This semester I learned about how much goes into being a leader. I had no idea the things that my nurse manager had to deal with and I didn’t know how much went into keeping our staff organized and happy. I think that it was good to be able to learn these things, even if I don’t have interest in being a nurse manager. It is good to know why there might be changes in policy or why managers do the things they do. It made me want to be a better employee and try and understand change and adapt to it. I found that there are ways to also be an unofficial leader in my nursing practice. I think that there are ways that I can influence those around me and help them to be motivated. I think that overall the lessons that we learned each week were useful and I am going to try and be better at applying them in my practice. I didn’t think it was going to be beneficial to work with a team online because you miss out on the face to face aspect, but I was actually pleasantly surprised by how well we did at communicating. The group activities were good at helping us problem solve and I also really enjoyed getting to know things about my team members that live in different states. It has been cool to go back through and read my journal entries from throughout the semester and reflect on the things that I learned and the activities that I did.
Risk management and legal responsibilities of nurse leader
This week as we discussed the nurse leaders legal responsibilities and involvement in risk management, there were quite a few things that I learned. It was interesting to be able to read a journal article concerning the topic.
Journal article: Connecting nursing leadership and patient outcomes: state of the science by Carol A. Wong, RN, PhD https://doi.org/10.1111/jonm.12307
In this article, the researchers performed a systematic review describing the evidence linking leadership with patient outcomes. They concluded that there is a clear connection between supportive leadership approaches and positive patient safety outcomes and higher patient satisfaction. They found that the “leaders’ value for and knowledge of patient care requirements, the quality of their interpersonal skills and their facilitation of healthy working conditions and engagement in leadership behaviors that inspire nursing teams to higher levels of performance are important predictors of improved patient outcomes.” (Wong, 2015)
So basically from the article, I learned that it is important for the nurse leader to
- know what patient care requirements are and value that knowledge (continue educating)
- develop good interpersonal skills
- facilitate healthy working conditions
- develop good leadership skills that inspire nursing teams
If the nurse leader develops these skills, they are more likely to decrease risks and will improve patient outcomes. It is important for a nurse leader to have this basis because they will be able to determine what practices might be leading to increased risks and they will have the better ability to handle situations that come up that are legally troublesome.
The discussion this week was focused on a dilemma that arose in an emergency room that was pretty complicated legally and presented a safety concern. It is a tough situation, but it really helped me reflect on the responsibilities that a nurse manager would have. The most important thing I think in that situation, is that policy changes should be made to prevent something in the future. I think that if a nurse manager recognizes the holes in the system, then they will be able to help prevent problems and learn from the mistakes that have been made.
I personally think that I will try and apply this week’s lesson in my practice by paying attention throughout my shifts and recognizing potential risks. I will then either adjust my own personal practice, or I will bring up the concerns with my nurse manager in order to help limit those risks for the safety of my patients. I will try and develop the skills mentioned in the article I read in order to prepare myself for leadership and for managing risks in the future.
This weeks topic focused on motivation, more specifically motivating employees. It was interesting to read about all the different ways that there are to actually motivate and to come to the conclusion that realistically each individual has different things that motivate them. This makes it pretty difficult when you are responsible for helping motivate a whole team. Basically, it is important to learn what does motivate each individual and to work to help motivate them. I started to reflect on things that really motivate me, and try to find out what I might need from my leaders to help me. I think that some of my main forms of motivation include
- Knowing that I can positively influence a patient or coworker. For example if I know that the next shift is really short staffed and that they have a need for someone to come in, I am motivated to come to work.
- Verbal recognition for my hard work (but individually.. I don’t like being recognized in front of groups for things. It just takes one person to say something like “You were really attentive in that code.” or “Thank you for helping me pass meds”
- Incentives (money, food, swag, etc)
Those are just a few things that I think motivate me personally, but I know that there are a lot of other things that drive me. It is different with each thing too. For example, to motivate myself to work out I like to watch a pump up video or listen to podcasts about people doing some awesome physical things (like super marathons, etc.,) Just by hearing about other people’s accomplishments helps motivate me to try and meet my goals.
