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Happy Birthday Marie! July 17, 2017

Posted by mariemanthey in Creative Health Care Management, History, Inspiration, Leadership, Manthey Life Mosaic, Nursing Peer Support Network, Nursing Salons, Professional Practice, Thought for today, Values.
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This is Claire talking (Marie’s daughter, and co-editor of this site), checking in with you on this celebratory day!

I know Marie values each and every one of you, and loves hearing from you and having conversations with you – whether in person, in various professional / civic roles, on social media, here on the blog.

And so today on her birthday, I wanted to formally welcome you all back to this blog.

In the last few months, we’ve started to get active again — exploring various kinds of posts with a multitude of topics including Nursing: it’s history, challenges, future, best practices, values & inspiration etc.. as well as CHCM activities, Marie’s life (Mosaic), Nursing Salons, the Nursing Peer Support Network, activities at the University of MN School of Nursing, and so on.

If you have a moment today, would love to hear any preferences from you about types of content, questions you have for Marie, how often you’d like us to post, how you’d like to hear about posts, and anything else to make this blog a win-win.

We never know how long any of us have here. Marie is the epitome of taking care of herself, taking responsibility for her health and well-being, and we hope to have years and years yet. In any case, the more conversations she can fit engage in, the better!

Oh, one more thing- Happy Birthday Marie!

Thanks much for your participation.

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:

RAA Content Series – Part I May 2, 2017

Posted by mariemanthey in History, Leadership, Manthey Life Mosaic, Professional Practice.
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Part I


A useful framework for improving the workplace and other areas of life is RAA. RAA stands for Responsibility, Authority and Accountability. Those words convey multitudes of meanings.   Their use in this paper is based on definitions found in dictionaries, and applied in this article to:

Organizing complex functions,

Clarifying interpersonal relationship issues and

Achieving the full experience of will power.

To introduce this concept, I’ll share the story of its origins, and how this concept came to become the framework I hold up to every aspect of life.

It started when a group of nurses on a single hospital unit began to change the way they were taking care of their patients.   It was the late sixties and unrest was a societal norm.   I connect the underlying causes motivating the protesters and the changes initiated by these nurses.     These days, with different kinds of disruptions underway, the relevance of these concepts is higher than ever.

Paul Goodman wrote about decentralization, the Equal Rights Amendment was nearly passed, ‘power to the people’ was a popular slogan.   As I was trying to understand the principles behind the changes the nurses were making, I was led to literature about Responsibility, Authority and Accountability.   Interestingly enough, some of that literature was about the use of these concepts in military organization, and in the law.   Ultimately, I opted for a simple definition based on dictionary terminology.   My definition is as follows:

Responsibility – The clear allocation and acceptance of response-ability so everyone knows who is doing what (who is managing the process of each specific functionality being accomplished).

Authority – The right to act – to make decisions and direct behavior of others – in the area for which one has been allocated and accepted responsibility.   There are two levels of authority: Authority to recommend and authority to act.   Clarification of which level applies in each specific situations is functionally useful.

Accountability – The retrospective review of the decisions made or actions taken to determine if they were appropriate.   In the case of the decision-making having been non-optimal, corrective action can be taken for the purpose of improving functionality. That corrective action must never be punitive.



I spent the next 10 years pragmatically applying these concepts to both a delivery system for nursing care and to the complex bureaucratic institution known as a hospital.   These were not theoretical applications of concepts or armchair speculations, but rather actual reorganizations involving changing roles, relationships and responsibilities of real people working in real hospitals.   During that period of pragmatic and intense organizational application, I learned many things.   Among them:

  1. How changing work organization impacts on personal development, as well roles, relationships, work quality and energy levels of workers.
  2. How 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.
  3. How personal maturity and responsibility acceptance are totally intertwined
  4. The defined difference between a profession, an occupation and a vocation.


Lack of clarity and disparity of balance regarding among these concepts results in dysfunctional organizations and negative interpersonal relations.   These conditions in turn, produce low morale, inefficiency and low quality work.

