The Sustainability Blog will be taking a temporary hiatus in order to plan for the next phase of our project. Before we go, though, how about one last, chewy post for the road?

10 Tips for SANE Sustainability:

We’ve been fortunate in the course of the National SANE Sustainability Technical Assistance Project to learn a great deal being out in the field and talking with SANE Coordinators from around the country. In our work, with both individual programs and groups of SANEs and SART members, we’ve seen some commonalities that transcend geographic areas and program structure. Maybe we can’t quite call them universal truths, but here are 10 tips for sustainability (in no particular order) that were repeatedly underscored throughout the three years of the project:
1.    Don’t forget the nurse in SANE: when hospitals and healthcare funders don’t see the healthcare dividends provided by SANE programs they are less likely to provide long-term support. More importantly, only 10% of our patients will ever see the inside of a courtroom, but 100% of our patients will have the opportunity to develop healthcare sequelae from the sexual assault. Shouldn’t that be our priority?
2.    Rethink program structure: Is 24/7 coverage truly achievable in your program? If not, consider consistent, dependable coverage that’s well understood by all community partners. Then invest some time into creating transfer agreements to other regional SANE programs or provide high quality training for area emergency department personnel to help fill in gaps when coverage is simply not available.
3.    Recruit with specificity: If Labor and Delivery needs someone for weekend nights, they recruit personnel who can work those shifts. If the Emergency Department needs nurses who are already ACLS certified, they recruit with that skill set in mind. Why should SANE programs operate any differently? You know what shifts aren’t being covered and what skill sets you need. Recruit based on the needs of your team. That ensures a better fit right from the beginning.
4.    Look at the nexus between leadership and retention: Many SANEs who left programs told us their departures were directly related to poor leadership by program coordinators. This was illustrated by issues such as coordinators expecting more from staff than they were willing to do themselves; lack of any appreciable feedback; and poor communication between staff and the coordinator.
5.    Invest in people, not things: New toys are fun, but they’re often unnecessary. A new colposcope or expensive photography system may seem like something your program needs, but what’s more important are competent, current clinicians. When you invest in people you help maintain an effective workforce and make it easier to recruit new team members. Continuing education, call and court pay, a raise in case fees—these help maintain a team that is reliable and knowledgeable. Will patient care be enhanced when you purchase the $20,000 piece of equipment versus the $500 one? Maybe not. Will patient care be enhanced when they encounter a nurse who is current and comprehensive in his or her practice? Definitely.
6.    Learn and articulate SANE value: Do you know the economic worth of your staff and the services you provide? Hospitals and other funders speak in dollars and cents. If you want to be able to make a case for financial support you have to speak the language. This means writing a business plan. Don’t know how? No problem—we have what you need right here to get started.
7.    Let go of the “If I don’t do it no one will” mentality: Is there a quicker path to burnout than non-stop call? I don’t think so. Know when to say when and spend some time on Plan B—emergency department backup, triage and support by a neighboring SANE program, whatever it takes to give yourself the occasional break. Sustaining SANE programs starts with sustaining yourself.
8.    Learn to ask for help: Today more than ever there are plentiful resources for assistance. Whether it’s national resources like NSVRC and SAFEta, state resources, like statewide SANE Coordinators, or local resources, like community collaborators, chances are there are people in your world available to advise and assist on topics as diverse as grant writing and vicarious trauma. If you can, try to avoid waiting to ask for help until it’s a crisis, though—think prevention, not cure.
9.    Start looking for a replacement: You may have no plans to leave your position any time soon, but that doesn’t mean you shouldn’t consider who would take over if you left. Mentoring takes time and a program that hinges on a single individual simply isn’t any more sustainable than a program that hinges on a single source of funding.
10.    Nurture and celebrate your staff: The greatest assets you have to your program are the nurses who staff the SANE schedule. Maybe you can’t compensate them in the ways you’d like. Perhaps sending everyone to the IAFN Annual Assembly is unrealistic. But celebrating the small triumphs, giving team members opportunities for recognition of their achievements at staff meetings, these are small gestures that pay big dividends. Whether it’s a couple of movie passes for the nurse who saw the most patients in a month, or cupcakes to celebrate a new nurse getting off orientation and onto the schedule, even small victories deserve notice and help staff feel more engaged and appreciated.
 

