tag:blogger.com,1999:blog-30007508206726332262024-02-18T22:23:16.669-08:00Novice to ExpertThis blog describes the nursing and leadership challenges from the staff nurse/nurse manager perspective. Composed of daily nursing practice insights and Ah-ha! moments, it also provides perspectives derived from other disciplines such as business, communication, sociology, and adult education.Mary Khttp://www.blogger.com/profile/14750610946925410261noreply@blogger.comBlogger51125tag:blogger.com,1999:blog-3000750820672633226.post-5179780448775521442020-02-06T18:07:00.000-08:002020-02-06T18:07:49.907-08:00Never Say in an Email What You Can Say in Person------and if you resort to email, don't hit the send button until you have thoroughly vetted your response.<br />
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I was included in a recent email string concerning recognition and awards.<br />
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Apparently, the Department Head (DH) send an email to the LPO requesting status of two awards (I did not receive the initial inquiry). This is the email discussion:<br />
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LPO: "The best we can do for Seaman X is an LOA, as for Petty Officer Y he was supposed to turn his brag sheet into me last week, I guess he did not feel it was that important. So now he has until this Friday to turn it in. v/r HM2(SW) <br />
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DH: "It is not for Petty Officer Y to turn in a brag sheet for an award. It is for you to gather his evals (he can help with this) and for you to write it up. Remember, awards are supposed to be surprises!!"<br /><br />I was sorely vexed with LPO's response. Since I was tasked with updating the status on Petty Officer Z in the same message, I asked LPO about the status. "It's on the board convener's desk." Then I asked him why he told the DH that Petty Officer Y didn't care.<br />
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"I didn't write that," he protested. "I was just thinking about it."<br />
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"Let me show you," I suggested. I read verbatim his email and he put his hand to his mouth. Finally, he said, "I am sincerely sorry. That is inexcusable."<br />
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<br />Mary Khttp://www.blogger.com/profile/14750610946925410261noreply@blogger.com0tag:blogger.com,1999:blog-3000750820672633226.post-14318515314934749682015-01-18T16:30:00.001-08:002015-01-18T16:30:45.038-08:00Homeowner Associations and Dysfunctional Leadership<span style="font-family: DanteMTPro; font-size: small;"><span style="font-family: DanteMTPro; font-size: small;"><table cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh-8YP7HC12fAOhWg9fJDxPgzUBGYTtuJgUhovPFWkP3izU-H-JB8AqHtUNAuBk_wLC8nXmN4Du_sZs3HPQ4mEi8UeET7ybYzcgt08920llp6poxL3u0LBowFwcBPTx59gDlpR9cLdnJnU/s1600/beliefs+-+behaviors.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh-8YP7HC12fAOhWg9fJDxPgzUBGYTtuJgUhovPFWkP3izU-H-JB8AqHtUNAuBk_wLC8nXmN4Du_sZs3HPQ4mEi8UeET7ybYzcgt08920llp6poxL3u0LBowFwcBPTx59gDlpR9cLdnJnU/s1600/beliefs+-+behaviors.jpg" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Without civic intelligence we are the sum of all our worst characteristics.</td></tr>
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When we moved to our neighborhood, I thought it would be important to participate in our <a href="http://en.wikipedia.org/wiki/Homeowner_association" target="_blank">homeowners association</a> (HOA). My spouse thought it was stupid. Because there are no real checks and balances on HOAs (usually due to an unengaged residential community) and there is no collective overarching belief in community (everyone is out for him/herself), personality conflicts are inevitable. <br />
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My HOA board is dysfunctional. I spent the last 15 minutes of the closed session listening to the president, the treasurer, and a member at large complain about and disparage each other. I missed the last meeting because I had a work conflict, but apparently this complaint session was a continuation of the last meeting. Three meetings ago, one of the HOA board members resigned, rather than work with another member of the board. I feel like I'm back in junior high school. If I didn't maintain the HOA website and chair the Social Committee, I might be inclined to pack it in, too. Especially since the meetings occur on the first Thursday of the month, which means I'm missing out on more fun activities to do (<a href="http://www.phillipscollection.org/events/phillips-after-5" target="_blank">Phillips After 5</a>, <a href="http://www.asgnova.org/ASG_NoVA/Sew_Related_Links.html" target="_blank">NoVA ASG Neighborhood Couture Group, </a>watching <a href="http://www.diynetwork.com/rehab-addict/show/index.html" target="_blank">Rehab Addict</a>). In fact, <strong>ANYTHING</strong> is more fun than doing HOA board activities.<br />
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This article from the New York Times, "<a href="http://www.nytimes.com/2015/01/18/opinion/sunday/why-some-teams-are-smarter-than-others.html" target="_blank">Why Some Teams are Smarter Than Others</a>," states that productive groups have good social sensitivity, take conversational turns and share the conversation equitably, and have female members. I can only surmise that, despite having a predominantly female board, we lack <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0115212" target="_blank">social awareness and emotional intelligence</a>. In a town full of former student council presidents, we have some serious power struggles. <br />
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When I was first elected to the board, I immediately researched what my role should be. I found the <a href="http://www.caionline.org/Pages/Default.aspx" target="_blank">Community Associations Institute</a> and used their materials to draft my impressions of what our web site and social committee should be. The board didn't provide me with any guidance on developing a charter, soliciting members, or giving me a budget. None of them has made an investment in their education on the board (like becoming a member of the CAI), or having guest speakers at the HOA board meetings. The president does not send out an agenda in advance, and the meeting minutes are inadequate: there is no assignment of responsibility and no due-outs. I understand everyone is a volunteer; it's just hard to accept. Maybe they're operating at the higher end of their potential, and I'm being unduly harsh. <br />
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The president believes that training offered by the HOA lawyer will clear up some of the problems, but I know it won't. The only thing that will fix this HOA is some mental health sessions. </span></span>Mary Khttp://www.blogger.com/profile/14750610946925410261noreply@blogger.com0tag:blogger.com,1999:blog-3000750820672633226.post-66029470324889080742014-10-29T18:10:00.000-07:002014-10-29T18:10:22.035-07:00Providing Effective FeedbackHBR recently reviewed best evidence for delivering feedback and they recommend against the sandwich" approach. It risks diluting the primary message and allows the person being counseled to focus on other things (as evidenced by the response from the example to "focus on the incompetent staff on the unit").<br />
<a href="http://blogs.hbr.org/2014/06/everything-you-need-to-know-about-negative-feedback/">http://blogs.hbr.org/2014/06/everything-you-need-to-know-about-negative-feedback/</a><br />
<br />I am a big believer in rehearsing prior to meeting. There are definitely some things you do not want to say and phrases you want to avoid because they can be explosive or derail the discussion. <br />
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I also believe that "Crucial Conversations" has good advice (from their newsletter "Vitalsmarts") when they recommend "getting your heart right" and addressing the mutual purpose with mutual respect. I think this letter on creating a safe environment for discussion (from the employee's perspective) is appropriate for both the employee and the supervisor. <br />
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<a href="http://www.crucialskills.com/2014/03/how-to-make-it-safe-for-you/">http://www.crucialskills.com/2014/03/how-to-make-it-safe-for-you/</a><br />
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<a href="http://www.emergingrnleader.com/feedback-fails-2">http://www.emergingrnleader.com/feedback-fails-2</a><br />
