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Discipline without Punishment (Poll!) May 30, 2017

Posted by mariemanthey in Creative Health Care Management, Leadership, Professional Practice.
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A crucial component of the Responsibility/Authority/Accountability paradigm is accountability, which means looking at results and determining what lessons can be learned, what needed behavior changes can be identified, what course corrections can be made.

Sometimes there is a need for the manager to address a staff nurse’s behavior directly, and the best way to do that is via positive discipline, which never includes punishment.   The derivation of the word punishment is penalty, while the deviation of the word discipline is learning.   We need a shift to discipline and away from punishment.

Punishment for mistake making and behavior problems is punitive when it incudes the intention of making the person feel shame or guilt.   Guilt as a behavior modification tool seems to be coming back in to popularity again, and that is truly mind-boggling.   And it is punitive.

I’d like to hear about your experience! Please join the conversation by participating in these two polls, and/or commenting.

 

Readers, please share examples of experiences when punishment (suspension, shame or guilt) was the goal; in contrast to times when discipline (learning) was the goal.

Memorial Day Remembrance: Nurses Serving! May 29, 2017

Posted by mariemanthey in Academia, History, Inspiration, Leadership, Professional Practice.
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Wartime nursing is unique, but also those periods in history tend to have an outsize effect on peacetime nursing as well. During World War II for example, huge changes took place. No one wants war, but we can honor those who served. I personally find this period fascinating, and with my work with the Heritage committee at the University of Minnesota School of Nursing’s Alumni Society, have been able to delve into it with great delight. Here are a few notes on some of what took place then, creating our present moment today.

As of 1943 the US Public Health Service had already funneled $ 5.7 m into nursing education, to stem the inevitable shortage of nurses, even as they knew that amount would be insufficient.

So Frances Payne Bolton, US Rep from Ohio, set in motion the Cadet Nurse Corps which was signed in to law that year. Under that program $150m was dispersed for scholarships and direct stipends – uniformly across the country, without regard for race and ethnicity, to all nursing schools.

Not only did this result in a massive surge of paramilitary recruits (targets were met every year), but nursing schools themselves radically transformed. The program was terminated in 1948, but by then 124,000 women had been enrolled, and nursing schools – especially those serving non-white populations – took huge steps forward in the condition of their facilities and equipment.

Here in Minnesota,  Katherine J. Densford, Director of Nursing at the U of Minnesota, was another leader active during that period, serving as president of the American Nurses Association among other positions.  She worked closely with Payne Bolton and Roosevelt to help supply nurses to the front lines – the University of Minnesota School of Nursing educated 10% of all US Cadet nurses educated during that period.

Densford also determined that the lag time between when nurses completed the recruitment application and when they were actually inducted actually took 6-8 months initially. She spear-headed efforts to reduce the bureaucratic tangle and as a result that lag time was reduced down to only 4-6 weeks!

A much needed -addition to the  Powell Hall nurses dormitory was built at the University of Minnesota with  Cadet Funds, and this is where I had my office while Primary Nursing was being created.

Another tidbit I wanted to share: May 1944, the national induction ceremony was held in DC, and it was for all nurses being inducted around the country, and so it was broadcast nationally on the radio.   KSTP carried in the Twin Cities. Thousands of nurses attended the induction  in Minnesota at the Northrop auditorium. The program included a song composed for the occasion, sung by Bing Crosby.

The ‘snappy’ nurse cadet uniform was actually created by Edith Heard – a famous Hollywood costume designer.  Wearing this uniform gave Cadet nurses the same ‘perks’ given to military men and women….like free admission to movies!

This bold initiative was a vital part of the war effort, serving both the military and civilian hospital needs.   This memorial day is a good time to remember the dedicated nurses who saved the lives of soldiers on the battle field.

 

Additional resources:

U of MN School of Nursing History

Leadership at the U of MN School of Nursing

Smithsonian website for the National Museum of American History, Kenneth E. Behring Center:

DHHS Report (NACNEP): The Role of Nurses in Primary Care (2010) May 27, 2017

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The Role of Nurses In Primary Care (DHHS, 2010)

 

Continuing the celebration of Nurse’s Month, here’s a great document from the US Govt supporting the importance of nursing and the connection between Nursing and Quality Patient Care.  The full link is at the top of this post. The Executive Summary is included here in full.

