promoting a culture of safety and a zero tolerance policy.  This results in clinicians failing to report critical information or question an order to avoid this type of behavior and conflict in the future.

Ironically, a survey on intimidation conducted by the Institute for Safe Medication Practices found that 40% of clinicians have kept quiet or remained passive during patient care events rather than question a known intimidator.⁶

Examples of Passive-Aggressive Behaviors

In addition to overt behaviors, it is essential to identify those behaviors that are passive-aggressive:^5,7

• Distrusting opinions of others
• Protecting own territory
• Difficulty accepting feedback
• Individuals who interfere in teamwork
• Using authority to punish others
• Monitoring team members behaviors
• Having no concept of own actions

There is a common tone that exists in the specific behaviors noted above.  This behavior has an end result of a dysfunctional team while promoting isolation and undermining the team goals of delivering safe and effective patient care.
Holloway and Kusy go further to note the classification of behaviors of ridicule, such as⁷:

• Humiliating others
• Making sarcastic remarks
• Pointing out the mistakes of others
• Putting down or blame

Consequences of Disruptive Behavior

Unprofessional behavior impairs or disrupts a healthcare team member’s ability to achieve intended outcomes.⁸  These types of behaviors can be more subtle but can result in the same outcome of compromised patient safety and poor outcomes.

The consequences of intimidating and disruptive behaviors can potentially:

• contribute to medical errors
• negatively impact safe and effective care
• result in poor patient outcomes
• impact patient satisfaction
• increase staff turnover

Proactively Addressing Disruptive Behavior

It is important to define and recognize behaviors that are intimidating and disruptive. However, recognition fails to go far enough. While it is true that phenomenal progress has been made in this area, there is a historical tolerance and indifference to intimidating and disruptive behaviors in health care, which will take time to overcome.⁹

Failure to address unprofessional behavior through formal venues is an indirect way of promoting undesirable behavior.

The first and most important component must be a high-level commitment to a zero-tolerance policy.  The Joint Commission has provided some helpful tips on how organizations should address this undesirable behavior¹⁰:

• Promote the organization’s code of conduct and enforce consistently and equitably at all levels
• Emphasize the organization’s zero tolerance for intimidating/disruptive behavior
• Establish policies/processes that encourage reporting of intimidating/disruptive behavior
• Establish expected code of conduct and hold team members at all levels of the organization accountable for modeling desirable behaviors
• Respond to patients and/or family members who are involved or witness intimidating and/or disruptive behavior
• Empower and educate staff on conflict resolution and how to respond to intimidating and/or disruptive behavior
• Provide proactive forums to encourage inter-professional dialogues

It is critical for organizations to be strategically proactive in their approach to a culture of safety.

Proactively Identify Strong Interpersonal Skills

Identifying those top-performing candidates possessing the interpersonal skills is a key component in taking a proactive approach.   Prophecy is committed to assisting with the identification of these candidates by offering valid and reliable assessment tools such as the Behavioral and the Situational assessments.

Prophecy’s Behavioral assessment includes not only a teamwork scale, but also identifies candidates who possess tendencies toward hostility – potentially foreshadowing disruptive behavioral challenges.

In addition, Prophecy’s Situational assessments replicate real-life interpersonal scenarios and assess performance dimensions such as:

• verbal communication,
• problem solving,
• providing calm/competent care,
• developing patient relationships and
• patient customer service.

These valuable tools can assist organizations in taking a holistic approach to interpersonal competencies in order to promote a culture of safety for their organization.

Let’s look at how Prophecy’s assessment tools help pinpoint developmental needs of individual employees, and provide a road map of the most beneficial kinds of training & development on an individual, or departmental, level.

Advising Healthcare Employee Transfers

In an article in the Harvard Business Review (1999), “Job Sculpting: The Art of Retaining Your Best People”, career experts Timothy Butler and James Waldroop found that by using the technique of matching people to jobs that resonate with the activities that make them truly happy, employee turnover decreased dramatically and productivity increased exponentially.

“Deeply embedded life interests do not determine what people are good at—they drive what kinds of activities make them happy. At work, that happiness often translates into commitment. It keeps people engaged, and it keeps them from quitting.”¹

Prophecy’s Behavioral assessment not only identifies these characteristics, but also allows you to match an individual’s results with multiple categories (ER, Med/Surg, ICU, etc.) to see which position fits their personality best.  Informed internal transfers help increase employee morale and motivate individual employes.

Clinical assessments can also be used to identify areas of skill deficiencies for training prior to transferring departments. This positions the employee to be fully capable of succeeding in their new role from the get-go.

