Week 13 Leadership in Nursing

This week we learned about motivation. I learned that we have common ideas on how to go about motivating employees including making them feel as if they have friends at work, providing incentives (healthy competition), helping them to feel valued as a person and an employee, giving them recognition for special achievements, and setting a good example by getting in there and helping when you can and getting to know your employees.

We didn’t really have a team activity except for the discussion which I thought was a great discussion on various team building ideas. Everyone came up with thoughtful and great ideas. I think it showed what motivates them in their work and can be a great example of what can motivate others as well. I think that is a key to this. Treating others as you would want to be treated. What would motivate me? 

I will utilize this information by watching what my employers are doing or not doing to build our unit team and hospital team. I will let my supervisors know how much I appreciate their efforts. They need the motivation to continue in good work as well. I will also look for opportunities to build my units morale as a leader.

My personal feelings about this unit are again recognizing what my supervisors are doing and that it is very calculated yet very appreciated. Kimball Peterson, our CEO comes walking through the ER at least once a week in the morning before starting his day. He is cordial, jokes with us and asks how we are doing. He is very visible and very approachable. I appreciate him and his efforts. I can see the efforts my ER director is making to be more visible and he is always so helpful when I need something. He also stands up for us in his myriad of meetings which means so much. When you have someone going to bat for you even if it means bucking the system and really trying to get to know you and help you it goes a long way to motivate me to be loyal and do my best for the unit.

Week 12 – Communication

1. What did you actually learned from the unit.

This week we learned about collective bargaining and communication.  I learned that I am STILL not a numbers person and will never be in charge of bargaining a union contract. Not that I would ever want to. 

I learned quite a lot from the communications websites Sean had us read. I especially appreciated the great descriptions of just exactly what assertive communication is and the “Six Techniques for Assertiveness in Communication”. Behavior rehearsal, repeated assertion, fogging, negative enquiry, negative assertion,  and workable compromise. 

Reminders of how to improve non-verbal language and learning to handle stress in the moment were very helpful. Also, learning how to listen effectively. I have tried to keep all these tips in mind as I have talked with family members and friends as well as people at work.

2. Discuss your feelings/experiences from the team activities? Did it change your opinion on the subject? If so, how? If not, why?

I hated the collective bargaining assignment. And that’s all I’m going to say about that. The team test #2 was interesting. I was assigned question #2 about a man with AIDS who did not want me to tell his wife about his condition. His wife happened to be pregnant with their unborn child. He threatens to sue me if I tell her. I asked throughout the week different people’s thoughts on the matter. Most everyone did not know but erred on the side of caution and said, stick with HIPAA. Some said there is no way to get around HIPAA. I just really felt like this couldn’t be right and researched it and found that there are ways to get around HIPAA, such as in the case of child abuse and dealing with a contagious disease (public health threat).  So this was very informative for me.

3. How you will utilize the information learned in your nursing practice.

I used the information I learned throughout the week but especially today. It was psych day in the ER. There was a 14-year-old girl who would not get out of her dad’s car but had made comments about thinking of hurting herself to several people. She was angry and felt like no one cared about her and was very hostile towards me at first. I tried to remember the tips for effective communication and listening and employed them. I still was not able to talk her out of the car, but whereas she was hostile at first, as I talked to her she calmed down and she was more civil and calm with me. 

I also used it with my family. I realized how important communication is and how messages can get so misconstrued and blame placed falsely if we are not assertive in our communication. But also that we can be assertive while still allowing another person to have their say, their opinions, and respect.

4. You personal feelings about the material covered.

I think it has been very helpful and is information I will hang on to. I can use it in every area of my life but especially in areas of leadership.

Operation and Strategic Planning – Week 11

1. What did you actually learned from the unit?

I learned that attaining a goal requires steps and planning and I learned what those steps entail in the corporate setting. I also learned that these steps don’t necessarily have to apply just to work or business but that I can apply them to my personal life. I actually did apply it to a family council we help this last week. We have a very sensitive, delicate, and difficult family situation we are dealing with and I was feeling like we were being driven apart as a family. I used the format that we learned this week. What is our family vision? Where are we and where is it we want to go? How do we get there? I don’t know that this situation can be data driven but the steps and ideas we came up with are definitely in the best interest of our family. It was very helpful to give the council some format, substance, and direction.

2. Discuss your feelings/experiences from the team activities? Did it change your opinion on the subject? If so, how? If not, why?

