It was nearly 0900 when HM3 came to me and asked me if I had seen HM2 that morning.
"Why do you ask?"
"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."
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?"
"We could have earlier, but now we're down staff."
"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.
"Why not send one of the HNs?" he asked.
"Because if it's something bad, I don't want to wreck the corpsman."
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.
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.
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.
"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."
No worries, ma'am.
Link to suicide screening for primary care clinics: Screening
Monday, September 22, 2008
Saturday, September 20, 2008
Workers Leave Managers, Not Jobs
From 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 Peter Vajda:
Twenty Indicators of Failing at Leadership
My favorite leadership failure indicators from his list:
Twenty Indicators of Failing at Leadership
My favorite leadership failure indicators from his list:
- Leaders who begin their responses to others’ suggestions or ideas with “no”, “but” or “however.”
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?"
- Leaders who rationalize counter-productive processes, procedures and nonsensical bureaucratic practices by saying: “That’s just the way it is.”
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."
- Leaders who become defensive every time someone questions, or is curious about, one of their thoughts, beliefs or decisions.
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.
- Leaders who are scattered, unfocused and unbalanced—be it mentally, emotionally or physically.
If you don't make a decision, then you can't be accused of making a bad decision, right?
- Leaders who are a source of weakness, confusion and passing the buck in a stressful and uncertain environment.
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.
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.
So, how do YOU feel about the idea that “soft skills” are so important to defining your career as a successful leader?
Thursday, September 11, 2008
Respect is a Two-Way Street
We 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.
Several people stood and asked their questions and were answered politely with every response staying on message. Evidently, this senior leader had extensive media training and, as my husband remarked, didn't get this high by being stupid or making stupid comments.
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.
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.
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 gracious and thoughtful leader who honestly and sincerely valued my input.
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, 29 Palms, Oak Harbor, and Lemoore. 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 Okinawa and 7 1/2 hours to Hawaii...providing the patient and the airplane are ready to go right that minute. From 29 Palms you could be in Los Angeles or San Diego in considerably less than 7 1/2 hours...and you don't have to worry about altitude either.
Several people stood and asked their questions and were answered politely with every response staying on message. Evidently, this senior leader had extensive media training and, as my husband remarked, didn't get this high by being stupid or making stupid comments.
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.
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.
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 gracious and thoughtful leader who honestly and sincerely valued my input.
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, 29 Palms, Oak Harbor, and Lemoore. 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 Okinawa and 7 1/2 hours to Hawaii...providing the patient and the airplane are ready to go right that minute. From 29 Palms you could be in Los Angeles or San Diego in considerably less than 7 1/2 hours...and you don't have to worry about altitude either.
Tuesday, August 26, 2008
Is 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.
"Get yourself to sick call," I replied. "You need to be SIQ [Sick in Quarters]."
"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."
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.
"That's what I thought," he said wearily as he forced his body out of the chair to return to the ward.
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.
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!"
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.
She fumed, "When is it going to end?"
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?
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.
"Get yourself to sick call," I replied. "You need to be SIQ [Sick in Quarters]."
"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."
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.
"That's what I thought," he said wearily as he forced his body out of the chair to return to the ward.
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.
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!"
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.
She fumed, "When is it going to end?"
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?
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.
Tuesday, June 24, 2008
Use Collaborative Leadership to Go Further
In “It’s Our Ship,” CAPT Mike Abrashoff describes the element missing from his first book, “It’s Your Ship---Management Techniques from the Best Damn Ship in the Navy,” a bold leadership approach that turned the conventional ideas of stodgy senior Navy leaders on its head. I used many of the techniques he described in his initial book to shape my own work environment in healthcare. What he describes in his latest book, and what I have come to realize in my own endeavors, is the wisdom of collaboration.
Instead of encouraging healthy sustainable improvements, competition (as in “the best”) can actually provoke schadenfreude (glee in another’s downfall) and off-track searches for armor chinks. Collaborative leadership looks to the bigger picture, to the mission and accomplishments of the larger organization that create opportunities for all to benefit.
Abrashoff uses the nautical theme to organize his material into eight chapters:
Ahoy – Welcome aboard our ship.
In this chapter, Abrashoff describes one of the techniques he used on the USS Benfold to welcome new sailors and describes learning good and poor leadership in his experiences on the Benfold. He highlights the practices of developing a company “World Tour,” where new employees receive a “passport” with lists of to-do training and customer-service classes. Another company hired its best customers, resulting in a turnover rate of less than 10% while competitors routinely face 70% turnover rates. Companies must continue to recruit people even after they’re onboard.
