add a comment
Many years ago I had a NM role, and looking back on it I remember it as a very positive experience. Lots of times I knew we had done a great job and our work was appreciated by both patients and physicians and even our bosses. I wonder how often today there is any recognition for excellence in nursing practice. I don’t mean just the HCAPS scores…. I mean the real deal.
Nurse Managers attend lots of meetings, fill out lots of forms, audit lots of stuff, and spend lots of time at their desk in front of a computer. Somehow, we have to get back to the notion that the NM is also a leader of the clinical practice of the unit. What if a NM spent just 15 min. a day ….every day asking a nurse about a patient story in order to just recognize, or even advance through inspiration a higher level of practice? What if a NM made a point of finding the good stuff the staff does and bragging about it? What can be done to improve the experience for Nurse Managers throughout the current system?
I’m really looking for some feedback from Nurse Managers about Fun and Joy….and what has worked for you to bring those experiences into your challenging role. You deserve it. You are the engine of the system. Take pride in your role and its importance.
Conversations Create Change November 12, 2013Posted by mariemanthey in Uncategorized.
add a comment
Recognition of the value of conversations to change ourselves and the world is slowly spreading organically from the experience of Salon conversations ….to using the same format and function in a variety of other settings. I have heard of using the question “What’s on your mind about…..?” as a non-judgmental opening for wide-ranging issues. The very openness of the questions removes constraints that might otherwise hinder creativity and deeper dialog.
I continue to be amazed at the directions the conversations take in Salons…..especially the ones where different levels of nurses from different types of settings,with vastly different role experiences come together to talk. And Most Surprising Fact!!!! ….they never, never turn into Bitch Sessions. I’m not exactly sure why…..but I am reporting the truth.
I’m curious… how have you seen that simple question used to stimulate a conversation?
Salon comments….from Cleveland Ohio October 31, 2013Posted by mariemanthey in Uncategorized.
add a comment
I was reminded that we rarely take a break to look up and enjoy the big picture. Marie spoke of our history and our potential! That journey is both humbling and exciting – knowing what other nurses have given to the professional role and realizing what great and powerful opportunities we have at this very moment. I am convinced that The James has the cognitive creativity to provide nursing leadership on the things that matter most in health care – the patient and the family.
Tags: Primary Nursing, Professional Practice Model, Relationship-Based Care, The James Cancer Center
add a comment
In early May I had the privilege of visiting The James Cancer Center, a division of Ohio State University Hospital. My colleagues at CHCM, particularly Susan Wessel and Janet Weaver, have been working with them for some time and had been telling me of the great progress in developing a highly professional practice model the James had been achieving.
What I saw was like a dream come true for me. I saw staff nurses free and motivated to creatively solve patient’s care problems! This isn’t about unusual staff nurses; they are basically the same as staff nurses everywhere. It is about leadership based on common sense and a cultural infrastructure of safety for the risk-taking of creative problem solving. It thoroughly convinced me that Primary Nursing can be done….and MUST be done. Our patients deserve this level of care and our nurses deserve this kind of high-trust, high-integrity institutional environment.
Here is an email I received today from Jamie Ezekeilian at the James (addressed to Susan Wessel and myself):
Dear Susan and Marie,
We did indeed complete our three-day Magnet site visit last Friday, and I couldn’t help thinking that you would have been so proud. At the checkout session with our three appraisers they said that they wanted to share what they thought were our “double-WOWs,” and the first thing they listed was our Professional Practice Model, Care Delivery System, and Relationship-Based Care! Some of their observations:
- We are living all aspects of RBC throughout the organization
- They were amazed that professionals beyond nursing (including physicians) could speak articulately about our PPM and RBC
- That Primary Nursing was so enculturated in all practice settings— they thought it unheard of for surgical services (periop) to be practicing Primary Nursing
- They were quite impressed with our communication across the continuum of care and of our care coordination
- They said that staff clearly felt cared for by each other and that is how they continue to do the difficult work of oncology nursing
- That all were focused on patients!
- That we have “clearly done this right”
- That staff throughout the organization are so excited to attend the RBC Symposium in September—”we heard about it everywhere we went”
I wanted to share this with you as an affirmation of your professional work and your passion for Relationship-Based Care. I am so grateful to you for your wisdom and so thankful that we have had the opportunity to work together.
