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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.


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.

Remembering the Simple Truths June 19, 2007

Posted by manthey in Creative Health Care Management, Values.
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John Nelson — nurse researcher, president of Healthcare Environments and CHCM adjunct faculty —  frequently shares data with us about the outcomes of our work with our clients. One hospital implementing Relationship-Based Care found that a richer skill mix decreased the dollars per Adjusted Patient Day, decreased ventilator-associated pneumonia and decreased patient falls with injury. John would hasten to add that this is a statistical correlation that does not indicate causality, but only a relationship between variables. I think the more we learn how to interpret and correctly discuss this kind of statistic, the better able we are to explain the importance of adequate staffing.

After the “reengineering” of nursing in the nineties (which had nothing to do with nursing, and everything to do with saving money), we lost sight of simple truths and replaced our authentic experience with “grids” which supposedly save money but which in reality wreak havoc with common sense.

Some truths we need to reclaim are:

  • Skill mix should be related to acuity not to a financial goal.
  • Changes in patient census should drive changes in total FTEs.
  • Continuity of assignment increases productivity (having the same patients two days in a row increase productivity by approximately 25%).
  • Use of support staff improves when delegation is based on trust. Working together builds trust, so pairing and partnering leads to the best use of NAs and LPNs.
  • Staff should only be pulled off their home unit when not to do so will have DIRE consequences. It should never be done just “balance the numbers”.
  • Morale of the staff determines quality of care. Morale is a function of how staff members treat each other.

Introducing Relationship-based Care is an excellent way to re-introduce these simple truths and return our profession to “common sense management”.

Conversations with Ourselves August 29, 2006

Posted by manthey in Creative Health Care Management, Leadership, Nursing Salons.
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When I first posted about the overwhelming response to my blog, I left off the comments emailed me by Gary Saltus, a physician colleague. Gary specializes in helping  groups through transformational change and is working with CHCM create a program to build Physician/Nurse relationships.

It’s a shame I left Gary’s comments out because they are so vital to this discussion.

Here are the highlights of Gary’s email, followed by my original response (again):

I enjoy and appreciate your constant journey of discovering more and more in nursing and health care. I keep coming back to your primary statement of talking to the different people in health care because it’s something you want to do. I imagine this is your purpose in life at this time –your constant search for discovery, wherever it takes you. I imagine this is the lens you use to see the world: How do we do health care better?

I agree with you about the importance of conversation, but I look at it through my lens of transitioning with individuals, teams, groups, and organizations.

The challenge as I see it is to get the people involved to have these conversations with themselves first, to learn who they are and what their purpose/vision is. They need this self-knowledge so they have the self-permission to present who they are to the interpersonal environment (another individual, team, and group) with confidence.

Before the individual, team, group or organization can tackle the difficult and major issues that you present in you blog, they must go through orientation, differentiation with resultant cohesion conversation with each other first. These are the stages of maturation according to John Cater, PhD at the Gestalt Center for Organization & Systems Development. They also must go through these stages in three phases. Assimilation, differentiation, and manipulation. Each phase brings the system closer with the common denominator being trust. This process is how I facilitate working with groups. So the bottom line is we can’t start tackling the big issues until the system has matured. The dilemma is that organizations don’t think they have the time to let the Nurses/Physicians/Administrators do this group work.

I admire your passion and drive to facilitate change in the Nursing/Health Care arena. Our passions are in attunement. Thanks for including me in your thoughts. I look forward to talking to you in the future about our passions and shared visions.

Gary, thanks so much for your thoughtful and insightful comments. I don’t have the grasp on gestalt that you do…but I definitely get the “gist” of what you are saying. I agree that the transformation has to start with the individual, and then move to groups and teams and that the employing institutions do not yet see the benefit of this kind of staff development.

Throughout my career I’ve been fascinated by how attitudes/behaviors of employees change as institutional and leader values change. I’ve seen so many dramatic changes (both positive and negative) in the lives of patients and nurses that I feel compelled to continue working with these issues. The issue of no time to engage in these discussions is really daunting. Also, the separation between professional cultures has erected many barriers to communication I am beginning to see coming down. Another thing that I find very interesting is that the barriers between nurse educators and practice nurses are also beginning to crack. Real light is beginning to shine through. One of the ways I get to see this is thru the monthly Nursing Salons which I have been doing at my home for the past five years. Attendees vary according to the email lists interests in coming on that evening. It is sort of a blend of the Open Space technology and Socrates Cafe conversation format. I have so enjoyed seeing nurse educators and nurse managers, staff nurses, alternative therapy nurses, public health nurses, etc all sitting around talking about some issue or another in nursing. A retired physician comes whenever he can. And you are right…..it really is about improving Health Care.

Building Professionalism: Trust and Risk Taking August 14, 2006

Posted by manthey in Creative Health Care Management, Leadership, Professional Practice.
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M. B., a nurse from Alberta emailed me with some comments about professionalism:

I highly value the principles of professionalism but find in some workplaces and amongst some nursing colleagues that this has varying connotations and meanings. I have put this question to various professionals in health care and some exclaim that it does not truly exist. The more I search I have come to realize that professionalism in an institution is largely dependent on leadership’s belief and value of professionalism.

The extent of the leadership’s belief is reflected in how professionalism is exercised and maintained in culture of that work environment. If this belief is low, then any kind of behavior is acceptable in that work environment. If it is high, then that the culture will be of mutual respect and high trust. This indeed would be the ideal workplace but I am afraid I have been exposed to both in my life time career, thus far. The first is “hell”, the second is “heaven”.

I was very confused about the meaning of “professionalism” for a long time as well. Then I was taught about the definition used by sociologists, particularly the professionals use of autonomous decision making. I think our lack of clarity about what decisions we can rightly make (despite the clarity of language in the license) leads to the ambiguity that exists at all levels

So, first of all, there is the matter of professional practice. And then the matter of professional behavior. I find it useful to concentrate on the first: professional practice. This is where, as my friend from Alberta notes, leadership is critical. If the CEO, COO, CNO, CFO — the top leaders of the hospital — do not accept the notion that nursing is a profession with decision-making authority, they will not trust nurses.

This lack of trust creates a workplace environment that is antithetical to the normal risk-taking of decision-making. This lack of trust in employees sets up structures and behaviors that result in negative interpersonal relations. Nevertheless, I have seen many examples of creative and courageous leaders (below the level of the “Os”) who have been able to create healthy unit or departmental level cultures in spite of a lack of support from the highest level.

I know these statements are a simplification of highly complex factors, but trust is one of the major reasons some hospitals are heaven for employees, while others are hell. Couldn’t agree more. Like many of us, M. B. is looking for ways to build up professional nursing:

I am looking for more tools, any works that are currently out there to share with others to move nursing in this direction.

Creative Health Care Management has some 3-day programs that can transform nurses and their practice. One is called Leading an Empowered Organization and is for unit and departmental leaders and managers.  The other two are Leadership at the Point of Care and Reigniting the Spirit of Caring, both for clinical care-givers. All three are set up so we can ‘train-the trainers’ and license the programs for use by associations, large systems, and individual hospitals

M. B. speaks for so many of us when she ends with:

I believe nursing is an honored and privileged profession/family to belong to.