When confronted with an off-color situation between a staff member and a resident, the effort that a manager puts into investigating the facts is more than just a good customer service gesture. The community must ensure that there is immediate action around the occurrence and that it is addressed systemically for the future. The charge nurse can play a very effective role in collecting facts and minimizing exposure.
Recently, a weekend nurse debriefed me on an abuse allegation that had been made just several hours earlier in the morning. The nurse had immediately assessed the resident situation and systematically clicked off a number of key facts regarding the incident:
- The assessment and status of the resident
- The immediate actions taken, including meeting with and immediately suspending an employee
- The staff involved, including other employees secondary to the incident
- Brief history and status of the resident and family
- Brief history and status of the employee
- Documentation, including witness statements, from above mentioned employees
- Educated conclusion to the allegation
- Action steps still needed
In addition to her consideration of these key steps, this licensed nurse minimized the disruption of employees and residents not directly involved. This maintained privacy for the resident and staff involved, and will hopefully enable leadership to conduct root cause analysis that can in the future identify abuse before it happens.
Successful communities will be those that have an outwardly positive culture. By consistently reinforcing not just positive outcomes but also positive behaviors, employees begin to find job satisfaction and success in just being happy. Employees who fail to embrace this culture standout more quickly and can be evaluated prior to an abuse situation.
Good investigation techniques often translate into good assessment skills, and similar strategies should be encouraged when dealing with other problems or diagnoses in the community. Leadership must build constructive questioning into daily processes. Nurses that use their senses to answer the questions of who, where , why, and how eliminate negative outcomes by considering the root cause of an issue. This includes an assessment of staffing, environment, emotions and morale. Often something happens in the course of a day or even week that sets off a chain of events, and employees should be able to identify when those situations are escalating.