Marie Manthey’s Nursing Salon

This year marks the 40th anniversary of the first development of  Primary Nursing – on a medical unit (station 32) at the University of Minnesota Hospital.

The really exciting part of this anniversary is an effort underway to gather the pioneers of that first unit….from the CEO, John Westerman to the other administrators including Dave Preston ( co-director of the project), Peter Sammond,  Stan Williams, and nurse leaders  Pat Robertson (Clinical Nursing Director), Diane Bartels, (Head Nurse, now a PhD ethicist), Karen Ciske, (Nurse Clinician) Colleen Person (unit educator),  and as many of the unit staff as we can locate.

There is a reason it started at that place and at that time.    Societal changes combined with an energetic surge of  internal hospital reform from the executive suite….coupled with deep frustration and dissatisfaction within nursing set the stage for this change.   The presence of several ‘thought-leaders’ who were also involved gave us a system-focused, principle-based understanding of the meaning of the nursing practice changes that evolved.     This understanding resulted in language to describe the innovation in a way that facilitated adaption to every setting where there are clinicians and patients.

That paragraph represents my understanding today about why it has had such an impact on practice and patient care….and I am thrilled we are celebrating it’s 40th year.

The gathering we are planning is pretty unstructured at this time.   So far, we are talking about getting together for lunch at Coffman Union at the U of Minnesota sometime in August.     I’m thinking this is a golden opportunity for us to capture the insights and learnings of some key figures in what became a massive change process.    I’ m interested in any suggestions readers have about what we should capture and how to do it.   What would you like to know about the experience of the execs, nurse leaders and staff involved in the risk that led to Primary Nursing!

The RBC Symposium sponsored by Creative Healthcare Managemenet is the latest manifestation of the current resurgence of Primary Nursing.    This resurgence  has also led me to offer a 5 day practicuum in August…info about both of these is available on chcm.com

On May 21, we had the regular one at my house (3 Salons for me in 10 days!…what a treat)…and I am inviting attendees to post a note…..I’ve done enough posting today….ciao!

At the Ways of Knowing conference  (for info, visit website of Center for Spirituality and Healing at the U of Minnesota)   I found myself often connecting the Salon experience I’ve been having with the things I was learning about mindfulness as a strategy for a healthy life.   For three days, wise people from all over the country and other countries as well, taught us about the relationship between ways of being…..and well-being.   So much was relevant for the nursing profession and pertinent to what we can do to heal ourselves and our profession.    Yes, even in the fact of working in a sick-system and seems to be taking forever to get on the right track.

The Salons kept coming up in my mind because of the depth of meaning experienced there….as well as the fact that being present at one in and of itself seems to bring all of us a degree of peace not found often in the pressure cooker of health care….and that is desperately needed.

I learned mindfulness in and of itself is healing….and that mindfulness meditation involves intention, attention and attitude…..and opens the door for experiencing the deep truths that lie at the very foundation of our work.   It is such noble work….and we are privileged to do it.   Being open to that truth changes the day to day experience of being a nurse.

In a few weeks, the entire conference will be posted on the website of the Center and I encourage everyone to watch for it.   If I can figure out who to add the link….I will do so now.   ciao. CSH Home

On May 19, just one week after kicking off a Salon in Leeds, England, I was invited to do the same thing in Anaheim California.    Here, some really innovative leaders at UC Irvine invited educators and practioners (including students and staff nurses) from three hospitals and several colleges to  a first time Salon.   This first one was held  in a private dining room of a favorite restaurant and there were over 35 attendees with much enthusiasm for the concept.

I am always fascinated by the comments made during the ‘check-out’…..and the consistency with which phrases like …”I loved hearing the passion experienced nurses still have” from the younger attendees and similar words from experienced nurses about novices.

It is also always interesting to me to see how quickly the discussion moves into deep content, into deep truths about the nature of nursing work.   I have invited them to add their comments to the blog….

Last week, on the eve of Nightingale’s birthday, nurses gathered in a private home to have a discussion about nursing.   They invited me to be there for the ‘kick-off’ of the first Salon in the UK.   It was energizing, rewarding and exciting.   The issues we discussed had to do with the basic values of nursing….and what it means to use a holisitic approach.    I felt completely at home, although I had only met one or two of the people there before.   But, we were nurses…..and there is a feeling of knowing one another that surfaces at times like this.

