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RAA Part III – Achieving Full Experience of Will Power June 15, 2017

Posted by mariemanthey in Creative Health Care Management, Manthey Life Mosaic.
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This is part III of an initial series of articles about RAA. Here are links to the previous parts:

RAA Part I

RAA Part II

 

After 10 years of experience applying these ideas to professional roles and organizational structures, I began thinking about them in relation to my own life.

By this time one thing I knew for sure was that when nurses accepted responsibility for the Primary Nursing (PN) role, they experienced empowerment and manifested less victim behavior than before…..and much less than those who’s did not accept responsibility.

I also knew for sure that accepting responsibility was an experiential activity……not an intellectual activity.   You can’t just think you are responsible….you have to experience it, to literally place yourself in the position of being responsible, in order to have full access to legitimate authority.

In PN, this only seemed to occur when the nurse established a responsibility relationship with the patient.   The explicit establishment of that relationship was necessary in order for the nurse to experience responsibility acceptance. The closed door of power (personal or other) only opens when an individual experientially recognizes their responsibility.

So, my epiphany moment occurred when I asked myself the question of whether or not I had accepted responsibility for my life.

I immediately remembered with resentment areas of my life where I felt victimized.   My ex-husband, a former boss….etc.   With great clarity I knew that if I had truly accepted responsibility for all aspects of my life, I would not feel victimized by past events. As this thought process evolved, I recognized that accepting responsibility for one’s own life involves the three major components of behavior: thinking, feeling and acting.

So, accepting responsibility for my thinking meant I had to develop new thought processes.  Often, my thinking fell into automatic pathways developed over the passage of life.   These pathways needed to be examined and in many cases changed, as they led directly to victim thinking.

The new thinking required the development of new neuron pathways, and then also lots of deliberate practice until consciousness of choice became my automatic thought process in response to situations and events in my life. This involved learning to make space in my reactions to events and people for the experience of choice.

Likewise, accepting responsibility for my feelings meant I had to learn some skills for handling feelings in an appropriate way which also often involved changing the way I think.   The connection between thinking and feeling began to be more manageable. Further, accepting responsibility for my actions helped me recognize the connection between thinking and acting and how action can positively influence thinking and feeling.

This overall development required me to develop new ways of being in my life, and the results have been increased positive energy, increased choices, and increased well-being.

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.

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!

 

 

Gratitude breeds gratitude;discontent breeds discontent April 26, 2014

Posted by mariemanthey in Thought for today.
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Everyone is free every day to choose how they want to experience the day.   As Dr. Phil says, ….we get to choose to contaminate or contribute…..every single day.    Often, the stress and workload in bedside nursing and in most hospital managerial roles can obscure this truth.    It can seem like everyone else has more impact on our experience than we do.

However, we can opt to contribute by intentionally reflecting on  the aspects of our lives and work that we are grateful for…..and we can intentionally refuse to spread discontent  by not engaging in it….even when we are invited to do so by a colleague.

It is time for each of us to take back the power we have to manage our own lives.   Choices have consequences.    Let us be clear about that and aware daily that we own our life experience.

A Marie Manthey Master Dialog for Nurse Managers: What Does and Doesn’t Work in the Real World June 25, 2013

Posted by mariemanthey in Announcements, Creative Health Care Management, Leadership.
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Please join me for a day-long dialog on maintaining resiliency, intention, presence, and mindfulness while doing the toughest job in health care today. Along with reflection and dialog, the day will be rich in time-tested take-aways that can be applied to practice.

July 12, 2013
CHCM Office, Minnetonka, MN
Registration Form & Pricing Details

July 30, 2013
CHCM Office, Minnetonka, MN
Registration Form & Pricing Details

Marie Manthey’s Master Dialog for Nurse Managers is also available for onsite presentations. Call Creative Health Care Management at 800-728-7766 to schedule.

Good Sunday Morning November 15, 2009

Posted by mariemanthey in Academia, History, Leadership, Values.
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I had to cancel my salon last month due to a heavy travel period.  In six weeks I was in CA, MI, NY, Germany (10 days) and Ireland.  It was an interesting experience because in 90% of the work I was speaking about Primary Nursing and Leadership.  About the past and the future. About the present, and Being Present.  There is a tremendous hunger within nursing to re-member, to re-connect with the basic values of the nursing profession.  And the enormous challenge is the workload and complexity issues that nearly overwhelm nurses is some settings.

During this past year I have been seeped in history.  Both of nursing in general and in the history of the School of Nursing at the University of Minnesota where a centennial celebration took place last week. This school is the first on-going school of nursing to start in an academic institution anywhere in the world, as far as we can tell.  (Columbia TC started at a graduate level).

I have been studying the work of the instigator of this school, a physician named Richard Olding Beard. His writings clearly demonstrate why nurses need to be educated, not merely trained, as the title of one article attests: “The Educated Spirit of the Nurse”.