<br />Mary Khttp://www.blogger.com/profile/14750610946925410261noreply@blogger.com0tag:blogger.com,1999:blog-3000750820672633226.post-50046026676343312442013-02-24T10:58:00.001-08:002013-02-24T10:58:44.037-08:00Think Sexual Victimization is Not a Leadership Issue? Think Again.The fallout from sexual victimization does not only affect the persons being victimized. From an article published in the November 2012 issue <a href="http://jiv.sagepub.com/" target="_blank">Journal of Interpersonal Violence</a>, researchers examined the extent of unwanted sexual attention, sexual harassment, unwanted sexual contact, sexual coercion, and rape within the last academic year and their effects on cadets' and midshipmen's perceptions of their leadership's morality and intolerance for sexual victimization.<br />
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They found those military cadets who were sexually victimized had significantly more negative views of their leadership's morality and intolerance for sexual victimization than nonvictims. That's not surprising. Unfortunately, it means that these military members continue their progression in their military careers, but the feelings and experiences forever affect their interactions with others and flavor their responses to situations they encounter in the military, not always for good. <br />
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Leaders have an obligation to ensure the safety and well-being of their subordinates. This includes establishing a climate that does not condone these behaviors and that actively works to eliminate or, if possible, to rehabilitate members who display these behaviors. It also means providing emotional and moral support to the victims.<br />
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When all is said and done, it happened on your watch. <br />
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<a href="http://www.ncbi.nlm.nih.gov/pubmed/2258112">http://www.ncbi.nlm.nih.gov/pubmed/2258112</a>Mary Khttp://www.blogger.com/profile/14750610946925410261noreply@blogger.com0tag:blogger.com,1999:blog-3000750820672633226.post-79501200043790079012013-02-24T10:56:00.001-08:002013-02-24T10:59:19.165-08:00Overcoming Perceptions in the Emergency Department<a href="http://www.blogger.com/%3Cscript%20src=%22http://player.ooyala.com/player.js?embedCode=15bDN4NToNZhu9eIbwPjMKTzdImWVtZz&playerBrandingId=&width=960&height=540"></script>" target="_blank"><script src="http://player.ooyala.com/player.js?embedCode=15bDN4NToNZhu9eIbwPjMKTzdImWVtZz&playerBrandingId=&width=960&height=540"></script></a>I work as a <a href="http://www.ena.org/IQSIP/Practice/NursePractitioner/Documents/CNSCompetencies.pdf" target="_blank">Clinical Nurse Specialist</a> in a community hospital emergency department. My most recent challenge has been ensuring we correct documentation problems on moderate sedation performed in the emergency department that were found as part of our annual <a href="http://www.jointcommission.org/" target="_blank">Joint Commission</a> self-survey.<br />
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Only one out of four procedures were documented thoroughly and accurately. Do I think we are taking short-cuts and harming patients? No. What I do think we're not doing isdue diligence in documenting the work we do and, if something bad were to happen, we have no way of proving before a jury that the work was performed to standard.<br />
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The problem is, the ER nurses don't see it that way and I am stymied in how to change this perception. Their first complaint was that the GI docs bring their patients down to do procedures at the end of their clinic day. "These aren't emergencies!" the nurses cry. They don't understand that these patients may not be emergencies, but these cases are urgent in that they drive the next diagnostic decision for that patient. They also don't understand budget constraints. <br />
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"If they keep their nurses past their standard working hours, they incur overtime which affects their budget. If there is somewhere else in the hospital that these procedures can be done without incurring overtime, doesn't it make sense to do the procedure there?" That just turned the conversation into complaints about how the ER nurses are dumped on and the hospital takes advantage of them.<br />
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I tried the approach that the nurse who is administering the sedation needs to "know" the patient and the best means of doing this was through documentation of the pre-sedation exam. "That's the physician's role," they asserted. <br />
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"You're right. It IS the physician's role," I agreed, "and there is nothing that says you can't ask the questions and review the patient's answers with the physician, especially if he or she is busy setting up. If the physician has completed the pre-sedation paperwork, there is nothing that says you can't review it and tell the physician, 'Hey, you missed a spot over here.'" I am so frustrated that they can't see this is a teamwork and patient safety issue. <br />
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I spoke with my ED nurse manager and she doesn't know how to change this. This moderate sedation problem is just the tip of the iceberg in this department. It's like watching toddlers---everyone LOOKS like they're functioning as a team, but they're not. It's all <a href="http://en.wikipedia.org/wiki/Parallel_play" target="_blank">parallel play</a>: the techs are doing their own thing, the nurses are doing their own thing, and the physicians are doing their own thing. In the meantime, patients spend much more time in the ED than they need to, the physicians are not meeting benchmarks, and the nurses station looks like the Cantina in Star Wars. <br />
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The unfortunate thing is, I think I know how to fix this, but I only have the consultant role in this department. I've asked about the <a href="http://www.annemergmed.com/article/S0196-0644(09)00531-9/abstract" target="_blank">operationalized</a> <a href="http://www.nypsystem.org/pdf/Nyack_30_Minute_Service_Standard.pdf" target="_blank">efficiency</a> of an emergency department that sees patients within 30 minutes and I've been shut down. I've enquired about starting<a href="http://www.jenonline.org/article/S0099-1767(11)00482-X/abstract" target="_blank"> hourly rounding</a>, <a href="http://psnet.ahrq.gov/resource.aspx?resourceID=18761" target="_blank">bedside shift report</a>, and <a href="http://www.leanhealthcareexchange.com/?p=1126" target="_blank">bedside triage</a> when census is low and I encounter extreme resistance from everyone, including the director. Mary Khttp://www.blogger.com/profile/14750610946925410261noreply@blogger.com0tag:blogger.com,1999:blog-3000750820672633226.post-67549527210331776862012-10-27T05:43:00.003-07:002012-10-27T06:38:46.129-07:00CPR Makes You UndeadI'm always on the lookout for information or videos that will add to my credibility as an instructor or encourage learners to retain information. I think this video on Bystander CPR is outstanding, one of the most imaginative and visually stunning videos I've seen. Let me know if you think the same!<br />
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Mary Khttp://www.blogger.com/profile/14750610946925410261noreply@blogger.com0tag:blogger.com,1999:blog-3000750820672633226.post-21435329535293864482012-07-10T09:49:00.000-07:002012-07-10T09:49:07.150-07:00Assisted Living Article in Health Affairs Provides Direction for Future<div class="separator" style="clear: both; text-align: left;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhs1_BRaB1ISvb8xuzhPXAffeev9s8oJ3pwpnTYLNn_HZZnsmqi20EMiZlf-of-tkIoe3cTafgCfSuiFiDxRIJePo7Yc6ihJbQTNj6AxChFpdjxLt8fL0u8VyX25t2MFcW8PPwEebtpJF8/s1600/empty+wheelchair.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"></a></div>
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhs1_BRaB1ISvb8xuzhPXAffeev9s8oJ3pwpnTYLNn_HZZnsmqi20EMiZlf-of-tkIoe3cTafgCfSuiFiDxRIJePo7Yc6ihJbQTNj6AxChFpdjxLt8fL0u8VyX25t2MFcW8PPwEebtpJF8/s1600/empty+wheelchair.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="255" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhs1_BRaB1ISvb8xuzhPXAffeev9s8oJ3pwpnTYLNn_HZZnsmqi20EMiZlf-of-tkIoe3cTafgCfSuiFiDxRIJePo7Yc6ihJbQTNj6AxChFpdjxLt8fL0u8VyX25t2MFcW8PPwEebtpJF8/s320/empty+wheelchair.jpg" width="320" /></a>I thought this article published in <a href="http://content.healthaffairs.org/content/31/7/1633.full.pdf+html" target="_blank">Health Affairs</a> was incredibly poignant. The stories, or cases, the author, Martin Bayne, presents are heartbreaking. The one that affected me most was the librarian who told him she didn't want to die alone; would he stay with her that night?<br />