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Executive Summary
As the projected demand for primary care increases exponentially and provider shortages intensify, necessity is driving a re-examination of the roles of nurses in primary care. The National Advisory Council on Nurse Education and Practice (NACNEP) convened two meetings in 2009-2010 to examine
the roles of nurses in primary care and strategies to increase workforce capacity and effectiveness, reduce barriers to practice, and strengthen the education of nurses for primary care.

Nurses have key responsibilities for the essential components of primary care articulated by the Institute of Medicine (IOM): integrating care, increasing accessibility to care, addressing a large majority of personal health care needs, building sustained partnerships with patients, and practicing in the context of family and community (Institute of Medicine [IOM], 1996). Their close proximity to patients in every setting where primary care is delivered provides unique opportunities for nurses to influence health outcomes and cost effectiveness.

The NACNEP identified three overarching recommendations to increase access to quality primary care in the United States:

(1) Decrease barriers to primary care nursing in the United States.

The Congress and the Secretary of the U.S. Department of Health and Human Services should leverage resources to enhance primary care capacity by promoting the removal of regulatory barriers that prohibit primary care nurses from fully exercising their scope of practice. The Secretary and Congress should compel federal and state governmental bodies to revise Medicare and Medicaid funding stipulations that inhibit access to primary care directly through regulatory scope of practice challenges or indirectly through inequitable reimbursement challenges. Additionally, the Congress and the Secretary should ensure reimbursement policies are provider neutral and adequate to sustain primary care practice including nurse-led models such as nurse- managed health centers.

(2) Promote educational initiatives that support and strengthen the nursing primary care workforce.
The Secretary and Congress should leverage federal, state and local governmental financial resources to build primary health care educational program capacity and increase clinical training sites that support interprofessional team competencies and innovative technology. The Secretary and Congress should support the development, implementation, and evaluation of primary care residencies/fellowships for nurses in teaching health centers and other community-based settings to increase the nursing workforce capacity to meet increased consumer demand for primary care.

(3) Support successful nurse models of primary care.

The Secretary and Congress should leverage federal, state, local government and private resources to expand current successful models of primary care services such as nurse-managed clinics, nurse/family partnerships, and school-based nursing clinics; and evaluate outcomes using comparative effectiveness. The Secretary and Congress should support the development and testing of innovative models to meet the primary care needs of specific populations such as nursing home residents, individuals with behavioral health issues and children with special needs. Additionally, Congress should support the development and testing of innovative nurse-led models in the medical home demonstration to expand the capacity of primary care and meet the changing public health needs for primary care. Lastly, the Secretary and Congress should increase access to and consumer engagement in primary care through convenient locations and creative use of consumer-oriented technology.

This report to the Secretary of the U.S. Department of Health and Human Services and the Congress summarizes the proceedings of the NACNEP meetings of November, 2009 and April, 2010.

Thought of the Day: Leadership May 26, 2017

Posted by mariemanthey in Leadership, Thought for today.
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Leadership involves inspiring and empowering people which creates and expands organizational resources.

Therefore you can have higher productivity, lower cost, more engaged staff, and higher  patient-satisfaction outcomes.

Recent travels: UC-Davis – among the best of the best! May 23, 2017

Posted by mariemanthey in Inspiration, Leadership, Professional Practice.
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I had the pleasure of visiting UC-Davis recently, and it was delightful as always to experience the culmination of so much of our shared vision of an optimal health care system.

Nursing here actually fits something I wrote years ago, a reprise of Judy Chicago’s “Merger: A Vision of the Future”

Here is that actual piece of hers:

And then all that has divided us will merge | And then compassion will be wedded to power | And then the softness will come to a world that is harsh and unkind | And then both men and women will be gentle | And then both women and men will be strong | and then no person will be subject to another’s will | And then all will be rich and free and varied | And then all will care for the sick and the weak and the old | | And then all will live in harmony with each other and the Earth.

Here is my health care variant:

And then a collaborative practice will emerge | And then care will be wedded to cure | And then health will come to a world that is diseased | And then both doctors and nurses will be gentle | And then both nurses and doctors will be respected | And then no person will be treated as a task or a task do-er | And then health will be within reach of most much of the time, and journeys through sickness will be periods of nurturance and care | and then the act of one person caring for another at the time when they are vulnerable will be held as crucial to the human race.

