True Leaders Good at Giving Bad News

The Selection List for Staff Corps Commanders was released two days ago. One of my colleagues was up for promotion and I've talked to her over the past few days. I thought she was holding up remarkably since she was passed over and I'm not sure why I didn't say anything to her about it.

In the passageway this afternoon, the Division Officer for the Emergency Department confided to me that she had told C she was so sorry. C whitened and gave a little gasp. "Is the list out?" she wanted to know.

"You don't know?" the Division Officer asked.

"No," C replied. "I've been checking the message boards constantly." So our esteemed Director for Nursing Services took the cowardly way out of delivering bad news---he let someone else do it inadvertently.

The Division Officer also told me the Director for Nursing Services failed to contact the candidates for the DUINS program (Duty Under Instruction----full-time graduate schooling) who were not selected at this last board. "'I can't get in touch with them," he said,'" she told me. "Well, that's BS because I had no problems contacting them. He just didn't want to be the one telling them the bad news."

Leaders don't get to give only good news. Being able to give bad news and temper it with constructive thought on being competitive the next go-round is a vital communication skill and can make the difference between having a demoralized worker and one energized with a plan for success the next time.

Dr Robert Buckman, an oncologist, knows how difficult it is to deliver bad news. He suggests active listening and kindly communicating reality. When the reality hits, it's important to legitimize the emotions, but not to become emotional yourself.

Perhaps I should be kind and understanding---but I can't. When you wear the rank of CAPTAIN, you lose the privilege to delegate the hard tasks to your subordinates. That's why you're the captain.

Maintaining Clinical Competency Through CEUs

I talked with a civilian nurse over the weekend who said she had spent nearly $500 to complete enough CEUs to maintain her certifications over the past 2 years. I was flabbergasted. I hope no one else is spending a lot of money to get CEUs when there are so many free options available. Here are some that I use (and I passed this information on to her as well):

http://nursingworld.org/ce/cecatalog.cfm While many require fees, there are two free CEU courses here. Check back periodically for new free courses.

http://www.medscape.com You can establish a homepage based on your specialty; the site requires free registration. It also offers a CE tracker and you can add CE units completed from other sources to maintain an accurate count (great for supplementing your brag sheet when midterms and fitrep periods roll around)

http://www.medpagetoday.com This site also requires free registration and can track CE.

http://www.netce.com/search.php This site has two free courses: Sepsis and HIV. Check back periodically for new free courses.

http://www.jhasin.com/template.cfm?TEMPLATE=include_viewprograms.cfm This site from Johns Hopkins offers a variety of courses. The additional benefit is occasional monograph mailings that enable you to complete CE readings and tests while you're away from a computer.

http://www.mededtoday.com This web site is sponsored by NovoNordisk and has free CEUs for the Registered Nurse and the Nurse Practitioner on a variety of topics.

http://www.cme-today.com This site offers a subscription service for monographs and CEUs. You can also complete CEUs online.

http://www.pcna.net/ This site, sponsored by the Preventive Cardiovascular Nurses Association provides several free CEUs and a host of additional information on cardiovascular health (considering joining!).

http://www.cmezone.com This website offers free CEUs on a variety of topics. Free registration.

Additional CEUs can be found at sponsoring pharmaceutical and hospital equipment sites. They include:
http://www.ahecme.com/
http://www.baxter.com/services/training_and_education/index.html
http://www.cmellc.com/

Make your nursing memberships count. See if free CEUs are offered as part of your membership benefits.

Another option that is becoming available is CE via MP3 or podcast. These allow you to listen through your MP3 player while you do other things.

No one should have to pay for CEU's---unless they want to.

Making Diabetes Self-Management Education (DSME) Classes Fun

I taught my first DSME class last month. I loved it. Part of being a nurse is being an educator---to patients, families, and colleagues. I hadn't had the opportunity to teach this class before because I had two nurses who were committed to teaching it as their role within a primary care clinic. But one nurse went to Iraq and the other transferred to Washington state. That left me to teach until I can get another cadre of experts trained. I went ahead and joined the American Academy of Diabetes Educators so I can learn and add to my credibility. I don't want to pass the wrong information to these patients who are relying on me.

I am in the process of trying to establish a DSME committee that would have physician oversight with a multi-disciplinary membership. My hope is that the training would continue to be evidence-based and provide a pool of qualified and respected instructors.

A wonderful resource for teaching is found on the University of Michigan web site. While I was waiting for everyone to show for class, I had them fill out this questionnaire on concerns that might interfere with learning about or managing their diabetes. I was amazed at the responses and so gratified that these individuals would trust me with this private information.

