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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!

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:

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

Salons – Looking Back, Looking Forward May 19, 2017

Posted by mariemanthey in History, Inspiration, Leadership, Nursing Salons, Professional Practice.
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Alternate title: Salons – Then and Now

A Talk for All Times | Nursing Forum, October 2010

Salon conversations | Nursing NewsNurse.com | 2012

 

Nursing Salons were created to provide a safe opportunity for people from throughout the diverse practice of nursing to share their stories, hear from others, come to grips with the realities of their workplace, offer support, and regain the feeling of unity.

They caught on like wildfire, not only in the U.S. but around the world as well.

At the top of this post you’ll see some links to the birth of these Salons: my article in Nursing Forum Magazine from 2010, and a note from an early adopter in 2012.

It’s interesting to relive those initial ground-breaking moments, and review the origins of all that has come to be.

Looking forward, I hope Salons continue to spread into every community and are attended by members of  all health professions.  These conversations create ripple effects throughout the system.

Imagine if doctors and nurses and professionals from other health disciplines all over the country met together and had conversations like this. Margaret Wheatley tells us that conversations change people and people change the world.

We see this happening in ways large and small at Salons. The salon in my home yesterday evening was no exception.

My dream is that doctors and nurses and all clinicians begin meeting in homes all over the US and talk to each other about the work we do.   I KNOW the health care system would be impacted in a major way.   We would migrate health care forward, in big changes and small changes, in ways that can not be specifically predicted but can be expected with absolute certainty.

I hope that everyone is able to take part in this wonderful vehicle for self-care and enhanced professional practice. And I hope that together we continue to build the best future possible for the health of society.

Have any of you has been to a salon recently? How did it go? Are any of you still looking for one near you? Are any of you planning events and considering adding a salon before/after/during? It’s always great to hear from you!

Reading List:

Turning to One Another: Simple Conversations to Restore Hope to the Future (2002) Margaret Wheatley

Richard Olding Beard: An Extraordinary Feminist. May 7, 2017

Posted by mariemanthey in Academia, History, Inspiration, Professional Practice.
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This note is about a work-in-progress, a scratch pad entry from the Desk of Marie Manthey.. it includes a resource list at the end and an invitation to comment and join in the process!

Nursing and the Women’s Movement have had an interesting, challenging and contradictory relationship since modern nursing was born around the 1870’s.

Never a feminist herself, Florence Nightingale created a profession for nurses – for women – where none had existed before. This profession is based on values that have been associated with women.

Fast forward 40 years to the life of Richard Olding Beard, a professor of physiology in the University of Minnesota Medical School. His strong vision of the contribution nursing could make to the benefit of society gave the school of nursing a trajectory that continues to compel the future.

He founded the School of Nursing at the University of Minnesota, which was the first nursing education program within an academic institution. He clearly supported higher education for women and recognized the foundation of science in nursing. He presciently imbued the School of Nursing with multiple societal values that continue to be expressed in the work of its graduates today. Richard Olding Beard saw Nursing’s potential capacity for increasing social justice in the world; for example because of how nursing values the act of caring for the sick – all of them – without regard for position, wealth or status.

There is much more to come, in the full article. To end this preview, here is one of my favorite quotes of his:

“The history of a university or school – and particularly of a professional school – may be guided or misguided by its governing body, may be inspired or uninspired by its faculty, but it is actually written in the work and in the play, in the life and character, in the future achievements and influence of its students.” R. O. Beard, Graduation of the School of Nursing, September 1923.

Beard’s writings (articles mainly) have been a treasure trove for me, and I encourage you to check them out. There is a collection of his writings at the Anderson Archives at the University of Minnesota Library.

Additional information: Honoring the Past, Creating the Future – School of Nursing Celebrates a Century of Leadership. Minnesota Nursing, Spring/Summer 2009. P 2-3.

Please comment below with any questions, thoughts, anecdotes etc..!

Timeless Treasures: ‘Utopia’ April 28, 2017

Posted by mariemanthey in Creative Health Care Management, Inspiration, Leadership, Professional Practice.
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By Marie Manthey

Utopia is a nursing unit where the staff members are treated with respect by both the hospital that hires them and they physicians with whom they work. It is a place where the respect people have for themselves and each other means that relationships are healthy and supportive. It is a place where people understand the value of maintaining their own peace of mind.

In this Utopia, nurses are self-confident and have a sense of self-worth. They know they aren’t perfect, and accept the reality that they will make mistakes. They understand that no one wants to make mistakes, but that mistakes are inevitable because they are human, and only God is infallible.