UC-Davis is among that group of hospitals that I feel very nearly reaches those ideals! Thank you for having me, and I look forward to seeing you all again soon at the Symposium!

Announcement: CHCM Book Release! May 22, 2017

Posted by mariemanthey in Announcements, Creative Health Care Management, Inspiration, Leadership, Professional Practice.
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I am  excited to let you all know about Creative Health Care Management‘s newest book publication!

It is called Advancing Relationship-Based Cultures, and I love both the content and the book’s authenticity regarding health care today.

Edited by Mary Koloroutis, and David Abelson, the book explores the  culture of health care organizations, what is  necessary for optimal outcomes, and strategies to achieve those outcomes.

Advancing Relationship-Based Cultures explains and expands a fundamental and often overlooked truth in health care: It is the confluence of relational and clinical competence that advances healing cultures.

A relationship-based culture is one in which a critical mass of people provides care and service with relational competence. In these cultures, the skills that foster relational competence are actively developed, nurtured, practiced, reinforced, and evaluated. While countless thought leaders have championed the importance of improving relationships, this book provides vision and strategies for system-wide culture transformation….and it does so with a depth and authenticity that is breathtaking.

Readers of this book will understand that a strategy that includes improving all relationships will improve all other measures as well. When you empower people, giving them the tools to take excellent care of themselves, one another, and the patients and families in their care; organizations thrive and patient-care is optimal.

Chapter Overview

  • Foreword: The Giver and the Receiver Are One
  • Overview: Advancing Relationship-Based Cultures
  • Chapter 1: A Relationship-Based Way of Being
  • Chapter 2: Attuning, Wondering, Following, and Holding as Self-Care
  • Chapter 3: Attunement as the Doorway to Human Connection
  • Chapter 4: The Voice of the Family
  • Chapter 5: Loving Leaders Advance Healing Cultures
  • Chapter 6: One Physician’s Perspective on the Value of Relationships
  • Chapter 7: Embedding Relational Competence
  • Chapter 8: The Role Human Resources in Advancing Culture
  • Chapter 9: Relationship-Based Teaming
  • Chapter 10: Care Delivery Design that Holds Patients and Families
  • Chapter 11: Evidence that Relationship-Based Cultures Improve Outcomes
  • Chapter 12: Relationship-Based Care and Magnet® Recognition
  • Epilogue: Continuing the Conversation
  • Appendix

Softcover, 344 pages. (2017)

ISBN: 978-1-886624-97-9

Speak to Groups of People?? Never! May 21, 2017

Posted by mariemanthey in Creative Health Care Management, Inspiration, Manthey Life Mosaic, Nursing Salons, Professional Practice.
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Honestly, that’s how I felt in the early years of my career! The thought of speaking publicly was a nightmare.

As a student, I made a choice between the two options for my Master’s Degree based partly on which one involved less public speaking!

I was sure that speaking to large groups of people was not and would never be necessary for me – it is not a part of Nursing – and it terrified me.

I was physically affected – I’m not exaggerating – every time I had to do it for some reason.

I had nausea, I had knock-knees, I had so much static in my head that I could hardly hear my own thoughts. Every time I did it I felt like I had failed miserably, and no matter what, I would never do it again.

However, life went a different way for me.

I was part of the team that created Primary Nursing, and other people wanted to know about that process. There were two ways to communicate about it – speaking and writing. Writing took forever! The two articles we wrote in 1970 just took a really long time to put together, edit, format, get references, all of that. Then we did another article in 1973 – again, it just took a really long time. I was Chief Nurse at first one hospital and then another, and my available time was just very limited – it was really hard to fit in time for writing.

Much as I hated speaking, it was a way to deliver the information that I wanted others to know, in real time, most efficiently.

So for those initial five years of talking about Primary Nursing, it was excruciating every time. Every time I had knock knees, nausea, static in my head, the physical costs were huge. I would actually feel sick to my stomach just looking at my calendar and seeing a speaking date written on it. But I just had to go out there and do it anyway, because the importance of the message demanded it.