One of my colleagues in the Health Promotions Department is more jaded and cynical. I had two no-shows for this class and I contacted them afterwards to discover what barriers or obstacles prevented them from coming. My colleague said, "If you offered bingo along with the class, a $100 pay-out and free cards, you wouldn't have anyone making excuses for not attending. In fact, they would call in sick to work in order to attend!"

I don't want to believe that of my patients. I would prefer to believe that they have other needs more pressing that prevent them from making their healthcare a priority in their lives: grandchildren who must be reared, power bills that must be paid (and no money to pay), fears and worries that so overwhelm them that no action is preferable to making the wrong decision. And so, I am entering this contest to win a book, "The Big Book of Diabetic Desserts, written by Jackie Mills MS, RD. My hope is to have a prize to offer one of my patients. Our Health Promotions Department has funds for purchasing patient education materials, but they cannot fund giveaways or incentives. Consequently, I buy trinkets out of my own pocket. I currently have about 950 Unite for Diabetes pins to distribute to my patients (I started with 1,000 pins). Of course, they're not purchased from the Diabetes web site; I had them made by a Chinese company in Shenzhen, just across from Hong Kong, because a 10-pack of pins cost 30 Euros.

Director for Nursing Services Billet Still Vacant...

Last week the senior nursing leadership posted an email regarding the selections for Senior Nurse Executive/Director for Nursing Services assignments for Fiscal-Year 2008. Glaringly vacant was the spot for DNS - Naval Hospital Guam.

The spouse envisioned the following dialogue:

Detailer: I have a great duty station for you. How does Guam sound?
Prospective SNE/DNS: Thanks, but I think I'll resign my commission.
Detailer: But you only have 19 years in. You'll lose millions!
Prospective SNE/DNS: Let's see, what is that address again? Oh yeah, jobsearch.com. Be seeing ya.

Recognition Crucial for Recruitment and Retention Efforts

The department head meeting yesterday was very interesting. Apparently, NO ONE from the command has gotten any formal recognition (NAM, COMM, even LOA) for the part they played in the Frank Cable mass casualty. The Commanding Officer (CO) said, "Well, there were over 200 people at Naval Hospital involved in the incident. We can't give everyone an award."

When one of the department heads said, "Well, the Frank Cable managed to give 113 awards to sailors for THEIR role in the incident," the CO said, "That never happened." Then the Public Affairs Officer cleared his throat and said he could provide the article from the Pacific Navigator.

Rumor has it that the command was submitted for a UNIT award and it was turned down...even though we were lauded throughout the Navy for our medical care.

And they wonder why there is a recruiting and retention problem for Naval Hospital Guam.

In the CO's call yesterday, he showed us two books that were passed out at the Surgeon General's conference: "Made to Stick" and "The Second Rule." I read the first and would like to read the second (I think it's on my wish list….just haven't had justification to pay for it because I have so many other books in the queue). I would recommend the CO read a few other books. My suggestions? "The Carrot Principle," "It's Okay to be the Boss," "It's Your Ship: Management Techniques from the Best Damn Ship in the Navy," and "First, Break all the Rules: What the World's Best Managers Do Differently."

All of these books state definitively that recruitment and retention efforts fail or succeed at the supervisor level and that recognition is what people crave most.

The CO can say, "Naval Hospital Guam gets kudos from all over the Navy," but until he puts his money where his mouth is and we see awards for people other than those who donated "multiple off-duty hours" to coordinating the Navy Ball (give me a break), he has no credibility for me.

Managing by Carrots--Are You Doing It Right?

Recognizing and rewarding employees is an integral function of the leader and manager. As someone who is internally motivated, I overlooked opportunities to recognize others in the past, but the article below, reprinted with permission from Adrian Gostick and Potentials Magazine, made me rethink the purpose of recognition and how to do it right.

Several years ago, I completed a nomination for one of my colleagues for her volunteer services within the community. When I submitted the nomination up the chain-of-command, the Director looked up at me from behind her desk and said, "Thanks. I meant to do this but ran out of time." The problem is I was a lieutenant taking the time to recognize the activities of a fellow lieutenant and the director was a captain, our immediate supervisor.

If you are truly taking care of your people, how can you possibly run out of time to recognize their good works?

The only praise that doesn't work is the hollow praise of "Good job." It doesn't take much to personalize it and to let the recipient know exactly what the "good job" constitutes. The phrase that pays says, "No one cares how much you know until they know how much you care."

