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.
Tuesday, August 26, 2008
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.
Tuesday, February 26, 2008
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.
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.
Friday, February 15, 2008
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.
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.
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.
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