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“Make Them Stop Fighting” May 16, 2008

Posted by mariemanthey in Academia, Nursing Salons, Professional Practice, Values.
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At last night’s (May 15) Salon, a Clinical Nurse Specialist told of an incident he was involved in yesterday, when another staff member asked him to “make them stop fighting”. The “them” was a Nurse Practitioner and a Medical Resident. The “fight” was a role conflict that surfaced during a patient discharge. You can guess. The resident said the practitioner was practicing medicine and the practitioner said the resident … well, you can fill in the blanks. This “fight” delayed the patient’s discharge by 5 hours!

This was one of the many experiences the 20+ guests brought to last night’s discussion. And this particular incident led us into an interesting and informative discussion of role conflicts: what they mean, how to deal with them, and how to avoid them.

Two of the guests had graduated just the day before our gathering and are interested in how to enter the work world in a healthy way. One guest was a nurse leader from Kenya, Africa, whose issues mirror ours in so many ways, even when the systems and the cultures are so different. She spoke of the problem of nurses not being confident and many people talked about ways to acquire inner strength as a nurse.

A topic brought up almost every month is the issue of “entry level” into practice. A related topic was the new roles being created in new education programs. ADs,BSNs, MN, CNS, CNL, DNP, Phd. Last night we eliminated some people’s confusion. Others learned about new developments. The discussion ultimately focused on the many complexities we face, and how we, as a profession, stay united in purpose and integrated in message as we continue to evolve.

As always, the contribution of individuals reflected the uncertainty and pain of change — but also the hope and belief that, whatever our preparation, our relationships with patients, with ourselves and each other is the key to honoring our covenant with society.

***

I encourage everyone reading this to, first of all, add your 2 cents worth to the discussion. I love to read your comments and will respond. Secondly, join me in a campaign to replicate these Salons. I am convinced that nurses desperately need a safe place to talk about the issues we face in daily practice, as well as the complexities of providing appropriate care in the broken health care system.

I will help anyone interested in getting one started. I have a new written description that summarizes my experience hosting one for seven years. The healing that occurs when these deep connections are made about important experiences is truly profound. And it is very easy to have a salon. Just ask and I will tell you how easily it can be done.

The wonderful thing about these gatherings is that there is no agenda, no minutes and no action steps! No carry-over from one to another. Each one is a total event in itself. We just come together in a safe environment, agree to professional confidentiality and use the Socrates Cafe format to handle the discussion. The result is hope and healing.

My goal now is to have websites throughout the US where a nurse can go to see the Salons scheduled in his/her city/town for the month! Nurses can then pick the one to go to based on their own schedule and the events location.

Several of us have started talking about how to do this. Frankly, we don’t have a road-map, but then,we didn’t have a road-map for Primary Nursing back in the late sixties. Look how that idea spread from one unit at the U of M to a world-wide movement!

I know this one can too.

Comments»

1. Mary Koloroutis - May 16, 2008

Dear Marie,

I appreciate the story shared. It illustrates how important it is for us all to stop fighting and create healing and compassionate environments. Environments where people interact with a consciousness, a knowledge of the ethical imperative we all have as health professionals to fulfill the shared sacred trust that is inherent in the privileged work we do. I am feeling hopeful as I read your blog and imagine the energy and connection that occurred in the salon last night. Such energy is contagious and, I am confident leaders for change evolve through conversations like the ones being shared in the nursing salons.
With deep respect,
Mary Koloroutis

2. Connie Thach - June 12, 2008

There are a few ideas made in the more recent June salon that could
appreciate the comment made here about the recurrent theme of entry level nurses and their concerns for creating healthy work habits. The first idea was what Marty shared yesterday night, which explained that we must first choose our attitude before we can successfully train for skills. With the right attitude, I think it is important to stress an overlooked advantage new nurses have, and when utilized well, will be proven very worthwhile to their professional careers. This advantage is having a clean slate. Specifically speaking, new RNs have a fresh start in forming healthy work habits.

Personally, when I rise for each shift, it is my mission that I adhere to certain practice habits that I feel are important to patient care. Some examples include organizing my patient’s room, trying to pre-medicate with pain medications before a painful dressing change, making myself present in the room each time I see any physicians walk into my patients room, and looking into my patient’s eyes or his/her family’s eyes and apologizing for any mistakes or for the wait time, and taking the time to teach them what each numbers mean on the bedside monitor. In the end, ask yourself what is it in your nursing care that makes you unique.