With heartfelt gratitude,
It’s about safety…..not maintaining ‘margin’ July 14, 2013Posted by mariemanthey in Uncategorized.
add a comment
Good crew supervisors do not focus on safety (what?) but rather on good supervision, crew cohesion, and work ethics. Safety is the result. Supervisors who constantly talk about safety have more accidents than those who focus on working relationships. ….safety has to be built into the system and is a byproduct of deeper personal and organizational commitments.
These comments are from an article re. safety for forest firemen. The current healthcare system obsession with bureaucratic mechanisms to ensure patient safety are adding complexity and chaos to an already chaotic system…..thereby actually increasing the incidence of errors. We need to use good supervision (not fear based control), healthy staff teamwork and strong work ethics in health care just as they do with their firefighting crews.
A Marie Manthey Master Dialog for Nurse Managers: What Does and Doesn’t Work in the Real World June 25, 2013Posted by mariemanthey in Uncategorized.
add a comment
Please join me for a day-long dialog on maintaining resiliency, intention, presence, and mindfulness while doing the toughest job in health care today. Along with reflection and dialog, the day will be rich in time-tested take-aways that can be applied to practice.
July 12, 2013
CHCM Office, Minnetonka, MN
Registration Form & Pricing Details
July 30, 2013
CHCM Office, Minnetonka, MN
Registration Form & Pricing Details
Marie Manthey’s Master Dialog for Nurse Managers is also available for onsite presentations. Call Creative Health Care Management at 800-728-7766 to schedule.
A painting is not created by a free floating hand making marks with oils on canvas. The hand belongs to an artist connecting with his or her mind, body, and spirit, not only to the process of creating a painting, but to those who will one day see the painting. The hands of the artist are not where the skill lies. Without the whole person showing up in the creation of the painting, there is no art; there is just painting.
The art of nursing can be thought of in much the same way. The nurse can show up as little more than a pair of hands doing tasks, but this is not nursing; this is just doing tasks.
The art of nursing (as is perhaps true of any art) is about connection. In the art of nursing, the nurse connects to the patient, and the nurse also connects to the profession of nursing. Advancing Professional Nursing Practice is about the art of both of those connections. It is a book in which the ANA standards are named and explained, connecting nurses to the practice and performance standards of their profession. It is also a book about Relationship-Based Care, which is a care delivery model that connects nurses to patients and families by removing barriers to the nurse-patient/family relationship and improving relationships throughout the organization.
I’m always happy for nurses who get to work in cultures that support healthy relationships throughout the organization, and I share the distress of those who work in environments that seem to be fueled by chaos and competition. It is the choice of the nurse, however, to show up in either environment as a whole person, fully invested in the care of patients and families or as simply a technically competent task doer.
In 1966, the way I viewed nursing was changed forever by an article I read in the American Journal of Nursing. It was written by Sister Madeleine Clemence, and it was called “Existentialism: A Philosophy of Commitment.” The way I saw it, this learned nun, a woman far ahead of her time, was challenging me, a young nurse leader, to show up as a whole person in my work. Her article challenged me to change my own practice and to mentor others to do the same:
“Commitment can mean many things: a promise to keep, a sense of dedication that transcends all other considerations, an unswerving allegiance to a given point of view. In existentialism, commitment means even more: a willingness to live fully one’s own life, to make that life meaningful through acceptance of, rather than detachment from, all that it may hold of both joy and sorrow.”
It was no accident that Sister Madeleine was talking about “acceptance of, rather than detachment from, all that life may hold” in the context of the nurse’s work. As a nurse herself, she could see that the work of the nurse is secular for all, but sacred for only those who commit themselves to making it so. As we go about the work of nursing, are we solving problems or are we entering into the mystery of what it means to be with a person who is suffering, vulnerable, and afraid? She quotes philosopher Gabriel Marcel, writing, “A mystery is a reality in which I find myself involved…where as a problem is [merely] in front of me.”
It raises a provocative question for nurses: Am I involved with my patients, or are they merely in front of me?
Over a century-and-a-half ago, Florence Nightingale helped to make nursing an art through bringing compassion into her own practice and then writing about it so that others might see that when the basic relational needs of the patient are tended to, there is a healing that takes place whether cure is possible or not. She famously encouraged the soldiers of the Crimean War to write to their loved ones. She understood the simple human truth that connection is healing—connection with loved ones (be they near or far), connection with one’s own thoughts and feelings, connection with the realities of one’s current situation.
