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Reading List – Treasures! June 30, 2017

Posted by mariemanthey in History, Inspiration, Leadership, Professional Practice, Values.
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Here are some books I’ve enjoyed and gained a great deal of insight and resources from. I’d love to hear your thoughts on these and your favorites as well!

The Power of Now by Eckhardt Tolle — I learned the incredible value of learning how to observe my thinking…..thus creating the opportunity to grasp a powerful truth.   That I am more than my thinking.   I am a whole being and by stepping away from my thinking I learn that my thoughts do not define who I am.    My being is more than my thoughts.   That awareness shifts my perspective on life.. Fascinating and exhilarating!

Small Great Things by Jodi Picoult – an ambitious tackling of the racial issues of our time, through the setting of nursing.   A highly experienced black nurse is forbidden by her nurse manager from taking care of the baby of a white supremacist couple….at their insistence.   The story from there presents a dilemma for the black nurse that results in a life-changing lawsuit.

Blessed Unrest by Paul Hawken (2007) – the world is undergoing transformational  changes of people, on a  small scale – in conversational salons and discussion groups, between neighbors and friends. These group conversations are about serious topics like spirituality and the role of governments.   And he makes the point that conversations can change people and people change the world.

The Immortal Life of Henrietta Lacks  by Rebecca Skloot incredible (true) story of medical ethics involving HeLa – two dime-sized tissue samples taken from Henrietta. The cells possessed unusual qualities and yielded amazing benefits for science; the effects for Henrietta and her family were.. less. Bioethics, racial injustice, and history co-exist in this story which starts in Baltimore, involves the Tuskegee Institute, and spreads benefits globally (for specific groups and humanity in general). Talk about health care disparity – really incredible. Recognition, Justice and Healing – hopefully this book brings us a step closer to these goals.  The film, staring Oprah Winfrey, premiered on HBO this past April and will be on DVD soon!

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..!

RAA Content Series – Part I May 2, 2017

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

 

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

Organizing complex functions,

Clarifying interpersonal relationship issues and

Achieving the full experience of will power.

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

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

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

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

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

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

 

ORGANIZING COMPLEX FUNCTIONS

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

  1. How changing work organization impacts on personal development, as well roles, relationships, work quality and energy levels of workers.
  2. How disparity in the balance between responsibility, authority and accountability at the personal, departmental and administrative levels of operations creates dysfunctional organizations and troubled human relationships.
  3. How personal maturity and responsibility acceptance are totally intertwined
  4. The defined difference between a profession, an occupation and a vocation.

IMPLICATIONS FOR ORGANIZATIONS

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

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

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

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

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

.. to be continued

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.
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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.

Social Justice November 17, 2007

Posted by mariemanthey in Academia, Nursing Salons.
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The aftermath to the Summit of Sages has been fascinating. I have been in two major discussions with nurses about social justice with almost explosive results.The first was at the Zeta Chapter of Sigma Theta Tau and the second was a week later at a Salon in my home.

At the Zeta Chapter about 50 attendees heard three nurse leaders from here in the Twin Cities speak about the issue of Social Justice from the perspective of their workplace. The first person is a CNO of a specialty hospital that provides coordinated care for children with severe developmental disabilities. She spoke of finding there were NO similar services available to their patients as they become adults. The whole segment of adults with developmental disabilities from childhood have no specialty in or out patient service providers.

The second speaker is from a local liberal arts college with a major nursing program who spoke about a college-wide initiative to eliminate abusive or violent communications among students and faculty members.

And the third CNO of a local community hospital spoke of her previous experience in the Canadian system where no one goes bankrupt or loses their home because of illness and no one dies because they can’t afford health care. She also spoke of the young adults who arrive in their ER due to a sports injury with no insurance because they are no longer on their parents plan and not yet established themselves.

After these three speakers, the audience entered into a free-flowing passionate discussion about the fact that as nurses we see the effects of this crazy “non-system” of health care … and yet we seldom speak about what we know. There was a strong consensus about the need for nurses to speak up about what we know and about how we think the system should change.