First of all, the issue of clarity.   The scope of responsibility involved in each and every role, needs to be clear to both the person in the role and to those who interact with that role.   Role confusion regarding scope of responsibility creates incredible job stress and interpersonal tensions.   Whenever responsibility has not been clearly allocated, there is a power vacuum resulting in power struggles.   These power struggles can fall anywhere on the spectrum from having individuals assume authority way beyond their legitimate scope and …conversely,  things not being done because everyone assumes the other person will do it.   Role clarity with specific attention to scope of responsibility is essential to effective functioning.

Clarity of authority levels is also crucial.     The delegation of authority should ideally be exactly commensurate to the scope of responsibility.   An effective decentralized organizational structure will reflect careful attention to matching responsibility to authority.   In some situations, individuals may be unwilling to accept responsibility and will therefore be reluctant to use the authority they have been delegated.   These individuals will manifest continued dependencies and often fall into victim thinking. On the other hand, some individuals refuse (or are unable) to see the limits of their responsibility scope, and insist on exercising authority over functions that fall outside their scope of responsibility.   These situations result in an abuse of power.

When these elements are not in alignment, individuals affected by that have an opportunity to provide correction.   For example:

Imagine a situation where your boss asks you to take over a new function.   Maybe run a new clinic in a nearby town, in addition to your current clinic responsibilities. He/she says “You are responsible for getting this up and running and ‘in the black’ within a year.   Do a good job!”     You may say, will I be choosing the site we will rent?   And the answer is “NO …the site is already decided.”   You may then ask, will I be hiring the staff for this clinic?   And the answer is NO…. the type of staff (and consequent costs) will be controlled by Budget Control Office.   You may ask, will I have a marketing budget to announce this new service. And the answer is NO…that is under the control of the marketing department. And you say, will I have anything to say about location, equipment to be purchased, staff to be hired, services to be given and amount clients will be charged, to which every answer is “NO – someone else has that responsibility.” You are only responsible for bringing it into profitability within one calendar year. In this scenario, a wise employee would say, ‘Boss…. I am willing to coordinate the opening of this clinic and to do everything in my power to assure financial success, but I cannot take responsibility for that since I have no decision-making authority.’

.. to be continued

The Mosaic of Marie Manthey’s Life April 30, 2017

Posted by mariemanthey in Creative Health Care Management, History, Inspiration, Manthey Life Mosaic, Nursing Peer Support Network, Nursing Salons, Professional Practice, Values.
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by Marie Manthey

I became ill at the age of 5 and was hospitalized for a month at St. Joseph’s Hospital in Chicago. It was a traumatic experience in a couple of ways. First of all, my parent’s didn’t know how to prepare me, since they had never been hospitalized themselves.. so they just said I was going to a large building. They left me there for a month, visiting twice a week, and sometimes when one or the other of them came, a very painful procedure was done involving an IM injection of their blood. As a result, I felt not only abandoned but also frightened and confused about the pain associated with their visits.

Florence Marie Fisher is the name of a nurse who cared for me. One day she sat at my bedside and colored in my coloring book. For me, that translated to ‘cared for me’ … and I decided then that I wanted my life to be about that kind of caring.

From that time on I knew I would be a nurse. I entered a hospital diploma program right after high school, and worked for the next four years as staff nurse, assistant Head Nurse, and Head Nurse. During the last of those years I started going to night classes in the community colleges .. not necessarily at first to get my degree.

I was invited to enroll in the degree program at the University of Minnesota, which was one-of-a-kind at that point. After 15 months of full-time study, I received my Bachelors degree in Nursing Administration. Soon after I was recruited into the U of M’s Masters program in Nursing Administration, in what was the last of the 3-quarter Master’s degrees.

Before finishing that degree, I was recruited by Miss Julian to be an Assistant Administrator of Special Projects. This was a new position that gave me an unbelievably valuable opportunity to learn first-hand about leadership and administration. I was able to experience directly not only organizational dynamics, but was also privileged to work with a group of administrators who used Senge’s principles of a learning organization even before he’d written ‘The Fifth Discipline.’

