A useful tool to help nurses safely triage their day and reduce stress
By Kent Soltys
January 15, 2024
What does MICRO stand for?
M — Manageable: Can the goal set be achieved under the current constraints or barriers faced by the practitioner?
I — Identifiable: Is the goal identifiable as a realistic priority and within the responsibility and scope of the practitioner?
C — Collaborative: Can achieving your goal involve the interdisciplinary team? Working together to achieve the goal set contributes to a cohesive team dynamic and can lead to improved patient outcomes.
R — Relevant, Realistic and Repeatable: Does the goal fall within relevant scope of the individual? Can it be achieved? Once achieved, can the skill or task be repeated to ensure continued proficiency?
O — Ongoing reflection/re-evaluation: Once the goal is reached, what was learned? What can be improved? What can be tracked to ensure continued positive progression?
MICRO goal-setting was born when I became frustrated watching the high level of anxiety and dejection on the faces of the nurses in acute care. As a medical surgical clinical nurse educator, much of my time is spent on the floors acting as a senior support and mentor to staff.
Health care has become increasingly challenging owing to the staffing crisis as well as the loss of senior nurses and appropriate mentorships to support new grads and young nurses alike. As I watched the day-to-day struggles faced by new nurses, I knew that many of their challenges could be alleviated with a tool that helps them to appropriately triage or prioritize their day.
MICRO goal-setting in a simulation
The concept of MICRO goal-setting was first introduced during clinical simulation and in-person education sessions. The intimate environment and smaller group sizes made introducing a new way of goal-setting easier.
The principle of MICRO goal-setting was explained as part of a simulation pre-brief. Staff were provided with an outline and context at the commencement of the simulation, and time was allotted for followup questions. The foundation of using MICRO goal-setting was reviewed, and learners were asked to incorporate the principles as they navigated the simulation.
At the completion of the simulation, the outcome of using real-time goal-setting and reflection during the simulation activity was explored. Feedback that was collected from the participants outlined the following: Participants noted times during the simulation when they were able to refocus because they were reflecting in real time upon the goals that were set prior to the commencement of the activity.
When reflecting upon the education session and how it could have been improved, participants suggested that providing a visual copy of MICRO goals in advance of the simulation would offer more time to grasp the context of real-time reflection and goal-setting.
MICRO goal-setting in teaching
An additional method I have used to roll out the MICRO goal-setting platform is in-the-moment teaching. As a clinical nurse educator, I have routinely noted that the best learning occurs in the moment at the nursing station or at the bedside.
The MICRO goal-setting platform supports this type of education. It allows me to speak with the staff to identify barriers they are facing in their day. From that point, we would work together using a key component of the mnemonic.
There are many reasons why this method of education delivery is effective, but one reason is that nurses are often overwhelmed. The never-ending workload, severe staffing shortages, and lack of senior nurses and mentorship support are leaving the bedside staff feeling the time crunch.
Balancing multiple patients in rooms, hallways, stretchers and cubbyholes, and being mindful that time is precious, has led to quick education blitzes. The MICRO goal-setting acronym allows me to spend one or two minutes at the nursing station, water fountain, or before a nurse enters the room, to set, prep, review, and enter a patient care scenario armed with tools that help reflection in the moment. The preparatory work to make this happen is to provide the nurses with a copy of the MICRO tool.
Those who have used MICRO goals have noted that the mnemonic is designed to encourage ongoing questions. Intentionally designed to promote ongoing inquisition, this tool provides an opportunity to problem-solve barriers that are unique to a nurse’s area of practice or management.
Example of MICRO goals in action
One nurse identified feeling overwhelmed with the patient load she was facing on her shift. The unit was short staffed, and her patient load consisted of acute and less acute cases. Her anxiety was related to medication administration, assessments, and being one of the only RNs on the floor.
In this instance, we took two minutes and looked at each component of MICRO goal-setting:
- We identified the barriers she was facing in meeting her perceived goal expectations. In this circumstance, the barriers the nurse felt were that her medications had to be given by a certain time; she had a patient going off the unit for a diagnostic procedure who had to be ready by a certain time; she had another patient in a pain crisis; and finally, she had to leave the unit soon to attend a meeting. Together we reviewed her patient assignment and designated priorities based on items that could be delayed or deferred and priorities that needed to be attended to first.
- We then reviewed the identified goals to see if they were manageable under the present unit status, including colleague support if and when needed.
- In collaboration, we agreed that the identified goals were manageable because some of the less acute patients were lower on the priority spectrum.
- We determined that the plan was relevant, realistic and, should a similar situation arise in the future, repeatable. We came to this decision because the delayed items for the less acute patients were reviewed, and none of the deferred actions had any direct impact on the high level of care or positive outcomes that the nurse was trying to maintain.
- The nurse and I engaged in ongoing reflection and re-evaluation to assess how the day progressed. She said that in taking the two minutes to break down the actions based on prioritization of expected outcomes using the MICRO goal-setting model, her day became more manageable.
The anxiety created when nurses lump their priorities together can feel crippling. However, breaking down the priorities into manageable and realistic goals allows nurses to see their expected work as portions rather than a whole pie. This re-framing and re-prioritization using my method of quick goal-setting offers nurses the opportunity to lessen stress and anxiety by deferring less acute priorities through a safe and effective method.
In conclusion, breaking down the daily workload based on prioritization of tasks can help nurses view their day as a series of smaller tasks versus one large, impossible challenge.
Ultimately, practitioners decide how they choose to use MICRO goal-setting in their practice. Some may use pieces of the framework to simplify their day, while others might use the framework in its entirety to help in prioritization of tasks. There is no wrong way to use this tool to help ease the burden of circumstances.
Every nurse whom I have the pleasure of interacting with and learning from has an incredibly difficult task. My goal is to work with nurses to simplify the burden of their workload. Only through constant change and reflection can we truly understand what we are capable of.
Kent Soltys, RN, BSN, is a clinical nurse educator and mentor working and living on Vancouver Island. He is also an advocate for supporting newly graduated nurses.