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NURSES IN RECOVERY….. September 1, 2014

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Substance use is a serious problem in society and even more serious in the nursing profession.
Nursing is the largest single licensed group within health care. Nurses spend the most time of any health professional in close contact with highly addictive drugs. Historically, chemical dependency and alcoholism have long been identified as significant issues for the profession. Addiction continues to be a major problem….and yet, no nurse enters the field expecting to succumb to a hidden trap that will jeopardize his or her own life and/or license and which may in fact cause harm to vulnerable people entrusted to their care.

The sacred, trusting covenant the nursing profession has with the public is ripped apart by the disease of addiction. Statistically, at least one in ten nurses will acquire a Substance Use Disorder (SUD) within his or her lifetime.

SUD identification often results in an intervention that brings the individual into a place of treatment. Regardless of how that identification is triggered, two actions ensue….the regulation of practice to protect patients and treatment of the disorder. Both the regulation by the Board of Nursing and the reality of treatment and recovery are major life consequences that are challenging and life changing. The need for peer support groups is well understood and already established for most other health professional groups, including physicians, pharmacists and dentists, but there is no such support group for nurses in Minnesota.

UNTIL NOW. A new organizatin is being formed called the Nursing Peer Support Network. Contact me for further information until our website is up. Meanwhile….this is a draft of our eventual goal statement.

To create within the nursing profession a commitment to value every single nurse….especially those on the road to recovery from SUD. This commitment is manifested by ‘return to work strategies’ that permeate every level and type of employment opportunity throughout healthcare. Nurses will become literate about SUD and recovery and be able to help others in places of employment better understand how to reduce the risks of employing in recovery…..even those with felony convictions. Various strategies and educational opportunities will be created to achieve this goal.

We need you help and support. Feel free to contact me via blog directly to my email or call me at 612-827-1611

A Labor Day reflection: CHOICE AT WORK! September 1, 2014

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I am one of the lucky ones….I knew nearly all my life that I wanted to be a nurse. When I was 5 years old, I was hospitalized for a month during which time I truly felt abandoned by my parents and worse yet, when they did come, a very painful procedure was performed on me. During this time, a nurse named Florence Marie Fisher colored in my coloring book. For reasons only known to God, that meant to me that she cared for me….in the fullest sense of that word care.
I knew from then on that being able to do that for another person was exactly what I wanted my life to be about…..and I’ve never looked back!
What made it full of wonder is that I have been able to learn so much about how to live from my work. A beautiful framework for living came through my work when I was involved in the original development of Primary Nursing. The framework links the concepts of responsibility authority and accountability in a dynamic relationship that can serve to correctly inform the proper relationship among people….the proper structure for an organization….the proper content of a job description. When each of those three elements….responsibility, authority and accountability are viewed in their proper sequence….when responsibility is legitimately allocated and authority commensurately delegated and accountability mechanisms are designed for recognition and education (and not for punishment)….then all aspects of an activity can be functional….and personal relationships can be healthy. But the most important thing I finally learned (sometime in my mid-forties) is that these same elements are at work in my life. The moment I call my epiphany occurred with a blinding flash of insight…..during which I instantly saw that as long as I blame someone else for whatever is wrong in my life, I am not accepting responsibility for myself. I decided to learn how to change that, and I have never found it necessary to feel victimized by any person or situation or institution again.
What does all this have to do with work? I believe we all have choices every day about all aspects of our work …..and that the choices we consciously (and unconsciously)make have the power to either expand our spirit….or to destroy it. I am continually amazed at how many people tolerate working in dysfunctional systems …..or in toxic workplace cultures, of for mean-spirited power hungry immature bosses. I know there are many factors operating that may reduce ones awareness or perception of choices. Nevertheless, I have come to believe that even in the most oppressive environments….consciousness of choice instead of consciousness of victimization is the key to being able to grow spiritually.
Ultimately, I think the real lesson to be learned is that we have a choice to manage ourselves…..or not. Self management means being aware of the importance of healthy interpersonal relationships. Open communication (no back-biting) functional trust and mutual respect are the three key ingredients to healthy interpersonal relationships. Open communication means taking the time to learn the tactful way to talk about difficult issues with co-workers….it is a skill we can choose to learn. Trust is a choice we need to be willing to risk giving…..because withholding it breeds only more mistrust….and mutual respect requires the judgment to see everyone (at all levels of status and education) as being of equal importance to the overall workplace morale. And I learned that morale influences the quality of the product more that any other single or combination of factors. In my world that means that the morale of a nursing unit staff will have more impact on the quality of care patients receive than does any other single or combination of factors. And morale is solely determined by the way staff members treat each other in the context of workplace realities….including the reality of more work to do than time available.
These incredibly valuable lessons came to me from my work experience…..and they dovetail completely with what I have learned in recovery.
Consciousness of choice ….of how to respond to my co-workers….of how to be present in my work…. of my values of integrity and authenticity…all of these and more are the opportunities of learning and growth I have received through my work. And I know that all of this came about because Florence Marie Fisher colored in my coloring book when I was five years old. She created a caring relationship with me…..and permanently influenced my life.
She never knew that. I published a book about Primary Nursing in 1979, and dedicated it to her. The publishers tried to find her, but where unable to. Recently I came across those onion-skin copies of the publisher’s letters to a couple of State Boards of Nursing trying to find her and remembered that they were unsuccessful in locating my Florence Marie Fisher. But I thought to myself that afternoon few months ago……Google! And so I googled her and found her obituary….which also listed her survivors. I have since had the pleasure of meeting her son and grandchildren and telling them about the impact she had….not only on my life…but also on my work, which has in turn influenced the experience of nurses and patients throughout the United States….and now also internationally. Of course they had no idea…..her simple act at work of coloring in my coloring book was a sublime act of co-creation. As nurses we can all find ways to choose to color in a coloring book. It is a choice we have to make, individually, and repeatedly. It is a choice that will not be documented….cannot be charged for….and that has a major impact on the lives of at least two people, the patients we care for and on ourselves. The choice to ‘be with’ the patient, instead of just ‘doing for’ changes the nursing experience for each individual who experiences this choice.

MinnPost Article on Nursing and Addiction May 29, 2014

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I was honored to be asked to talk with MinnPost reporter Sarah T. Williams about the problem of nursing and addiction. I’m really happy with how this turned out.
To read the article, click here.

Gratitude breeds gratitude;discontent breeds discontent April 26, 2014

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Everyone is free every day to choose how they want to experience the day.   As Dr. Phil says, ….we get to choose to contaminate or contribute…..every single day.    Often, the stress and workload in bedside nursing and in most hospital managerial roles can obscure this truth.    It can seem like everyone else has more impact on our experience than we do.   ‘

However, we can opt to contribute by intentionally reflecting on  the aspects of our lives and work that we are grateful for…..and we can intentionally refuse to spread discontent  by not engaging in it….even when we are invited to do so by a colleague.  

It is time for each of us to take back the power we have to manage our own lives.   Choices have consequences.    Let us be clear about that and aware daily that we own our life experience.

NURSE MANAGERS: DO YOU EVER HAVE FUN AT WORK? WHAT GIVES YOU JOY…..AT WORK? January 16, 2014

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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, 2013

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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, 2013

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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.

The Premier Primary Nursing Hospital in the United States July 23, 2013

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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,

Jamie 

It’s about safety…..not maintaining ‘margin’ July 14, 2013

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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, 2013

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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.

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