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In a culture that worships youth, we've forgotten the wisdom our elders have to pass on to us and we've made disrespectful choices in managing our journey of aging.</div>
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Bayne writes, </div>
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"To create guine long-term care reform, we as a nation need to perform a series of activities. We must understand the full nature and scope of the problem, including knowing the benefits that are and aren't available under skilled, custodial, and intermediate long-term care. We have to acknowledge the full range of policy options that exist and create a workable way to finance care using a mix of public- and private-sector support. People will also have to acknowledge their personal responsibility for leading purposeful lives, a part of which means considering the costs of long-term care and planning ahead for how to pay for them. In short, we must all be held accountable for ourselves and for the whole."</blockquote>
<strong><em> Everything is at stake.</em></strong> If you want to read more, check out his literary journal: <a href="http://thefeatheredflounder.com/">http://thefeatheredflounder.com/</a><br />Mary Khttp://www.blogger.com/profile/14750610946925410261noreply@blogger.com0tag:blogger.com,1999:blog-3000750820672633226.post-18849542091675523282011-03-25T17:26:00.000-07:002011-03-25T17:53:18.741-07:00Developing a Courageous Workplace<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgsTeLfd9bxMnpspFIyg11wIZb434UIL0vvDG5Cu9I8oRi_fl70AycMTW5LSGcjaN7PL6PKin9CbpHhqQqIqrAOsDOFVg6UKqvs8fnmvffMYp1B_db4hBKABGcCs9HdaW4vahwChClPXPI/s1600/courage.jpg"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 320px; height: 213px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgsTeLfd9bxMnpspFIyg11wIZb434UIL0vvDG5Cu9I8oRi_fl70AycMTW5LSGcjaN7PL6PKin9CbpHhqQqIqrAOsDOFVg6UKqvs8fnmvffMYp1B_db4hBKABGcCs9HdaW4vahwChClPXPI/s320/courage.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5588185312815208242" /></a><br />I am inheriting a dysfunctional clinic. One nurse is creating a hostile work environment and another nurse has resorted to communicating only by email to this nurse so she can limit her interactions. A clerk has "borrowed" over $1000 from her co-workers over the past year and HR says nothing can be done, that these "loans" could be considered "donations." I get ownership in May, but I am already pondering solutions.<br /><br />I thought this article on <a href="http://www.ccl.org/leadership/enewsletter/2011/MARwheres.aspx?sp_rid=NOT_SET&sp_mid=36418771">workplace courage</a> from the Center for Creative Leadership might provide some ideas for action. <br /><br />According to the article, people in a courageous workplace:<br /><blockquote>•Take on more challenging or complex projects.<br />•Actively seek out tasks that stretch their skills. <br />•Speak up more frequently, forcefully and truthfully.<br />•Be less risk-averse, less self-conscious and less apathetic.<br />•Do less brownnosing and complaining. <br />•Get more work done.</blockquote><br />That sounds good to me. A hostile work environment can cost a lot of money in recruitment and retention and lost productivity. So, one of the options I proposed to the current leader was the development of a code of conduct by the staff. I also proposed requesting a mediator from HR interview and evaluate the interactions of these workers for an unbiased opinion. Coming from a high-functioning unit and feeling quite competent, this clinic will provide quite the turn-around challenge. <br /><br />Am I feeling courageous?Mary Khttp://www.blogger.com/profile/14750610946925410261noreply@blogger.com0tag:blogger.com,1999:blog-3000750820672633226.post-10323951568319621672011-03-08T05:21:00.000-08:002011-03-08T05:25:03.211-08:00Enchantment<a href="http://www.guykawasaki.com/enchantment/landing/" target="_blank"><img alt="Enchantment by Guy Kawasaki" src="http://files.guykawasaki.com/enchantment/badges/enchantment-sam-a-125x125-01.jpg" /></a>Well, it's official. I took the <a href="http://great.guykawasaki.com/">quiz</a> and I scored very well. I am certified enchanting.Mary Khttp://www.blogger.com/profile/14750610946925410261noreply@blogger.com0tag:blogger.com,1999:blog-3000750820672633226.post-78355940045572702722011-02-21T22:14:00.000-08:002011-02-21T22:24:52.382-08:00The Last Five Minutes of the DayWith the increasing workload, I would come in to work and be overwhelmed with the areas and issues that needed my attention. So, I started doing a to-do list at the end of the workday. That worked pretty well, except I had items that were left undone and carried over to the next day for extended periods of time. Taking a good hard look at this meant acknowledging that either 1) the task was not that important (to allow it to lie undone for so long) or 2) it was too huge to process. I had to break big tasks down into manageable steps I could actually demonstrate to my fearful self that the big project could be done.<br /><br />I recently found another way to better use those last few minutes of the workday from the <a href="http://blogs.hbr.org/bregman/2011/01/the-best-way-to-use-the-last-f.html">Harvard Business Review Blog</a>:<br /><br />Every day, before leaving the office, save a few minutes to think about what just happened. Look at your calendar and compare what actually happened—the meetings you attended, the work you got done, the conversations you had, the people with whom you interacted, even the breaks you took—with your plan for what you wanted to have happen. Then ask yourself three sets of questions:<br /><br /><blockquote>•How did the day go? What success did I experience? What challenges did I endure?<br />•What did I learn today? About myself? About others? What do I plan to do—differently or the same—tomorrow?<br />•Who did I interact with? Anyone I need to update? Thank? Ask a question? Share feedback?</blockquote><br /><br />This is a pretty good tool for prioritizing the next day's tasks as well as for growing and maintaining relationships.Mary Khttp://www.blogger.com/profile/14750610946925410261noreply@blogger.com0tag:blogger.com,1999:blog-3000750820672633226.post-55252925679937174772010-11-23T08:44:00.000-08:002010-11-23T09:43:13.091-08:00Apologies can be unsatisfying<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKu-oXAKIE7o8KdyL1EkR68FX1qQdXjprW_R7Pb_3B1XpU1rn-GXCTyGwmSABQUQ2tvdp1faXOQlatWUUXEPIT9i_9eEqRwHY4D7AoqvOrgjo8HXr_JuSGvFPNl4SwgiWqWa5ZihocsNc/s1600/formal-apology.jpg"><img style="MARGIN: 0px 10px 10px 0px; WIDTH: 320px; FLOAT: left; HEIGHT: 239px; CURSOR: hand" id="BLOGGER_PHOTO_ID_5542793350893161714" border="0" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKu-oXAKIE7o8KdyL1EkR68FX1qQdXjprW_R7Pb_3B1XpU1rn-GXCTyGwmSABQUQ2tvdp1faXOQlatWUUXEPIT9i_9eEqRwHY4D7AoqvOrgjo8HXr_JuSGvFPNl4SwgiWqWa5ZihocsNc/s320/formal-apology.jpg" /></a><br /><div>My boss came to me yesterday afternoon and asked how the morning had gone. Then he held out customer service card where one of my colleagues in another department had written a negative response about me. </div><br /><div></div><br /><div>Frustrated with what I perceived to be this person's inability to solve the problem, I grabbed the patient's ID out of his hand so I could pull up the online records. I immediately knew this was a mistake, but I didn't apologize. I wish I had. Instead, I softened everything from that point on, explaining everything I was doing and trying to be as helpful as I could be, hoping this person would see the grabbing as an anomaly. </div><br /><div></div><div>He didn't.</div><br /><div></div><div>So I told the boss I planned to apologize to this person.</div><div></div><br /><div>Today, after the mad rush, I stopped by the lab. The technician immediately recognized me and ushered me into an office. It wasn't what I expected. I had actually planned to apologize in front of others so they would know I respected this person and that I was acknowledging my role in behaving badly. But, this must have been what he wanted and needed.</div><br /><div></div><div>I told him <a href="http://www.billosophy.com/2010/03/10-rules-for-an-apology/">I was sorry</a>. I shouldn't have done what I did and I wouldn't do it again. </div><br /><div></div><div>I asked him why he had submitted the comment card instead of talking to me. He said, "I wanted to bring it to your attention. I wanted to make sure you weren't treating your junior sailors this way."</div><br /><div></div><div>I then asked him why he didn't call me on my behavior at the time. "I recognize there is a difference in rank," I told him, "but if you were justified, as both of us know, then what was the point of not calling me on it there in front of those junior sailors? Wouldn't that have been a more powerful example of how to role model behaviors for those sailors?" Truth should be able to speak to power.