We’ve been on a role this week digging into the characteristics of a clinical leader. We are going to dive into the glue of it all today. Trust. In any profession, there is a foundational need to build trust. In this article, we will discuss why trust is so important and how to get it.
If you haven’t caught the previous parts, please check them out below.
As a clinical leader having others’ trust can make or break your career. I learned early on; trust is such a valuable yet fragile thing to have. The good news is you already have a leg up on every other profession just by being a nurse! In 2016 Nurses were ranked #1 in Honesty, and Ethical Standards per the Gallup Poll ratings done December 7-11, 2016. This is the 15th straight year topping this list with 84% of the public rating nurses as “High/Very high.” Compare this to members of Congress where 59% of Americans rated their Honesty, and Ethical Standards as “Low/Very Low.”
Find the full results here – Gallup Poll.
Why is that? What do nurses do to foster such a high rating?
In a recent article on boston.com Inna Khazan was cited as saying, “Nurses are the one you call if you need something. People tend to place more trust in those that are directly caring for them.”
As a clinical leader patients, families, staff, and co-workers all rely on your opinion. However, without trust your opinion means squat. I remember when it dawned on me how important this is and how we must continually work to gain it.
Around my first week as a supervisor, we had a new admit come in. I remember meeting them and introducing myself and right away they had a complaint. The room was too cold. “Oh, this is an easy one,” I thought to myself, I can fix this. I assured them I would take care of their problem.
Then I got a call. A patient had fallen, and I needed to respond. I ran to the scene and took over. We provided minor first aid to a small laceration, and luckily the patient was okay! Now around this time, my shift was coming to an end, so I finished out my day and took off. Completely forgetting about the new admits request. Oops. No big deal right?
The next day I went in to check on them, you know, make sure everyone was treating them well.
“Why is my room still freezing we asked you yesterday to fix this”!
“I am so sorry I don’t know why no one has fixed this yet,” I said as if I told someone to fix it.
About the time these words leave my mouth, in walks maintenance.
“We will have this fixed in no time thanks for calling us we had no one told us this wasn’t working.”
And… I had done it. They couldn’t prove that I hadn’t reported it, but they saw right through me. Trust was out the window.
This might seem like a minor thing at face value but fast forward a few months. Our relationship deteriorated. It didn’t matter what I said or what I did; it was wrong. I was having to explain myself at every step and often that wasn’t even good enough. This was one of the most challenging assignments I have ever had. Not because of the acuity or the complexity of the care, but because it was based on a foundation of mistrust. I had lied and crushed it from the beginning. What saved this one? Eventually, I walked into the room looked the patient and the family in the eyes and apologizing. I admitted my fault and took ownership. I told them I had forgotten to notify someone of the room and feel that led to a negative relationship and I apologize.
“When the trust account is high, communication is easy, instant, and effective.”
― Stephen R. Covey, The 7 Habits of Highly Effective People: Powerful Lessons in Personal Change
So how do you go about building trust?
As you can probably guess by now. I learned my lesson. One of the first lessons I tell new nurses is this one. If you make a mistake come to me. Be honest, and we will do whatever needs to be done to fix it or make it right. But don’t lie, not even by omission. I don’t know a single nurse who has lost their license by accident. It is more often by trying to cover up mistakes than the actual mistake itself. Look, we all make mistakes. We all forget to do something. The only way to recover is to shine a light on it, apologize, and strive to do better. If you can’t be trustworthy in the little things, you can’t be trustworthy in the big things.
Nurses are pulled in dozens of directions every day. It is important to find a system to keep you on task and remind you to follow through. I figured out a long time ago if I don’t write something down I will never remember it. As a clinical leader, I have learned to treat my day as if I am at the bedside. Being bedside, we often have a scrap piece of paper that we took report on; for some reason as clinical leaders, we stop doing that.
I now have a notebook or laptop or sometimes even just my phone that I am constantly taking notes on and am a huge fan of running to-do lists. I start my day by making a list of things I need to accomplish and as the day goes on, I will add to this list or scratch things off. My last hour or so I take a minute to look at my list and triage what’s left. Anything that absolutely can’t wait, I do then. If it can be postponed till the next day, I will start my list for tomorrow and add these items to it.
The key here is communication if you can’t complete a task make sure you let the person relying on you know. Also, give them your deadline on when you will have it done. I usually say something like, “I had some things come up today and was not able to complete that task, I have it on my list for tomorrow and will have finished by this time. Does that work for you?” That way they know you didn’t blow them off.
We learned a lot about triage in nursing school. I propose you can take what you learned and apply this to your role as a clinical leader. Just like triaging patients takes practice, triaging interruptions takes practice as well. I find new nurse leaders usually start out one of two ways.
The first, take on everything as soon as it crosses their plate. These nurses are sitting with a patient doing an assessment, and someone walks in with a phone call. They excuse themselves and answer the call, going back to the patient to only have someone else interrupt. Once again, they excuse themselves and take care it. This cycle turns into a pattern for their work day. They are always stopping what they are doing and taking care of the next” emergency.”
The second group is very task orientated. They sit down to do the assessment, and someone comes with a phone call and before finding out who the caller is the nurse shoos them out the door. However, in this case, it was the doctor who is getting on a plane and needs to give them an order for the patient they are currently assessing.
Both of these leads to patients and families feeling that they can’t trust in your leadership. They may feel you are flighty and not listen or so busy you can never be bothered with their concerns. By learning to make quick triage decisions, you can learn to prioritize your day and your responses. Taking care of those critical situations while devoting your attention to the task at hand.