This event  took place in Doncaster, near Leeds, north of London.   Hopefully more will start up around the UK….and this first one will continue on a regular basis.

A couple of my English nurse friends were there, including Steve Wright, a well known leader in the UK whose book Sacred Space has guided my thinking about my own spirituality and the connection spirituality has with nursing practice.

A couple of other leaders were there as well….and the age/experience/education span was as generous as it is here.    We had a student nurse….and a wonderful retired enrolled nurse (similar to LPN here)….and again, the passion for practice encompassed all present.

I am hoping someone who was there will contribute to the blog….and that everyone starts sharing this experience with the nursing community through this blog.

We met at my house on  April 13th and had great conversation about nursing from many different perspectives.   I can’t tell you   how important these kinds of meetings are….and how deeply committed I am to helping this concept grow across the US.   I do have guidelines available for anyone and you can receive them by just asking me for them.   Also I am available for phone conversations to help other groups get started.

With permission from the writer, I am copying an email I received from one of the attendees of that Salon

Hi Marie,

I neglected saying goodnight and thank you to you last night……my  apologies.  I was in a discussion with Paula about evidence based practice and we just kept talking and walked out!  Oh dear I thought,  but then I imagined, it was okay with you as the salon again fostered  great conversation.

Maybe its because I’ve been away for awhile, but last night struck me  silent.  I was deeply moved by R’s closing comments…..I  actually had tears in my eyes.  For the first time in her nursing  career she was proud of her profession.  Do we need any more proof how  powerful these salons can be?  I’ve missed them.

Thank you so much Marie……you enable us to ponder the wonder of nursing and how much we can touch other’s lives.  And I am grateful.

See you next time,  D.

So, you see readers, why I am so passionate about this idea ….and see it as a way to bring true healing right into our personal/ professional lives.

I need to apologize for not getting to this blog more often….and to let you know I intend to change that starting now.    I will be responding to all comments after I complete this post.

One of the Consultants at Creative Healthcare Management recently sent me this description, written while her daughter was receiving care at a major medical center in the Midwest.   My question to readers is this:   If you see yourself in this description….what can you do to ‘be with’ rather than just ‘do for’ your patients?   Or does anyone want to explain why ‘doing for’ is really enough?      Responses are welcome.

“Care has been fine, but not extraordinary.  They  received Magnet designation in 2007 and have a great deal of pride.  Everyone asks each time they leave the room if there is anything else we need — and they have clearly received customer service training (AIDET).  The manager just visited our room and was gracious and emphasizing that we let them know if there is anything they can do.  The trouble is, they are doing -………  But there is no “curiosity”, no whole picture perspective — when asked the nurses rarely know the plan — I rarely see a therapeutic process; the nurse comes in to give meds, check if there is anything needed.  So very nice, polite — but detached.  I found myself charting my perspective using the boundary diagram from my article in the field guide on boundaries for the therapeutic relationship.  Underinvolvement is the main descriptor I would use.

We have had some lovely exceptions.  The pharmacist,  who we know from the transplant team spent 20 minutes with us yesterday making sure that we had all questions answered and providing some background information and questions.   A physician sat at eye level and began by asking Alicia about her and what this means in her life right now.  She was able to talk about school, and it went on from there.  He was extremely encouraging — reminding us that it has always been the case that my daughter would outlive the life of her kidney, and that we will take each challenge as it comes.  We do not have the biopsy results yet, but if it is early rejection we are dealing with, that can be treated and the kidney can continue to serve her.

I try to stay clear and unemotional about the lack of professional consciousness I see in so many nurses.  I feel so sad, because when they only focus on the things they are doing, they lose sight of the human being and the power of their care and they lose the amazing satisfaction that would come from a connection.  I am clear that it would take no more time to connect and involve the patient than to come in and out doing for the patient.  I believe the nurses on this unit like their work, and that transplant nursing would be extraordinarily satisfying.  So, the nursing care is fine.  The question is, is that enough?  I have nothing I would complain about, and I believe most patients would say the care was very good because the staff is responsive.  My daughter asked why so many people (nurse,  physician, nurse practitioner) give her the same information as though she is hearing it for the first time.  Not one nurse has asked Alicia about herself or what this hospitalization means to her — what she might be worrying about — what is most important to her.  This morning as I walked for my coffee I noticed no one looked up anywhere through the hall ways to the cafe, so I began initiating and spoke to people even when they were looking at the ground.  I got responses in return and I am teaching my daughter how to be the iniator of relationships so that she can be seen and receive what she needs.  I have also had to work with her to monitor her responses (she got rather hysterical when experiencing pain and not feeling heard by the nurse — who I understand called her a whiner– I was out of the room at the time) — I followed up with the nurse and worked to help her feel safe and less defensive, we came up with an approach to Alicia’s pain and by the end of the day it was managed.  I had to intervene, though because I could see that the nurse was irritated with her and I want Alicia to learn how to care for relationships so she does not get written off.  She will need to be an expert as she will be needing care all of her life. “

January One, Two thousand and nine.