</div><br /><div></div><div>He didn't seem to understand what I was trying to say. "Would you like me to do anything else? Do you need anything else from me?" I asked. It didn't seem nearly enough. Perhaps the apology and my presence were all he wanted and that would suffice, but for me, it was very unsatisfying.</div><br /><div></div><div>I talked to my boss this afternoon and told him I apologized to the lab technician. I also explained that it didn't help me; I knew I was wrong, but the apology didn't meet MY needs. I didn't know if it was the inequality in status or the cultural differences, but I needed something more. </div><div></div><br /><div>I have a problem with trying to speed things up and can adopt a tone of voice that irritates people or suggests condescension. I suggested to my boss that perhaps I could ask my colleagues to help me identify when I'm getting to close to the edge by using some code word to help me step back from the situation and regain control of my feelings and actions. </div><br /><div></div><div>"It could be helpful," he acknowledged. "That's the principle behind <a href="http://en.wikipedia.org/wiki/360-degree_feedback">360 degree evaluations</a>." But he left it up to me to broach the topic with my subordinates. So that's my plan for tomorrow as I begin my trek toward a more <a href="http://www.umassmed.edu/cfm/leadership/index.aspx">mindful workplace</a>. </div>Mary Khttp://www.blogger.com/profile/14750610946925410261noreply@blogger.com1tag:blogger.com,1999:blog-3000750820672633226.post-73239443159866621152010-09-22T03:02:00.001-07:002010-09-22T03:02:37.629-07:00Leadership Tied to Maturity and ReceptivenessSo I spent my lunch hour composing an email response loaded with what I thought were leadership newsletters, books, and articles, along with the observation I was not a great leader. I also stated I did not have to be the expert; I only needed to know who was and to let him or her shine. I read it through several times to make sure there were no errors, that nothing could be miscontrued or misunderstood, and sent it off, full of hope that everything would be made as new as I wrote in one sentence: a clean slate to start again. <br /><br />I sent the email at 1244. I received a response at 1250. Six minutes. And the response? Ma'am,<br />Noted. Thank you for your time.<br /><br />In my mid-to-late 20's, I might have had my own image tied into what and how I wanted to be perceived by others. Maybe I would have responded with the same speediness, the same acerbity, the lack of depth and gratitude. And maybe that's my error---in thinking she would be grateful. <br /><br />Well, maybe someday she will be. I can hope.Mary Khttp://www.blogger.com/profile/14750610946925410261noreply@blogger.com0tag:blogger.com,1999:blog-3000750820672633226.post-24238520351953358882010-06-17T14:41:00.000-07:002010-06-17T15:36:59.731-07:00A Little Like Dying<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgdKZpv6FcRsQvHpNvGMWC0P9ll2X_wWH8G_1JJZBsfa7_OWfRmCxVHUhzcQAqSN-KvL4-CSD4datwnuJ6Ja61PxC4gy9-FjPj52uCZC0n7HjW7_d3Vo53sxPUpsjgleRaHpNEFmBa_jiA/s1600/deployment.png"><img style="MARGIN: 0px 10px 10px 0px; WIDTH: 230px; FLOAT: left; HEIGHT: 320px; CURSOR: hand" id="BLOGGER_PHOTO_ID_5483874711999940370" border="0" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgdKZpv6FcRsQvHpNvGMWC0P9ll2X_wWH8G_1JJZBsfa7_OWfRmCxVHUhzcQAqSN-KvL4-CSD4datwnuJ6Ja61PxC4gy9-FjPj52uCZC0n7HjW7_d3Vo53sxPUpsjgleRaHpNEFmBa_jiA/s320/deployment.png" /></a> I've known for a few months now I will be deploying. Pretty much in denial for the first few months, I was able to tolerate this and, because of the chaos and uproar at work, almost welcomed the respite from the <a href="http://en.wikipedia.org/wiki/Beltway">Beltway</a> drama and politics. <div><br /><div></div><div>That changed as I got my <a href="http://www.anthrax.osd.mil/">anthrax shot </a>(which laid me low) and I avoided a <a href="http://www.smallpox.mil/">smallpox vaccination </a>because of some mysterious dermatitis on my collarbone. All of a sudden I have less than 28 days left on this side of the world, no childcare plan in place yet, and overwhelming grief that I have not been able to accomplish all I set out to do in my assignment as the department head of surgical nursing.</div><div></div><br /><div>In leaving for the unknown with hopes of returning, I understand my grief is due to changes beyond my control. I won't be returning to this same position. I can't; someone else will have stepped in to take the helm. So what will I do when I come back? Will it be as challenging? Will I like it? Will it be---dare I say--fun?</div><div></div><br /><div>I've been keeping in touch with one of my <a href="http://en.wikipedia.org/wiki/Lieutenant_(junior_grade)">JG</a>'s in <a href="http://en.wikipedia.org/wiki/Kandahar">Kandahar</a> who has excelled and is over half-way through her deployment. "What do you want to do when you get back?" I asked, hoping she would want to stay and provide leadership and expertise on the unit. </div><br /><div></div><div>"I'd like to go to the APU or PACU," she wrote. "I've been working on the wards and assisting with trauma, which can be rewarding but draining. I'd like a break." </div><br /><div></div><div>So, I asked her if she'd considered becoming an <a href="http://www.nursesource.org/perioperative.html">OR nurse</a>; would she have time to shadow a nurse there? She'd have the opportunity to provide attention to detail, work as a team, and monitor patient safety. "It provides some distance from the patient," I suggest.</div><div></div><br /><div>As an <a href="https://www.nffsp.org/skins/nffsp/display.aspx?ModuleID=8cde2e88-3052-448c-893d-d0b4b14b31c4&CategoryID=f4882b19-3c99-499e-96fd-645dc0415541&ObjectID=bc6223b6-f8ec-40c1-99b0-529d34c6aaae">Individual Augmentee (IA)</a>, I am plucked from my workplace and sent alone (mostly) to meet up with other individuals to form a tribe of providers to do a job far away from our families and support networks.</div><br /><div></div><div>I've had lots of people ask me over the past two weeks: Are you okay? </div><br /><div></div><div>"Yes," I say. "I think so." </div><div> </div></div>Mary Khttp://www.blogger.com/profile/14750610946925410261noreply@blogger.com0tag:blogger.com,1999:blog-3000750820672633226.post-90045435829841361602009-07-20T23:07:00.000-07:002009-07-20T23:19:28.711-07:00Sparta Humor Very Similar to Healthcare Humor<a href="http://zenpundit.com/?p=3161">The Spartan Sense of Humor by Steven Pressfield </a>is very similar to that found in First Responders and Healthcare Workers. I love what he writes:<br /><blockquote>["T]hey’re not jokes. They’re not meant just to raise a laugh. Yet they’re funny, they’re on-point. Second, they don’t solve the problem. Neither remark offers hope or promises a happy ending. They’re not inspirational. They don’t point to glory or triumph–or seek to allay their comrades’ anxiety by holding out the prospect of some rosy future outcome. They face reality. They say, “Some heavy shit is coming down, brothers, and we’re going to go through it.”</blockquote><br /><br />That could be said about a lot of workplaces right now...Mary Khttp://www.blogger.com/profile/14750610946925410261noreply@blogger.com0tag:blogger.com,1999:blog-3000750820672633226.post-65927333525837678812009-07-15T21:56:00.000-07:002009-07-16T00:37:21.120-07:00Use Your Peripheral Brain<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEji5svv8RUV5s8nS4jQNeQfalCDDRs9PXBbFqdacczuEyFv4Wlj_-qoXlspTSJxzC1qpmvYoZKEMPxfkkcFkW9Ku37ZGaKik-fIZt1yp2t_xAgGFWtEAdzzv0zftX81xyqHvxGXAxItdk0/s1600-h/exposed+brains.jpg"><img style="MARGIN: 0px 10px 10px 0px; WIDTH: 213px; FLOAT: left; HEIGHT: 320px; CURSOR: hand" id="BLOGGER_PHOTO_ID_5358958794213490690" border="0" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEji5svv8RUV5s8nS4jQNeQfalCDDRs9PXBbFqdacczuEyFv4Wlj_-qoXlspTSJxzC1qpmvYoZKEMPxfkkcFkW9Ku37ZGaKik-fIZt1yp2t_xAgGFWtEAdzzv0zftX81xyqHvxGXAxItdk0/s320/exposed+brains.jpg" /></a><br /><div>Today was a Command Urinalysis. Usually, that's not a problem, just an inconvenience. However, my name was on the list, I had requested this morning off due to another appointment, and the instructions on the Command Urinalysis list stated that a memo attesting to the individual's unavailability for this random urinalysis was insufficient. Members needed to provide copies of special liberty chits, memorandums, and leave or TAD paperwork.<br /><br />Incredible. The one morning I am not at work, all bedlam breaks loose. The LPO, instead of requesting assistance from more experienced officers, directs his junior enlisted to generate a special lib chit for me and backdate it. Not a good idea. Besides, officers don't routinely route special request chits; they generally draft memos or letters requesting time off. The fact of the matter is, this wasn't an incident that would require written notification.