Nurses in Utopia have a sense of purpose in life and believe they have both the right and responsibility to shape their own futures.

Nurses in Utopia feel good about themselves and can therefore love their patients. They recognize and respect the interests of other nurses, patients and physicians and respond to them appropriately. These nurses have an ability to get the job done, even within their own limitations. They are free to use the very best level of skill, knowledge, intuition, and personality strengths they possess in administering care to their patients. They understand the fundamental value and worth of their profession and are ennobled by the dignity of the human interactions they engage in during the normal course of their professional activities.

Nurses began working in this Utopia early in the Nineties, when they finally learned that the essence of human growth lies in the self and that in order to grow, one must change and that each of us can only change ourselves — not anyone else.

References:

Relationship-Based Care Field Guide

Visions, Strategies, Tools and Exemplars for Transforming Practice

Editors: Mary Koloroutis, Jayne A. Felgen, Colleen Person, Susan Wessel

Part 1: Vision ||Chapter One: Begin at the BeginningPage 41

Originally published in Primarily Nursing Journal, 7[5].

Substance-Use Disorders in Nursing: U of MN curriculum incl Manthey’s story (video link) April 26, 2017

Posted by mariemanthey in Academia, Nursing Peer Support Network.
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School leads collaborative efforts to address substance use disorders in nurses
by: Brett Stursa

The numbers are well documented. About one in 10 people in the United States has a substance use disorder, which mirrors the number of nurses and other health professionals with the illness.

That means about 300,000 nurses nationwide are living with a substance use disorder, and in Minnesota that translates to about 12,700 nurses.

While the numbers are straight forward, the consequences of substance use disorders on lives are complicated and nuanced. Concerned about the scope of the problem and its impact on patients and nurses’ well-being, Dean Connie White Delaney, PhD, RN, FAAN, FACMI, sought to identify strategies to address the issue of substance use disorder in nurses.

“Nobody is untouched by addiction,” said Delaney. “Even though it brings to the surface many difficult issues, it is critical to the health of our patients and nurses that we talk openly and address it.”

In 2014, Delaney invited state leaders in licensing, education and recovery, as well as the school’s largest clinical partners University of Minnesota Health and Fairview Health Services, to develop a deeper understanding of the landscape in Minnesota and identify a blueprint for action. All who were invited were quick to accept the invitation. Shirley Brekken, MS, RN, FAAN, executive director of the Minnesota Board of Nursing, was eager to get to work. “I think that each of us was looking for something, for a way to protect the public, be supportive of recovery and make nurses aware of how easily addiction can occur,” said Brekken. “There was recognition that if we do it together we can have a far greater impact than if each of us is operating on our own.”

“Nobody is untouched by addiction. Even though it brings to the surface many difficult issues, it is critical to the health of our patients and nurses that we talk openly and address it.” – Dean Connie White Delaney

The group, called Prevention Awareness Addiction Recovery Reentry and Support, quickly determined that education and support were priorities. Since the first meeting in 2014, the School of Nursing developed and launched an integrated statewide approach encompassing education, prevention, recovery and support.

Educating students on the risks

A stressful job, stigma and shame about substance abuse, and a lack of education regarding self-identification all contribute to the risks nurses face. “There are a lot of risk factors that are unique to nurses that weren’t being discussed in the education that the students were getting,” said Dina Stewart, RN, a Doctor of Nursing Practice student who worked with Christine Mueller, PhD, RN, FGSA, FAAN, associate dean for academic programs, and others to develop a learning module for all pre-licensure students. “It’s largely something nurses don’t talk about still because of the stigma.”

The module, which will be made available to pre-licensure programs across Minnesota, is designed to help students understand the risk factors nurses face, with the idea that if nurses know their risks they are better equipped to avoid them. Another objective is to give emerging nurses a plan of action if a colleague exhibits symptoms. “One of my biggest hopes is that it can be discussed openly without any shame associated with it,” said Stewart.

Many nurses don’t seek help because they fear they will lose their licenses to practice. The education describes the protections in place to assist nurses and other health professionals. Minnesota offers nurses and other health professionals a confidential monitoring program. “Nurses are worried they are going to lose their livelihood when really there are protections in place to assist them if they come forward on their own,” said Stewart.

Introducing peer support for nurses in recovery

The goal is that the education being taught in the classroom will be bridged to extend to orientation and ongoing professional development in practice settings. Until recently, nurses who sought treatment and hoped to re-enter the profession had little assistance from each other. Nurses in Minnesota now have a peer support network, which works to foster peer support for nurses in recovery.

