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I switched to a Nurse Practioner and I couldn’t be happier October 23, 2017

Posted by mariemanthey in Inspiration, Professional Practice, Values.
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I am now in the care of an independent Nurse Practioner,working in a Nurse Practioner Clinic within the U of Minnesota School of Nursing and I couldn’t be happier.

The difference in my experience between a humanistic Internal Medicine MD and my nurse practioner is noteworthy.   I was in the care of my primary care physician for many years and I had selected him  because I knew of his humane approach to his work.  He examined me fhrough the lens of either my symptoms if I had a health problem, or through the tasks of the annual physical   Sometime during the visit, he always asked if there was anthing going on in my life I needed to talk about.   I know he cared,  and that he was an expert in internal medicine and for this reason I stayed with him for over 20 years.

Now I am seen in a independently run Nurse Practioner Clinic.  The difference in my experience lies in my NP’s approach to me as a person, not a task (the physical) or a symptom.    The change it made was powerful….and I believe speaks strongly to the sucessful development of this role and how it is differentiated from the role of specialty medical practices.

Nurses look at people through a different lens than physicians and good nurse practioners blend the strengths of whole person  orientation with a focus on health and management of health related problems.

I am so grateful.


As it happens: RBC Symposium Day 3_ Wednesday, June 21 June 21, 2017

Posted by mariemanthey in Creative Health Care Management, Inspiration, Leadership, Professional Practice, Values.
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This is the busiest day of the CHCM International Relationship-Based Care Symposium, so to keep the posts from getting too long, will be sharing snippets & segments!

Launched by the wonderful Keynote by Lois Swope on compassionate care; with an all-attendee mid-day session on relationship-building in Indian Health from Phoenix Indian Medical Center; and concluding with a Poster Session; the day also included two breakout sessions with 5 choices each of those sessions! (Please join me in thanking the CHCM staff, they’ve been working extremely hard to bring this all together!)

As it happens: RBC Symposium Day 2_ Tuesday, June 20 June 20, 2017

Posted by mariemanthey in Creative Health Care Management, Inspiration, Leadership, Professional Practice.
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Today is the first official day of the 2017 International Relationship-Based Care Symposium, here in Minneapolis at the Hilton Minneapolis! Read on for notes, hand-out links and inside peeks into Day 2.

The MusicParadigm experience made a huge impression on me when I first took it in, several years ago. I told everyone I talked to about it for weeks! It is such a unique,  substantively clear demonstration of the clear power of positive leadership. If you are experiencing it with us today, I would love to hear what you think of it! Otherwise I hope you catch it as soon as you’re able.

I’ve written about The James previously on this blog – along with UC-Davis they hold a pre-eminent position in US critical care health care systems for their extensive and inspired implementation of Relationship-Based Care.

1.Hosp, 6.Doors, 60.Wards   – Such an amazing presentation, from a multi-site hospital in Italian-speaking Switzerland; implementing Relationship-Based Care – escaping silo’s and nurturing compassionate care.

Theory without Practice is empty and Practice without Theory is Blind – Emmanuel Kant

Next was a presentation from the CNO and the CMO about how they’re partnering at Pennsylvania Hospital,  and creating an extraordinarily healthy culture there.  The day ended with a  delightful vocal experience of Full Voice lead byBarbara McAfee!

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



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.

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

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

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

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

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

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

However, life went a different way for me.

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

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

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

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

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

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

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

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

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

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

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


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


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


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??

Marie’s House Last evening, Nov. 10, 2010 November 10, 2010

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Last evening’s Salon was another remarkable event. It was that interesting mix of students and faculty, young grads and seasoned staff nurses that always results in a captivating conversation.  This time it ranged from why these students chose nursing to the sense of emergence of spirituality (not religion) within practice, manifested by recognizing the importance of a nurse’s healing presence. This led to talking about the  urgency of nurses today learning how to not only perform complex care activities competently, but to also be available personally for a deeper connection with patients and families.

Attendees came from nearby neighborhoods….but also from far away.   At least two people drove over one hour each way to attend.  A DON of a rural critical access hospital comes nearly every month and feels nourished and refreshed at the close of the Salon.

The variety of reasons we come into nursing, the variety of places we work, and the variety of issues we all have makes each discussion a phenomenal learning experience.

Salon Replication! Great News! September 19, 2008

Posted by mariemanthey in Inspiration, Leadership, Nursing Salons, Professional Practice.
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After several years of steady growth and solid experience, it became clear several months ago that more Salons are needed. There are several reasons why:

  • Many nurses commented that this is the only place they get to talk about really important issues they face.
  • I was notifying people Salons were “standing room only” or was starting “stand-by lists” because my living room walls wouldn’t expand any more.
  • It was becoming so crowded people weren’t getting enough chance to talk

So, we started encouraging others to consider sponsoring, and I wrote up some easy guidelines to help.  I am delighted to tell you that we now have two new monthly Salons, and a third one may be starting up in the near future.   I am ecstatic!

A calendar of Salons is being developed for the U of M School of Nursing, Zeta Chapter website and I hope to see even more proliferate.  My dream is to have a calendar on the website where any nurse can go any time to find a Salon that fits her schedule and is in her neighborhood.  Maybe 8 or 10 a month! Around the metro area, including the suburbs!  We have a ways to go, but this is a start. It feels similar to the start of Primary Nursing in that it feels so right that it must be replicated.  As you read the posted comments, you can see that people are interested in other parts of the country and I will do everything I can to help them be successful.


BTW, I took the summer off  from the blog, but not the Salons. I apologize for not checking it more and sharing our experiences at the Salons we held every month. I will do better at keeping up with the blog.

