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Symposium Reflections July 30, 2017

Posted by mariemanthey in Creative Health Care Management, Professional Practice.
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This is a reflections from just on of the many mind-opening events of our recent Symposium. of the Symposium.

A Pre-conference was a program about the Daisy Foundation’s values and accomplishments through their recognition of exemplary nurses as nominated by their patients.   Studies of these scores have come under laser focus as reimbursement amounts are now based on those scores.    One of the findings had to do with how strongly a single negative experience colors the WHOLE experience for a patient…..even when 99% of the experience was positive.

It reminds me of a powerful paradox the sits within the nursing profession…..the fact that when nursing care is perfect, it simply shows that nothing (No THING) went wrong.   It is an absence that is difficult to describe, to count …and even to value.

So….it is fair to say about nursing….

Everyone knows when something is done wrong

No one knows when everything is done right…..because (NO THING ) has occurred.

P.S.  Your reflections welcome and much appreciated.

EVERYBODY, SOMEBODY, ANYBODY, AND NOBODY July 24, 2017

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As you know if you follow this blog, we take RAA – Responsibility, Authority and Accountability – very seriously.   We feel that that paradigm has the power to create healthy workplaces, excellent health care and healthy nurses, doctors, and staff.  Anywhere. These discussions are serious, practical, conceptual, and (we hope) useful.

Variety being the spice of life, today’s entry into the conversation is provocatively different. Today we provide to you a highly-scientific, term-by-term description (or not) of what it’s like when RAA is not in place. Anywhere. Well ok, not that scientific or academic – but highly accurate nonetheless!    Think of how often in your personal and private lives you have experienced this exact dynamic!

In this world, there are four kinds of people: EVERYBODY, SOMEBODY, ANYBODY AND NOBODY.

There was an important job to be done and EVERYBODY was asked to do it. EVERYBODY was sure that SOMEBODY would do it. ANYBODY could have done it but NOBODY did.

SOMEBODY got angry about it because it was EVERYBODY’S job. EVERYBODY thought that SOMEBODY would do it, but NOBODY realized it wouldn’t get done by ANYBODY.

It ended up that the job didn’t get done, but EVERYBODY accused SOMEBODY and NOBODY accepted responsibility.

Moral: EVERYBODY’S job is ANYBODY’S. NOBODY can be SOMEBODY unless he’s willing to do ANYBODY’S work.

How about you? All EVERYBODYs, NOBODYs, ANYBODYs, and SOMEBODYs  welcome – tell us your story.

Salon Update – Wednesday, July 19 – Draft July 21, 2017

Posted by mariemanthey in Leadership, Nursing Salons.
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The salon recently at my home was one of the best… which is what we always seem to say as we are checking out.

I’m often asked the ideal size of a salon, and I’ve come to the conclusion that something between 10 and 15 is just about right.

Having said that, I have had wonderful conversations with just 2 or 3, and I’ve facilitatated mass salons simultaneously for about 180 people seated at round tables at the TX nurses assn. delegates meeting. The excitement, enthusiasm and utter joy experienced during the checkout of all the groups was absolutely magnificient.

So, size for a salon is a moving target and should never be a determining factor on whether to hold one or not. If a group is very large – say 30 or more – it is entirely possible to have them divided in to two salons that meet simultaneously.

A further word about Wednesday night’s salon: it was truly inter-disciplinary, as so many are now. There were occupational therapists, a social worker, a physician, and the rest were nurses from such far-ranging occupations as a forensic-health medical examining nurse, a faculty member, a nurse executive, and staff nurses from different places working in different specialties. Truly eclectic yet the conversation was totally congruent in values and in the experiences of being a health care practitioner.

A Core Value: Humanization of Patients July 20, 2017

Posted by mariemanthey in Manthey Life Mosaic, Professional Practice, Values.
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Many many years ago I was being pressesd to articulate my deepest passion about Nursing.   Specifically,  what did I believe is the fundamental core value of the nursing profession?     After thinking about it deeply, I came up with a deep believe that  our most important role is to facilitate the humanization of patient care,…. which required that we first humanize the experience, practice and focus of nurses.   Nurses cannot humanize patient care unless they are empowered in their role and in practice.  Humanization of health care for patients  means  engagement of patients and their families in decisions about treatment choices, as well as end of life choices.    This ultimate exercise of free will is the pathway to fulfillment as a human….and the restriction of free will is dehumanizing.

I see this goal  becoming closer to reality in many situations, thanks to nursing’s incredible advances, as well as to advances in technology and  many other societal advances.   However,  I think much work is still needed to promote nursing’s role as patient advocates for their greater involvement in decisions.  The culture change we seek is to humanize patient care.   Nurses must support patients ability to accept responsibility for themselves, and to exercise their own  free will about their treatment and their lives, knowledgeable about the options that are available to them.

Empowered nurses are needed to empower their patients.