For me, getting up and speaking was a much more effective way to get the word out, than writing. People were curious and I wanted to let them know about Primary Nursing and its benefits for the nurse-patient relationship.  The effect Primary Nursing had on the patient’s experience – that’s what was so important. My passion about that essence of Nursing just saw no boundaries.

So, I made myself learn how to do public speaking, even though for most of the first five years, nothing got better. It was just as horrible, just as debilitating, just as uncomfortable every time as it always had been, for years on end.

Years later, little by little, it started to get better. I began to get some sense of self-confidence about it, to the point where I was actually able to look at  a speaking date on the calendar and not get terrible anxiety about it.

After that, I began slowly to not only be comfortable speaking, but to enjoy it. I began to be able to take in the visual and auditory feedback of the crowd and use that information to fine-tune my delivery. I learned how to be present with my message, and also present with the people I was delivering the message to.

And for these decades since then, speaking has been a huge positive for me. It’s still all about getting the message out – about Relationship-Based Care and other ways to enhance the nurse-patient relationship – in the best way possible.

The power of conversation is really what it all comes back to. I am engaging in a one-way conversation when I speak to audiences. I very much want for the audience to engage as well though, always. That’s why I like to speak within a schedule that allows for break-out sessions. I want folks listening to me to be able to speak with and listen to each other and me as well, and to have their experiences also be part of what is shared.

Nursing salons are another extension of that important need to connect – to hear each other and share each others’ experience.

Conversations Change People, People Change the World! – Margaret Wheatley

 

Salons – Looking Back, Looking Forward May 19, 2017

Posted by mariemanthey in History, Inspiration, Leadership, Nursing Salons, Professional Practice.
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Alternate title: Salons – Then and Now

A Talk for All Times | Nursing Forum, October 2010

Salon conversations | Nursing NewsNurse.com | 2012

 

Nursing Salons were created to provide a safe opportunity for people from throughout the diverse practice of nursing to share their stories, hear from others, come to grips with the realities of their workplace, offer support, and regain the feeling of unity.

They caught on like wildfire, not only in the U.S. but around the world as well.

At the top of this post you’ll see some links to the birth of these Salons: my article in Nursing Forum Magazine from 2010, and a note from an early adopter in 2012.

It’s interesting to relive those initial ground-breaking moments, and review the origins of all that has come to be.

Looking forward, I hope Salons continue to spread into every community and are attended by members of  all health professions.  These conversations create ripple effects throughout the system.

Imagine if doctors and nurses and professionals from other health disciplines all over the country met together and had conversations like this. Margaret Wheatley tells us that conversations change people and people change the world.

We see this happening in ways large and small at Salons. The salon in my home yesterday evening was no exception.

My dream is that doctors and nurses and all clinicians begin meeting in homes all over the US and talk to each other about the work we do.   I KNOW the health care system would be impacted in a major way.   We would migrate health care forward, in big changes and small changes, in ways that can not be specifically predicted but can be expected with absolute certainty.

I hope that everyone is able to take part in this wonderful vehicle for self-care and enhanced professional practice. And I hope that together we continue to build the best future possible for the health of society.

Have any of you has been to a salon recently? How did it go? Are any of you still looking for one near you? Are any of you planning events and considering adding a salon before/after/during? It’s always great to hear from you!

Reading List:

Turning to One Another: Simple Conversations to Restore Hope to the Future (2002) Margaret Wheatley

Absence of RAA – Problems Universal May 16, 2017

Posted by mariemanthey in Inspiration, Leadership, Professional Practice.
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..Disparity in the balance between responsibility, authority and accountability at the personal, departmental and administrative levels of operations creates dysfunctional organizations and troubled human relationships.

Case Study Working Kitchen.docx

Case Study_Small Organization.docx

Nursing_More Work Than Time

Absence of RAA in the workplace leads to many problems and struggles that make it much harder to get the work done. Not only that, but the people involved are required to spend additional energy and internal resources just to continue on, all the while contributing much less to their groups’ effectiveness than would otherwise be the case.

Today we’re looking at some non-nursing examples, because RAA has universal applicability, and it can be easier to identify things when they are at a distance from one’s own situation.

At the top of this posting, you’ll see links to the case studies we’re referring to in this post. One describes a dysfunctional restaurant situation, the other a problematic instance in a small organization.

In both cases – symptoms are unhappy workers, managers on the defensive and not leading positively, and stressful work experiences.