Last night’s Salon was another powerful experience. There were about 18 people here and the conversation was fairly general: three senior students talked about their “first job jitters” and a couple of middle aged nurses and a soon-to-retired nurse talked about “reinventing” themselves.

Then a relatively new grad told of a recent incident with a patient of hers who fell and sustained an injury. The unit was very busy and the new nurse was not able to get someone in to help her return the patient to bed, despite asking several people — everyone was too busy.   She felt she failed by not being assertive enough and was suffering extreme guilt because she felt totally responsible. That comment opened a floodgate of experiences we had all had when we were involved in a mistake and also very valuable information about root-cause analysis and other error-prevention measures currently in use. The upshot of all of us sharing our “mistake-experiences” was a sense of deep connection.

The new nurse felt the kind of support I had received from my head nurse fifty years ago, when as a new grad, my patient fell out of bed and I felt so guilty I believed I was unworthy to be a nurse. I truly believed I needed to give up nursing!

My head nurse put her arms around me and made me promise to come back to work the next day. She did that for several days.   Last night, all of us, from student to retiree, did just that for the new nurse.

During check-out several people commented how extraordinary the discussion had been and how good they feel being a nurse.

The students had the rare opportunity to again hear the truth about the real world of nursing, something for which they frequently express heartfelt appreciation.

Update (9/29/2011): You can find the Zeta Chapter’s calendar of Salons in Minneapolis metro area here.

Nursing Salon on Jan 17, 2008 January 21, 2008

Posted by mariemanthey in Nursing Salons, Values.
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The group at this Salon was another interesting mixture of different ages: from a couple of student nurses, to several new as well as senior Staff Nurses, Nurse Managers, an Educator, a retired Physician and a couple of Clinical Nurse Specialists.

The discussion eventually focused on pressures created by the health care system and the relationship issues present in current practice settings. Systems and Relationships.

As usual, the electronic medical/health record was front and center, but not only the usual age-related differences in use and perception. This discussion also focused on how electronic records are changing the thought processes nurses use.  A very experienced NICU staff nurse mentioned the reality that critical thinking also refers to decisions about what not to do, which is equally as important as the decisions about what to do. However, the structure of the EMR  requires those decisions to be revisited in order to complete documentation.

That comment just opened the door to more discussion about the control over practice thinking that is mandated by the EMR.  An experienced Delivery Room nurse commented about the problem of trying to put in q2min. vitals during a critical episode (not having learned typing), while another commented on the ease of her system that automatically inputs physiological data from another computer system. Both realities impact the nurses’ thinking.

And of course, this whole discussion was framed around the issue of relationships: nurse/patient, physician/nurse and nurse/nurse.  We talked about how important is is for students to learn, while in school, to manage  themselves in these highly stressful situations. It also became clear  that if that skill is not learned in school, it must be learned in the workplace.  The key to healthy relationships is the ability to manage oneself.

At the end of the evening,  comments reflected the belief that the human contact between patient and nurse is the eternal and important truth about nursing and that there is hope it will always remain at the core of our practice.

Here are a couple of follow-up emails I received.

Marie,Thank you for allowing me to attend your last Salon with my preceptor, Michael P! I had a wonderful time. You are an excellent cook and an engaging conversationalist!

I am in the process of writing a paper about the CNS impacting organizational culture. While researching, I came across a paper written by Lorraine Hardingham, a nurse clinical ethicist, who defends her position that “as human beings, we are essentially interrelated, and therefore, both personal and professional integrity, rightly understood, is relational in nature.” It seemed to fit with that night’s themes of Systems and Relationships. I attached the article if you are interested.

You mentioned that you’d be willing to send files on how to start a Salon. I hope to finish the CNS program in May and pass the certification exams. Then, I would love to start a group here in the Fargo-Moorhead area. Please send your information when it is convenient for you.

Again, thank you for a memorable time of connecting at your home.

With deep regard, Patrick S.

And from Deb M:

Again, another stimulating evening Marie. I come home all revved up and unable to sleep with thoughts racing through my brain. Thank you so much for these incredible forums! I am able to feed my body and my soul and I thank you

The Salon Last Night:: Dec. 6, 2007 December 7, 2007

Posted by mariemanthey in Nursing Salons.
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There was a large group here last night, several returnees and several first-timers. The mix of newbies and old-timers was energizing, and provided both balance and passion to the discussion. Mid-career nurses brought workplace dysfunctionality experiences to the discussion, while students and new grads expressed concern about being accepted as members of a nursing staff after they graduate and about being able to handle the incredible stresses and workloads required of staff nurses in today’s hospitals. Because we were able to listen to each other intentionally we quickly found common ground to express ways to handle various situations within the workplace and to acknowledge the value of the wide age-distribution that exists in nursing today.

One nurse spoke with deep feeling about a terminally ill seven-year-old whose disfigurement in death was extremely disturbing to this nurse in her second year of practice. Older nurses were able to help this young nurse see this experience from a perspective that was both comforting to her and that allowed her to see the value she brought to this patient by her compassionate presence. It is this kind of support and perspective that is only available from seasoned nurses who have learned these things from their own experience.

It brought to my mind again the importance of using reflective practices to absorb and learn from the often incredible experiences we nurses have in this work of ours. In the old days when student nurses lived in dorms there were usually times and opportunities to talk about the sometimes mind-blowing sights, sounds and smells of nursing, of dealing with life and death and disfigurement. In today’s health care reality, nurses often don’t have time to even talk to colleagues at work, and end up suppressing or stuffing unprocessed feelings. These Salons provide that kind of opportunity and really deserve to be replicated. I would like to help anyone get one started, and I have a written description of the way to do it which I am happy to share with everyone.