If I were ever to become a manager or nurse leader in the hospital setting, I think that I would make this a question for quarterly interviews so that I could help my employees be motivated. I think that is important because then, I won’t be wasting efforts trying to motivate in a way that is not received. It was great to do the group work this week because it really helped me see that everyone is individually unique when it comes to morale and what they think will boost their moral. I am going to work hard to try and recognize when my employer is trying to motivate me and recognize that it sometimes takes different forms, and I am going to think about that with my patients too.
This week was about collaboration and compromise. It was interesting to be able to do some practice activities with collaborating like the game with different scenarios and also the activity where we were working as a union rep trying to negotiate pay. It was actually really difficult because I asked for too much at the beginning and it cost a lot of time and money in strikes, but it was also interesting to see that in the long run their were benefits for the employees that stuck it out and signed a 3 year contract. I never understood the point of strikes before but doing the activity helped me understand. Doing the group activities also helped to teach collaboration. I am going to further utilize the things that I learned this week by paying attention to the opportunities at work to collaborate and compromise. I don’t usually have to deal with it much because I am not a manager, but I did realize that oftentimes with some difficult patients there is an opportunity to meet them half way.
This week was focused on strategic planning. I thought it was interesting how goal-oriented effective planning is, which makes sense. In order to plan something, there should be a good end goal in mind, and plans should be made toward that goal. If there is not a clear place that we want to be, then we could basically go anywhere with our plans, and they won’t be focused. I haven’t thought about all the different planning that goes into running health care organizations. Not only do we need to plan for what is best for our patients, but also for employees and the community. In the group activity this week, it was difficult to decide what health care organizations should go where and to plan out what the best thing was for the community. I think that planning is something that is especially difficult for me because I am the type of person that likes to just go with the flow or “wing it”. I always have a goal in mind, but I don’t necessarily always sit down and plan out my path as often as I should. I think that that is something that I need to work on and improve if I am going to be a leader in healthcare. It doesn’t just mean organizing, but it means implementing as well. Lately it has been hard to plan when I will do my school work because I have been so burnt out and I have been so busy with work and personal life, but I think that better planning might actually just make everything better.
Interview with Sandra Schulz owner of The Cake
- How does one decide how to split up budgets? Do you split it up by dollar value or percentage?
- Percentages, because the dollar value changes each month depending on our profits.
- Do you have investors? If so do you recruit them or do most volunteer themselves?
- We had investors when we first started our company, but they have been paid what was promised them and we ended our contracts with them. They were recruited.
- Do you use a yearly budget or split it up to quarters and biannual budgets?
- Who decides on what the annual budget is?
- My husband and I do.
- How big is the margin for overage and what happens when you don’t stay within budget?
- We save 10% for overage mostly because of the chance that we won’t be busy some months. We usually stay within budget, but if we don’t, then the costs come out of our pocket.
- What is the disciplinary action when budgets aren’t met and where does the overage money come from?
- Since it is our own business, we lose the money.
- Do you oversee multiple department budgets? If yes, how are they different?
- If required to make budget cuts, where do you start? Do you prefer to cut employees or look for other options?
- I prefer to look at all options at the same time. I try to ask if there are days we have too many employees working. Are we wasting product?
- What do you find most difficult about budgeting for a company?
- It is never consistent from month to month and always takes a lot of time out of my week when I am budgeting. That is usually time I wish I could spend doing something else, and if we are short that month then it is very stressful.
- How does budgeting for a company differ from budgeting for an individual?
- It actually is pretty similar, but other people’s livelihoods depend on it.
After this interview, I learned that owning a small business is stressful especially when it comes to budgeting. I learned that there are so many different ways to go about budgeting and that usually the results of poor budgeting effects long term success. I learned that at least for budgeting for small businesses is very similar to personal budgeting. It takes a lot of discipline and you have to plan for unexpected results.