<br /><br />So, my LPO decided his brain power was sufficient for responding to this situation. If he had been on "Who Wants to be a Millionaire," he probably would have lost his opportunity to win. <a href="http://www.steveshapiro.com/2009/07/08/crowdsourcing-millionaire-lifelines/">Steven Shapiro has a better answer </a>and one this LPO can employ now and for future emergenices.<br /><br />Typically, "Who Wants to be a Millionaire" allows you to use all your accumulated knowledge to answer questions of increasing difficulty and esoterica. You may finally get to a point where you can no longer weed out obvious distractors and have exhausted your personal information fount. That's where consulting others comes in handy.<br /><br />Phone-a-Friend only works if your friend is more knowledgeable than you. In the Navy, people who are consulted by others are usually <a href="http://www.urbandictionary.com/define.php?term=sea%20lawyer">Sea Lawyers</a>. That is not a popular moniker.<br /><br />In Fifty-Fifty, two of the answers are removed. However, if you have no answers or you know that the answers you do have are probably not right, this option doesn't help.<br /><br />Ask the Audience is a little better, but again, it relies too heavily on the knowledge of the crowd. As with 50-50, if you don't know your options or you know what you do have is not correct, asking your audience won't be helpful.<br /><br />Finally, Ask the Expert. This is what I told the LPO to do for future problems. For one thing, consulting with someone who has considerably more experience will provide a lot more viable options. Also, the expert will tend to have more rank and authority to take the heat or to run interference for him.<br /><br />In healthcare, many medical and nursing students have notecards, crib sheets, or <a href="http://www.amsa.org/tnp/articles/article.cfx?id=387">PDA</a>s to scribble the information they need at fingertip notice and they refer to these bits of data as their <a href="http://stanford.wellsphere.com/brain-health-article/relying-on-a-peripheral-brain/622403">peripheral brains</a>. In the business world, they call it networking---using people (and their collective knowledge) to find answers and get ahead.</div>Mary Khttp://www.blogger.com/profile/14750610946925410261noreply@blogger.com0tag:blogger.com,1999:blog-3000750820672633226.post-31775355593613248492009-05-22T17:53:00.000-07:002009-05-22T18:11:43.327-07:00Wind Mills and Flail ExercisesI have two months left and it is hard to summon the strength to continue to rail against waste and indifference. Six months from now it will be as though I never set foot here. And you know what? I have come to the conclusion that having the military run hospitals is stupid because we have a new Commanding Officer every two years and the status quo has to be shaken up, corporate knowledge must be lost, and politics must be endured, because no CO ever gets ahead by continuing to do what his or her predecessor has done (even if it is succeeding wildly---which has not been the case, unfortunately).<br /><br />I am aghast at the amount of corporate knowledge I have accumulated and the fact that I cannot possibly communicate all the information for one-of-one situations that have happened so someone else doesn't have to reinvent the wheel or undergo a flail exercise (FLAILEX). Quite frankly, I don't think I've truly amassed such founts of information so much as I've discovered my network of people who know or who know other people who know the information I need. The biggest problem with functioning where I am is being surrounded by people who feel they must know everything and if they don't know it, there is no one else who can possibly know what they need to know. It is silo-ization at its finest. [In 2002, Vicki Casey, program director of Information Highways, used the word "<a href="http://www.infotoday.com/it/may02/dykstra.htm">siloization</a>" to describe the smokestack-like structures that promote knowledge hoarding, rather than knowledge sharing and collaboration.]<br /><br /><u>Case Study</u><br />The LPO needed to get a bile bag (don't ask) from the OR. He called us in the endoscopy suite and said the OR tech didn't know what he was talking about. Instead of telling the OR tech, "Look, is there someone else I can talk to?," the LPO calls us. And instead of the OR tech being creative and helpful, he stops at the "Dude, I have no idea what you're talking about. End convo."<br /><br />The inability to think creatively is not limited to the enlisted ranks. I had another Division Officer approach me for information about wound care. I'm not an expert. I only read the labels (but I did sleep at a Holiday Inn Express last night). So I look through the Phone Book and call healthcare agency who accepts patients from our hospital. I ask to talk to someone about wound care. They transfer me to Sofia. Sofia walks me through the steps, I transcribe them, and I hunt down the products (unfortunately, we don't have a few, so I direct my Supply Petty Officer to order them). I give the instructions to the Division Officer, note the telephone number and name for her in case she has future questions, and make a mental note to bring my corpsmen up to speed on wound care supplies and information. It didn't take very long, maybe 15 minutes total, including a call to another hospital for their wound care specialist who wasn't due to work until later that afternoon.Mary Khttp://www.blogger.com/profile/14750610946925410261noreply@blogger.com0tag:blogger.com,1999:blog-3000750820672633226.post-70497107557510067702009-05-03T00:16:00.000-07:002009-05-03T02:09:34.593-07:00Overcoming Defensiveness Key to Better Workplace EnvironmentMy LPO was being counseled by the Senior Enlisted Leader (SEL) for our directorate.<br />"Your problem is you're too defens---" was all he was able to get out before the LPO interrupted, saying, "No, I'm not!"<br /><br />This occurred after he had already been brought in to my office to discuss progress on a self-improvement plan. In that discussion, the LPO could not get himself under control to stop talking, even after repeated and even rude requests to be quiet.<br /><br />After his discussion with the SEL, he came to me and said he recognized he had a problem. "So if you see me bringing my hand to my mouth," he said. "That's my way of slowing myself down so I don't interrupt or respond right away."<br /><br />I told him I was curious about when this defensiveness had started. "When I became a corpsman," he said. "People assume because I started out in another specialty, I don't have any medical knowledge." He pointed out several individuals, including the Department Head and a fellow surgical technician as culprits in minimizing his experiences and abilities. "Well," I said. "There are gaps in your knowledge and not everyone knows what they are. Isn't it better to assume you <em>don't</em> have an essential skill than to assume you do?"<br /><br />In any case, I doubt his defensiveness just started when he became a corpsman. <a href="http://www.icmrindia.org/free%20resources/articles/teambuilding6.htm">Argyris, a leader in adult education, believes defensiveness starts in childhood and is reinforced throughout life.</a> However, he is taking positive steps to correct this behavior. As <a href="http://www.businessknowhow.com/growth/defensive.htm">Jim Tamm</a>, author of <a href="http://www.amazon.com/gp/product/0060742518/ref=ase_thebusinessknowh?s=books&v=glance&n=283155&tagActionCode=thebusinessknowh">Radical Collaboration</a>, says, recognizing defensive behavior is the first step. <a href="http://www.nathancobb.com/">Dr Nathan Cobb</a>, a psychologist and marriage therapist in Calgary, has a very good workbook on overcoming defensiveness. Although "<a href="http://www.nathancobb.com/support-files/overcoming-defensiveness.pdf">How to Overcome Defensiveness</a>" is directed towards marriage, my LPO admitted that he adopted a defensive attitude at home, too.<br /><br />One of the important things I learned in our encounter that started this spiral was my own role. I <em>chose</em> to become angry when the LPO would not stop talking and, for that, I regret my responses. <a href="http://www.ridge.com/downloads/DestructDynamicsDefensive.pdf">Ridge Training's Overcoming the Destructive Dynamics of Defensiveness</a> could have helped me stop my inner Mr Hyde from erupting.<br /><br />The second step is acknowledging the emotions that come with the awareness of defensiveness. In this case, the tenets of yoga (breathing) and Buddhism (mindfulness) are invaluable. <a href="http://www.amazon.com/Miracle-Mindfulness-Thich-Nhat-Hanh/dp/0807012394/ref=sr_1_1?ie=UTF8&s=books&qid=1241339057&sr=1-1">The Miracle of Mindfulness</a> by Thich Nhat Hanh looks promising. The link from YouTube provides mindfulness using movement.