POINTED PRAISE PRODUCES BETTER RESULTS
Recognition without specifics can be worse than no recognition at all
Adrian Gostick and Chester Elton

The next time your young child, grandchild or niece brings home a Rorschach painting from school, try an experiment. Instead of patting her on the head and saying, “Aren’t you just the best little artist,” try talking about the specifics of the painting.

“Why did you use red here?” “What have you drawn here?” “What action is going on in this area?”

When you praise the child and hang the painting on the refrigerator, use specifics such as, “I love how your flowers are turning toward the sun; that’s very observant.” Or, “You know, I don’t know that I’ve ever seen scarier blue alien bugs.” We guarantee that your little one will light up to such specific praise and remember it for a much longer time.

Author and scholar David Cherrington gives a fun demonstration of why such specificity is so important in his book, Rearing Responsible Children.” Cherrington says of one father he observed, “He expressed appreciation to each of his three children individually in the presence of his wife. The father’s comment was a simple statement: ‘I just want you to know how much I appreciate everything you do.’ (The father supposed, like many managers, that any kind of praise would have a positive impact.)

“After he made the comment and left, his wife asked each child why the father had expressed appreciation. The 10-year-old replied, ‘I guess he must be upset because I didn’t get the dishes done like I was supposed to.’ The 13-year-old replied, ‘I don’t know. I guess he was just feeling sentimental.’ The 15-year-old said, ‘Who knows what he meant. I don’t think he understands what’s going on around here.’”

Say what you mean
In the work world, we’ve all known bosses who have fired out glibly, “Hey buddy, you’re doing a great job,” or “I appreciate all you do,” or “You sure look busy.” Unfortunately, these hollow phrases often leave employees wondering, “Does this guy have any idea what I really do around here?”

“Expressing appreciation in general, unspecified terms fails to communicate what the person did right and often appears insincere,” says Cherrington. Instead, when giving praise, describe the great behavior, why it was helpful, and say thanks. It’s that easy.

By taking a few minutes to prepare, and by using a few helpful techniques, your day-to-day recognition moments (and your formal recognition events) can do much more than simply thank employees for their contributions; they can enhance working relationships and increase feelings of loyalty and commitment.

No secret intelligence
To ensure that you’ve remembered everything, consider using the following mnemonic device: CIA – the Company (and department), the Individual and the Award. To help recall this acronym, remember that a good presentation takes a little bit of investigative work.

Company: Be prepared to talk about the company and team goals. You’ll want to reiterate why this is a great place to work (your success, your history, exciting changes, superior quality, etc.).
At FedEx, for example, managers use the recognition presentation as a time to talk about their values of people, service and profit.

Individual: Relate specifically what the individual did to earn this award or recognition and how this achievement helps fulfill your team and company goals. To get the most impact, except with very shy recipients, you’ll want to invite co-workers to talk about the person’s qualities, creativity, dedication and specific work achievements.

Award: Finally, talk about what you are presenting to your employee – whether a formal award for service or performance or a more informal award. If it’s a formal award, talk about the symbolism incorporated into the item – the gold company logo or emblem, the engraving, etc.

Never bad timing
The great thing about carrots is that they are always in season. When times are good in your company, effective presentations will give you a chance to celebrate and reflect. Unlike monetary rewards that dry up when times are tight, carrots can be used during downturns to bring you closer together and give you hope that better times lie ahead.

By making the presentations public, you not only make the person being recognized feel appreciated, but also inspire those who are in attendance. In fact, a great presentation should get people asking themselves, “What memorable or noteworthy things have I done for the company?”

Here’s an example of how it’s done right: Grocery store chain Festival Foods in Onalaska, WI, invites customers and employees to “huddle up” for recognition moments. Twice a year, the company brings in all store directors for hands-on training and meetings called “Festival College.”

After the training, leaders from the company offices go to stores for regular presentations – not only to ensure that recognition is being done right, but to get involved themselves and lead by example. As Festival Foods President Dave Skogen says, “While it’s crucial to have the best quality products and the cleanest, most attractive facility, ultimately it’s employee attitude that brings customers back.”

Adrian Gostick is director of marketing and corporate communications for the O.C. Tanner Recognition Company (www.octanner.com). Chester Elton is national director of performance sales for O.C. Tanner. This article was excerpted from their book The 24-Carrot Manager: A remarkable story of how a leader can unleash human potential (Gibbs Smith, 2002).

If you don't have time to read, consider listening to their podcasts:
http://www.podcastdirectory.com/podcasts/6582

Are You a Knowledge Hoarder?

