Mulligans Work in Healthcare, Too

Lony C. Castro, professor and chairwoman of the obstetrics and gynecology department at Western University of Health Sciences, writes in the LA Times: 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.

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?"

This was all it took to help them realize I was distressed by this injustice and we were in it together. I had some Red Dress pins 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.

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.

Processing Betrayal in the Workplace

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.


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."


The LPO laughed.


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.


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."


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.


This article, Betrayed? 7 Steps for Healing, 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 (Observe and acknowledge what has happened) 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: Allow feelings to surface.


Step 3 says to Give employees support. 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.


In order for me to work through this, step 4 suggests Reframe the experience. 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.


In step 5, they suggest I Take responsibility. 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.


Step 6 is the hardest: Forgive. 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.


Finally, step 7 is Let it go and move on. As with Kubler-Ross's work on the stages of death and dying, 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.


Click here for more information about the Reina Trust Building Institute and their book, "Trust and Betrayal in the Workplace: Building Effective Relationships in Your Organization, 2nd Edition (2008)."

Storytelling in Long Term Care Facilities

This 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.

This article from Provider Magazine, Creative Tasks Spark Imagination, 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 Timeslips, which promotes social interaction. It helps to reduce the isolation that many persons with dementia may experience.

The second technique involves storyboarding which can be done by the resident or by the family, if the resident is not able to participate. Upon completion of the storyboard, a celebration is held to celebrate the individual's life.

In the third technique, individuals write their life stories in a 6-10 week storytelling workshop.

What I found most satisfying are the ending paragraphs:

"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.

"These stories touch people in remarkable ways, no matter what age or ability."

I also found storyboarding for personal growth an interesting topic in itself. 37 Days discusses her experiences with storyboarding and this writer demonstrates how it can be done:

Storyboard Your Life

Get your own at Scribd or explore others: Literature Essays paper future

If Only It Were That Easy

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

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:

• 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?

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.

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.