jump to navigation

Personally… Being Mortal by Atul Gawande June 11, 2017

Posted by mariemanthey in Inspiration, Manthey Life Mosaic, Professional Practice.
Tags: , , , , , ,
2 comments

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:

NY Times Book Review

Frontline: PBS Special

Pennsylvania Library Book Discussion Notes

The Guardian Book Review

Nursing: More Work to do than Time Available June 6, 2017

Posted by mariemanthey in Leadership, Professional Practice.
Tags: , , , , , ,
add a comment

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: , , , , , , , ,
add a comment

..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!

 

 

A Wise Woman Once said….A Celebration of Florence Nightingale’s Legacy May 12, 2010

Posted by mariemanthey in Academia, History, Leadership, Professional Practice, Values.
Tags: , , , ,
9 comments

A wise woman once said: “It is fundamental that the hospital shall do nothing to harm the sick.” This woman then went on to create what has become in modern times, the profession of nursing. She instinctively recognized the eternal truth of the phrase “To whom it is given”, to care for the sick and to found the profession of nursing – based on the equal strengths of knowledge and compassion.

I often think about Florence Nightingale’s legacy using the metaphor of a seed. Within every seed are all the qualities and characteristics of the entity that is to grow from the seed. Not all qualities and characteristics are nourished and grow equally. Some grow quickly, others much more slowly. And so it is with Nightingale and nursing. In celebrating her life, and its meaning for nursing and for the world, the qualities and characteristics she embedded in the profession deserve to be recognized, both those that flourished and are strong today, as well as those that have yet to be developed. http://en.wikipedia.org/wiki/Florence_Nightingale

Some of Nightingale’s strongest qualities are that she was an intellectual, environmentalist, statistician, politician, administrator, spiritualist and hands-on caregiver.

Nigthtingale’s intense spirituality is made evident in a book of her letters written to her family while on a three month tour of Egypt and Greece. She was not so much religious as she was spiritual. I was amazed to learn that she studied every religion, including paganism, since she believed any one of them could bring her closer to God. Her passion to serve the sick is a direct result of her spiritual life.

As is well-known, Florence was a lady of highest standing is society. Her parents were wealthy. In fact, after their wedding, they embarked on a six year honeymoon tour of the world. They named their first child, Florence, after the city she was born in and their second, Parthenon, for the major tour feature of the city where she was born.

Florence knew early in her life that the role society assigned to her was not acceptable to her. She was highly intellectual; a quality that resulted in her being taught by her father. She learned subjects not generally understood by women like geography, mathematics, politics and world history. She rebelled against her family’s and society’s beliefs about the role of women in the upper classes and eventually, with enormous struggle and cost, prepared herself as a nurse. She believed in the depth of her soul that this was God’s will for her.

Her skill as an administrator became evident when she was commissioned to nurse English soldiers in Scutari. She understood the value of resources and how to use them to accomplish a goal. When the Army Surgeons refused to allow the nurses access to the hospitalized soldiers, Florence withheld access to the ship full of supplies. She managed to withhold access to them until the surgeons relented and invited the nurses to come and work in the hospital. So not only was she an administrator, but also a politician. She analyzed and used the “pockets of power” in any situation. Today, nurses have well-developed administrative skills, but we still need to sharpen our political acumen.

Another interesting strength of Nightingale is in her use of statistics. In contrast to modern nurses, Nightingale loved the field of statistics and was quite creative in her use of numbers. She actually reformed the British military health care system by demonstrating statistically a dramatic drop in mortality rates when soldiers were in the care of nurses. During the war that statistic went from a 43% death rate to a 2% death rate due to the incredible reforms in hospital care she pioneered. Speaking of pioneering, the field of statistics considers Florence one of their pioneers as she created the first pie chart that clearly shows metric relationships among various segments of a whole. Several years ago the magazine, Science News, ran a feature on Florence as their pioneer, showing her on the cover with a replica of one of her pie charts. http://www.sciencenews.org/index/generic/activity/view/id/38937/title/Florence_Nightingale_The_passionate_statistician

Nightingale’s life reflects a wholesome integration of intellect and spirit. She was brilliant; considered a mystic – one who has received a revelation directly from God. As I read Barbara Dossey’s book about Florence’s life, I was amazed to learn she wrote and spoke in five languages. She even made notes in her bible in five languages, which meant she could actually think in different languages. http://www.dosseydossey.com/barbara/book.html

She walked among the pallets in the rat and vermin infested hospitals for the lowly foot soldiers, whispering words of encouragement and hope to the suffering soldiers. She embodied the twin values of knowledge and compassion. The lowly soldiers nicknamed her “The Lady with the Lamp.” They told their parents and families about this remarkable woman. Word quickly spread throughout England that “a high-class lady” was saving lives in Crimea. Grateful parents began donating small sums of money to what eventually became the Nightingale Fund. Florence used this money to start the first modern school of nursing at St. Thomas Hospital. Therefore the profession of nursing as we know it today was funded, not by the health care system, but from outside sources.

One of the criteria used to differentiate a profession from an occupation is that a profession is based on a system of values so fundamental to the nature of mankind that those who hold them can be said to profess to them, as in witnessing. Thanks to the seeds planted by Nightingale, nursing has just such a system of values.

Deeply embedded in the profession of nursing is the belief that of all the forms of human interaction, that of one human being helping another is of high value. Such a simple concept, and yet so rare in modern society. We live in a world today that values competitiveness over cooperation; winners are “better” than losers, which rewards aggressive behaviors in the conduct of daily business affairs and that condones violence as an appropriate way to address wrongs.

We work in institutions that are run as businesses, where profitability trumps all other values. Where putting a price tag on the value of nursing has been an elusive goal. I’m sure Nightingale is proud of Linda Aiken’s research showing that when there is a higher ratio of RN’s to other staff, fewer patients die and there are less complications.

Yet, nursing holds on to the value of one human being helping another. We know the incredible privilege we have when people give us access to all levels of their being: their bodies, minds, spirits and emotions and we cherish that privilege. The public’s trust is reflected in the Gallup polls where nursing is consistently the most trusted profession.

We cherish the privilege of walking into the room of a sick person and being able to interact in a way that alleviates their pain, or increases their comfort. This is an act of nobility and dignity.

Nightingale said nursing is a noble profession; it is up to you nurses to make it noble. There is nothing wrong with our values, even though they are not shared by the system or society. If the world accepted our values, it would be a more civilized world.

Marie Manthey on the birthday of Florence Nightingale.

My August Salon August 10, 2009

Posted by mariemanthey in Creative Health Care Management, Inspiration, Nursing Salons, Professional Practice.
Tags: , , , , , ,
6 comments

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: , , , ,
2 comments

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: , , , ,
add a comment

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