<br /><object height="364" width="445"><param name="movie" value="http://www.youtube.com/v/oWerJwf3-3I&hl=en&fs=1&rel=0&color1=0x2b405b&color2=0x6b8ab6&border=1"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/oWerJwf3-3I&hl=en&fs=1&rel=0&color1=0x2b405b&color2=0x6b8ab6&border=1" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="445" height="364"></embed></object><br /><br />This website provides information on using <a href="http://www.hypnosisdownloads.com/learn_hypnosis.html">hypnosis</a> to overcome <a href="http://www.hypnosisdownloads.com/downloads/self_improvement/being-defensive.html">defensiveness</a>. I'll let you know how it goes.Mary Khttp://www.blogger.com/profile/14750610946925410261noreply@blogger.com0tag:blogger.com,1999:blog-3000750820672633226.post-27528182166415642162009-04-08T03:34:00.000-07:002020-02-06T17:48:03.023-08:00Supervision is a lost art...A guest article written by <a href="http://www.bizlearn.biz/">Michael Taplin </a>on <a href="http://www.slowleadership.org/blog/">Slow Leadership</a> really resonated with me. His article, "<a href="https://docs.google.com/document/d/1SSmdRmoPPAApTS4fs82raT_VyLyWy6OAYyvrCJJf2eo/edit?usp=sharing" target="_blank">The Lost Art of Supervision</a>," discusses how everyone has become a leader, but we've lost our supervisors, the ones who tower over us to teach us what we must do, to hold us accountable to our responsibilities, and to remind us of our moral code.<br />
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Super article—a must read for anyone who wonders where they fit into the current world.Mary Khttp://www.blogger.com/profile/14750610946925410261noreply@blogger.com0tag:blogger.com,1999:blog-3000750820672633226.post-4685542633623841612009-02-17T02:25:00.000-08:002009-02-17T02:53:04.575-08:00Mulligans Work in Healthcare, Too<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEibwesjlvSkWHn5Jn34GfkqVjhw-93xIxmdX_PT_qVxG43yyA7jFlJrQUUh8mn8-LVFdOeIu_ubnLPZYbHDA5RQ7DLf0GRb2sk0b9Ttk3fhgp-ximA3RrqCe5f8Kob1qgs1RmaZkQhCyic/s1600-h/redDressPin.jpg"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 200px; height: 262px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEibwesjlvSkWHn5Jn34GfkqVjhw-93xIxmdX_PT_qVxG43yyA7jFlJrQUUh8mn8-LVFdOeIu_ubnLPZYbHDA5RQ7DLf0GRb2sk0b9Ttk3fhgp-ximA3RrqCe5f8Kob1qgs1RmaZkQhCyic/s320/redDressPin.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5303717403485760818" /></a><br />Lony C. Castro, professor and chairwoman of the obstetrics and gynecology department at Western University of Health Sciences, <a href="http://www.latimes.com/features/health/la-he-inpractice16-2009feb16,0,2072006.story">writes in the LA Times</a>: If a doctor's visit is going badly, you can start over---Maybe the physician was distracted. Or spoke too quickly. Whatever the communication problem, take a deep breath and try again. Sometimes doctor and patient benefit from a second take.<br /><br />This happened to me, although in an inpatient setting. The family was very angry because they had brought their mother to the ER--twice---with symptoms of a stroke. I couldn't understand why she wasn't admitted to the unit at the first visit so I was angry with the physician for putting me in this position. After a heated discussion with the daughter, I took a deep breath and said, "I'm sorry. I hate having to apologize for another healthcare provider's mistake. Can we start over?"<br /><br />This was all it took to help them realize I was distressed by this injustice and we were in it together. I had some <a href="http://www.goredforwomen.com/">Red Dress pins </a>in my office. When I was finished assessing the patient, I grabbed a handful and gave one to each daughter. I explained to them they were each at risk for stroke because of their mother's history and this was an opportunity for them to make lifestyle changes that could delay or prevent this occurrence for them.<br /><br />Do-overs allow you to take a deep breath and start with a clean slate. If it's not your fault, then it allows the other person a little grace. And God knows, we can all do with a little of that now and then.Mary Khttp://www.blogger.com/profile/14750610946925410261noreply@blogger.com1tag:blogger.com,1999:blog-3000750820672633226.post-64832773262859170542008-12-28T01:15:00.001-08:002008-12-28T01:26:36.822-08:00Processing Betrayal in the Workplace<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiBuFC9K7_NoP33KoqeSD725X825Vi4Porav6TUFChvfPunON3NNQOABDr67JzDkudNDA-0iiRHf59GdRt294S26oSBJ1CakXQ_pJRKmLj8TKunkTT_21OatXhNtBSV7tE07tHggEyK_AA/s1600-h/ReinaTrust.gif"><img id="BLOGGER_PHOTO_ID_5284767287146501506" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 320px; CURSOR: hand; HEIGHT: 234px" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiBuFC9K7_NoP33KoqeSD725X825Vi4Porav6TUFChvfPunON3NNQOABDr67JzDkudNDA-0iiRHf59GdRt294S26oSBJ1CakXQ_pJRKmLj8TKunkTT_21OatXhNtBSV7tE07tHggEyK_AA/s320/ReinaTrust.gif" border="0" /></a> My Leading Petty Officer (LPO) decided to bail on mandatory training for the holiday. I did not realize this until one of my colleagues remarked, "You'd better tell your corpsmen to get back to work. They need to stop paging themselves out of training." I was furious and embarrassed.<br /><br /><br />I walked into the main office where all the HMs were sitting and talking and asked if everyone had attended training. One of the HMs said pointedly, "Some of us did, ma'am."<br /><br /><br />The LPO laughed.<br /><br /><br />I was speechless for a moment, then said, "What a great leadership example you set." I turned and walked back to my office. They went to lunch.<br /><br /><br />When the corpsmen came back, the LPO stuck his head in my office. "Ma'am, I just wanted to let you know that I took what you said to heart. I'll be going to the afternoon training session."<br /><br /><br />It has been several weeks and I am still angry about it. I don't understand why this still infuriates me. Part of the problem is this LPO is a cross-rate---he did not attain second class in the HM field, but exposure to the fleet should have impressed upon him the importance of setting the example and completing mandatory training, no matter how much a waste of time the training may be.<br /><br /><br />This article, <a href="http://www.ccl.org/leadership/enewsletter/2008/DECbetrayed.aspx">Betrayed? 7 Steps for Healing</a>, provides a good process to work through the feelings aroused by betrayal or a loss of trust. I'm pretty sure my HMs have already worked through the first step (<strong>Observe and acknowledge what has happened</strong>) and have moved on. The LPO came to my office and apologized for his behavior later that day so we've also accomplished step 2: <strong>Allow feelings to surface</strong>.<br /><br /><br />Step 3 says to <strong>Give employees support</strong>. I am still finding it difficult to be in the same room with this person---I feel uncomfortable in his presence...which makes me angry at myself. I sent an email message to him stating I was still available for mentoring and coaching, but he never responded, so I can only imagine he is just as uncomfortable.<br /><br /><br />In order for me to work through this, step 4 suggests <strong>Reframe the experience</strong>. In this step, I have to look at the role I played in this issue. Clearly, I did not have him think through the scheduling of training attendance: having all HMs but one at the morning session would not allow flexibility for emergencies within the clinic. In discussing this issue with the Senior Enlisted Advisor and the Department Head, I have realized that my leadership efforts and input are neither wanted nor desired. Asking myself questions like "How can I change my response?", "What choices or options do I have now?" or "What can I learn about myself and others from this experience?" gives me valuable insight into myself and my own actions and responses.<br /><br /><br />In step 5, they suggest I <strong>Take responsibility</strong>. I should ask myself, "What can I do now? What is in my control and what isn't? What can I do to make a difference?" In this case, I can simply give away control (ha! I never had it!) and refer questions on any clinic operations to the Department Head for action.<br /><br /><br />Step 6 is the hardest: <strong>Forgive.</strong> I must free myself of the anger, bitterness and resentment. "What needs to be said or done to put this issue to rest?" My biggest complaint here is the lack of communication and my lack of inclusion in clinic operations.<br /><br /><br />Finally, step 7 is <strong>Let it go and move on.