I have to say I hated the group activity this week. I am in no way a gamer. I hate electronic games. I have never picked up a game controller in my life. Not once. So I was confused by the assignment. I relied heavily on my team members to get most of the assignment done although I did add written ideas as to what I believed our town needed and where I did not do the actual placement and don’t know how we were to compete against another team. Other than just pretending in real life we were competitors but not really making moves against each other in the game. Glad I had a team for this one.

3. How you will utilize the information learned in your nursing practice.

I can see myself utilizing this information in every area of my life, not just in my nursing career, as I did with this family council. I will apply it if I am ever placed in a position of leadership to garner help and information and input from coworkers as well as helping to attain any goals for the department. I could also use it to communicate to family members about their very ill family member. When they are trying to decide on what to do for end-of-life care for their loved ones, I can I ask the pertinent questions, educate and allow them to answer themselves. What do you want to see happen with your loved one? What is the situation now? Where is it you want this to go? Or what will be the most likely outcome? How can we help your loved one attain their wishes or how can I help the family member? Is their decision in the best interest of the patient?

4. Your personal feelings about the material covered.

This information can be applied in so many ways to so many situations. It was VERY helpful to learn and came at a very opportune time for me this week. I love structure and having direction. I know that these things are very fluid and change frequently and must be reassessed frequently but it is nice to understand a format and a structure to the goals and decisions.

Managing Change

I learned a lot from this unit. Managing change is difficult whether it is change in our personal or business lives. In making changes we must ask ourselves if the change is realistic, is it achievable, and is it measurable? We also need to ask ourselves What do we want to achieve with this change? Why do we want to achieve this? How will we know it has been achieved? Who will it affect? How will they react? How much can we do ourselves and what parts will we need help with.

When we are initiating the changes we would like to see come about we need to thoughtfully plan, implement the changes with sensitivity and make sure to consult and involve the people who will be affected by the change.

I absolutely LOVED the story of, “Who Moved My Cheese”. I even downloaded it on to my reading files to keep and refer back to in the future. I started reading and by the end had jotted down two pages of thought nuggets of wisdom about change, about fear, about facing life’s changes with enthusiasm and hopefulness. The best sentence and a thought I will want to ask myself many more times in my life was, “What would you do if you weren’t afraid?” This is such a motivating statement.

I will use this knowledge in my nursing practice to anticipate change, accept change without grumbling and blaming, looking for the good things that can come from that change, and not being afraid of the change. In a leadership position, I will be very sensitive to the people that change effects and try to involve them as much as possible in the changes I want to introduce.

Career Planning and Staffing

This week we discussed career planning and staffing issues. I’ll start with staffing. Staffing is only second to budgeting in subjects I want to avoid.  Both of those subjects are a little computational and I know that I have a computational weakness as well as an inability to easily connect the abstract or conceptual aspects of math or numbers with reality. I can see it distantly as making sense, but then when it comes down to putting numbers or the order of something on paper, I get confused or overthink stuff. So I was glad to have to contribute to our staffing assignment only 1/5 part and that my team members must be better at abstracts than me. I learned that staffing is much harder than it looks and I’m glad I don’t have to do the schedule at work. I also understand why nurses are called off and census counts are so important now.

Now, career planning… this was an interesting subject to discuss. I learned there are some very ambitious nursing students that I am in class with. I was interested to read about their goals and how they intend to get there. I think the future of our younger nursing students is bright and mostly they are a great group heading out into the world. Lots of hope. 

The Future of Nursing

This week we talked about and listened to a presentation on the Future of Nursing. I can say that a lot of lightbulbs came on in my head this week. As I learned about the initiatives in the Campaign for Action for the Future of Nursing, I realized how much HCA has been pushing for these initiatives. There have been many things instituted over the last few years that I didn’t understand and may have balked at. But when taken as a whole looking at the big picture with a purpose instead of just piecemeal requirements, it all begins to make sense. It makes me proud to work for a company that recognizes nursing as a profession deserving of respect and progress and as an important contributing part of the future of healthcare. They have been very supportive of the continuing education of their nurses through Healthstream modules every year, making sure professional credentials are up to date and making those classes available to their employees. They started a nurse residency program for new nurses and are investing so much money into the reimbursement of tuition for RNs going back to school to earn a BSN.