In my previous incarnation as a small unit leader, I was not wildly successful. It stemmed largely from my personal insecurities. When I needed someone to cover for me or to complete a project, I was helpful...but not as helpful as I could have been. I invariably omitted some vital piece or a bit of information that could have helped the other person succeed. I called this "knowledge hoarding" and I was a consummate player in the game. It took me a long time to realize that true power comes from knowledge sharing.

As a more seasoned leader, I try to give my juniors all the information I can. The benefit of open communication means they come to me with their questions and concerns, and they often possess information I need to provide to senior leadership.

Marshall Goldsmith addresses this issue much more eloquently than I can, and he and Patricia Wheeler have graciously permitted reprinting an excerpt from one of his monthly newsletters here. Consider subscribing to Leading News---their monthly newsletter dedicated to helping leaders become successful.

Withholding Information
By Marshall Goldsmith

In the age of knowledge workers, the saying that information is power is truer than ever—which makes withholding information even more extreme and irritating.

Intentionally withholding information is the opposite of adding value. We are deleting value. Yet it has the same purpose: to gain power. It’s the same old need to win, only more devious. And it appears in more forms than merely playing our cards close to our vest. You see it in people who exaggerate the virtue of keeping a secret; they use it as an excuse to leave you out of the information flow. You see it in its passive-aggressive incarnation in people who don’t return your phone calls, answer your emails, or only give partial answers.

If you don’t understand why it annoys people, reflect on how you felt about the following events:
- A meeting you weren’t told about
- A memo or e-mail you weren’t copied on
- A moment when you were the last person to learn something

The problem with not sharing information—for whatever reason—is that it rarely achieves the desired effect. You may think you’re gaining an edge and consolidating power, but you’re actually breeding mistrust. In order to have power, you need to inspire loyalty rather than fear and suspicion.

What I’m describing here is not just the willful poison-sowing refusal to share information, the way people behave when they want to divide and conquer. I’m also talking about all the unintentional or accidental ways we withhold information.

We do this when we’re too busy to get back to someone with valuable information.

We do this when we forget to include someone in our discussions or meetings.

We do this when we delegate a task to our subordinates but don’t take the time to show them exactly how we want the task done.

I was advising a friend who was having trouble with his assistant. They weren’t meshing as a team but he didn’t know why or how to fix the problem. I asked him, “What would your assistant say is your biggest flaw as a boss?”

“That I don’t communicate enough with her,” he answered, “and I leave her out of the loop.”

I observed him one day at work, and what I saw explained everything. He was already at his desk checking his e-mail when his assistant arrived. She poked her head in to say good morning, and he waved as he talked on his cell phone. When the call ended, he turned back to his computer. His assistant periodically came in to notify him of calls, which he took while continuing to scan his computer. After a few hours, I asked him if all days were like this.

“Pretty much,” he said.

My friend, indeed, was guilty of keeping his assistant in the dark, but he was not doing so maliciously or intentionally. His work life was like a haphazard fire drill. He was so distracted, so disorganized, so busy responding to calls and putting out fires that he never had time to sit down with his assistant for a daily briefing.

If he had, I suspect it would have solved their information sharing issue.

I suspect this is a big reason why so many of us withhold information. It’s not that we want to keep people in the dark. It’s simply that we’re too busy. We mean well. We have good intentions. But we fail to get around to it. As a result we become bad at sharing information, and over time it begins to look like we are withholding information.

Being bad at sharing information doesn’t mean we are willfully withholding it…but the net result is the same in the eyes of the people around us.

How do you stop withholding information?

Simple answer: Start sharing it.

That’s what my friend did. He made sharing information a higher priority in his busy day. He made time to debrief his assistant daily, and held to this commitment no matter what was going on.

If this is your problem, I advise the same solution. You will not only improve your communication, but you will prove that you care about your coworkers, demonstrating that what they think matters to you. It’s not often we get such a two-for-the-price-of-one solution to our interpersonal challenges…but making the subtle shift from withholding to sharing information is one of them.

Excerpted from What Got You Here Won’t Get You There, 2007

Marshall Goldsmith is a world authority in helping successful leaders achieve positive, measurable change in behavior: for themselves, their people and their teams. He has been named one of the top 50 leaders influencing the field of management over the last century (American Management Association), one of the five most respected executive coaches (Forbes) and among the top ten executive educators (Wall Street Journal). Marshall invites you to visit his library (MarshallGoldsmithLibrary.com) for articles and resources you can use.