Supervision to Enhance Relationship-Based Care & Nursing Task Efficiency

by Sharon Strand Ellison

A Complaint about a Nurse Taking Too Much Time for Tasks

Faith complained to Joan, her supervisor, saying, “Angela’s not working fast enough. She is taking about 5 minutes per room on her rounds.” Joan, as supervisor to both nurses, now has the difficult task of determining what issues are contributing to the problem. Angela may be inefficient in her performance of routine tasks, or she may be taking a little extra time with a few patients who are upset. Or, it may be some of each.

Despite the level of compassion so many nurses have for patients, achieving the goal of consistently strong relationship-based care is still a struggle. Part of what impedes the progress is dealing with situations like Faith’s complaint. How Joan responds, both to the complaint and to Angela’s choices, can impact the quality of care among nurses she supervises. Even taking the time to sort it out is difficult in a fast-paced, stressful health care environment.

Ignoring the Issue

Joan might say to Faith, “Well, Angela’s pretty new, it might take her a little while to get up to speed.” This could leave Faith with the sense that her concerns are being ignored. Joan might ask Angela, “How are things going? Do you feel like you are getting things done pretty efficiently? Here, Angela may quickly deduce that someone is concerned about her pace and feel the sting of indirect criticism. Or Joan might say, “Can you work on your pace a little, so you don’t spend too long in any one room?” Here, Angela might get hear the implication that she should tend to the physical care only, and not take time to talk with any patients.

In most professions where the majority of professionals are women, there is a tendency to not want to hurt people’s feelings, so comments are often made indirectly. Of course, in any environment, there are also those who express their honesty harshly. Men and women alike tend to lean either toward being indirect or being abrupt when they give feedback. With the use of traditional communication methods, both direct and indirect feedback are often experienced as “criticism.” Both can fuel power struggles.

Being More Direct with Both Employees

Learning to speak to each other very directly while being respectful and caring can create an environment that fosters the kind of decision making essential to relationship-based care. Joan might say directly to Faith, “I don’t know why Angela is often spending 5 minutes in a room. I will talk to her and get some information about whether the issue is learning the routine, organizational skills and/or choices she is making about talking with the patients.” Here, she is responsive, while making it clear that there could be a number of issues that might color the situation differently.

When speaking to Angela, Joan said directly. "I have noticed that you are taking about 5 minutes in each room, which in some cases, might be a little long. I want to find out more about what your process is and at the same time be clear that I want to support you, not criticize you. Would you be willing to give me an example of what you might do in a room where it takes you the longest?"

Angela replied, “Today, one patient, Deborah Johnson, had not slept and looked really worried so I sat down and asked if she was upset. She told me she was worried about how long it was going to take her to get back to work after her hip replacement. She was afraid she’d run out of sick leave and she couldn’t afford it. She was also helping her daughter get through a program to become a dental assistant and was worried that if she couldn’t help her she’d have to drop out.”

Angela said she talked with Deborah realistically about how long rehab can take and advised her of some of the things she could do, both to heal as quickly as possible and to protect herself from doing too much and damaging her hip in the process. Angela concluded, "It turned out she’d been afraid to take her walks so soon after the operation for fear of hurting herself and taking longer to get better. After we talked, I think she felt much better, and was motivated to do her exercise."

Joan created a context for her question and then asked it in a way that gathered information rather than conveying judgment. In the process, she found out that Angela had been very skillful with this patient.

Next, she asked, “Would you tell me what you did in one of the rooms where you spent the least amount of time and about how long it took?" This time, Joan found out that Angela had spent what she considered to be too long talking to a patient who didn’t have a significant emotional need. Angela was afraid of looking “cold” if she didn’t talk to every patient. While Angela had good instincts about relationship-focused care, she wasn’t discerning when to make efficient work of taking care of the patients' physical needs.

With this information, Joan was able to guide Angela. Faith and other nurses could see improvement in her pace. In many hospital settings, as in other professional environments, Joan may not be able to tell Faith what she found out when she talked to Angela. She might, however, be able to say, “I have spoken to Angela and believe she is committed to strengthening her efficiency while meeting patients' emotional needs.”

Joan might also ask Faith, “Do you talk with patients very often if they look upset or do you focus more on their physical needs?” With this question, she might open a discussion and discover that Faith has a hard time feeling comfortable asking patients what’s wrong when they look upset. If so, she could give Faith guidance on how to ask the patient, or if Faith is too uncomfortable, to let Joan know so that someone else could go and talk to the patient. Joan could say, “What I hope for is that we can all get stronger in being very efficient when the patient is doing fine and knowing how and when to take the time to talk with patients when they need support.”

The tradition of patient care that is primarily focused on physical tasks is still strong for many nurses. A health care supervisor can send messages that inadvertently reinforce resentments among healthcare professionals who fall in different places on the continuum of balancing physical and emotional care for patients. With directness and supportive honesty, a manager can create an environment where everyone strengthens the wisdom of their choices.


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