So last week was the culmination of a very busy two months for me and I am now getting back to semi-retirement, whatever that means.

One more thing: the Centennial Gala was the time of an announcement about the establishment of the Marie Manthey Professorship for innovative practices.  If you would like more info about supporting creativity and innovation, add a comment or just email me. I am very excited about it.  Recruitment for the position has not yet started, as fund-raising continues.

Recent Reflections May 30, 2009

Posted by mariemanthey in Academia, Inspiration, Nursing Salons, Thought for today, Values.
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At the Ways of Knowing conference  (for info, visit website of Center for Spirituality and Healing at the U of Minnesota) I found myself often connecting the Salon experience I’ve been having with the things I was learning about mindfulness as a strategy for a healthy life. For three days, wise people from all over the country and other countries as well, taught us about the relationship between ways of being and well-being. So much was relevant for the nursing profession and pertinent to what we can do to heal ourselves and our profession.  Yes, even in the fact of working in a sick-system that seems to be taking forever to get on the right track.

The Salons kept coming up in my mind because of the depth of meaning experienced there, as well as the fact that being present seems to bring all of us a degree of peace not found often in the pressure cooker of health care. And that is desperately needed.

I learned mindfulness in and of itself is healing. Mindfulness involves intention, attention and attitude and opens the door for experiencing the deep truths that lie at the very foundation of our work. It is such noble work and we are privileged to be able do it. Being open to that truth changes the day to day experience of being a nurse.

In a few weeks, the entire conference will be posted on the website of the Center and I encourage everyone to watch for it.  Ciao.

Conversations with Ourselves August 29, 2006

Posted by manthey in Creative Health Care Management, Leadership, Nursing Salons.
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When I first posted about the overwhelming response to my blog, I left off the comments emailed me by Gary Saltus, a physician colleague. Gary specializes in helping  groups through transformational change and is working with CHCM create a program to build Physician/Nurse relationships.

It’s a shame I left Gary’s comments out because they are so vital to this discussion.

Here are the highlights of Gary’s email, followed by my original response (again):

I enjoy and appreciate your constant journey of discovering more and more in nursing and health care. I keep coming back to your primary statement of talking to the different people in health care because it’s something you want to do. I imagine this is your purpose in life at this time –your constant search for discovery, wherever it takes you. I imagine this is the lens you use to see the world: How do we do health care better?

I agree with you about the importance of conversation, but I look at it through my lens of transitioning with individuals, teams, groups, and organizations.

The challenge as I see it is to get the people involved to have these conversations with themselves first, to learn who they are and what their purpose/vision is. They need this self-knowledge so they have the self-permission to present who they are to the interpersonal environment (another individual, team, and group) with confidence.

Before the individual, team, group or organization can tackle the difficult and major issues that you present in you blog, they must go through orientation, differentiation with resultant cohesion conversation with each other first. These are the stages of maturation according to John Cater, PhD at the Gestalt Center for Organization & Systems Development. They also must go through these stages in three phases. Assimilation, differentiation, and manipulation. Each phase brings the system closer with the common denominator being trust. This process is how I facilitate working with groups. So the bottom line is we can’t start tackling the big issues until the system has matured. The dilemma is that organizations don’t think they have the time to let the Nurses/Physicians/Administrators do this group work.

I admire your passion and drive to facilitate change in the Nursing/Health Care arena. Our passions are in attunement. Thanks for including me in your thoughts. I look forward to talking to you in the future about our passions and shared visions.

Gary, thanks so much for your thoughtful and insightful comments. I don’t have the grasp on gestalt that you do…but I definitely get the “gist” of what you are saying. I agree that the transformation has to start with the individual, and then move to groups and teams and that the employing institutions do not yet see the benefit of this kind of staff development.

Throughout my career I’ve been fascinated by how attitudes/behaviors of employees change as institutional and leader values change. I’ve seen so many dramatic changes (both positive and negative) in the lives of patients and nurses that I feel compelled to continue working with these issues. The issue of no time to engage in these discussions is really daunting. Also, the separation between professional cultures has erected many barriers to communication I am beginning to see coming down. Another thing that I find very interesting is that the barriers between nurse educators and practice nurses are also beginning to crack. Real light is beginning to shine through. One of the ways I get to see this is thru the monthly Nursing Salons which I have been doing at my home for the past five years. Attendees vary according to the email lists interests in coming on that evening. It is sort of a blend of the Open Space technology and Socrates Cafe conversation format. I have so enjoyed seeing nurse educators and nurse managers, staff nurses, alternative therapy nurses, public health nurses, etc all sitting around talking about some issue or another in nursing. A retired physician comes whenever he can. And you are right…..it really is about improving Health Care.