Improve your environment through communication and change.

W hen Linda agreed to become nurse manager for the floor of a major teaching hospital, she had no illusions that turning around this " war zone, " as she describes it, would be easy. Nurses were using street language in front of patients. Staff members yelled at each other. Patients routinely wrote complaints about the staff. In other words, respect, teamwork, and accountability were scarce. These interpersonal problems seemed at odds with the hospital's prestigious medical reputation. It was regularly ranked as one of the ten best hospitals in America. Yet, Linda was the eighth nurse manager on her floor within 8 years. This lack of continuity made it difficult to establish a culture where effective communication, teamwork, or collaboration could grow. However, it was important for Linda to try. She knew that patients would suffer from an unhealthy environment. Her assessment is easily validated. Research states that relationship issues are real obstacles to the development of work environments in which patients and their families can receive safe, excellent care. Inattention to work relationships creates obstacles that may become the root cause of medical errors, hospital-acquired infections, and other complications. 1 Successful strategies Like Linda, you may want to change a destructive atmosphere in your organization to help provide the best possible patient care. To cultivate a healthier, team-oriented environment , begin by making an honest appraisal of your situation. Talk with people who'll speak frankly. Then, estimate how long it'll take. You may not get everything you need, but doing something is better than doing nothing. It'll take a lot of work. Early on, Linda's team worked 12-to 14-hour days. That included the assistant nurse managers for the three divisions on her floor and their assistants. Members were often paged at home to deal with issues. Progress was slow, but the effort was worth it. Here's an overview of some of their successful strategies that can serve as a framework for change: 1. Gain the administration's support. If you can't attain it at the highest level, get the backing of those immediately above you. You want them to go to bat for you with their own bosses. Linda was fortunate to gain support from her director and CNE. Be prepared to sell your ideas of what you hope to accomplish and how you plan to go about it. All you're asking for now is to be allowed to …