Developing Hospital Department Trainings

Once a department completes the assigned assessment you can pull reports showing benchmark scores department wide.  Digging into these reports helps pinpoint gaps in education allowing you to determine focus areas to maximize your clinicians’ hours spent training:

Prophecy’s Situational Assessments showcase areas of improvement such as:

• customer service
• prioritization skills
• conflict management

Clinical Assessments offer a detailed view on clinical knowledge, skills, and abilities that need to be developed as a whole within a department.

For example, results from an ICU department might show low scoring in a category such as Endocrine knowledge.  So, an education initiative could be developed to increase knowledge around:

• special protocols for diabetic patients
• the effects of insulin and oral anti-diabetic agents
• treatments for hyperglycemia and hypoglycemia

With the majority of Prophecy’s Nursing and Allied Health assessments being developed using Prophecy’s rigorous validation process, parallel forms are available, offering clients “A” and a “B” versions. Parallel forms, although alike in content breadth and difficulty level, house unique questions from one another. This aids Prophecy clients in the ability to offer pre-training / post-training testing with unique question sets to further facilitate and customize education initiatives.

Creating Individual Improvement Plans

Even though Prophecy’s assessment suite allows for global diagnostics of incumbent staff members in an unlimited number of grouping combinations (departments, facility locations, health system-wide, etc.) individual results capture the same deficiencies on a more personal level.

The evidence is clear that employee development not only leads to increased productivity, but also that organizations that focus on employee development create an enduring impression on their staff earning loyalty.

“According to the American Nurses Association (ANA), the cost of recruiting and replacing an RN is 1.1 to 1.6 times an annual nurses’ salary. According to the Bureau of health Professions, the mean RN salary for 2010 is $66,530.”²

With the ANA reporting that the current cost of replacing a nurse averaging over $80,000, fostering loyal employees is a wise investment.

Loyal employees tend to stay with their organizations not only in good times,
but in challenging times as well.

Running a staffing business is a little like playing the game whac-a-mole. Just when you’re bill rates are providing the needed margin boost, your worker’s comp audit comes back and you’re due an increase, or your professional liability carrier has had a bad year and your number is up. These are only a couple of the issues that face healthcare staffing firms every day, but are examples of the ever moving targets that must be addressed.

Selecting a healthcare staffing application will not eliminate the various “pop-ups” that managers face, but it should provide seamless tools to proactively address these issues. I like to use the analogy of officials in sporting events. The best and most effective officials are the ones that are rarely, if ever, mentioned during the course of a game. Their job is to enforce rules of competition while attempting to eliminate the specter of subjectivity.

At the end of the day, a healthcare staffing firm wants to see their internal processes followed without exception, and their desired outputs created without interruption.  Here are some classic mistakes firms make in their software decision process:

1)   Wow! It looks SO GOOD! I love the icons and beautiful interface! 

Be careful, and try to remember what the official looked like at the last competition you watched. If you can’t, then likely the official was doing their job exactly as expected without drawing undue attention to themselves. Great that they combed their hair and tucked their shirt in, but ultimately that’s not what they are there for.

2)   This software does EVERYTHING!

Beware the Holy Grail of healthcare staffing software! When was the last time you saw an official attempting to sell snacks while trying to focus on managing the game? It would not be impossible to sell snacks during a game, but it would certainly diminish the effectiveness of both activities. Make sure you have applications that are devoted to the areas of your business to complete your processes.

3)   This system is SO CHEAP!

The cost of a healthcare staffing software is relative to the cost of doing business. Having volunteered to referee various sporting events when my children were young, I realized what they got was pretty close to what they paid for!  When the speed picks up, and the stakes get higher, there will always be a cost associated with quality. Too many firms ignore the costs associated with down time, time on the phone with support, and ultimately the flexibility of the system to do exactly what the client wants.

The next time you watch a sporting event, take heed of the officials, and stop to appreciate how the best ones are rarely noticed!

For more info, contact Julie Moore directly at 615-349-1985 ext 702.

Find out more about BlueSky Medical Staffing Software by visiting the
BlueSky Blog, Twitter account, or Facebook page.

Why should staffing agencies pay for testing clinicians
before placing them?

Given their tight relationships with clients, the BSS support team’s rationale behind the importance of staffing agencies testing their clinicians before placement weighs heavily on each client’s decision.

So, we put together a reference for the BSS staff of our top 5 reasons all healthcare staffing agencies should not skip the step of testing the competency of their clinicians before hiring them.

Be sure to read the full article, but here is the CliffsNotes version!

