Dear Helpdesk: Bridging the Gap Between Nursing and EVS for Patient Safety

Dear Helpdesk: Inoculating your work life with IP Wisdom

Dear Helpdesk,

On your rounds in the facility, you continue to find cleaning opportunities on the unit. Your environmental services (EVS) staff is challenged with low staffing, and your nursing and ancillary staff do not feel cleaning is their job. How do you facilitate the communication and expectations of these 2 groups to come to a compromise for patient safety?

Sincerely,

Infection preventionist (IP) Bridge-builder

Dear IP Bridge-builder,

Thank you for sending this question and highlighting a scenario many IPs may encounter. What I appreciate most about your question is how IPs can unite different departments under a shared goal: patient safety.

How this scenario is framed matters, and you took the first step by posing this as a problem that can be solved by tackling a shared common goal. The solution you are advocating for is fostering a culture of teamwork and cooperation, highlighting how both teams can come together to effectively address cleaning challenges and ensure the well-being of your patients.

The second step is to do some recon and assess the nature of the cleanliness opportunities. Are these opportunities limited to one unit, or are they also observed in other areas? How long have these opportunities been observed? Once you have some idea of the scope and duration of the issue, I invite you to approach this situation from a place of curiosity and compassion. Generally, when an area is identified as having repeated or ongoing cleaning opportunities, there are underlying reasons why. If you still need to, I invite you to meet 1:1 with your EVS leader to share your observations and solicit their input. These insights will provide vital intel before connecting with the unit’s leadership.If appropriate, I encourage you to meet with the unit’s leadership in person; ideally, it includes rounding the unit together. This approach aims to understand how the unit is experiencing cleanliness issues and how they have impacted them. This also allows you to hear the thoughts and feelings of the staff and gauge how open the unit staff might be to working with EVS on a shared approach.

Step 3: Reflect on what you have learned, the underlying circumstances that led to this situation, and how open both departments seem to be to finding a shared solution. Additionally, unless this situation is limited and temporary, you may need to think strategically about how to support EVS.

Nurse and EVS working together

(Image credit: author with AI)

Step 4: Scheduling a joint unit round. Ideally, scheduling a joint unit round between EVS and unit leadership will allow both departments to examine the identified opportunities and determine how best to resolve them. To help make this round successful, frame the meeting and joint round around how these cleanliness opportunities can be resolved.

Here's a tip: If you encounter disagreements about who is responsible for cleaning what, don't let those points derail the conversation! Instead, capture those points for a follow-up discussion. Remember, the goal is to find a solution that works for everyone, not to assign blame.

Let's take the medication room as an example: EVS needs a nurse present, but floor nurses cannot spend extended time there. In this scenario, what is the middle ground? To assist you, pay close attention to body language, what is being said, and what is not being said. It is not uncommon for there to be unspoken underlying factors at play that dictate and inform how each department will support a joint initiative.

Ideally, some agreements are made on how both departments can support the existing challenges. At the end of the joint round, acknowledge the challenges, recognize how each department has compromised, and wrap up highlighting the value for the patients. Finally, note the items the departments have agreed on. If there are any outstanding items to work through, ask each department what they would like to do as the following steps, including setting another joint round in a week or 2 to assess how the plan is going.

Step 5: Meet with each department separately to ask their perspective on how the joint round went. This will provide you with additional insights into how each department walked away from the joint rounding session feeling and their openness to continuing to work together. Consider asking what they want to see as the next steps and what a resolution might look like.

Step 6: Building on the joint rounds and initial agreements, consider building a joint short-term plan to address the cleanliness concerns. Depending on the anticipated duration of the EVS staffing issues, consider bringing in additional key stakeholders to develop a longer-term solution. This may include discussing it at your infection prevention committee meeting or possibly with your environment of care committee or regulatory group. Before deciding how best to escalate, work with your key stakeholders and make those decisions together.

Following these 6 steps, an IP can effectively facilitate a collaborative environment between EVS and nursing departments, improving patient safety and a more harmonious workplace. Approaching cleanliness challenges as shared opportunities, rather than assigning blame, IPs can empower both departments to work together towards a common goal: patient safety. Through open communication, empathy, and strategic planning, IPs can nurture a culture of teamwork and cooperation, ultimately benefiting patients and staff. Bringing people together for patient safety is what IPs do best, and leveraging soft skills to get key stakeholders at the table is how we get it done.