Marie Manthey’s Nursing Salon

I decided to query email list I use to inform people when the Salon is scheduled about why they even come to this event. Everyone is soooooo busy, there are many reasons why not to come. Every once in awhile, I’ll send you their answers to that question. Here are two:

The reason I show-up at the salon is for an up-close and personal dialogue about the state of nursing in a variety of settings. Thank goodness we have so many different attractions to different populations and different settings.
That makes for many career options and we all have a slightly different “take” on the state of healthcare and the state of nursing.

I also find the different organizational stances really interesting.  It makes me feel less alone in both the intimate and public struggle of healthcare.  Sometimes it is a transcendent experience, like after the bridge collapsed and Marty said she felt “we built a bridge here today” as our conversation kept veering back to that sad event.  Other times I get my energy rev-ed up and then feel a bit of a let down as action is up to me and I don’t always see a way.  Most of the time the Salon is a great reflective process to feed my brain and my soul.  I get nourished by the people via their hope, humor, and honesty.  The expectation to just “BE” in the setting of confidentiality and a meal is pure presence that I have not had very often as an adult and never in my professional life. 

In today’s climate of the “Rage Industry,” and where Target customers are called guests, and patients are called consumers, I can come back to my core of nursing in a gentle and intelligent way with good conversation. I find it very good medicine!
DG 

Hi Marie,
I came to the first salon having no expectations nor a full understanding of what I was going to experience. What I found was a diverse group of people that care about nursing and where it is headed. I loved that it was an informal opportunity to explore and express ideas that had been percolating without a ready outlet.

I came back because I think it is a great chance for people to expand their experiences as nurses beyond their chosen patient population and see nursing as a whole. Though we may choose to work with different patient populations we see mainly the same issues arise on every level whether it be short staffing, inadequate leadership (both formal and informal), or lack of participation in unit related activities.

We also share the same love for our patients and their families no matter what their age. We all felt a calling to nursing, and sometimes we need a reminder of what that calling was and why we worked so hard to answer it. I found this when I attended my first salon, and I hope to continue to renew my passion for nursing and search for further solutions through future meetings. Thank you for the opportunity!

Sincerely
HG

A recent dialog among Creative Health Care Management (CHCM) consultants resulted in an internal communication I have decided to share with the blog.  As always, your comments are welcome.  (Also…how do you like the new look?)

This communication about Relationship-Based Care started with a question from Mary Koloroutis via email within our company.   

From Mary to all Consultants: 

An issue that continues to surface in the RBC Leader Practicum and in some interactions I have with nurse managers and unit practice council members is that as much as they would like to implement a primary nursing model of nursing practice, that the acuity, staffing realities (ratios and schedules), and the geography of the unit, create huge barriers to their getting there.   How are client managers addressing this?

Jayne Felgen, president of CHCM, sent this reply: 

From Jayne Felgen to Mary, copied to all consultants: 

It IS the HEART of  RBC…accepting a responsibility relationship for the patient’s care throughout their stay on that unit is the ultimate expression of professional practice.

I’m naming it and claiming it! So, the work of the Unit Practice Council is to review current scheduling and assignment practices (Work Complexity Assessment) looking especially for fragmentation reduction opportunities…to make it more likely that the nurse who agrees to perform the admission activities might also chose to be the primary nurse.

So, like an attending physician retains responsibility despite multiple consultants, or her/his day off, so do nurses create an infrastructure in which they claim responsibility for 1-2 patients among their typical assignment. Once those responsibilities are “owned”, the nurses communicate in more deliberate ways, proactively, more precisely…not unlike a parent leaving explicit instructions for the sister who’s caring for the kids while parents have a get-away. When they return, they resume care. While they’re gone, they’ve anticipated every possible need.

Having said that, 100% compliance with this may be impossible, but, we urge them to shoot for it because it’s the right thing to do. And, using Appreciative Inquiry (AI) principles, learn why it worked when it worked, and then do more of that.

