Team work and team spirit | REW, SS | 1. | Lack of recognition and respect between nurses and beneficiary attendants (BA) | Regular team meetings |
SS | 2. | Negative comments harm the work climate | Training session on team work as needed |
PD, SS | 3. | Lack of mutual assistance | |
REW, SS | 4. | Nurses leave it to BA to stop patients’ bell | New bell system |
REW, SS, DL | 5. | BA feel they are at the bottom of the social ladder and not part of the team | Job enrichment, training, schedule stabilisation, equipment availability |
REW, SS | 6. | Perceived inequalities in hierarchy status of night v evening v day personnel | Remind staff that they can switch work shifts for 15 days every year |
Meeting reports should be made available to all |
SS, REW | 7. | When confronted with negative attitudes from doctors, nurses come to doubt their own competence | Meetings with doctors to sensitise them to the problem |
DL, PD | 8. | Lack of cooperation from doctors, in particular when woken up at night for medical advice | Team support |
| 9. | Unreasonable delays from doctors in answering calls | |
| 10. | Doctors sometimes leave it to nurses to be the bearers of bad news | |
REW | 11. | Nurses’ work is taken for granted by doctors | To discuss during team unit meetings |
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Staffing processes | | | Lack of stability of team units and unskilled personnel increase the need for supervision by nurses: | Creation of an expertise pool for replacements (stabilisation of replacements) |
PD | 12. | Frequent replacements by unskilled staff | Extended training period |
| 13. | Trained personnel on recall list unavailable | Support and integration of new staff (better guidance, twinning, continuous training) |
| 14. | Shortcomings in new staff training | Self-management of replacements by unit |
| 15. | Frequent questions on drug use by young nurses | Provide tools (drugs and intravenous injection guide) |
PD, DL, REW | 16. | Non-replacement of reception clerks causes work overload on return | Creation of a pool of trained clerks for replacement |
Hire and train more clerks |
PD | 17. | Short probationary period | Longer probationary period in particular cases |
Addition of one instructor |
PD | 18. | Long delays in filling positions | Make changes to staffing process |
REW, DL | 19. | Last minute information about job allocation | Self-management of replacements by units |
REW | 20. | Perceived inequity in job security status allocation | Information provided by head nurses |
REW | 21. | Staff from unit A feel that their unit should be recognised as ultra specialised | Project is in motion |
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Work organisation | PD | 22. | BA leaving the unit for patients transportation causes work overload for co-workers | The “stretcher project”† should help solve the problem |
23. | Shortage of BA when emergencies occur and during night and weekends |
PD | 24. | BA work overload necessitates nurses’ help | Twinning and task rotation between BA and nurses in one unit |
25. | Chronic responsibility of heavy cases to the same person |
PD | 26. | BA working for more than one unit in the same shift cause work overload when leaving the unit | Hire more BA (unit B) |
PD, SS, REW | 27. | Weaker BA have physical difficulties in accomplishing certain tasks requiring physical strength | Training |
DL | 28. | BA’s perceived lack of control over their work. They feel that they simply obey orders | The “stretcher project” should help solve the problem |
REW | 29. | Unpaid overtime is often mandatory to ensure patient’s wellbeing. Nurses feel guilty when work is unfinished | Learn to “let go” at the end of the shift |
Improve team communication |
PD, DL, REW | 30. | Lack of time for “CARE” | Solutions to other time constraints will help |
31. | Work is done quickly and under time pressure | Mutual support and team work |
PD | 32. | Work overload for head nurses | Better communicate to caregivers the nature of their work |
DL, SS, REW | 33. | Frequent mandatory meetings restrain their availability | Obtain administrative support |
| Reassign certain care taking tasks to others |
DL | 34. | Nurses are uncomfortable with having to consult doctors by phone for drug prescriptions | Elaboration of new protocols and of permanent prescriptions |
PD, DL | 35. | Nurses sometimes feel that excessive therapeutic measures are taken. They must comply with certain medical decisions counter to their values | Nurses training on treatment motives |
PD | 36. | Vigilance is mandatory to redress errors and omissions from Pharmacy | Problem will be submitted to the nursing-pharmacy committee. A sub-committee will be charged with describing the problem objectively |
New “Unidose” system will help |
PD | 37. | Long delays for Pharmacy orders completion | The new load elevator solution is under evaluation |
38. | Errors in Pharmacy orders delivered by load elevator |
PD | 39. | Inadequate Pharmacy work hours | The problem will be documented in more detail |
PD, DL | 40. | The specialised unit requires workers polyvalence | Palliative care patients should be appointed to well trained care providers |
The hospital has a project aiming to group palliative care patients together |
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Training | REW | 41. | Perceived inequity in access to training sessions | Annual training plan available for consultation and registration |
42. | Evening and night shift care providers feel they receive only a summary of training sessions | Day shift instructors will be asked to give training sessions during evening and night shifts |
PD | 43. | Training outside the unit during work hours causes overload for co-workers | Training of care providers on their unit, during their shift by a clinician |
SS, PD | 44. | Emotional difficulty of having to deal with death on a regular basis | Access to psychological support as needed |
Training in palliative care |
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Communication | SS | 45. | Communication problems from management to nurses and nurses to management, as well as between teams and work shifts | Revision of information and communication systems |
Work meetings between teams and work shifts |
DL, REW | 46. | Miscomprehension of staffing process brings about feelings of not being consulted nor respected | Consultation of nurses from all work shifts in the decision making process |
PD, DL | 47. | Lack of communication about patients’ condition due to non overlapping work schedules | Establish overlapping schedules |
PD, DL | 48. | Insufficient knowledge of patients by doctors requires nurses’ assistance and disrupts their work | Implementation of a clerk’s register |
REW | 49. | Management of hours conversion‡ perceived as a barrier to holidays and vacation | Better and continuous communication of information (oral and written) |
50. | Misunderstanding by staff of holiday allocation |
PD | 51. | Vocabulary used varies within hospital | Exchange documents to standardise vocabulary |
REW | 52. | Caregivers feel that their suggestions are not implemented | Implement suggestions through intervention team |
Ensure follow up and communication of interventions |
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Ergonomy | PD | 53. | Lack of space at nurses’ work station | Ergonomic rearrangements |
PD | 54. | Unsafe and counter-productive disposal of televisions in patients’ rooms and difficult access to patients’ bathroom | Ergonomic rearrangements |
PD | 55. | Patients’ constant bell ringing | Installation of new bell system |
PD | 56. | Software (PIMDI system) is inadequate and time consuming | Make contacts with IBM |
Restart PIMDI users committee |
Contact person available for support |
| System will be reviewed in 2 or 3 years |