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

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

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

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

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

I am so grateful.



Posted by mariemanthey in Leadership.
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As you know if you follow this blog, we take RAA – Responsibility, Authority and Accountability – very seriously.   We feel that that paradigm has the power to create healthy workplaces, excellent health care and healthy nurses, doctors, and staff.  Anywhere. These discussions are serious, practical, conceptual, and (we hope) useful.

Variety being the spice of life, today’s entry into the conversation is provocatively different. Today we provide to you a highly-scientific, term-by-term description (or not) of what it’s like when RAA is not in place. Anywhere. Well ok, not that scientific or academic – but highly accurate nonetheless!    Think of how often in your personal and private lives you have experienced this exact dynamic!

In this world, there are four kinds of people: EVERYBODY, SOMEBODY, ANYBODY AND NOBODY.

There was an important job to be done and EVERYBODY was asked to do it. EVERYBODY was sure that SOMEBODY would do it. ANYBODY could have done it but NOBODY did.

SOMEBODY got angry about it because it was EVERYBODY’S job. EVERYBODY thought that SOMEBODY would do it, but NOBODY realized it wouldn’t get done by ANYBODY.

It ended up that the job didn’t get done, but EVERYBODY accused SOMEBODY and NOBODY accepted responsibility.

Moral: EVERYBODY’S job is ANYBODY’S. NOBODY can be SOMEBODY unless he’s willing to do ANYBODY’S work.

How about you? All EVERYBODYs, NOBODYs, ANYBODYs, and SOMEBODYs  welcome – tell us your story.

Leadership, by the book: the Army Manual book July 10, 2017

Posted by mariemanthey in Leadership, Professional Practice, Values.
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U.S. Army's Army Field Manual 6_22 on Leader Development
i.t.o. psychological & psychiatric criteria for leadership.

This content is written by Prudence L. Gourguechon, widely known national expert on psychoanalysis for the fields of business, law, politics and marketing.

“Despite the thousands of articles and books written on leadership, primarily in the business arena, I have found only one source where the capacities necessary for strategic leadership are clearly and comprehensively laid out: the U.S. Army’s “Field Manual 6-22 Leader Development.”

“The Army’s field manual on leadership is an extraordinarily sophisticated document, founded in sound psychological research and psychiatric theory, as well as military practice. It articulates the core faculties that officers, including commanders, need in order to fulfill their jobs. From the manual’s 135 dense pages, I have distilled five crucial qualities:


“According to the Army, trust is fundamental to the functioning of a team or alliance in any setting: “Leaders shape the ethical climate of their organization while developing the trust and relationships that enable proper leadership.” A leader who is deficient in the capacity for trust makes little effort to support others, may be isolated and aloof, may be apathetic about discrimination, allows distrustful behaviors to persist among team members, makes unrealistic promises and focuses on self-promotion.

Discipline and self-control

“The manual requires that a leader demonstrate control over his behavior and align his behavior with core Army values: “Loyalty, duty, respect, selfless service, honor, integrity, and personal courage.” The disciplined leader does not have emotional outbursts or act impulsively, and he maintains composure in stressful or adverse situations. Without discipline and self-control, a leader may not be able to resist temptation, to stay focused despite distractions, to avoid impulsive action or to think before jumping to a conclusion. The leader who fails to demonstrate discipline reacts “viscerally or angrily when receiving bad news or conflicting information,” and he “allows personal emotions to drive decisions or guide responses to emotionally charged situations.”

“In psychiatry, we talk about “filters” — neurologic braking systems that enable us to appropriately inhibit our speech and actions even when disturbing thoughts or powerful emotions are present. Discipline and self-control require that an individual has a robust working filter, so that he doesn’t say or do everything that comes to mind.

Judgment and critical thinking

“These are complex, high-level mental functions that include the abilities to discriminate, assess, plan, decide, anticipate, prioritize and compare. A leader with the capacity for critical thinking “seeks to obtain the most thorough and accurate understanding possible,” the manual says, and he anticipates “first, second and third consequences of multiple courses of action.” A leader deficient in judgment and strategic thinking demonstrates rigid and inflexible thinking.