Until we accept this responsibility at this level, we’ll continue to ignore the crazy schedules (1 day on, one off, 8-10-12 hour shifts reporting on/off to each other, robbing Peter-to-pay-Paul floating practices, being married to geography rather than relationship, and other craziness that produces high variability and low professional reward/satisfaction in our systems.

I am abundantly clear that we must step up and claim our practice…not by tasks or shifts, but one relationship at a time…nurses, therapists, social workers, pharmacists, etc. It’s the professional v. technical dialog again.

The Nursing Salon has enjoyed some good publicity in the current issue (May/June) of NurseWeek. We continue to experience, with the Salon, a healing of the hurts sometimes created by deep-seated problems within nursing practice. A sense of hope continues to be the most prevalent content on our check-out at the end of each discussion. No matter the number of people, no matter the age, no matter the level of education (we have LPNs and PhDs) no matter the specialty, no matter the setting — when we come together to talk about what is currently on our mind about nursing, the talk is authentic, value-driven, and powerful.

I would love to see this idea spread. I believe some other groups have started up and I would love to hear from you, how it is going. I would be happy to help anyone get another group started, and I have information on how to go about doing so. It is practically stress-free for all of us…..me as the host and all those who come. If anyone wants info or help, email me at mmanthey@chcm.com. I will share our experiences, answer your questions and to what I can to support to your group.

I had a most thrilling experience today … 

Some of you may remember that I dedicated my book, The Practice of Primary Nursing to a nurse named Florence Marie Fischer. Sometimes when I speak, I tell my own story about how I became a nurse… and I always mention Florence Marie Fisher. I became ill at the age of 5 and was hospitalized for a month at St. Joseph’s Hospital in Chicago. It was a traumatic experience in a couple of ways. First of all, my parents didn’t know how to prepare me, since they had never been hospitalized themselves. So they just said I was going to a large building. They left me there and visited occasionally. However, when one or the other came, a very painful procedure was done involving an intramuscular injection of their blood (horribly painful), so I felt not only abandoned but also frightened and confused by the pain associated with their visit.

Florence Marie Fisher is the name of a nurse who cared for me. She would sit by my bedside and color in my coloring book. For some reason, that translated to me to mean she ‘cared for me’. I decided right then that I wanted my life to be about that kind of caring, and from then on, I knew I would be a nurse. As a kid I often got doctor/nurse kits for Christmas, and I always threw away the doctor stuff. Only being a nurse was of any interest to me.

Forty years later I wrote the book on Primary Nursing. When I finished, the publisher asked me who I wanted to dedicate it to, and after a few minutes of thought I said Florence Marie Fisher. Although we had never communicated in any way after I left the hospital, I never forgot her name. And so the book was dedicated to her.

The publisher thought it would be really cool to find her, so they contacted the Illinois State Board of Nursing, whose records indicated she had moved to Indiana and that her last name was Ambrose. They then wrote to the Indiana Board to locate her, but there was no response to their request, and the search had come to an end.

It was earlier just today, when my search resumed. I was going through my papers in preparation for turning them over to the University of Minnesota Library Archives. I found copies of the publisher’s letters to the state boards and got to thinking about a way to search for Florence Marie Fischer that wasn’t available almost thirty years ago… the Internet.

Now for the thrilling part. I didn’t find her, but I found her son… and I just finished talking to him. As I was explaining my connection to his mother, I got choked up several times just realizing I was actually talking to Florence Marie Fisher’s son! He was just as thrilled to hear from me, as he had no idea of his mother’s impact on me. Out of nowhere he gets this call about the influence his mom had on me. She died in 1989, so I guess I was just meant to find him now…. not back in 1979 when I was writing my book.

He knew nothing of me, my work, or his mother’s connection to that work. It is a straight line for me. And as I told him about my work, the book dedicated to his Mom… the impact on nursing and patient care this work has had… he got just as choked up as I was.

The connection we had was extraordinary. I never thought I would find her, and I guess technically I didn’t, but talking to her son felt very close. And being able to tell her son about the tremendous impact she had on me was one of the high points of my life!

I am sending him one of the few remaining first edition hard copies of The Practice of Primary Nursing and the second edition, which is also dedicated to Florence Marie Fischer.

