Is it an individual issue?

If there is only one individual involved, make sure the discussion is held in private. People who want to make a statement may feel they have won if they feel that others have taken notice, or that they have got something in return for behaving this way. Once you have listened to their issue, agree appropriate alternative action and ensure they agree to abide by the terms of the policy in future. Make sure they are aware that if they continually breach the uniform policy or dress code, they are liable to disciplinary action. Remember to let them know that you will be making a file note of the discussion and agreed actions (see Ch. 4).

Is it a team issue?

If you have recently taken over a new team as a ward manager, you may find yourself confronted with several members or even the whole team who are not adhering to the uniform policy. It can be a tricky situation if they have been doing this for years. It would be advisable in such a situation to raise the issue at a team meeting and have a general discussion about dress codes and uniform issues.

Cultural, race and religious requirements

While all staff should adhere to the uniform policy, you must be sensitive to the needs of different cultures, races and religions. You should be able to accommodate these needs within the uniform policy. If there are particular difficulties, consult your human resources (HR) advisor. It would not be appropriate to discipline staff for non-compliance from having to adhere to a particular cultural, race or religious dress code.

Swot analysis

SWOT stands for ‘strengths, weaknesses, opportunities and threats’.

Draw a matrix (Fig. 14.1) and get your team to identify:

Fig. 14.1 SWOT analysis.

Appendix 14.1 gives an example of a SWOT analysis. This tool helps teams to identify the weaknesses and threats of either the current system or the new system being proposed. But don’t leave it there, otherwise you will just be left with a long list of factors and no attempt to do anything about it.

Getting staff to manage their time more effectively

Don’t be tempted to send people on time management courses unless the course is particularly aimed at clinical staff. Time management courses are usually more helpful for office workers or people who do not spend their working days dealing with the unpredictable. Teaching people to manage their time at work becomes a lot more complex where unpredictable patient care is involved.

A more effective method of helping this individual would be to take some time to work alongside them, preferably for whole shifts at a time. That way you (or one of the more senior members of your team) can show them how to prioritise their work and how to deal with the unpredictable. Your seniority will also give them permission to lower their standards when necessary, such as in times of staff shortages. An example is helping a patient with partial paralysis from a recent stroke to get dressed. A high standard of care would be:

However, rehabilitation takes a lot of time and patience. If the nurse has eight patients in a similar position, delivering an exceptionally high standard of care for every one of them may simply not be feasible within the time limits of their shift. They can either give all eight an adequate standard of care, i.e. talk the patient through some of the process and physically help them through the rest, or purposefully delay some parts of their care until the later shift comes on duty.

Prevent burnout

Many nurses have learned how to manage their time and priorities through experience, but some are reluctant to lower their standards and end up exhausted by not taking their breaks or staying on late to finish their work. People who work like this rarely complain. They simply get on with it, thinking that they have to make sacrifices in order to deliver a high standard of care. Watch for people like this and take action before you end up with an exhausted and stressed member of staff. Often it is their home life and self-esteem that suffers long before the stress and exhaustion become an issue at work. By the time they reach the stage of taking time off sick from ‘burnout’, it may be too late for you to take action.

By spending time working with the individual as outlined above, you can show them how to work out which aspects of their work are the real priorities and which are their own personal priorities. You cannot just tell people how to plan and prioritise their care at the beginning of the shift; things always change. A patient’s condition may unexpectedly deteriorate or there may be unexpected admissions or transfers. If you work the whole shift with them, you can demonstrate how to re-prioritise as changes occur.

Maintaining good standards of care

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