Personally… Being Mortal by Atul Gawande June 11, 2017
Posted by mariemanthey in Inspiration, Manthey Life Mosaic, Professional Practice.Tags: Empathy, Florence Nightingale, Health Care System, Reading List, Reflective Process, Relationships, Staff Nurses, Trust
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I lost a close friend recently, after a long struggle with some chronic medical conditions.
It’s a sad period, but one comfort is that his last days went as well as they possibly could. I’m reminded of this book: Being Mortal, written by practicing surgeon Atul Gawande.
In the book Atul explores what it means to ensure that the positive meanings of one’s life extend through the final phases of that life, clinically and in all other ways. Atul has completely defeated the normative medical profession’s reluctance to address that period after medicine stops being applicable. He explores what continues to be important for the person themself and their family.
I found it extremely moving and useful – not just for that period but for everyday. Highly recommend!
Additional Resources:
Nursing: More Work to do than Time Available June 6, 2017
Posted by mariemanthey in Leadership, Professional Practice.Tags: Decision-Making, Escape Victim Mindset, Hospitals, Mindfulness, Reflective Process, Self-Care, Staff Nurses
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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.
Absence of RAA – Problems Universal May 16, 2017
Posted by mariemanthey in Inspiration, Leadership, Professional Practice.Tags: Decision-Making, Escape Victim Mindset, Mindfulness, Nurse Managers, RAA, Reflective Process, Relationships, Self-Care, Staff Nurses
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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!
My August Salon August 10, 2009
Posted by mariemanthey in Creative Health Care Management, Inspiration, Nursing Salons, Professional Practice.Tags: CHCM, Health Care System, International, My Salon Updates, Primary Nursing, Reflective Process, Self-Care
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This one was special in that it was scheduled (by me) right in the middle of a five day practicum on Primary Nursing. This was the first Practicum I’ve ever done, and it was a delightful experience for me and for the attendees. We had a great time and we all learned a great deal.
In the middle of this event, I had a Salon scheduled. All the Practicum attendees opted to come, so we had a group of around 20-22 people. It was large, but the conversation flowed well, because so many knew each other already from the class.
The theme for the evening ended up being “self-care” a huge challenge for many nurses as well as non-nurses. The beautiful part was the recognition that if we are not taking good care of our own beings — mentally, emotionally, physically and spiritually — it is hard (if not impossible) to take good care of others.
I am looking forward to the attendees contributions to the blog…..bring them on!!
“Tonight Has Been Revolutionary for Me” October 30, 2008
Posted by mariemanthey in Leadership, Nursing Salons.Tags: Conversations, Health Care System, Hospitals, My Salon Updates, Reflective Process
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A male sophomore nursing student made that comment during the check-out of last night’s salon. We had a full house again and the usual mixture of some students, some staff nurses, a couple of people in managerial roles, a faculty member, A CNO of a major medical center, etc. About 1/3 were new to the Salon format and the rest had been here before.
The student who felt revolutionized by the discussion went on to say he had been part of discussions groups many times in the past, but he had never experienced this kind of conversation before. He mentioned particularly the depth and meaningful topics and the powerful sharing of important experiences and understandings that went into our discussion. He concluded his comment saying he is at a different place in life as the result of attending the Salon.
Also during check-out many people commented on the value of having students present.
One of the interesting questions raised by an experienced staff nurse is “Can compassion be taught?” The richness of that discussion cannot possibly be summarized in a few sentences here. Suffice it to say it ranged from giftedness on one hand to “on-the-job-retirees” on the other hand. Again, the students perceptions about some of their classmates was perceptive and valuable
A major topic was the wave after wave of consultants being hired who bring new “administrative” initiatives that are of little value to nurses except to consume valuable time. Several people in managerial roles commented on the amount of time they spend preparing reports, doing surveys, checking to make sure nurses are “saying things the right way,” etc. that they have little time to actually function as leaders, or even as managers. A particular point of great frustration is the cost of these consultants who seem to know little about the functions of the hospital other than the requirements of their particular program. The cost of these consultative packages was juxtaposed against the many layoffs starting in this community as hospital census declines in the face of the current economic crises.
We also talked about the basic uncertainty that is characteristic of the work of nurses and realized that is expanding to more areas of everyday life. Personal security vs. job security was a fruitful discussion and led to the notion that every nurse should have a Plan B in mind, for mental health even if it is never necessary to use it.
Why nurses come to the Nursing Salon October 2, 2007
Posted by mariemanthey in Leadership, Nursing Salons, Professional Practice.Tags: Conversations, Health Care System, My Salon Updates, Nurse-Patient Relationship, Reflective Process
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I decided to query the email list I use to inform people when the Salon is scheduled about why they even come to this event. Everyone is soooooo busy, there are many reasons why not to come. Every once in awhile, I’ll send you their answers to that question. Here are two:
The reason I show-up at the salon is for an up-close and personal dialogue about the state of nursing in a variety of settings. Thank goodness we have so many different attractions to different populations and different settings.
That makes for many career options and we all have a slightly different “take” on the state of health care and the state of nursing.I also find the different organizational stances really interesting. It makes me feel less alone in both the intimate and public struggle of healthcare. Sometimes it is a transcendent experience, like after the [35W] bridge collapsed and Marty said she felt “we built a bridge here today” as our conversation kept veering back to that sad event. Other times I get my energy rev-ed up and then feel a bit of a let down as action is up to me and I don’t always see a way. Most of the time the Salon is a great reflective process to feed my brain and my soul. I get nourished by the people via their hope, humor, and honesty. The expectation to just “BE” in the setting of confidentiality and a meal is pure presence that I have not had very often as an adult and never in my professional life.
In today’s climate of the “Rage Industry,” and where Target customers are called guests, and patients are called consumers, I can come back to my core of nursing in a gentle and intelligent way with good conversation. I find it very good medicine!
DG
Hi Marie,
I came to the first salon having no expectations nor a full understanding of what I was going to experience. What I found was a diverse group of people that care about nursing and where it is headed. I loved that it was an informal opportunity to explore and express ideas that had been percolating without a ready outlet.I came back because I think it is a great chance for people to expand their experiences as nurses beyond their chosen patient population and see nursing as a whole. Though we may choose to work with different patient populations we see mainly the same issues arise on every level whether it be short staffing, inadequate leadership (both formal and informal), or lack of participation in unit-related activities.
We also share the same love for our patients and their families no matter what their age. We all felt a calling to nursing, and sometimes we need a reminder of what that calling was and why we worked so hard to answer it. I found this when I attended my first salon, and I hope to continue to renew my passion for nursing and search for further solutions through future meetings. Thank you for the opportunity!
Sincerely
HG