1) Hire More Qualified Caregivers

Stand out from competitors by being proactive and selective in your hiring process based on the ability to prove clinical competencies.

2) Reduce Do Not Return Orders

So, testing a clinician’s job knowledge, skills, and abilities before placing them with a facility directly decreases the likelihood of a facility filing a DNR due to clinical skill deficiencies.

3) Increase Nurse Applicants

Once facilities recognize the higher caliber staff you place, they will increase the number of placement requests with your agency.

4) Increase Demand of & Improve Contract Terms

Demonstrating your ability to place high caliber caregivers, volume of demand increases.  Facilities value your organization’s referrals putting you in the driver seat to negotiate better terms of contracts!

5) Stay Out of Court!

The use of validated healthcare competency exams ensures compliance with federal guidelines!  If adverse impact claims (hiring discrimination) are filed against your organization, using validated hiring tools can assist you with defending these claims.

Want more reasons?!  We’d be happy to provide them.  Our list could have kept going and going and…well, you get the point.  Please help us continue to add to this list with your reasons in the comments section below!

Why can dysrhythmia exams seem so challenging? 

Well, unlike typical specialty-specific exams, such as an ER Exam for Emergency Room nurses, or PCU for Progressive Care Unit nurses, dysrhythmia exams are developed with all specialized fields in mind.

With the use of advanced bedside monitoring technology, nurses can forget the basics they first learned in their formal EKG training, when it comes to interpreting rhythms.

What does that mean for each individual nurse? 

Well, a Neuro ICU nurse may have grown more accustomed to depending on bedside cardiac monitors and alarms and alarms since their specialty lies in neurology.  A Progressive Care nurse, on the other hand, deals with dysrhythmias on a frequent basis and should be more alert to quickly interpret and evaluate arrhythmias.

Dysrhythmia exams take away the familiar beeps and alerts of ECG monitors forcing the test taker to demonstrate their ability to detect, measure, and interpret cardiac rhythms.

Regardless of the specialty, correct identification and treatment of dysrhythmias are a key component to safe patient care.  Incorrect identification could lead to irreversible damage and potential fatalities – unanimously, the worst outcome of medical errors.

How should nurses prepare for a dysrhythmia exam?

1)    Read all Prep Material.

No, we don’t mean skim – seriously STUDY all material provided by the testing company.  If the company didn’t find the information vital to a nurse’s success, they wouldn’t use their resources to put the information together.

For instance, both Prophecy’s Dysrhythmia Interpretations (Only) and Dysrhythmia Interpretations and Measurements exams are accompanied by content outlines.  These content outlines contain extremely useful information to help refresh a test taker’s familiarity with dysrhythmias – much of which I used to create this helpful blog!

2)    View ECG Rhythm Strips

Whether the nurse Googles phrases such as:

• Bradycardia Rhythm Identification
• Atrial flutter Monitor Reading
• 2nd degree-Mobitz II Rhythm Measurement

… or pulls out old nursing school text books, he/she should practice interpreting rhythms prior to launching their timed/scored assessment.

Prophecy’s Content Outline for these assessments name all the potential types of rhythms assessed on the Dysrhythmia exams!

3)    Recall How to Properly Read ECG Paper

Prophecy’s content outlines provide nurses with a detailed review on how to use ECG paper to properly measure rhythms.  This is one of the images available to nurses as they commence their preparation for the Prophecy’s Dysrhythmia Assessments.

Being able to use ECG graph paper for measurements directly leads into one’s ability to identify regular or irregular rhythms – step one below.

4)    Memorize the Steps to Rhythm Interpretation

1. Is the rhythm regular or irregular?
2. If it’s irregular, is it irregularly irregular?
3. What is the rate?
4. Is the rate too slow or too fast?
5. Is there a P for every QRS?
6. Is there a QRS complex for every P-wave?
7. What is the P-R Interval? Is it constant?
8. Is the R-R interval regular?
9. What is the QRS duration?
10. Is the QRS wide or narrow?
11. Are the QRS complexes grouped or not grouped?

Skipping any of these steps could be mean the difference between passing and failing a Dysrhythmia Assessment, being offered or denied a placement, or failing to become proficient enough in ECG interpretation to save the fragile lives of patients in the future.

We strongly urge hospital educators, staffing agencies, and recruiters to stress (no pun intended) the importance of nurses following these steps prior to attempting any Dysrhythmia assessments.

• Operating Room – First Assist
• Preoperative Care

Both of these assessments are now available on the Send Exams screen.