The compassionate focus on connection that Florence Nightingale brought to nursing is still there, but it has gotten lost in the shuffle throughout history every time there was a major change in the world of health care. Here is some historical background:
Prior to the Great Depression, private duty nursing was the main avenue of employment for the nation’s RNs. As the Depression eliminated this avenue for many, RNs returned to their home hospitals as temporary workers, often on a volunteer basis, sometimes working for their room and board. As such, they found themselves working in a highly regimented, task-based, time-focused system of care that was designed to control practice and teach student nurses. This eventually became the main avenue for employment of RNs and remained so until fairly recently. This move from more autonomy for RNs to less autonomy is a pattern that has repeated itself throughout modern history.
After WWII, the proliferation of new hospital beds coupled with the baby boom (which greatly reduced the nursing workforce), resulted in team nursing, a delivery system designed to maximally utilize technical expertise and assistive support staff under the direction and supervision of an RN. Again, the focus was on assigning and supervising the performance of tasks, since the only person educated to provide a therapeutic relationship was nearly always consumed with supervision and the performance of tasks requiring a higher skill level than that of her staff.
The system upheaval that characterized the last 30 years of the twentieth century, which was driven by finance, technology, and regulation, resulted in most health care organizations dealing with higher patient acuity coupled with severe cost cutting, which again resulted in a focus on managing the tasks of care rather than managing therapeutic relationships. The resulting dehumanization within the care system drove a spiral of regulations and system constraints that further complicated (and continue to complicate) an already maximized complex adaptive system.
The age we live in is no different. As we deal with the myriad changes of health care reform, we’re seeing, once again, a return to task-based practice. This time, however, it feels different to me. I’m heartened by the numbers of organizations that are embracing Relationship-Based Care and books such as See Me as a Person which address the need for nurses and other caregivers to be “in it” with their patients rather than merely ministering to their bodies. As the next major societal shift in health care advances, whatever it is, the profession of nursing must continue to define itself. Society trusts us to do so, and our covenant requires it.
Nurses must ask themselves some important questions: What exactly is it that must always be present in order for nursing to really be nursing? What is the actual core of nursing? What strengthens that core? And what must be present in order for that core to even exist? In short, what is the nursing imperative?
I would ask you to mount your own inquiry, and come up with your own answers. Here are mine:
The nursing imperative is a two sided coin. On one side there is the imperative to be clinically competent in both technical skills and clinical judgment. The other side is the willingness to step into being with the human being for whom the nurse is caring. In health care, people experience vulnerability at every level of their being: mental, emotional, physical, and spiritual. The privilege of nursing is having the knowledge and skill, the position and relationship, to interact with a vulnerable human being in a way that alleviates pain and increases mental, emotional, physical, and spiritual comfort. This is the privilege of nursing—the being with a vulnerable human being. If this privilege is ignored or overlooked, nursing isn’t happening. No matter what is happening in a care environment, authentic human connection with the vulnerable human beings in our care can and must happen. That, to my mind, is the nursing imperative.
It’s clear that half of the nursing imperative is that we have a mastery of the technical aspects of nursing, but the other half of the nursing imperative—and it truly is no less than half—is staying present to the vulnerability of others. This book seeks to address the dual nature of the nurse’s work, both the instrumental and relational. If you are a nurse (or about to become one), I’d ask you to keep this dual nature in mind as you read this book.
Marie Manthey, MNA, FRCN, FAAN, PhD (hon.)
March 8, 2013
 Clemence, M. (1966). Existentialism: A philosophy of commitment. American Journal of Nursing, 66(3), 500-5.
Nurses connections April 7, 2013Posted by mariemanthey in Uncategorized.
Similarities and differences…….nurses tend to magnify superficial differences (age, education,)and gloss over the important shared value of the privilege of being a healer.
A question for all….. April 20, 2012Posted by mariemanthey in Uncategorized.
What do the words THE NURSING IMPERATIVE mean to you?
Gallup poll…nursing vs. congress! January 1, 2012Posted by mariemanthey in Uncategorized.
Once again nurses have highest ranking in ethics and honesty among all 21 professions tested. And guess what?….congress members were scraping the bottom of the list right along side of used car sales people. What do you think we should do about this? Elect more nurses to Congress? Have the nursing profession conduct classes in ethics, honesty and trustworthiness for members of congress? What do you think? …..