What will this year bring?  Despite the economic down turn, which is undoubtedly affecting every single one of us negatively  in some way…..there is the paradoxical feeling of HOPE….for the future, the world, this country, health care….and… the nursing profession.

The downturn is scaring new grads….who entered school expecting life-long job security, only to find that in some regions, low census numbers  require staff reductions…..some lay-offs….some empty positions not being filled.    Those of us who have lived through these ups and downs  know this is temporary, but that doesn’t help a new grad with 30-50 K in school loan debt.   They need HOPE in the future job market.

HOPE.   We all know the health care system is broken.   We know we spend too much money on many things and not enough on other things…..because of reimbursement decisions made by someone somewhere.     As the changes in the system come down the pike, I pray we as a community of health care workers find a strong voice to help the decision makers use our knowledge and skills to the maximum in order to improve the health of Americans and the humanity with which are sick are cared for.

As readers of this blog know….I am very excited about the potential for Salons to help heal and strengthen the contribution every nurse makes every day.    I think our conversations help us think creatively about how we can better cope with stress and be a positive force for the health of society and to create healthy workplaces.

My personal HOPE for 2009 is that we have an astronomical increase in Salons…..that they start up in every corner of the country.    That besides purely nursing salons….another type starts up…..interdisciplinary salons.   First for doctors and nurses.   For us to learn about each other as people….so that our role relationships on the job can be healthier.

I am asking every who is currently running a Salon…or planning to start one, to please let us know through the blog…..or email me personally, so I can begin tracking the spread of this idea.   My email can be accessed by clicking on my picture on the CHCM website (chcm.com).

We are moving up to four a month here in the Twin Cities.   We have a calendar posted on the  U of M,  STTI chapter website….and people can RSVP just by clicking a button.   This is still just beginning….but I think we are creating a model that will help others.

2009.   Just think of it.  A New President.   New problems.   New solutions.   HOPE.

A sophomore male nursing student made that comment during the ‘check-out’ of last night’s salon.    We had a full house, again and the usual mixture of some students, some staff nurses, a couple of people in managerial roles, a faculty member, A CNO of a major medical center, etc.   About 1/3 were new to the Salon format and the rest had been here before.

The student who felt revolutionized by the discussion went on to say he had been part of discussions groups many times in the past ….but he had never experienced this kind of conversation before.   He mentioned particularly the depth of meanings…and the powerful sharing of important experiences and understandings that went into our discussion.  He concluded his comment with a statement to the effect that he is at a different place in life as the result of attending the Salon.

Also during check-out….many people commented on the value of having students present.

One of the interesting questions raised by an experienced staff nurse is “Can compassion be taught?” The richness of that discussion cannot possibly be summarized in a few sentences here.   Suffice it to say it ranged from giftedness on one hand to ‘on-the-job-retirees’ on the other hand.   Again, the students perceptions about some of their classmates was perceptive and valuable

A major topic was about the wave after wave of consultants being hired who bring new ‘administrative’ initiatives that are of little value to nurses except to consume valuable time.   Several people in managerial roles commented on the amount of time they spend preparing reports….doing surveys….checking to make sure nurses are ’saying things the right way’, etc. and the fact that there is so litle time to actually function as leaders …..or even as managers.  A particular point of great frustration is the cost of these consultants who seem to know little about the functions of the hospital other than the requirements of  their particular program. The cost of these consultative ‘packages’ was juxtaposed inlight of the many layoffs starting in this community as hospital census declines in the face of the current economic crises.

We also talked about the basic uncertainty that is characteristic of the work of nurses and realized that is expanding to more areas of everyday life.  Personal security vs. job security was a fruitful discussion and led to the notion that every nurse should have a Plan B in mind…..for mental health even if it is never necessary to use it.