I hope everyone will be able to take some time these next few months to nurture themselves. I know that's my goal. Thanks for reading and I look forward to connecting with many of you again this fall. Have a safe and peaceful summer, everyone!

SAFEta Source is hosting a free webinar on SANE program peer review that is a must for anyone running a program. Particularly if you are struggling with how best to set up a peer review process or have not yet considered the benefits of peer review. The webinar will be held June 22nd at 2pm ET. Advanced registration is required to attend.

From the site:

Presented by Suzanne Rotolo, PhD, MSN, RN, SANE-A, SANE-P, CFN, and Lisa Gorham, BSN, RN, SANE-A, SANE-P, CFN, this webinar will offer education and practical solutions to clinicians who are looking for resources on peer review. At the end of the event, attendees will be able to:

1.    Describe the peer review process

2.    Identify reasons that peer review should take place

3.    Identify resources in particular practice arenas that can validate the peer review process

Suzanne Rotolo, PhD, MSN, RN, SANE-A, SANE-P, CFN has been a nurse since 1976. In 1981 she began working at Inova Fairfax Hospital/Inova Fairfax Hospital for Children in the Emergency Department. In 1991, she developed the first Sexual Assault Nurse Examiner (SANE) Program in Virginia. In 1993, under Rotolo's direction, the SANE Program changed to the FACT (Forensic Assessment and Consultation Teams) Department, which now comprises the SANE program, the Domestic Violence program, the Physical Child Abuse program, and the Body Cavity Search program for the adult detention center. Rotolo has examined over 5,000 patients reporting sexual assault. She has been qualified as an expert in sexual assault over 150 times in Virginia, Maryland, Washington, DC, and the U.S. Virgin Islands. Rotolo received her PhD from George Mason University in 2009, with her dissertation on the "Patterns of Genital Trauma in Sexually Assaulted Women." She is nationally certified as a SANE-P, a SANE-P, and is also a Certified Forensic Nurse (CFN). She is well published in the forensic field and is a founding member of the national and local chapters of the International Association of Forensic Nurses (IAFN).

Lisa Gorham, BSN, RN, SANE-A, SANE-P, CFN graduated from Northern Virginia Community College in 1996 and went on to receive her BSN from Old Dominion University. She had worked in the areas of geriatrics, mental health, addictions, research, pediatrics, and sexual assault. She has performed sexual assault examinations since 2002, lectures on the subject at George Washington University, participates in case reviews with a local county child advocacy center, and has jointly published an article on the topic of peer review as it relates to sexual assault examinations. She currently resides in Maryland with her family and works for Inova Fairfax Hospital's Forensic Assessment and Consultation Team.
 

NNEDV has a new bulletin, Privacy Concerns When Posting Content Online that's worth perusing. Particularly for those of you using social media sites like Facebook, I think it's a good common sense overview. I think it's a great one-pager to provide new staff members, since it's critical for SANEs to consider what they post and how it can impact them professionally.

One of the issues we've heard repeatedly in this project is the challenges staff and contract SANEs feel in communicating with their managers and agency administrators. Not feeling like they have a voice and not feeling like their concerns are being addressed has led to problems with retaining good quality, competent nurses. So I was pretty interested in this article over at the Harvard Business Report's Best Practices blog, How to Give Your Boss Feedback. I have to tell you, I found a lot of the advice to be pretty reasonable and applicable to our work, as well.

I'll be interested to know what you think and if you have any other strategies that seem to work.

First off, apologies for the paucity of posts as of late. I am smack in the middle of a 12 city/8 week tour of the US (because March and April are incredibly busy training months), and I simply haven't been able to keep up. This week is relatively quiet with only an overnighter for me tonight, so I hope to get more content up than I have over the past 2 weeks.

I have been asked by a couple readers about leadership coursework with nursing CEUs attached. I'm happy to report that Contemporary Forums has a couple low-cost options ($15/each) that might be a good solution. I recognize that many of the CEU programs out there in this arena can be very pricey, so these might be worth checking out.

Over at the FHO site, I've posted some information on a forensic compliance self-assessment from EVAW. EVAW is the technical assistance provider on this issue, and they've put out some great information on their site. If you have questions about your own program's compliance, definitely check it out.