Staff nurses and nurse managers tell me they really like Crucial Conversations as a guide in managing morale problems. Here’s the deal: morale problems are always caused by problems in interpersonal relations among the staff. This book gives very specific and useful advice about how to talk about important issues/behaviors that are a problem among co-workers. Everyone has to handle these issues for themselves. It usually doesn’t work to expect the nurse manager to step in and solve problems at the staff nurse level. The more each individual develops the skill of managing their own relationships successfully, the healthier a unit’s morale will be. The manager’s job is to help the staff develop the skill to talk about difficult situations skillfully, so that a solution can be reached that doesn’t make the situation worse. 

So…if there are managers out there who haven’t found the book yet, I suggest you get it. Add it to the unit library and use it to provide guidance and support to the staff to manage their own relations successfully.

Add your stories about handling difficult situations to the blog.You never know when your experience will be a ‘teachable moment’ for someone else struggling with a similar problem.

Latest news indicates the shortage produced by baby boomer retirements will only be in the neighborhood of 350,000, rather than the 700,000 originally projected. Great news! But the shortage is still a huge problem.

Besides losing the experience, skill and wisdom gained over years of clinical experience, I worry that we also might lose some of our history. One of my personal delights at this point in my career (50 years this year!) is being involved in ‘heritage-work’. If you have artifacts, pictures, etc. of nursing decades ago, see if your local school of nursing has an interest in preserving items of historical value.

An advantage to having 50 years of experience is the personal knowledge of how it was to compare to how it is and the ability to creatively think about how it can be. One of the realities that sometimes clouds the incredible upward trajectory of nursing is the way changes in the workplace can negatively impact nursing’s contribution to the health of society. This kind of thinking, remembering and projecting is an important contribution senior nurses can make as they prepare to retire. Also, retirement itself is being re-considered as we speak. Clinical support for student nurses is just one of the ways being implemented now to ‘pass on’ the experience and wisdom acquired in years of practice.

Another need is to pass on the underlying values of the nursing profession. We who know need to teach the value-foundations of the nursing profession to the new crop coming in. Our covenant with society is profound. Our opportunity to make a difference in the lives of human beings is the constant that occurs in busy ICU’s, ambulatory surgical suites, in nursing homes, on peds units, in doctor’s offices…..in every setting every day we have an opportunity to make a difference in the lives of the people we contact. What a privilege! Those of us who learned that in years of practice need to take responsibility for ‘passing it on’ to the younger generation of nurses.

I invite veteran nurses to share stories of the ‘good old days’ that might help young nurses connect with our heritage. Do you know someone who made a difference in the life of an iron-lung patient? How did nurses care for people with TB, knowing they might become infected? Did you care for patients recovering from cataract surgery, on bed rest with sandbags holding their head steady for 10 days? Where did YOU make a difference?

Send us your stories about handling difficult situations. You never know when your experience will be a ‘teachable moment’ for someone else struggling with a similar problem.

It is my New Year’s resolution to post to this blog more regularly.

Join me. Make it your resolution to comment on my writings.

Although I usually don’t share my New Year’s resolutions because they are mostly about my ‘inside stuff’….one that I will share is a promise to write 3-4 times a week on the blog. And…..to encourage you to respond because we all have opinions and experiences to share…and there is value in doing so. What got me started doing this blog in the first place is a comment from my colleague Jane Felgen about putting the Salon idea onto the web. The way it works at my home is that after we sit down to eat, I ask the question of the group….What is on your mind about nursing tonight’? So….let’s try that here…..What is on your mind right now about nursing as you are reading this blog? In a couple of sentences say what you are thinking about as you browse through the blog…or now at the beginning. Others reading your current issue/question/problem/hope/ambition/fear/worry/frustration may wish to comment. I know I will. From this we will be able to have an electronic version of our monthly experience here at my home.