</strong> As with <a href="http://www.elisabethkublerross.com/">Kubler-Ross's </a>work on the <a href="http://changingminds.org/disciplines/change_management/kubler_ross/kubler_ross.htm">stages of death and dying</a>, I will not be able to accomplish these steps in order and all at once---it takes time. I love the model posted at the top of this article.<br /><br /><br />Click here for more information about the <a href="http://www.reinatrustbuilding.com/">Reina Trust Building Institute</a> and their book, "<a href="http://www.amazon.com/gp/product/1576753778/ref=pd_rvi_gw_2/102-1421937-2668959?%5Fencoding=UTF8&v=glance&n=283155">Trust and Betrayal in the Workplace: Building Effective Relationships in Your Organization, 2nd Edition (2008)."</a>Mary Khttp://www.blogger.com/profile/14750610946925410261noreply@blogger.com0tag:blogger.com,1999:blog-3000750820672633226.post-72911737819321143292008-11-22T19:38:00.000-08:002008-11-22T20:32:05.826-08:00Storytelling in Long Term Care FacilitiesThis article really resonated with me. I truly believe in the value of storytelling and if stories carried actual physical weight, I would weigh a lot more than I did when I first started in nursing because of the patients' stories I carry with me.<br /><br />This article from <a href="http://www.providermagazine.com/">Provider Magazine</a>, <a href="http://www.ahcancal.org/News/publication/Provider/CaregivingOct2008.pdf">Creative Tasks Spark Imagination</a>, outlines three techniques used in a long term care facility for residents along the continuum of memory impairments (from none to late-stage Alzheimer's or dementia). The first technique is based on <a href="http://www.timeslips.org/">Timeslips</a>, which promotes social interaction. It helps to reduce the isolation that many persons with dementia may experience.<br /><br />The second technique involves <a href="http://multimedia.journalism.berkeley.edu/tutorials/reporting/starttofinish/storyboarding/">storyboarding</a> which can be done by the resident or by the family, if the resident is not able to participate. Upon completion of the <a href="http://www.nccnhr.org/uploads/Perrson,Overall-Laib,Atkerson-1of1-Concurrent(CreativityContinuum).pdf">storyboard</a>, a celebration is held to celebrate the individual's life.<br /><br />In the third technique, individuals write their life stories in a 6-10 week storytelling workshop.<br /><br />What I found most satisfying are the ending paragraphs:<br /><br /><blockquote>"Many facilities have implemented these activities for their residents, and in some cases, reported increased wellbeing and cognitive functioning among participating residents. Implementing these creativity tools supports, encourages, and inspires residents, their families, and staff.<br /><br />"These stories touch people in remarkable ways, no matter what age or ability."</blockquote><br />I also found storyboarding for personal growth an interesting topic in itself. <a href="http://37days.typepad.com/37days/2005/10/frame_your_stor.html">37 Days </a>discusses her experiences with storyboarding and this writer demonstrates how it can be done:<br /></p><blockquote><a title="View Storyboard Your Life document on Scribd" style="DISPLAY: block; MARGIN: 12px auto 6px; FONT: 14px Helvetica,Arial,Sans-serif; TEXT-DECORATION: underline; font-size-adjust: none; font-stretch: normal; -x-system-font: none" href="http://www.scribd.com/doc/3778216/Storyboard-Your-Life">Storyboard Your Life</a><object id="doc_273603402228503" codebase="http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=" height="500" width="100%" align="middle" classid="clsid:d27cdb6e-ae6d-11cf-96b8-444553540000" name="doc_273603402228503"><param name="_cx" value="13732"><param name="_cy" value="13229"><param name="FlashVars" value=""><param name="Movie" value="http://documents.scribd.com/ScribdViewer.swf?document_id=3778216&access_key=key-2hi71hcx3040y9poxpuu&page=1&version=1&viewMode="><param name="Src" value="http://documents.scribd.com/ScribdViewer.swf?document_id=3778216&access_key=key-2hi71hcx3040y9poxpuu&page=1&version=1&viewMode="><param name="WMode" value="Opaque"><param name="Play" value="0"><param name="Loop" value="-1"><param name="Quality" value="High"><param name="SAlign" value="LT"><param name="Menu" value="-1"><param name="Base" value=""><param name="AllowScriptAccess" value="always"><param name="Scale" value="NoScale"><param name="DeviceFont" value="0"><param name="EmbedMovie" value="0"><param name="BGColor" value="FFFFFF"><param name="SWRemote" value=""><param name="MovieData" value=""><param name="SeamlessTabbing" value="1"><param name="Profile" value="0"><param name="ProfileAddress" value=""><param name="ProfilePort" value="0"><param name="AllowNetworking" value="all"><param name="AllowFullScreen" value="true"><br /> <embed src="http://documents.scribd.com/ScribdViewer.swf?document_id=3778216&access_key=key-2hi71hcx3040y9poxpuu&page=1&version=1&viewMode=" quality="high" pluginspage="http://www.macromedia.com/go/getflashplayer" play="true" loop="true" scale="showall" wmode="opaque" devicefont="false" bgcolor="#ffffff" name="doc_273603402228503_object" menu="true" allowfullscreen="true" allowscriptaccess="always" salign="" type="application/x-shockwave-flash" align="middle" height="500" width="100%"></embed> </object><div style="DISPLAY: block; MARGIN: 6px auto 3px; FONT: 12px Helvetica,Arial,Sans-serif; font-size-adjust: none; font-stretch: normal; -x-system-font: none"><a style="TEXT-DECORATION: underline" href="http://www.scribd.com/upload">Get your own</a> at Scribd or <a style="TEXT-DECORATION: underline" href="http://www.scribd.com/browse">explore</a> others: <a style="TEXT-DECORATION: underline" href="http://www.scribd.com/browse?c=64-literature">Literature</a> <a style="TEXT-DECORATION: underline" href="http://www.scribd.com/browse?c=66-essays">Essays</a> <a style="TEXT-DECORATION: underline" href="http://www.scribd.com/tag/paper">paper</a> <a style="TEXT-DECORATION: underline" href="http://www.scribd.com/tag/future">future</a> </div><br /></blockquote>Mary Khttp://www.blogger.com/profile/14750610946925410261noreply@blogger.com0tag:blogger.com,1999:blog-3000750820672633226.post-4229032962434094542008-09-22T15:59:00.000-07:002008-10-10T04:44:40.143-07:00If Only It Were That EasyIt was nearly 0900 when HM3 came to me and asked me if I had seen HM2 that morning.<br /><br />"Why do you ask?"<br /><br />"Well, his jacket is here and the light is on, but no one's seen him today. We've called his cell phone and it just rings and rings."<br /><br />Dread consumed me. Today was the anniversary of LT Willman's death and it had been on my mind for the past week. "Do we have anyone we could send to his house?"<br /><br />"We could have earlier, but now we're down staff."<br /><br />"Let me see what I can do." I called his cell phone and it rang just as HM3 said. I found the recall bill with his landline phone and called it, saying I was worried about him and could he call back as soon as possible. I told the Department Head our HM2 was not available and I was going to call Base Security.<br /><br />"Why not send one of the HNs?" he asked.<br /><br />"Because if it's something bad, I don't want to wreck the corpsman."<br /><br />I called Security and asked the Dispatch if they could send a patrolman to do a courtesy call for us. I explained that we had left messages on the HM2's cell phone and landline and HM2 was normally at work before all of us. I also explained that HM2 suffered from PTSD and his spouse was deployed. "Let me talk to the Watch Commander," she said. I waited on hold.<br /><br />HM3 popped into the doorway. "HM2 just called. His dog knocked his cell phone off the table and he overslept." Relief flooded my brain and my shoulders relaxed. When the dispatch operator returned, I explained we didn't need their services after all.<br /><br />When HM2 got into work, I sat down with him and talked to him about suicide. "You don't have to worry about me," he responded.<br /><br />"But I do," I said. I told him about LT Willman and how he was the last person who anyone would have believed would die at his own hand. I still have his request for the PICC line course in a folder in my desk. Such a silly thing to hold on to. I used to drive by his house in the weeks following his death, looking at the yellow police tape barricading the doors. I told the psychiatrist that I did this. Why? he asked. I'm not sure, I said. I guess I believe that one of these times when I drive past, the yellow tape will be gone, and he'll be in his yard, waving and telling me, "No worries, ma'am."<br /><br />No worries, ma'am.