Whether the setting is an ICU unit, a Neo-Natal unit, or even hospice. Empowered nurses can make sure the patients and their families have all the necessary information to make their own life decisions – about end of life, or about courses of treatment – and that they are empowered to do so.

The change is coming.   Let’s make sure the nursing profession is ready to fully engage in the humanization of health care. The public is more ready than the health care system.

From: Longfellow To: Nightingale July 4, 2017

Posted by mariemanthey in History, Inspiration.
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Santa Filomena

Poem by Henry Wadsworth Longfellow

Whene’er a noble deed is wrought,
Whene’er is spoken a noble thought,
Our hearts, in glad surprise,
To higher levels rise.

The tidal wave of deeper souls
Into our inmost being rolls,
And lifts us unawares
Out of all meaner cares.

Honor to those whose words or deeds
Thus help us in our daily needs,
And by their overflow
Raise us from what is low!

Thus thought I, as by night I read
Of the great army of the dead,
The trenches cold and damp,
The starved and frozen camp,–

The wounded from the battle-plain,
In dreary hospitals of pain,
The cheerless corridors,
The cold and stony floors.

Lo! in that house of misery
A lady with a lamp I see
Pass through the glimmering gloom,
And flit from room to room.

And slow, as in a dream of bliss,
The speechless sufferer turns to kiss
Her shadow, as it falls
Upon the darkening walls.

As if a door in heaven should be
Opened and then closed suddenly,
The vision came and went,
The light shone and was spent.

On England’s annals, through the long
Hereafter of her speech and song,
That light its rays shall cast
From portals of the past.

A Lady with a Lamp shall stand
In the great history of the land,
A noble type of good,
Heroic womanhood.

Nor even shall be wanting here
The palm, the lily, and the spear,
The symbols that of yore
Saint Filomena bore.

Reading List – Treasures! June 30, 2017

Posted by mariemanthey in History, Inspiration, Leadership, Professional Practice, Values.
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Here are some books I’ve enjoyed and gained a great deal of insight and resources from. I’d love to hear your thoughts on these and your favorites as well!

The Power of Now by Eckhardt Tolle — I learned the incredible value of learning how to observe my thinking…..thus creating the opportunity to grasp a powerful truth.   That I am more than my thinking.   I am a whole being and by stepping away from my thinking I learn that my thoughts do not define who I am.    My being is more than my thoughts.   That awareness shifts my perspective on life.. Fascinating and exhilarating!

Small Great Things by Jodi Picoult – an ambitious tackling of the racial issues of our time, through the setting of nursing.   A highly experienced black nurse is forbidden by her nurse manager from taking care of the baby of a white supremacist couple….at their insistence.   The story from there presents a dilemma for the black nurse that results in a life-changing lawsuit.

Blessed Unrest by Paul Hawken (2007) – the world is undergoing transformational  changes of people, on a  small scale – in conversational salons and discussion groups, between neighbors and friends. These group conversations are about serious topics like spirituality and the role of governments.   And he makes the point that conversations can change people and people change the world.

The Immortal Life of Henrietta Lacks  by Rebecca Skloot incredible (true) story of medical ethics involving HeLa – two dime-sized tissue samples taken from Henrietta. The cells possessed unusual qualities and yielded amazing benefits for science; the effects for Henrietta and her family were.. less. Bioethics, racial injustice, and history co-exist in this story which starts in Baltimore, involves the Tuskegee Institute, and spreads benefits globally (for specific groups and humanity in general). Talk about health care disparity – really incredible. Recognition, Justice and Healing – hopefully this book brings us a step closer to these goals.  The film, staring Oprah Winfrey, premiered on HBO this past April and will be on DVD soon!

Role of Nurse Manager: Needs Support to be Supportive June 13, 2017

Posted by mariemanthey in Creative Health Care Management, Leadership, Professional Practice, Uncategorized.
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I’m reminded frequently about how strongly a leader’s influence drives the quality of work done…on nursing units and in every workplace.  The clarity of role definitions in the workplace – and in particular how the role of the leader is defined – is essential to effective leadership.

Leadership is often confused with limitless power.  Unclear scopes of responsibility for leaders and others creates confusion, unsatisfactory outcomes and personal stress among workers which in most cases results in bad outcomes.   This seemingly simple element is often the culprit of toxic work environments.

Leaders Empower Staff – that is the name of a basic curriculum component of CHCM’s work, and it’s also a phrase which sums up  much of our leadership philosophy and seminar focus.

We believe that the people who do the work should be empowered to make  decisions about the work, and good leaders actively support that by intentionally putting that power in the hands of their staff.

There are many specific skills and practices that need to be in place for the leader to do that and to support that structure. One of our accompanying basic beliefs is this: nobody walks in to a leadership role with everything already in place to be successful. Each new leader will have some parts of the skills set, and they’ll need to gain the rest on the job.