Watching the presentation by Dr. Gonzalez-Guarda, made me proud to be a nurse, it made me excited for the future of my profession and it made me really want to continue my education to become an APRN. It made me realize what a unique position we are in as a profession on the frontlines of healthcare to contribute to the conversation of the shaping of health care. 

 

Budgeting

I understand that I am growing and stretching and supposed to be doing things that are hard for me because that is how I will grow, but I am just going to say that I hated this week’s topic and work. I learned that being responsible for the budget in a department means making tough decisions sometimes. Throughout this course, I have been discovering what my ER supervisor goes through. I have learned that he is actually very good at his job and that I don’t want his job.

Budgeting is not my forte’. Numbers baffle me and that’s why I didn’t become an accountant. My brain just doesn’t think that way and everything becomes very jumbled in my head but I can look at a spreadsheet such as the one we did this week and see some areas where there might be problems. I would like to have brought this budget example to my supervisor to get his ideas and see how he would look at it. I think that I still will just to get his feedback. 

The discussion on the budget was actually very interesting to see what thoughts everyone had. There was disagreement and some really creative ideas on ways to save money in the department. That’s why we work in groups or teams to tackle stuff like this because everyone has a little different perspective and input and ideas to solve the problem. It all works together to make a good plan, or at least as good a plan that we can facing this kind of budget cut. 

I will use this knowledge in my career by being supportive of my manager when he tells us we need to cut certain budget items or to be wary of wasteful practices. I will look for ways that will save the department money.

Firing-Discipline Interview

This week I interviewed Daren Rigtrup who is a co-owner of the Rigtrup Egg Farm in Santaquin, Utah. I learned that we had too many close-ended questions for this interview. I also learned that what Sean taught us in his lectures in this module, was followed by Daren as well. Three write-ups before being dismissed, verbal warnings and how they are stored, and having someone from HR in on the firing moment. 

It was interesting to note that when an employee is fired, they are usually not surprised by it because they have had the previous warnings which leads to how Daren is able to do the difficult thing of firing someone. These people know what is expected of them and yet even after three warnings, continue to choose a path that they know will get them fired. The only thing that does surprise them is that they aren’t getting more chances to screw up.

The interview questions and answers were as follows:

How many disciplinary write-ups can an employee receive before they are dismissed? Three.

Are verbal warnings given? If so, how are they recorded and how long are they kept? Yes.  They are recorded on an employee verbal warning log and are kept for one year.

When terminating or disciplining an employee, do you have to include personnel from HR? Yes.

During verbal or written warnings, is it made clear that the employee’s job is in jeopardy? Yes.

Do employees have the opportunity to respond to allegations and if so, is it a verbal or written response? Yes they are and it is in either form but almost always happens verbally.

How comfortable are you with disciplining or firing employees? If you are uncomfortable, how do you manage to do it? It’s never easy to fire employees.  I manage it by recognizing they chose their actions and because of those choices they had to pay the consequences which they agreed to when hired.  

What rules and regulations exist to protect employees from being wrongfully terminated? The rule we have in place is that 3 people have to be involved in the decision to terminate an employee.  One of those has to be the HR rep. The HR rep is supposed to represent the employee and make sure their side is being represented fairly.  

How frequently is someone actually fired rather than just disciplined? We have 38 employees and this year, there have been 3 people fired.

How do you go about firing an employee while attempting to remain on good terms? We do our best to keep calm and professional and emphasize what steps led to the firing.

Who is present from the company when an employee is getting officially fired? How does that meeting typically play out?  Almost always it is the person who hired them which are the two managers we have.  Occasionally the owner has had to step in and do it but that has been less frequent.  The meeting usually goes as normal as can be. In most cases, the employee isn’t surprised because of the previous discipline that has taken place.  Some are disappointed thinking they should have more chances but our program doesn’t allow it. (If we make exceptions for this employee and not that employee, then control is lost and the program is meaningless in the eyes of employees.)   

NURS 4500 – Week 6

I learned in this unit that ethics committees can be a great help source for us to work through ethical dilemmas that we face. They are not the final answer but a piece in the puzzle in helping to make wise decisions when it comes to ethics. I learned that coming together with different outlooks or ideas on an ethical dilemma often helps us to come up with a solution that may serve all or at least that can be acceptable to most. Ethics committees can help to create and maintain an ethical environment for healthcare workers. I also didn’t realize but learned that an ethics committee can be made up of lay people and that it doesn’t really have any teeth but just offers an opinion.