It was during this time that I became one of two Project Directors for Project 32 (at the University of Minnesota), a pilot program to improve hospital services from an interdisciplinary/interdepartmental perspective. This project eventually morphed in to Primary Nursing, and my career became about understanding and implementing organizational changes that result in the empowerment of employees and the accompanying development of healthy workplace cultures.

Throughout the next ten years of my life in nursing administration – first at another community hospital within the Twin Cities, and then at Yale New-Haven Hospital in Connecticut – I freely helped others with Primary Nursing.. Always accepting visitors and often speaking both locally and nationally as well as publishing as time allowed.

During this period of my career, what had been a manageable, socially acceptable level of alcohol consumption escalated in to full-blown alcoholism. There was an intervention and I entered a 6-week residential treatment program on the East Coast, and have been sober ever since.

In my first year of sobriety as I was feeling my way forward, there were no positions in Nursing Administration available to me. Instead I wrote my initial book on Primary Nursing .. and returned calls to all who had ever asked me to speak, putting out the word that I was available for speaking and consulting. The result was that Creative Nursing Management, Inc. was born, now the longest-running nurse-managed health care consulting firm in the U.S.

When I finished writing Primary Nursing, the publisher asked me who I wanted to dedicate it to.. and that had to be Florence Marie Fisher, the nurse who had colored in my coloring book when I was five. We weren’t able to contact her then, and so I gave up on that idea of actually connecting with her.

My career as a successful entrepreneur has continued ever since. Running a business was not ever something I thought I would do. I didn’t see myself as a businesswoman, but rather as a professional woman. Nevertheless, through many trials and many errors, the company grew. I often say we were successful not because of my business acumen, but rather because my work was authentic and based on real-world realities and values.

In time we grew into a multi-faceted, multi-national firm called Creative Health Care Management. I sold the firm when I turned 65 (in 2000) to the employees themselves. Now in semi-retirement (still, in 2017!) I remain involved in the important work of developing nursing practice and improving patient care.. just without the stresses and challenges inherent in leading an entrepreneurial entity.

An additional aspect of my work today involves tackling the challenge of Substance-Use Disorder. A group of us concerned with the problem of shame and stigma associated with SUD formed a Peer Support Network here in Minnesota, and we are partnering with entities involved in all aspects of the situation.

Another vitally important component of my professional life today has to do with my involvement with my alma mater. After transitioning away from day-to-day involvement in the running of CHCM, I became active in the Alumni organization at the U of M School of Nursing, and also became an adjunct faculty member there. In 1999 the University of Minnesota awarded me with an honorary doctorate, which was thrilling beyond compare. Today I am also active with the Heritage Committee at the School of Nursing, and am engaged in other ways as well with the University.

I also continue to be a part of my own and others’ Nursing Salons – a safe space for nurses in all walks of the profession to share conversations and support one another.

My ongoing interest in changing the way we think about workload and resources is part of the same picture. As healthcare incorporates more and more technology, the temptation strengthens to discard the human caring aspects.

As nursing matures as a profession, I am more convinced than ever, that the choice to care – and to express care and compassion by one’s behavior – is the absolutely correct choice nurses must make in order to continue to serve society justly.

Clinical competence must be on one side of the nursing coin, and care on the other. This is the ‘Coin of the Realm’ nurses must choose if, in fact, the covenant between nursing and society is to continue to exist.

Primary Nursing is 40 years old!! June 9, 2009

Posted by mariemanthey in Announcements, Creative Health Care Management, History, Leadership, Manthey Life Mosaic, Professional Practice.
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This year marks the 40th anniversary of the first development of  Primary Nursing – on a medical unit (station 32) at the University of Minnesota Hospital.

The really exciting part of this anniversary is an effort underway to gather the pioneers of that first unit, from the CEO, John Westerman to the other administrators including Dave Preston ( co-director of the project), Peter Sammond, Stan Williams, and nurse leaders  Pat Robertson (Clinical Nursing Director), Diane Bartels, (Head Nurse, now a PhD ethicist), Karen Ciske, (Nurse Clinician) Colleen Person (unit educator),  and as many of the unit staff as we can locate.