The second idea was what you said, Marie, that we must wake up and be conscientious of our moment and surroundings. The anxiety and intense learning experience for the first several months of nursing can easily take a turn down the slippery slope of job satisfaction resulting the RN to feel confused, dispirited, and lost in the constant momentum of seeing, doing, and learning. What struck a chord in me when I heard you say this was that I must allow myself to accept what I cannot control, to be patient with myself, to remind myself that what I am going through is not uncommon among new RNs, and that I should take these obstacles as natural passages toward gaining more experience.

Often times, the word in “gaining nursing experience” is generally
referred to technical skills (i.e., IV pumps, documentation) and medical competence (i.e., pharmacology, nursing diagnoses). However, let us not forget the other equally influential portion of the meaning of this word and it is the social aspect of such experiences. What has been refreshed to the meaning of “experience” now is to also become familiar with the political and dynamic culture of the workplace. As new nurses emerge into the professional workforce, they also must become socialized into a culture that is different from what they may have previously hoped and expected. Examples include understanding personality differences among coworkers (i.e., some nurses are fast paced workers while others are not), accepting the fact that not everyone on the unit may get along, and/or following mandated protocols that may not agree with you.

Next, this alludes to potential conflict that may arise in our work. While I do not have much to comment on conflict resolution, I do know what I can do to help minimize misunderstandings among coworkers and showing respect among staff. If we can consider a fight between staff members as an acute event, then ongoing acts of respect and professionalism would be like health and wellness promotion and prevention. From personal experiences and leadership teachings, I have strongly embraced one of The Five Practices of Exemplary Leadership by J. M. Kouzes and B. Z. Posner, which is to “Encourage the Heart” (link provided below).

Finally, out of respect of everyone around me, I make sure that no one goes unappreciated or unrecognized. Dr. William Worall Mayo, one of the founding fathers of Mayo Clinic, once said, “No one is big enough to work independent of others.” Respect can be shown when you acknowledge the presence of the housekeeper who helps takes the trash out of my patient’s room and I thank them as they walk out. It can be shown when you take the time to give the nursing assistant report about the patient rather than telling them what to do or helping them remove the linen bags from the room when you have the time. You must believe that it is the little things that counts.

If you like what you see, reinforce it with positive outcome and model the way. It helps to be consistent with this positive behavior so that those who work around you will come to know better and your intentions. Thus, decreasing chances of misunderstandings. It is in this dedicated maintenance that fosters a better work relationship with those around you and hopefully lead to a more successful type of happiness (link provided below).

“Encourage the Heart”
http://www.leadershipchallenge.com/WileyCDA/Section/id-131055.html

Neat article about the effects of gratitude:
http://leadershipchallenge.typepad.com/leadership_challenge/encourage_the_heart/index.html

3. Connie Thach - June 12, 2008

Correction:

Last paragraph: “It helps to be consistent with this positive behavior so that those who work around you will come to know you better as well as your intentions.”

4. Nancy Sellers - June 21, 2008

Dear Marie,
A professional colleague told me about your “Nursing Salon” idea so I found your website. I will finish my Master’s degree in Nursing Administration in August – 30 years after completing my BSN. I just couldn’t decide what area to pursue in my varied nursing career, but finally concluded that I was first and foremost a nurse – regardless of where I was working. I am working with my mentor during my administrative residency to write an article on different methods for nurse retention. Your concept is fascinating. I’m ready to start one here in our city! One concept I am exploring is the idea of utilizing the Appreciative Inquiry process within a large hospital setting to build on the strength of nurses as a retention tool. I’d be interested in hearing any thoughts or ideas you might have on the subject. Thanks for all of your work in promoting our often misunderstood profession.

5. Amy E. Rettig - August 27, 2008

Coincidence?
For the past few weeks, I have been noticing role confusion in my professional practice. I am a new CNS for an ambulatory area that has not had a permanent CNS before. While we figure out what the needs are for the 4 units I am privileged to be involved in, I look to my peers who are adapting to a “newbie” and now realign their own professional practices. Plus, we have the added pressure (though subtle) of the new DNP that is being offered! My head is spinning! Thank you for the blog!


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