Operating Room – First Assist Skills Checklist

The Operating Room – First Assist Skills Checklist is appropriate for the clinician functioning in the role as a First Assist.  This skills checklist encompasses the following:

• Perioperative Care
• General Skills
• Advanced Skills Sets
• Surgical Procedures related body systems
• Equipment common to the First Assist

Preoperative Care Skills Checklist

The Preoperative Care Skills Checklist is appropriate for the clinician providing preoperative care such as commonly seen in outpatient settings.  This skills checklist encompasses the following:

• General Preoperative Preparation
• Plan of Care Development including preop teaching & interdisciplinary collaboration

We hope these new additions will further meet your growing business needs!

Clinical Operations Support

PPS, under direction of Chris Carrington, RN MS, Chief Clinical Officer of Prophecy Healthcare, offers a cost effective Clinical Oversight program providing the following to healthcare staffing organizations:

• clinical expertise
• operations
• risk management
• quality improvement guidance and support

As a well established nurse staffing company, RN & Allied Specialties employed two full time Registered Nurses. Andrew Lamberson, President of RN & Allied Specialties, knew they had to address this salary expense but the company could not be left without an RN presence.  The RN function was extremely important to the company’s overall quality control – interviewing, credentialing, oversight and incident involvement.

Reducing RN Expense for Staffing Agency

Given the firm’s association with Christine Carrington, RN, MS, Chief Clinical Officer of Prophecy Healthcare, since 2008 when she helped RN & Allied Specialties obtain its Joint Commission Healthcare Staffing Services Certification, Lamberson reached out to explore options.

Lamberson commented, “In talking with Chris, she shared her Clinical Oversight program with me and I was immediately intrigued as well as relieved – we had an option, a good option.”

Ultimately, Lamberson elected to shift the entire RN responsibility to Prophecy Professional Services.  Carrington personally handles all of their clinical interviews and clinical incidents working with their staff and external workforce as though she is an RN & Allied Specialties employee.

“Playing an active role in this turn-around success story has been so rewarding on a personal level,” said Chris Carrington, Chief Clinical Officer of Prophecy Healthcare.  “We were able to create a solution at a time of need for a very deserving organization.  Being considered part of the RN & Allied Specialties family is an honor and I enjoy each interaction with Lamberson and the rest of his team.”

On a personal note, we appreciate RN & Allied Specialties being willing to allow us to share their story in hopes to help other staffing agencies in the industry recover from this challenging economic time.

Be sure to check out the full release here!  And, let us know if you would like more information on reducing in-house RN expenses with clinical operations support.

Here are some tips for using customer feedback to
change your company behavior for the better.

1) Real Time Feedback. 

The sooner you receive customer feedback the better. Most companies are still asking for customer feedback quarterly or only a few times a year. This can cause customer attrition that is hard to recover from. Be sure you have a mechanism in place that allows your customers to give you feedback instantly and at times it’s convenient for them.

2) Direct Feedback. 

Make sure customer feedback is sent directly to the team member responsible for delivering the service to the customer. This way, your team members get consistent responses to their interactions so they can adjust their behaviors and actions properly. Positive feedback reinforces their exceptional service and negative feedback alerts them to issues and areas they can improve on.

3) Focus on Details. 

There has been a lot of talk about the gamification of customer service recently. Common components of gamification include things like points, scores and leaderboards. While these things help increase engagement and are a big aspect to the overall success of a closed loop customer feedback process, it’s important not to lose sight of the big picture. When measuring customer feedback, it’s important to focus on the specifics requests and actionable items found within this feedback, rather than on the scores themselves.

4) Keep Managers Engaged.

It’s important that company managers and executives have insight into customer feedback. These team leaders may not need to know every detail of each customer interaction, but it’s crucial they have an overall sense of customer sentiment and important issues that need attention. This information should encourage team leaders to use customer feedback for coaching, not just evaluating - ultimately helping employees meet their personal, team and company goals.

5) Lessons become Guides. 

Design training and company on-boarding programs to reinforce the value of lessons learned from your closed loop customer feedback process. The relationship building and problem solving strategies learned daily from this process can eventually guide the entire direction of your company.

Really, it’s quite simple: Collect consistent, real-time feedback from your customers that goes directly to the team members providing customer service. Be sure that feedback is accessible to managers and executives, and pay attention to the details. Use this information to coach and reward employees, address customer issues and use as guiding principals for your company as a whole. Following these tips will help your company create a culture of exceptional customer service.

Blog post by  Jason Lander, Founder and CEO of Hively and Staffing Robot.