“Self-awareness requires the capacity to reflect and an interest in doing so. “Self-aware leaders know themselves, including their traits, feelings, and behaviors,” the manual says. “They employ self-understanding and recognize their effect on others.” When a leader lacks self-awareness, the manual notes, he “unfairly blames subordinates when failures are experienced” and “rejects or lacks interest in feedback.”


“Perhaps surprisingly, the field manual repeatedly stresses the importance of empathy as an essential attribute for Army leadership. A good leader “demonstrates an understanding of another person’s point of view” and “identifies with others’ feelings and emotions.” The manual’s description of inadequacy in this area: “Shows a lack of concern for others’ emotional distress” and “displays an inability to take another’s perspective.””


From an intraprofessional leadership perspective, this is a universal summary of essential leadership skills from a valid source.   Going back to Florence Nightingale, great leaders when matched to this set of criteria have great capacity to be powerful leaders who truly make a difference. Hospital origins were deeply linked to the military mindset of regimentation, discipline, following the chain of command, and maintaining discipline. Sometimes in ways that de-humanized patient care.

This value-based list of leadership skills represents an exciting awareness important values that can greatly improve performance and promote better engagement.

My own learning during the early development of Primary Nursing included an invaluable gift from ‘military literature’.    I don’t remember the exact document or book, but I know the conceptual paradigm of Responsibility Authority and Accountability came directly from a description of  a military ‘chain of command’ writing.   We were not using words like that in nursing during PN’s early development.

Every sector has a contribution to make to the collective well-being!




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!

Role of Nurse Manager: Needs Support to be Supportive June 13, 2017

Posted by mariemanthey in Creative Health Care Management, Leadership, Professional Practice, Uncategorized.
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I’m reminded frequently about how strongly a leader’s influence drives the quality of work done…on nursing units and in every workplace.  The clarity of role definitions in the workplace – and in particular how the role of the leader is defined – is essential to effective leadership.

Leadership is often confused with limitless power.  Unclear scopes of responsibility for leaders and others creates confusion, unsatisfactory outcomes and personal stress among workers which in most cases results in bad outcomes.   This seemingly simple element is often the culprit of toxic work environments.

Leaders Empower Staff – that is the name of a basic curriculum component of CHCM’s work, and it’s also a phrase which sums up  much of our leadership philosophy and seminar focus.

We believe that the people who do the work should be empowered to make  decisions about the work, and good leaders actively support that by intentionally putting that power in the hands of their staff.

There are many specific skills and practices that need to be in place for the leader to do that and to support that structure. One of our accompanying basic beliefs is this: nobody walks in to a leadership role with everything already in place to be successful. Each new leader will have some parts of the skills set, and they’ll need to gain the rest on the job.

Each time a new leader is hired, there needs to be a systemic process of determining what they need to be successful in that role, and to provide the training, support, skills development, mentoring, etc.. necessary in order for them to grow in to that role.

Otherwise, insecure, ill-prepared leaders may assume that empowered staff are a threat to their authority and therefore to their success.   These leaders …at all levels in a hierarchy…..will hold on to power  to feel secure. Staff then are hindered from contributing at their highest level, restrained from using their actual knowledge and skill, and devalued within the workplace.  Morale is negatively affected.

Staff  need to be developed professionally so that they are confident and comfortable using their legitimate power.  Within their scope of responsibility, they need to learn how to identify operational problems, to generate solutions, to implement the solutions.  This level of employee engagement is a dream scene for most executives.

Both staff and leadership need to accept the fact that as humans, they’ll make mistakes, and that those mistakes are to be treated as opportunities for growth, not punishment. Integral to that is for leadership to actually react that way to mistakes!

Leaders do constantly need to bring their best selves to the job, to actively create for themselves a goal behavior pattern based on best leadership practices, and do their best to live up to those goals.

Accountability is crucial.