The meetings do not take the place of treatment or AA, but rather provide an opportunity for nurses to talk about their recovery and the challenges unique to nursing. “The main hurdles are stigma and shame. That’s especially true in nursing because we are dedicated to helping people and when we realize that we may have harmed people, the shame of that is overwhelming,” said Marie Manthey, RN, Nurses Peer Support Network board chair. Manthey’s own story of recovery is shared in the School of Nursing’s module.

Regular meetings of the network are held in eight cities across the state, and on any given week, there are 10 to 15 people at each meeting. Plans are underway to expand to more cities. “We would like to have meetings in every area where there are groups of nurses who would benefit from it,” said Manthey, a School of Nursing alumna.

Reflecting on the progress made and the work still to be done, Dean Delaney credits the group’s collaborative spirit and willingness to be vulnerable during difficult conversations for its successes. “What’s underlying the development of this integrated model, ultimately, is ensuring the highest trust and safety of the public and also supporting our professionals,” said Delaney. “The way to enhance the health of the public is ensuring the health of care providers, including nurses. We have the framework and we are committed to build on it.”

Substance-Use Disorder Awareness added to UofM SON Curriculum April 20, 2017

Posted by mariemanthey in Academia, Nursing Peer Support Network.
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House of Charity generously supports MinnPost’s Mental Health & Addiction coverage; learn why

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With high-stress jobs and access to sometimes-addictive medications, some nurses are at elevated risk of developing substance-use disorder.

The very real issue of substance-use disorder among nurses isn’t something that gets talked about all that much in nursing schools. A new curriculum created by the University of Minnesota School of Nursing and made available to nursing schools around the state is trying to get that timely conversation started.

It’s almost as though the profession has been avoiding talking about the issue, said Christine Mueller, RN, Ph.D., associate dean of academic programs at the U of M School of Nursing.

“If substance-use disorder gets talked about in nursing programs at all, it is usually very superficial,” she said. “At the University of Minnesota, prior to the development of this curriculum, we had not been intentional about making sure that this was an official part of the conversation. But now we’ve created a way to devote an entire class session or online module to the topic. ”

This focus is important, Mueller added: “At the end of the day, substance use disorder among nurses is a quality and safety issue for patients, and we have a big focus on patient quality and safety in our program.”

With high-stress jobs and access to sometimes-addictive medications, some nurses are at elevated risk of developing substance-use disorder, Mueller said. Though at an estimated 10 percent, the rate of addiction among nurses is no higher than in the general population, the risks of coming to work impaired or diverting patient medication could put lives on the line.

Jace Gilbertson, a senior in the U of M’s BSN program, said that nurses with addiction issues sometimes find themselves in a particularly tough spot. And it’s not something they warn you about in school.

“As nurses, we are right there on the front lines,” Gilbertson said. “When I finish my degree, I’ll be working in an emergency department. That is a chaotic environment where things happen fast and the stress levels are high. In the nursing profession, there is that stigma and shame around the idea of substance use, but by just being a nurse we put ourselves at a higher risk of coping with stress by using medications and alcohol. Being open about that risk could help stop a lot of problems before they get out of hand.”

Designed to respond

The curriculum, which was developed by Mueller and Dina Stewart, a University of Minnesota doctor of nursing practice (DNP) candidate, was “prompted by the fact that there had been some press about nurses who have substance-use disorder and the role of the Board of Nursing plays in this issue,” Mueller explained. “Our school decided to be proactive and work with the Board of Nursing and others to think about what we could do together to address the issue of substance-use disorder in nurses. One very obvious thing that a school of nursing could do is to ensure that our students are knowledgeable about the topic. That’s where our new curriculum came in.”

Christine Mueller, RN, Ph.D.

Christine Mueller, RN, Ph.D.

The curriculum was added to the University’s degree program this semester. Other nursing schools around the state are also in the process of incorporating it into their programs.

The curriculum’s goal, Mueller explained, “is for students to develop an awareness about substance-use disorder in nurses and about the risks that substance use creates.”

Mueller said that she and Stewart designed the module in part to provide answers to common questions that nursing students ask, including “Why are nurses more at risk for substance-use disorder? What can nurses do to mitigate that risk? What can a nurse do if they come in contact with colleagues that have substance-use disorder? How can you recognize the problem? What is your responsibility if you suspect diversion?”

The format worked well for Gilbertson.

“In this module, we learned how to recognize the signs and symptoms of an impaired nurse,” he said. “We learned it is not a punitive thing to report a colleague if you suspect substance use — it is for the benefit of that nurse to help them get he help they need and put the patient first. It puts the integrity of the profession front and center.”