Buoy up your people – inspiring everyone to be their best.
In this chapter, he states, “A great leader defines excellence and then inspires his team to exceed it through training and staff development.” He then reviews several companies who have developed innovative training programs.
No more aye-aye men (or women) – cultivating truth-telling.
Wishful thinking is dangerous and he gives suggestions on how to deliver bad news and how to keep communication flowing up and down. Honesty and integrity are to be nurtured and encouraged.
All hands on deck – unifying a crew.
Abrashoff says, “Mindless rivalry leads to backstabbing, an ethos of every man for himself, and probably unit failure when danger threatens.” He adds, “Nothing beats the power of unifying disparate people, of showing them the magic of working with and for each other instead of against each other. Quite simply, the first law of leadership in today’s world is to give people irresistible incentives to collaborate for a purpose that enhances everyone.”
Foul weather doesn’t respect rank – creating a climate of trust.
An ancient proverb says a fish rots from the head down. Abrashoff discusses the importance of developing trust, pursuing excellence without arrogance, and treating all with courtesy and respect. He also reviews the principle of fairness and justice.
Navigate by the stars – Clarifying what it’s all about.
Do you know the mission of your organization? Then you have to communicate, focus on what matters, and teach your organization’s core values.
Sail close to the wind – taking the right risks.
Good leaders calculate the odds so risks are minimized.
Fly your true colors – Leading by example and getting results.
Abrashoff discusses the importance of courage. A leader’s main function is to set the right example and leaders can be found at all levels throughout an organization. It’s important to know that good leadership can inspire people to do their best everyday.
In conclusion, collaborative leadership is what makes an organization unbeatable. I highly recommend this book for the interesting situations and the vivid examples leaders at any level can put into play at their companies.
Instead of encouraging healthy sustainable improvements, competition (as in “the best”) can actually provoke schadenfreude (glee in another’s downfall) and off-track searches for armor chinks. Collaborative leadership looks to the bigger picture, to the mission and accomplishments of the larger organization that create opportunities for all to benefit.
Abrashoff uses the nautical theme to organize his material into eight chapters:
Ahoy – Welcome aboard our ship.
In this chapter, Abrashoff describes one of the techniques he used on the USS Benfold to welcome new sailors and describes learning good and poor leadership in his experiences on the Benfold. He highlights the practices of developing a company “World Tour,” where new employees receive a “passport” with lists of to-do training and customer-service classes. Another company hired its best customers, resulting in a turnover rate of less than 10% while competitors routinely face 70% turnover rates. Companies must continue to recruit people even after they’re onboard.
Buoy up your people – inspiring everyone to be their best.
In this chapter, he states, “A great leader defines excellence and then inspires his team to exceed it through training and staff development.” He then reviews several companies who have developed innovative training programs.
No more aye-aye men (or women) – cultivating truth-telling.
Wishful thinking is dangerous and he gives suggestions on how to deliver bad news and how to keep communication flowing up and down. Honesty and integrity are to be nurtured and encouraged.
All hands on deck – unifying a crew.
Abrashoff says, “Mindless rivalry leads to backstabbing, an ethos of every man for himself, and probably unit failure when danger threatens.” He adds, “Nothing beats the power of unifying disparate people, of showing them the magic of working with and for each other instead of against each other. Quite simply, the first law of leadership in today’s world is to give people irresistible incentives to collaborate for a purpose that enhances everyone.”
Foul weather doesn’t respect rank – creating a climate of trust.
An ancient proverb says a fish rots from the head down. Abrashoff discusses the importance of developing trust, pursuing excellence without arrogance, and treating all with courtesy and respect. He also reviews the principle of fairness and justice.
Navigate by the stars – Clarifying what it’s all about.
Do you know the mission of your organization? Then you have to communicate, focus on what matters, and teach your organization’s core values.
Sail close to the wind – taking the right risks.
Good leaders calculate the odds so risks are minimized.
Fly your true colors – Leading by example and getting results.
Abrashoff discusses the importance of courage. A leader’s main function is to set the right example and leaders can be found at all levels throughout an organization. It’s important to know that good leadership can inspire people to do their best everyday.
In conclusion, collaborative leadership is what makes an organization unbeatable. I highly recommend this book for the interesting situations and the vivid examples leaders at any level can put into play at their companies.
Wednesday, June 11, 2008
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.
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.
Sunday, May 25, 2008
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.
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.
Subscribe to:
Posts (Atom)
