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Going Live March 31, 2006

Posted by manthey in Creative Health Care Management, Leadership, Nursing Salons, Professional Practice.
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So, here we are: after a few months of talking planning and learning by trial and error, we are ready to get my blog up and out there for everyone to see. I go forward in this with very mixed feelings.

First of all I’m excited because I see this as a new way for nurses to come together, discuss important issues, gain strength and focus while recognizing and respecting differences. I believe this kind of discussion will clarify our understanding of complex issues and help us discover new truths.

That is the good news. The hesitation is because I’m not exactly sure what a blog is and exactly how it works. Friends of mine in the office of Creative Health Care Management are helping me with all that and assure me it is a good idea and entirely doable. So … here goes.

I’ve always believed that professional nursing occurs at the point of interaction between the RN and the patient whether that is the bedside in the hospital; the exam room in the office or clinic; or in the patient’s home. So to me, the staff nurse position is the one we need to focus on for development, enrichment and support.

I’ve enjoyed the big challenge of tackling and removing the barriers, both external and internal, which interfere with the nurse delivering the very, very highest level of competent compassionate care during those moments of interaction with the patient. This has involved changing the focus of management to leadership. That means the individual staff nurse must mature and develop enough to manage his or her self, relationships, and practice. It also means organizations have to change so they support creative problem solving of the staff nurse at the bedside. Obviously this has been a tall order. But Primary Nursing was a giant leap forward from which many lessons were learned that are still being operationalized today.

In all my 50 years in this field, I have never been so convinced that we have what it takes to move nursing into true mature professionalism. I have a profound sense of the changes in organizational dynamics that has occurred in my lifetime. Every time I speak with a group of nurses, I am amazed and energized by the incredible passion for patient care alive in nursing today.

A few years ago, I started a Nursing Salon. My intent was to bring nurses together to talk about the big issues of the day and to get in touch with the down-deep values of nursing. These Salon meetings always restored our hope.

Our cumulative wisdom is now so much more accessible due to the electronic revolution. Nurses from all around the world, in all settings and specialties can pool our experience and knowledge, thus increasing the intellectual capital available to all of us in the field. I hope this blog can play a role in energizing and informing the lives of those who visit.

Nurses Have an Amazing Capacity To Do More! March 24, 2006

Posted by manthey in Professional Practice.
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I know if I said this in a speech before an audience of nurses, many would get angry, and some would probably walk out. And yet, it is a statement I believe to be true. Not all nurses. Not in all work situations. Not all the time.

But over my many years in the profession, I have seen the restraints that handicap our role expansion and have envisioned the contribution nurses could make to the health care of society if those restraints were removed. The realities I call restraints are both internal and external. Some are imposed by regulations designed to protect the job security of others, as well as the job security of nurses. Some are in place because of historical precedents not yet dissolved … precedents like inadequate education, cost constraints, physician-nurses role delineations disputes, and the sexual discrimination still somewhat prevalent in today’s society. Some of these are so big, and are kept in place by such powerful forces, they seem insurmountable.

Others are restraints of our own making. These include a pervasive reluctance/fear to accept responsibility for ourselves, our practice and our interpersonal relationships. They include a “within the profession” reluctance to assert the right of control over nursing practice by virtue or our license. They include a willingness to work in environments that are dysfunctional … without either fixing the problem or leaving the work setting. They include an incredible tolerance for ‘within the profession’ disputes about solvable problems like entry-level educational standards and proper utilization of support staff (including Lens). Enormous amounts of energy are dissipated at the highest levels of professional development on issues that require strategic and tactical decision-making among various interest groups within the profession. Decisive action in these areas, (while probably not agreed to universally) would still have the power to restore energy to more productive uses.

What do I envision? For openers … the lack of continuity at the system level that patients suffer from could be solved by developing procedures for call-backs to patients homes. Not all patients, not all the time, but it a responsible nurse can decide whether to do so or not. I can envision a role for RNs that includes time for “‘looking at the big picture” and exercising real coordination/cooperation among specialties in highly complex situations. This can be done by providing appropriate technical support staff. I can envision nurses partnering with physicians (or other primary providers) collaborating in decision making, along with empowering patients to participate/own health care decisions. I can envision nurses creating support structures for non-nurse care providers that both educates them in the techniques of patient care and also supports them emotionally

I am a partner in a company that has software for healthy people to track their own health care data and set goals under the guidance of an advanced practice nurse. The employees enrolled in our program have significantly fewer major health problems, and cost their employer much less for health care.

We are so bogged down in task performance, so diminished by our sense of self-worth and so willing to abdicate responsibility for what we are licensed to do that we haven’t taken the time to lift our eyes, envision a new future and and learn how to play together to create a world here nurses are having a major impact on the health of society and are manifesting healthy lives ourselves!

Claiming our Authority March 13, 2006

Posted by manthey in Professional Practice, Thought for today.
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Some days, I am deeply concerned about nursing: we are not helping in the way that we could be. The average RN does not get to make decisions about the kind, degree and amount of nursing care our patients get. That should be the first item on any staff nurse job description.

We need to claim our authority.

We need to stop using “assessment” and other mealy mouthed words that allow us to avoid talking about authority and responsibility.

Some Fundamentals March 10, 2006

Posted by manthey in Creative Health Care Management, Leadership, Professional Practice.
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My friend and colleague, Mary Koloroutis, is working on a field guide to Relationship-Based Care. She has been looking over some of my old writings and asking me questions, trying to clarify some fundamental concepts. As we talked, I realized it is important to review those fundamentals every so often.

So, here is what I shared with Mary about Articulated Expectations and Authority:

Authority has to do with power: the power or right to take specific actions. This is the concept so hard for nurses to accept, and yet it is the foundational element of a profession, which has the defining characteristic of autonomy as the core of its meaning.

Autonomy — the right to make decisions based on an “identifiable body of knowledge acquired in a formal education program” — is one of the main characteristics that differentiates a profession from an occupation or a vocation. In order to have autonomy, one needs to exercise authority.

The three concepts — Responsibility, Authority and Accountability — are three aspects of a single process: decision making. Whether it is decentralized or centralized doesn’t really change the process. Whatever the allocation of responsibility, it is only right and just for the person who accepts that responsibility to have commensurate authority. Anything less than that is fundamentally unjust. I believe this is true throughout life. In relationships of all kinds — especially that of parents of adult children.

And as nurses we remain unclear about our true responsibility, in that we accept responsibility for many functions over which we do not and should not have any authority. And  we refuse to accept responsibility for that for which we are licensed. To me this is the essential conundrum that needs to be resolved at this point in time, for now and the future.

It is not surprising that we are here, given the history of women’s oppression in the greater society, but the challenge now is to grow out of “here.” I continue to believe that with the attention paid to autonomy in Magnet and the lack of reaction to it among our physician and administrative colleagues is proof positive that any failure to perform autonomously at the bedside is ours to own. My severe frustration is that everyone seems to agree with me, but no one has come forward to join me in making this growth step happen.

PS. Collaborative practice is not in opposition to autonomy — au contraire — true collaboration cannot exist without prior autonomy.