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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.

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

Posted by mariemanthey in Professional Practice.
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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.

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

Blast from the Past: Feisty Former Chicagoan (1978) May 13, 2017

Posted by mariemanthey in History, Inspiration, Leadership, Manthey Life Mosaic, Professional Practice, Values.
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Primary Nursing: Hospitals bring back Florence Nightingale

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This article was one of the first in mainstream media about Primary Nursing, Marie Manthey .. and Florence Nightingale!

The picture on page 1 is so wonderful, isn’t it?

Here are some excerpts from the article, which you can see directly via the links at the top of this post.

“We’re not just dealing with inert lumps of flesh that hurt” Davis says. “We’re dealing with people’s emotional well-being, too. And that’s what makes nursing exciting again.”

Chicago Tribune: Sunday, February 2, 1978

by Joan Zyda

Sometime after World War II, the American registered nurse was forced into being less like Florence Nightingale and more like a factory foreman.

The shortage of nurses resulted in assembly-line nursing, which brought with it an assortment of nameless, often uncaring persons who trained for brief periods before being turned loose on patients. They were practical nurses, vocational nurses, technicians, orderlies, nurse’s aides, and nursing assistants.

If you’ve been in a hospital in the lst three decades, you have seen this production line in action. Somebody took your temperature, somebody else gave you a bath, somebody else took your blod pressure, somebody else brought in your food tray, somebody else …

Conducting this “orchestra” was, and still is, the chief duty of the registered nurse in most hospitals. Despite years of learning to care for sick people, she ends up in a supervisory job that takes her out of the mainstream of patient care. If she sees patients at all, it’s only briefly when she gives them a shot or a pill, or if there’s a “problem.”

“The patients are completely perplexed and often get irritable or depressed by this fragmented and impersonal care; it frights and frustrates the doctors; the morale of nurses sinks to an incredible low, resulting in a high turnover rate and absenteeism; and it has caused a decline in patient care at many hospitals,” says Dr. William Shaffrrath, diretor of the National Joint Practice Commission in Chicago.

The commission was set up in 1972 by the American Medical Association and the American Nurses Association to solve the growing dissatisfaction with hospital nursing care.

Teh solution, with which the commission has been shaking the pillars of medicine, is to put the registered nurse back at the patient’s bedside, where she can use her training. Some hospitals have already done this, including Rush-Presbyterian-St. Luke’s Medical Center, University of Chicago Hospitals, Good Samaritan Hospital in Downers Grove, and Evanston Hospital.

“Most nurses we talked to are frustrated. They don’t want to be supervisors,” Schaffrath says. “They prefer hands-on nursing in the Florence Nightingale tradition. They want to walk cot to cot, tending to and cheering on the patients.”

Schaffrath credits Marie Manthey, 42, a fiesty former Chicagoan and now vice president of patient services at Yale-New Haven Hospital in Connecticut, for blowing the whistle on nursing. She has advocated for the “return to the bedside” alternative in articles in several prominent medical journals.

As a registered nurse for 22 years, Manthey has had an inside look at the failings of her profession.

“Registered nurses have become faceless people, and it’s the system’s fault,” she says. “Nursing has become extremely production-oriented with very little concern for human needs. Most nurses are embarrassed about that. They say, almost apologetically, ‘Well, I’m just a staff nurse,’ which equates to, ‘I’m just a housewife.’

“But if nurses got their identity back,” Manthey says, “they’d be a proud people again. Then they’d be saying, ‘Hey, wait a minute. I am a staff nurse. I am an important person.”

“Nurses are supposed to be in the thick of things,” Manthey says firmly.

Manthey has coined her remedy, “Primary Nursing” a system whose main goal is just that — to get the nurse to provide total nursing care to a patient during their hospitalization. That means the same nurse does all the work for a patient from admission to discharge.

“The Nurse and the Patient get to know each other,” Manthey says.

With Primary Nursing, the nurse takes over many tasks she used to assign her aides.. because they’re all relevant to patient care.”

/ end content on front page of article, clip 1of2

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For further content from this article, see clipping number 2, and/or let us know if you’d like us to post further excerpts here.

Isn’t it amazing to look back and remember the days when Nursing was at that factory-process level??

What Would Nightingale Do? May 12, 2017

Posted by mariemanthey in History, Inspiration, Leadership.
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Happy birthday, Florence Nightingale!

Florence’s life and career continue to be an inspiration for Nursing as well as leaders in general. She was an extraordinary strategist who had powerful insights into organizational dynamics. Facing a challenge, she would assess the pockets of power, align herself with strong allies, and convince people that a solution to the problem would be found.

She was able to make tough choices, including letting some things go until they had to be fixed.

I’m reminded of the story of her arrival in Crimea. The British Military Surgeons refused to let her enter the hospital. They did not want to deal with a “do-gooder” … and a lady at that.

The fact that she arrived with a ship fully loaded with medical supplies, dressings, bedding, food, clothing, etc. gave her the leverage she needed.

She responded to their refusal to let her enter the hospital by refusing to allow the ship to be unloaded. For some days it sat in the harbor with desperately needed medicine, equipment and supplies — until finally surgeons changed their minds and invited her and her nurses to come work in the hospital. It seems clear to me that during those days the ship was in the harbor, there were patients who suffered because they didn’t have the food and medicine on the ship.

The lesson I take from this is that the strategy of letting a failing system fail might be better than the situation-by-situation “fixes” nurses engage in, which take them away from the patient.   Complex systems call for systems-based solutions.  Strategy is important.

We need the courage of Nightingale to focus our energy where it will be best used for patient care now, as she did back then.