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A ‘Mass Salon” event at the Texas Nurses Association meeting April 20, 2016

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Texas has done it again.    Last Saturday I introduced Salons to the House of Delegates and for the next two hours, about 170 delegates experienced a Salon conversation at their tables.   The same format was used…check in, have a conversation, check out.   It is such a simple formula, I am always amazed at what happens at an experiential level.   After each table had ‘checked out’ we had a room wide sharing.   And that is where the magic and/or miracle was seen.   Among the comments was amazement at how easy and conversation flowed..”like fish moving in a school”…..it seems organic and effortless the way the conversation moved based on the check-in.   Another comment was how easy it was despite vast age and experience differences..   “Amazingly energetic”.   Easy to reach common ground.   Nursing has the same values no matter where is it practiced.   Found the bedrock of who we are….reached common ground.   And finally as always….the word Hope came through.   This seems to be an almost universal result of a salon conversation.

The reason I was asked to do this by the TNA is they are encouraging their members to form Salons all over Texas….and the members present were encouraged to become or recruit hosts in their regions.   The TNA will provide a website to post information about all meetings, including the opportunity to RSVP right on the website.   This is a really important development and will greatly facilitate the success of this movement.

Thank You Texas….for once again Thinking Big

A Salon in New Mexico February 12, 2016

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Next week on Feb. 23 There will be a Salon in Albuquerque.……my hope is that someone gets them started both here and in Sante Fe and I also hope that the movement continues to grow, as it does make a difference!

In a way it reminds me of my early experience with Primary Nursing. The growth was organic. From a couple of short articles in the literature (same with salons) to years of talking about it and helping others get it started…(during which time it was unclear what the impact was) to a slow spreading throughout the profession ( including education finally) and throughout the world. Just like Salons (I hope)…Primary Nursing was alsosort of ‘under the radar’ of officialdom in health care. No nursing organization ever officially endorsed the concept. No financial impact was ever recognized by the system. For years/decades, I was asked ‘how widespread is Primary Nursing throughout the country? For which I had no answer. No one ever counted up the implenentations!      No national surveys were done.   Ever.   We still don’t know.

The same thing is happening with Nursing Salons….people ask me where are they happening? Sometimes we hear they are happening….but mostly not…it is a happening! Simply a happening.    When Salons ‘happen’ all over the country, change

happens all over the country. Funny, isn’t it?


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Here it is the first Sunday in January and I am actually keeping my resolution to post regularly!   Sort of squeezing it in a busy day but here it is.   The third area of my current interest and energy choice is the Nursing Peer Support Network we recently created in Minnesota.   Many of you know that I have been an active member of the larger nursing community for many decades….over 50 years as a nurse.  Some of you also know that for  37 of those years I have been in recovery from the disease of alcoholism……in fact, the majority of my ‘visible’ contributions to nursing have been accomplished during these 37 years.

At no time during this period of my recovery, during which I have been an active participant in a 12 step program …..did I even SEE what generally happens to nurses who become addicted to either drugs or alcoholism.   During the past 2-3 years, I have seen this clearly and am frankly appalled.   Two issues in particular ‘appall’ me;

One is the lack of knowledge nurses have of the continuum that exists from taking that first Percocet or Vicodin ….by ‘diverting’ it from a patients supply…….to a consequence a few years later when up to 15% of them are facing criminal proceedings even perhaps a felony conviction, which essentially means loss of ones license to practice nursing.   We are not doing a good job of making this danger clear to nurses.    

The second issue is the paradoxical thinking that leads to an enormous issue of profession shame about the stigma of addiction.    The paradox that we hold simultaneously in our ‘profession’s mind set’ is that addiction is both a disease and a moral failure.

The ambivalent feelings and attitudes many nurses have about addiction can be attributed to many factors having to do with family issues, as well as experiences caring for addicts.   Nevertheless, as a profession we really need to step up in a mature understanding that addiction is a disease from which individuals can recover and return to their profession with full capacity to be highly effective practioners.

Many states have programs to help nurses into safe recovery.    Minnesota did not until we established one a little over a year ago.   It is called the Nursing Peer Support Network and the website is http://www.npsnetwork-mn.org.

I will periodically be posting more on this topic as recovery from addiction is a process very similar to what we in nursing are doing in recovery from a state of co-decency to our rightful state of full professional status.   I have learned so much in this past year and feel deep passion that we need to face the stigma of addiction fully in order to help the ‘still suffering addicted nurse’.


Happy New Year….R & R December 27, 2015

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R  &  R refers to Reflection and Resolution.    My goal in writing this is to honor the end 2015 with reflection and with the same post honor the beginning of 2016 with a committed  resolve to keep up the post.    My track record for keeping the post relevant is not good, and I intend to develop a ‘posting habit’.   Goodness knows I have enough life experience creating both good and bad habits, that I should be able to be successful in doing this.


My reflection about the past year is based on the three major areas I now choose to spend my time and energy.   They are 1) Clinical practice issues, 2) the history of nursing, especially the U of MN School of Nursing and 3) my newest passion, creating a peer support service for nurses in addiction/recovery/reemployment.    (upon immediate reflection….this will either be a couple of posts….or one very long one!)

First of all, Clinical Practice issues.    The work of the company I founded, Creative Health Care Management, continues to function as Health Care thought leaders through speaking at national conference, publishing thought-provoking professional books, articles and a quarterly journal, and helping care systems  provide a healthy culture for people receiving care and those caring for them. (A very tall order!)  I have the sheer pleasure of working with colleagues who are value driven, highly experienced change agents.   When we get together and talk about our work (twice a year) it is like the best think tank you can imagine.   I will try to do a better job of telling you the exciting ideas and realities of this work.

My love of history started with Primary Nursing.   I hated history as a student and therefore knew little about it.    Something about Primary Nursing spoke to me about the past so I started reading old AJN’s.   Amazing!    Shortly I was hooked on history, fell in love with Nightingale’s story and continued paying attention to history for a couple of decades.   In retirement (!) I joined the Heritage committee of the U of MN SON and became chair of the committee several years ago.   This committee is made of six people who are passionate about understanding history and who delight in making the connection between the past and the future.   We are one of the most hard-working committees of the Alumni Society and our engagement is such that we spend many hours on our subject in addition to the six hours/month in our committee meetings.   Faculty and students, with great leadership from Dean Connie White Delaney, have come alive with interest in history and it is being incorporated into curriculum with increasing frequency.

In my next post, I will continue this year end reflection by sharing a newly developed passion for helping nurses who are dealing with addiction, recovery and re-entry into the profession.

Thanks to all who read this.   Please dialog with me and with each other.   Back soon.


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.


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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?