I’ll tell you about some recent responses to that question. At a recent salon, one nurse discussed a recent medical board meeting where MDs expressed a great concern about the new DNP (Doctorate in Nursing Practice degree), saying it might confuse patients to have another ‘doctor’ around! (A great discussion on that point!) A new grad asked what the future will be like for her…when the baby-boomers retire and the future terrific shortage arrives. An experienced nurse talked about her challenges precepting new grads in a NICU and also expressed concern about her unit’s remodeling that will result in all private NICU rooms. A home care nurse exec talked about the isolation nurses experience i.e., the absence of colleagues in the workplace when all their work is in patients homes.

As for this blog, I am asking anyone who reads this comment to answer the question: What is on Your Mind About Nursing Right Now? Post your comment here. Respond to other people’s thoughts, experiences, ideas, solutions, hopes, dreams, wishes and fears. If the blog turns out anything like the ’salons’…..we will all benefit in ways .

And so to get us started, here is what is on my mind about nursing: On this first day of the New Year, I am amazed that after 50 years of nursing, there is still so much to learn and so much for me to do. I marvel at the awe a new nurse has in being able to connect deeply with a patient and KNOW she/he has made an important difference in that patient’s experience. I love to see a manager ‘get’ the meaning of leadership and realize that as a leader they are able to influence the quality of care for a whole group of patients. As a consultant I especially love it when a CNO expresses profound delight at the changes she sees in the delivery of care after a transformational experience for the staff.

I also know in the deepest level of my being that the problems we face working in dysfunctional systems on toxic units and with chronic staffing shortages – all these problems – cannot be allowed to usurp the passion nurses have for patient care. And they will not. We will find ways to overcome them. Of this I am certain.

This past week I’ve had the pleasure to work with nurses in Arkansas and Missouri. I continue to be amazed at how simple truths about the nature of our work touch nurses deeply. At no time have I been with hard-shell attitudes or cynical skepticism.

Not that skepticism and resistance isn’t there. It’s just that when we strip away the ‘problem seeking’ approaches we customarily use, there is an incredible source of positive energy waiting to be tapped. I don’t remember this positive energy being so apparent in the past.

There seems to be a much stronger recognition of the values that form the base of our profession. I sense a belief that we have solutions to problems caused by dysfunctional systems but we just aren’t sure how to go about implementing them. I hear a clear appreciation of the importance of our intellect and our compassion

I am encouraged by the whole notion of Re-igniting the Spirit. I want to hear from like nurses whose spirit has been re-ignited. Tell us how it happened and what it means to you on a daily basis.

Had dinner last night with Jayne Felgen, the President of Creative Health Care Management. It is always so good to touch base with her. We are both into such interesting aspects of our work there is barely time to catch up with family and personal stuff.

She has just returned from England where a group of dynamic individuals from eight countries are designing a research project about patient satisfaction in the context of a therapeutic relationship with a patient and nurse autonomy. These incredible individuals have been meeting in various places around the world as a result of a chance meeting on the deck of my house at a Sunday morning brunch during the last Summit of Sages in October 2004.

Which reminds me: watch for info on the next Summit  of Sages, October 14 - 16, 2007. Details are still being planned but we know the topic will be “Social justice as a core value of nursing” and the keynote speaker is Maya Angelou! It doesn’t get much better than that!

I have always wondered what would happen if salons all over the county were touching the heart of nursing.  It looks like I am beginning to find out. Over the weekend, I received this email from Dawn, a nurse in Virginia.

I just wanted to let you know how you have inspired me. I read your article on the Nursing Salon and have since started a nursing salon of my own at hospital. Our salon is a combination book club/discussion group. We read a book and then meet for “lively conversation” and refreshments!  We have read Code Green: Money-Driven Hospitals and the Dismantling of Nursing (we used several of your articles and interviews to support the reading and supplement the discussion) and we just finished Suzanne Gordon’s Nursing Against the Odds. The Nursing Salon is fully funded (I applied for a Nursing Morale Grant and was awarded $1,000 from our health system) and so there is absolutely no cost to the participants. We have increased in numbers since beginning in May and presently average 20 participants each month. Thank you so much for all you have contributed (and continue to contribute) to the profession; you are an inspiration to us all.