<br /><br />Link to suicide screening for primary care clinics: <a href="http://www.pdhealth.mil/guidelines/downloads/Suicide_Screening.pdf">Screening</a>Mary Khttp://www.blogger.com/profile/14750610946925410261noreply@blogger.com2tag:blogger.com,1999:blog-3000750820672633226.post-33201113020896838202008-09-20T21:10:00.000-07:002008-09-20T21:44:33.191-07:00Workers Leave Managers, Not JobsFrom a nursing leadership perspective, the middle manager and his or her emotional intelligence are critical elements in recruiting and retaining nurses. Slow Leadership, one of my favorite blogs, features writing from <a href="http://www.spiritheart.net/">Peter Vajda</a>:<br /><br /><a href="http://www.slowleadership.org/blog/2008/09/twenty-indicators-of-failing-at-leadership/">Twenty Indicators of Failing at Leadership<br /></a><br />My favorite leadership failure indicators from his list:<br /><ul><li>Leaders who begin their responses to others’ suggestions or ideas with “no”, “but” or “however.” </li></ul><p>This one happens all the time. Currently, my department is pushing through a space utilization request. I've had staff at every level of the approval process tell me, "You know that this space is already spoken for, right?"</p><ul><li>Leaders who rationalize counter-productive processes, procedures and nonsensical bureaucratic practices by saying: “That’s just the way it is.” </li></ul><p>Oftentimes, it takes more energy to keep the status quo than to consider an alternative. I wanted to do a replication research project when I first got here and was rebuffed. "It'll take too long to get the project approved."</p><ul><li>Leaders who become defensive every time someone questions, or is curious about, one of their thoughts, beliefs or decisions. </li></ul><p>Fortunately, we've had a regime change and it appears the newly-instated leadership is open and accepting, which was not middle management's experience with the previous occupants of the C-suite.</p><ul><li>Leaders who are scattered, unfocused and unbalanced—be it mentally, emotionally or physically. </li></ul><p>If you don't make a decision, then you can't be accused of making a bad decision, right?</p><ul><li>Leaders who are a source of weakness, confusion and passing the buck in a stressful and uncertain environment. </li></ul><p>My director scheduled a call to a specialist in a project I was working on. He commandeered the conversation and asked questions I already knew the answers to and failed to ask the questions for which I needed information. He made both of us look foolish and ill-prepared and wasted this other person's time.</p><p>Fortunately, Vajda also offers antidotes to these leadership problems through self-reflection with directed questions. I would encourage you to read them for personal insight and work. I know I used to consider being an expert clinician the height of professionalism. I'm coming up on the two-year anniversary of LT Willman's death and another well-respected nurse attempted suicide this past month. Real leadership is hands-on and messy. </p><p>So, how do YOU feel about the idea that “soft skills” are so important to defining your career as a successful leader? </p>Mary Khttp://www.blogger.com/profile/14750610946925410261noreply@blogger.com1tag:blogger.com,1999:blog-3000750820672633226.post-84822301585800778212008-09-11T02:13:00.000-07:002008-09-11T02:15:17.067-07:00Respect is a Two-Way StreetWe recently had the opportunity to ask questions of our senior leadership. With nearly everyone in our command seated in a large auditorium, it is intimidating to stand, state your name and workplace, then coherently state your question.<br /><br />Several people stood and asked their questions and were answered politely with every response <a href="http://pr-impact.com/mediaminuteblog/2008/06/30/dont-say-too-much/">staying on message</a>. Evidently, this senior leader had extensive <a href="http://pr-impact.com/mediaTraining.html">media training</a> and, as my husband remarked, didn't get this high by being stupid or making stupid comments.<br /><br />At least, until I stood and asked my question. This senior leader look over my shoulder at someone then stared directly at me. "I see your director looks like he's sucking on a lemon," he said. He added, "And it's not a sweet lemon." He said a few more words about this lemon and my director's facial expressions, then started comparing our workplace and mission to our mainland counterparts who are also somewhat geographically isolated.<br /><br />While my intent was certainly not to embarrass this official nor to make life difficult for myself, it served only to indicate the level of intimidation that is present in this type of environment and it also served to illustrate that these cattle calls require attendees to ask only those questions that are bland and inoffensive.<br /><br />How much simpler would it have been to respond, "You know, that is an interesting question. I don't know the answer, but I will definitely look into it. Thank you for asking." I would have considered him to be a <a href="http://www.respectfulworkplace.com/blog/2008/08/rules-for-respectful-engagement/#more-27">gracious and thoughtful leader </a>who honestly and sincerely valued my input.<br /><br />In this exchange, I lost face with my director for embarrassing him and I damaged my own credibility with my peers. On the other hand, this senior leader lost substantially more in the ridiculous comparisons between Guam, <a href="http://www.nhtp.med.navy.mil/">29 Palms</a>, <a href="http://nhoh.med.navy.mil/">Oak Harbor</a>, and <a href="https://lemoore.med.navy.mil/">Lemoore</a>. If a patient is taken to anyone of those hospitals and requires more comprehensive treatment, the patient can always be medevac'd, just as a patient can be medevac'd from Guam. But it takes at least 4 hours to fly to <a href="http://www.oki.med.navy.mil/">Okinawa</a> and 7 1/2 hours to <a href="http://www.tamc.amedd.army.mil/">Hawaii</a>...providing the patient and the airplane are ready to go right that minute. From 29 Palms you could be in <a href="http://www.mapquest.com/maps?1c=Twentynine+Palms&1s=CA&2c=Los+Angeles&2s=CA">Los Angeles</a> or <a href="http://www.mapquest.com/maps?1c=Twentynine+Palms&1s=CA&1y=US&1l=34.135601&1g=-116.053299&1v=CITY&2c=San+Diego&2s=CA&r=s">San Diego</a> in considerably less than 7 1/2 hours...and you don't have to worry about altitude either.Mary Khttp://www.blogger.com/profile/14750610946925410261noreply@blogger.com0tag:blogger.com,1999:blog-3000750820672633226.post-82160249826601952542008-08-26T03:47:00.000-07:002008-09-11T02:28:12.978-07:00Is This My Battle?I asked a corpsman to come from MSU to brief my corpsman on the Sailor of the Quarter Board for tomorrow. He brought his paperwork and instructed her on how to acquit herself properly and professionally. Then he sat down and that's when I noticed the glassy eyes. "I had a 101.6 degree temperature this morning," he said.<br /><br />"Get yourself to sick call," I replied. "You need to be SIQ [Sick in Quarters]."<br /><br />"I would, but the Division Officer said she would call in another corpsman to cover for me and those corpsmen have already worked three shifts."<br /><br />He told me there were 8 patients and 3 would be discharged home. They had another nurse working who had been a corpsman herself, an LPN, a ward clerk, and an orienting corpsman. "That's more than enough to handle the workload," I said.<br /><br />"That's what I thought," he said wearily as he forced his body out of the chair to return to the ward.<br /><br />I thought of all the leadership books I've read, the ones I've made notes in, the ones I've loaned out. I sat in on the ranking board for the lieutenants and listened to the senior leaders ponder the limbo between being honest and being kind. This nurse is more concerned with herself, how she ranks among other nurses, and how she can accumulate collateral duties and accolades to improve her standing within the command than she is about being kind and doing the right thing.<br /><br />I can still remember her venting when a newly-reporting lieutenant had asked if she could leave early. "She left early on Tuesday, and now she wants to leave early today!"<br /><br />I reminded her that this lieutenant had only been on island for two months and still had errands and obligations tied to moving. "Cut her some slack," I advised.<br /><br />She fumed, "When is it going to end?"<br /><br />In retrospect, I believe she really wanted me to recognize that she was doing hard work, which I did, but I didn't acknowledge it aloud to her. So I failed her. And I have to wonder, at what rank do you need to give up the notion of "atta boys" and kudos? Or is this something we all crave no matter our status?<br /><br />When you do the right thing for your people---that's when you can persuade those people that the journey with you will be interesting and challenging, that's when you can demonstrate to those people that they will gain much and learn more, that's when you know you are truly a leader...and not just someone out taking a walk.Mary Khttp://www.blogger.com/profile/14750610946925410261noreply@blogger.com0