Each time a new leader is hired, there needs to be a systemic process of determining what they need to be successful in that role, and to provide the training, support, skills development, mentoring, etc.. necessary in order for them to grow in to that role.

Otherwise, insecure, ill-prepared leaders may assume that empowered staff are a threat to their authority and therefore to their success.   These leaders …at all levels in a hierarchy…..will hold on to power  to feel secure. Staff then are hindered from contributing at their highest level, restrained from using their actual knowledge and skill, and devalued within the workplace.  Morale is negatively affected.

Staff  need to be developed professionally so that they are confident and comfortable using their legitimate power.  Within their scope of responsibility, they need to learn how to identify operational problems, to generate solutions, to implement the solutions.  This level of employee engagement is a dream scene for most executives.

Both staff and leadership need to accept the fact that as humans, they’ll make mistakes, and that those mistakes are to be treated as opportunities for growth, not punishment. Integral to that is for leadership to actually react that way to mistakes!

Leaders do constantly need to bring their best selves to the job, to actively create for themselves a goal behavior pattern based on best leadership practices, and do their best to live up to those goals.

Accountability is crucial.

In some workplaces – within healthcare and outside of it – the accountability of leaders is sometimes problematic.  It is easy for leaders to obfuscate personnel problems, particularly if they don’t know how to or don’t want to deal with them..   The obfuscation may show up as being able to provide assurance to those they report to that staff are fine, operations are fine, progress towards goals is happening, the ship is tip-top. They may not  share sufficient detail about problem employees, hence  obfuscating their own responsibility to act, resulting in avoiding personal accountability as  leaders.   A great deal of the angst, stress and toxicity in workplaces today is due to inadequately prepared  leaders who are not held accountable for learning the basic skills necessary to create a culture of safety and empowerment.

Our values, principles and practices of Creative Health Care Management focus on changing workplace  cultures so that all members of the team (starting with the leader) have the support they need to produce efficient and effective productivity. The clear allocation of responsibility coupled with the delegation of commensurate authority and accountability are the key components to leadership and management success in every workplace.

The Nurse Managers who gain these leadership skills are the MOST essential element to creating a relationship-based environment that is healing for both the staff who work there and the patients who receive care there.

Nursing: More Work to do than Time Available June 6, 2017

Posted by mariemanthey in Leadership, Professional Practice.
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Nursing staffs often face unpredictable peaks in workload. These peaks can occur at any time and maybe be caused by any of a number of factors: unexpected admissions, sudden changes in patients’ acuity levels, or true life-or-death emergency situations.

These peaks are sudden, stressful, and highly charged emotional events.

As workload escalates, experienced staff members begin prioritizing and scanning: scanning the care environment, selecting the next most important thing to do, and doing it.

This triage process may go on for minutes or hours, is informed by high-level critical thinking, and results in  patients receiving safe and adequate care but not receiving every item of ordered or desired care.

Those non-delivered care items are not consciously omitted, nor are they forgotten. In fact, they lie waiting in the nurse’s professional- thinking brain space until the stress is over, the documentation is done and they have left for the day. On the way home, these ‘undone’ activities float to the surface and cause feelings of guilt, failure and anger – anger because the quality of care delivered didn’t meet the nurse’s own standard for care.

I believe that the treatment for this situation is to acknowledge explicitly throughout the profession and throughout the health care system that, as professionals, nurses have the right and the responsibility to determine what to do and what not to do when there is more work to do than time available.   And when questioned,  nurses need to be able explain their rationale for the decisions that were made.

Common sense requires recognition of this reality.

Recognition and understanding of heretofore  ‘hidden truths’ about nursing work can lead to much more productive research and practices, and can help dispel legacy myths about nursing practice…that we  always give total patient care.   That leads us right into the dysfunctional mind set of fear and guilt about staffing that now is all too often present in the life of a staff nurse.

More about ‘hidden truths’ relation to nurse resources and nurse workload in another posting.

Belief: Health in Healthcare June 4, 2017

Posted by mariemanthey in Creative Health Care Management, Inspiration, Manthey Life Mosaic, Thought for today.
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From the notebook of Marie Manthey, 1982

Belief:

CNM (CHCM now) believes that the relationship between mind and body is absolutely integrated and that the state of mind clearly influences the health of the body.

Management of health professionals, therefore, must consist of teaching this relationship as a management value and teaching managers how to manage their lives.

Basic principles of management should be taught at both the humanistic and scientific levels.

Advanced management training programs we developed promote the use of unique creative living approaches to solving complex organization problems.

Hospitals must be healthy so that the staff can help patients regain their health. The organizational diseases of disinterest, apathy, anger, isolationism,  generally negative interpersonal relationships and the illegitimate punitive use of power are manifestations of disease and can be treated by changing attitudes and perspectives and teaching basic truths of human existence and behavior.

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.