Real risks — and help

The curriculum also provides important information and warnings about the real risks of substance-use disorder for nurses and their patients.

“We try to help students understand the consequences,” Mueller said. “If you come to work impaired, you could lose your job or you may not be able to work until you deal with the problem. If you get to the point where you divert medication, that is a felony, and you can’t practice in this state if you have been convicted of a felony.”

This information hit home with Gilbertson, who sometimes struggles with what he sees as a pressure for perfection within the profession.

The curriculum helps nursing students step away from the myth of the “perfect nurse,” he said: “As nurses we re not immune to suffering from substance-use disorder, even though we are some of the most trusted people in the hospital. As our patients’ advocates, we have to be strong all the time and not show any weakness. Because there is a stigma around substance use and addiction problems, nurses try to hide their addictions. That’s when things can get dangerous.”

Jace Gilbertson

Jace Gilbertson

The course also includes a recorded interview with University of Minnesota School of Nursing graduate and substance-use disorder advocate Marie Manthey. In the interview, Manthey tells the story of her own struggle with substance use when she was a practicing nurse.

“Marie’s story really brings it home for students,” Mueller said. “She does a great job explaining how substance use can be so insidious in the profession.”

Through Manthey, students also learn about the Nurses Peer Support Network, a program designed to help nurses recover from substance-use disorder and support them in their recovery.

“One of the most important things for new nurses to understand it that substance-use disorder is a disease, not a moral deficit,” Mueller said. “People can recover from this. We try to make that point clear in the curriculum.”

Realizing that it is possible to recover from substance use disorder and continue working in the nursing profession was an important realization for Gilbertson.

“There are steps a nurse can take to be rehabilitated from substance-use disorder,” he said. “It is reassuring as a nurse going into the profession to know that there is a safety net and there are people out there caring for you.”

Part of closing course

At the U of M, the new curriculum is now a required element of the program’s final “Transition to Practice” course. Mueller explained that the placement was intentional, serving as a key introduction to the realities of life as a working nurse — and as a reminder of the importance of being aware of the risks that substance-use disorder creates.

“It made a lot of sense to place it in our curriculum in the last semester or the last year of the program when students are beginning to think about transitioning to practice,” she said.

Gilberson agreed.

“I think the curriculum is placed well,” he said. “It’s a good reminder of how we should be taking care of ourselves as we go into the profession of nursing, a good call to action for nurses just entering the workplace, a good opportunity to teach nurses early on that this is a reality that they may face during their careers.”

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.

The Premier Primary Nursing Hospital in the United States July 23, 2013

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In early May I had the privilege of visiting The James Cancer Center, a division of Ohio State University Hospital. My colleagues at CHCM, particularly Susan Wessel and Janet Weaver, have been working with them for some time and had been telling me of the great progress in developing a highly professional practice model the James had been achieving.

What I saw was like a dream come true for me. I saw staff nurses free and motivated to creatively solve patient’s care problems! This isn’t about unusual staff nurses; they are basically the same as staff nurses everywhere. It is about leadership based on common sense and a cultural infrastructure of safety for the risk-taking of creative problem solving. It thoroughly convinced me that Primary Nursing can be done….and MUST be done. Our patients deserve this level of care and our nurses deserve this kind of high-trust, high-integrity institutional environment.

Here is an email I received today from Jamie Ezekeilian at the James (addressed to Susan Wessel and myself):

Dear Susan and Marie,

We did indeed complete our three-day Magnet site visit last Friday, and I couldn’t help thinking that you would have been so proud.  At the checkout session with our three appraisers they said that they wanted to share what they thought were our “double-WOWs,” and the first thing they listed was our Professional Practice Model, Care Delivery System, and Relationship-Based Care!  Some of their observations:

  • We are living all aspects of RBC throughout the organization
  • They were amazed that professionals beyond nursing (including physicians) could speak articulately about our PPM and RBC
  • That Primary Nursing was so enculturated in all practice settings— they thought it unheard of for surgical services (periop) to be practicing Primary Nursing
  • They were quite impressed with our communication across the continuum of care and of our care coordination
  • They said that staff clearly felt cared for by each other and that is how they continue to do the difficult work of oncology nursing
  • That all were focused on patients!
  • That we have “clearly done this right”
  • That staff throughout the organization are so excited to attend the RBC Symposium in September—”we heard about it everywhere we went”

I wanted to share this with you as an affirmation of your professional work and your passion for Relationship-Based Care. I am so grateful to you for your wisdom and so thankful that we have had the opportunity to work together.

With heartfelt gratitude,

Jamie