With over a decade of experience in the field of healthcare assessments, Ron brings a unique perspective to the panel.

Assessment Futurism, “Not what assessments should be,
what assessments could be in the future”!

Tuesday, April 17th 1:00 – 1:45 PM/Central time

The panelist will be touching on what assessments should be today such as valid, reliable, predictive and legally defensible as well going deeper into what assessments could look like in the future: 2020, 2050 and beyond.

Healthcare Industry Pioneer

Ron has a proven track record for taking healthcare competency to the next level.  His flagship product, NurseTesting.com was the first online Pre-Employment Testing Company exclusive to the Healthcare Industry. Initially focusing solely on clinical assessments measuring clinical competencies, efforts to exceed industry expectations led to isolating critical competencies missed in traditional testing initiatives, such as:

Thus prompted the development of Prophecy Healthcare – a holistic approach to nurse competency assessments.  After only two years in the market, Prophecy is already changing the way health systems and hospitals approach human resource initiatives for the better.

Please join the webinar for the first futurism discussion about assessments and the use of assessment tools. With only 100 registration spots available, you will want to reserve your space today.

There are many moving parts when conducting a physical assessment, and nurses use many tools when assessing a patient’s overall physical status.  Some of those tools include:

• a stethoscope,
• an oxygen saturation monitor,
• a pen light, and many others.

Portable ECG Monitor

The portable ECG monitor uses electrodes attached to the surface of the skin on the patient’s chest and interprets the electrical activity of the heart over a period of time.  Due to the high frequency of using this device in routine patient care, it is imperative that nurses responsible for these patients have a comprehensive understanding of ECG monitor itself and how to interpret the electrical activity of the heart, as seen on the ECG tracing.

Statistics show that heart disease is the leading cause of death for both men and women, and causes almost 25% of deaths –one in every four– in the United States.¹  Every year, about 785,000 Americans experience their first heart attack.  Another 470,000 who have already had one or more heart attacks have another attack.²  These statistics alone explain how important the ECG monitor is in overall cardiac assessment of patients.

The monitor allows healthcare professionals to detect cardiac abnormalities, including those in which the patient is asymptomatic (no chest pain or pressure, no shortness of breath, no reports of fatigue, etc.).  The ECG is a recording of the electrical activity of the heart, and provides clinicians with information about many heart conditions as evidenced by characteristic patterns on the ECG tracing.³

ECG Tracing Interpretation

Interpreting the ECG takes serious skill, a keen eye, and a good theoretical foundation of knowledge on the different dysrhythmias and concepts around the heart’s conduction system.  The ability to interpret the tracing takes many years of practice to master and is becoming more important in the world of advanced technology used in patient care.

This knowledge in important because the ECG monitor is used in so many different patient care areas, including the operating room, emergency rooms, critical care areas, outpatient stress testing, outpatient surgery centers, clinics, and many more!

The output from the ECG monitor provides the clinician with information such as baseline heart rate and the heart’s electrical conduction system.  When abnormalities are seen, it can provide clues to medical problems with a patient, including:

• electrolyte imbalances
• pacemaker malfunction
• heart valve disease
• inflammation of the heart
• abnormal heart rhythms
• toxic levels of drugs within the body
• insufficient cardiac blood flow
• death of heart muscle due to a coronary thrombosis.⁵

The nurse’s identification and recognition of arrhythmias and linking the information to the clinical status of the patient are critical to safe, effective practice.  A recent study concluded that nurses were able to recognize that an ECG tracing was in fact, life threatening, but they were unable to correctly identify the actual arrhythmia.  Subjects in the study confessed that they have worked with experienced critical care nurses that do not know the difference between supraventricular tachycardia and ventricular tachycardia.⁶

Prophecy Hopes to Help Fill in ECG Interpretation Gaps

Prophecy is dedicated to assisting clients in providing quality patient care.  One of the first things any employer can do is assess the clinicians level of knowledge and competency in relation to their specialty.  Prophecy’s recent launch of basic dysrhythmia assessments can assist clients in validating such competence for nurses who are required to have this skill on the job.  These assessments critique the nurse’s ability to interpret heart rate, PR interval and QRS duration measurements, as well as the overall cardiac rhythm.

As mentioned throughout this article, the ECG monitor is a frequently used tool in overall medical management of a patient.  While nurses provide constant supervision of care, it is obligatory that nurses are able to demonstrate competency in this skill.

For more information on these assessments or how Prophecy can assist you in determining competency in your applicants, as well as your incumbent workforce, please reach out to us at 888-PRE-HIRE Opt. 3.