The second discussion was at a Salon a week later and again, the stories about what we know were overwhelming. A quick summary:

  • ER Nurse Manager told of 3 patients in 2 weeks who died upon arrival at the ER door, having waited too long because they didn’t have insurance. Upon arrival at the place of help, they simply gave up the struggle. She also told of a man arriving in a friend’s car with a bleeding leg. She looked at it while he was still in the car and realized it was shooting arterial blood. He waited some time for his friend because he couldn’t afford an ambulance.
  • A Medical ICU nurse told of excessive end-of-life activities that have astronomical costs for elderly patients with no hope of recovery.
  • Another nurse told of the multiple-birth cases where 5 and 6 babies are born, most of whom cannot survive but whose care is always extremely costly.

The point that was made over and over again is that as nurses we are at the point of care and see the effects of the current health care crises on the lives of our citizens. the discussion ended with a commitment to find ways to speak our  “truth-to-power.”

The Latest Salon Report November 2, 2007

Posted by mariemanthey in Academia, Nursing Salons, Values.
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Last night we had our monthly salon at my home. About half the group was new and the other half had been here before. This time only one student nurse came and one fairly new graduate working as a staff nurse and 3 attendees were not nurses, one teaches at health related topics at a local college, one is a retired physician I have known for a long time and the other was a visitor from Iceland who wanted to see how a salon worked. Most of the rest were middle-aged staff nurses and nurse managers from various hospitals around the Twin Cities.

Although many topics were raised during the initial check-in, we ended up focusing on a wide-ranging discussion related to staffing/resource issues, social justice and inequities in the health care system so often part of the every day life of a nurse.

A manager at a local ER told about three patients who died on the floor of the ER vestibule, collapsing as soon as they arrived, having stayed away from care until the last possible moment because they have no insurance.  She also told of a man who cut his leg and waited for a friend to drive him to the ER as he couldn’t afford an ambulance. This man had an arterial bleed and had lost enormous amounts of blood before he arrived. In this ER visits are increasing astronomically while care hours/visit are continuously reduced to increase margins.

A NICU nurse talked about the cost of caring for multiple birth babies (5 or 6) the result of infertility treatments who stay in NICU’s for months. Often staffing throughout their life is 1:1 or 2 nurses/baby. The last group six births resulted eventually in one baby actually living. A nurse manager of a medical ICU talked about the hundreds of thousands of dollars spent during the last few weeks or months of care for catastrophically failing people in their nineties.

The student is now in her public health rotation and wonders why the savings created by keeping people healthy isn’t part of the economic equation.

This may sound like an overall pessimistic evening, but it was far from it. I can’t really explain what happens at a Salon, but we seem to be able to connect with our positive values and experience strength just from knowing each others’ experiences and values.

I am definitely sensing from this discussion and others that have been occurring recently that the “Voice of Nursing” is in the process of become loud enough to be heard. I’m not sure just how this will happen, but I sense a real strengthening of our commitment to make the world a better place coupled with an awareness that we are strong and can be stronger.

I am encouraging all of us to initiate conversations about social justice in all of our professional meetings. Specialty organizations looking for great programs for their meetings could do what the Zeta chapter of Sigma Theta Tau did here last week when three nurse leaders presented brief comments about social justice issues in their workplace. The discussion that ensued was energizing and confidence-building. This concept of social justice has a rippling effect that continues to strengthen with each new discussion.

Summit of Sages and Maya Angelou October 23, 2007

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The 2007 Summit of Sages was an amazing experience. So many nurses gathered in one place to talk about Social Justice and Nursing. My head and heart are still reeling from everything I heard, saw and thought.  

For me, one of the most moving events was Maya Angelou’s speech and the time she spent with us. 

Walking reverently, majestically, she filled the room with her presence. Carefully seating herself as if fragile, quiet for a moment, she opened her remarks singing: “the rainbow is in the clouds”. This remarkable, beautiful queenly black woman then spoke for an hour, touching on a variety of topics with reverential seriousness, yet delighted the crowd with an infectious smile and keen humor. She occasionally referred to herself as a six foot tall black woman and spoke of her son, of racism, poetry and the meaning of life. 