Dawn, thank you so much, both for your kind words and for starting another salon. I hope your inspire others.

When I first read Code Green, I was sort of heartbroken. It was a book about people I knew and respected tremendously and hospitals I considered among the best in the country from a nursing practice point of view. So I was disheartened. Then I found out about changes at the very top and a refocusing of the facility. I was given the opportunity to conduct rather lengthy interviews with the new CEO and CNO, and my feeling of devastation was greatly relieved. Although the culture changes required in order to merge these two great places was enormous, the new leaders were able to go to the staff for answers about how to improve the situation. Their process and the subsequent turnaround are reported in Creative Nursing a journal published by Creative Health Care Management. You can find a .pdf of that issue here. (And interesting historical note: this issue is also the first published reference to the Nursing Salon in my home.) So, if you didn’t include this latter piece in your book club, it would be helpful to the members of the salon to make this available.

Please keep my blog updated on your salon activities. The same goes for everyone else.  Let me know what you are doing. If this idea takes hold, there might be a regular section of the blog devoted to Salon Notes.

When I first posted about the overwhelming response to my blog, I left off the comments emailed me by Gary Saltus, a physician colleague. Gary specializes in helping  groups through transformational change and is working with CHCM create a program to build Physician/Nurse relationships.

It’s a shame I left Gary’s comments out because they are so vital to this discussion.

Here are the highlights of Gary’s email, followed by my original response (again):

I enjoy and appreciate your constant journey of discovering more and more in nursing and health care. I keep coming back to your primary statement of talking to the different people in health care because it’s something you want to do. I imagine this is your purpose in life at this time –your constant search for discovery, wherever it takes you. I imagine this is the lens you use to see the world: How do we do health care better?

I agree with you about the importance of conversation, but I look at it through my lens of transitioning with individuals, teams, groups, and organizations.

The challenge as I see it is to get the people involved to have these conversations with themselves first, to learn who they are and what their purpose/vision is. They need this self-knowledge so they have the self-permission to present who they are to the interpersonal environment (another individual, team, and group) with confidence.

Before the individual, team, group or organization can tackle the difficult and major issues that you present in you blog, they must go through orientation, differentiation with resultant cohesion conversation with each other first. These are the stages of maturation according to John Cater, PhD at the Gestalt Center for Organization & Systems Development. They also must go through these stages in three phases. Assimilation, differentiation, and manipulation. Each phase brings the system closer with the common denominator being trust. This process is how I facilitate working with groups. So the bottom line is we can’t start tackling the big issues until the system has matured. The dilemma is that organizations don’t think they have the time to let the Nurses/Physicians/Administrators do this group work.

I admire your passion and drive to facilitate change in the Nursing/Health Care arena. Our passions are in attunement. Thanks for including me in your thoughts. I look forward to talking to you in the future about our passions and shared visions.

Gary, thanks so much for your thoughtful and insightful comments. I don’t have the grasp on gestalt that you do…but I definitely get the ‘gist’ of what you are saying. I agree that the transformation has to start with the individual, and then move to groups and teams and that the employing institutions do not yet see the benefit of this kind of staff development.

Throughout my career I’ve been fascinated by how attitudes/behaviors of employees change as institutional and leader values change. I’ve seen so many dramatic changes (both positive and negative) in the lives of patients and nurses that I feel compelled to continue working with these issues. The issue of no time to engage in these discussions is really daunting. Also, the separation between professional cultures has erected many barriers to communication I am beginning to see coming down. Another thing that I find very interesting is that the barriers between nurse educators and practice nurses are also beginning to crack. Real light is beginning to shine through. One of the ways I get to see this is thru the monthly Nursing Salons which I have been doing at my home for the past five years. Attendees vary according to the email lists interests in coming on that evening. It is sort of a blend of the Open Space technology and Socrates Cafe conversation format. I have so enjoyed seeing nurse educators and nurse managers, staff nurses, alternative therapy nurses, public health nurses, etc all sitting around talking about some issue or another in nursing. A retired physician comes whenever he can. And you are right…..it really is about improving Health Care.