From the Office on Victims of Crime:

On February 24, 2010, at 2 p.m. (eastern time), the Office for Victims of Crime (OVC) will present a Web Forum discussion with Anne Seymour and Viki Sharp regarding Strategic Planning for Victim Service Leaders. Ms. Seymour is Cofounder and Senior Advisor of Justice Solutions, a nonprofit organization in Washington, D.C., that specializes in criminal and juvenile justice, crime victims’ rights and services, and community safety. In addition to serving victims for 25 years as a crime victim advocate, she has also helped more than 30 local, state, and national entities to develop strategic plans and authored or contributed to more than 30 OVC publications, including the Strategic Planning Toolkit. Ms. Sharp has spent 30 years as an advocate for crime victims’ rights and continues to educate and train others during her retirement. As a consultant for the National District Attorneys Association and OVC, Ms. Sharp helped establish and expand victim services throughout the country and provided extensive training in crisis intervention, communication, vicarious trauma, team building, and victimology to law enforcement and victim service providers. For more information about the Web Forum discussion, visit http://ovc.ncjrs.gov/ovcproviderforum.

Visit the OVC Web Forum now to submit questions for Ms. Seymour and Ms. Sharp and return on February 24 at 2 p.m. (eastern time) for the live discussion. Learn how to participate beforehand so you are ready for the discussion.

Over at RWJF's Future of Nursing blog, Dean Marla Salmon, from the University of Washington School of Nursing poses the question, what do we need to teach the nurse of tomorrow? This is a pretty important question, and one we have discussed frequently here at the sustainability project. Because one of the struggles we so often see in SANE programs around the country are nurses who have never had access to education focused on business management, leadership development or public policy. These are all critical areas that impact the day to day lives of SANE programs. A lack of these skills (or a failure to even see this skills as being relevant and necessary) makes it difficult to keep SANE programs healthy and viable for the long-term.

I don't think every SANE program manager needs an MBA (although it wouldn't hurt to have a few more in our ranks), nor do I think we should be shifting foundational nursing education away from the clinical skills that are so central to the profession. But I agree with Dean Salmon when she writes, "A good start would be strengthening the connection between initial, graduate and continuing education.  These linkages are not well defined – nor are resources that are now separately associated with each. Perhaps we should think about the possibility of a lifelong learning “curriculum” or some sort of career development framework as a way of shaping some new conversations about education and learning.  This could engage both our educational and service institutions in supportive and coordinated ways." An expectation that continuing education is not only part of the career path, but occurs in a purposeful and organized fashion? Continuing education tailored toward professional growth and development, and not just randomly chosen as a means for maintaining certifications or satisfying agency policies? Yes, please. It would certainly strengthen our specialty.

I am working on crafting a response to Dean Salmon's post. I hope some of you will also consider weighing in on what we should teach the future nurse. It's a great opportunity to give some feedback to an organization that has definite influence on the future of nursing.

Here's a practical concept for all of you managers: managing up. It's the idea of positioning people so as to accentuate the positive. You can manage up your boss, your staff and even your organization. When you think about how managing up creates an environment where people feel valued and respected, the sustainability implications become pretty clear: easier to recruit, easier to retain.

Quint Studer outlines the concept of managing up in a short piece he published in December. It's definitely worth your time. 

I am a hothead. Anyone reading this who knows me is smiling and nodding right now, because they know my default setting is holler. So I was intrigued by this post over at The Happiness Project last week about under-reacting to problems. That's not to say the post's author advocates ignoring or minimizing problems; simply that as she points out, not every problem requires a full-bore freakout. Calm and well-humored trumps yelling and losing it in most cases--it doesn't help you and it certainly doesn't remedy the situation.

This probably seems painfully obvious to many of you, but I think it's worth mentioning here simply because as programs face inevitable challenges such as funding cuts and staffing shortages, it's sometimes difficult to keep it all contained when wading through the muck. However, SANEs around the country have repeatedly told us that the actions and attitudes of program directors significantly impact their decisions to stay on board when things get rough. Managers who are able to tackle problems without projecting a feeling of impending doom on their staff may find that people are willing to hang in there and see what happens next, rather than bail in the face of what appears to be certain disaster.

As for me, I am trying to adopt a new attitude of fervent under-reacting. I'll let you know how it goes...