Throughout her time with to us she frequently returned to the theme of “the rainbow is in the clouds.” She reminded us that rainbows only appear in clouds – not in the bright sunny skies. An act of kindness that seems inconsequential to us may alter the life of the person to whom we were a rainbow in the clouds. 

Dr. Angelou shared the example of her Uncle Willie. Afflicted by almost total paralysis of the left side of body, Uncle Willie earned meager wages as a shop keeper in a small town in Arkansas. However, his condition and small income didn’t deter Willie from being a rainbow in the clouds – touching the lives of thousands and indirectly, millions of people. After the divorce of Dr. Angelou’s parents, Uncle Willie raised Maya and her brother. Stern but fair, Uncle Willie taught them the importance of education, work and ethics.  

On top of raising the two children, Willie befriended a local boy town whose mother was blind and unable to support her son. Uncle Willie paid the boy to do odd jobs and errands around the store, instilling the same values he taught to Maya and her brother. That boy went on to be the Mayor of Little Rock, Arkansas where he would become a Rainbow in the Clouds himself.  

Years later, when Uncle Willie passed away, the Mayor contacted Maya. He wanted to pay the family back for Uncle Willie’s kindness by ensuring his assets and property were protected and allocated appropriately. He met with Maya and gave her the name of a prominent lawyer in Arkansas. This lawyer had a special friendship with the Mayor, as he had been the lawyer’s “rainbow in the clouds,” acting as a father figure, guiding him as a student leader in high school, and helping his mother who had been widowed while only six months pregnant. Later, the Mayor would then help get this lawyer into the Arkansas legislature.  

The lawyer certainly made sure Maya’s assets were protected, but he did much more than that. With his start in the Arkansas legislature, he went on to become the Governor of Arkansas. As a result of Uncle Willie helping a boy in need, another boy in need had gone on to become a lawyer, the Governor of Arkansas, then became the President of the United States: Bill Clinton. 

Interspersed with her stories of Uncle Willie’s shining Rainbow in the Cloud moments, Maya told of being a sixteen year old, unwed, pregnant, six foot tall black girl yearning – but certainly not educated to be – a translator for the United Nations. She contrasted her feelings then with the pride, many years later, at being asked to write a poem for Bill Clinton’s inaugural speech followed by being elated and absolutely awestruck at being asked to write the poem celebrating the fifty year anniversary of the United Nations. 

Between these and other poignant stories, she also used her voice as a musical instrument, singing and calling out, murmuring low and laughing raucously.  

What struck me forcibly was the sub-text of reverence toward life, toward poetry and toward herself as a woman. Her tone, language inflection and facial expressions reflected a deep sense of self-respect for herself and her life. And for poetry. This reverence for women and for poetry embraced the nursing profession. She referred to nursing both as living poetry and as a beautiful example of the Rainbow in the Clouds. 

Tearful and emotional, Maya accepted the honorary doctor of humane letters from the University of Minnesota. You can read more about it, and see the poem she dedicated to us on the School of Nursing’s website.  

As it all settles out I will be writing more, and I know Creative Health Care Management, The University of Minnesota School of Nursing and Creative Nursing Journal will be sharing more details over the next few weeks and months.

Reflections on a Monday Evening Well Spent October 3, 2006

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Had dinner last night with Jayne Felgen, the President of Creative Health Care Management. It is always so good to touch base with her. We are both into such interesting aspects of our work there is barely time to catch up with family and personal stuff.

She has just returned from England where a group of dynamic individuals from eight countries are designing a research project about patient satisfaction in the context of a therapeutic relationship with a patient and nurse autonomy. These incredible individuals have been meeting in various places around the world as a result of a chance meeting on the deck of my house at a Sunday morning brunch during the last Summit of Sages in October 2004.

Which reminds me: watch for info on the next Summit  of Sages, October 14 – 16, 2007. Details are still being planned but we know the topic will be “Social justice as a core value of nursing” and the keynote speaker is Maya Angelou! It doesn’t get much better than that!