There is a reason it started at that place and at that time. Societal changes combined with an energetic surge of  internal hospital reform from the executive suite coupled with deep frustration and dissatisfaction within nursing set the stage for this change. The presence of several thought-leaders who were also involved gave us a system-focused, principle-based understanding of the meaning of the nursing practice changes that evolved. This understanding resulted in language to describe the innovation in a way that facilitated adaption to every setting where there are clinicians and patients.

That paragraph represents my understanding today about why it has had such an impact on practice and patient care. I am thrilled we are celebrating it’s 40th year.

The gathering we are planning is pretty unstructured at this time. So far, we are talking about getting together for lunch at Coffman Union at the U of Minnesota sometime in August. I’m thinking this is a golden opportunity for us to capture the insights and learnings of some key figures in what became a massive change process.  I’m interested in any suggestions readers have about what we should capture and how to do it. What would you like to know about the experience of the execs, nurse leaders and staff involved in the risk that led to Primary Nursing?

The RBC Symposium sponsored by Creative Healthcare Managemenet is the latest manifestation of the current resurgence of Primary Nursing.  This resurgence  has also led me to offer a 5 day practicum in August. Info about both of these is available on chcm.com

Florence Marie Fisher February 16, 2007

Posted by manthey in Manthey Life Mosaic, Professional Practice.
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I had a most thrilling experience today …

Some of you may remember that I dedicated my book, The Practice of Primary Nursing to a nurse named Florence Marie Fisher. Sometimes when I speak, I tell my own story about how I became a nurse and I always mention Florence Marie Fisher. I became ill at the age of 5 and was hospitalized for a month at St. Joseph’s Hospital in Chicago. It was a traumatic experience in a couple of ways. First of all, my parents didn’t know how to prepare me, since they had never been hospitalized themselves. So they just said I was going to a large building. They left me there and visited occasionally. However, when one or the other came, a very painful procedure was done involving an intramuscular injection of their blood (horribly painful), so I felt not only abandoned but also frightened and confused by the pain associated with their visit.

Florence Marie Fisher is the name of a nurse who cared for me. She would sit by my bedside and color in my coloring book. For some reason, that translated to me to mean she “cared for me.” I decided right then that I wanted my life to be about that kind of caring, and from then on, I knew I would be a nurse. As a kid I often got doctor/nurse kits for Christmas, and I always threw away the doctor stuff. Only being a nurse was of any interest to me.

Forty years later I wrote the book on Primary Nursing. When I finished, the publisher asked me who I wanted to dedicate it to, and after a few minutes of thought I said Florence Marie Fisher. Although we had never communicated in any way after I left the hospital, I never forgot her name. And so the book was dedicated to her.

The publisher thought it would be really cool to find her, so they contacted the Illinois State Board of Nursing, whose records indicated she had moved to Indiana and that her last name was Ambrose. They then wrote to the Indiana Board to locate her, but there was no response to their request, and the search had come to an end.

It was earlier just today, when my search resumed. I was going through my papers in preparation for turning them over to the University of Minnesota Library Archives. I found copies of the publisher’s letters to the state boards and got to thinking about a way to search for Florence Marie Fisher that wasn’t available almost thirty years ago … the Internet.

Now for the thrilling part. I didn’t find her, but I found her son.

And I just finished talking to him.

As I was explaining my connection to his mother, I got choked up several times just realizing I was actually talking to Florence Marie Fisher’s son! He was just as thrilled to hear from me, as he had no idea of his mother’s impact on me. Out of nowhere he gets this call about the influence his mom had on me. She died in 1989, so I guess I was just meant to find him now not back in 1979 when I was writing my book.

He knew nothing of me, my work, or his mother’s connection to that work. It is a straight line for me. And as I told him about my work, the book dedicated to his Mom, the impact on nursing and patient care this work has had. He got just as choked up as I was.

