I am fortunate to work in a Magnet hospital and one that, even before achieving Magnet status, was open to new ideas from nurses. I see patients in different hospital units, the oncology unit, the surgical unit, the intensive care unit. And because I travel throughout the hospital I encounter nurses in different settings. Perhaps because I am outside of the chain of command, a trusted other, I am often asked for my input on a variety of issues, some clinical, some job stress-related. With the support of our chief nursing officer (CNO), I have been able to put together a small pilot project aimed at mentoring. My idea is simple: support nurses in their practice, whatever that takes.
Over the course of 18 months, I have gone from an ad hoc/organic process to a more formalized and developed approach. In the beginning, I had a brief explanation of what the pilot program was about, but I quickly realized this was too clunky. I kept the parts that made sense, stopped with the mundane esoteric parts, and started with wording that seemed to fit with the adjusted nature of my “pitch.” The challenge was that I needed to make adjustments to more completely communicate my process. And I used the Keep/Stop/Start analysis to help me to this.
When I am doing rounds as part of the mentoring project I am often asked for support/help from nurses. My role as a mentor is not to solve problems but to help nurses solve their own problems. For example, there are a few sickle cell patients who end up on our oncology unit on a regular basis with out-of-control pain. Managing pain in sickle cell patients in a pain crisis is challenging for a variety of reasons; their pain is complicated, and because of the chronic nature of the pain their pain behaviors do not always match their pain descriptions. Each nurse approaches patient care in a different way, which in and of itself creates a layer of complexity. After being asked several times about how to approach the complex pain management of sickle cell patients, I turned it around and asked, “What do you think we should keep doing as part of their care plan? What do you think we need to stop doing? What new things could we start doing?” The communication challenge is not between patient and nurse but between nurse and nurse. Keep/Stop/Start is a framework that can be used to address that challenge.
We communicate with others throughout the day and in a variety of settings, and every communication can present its own challenge. Using Keep/Stop/Start is one more tool that can help us be more effective communicators as we care for patients and interact with co-workers.
Ann Brady is a symptom management care coordinator at a cancer center in Pasadena, California.