In some workplaces – within healthcare and outside of it – the accountability of leaders is sometimes problematic.  It is easy for leaders to obfuscate personnel problems, particularly if they don’t know how to or don’t want to deal with them..   The obfuscation may show up as being able to provide assurance to those they report to that staff are fine, operations are fine, progress towards goals is happening, the ship is tip-top. They may not  share sufficient detail about problem employees, hence  obfuscating their own responsibility to act, resulting in avoiding personal accountability as  leaders.   A great deal of the angst, stress and toxicity in workplaces today is due to inadequately prepared  leaders who are not held accountable for learning the basic skills necessary to create a culture of safety and empowerment.

Our values, principles and practices of Creative Health Care Management focus on changing workplace  cultures so that all members of the team (starting with the leader) have the support they need to produce efficient and effective productivity. The clear allocation of responsibility coupled with the delegation of commensurate authority and accountability are the key components to leadership and management success in every workplace.

The Nurse Managers who gain these leadership skills are the MOST essential element to creating a relationship-based environment that is healing for both the staff who work there and the patients who receive care there.

Personally… Being Mortal by Atul Gawande June 11, 2017

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

NY Times Book Review

Frontline: PBS Special

Pennsylvania Library Book Discussion Notes

The Guardian Book Review

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..!

Looking forward to Nurses Week! May 5, 2017

Posted by mariemanthey in Inspiration, Professional Practice, Thought for today.
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May is Nurses Month!

Let us take this opportunity in the cycle of time to reflect and celebrate the gift that we have.

Forever, in the history of civilization, there has been an inclination among people to reach out and help another in need in their community. Forever, in the history of civilization, it has been understood that this form of human interaction is of greater benefit to society then interactions that are harmful, destructive, damaging, or painful. Yet, for reasons that are somewhat imperfectly understood (by us and others), those of us who regularly engage in the helpful and compassionate interactions are undervalued, or devalued in this particular period of the history of mankind.

The fact that materialism, success in business, scientific knowledge, wealth, and gaining a competitive edge using aggressive techniques are the common sources of prestige and status must not interfere with the clarity of our vision that the work we do has enormous significance in the ultimate advancement of civilization.

Nurses are among the most trusted professionals in the eyes of the public, but that trust not always taken into account in the rewards side of the ledger. Nurses need to stop taking personally the way society can undervalue our work, and focus on making visible the impact our type of interaction can have on the level of civilization experienced by those who live in the world today.

Let us celebrate the power we can have via the choices we make in our nursing interactions with humanity… let us find ways to help the rest of the world understand what it is missing.. let us cherish the feeling we get from our work when we are conscious of the sanctity of one human being helping another.

For that is what Nursing is.

Let us Celebrate!!

Updated from original text published in ‘Primarily Nursing’, From the Desk Of column, 1988.

Gallup poll…nursing vs. congress! January 1, 2012

Posted by mariemanthey in Inspiration, Leadership, Professional Practice, Thought for today, Values.

Once again nurses have highest ranking in  ethics and honesty among all 21 professions tested.   And guess what?….Congress members were scraping the bottom of the list right along side of used car sales people.   What do you think we should do about this?   Elect more nurses to Congress?   Have the nursing profession conduct classes in ethics, honesty and trustworthiness for members of congress?   What do you think? …..

Key messages about Advanced Practice Nursing November 23, 2011

Posted by mariemanthey in Leadership, Professional Practice, Thought for today.
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During this time of system reform, nursing needs to be positioned to maximize -our strengths.    Legislative restrictions on advanced practice nursing need to be eliminated.   Here are some key messages.     Talk it up!

  • APNs are trusted professionals who are well tested in the community with a long track record of quality & safety. 


  • When APNs are allowed to practice fully, they can provide care that is more economical and better than our current health care system allows and this savings can be passed on to the state and to consumers.


  • Government is in the way, and the legislature needs to act to remove regulatory barriers which prevent APNs from fully practicing to meet the needs of the public.