I don’t think I really had an opinion on the subject of ethics committees. I just knew they existed but had never used the ethics line.  I will definitely consider using the ethics line if I come across a difficult decision at work that I face or come across a policy I think is unfair.

I don’t think I want to be on an ethics panel. I think it would give me a headache to be bombarded with so many points of view or to construct different scenarios and their possible outcomes. It would be very difficult.

 

Performance Appraisals

This week we focused on Performance Appraisals. I really hope I never have to do these or next week’s topics. However, I did learn a lot from Ron Porter who is the CEO of Lodgable. It is a website where you can go to and see all the different vacation lodging rental website offerings such as VRBO, HomeAway, Airbnb, etc. He also runs a fitness drink company. His answers were much more inclusive than last week’s interview and I learned much from them. As last week, I wanted to post his interview answers so I can remember them in the future. Some of the key things I noticed in Ron’s interview were that communication is key and making sure everyone is on the same page and has a good understanding of what is expected of them before they are even hired. Also that, at least for Mr. Porter’s company, the evals are not as important as touching base with the employee and having that line of communication open. Ron Porter’s Interview – Week 5:

Performance Appraisal Interview Questions

How often do you conduct performance evaluations? Would more frequent mini evaluations to check on the progress of the employee in accomplishing their annual goals be helpful?

a. This has varied throughout my career.  Large corporate environments we conducted Performance Evals quarterly.  In the small business we have annual performance evals with weekly KPI reviews.

b. Yes, mini or informal, focused KPI reviews are essential to accomplishing the “Real Work” required to achieve objectives.

What information do you base your evaluations on? What or who is the source of information to determine whether the employee is performing effectively or not?

a. In my current environment, the evals are based on KPIs (Key performance indicators).

b. The individual responsible for the KPI and relevant co-workers (is the reviewee accomplishing what we all agreed to?)

What are the top indicators you look for to determine whether someone is a problem employee or an exemplary employee?

a. Performance against KPIs

b. Alignment with company objectives

c. Contribution to culture (it’s more than just work)

How do you assess if employees are unhappy or unable to do their job? Is there a resource for them to voice concerns if they have them?

a. Pre-hire assessments are critical.  In addition to reference checks, when interviewing a potential hire, we request they take a day to participate in a “This is the kind of work you will be doing…” We observe how they perform if they really know how to do what they say they can do & what we need to be done. Weekly team face-to-face performance reports are conducted in an open & honest forum.  The “reviewee” knows & so does everyone on the team if someone is unhappy or inept.

b. Yes, Human Resource Director & Owners all lend a listening ear.

What kind of support opportunities do you give employees after they receive a bad evaluation? What is the timeline/expectation for improvement after a bad eval?

a. One-on-one training. If relevant, training course (online or in class), assigned mentor, review of KPIs for clarification & expectation. Emphasis on personal accountability.

b. Timeline depends but in small/lean business environments everything is critical so we don’t have the luxury of letting “Fake Work” linger on.  Typically 30 days.

Do you set company goals? How often? Do you encourage employees to set goals within their department or individual goals?

a. Yes.  At least annually.  Market changes may dictate we do this more often.  A certain amount of flexibility is required but moving targets can kill performance & culture.  Skill & art required here.

b. Company goals dictate department goals. Department goals dictate individual goals. Everyone better be aligned and that alignment is an ongoing exercise.  Real Work becomes Fake Work without continual assurance of alignment across the company.

What systems are in place to motivate employees to perform well as far as incentives or repercussions based on the outcome of their evaluation?

a. Pay for performance (Profit sharing)

b. Owners understanding of what motivates each individual and crafting incentive to that end.

How much does a potential pay raise for employees factor into how you conduct performance appraisals?

a. If I’m understanding this question correctly, potential pay raises don’t factor into how a performance appraisal is conducted.

After you conduct a performance evaluation, who else sees this information in your company? Where is it kept?

a. HR Director. Other Owners.

b. HR office, personnel files in locked cabinet.

Do you feel that formal yearly evals are helpful, or is there something you think would be better for giving employees feedback?

a. In & of themselves, annual evals are zero to marginally successful when it comes to ensuring the effective & efficient performance of work to required objectives.  In our environment, a year can be a LIFETIME. 🙂 The project-by-project, day-by-day, week-by-week KPI reviews & alignment checks are most effective.