The connection we had was extraordinary. I never thought I would find her, and I guess technically I didn’t, but talking to her son felt very close. And being able to tell her son about the tremendous impact she had on me was one of the high points of my life!

I am sending him one of the few remaining first edition hard copies of The Practice of Primary Nursing and the second edition, which is also dedicated to Florence Marie Fisher.

Loving What I Do October 18, 2006

Posted by manthey in Academia, Creative Health Care Management, History, Manthey Life Mosaic.
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Yesterday I had a great experience. The University of Minnesota School of Nursing Foundation invited me to do the Printy lecture, a funded annual event for the past 15 years. My talk was titled “Back to the Future.” The auditorium was nearly full — .over 100 nurses and a few visitors. The talk went well and the questions afterwards were good. What was especially rewarding for me was the cross section of my life represented there: from nurses I taught, to nurses I worked with, to nurses with whom at some time or another I plotted and planned and schemed with to improve patient care.

I just love being where I am. Semi-retired meaning I have time to do things I couldn’t do when I was running CHCM. Acknowledging my 50th year in the profession, and feeling good, really good about that. Loving history and having an opportunity to work on nursing history for the School of Nursing. Having access to information and the latest thinking about the future of health care — both the good and the bad of it. Being able to reflect on the past and project into the future. And being able to think about what it all means and to share those thoughts with others.

It just doesn’t get much better than that. Except to also be attached to a progressive School of Nursing that I believe is reigniting the Spirit of Inquiry and Research through a transformation process that is improving the culture of the school for both students and faculty.

Leading for Change December 16, 2005

Posted by manthey in Creative Health Care Management, Inspiration, Leadership, Manthey Life Mosaic.
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Recently a graduate student in nursing asked if she could interview me for an assignment on Leadership.  As I answered her questions (“When did you first know you were a leader?” “Where did you learn how to be a leader?” “What is the most important thing you learned?”) I was led into some insightful reflections about change I’d like to share with you. I hope the readers will share their own insights as we “blog-on” together.

First of all, when Primary Nursing was originally implemented, I knew nothing about change. If I had, Primary Nursing might not have started when it did. We were trying to do something else, called Unit Management. A few roadblocks along the way led us to change directions dramatically, with the result that the staff of real unit actually implemented the delivery system before we knew they were changing delivery systems. They didn’t know it either…none of us understood the profound change the staff was creating as they moved from traditional team nursing into what we eventually called Primary Nursing.

I didn’t know about PERT charts and force field analysis, or about how to deal with resistance, or any of the theories commonly taught as part of the change process. Therefore, we didn’t have steps outlined with time tables, goals, benchmarks, etc…. and were thus free to support the staff throughout this period of change.  All we had to guide us was common sense.

Which leads to the first learning. Decentralized Decision-Making is the core of Primary Nursing.   As I came to understand how this organizing principle works, I eventually constructed the following equation:   Change:Empowerment = Empowerment:Change.  This equation is founded on the truth that the people who know the most about the work being done are the people doing the work. Therefore, their knowledge needs to be used in deciding how to improve the work.

What role does that leave Leaders?   And how can Leaders get people to agree on how to improve their own work?

The second learning has to do with the use of visioning and inspiration as leadership tools.  One of the most important roles of a leader is to be able to paint a picture of a foreseeable future that is more desirable than the present, in language that inspires others to follow.  A “good” leader will base this vision on values that are positive universal human values.

And the third learning has to do with infrastructure. A good change project (one that is successful) will incorporate a structural design that provides clear roles/expectations for appropriate decision-making at the various levels of authority. The design of the structure must be carefully thought-out……be based on the current role responsibilities throughout the department/institution with decision-making carefully allocated to the appropriate authority levels.

Those of you who have read Relationship Based Care: A Model for Transforming Practice will recognize in the above paragraph two of the four elements of Jayne Felgen’s theory of change: Inspiration, Infrastructure, Education and Evidence. Our extended experience with operational change will hopefully extend educational realms.