The main issue is lack of clarity about the scope of responsibility.   When individuals don’t have clarity about the scope of their responsibility vis-a-vis mangers, etc., the workplace becomes dysfunctional.    Conversely, when the scope of responsibility allocation is clear, but commensurate authority is not delegated, the stressful workplace becomes dysfunctional.   And finally, when responsibility has been clearly allocated, but is not fully accepted by the individual, the workplace is stressful and becomes dysfunctional.   Responsibility Authority and Accountability need to be sequential and commensurate.   Any disparity or imbalance creates a stressful and dysfunctional workplace culture. When workers are given responsibility without authority and accountability, they are prevented from doing their useful best.

When managers are given authority but never held accountable, they do not have the opportunity to learn and grow.

Managers and staff perceive each other through their own filters, clouded by their own life experiences and expectations, and impacted by organizational and external forces outside the control of either of them.

Often people feel their situation is hopeless, and they just check out.

In these difficult times, it’s important for each of us to bring our best self forward in pursuit of our goals.  Success in one’s work life often results in the perception that one’s life is successful….and it is!    RAA and related concepts are useful in that process.

Acceptance of allocated responsibility is an important strategy because it results in actually experiencing the reality that we always have choices. We have small choices and a few big choices available to us pretty much continually, if we are honest.

The act of simply making a choice is powerful, even when the choice itself is small.

Like staff nurses who have more work to do than time available, everyone in the workplace needs to honestly assess to the best of their abilities and skills what most needs to be done, and then Own Those Choices. Letting go and trusting people to interact with us as needed in a healthy way about our choices (and their choices) frees up a wonderful amount of energy.

We can model the behavior we want to experience. We can manage our feelings from within the situation, look at it objectively, and assess the likelihood of it becoming something we  consider tolerable/optimal.

We can decide to stay in situations that we don’t like because of reasons that are valid – making even that choice is itself an improvement, and opens up other choices.

The suffering martyr/victim posture is limiting and destructive, and is never necessary or useful. By taking care of ourselves more, we’re also acting in the best interests of those around us (in the long term certainly).

We’d love to hear your stories of your struggles, journeys, lessons and useful insights!

 

 

Symposium Update! May 15, 2017

Posted by mariemanthey in Academia, Creative Health Care Management, Inspiration, Leadership, Professional Practice.
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5 Reasons to Attend the 2017 International Relationship-Based Care Symposium – June 20-22 – Minneapolis, Minnesota

The 2017 International Relationship-Based Care Symposium is only five weeks away! It will be an event filled with inspiration, practical action, healing and hope for the future. Need more reasons to attend? Check out the brochure here, and book your flight!

  • Like-minded People with Shared Commitment:Surround yourself with an international community of health care leaders who are transforming the way health care is provided. You will leave inspired and have a renewed commitment to achieve excellence in health care.
  • Dynamic Speakers: David Cooperrider will engage you in the synergistic process of Appreciative Inquiry to boldly envision and commit to a collective future for health care. You will discover more about compassionate partnerships and the art and science of healing relationships with Robin Youngson. Maestro Roger Nierenberg will place you in the middle of a professional orchestra for a multi-sensory experience in organizational dynamics.
  • Celebrate Outstanding Work in the Field:Honor colleagues and learn from stories of extraordinary innovation with the healthcare teams who discovered them. At the Symposium Poster Extravaganza, health care leaders from all over the world will share innovative strategies designed and implemented at their organizations to advance Relationship Based Care and Cultures of Excellence.
  • Interprofessional Continuing Education: We’re proud to be partnering with the University of Minnesota Interprofessional Continuing Education to offer contact hours for this event. The symposium will highlight the critical role of interprofessional relationships in the domains of safety, quality, and experience of health care.
  • YOU WON’T HAVE ANOTHER CHANCE UNTIL 2021! The symposium is only offered every 4 years. Don’t miss this opportunity. Participants from 2013 said, “The most powerful conference I have ever attended!” and “I came here this week with hopes of finding a way to break the barriers between MDs and RNs, and I’ve taken away with me so much more. This has not only been a career changing milestone but a personal stepping stone that I will never forget!”

Read more about the Symposium and register today at chcm.com/symposium. See you in Minneapolis!