This week we learned all about the future of nursing. I thought it was interesting that this was a topic all on its own and it was actually really insightful. I learned that there are nurses out their that are advocating for the profession and that many nursing leaders truly believe that the future of nursing is basically the future of healthcare. I already knew lots of the information, like there is a disparity between gender and racial diversity in nursing, but I didn’t know that the goal in nursing was to fix that. I also knew that lots of nurses don’t go on to get graduate degrees. I think this is one of the most important changes that can happen in the future of nursing. I plan on going on to get a graduate degree, but there is this time in between where I want more experience and it is hard to go straight on to graduate school without working for awhile. I think that it is this time that a lot of nurses end up working and just stay working as a floor nurse because they like it or because life gets in the way and they never go back to school. I wonder if there is something that can be done to help keep nurses in school or to make it a little easier to go from bachelors to masters without all the experience. I think that after this unit, I am going to try and be more aware of what I can do to help with the goals that nursing leaders have made and try to help improve the future of nursing.
This week, the focus was on budgeting in healthcare. I think this is such a hard topic for me, because it is something that I hate that we have to deal with. Even though I am not a manager, I am definitely affected by budget issues. I am actually getting so sick of being short staffed and getting burned out because our budget makes it that our floor has high nurse to patient ratios. I think that there are so many areas that the hospitals and healthcare can cut, but the easy thing to do is to cut staff members. It has been frustrating to experience first hand the quality difference in supplies when the hospital switches over, so that is always frustrating too. If anything, I learned this week that there is never going to be a perfect solution, and there are sacrifices that always need to be made financially. It is just up to a good leader to decide what the best worst thing is for their unit and their staff. I think that communicating with staff members about the budget might actually help them to accept the fact that there are changes and might make these changes easier. Overall it was a good lesson this week, because it was eye-opening. I just hope I never have to be in this position of leadership because this just isn’t fun to me.
- Do you help the employees set goals to improve themselves before the next performance appraisal? Yes If so, what are some common goals that are chosen? Typically they are centered around helping the employee increase their competency and proficiency. Competency is focused acquiring new skills and proficiency is focused on mastering existing skills (requires tracking key indicators such as speed, rate, or quality of outcomes).
- How do you tell your employees to prepare for performance appraisals? I have found it best to have employees participate in tracking their progress regularly so that the performance appraisal is a natural and organic component of their work. A process and not a separate or dreaded event. Following this method means there should never be surprises for the employee during appraisals.
- How do you help employees feel comfortable (and not like they are in trouble for something) during their performance appraisals? The approach outlined in the last answer helps eliminate negative feelings about appraisals.
- What are some of the phrases and questions you use to invite change? The focus is on adding value and how the employee can identify areas which are strengths and areas are weaknesses. The goal is for the employee to be the main source of the evaluation. So simple language that fosters this is used. “What areas do you feel most confident?” “Which tasks do you struggle with?” “What gives you the most satisfaction?” “What assignment do you least enjoy/like?” “Brief & debrief, deconstruct, analyze,” Which types of phrases or wording to you avoid? Ultimatums or demands tend to be counter productive. Accusatory phrases cause the employee to be defensive. The purpose of an appraisal is to work with employees to develop strategies for adding value and increasing satisfaction/fulfillment for the employee, employer, and the customer. They should never be used as a mechanism for discipline or correction. Those should be handled separately and immediately.
- How do you stay consistent with your performance appraisals with each employee? Keeping the key indicators for growth and skill mastery simple, involving the employee in tracking those key indicators, and reviewing them regularly with the employee. These things help keep appraisals from being time consuming, cumbersome, and disruptive. Keeping things positive and constructive eliminates the tendency for avoidance by employees and the employer.
- How do you work with employees that have scored unsatisfactory for multiple evaluations? This should be an ongoing process that doesn’t just happen at an appraisal. If the key indicators are not being met consistently, it is critical to identify the underlying cause jointly with the employee and work to resolve it. If attitudes and actions are not improved corrective action needs to take place in a timely way. This should not be an appraisal, but a disciplinary action.
- How do you explain to employees that feel they have excelled more than what they were scored as on the evaluation? Using the method outlined in the response to question #2 helps keep the employees performance transparent and up-to-date so the employee can constantly and constituently measure it against clearly state expectations.
- Do you feel it is beneficial to gather peer reviews to include in the performance evaluations? No Why or why not? I have found that this approach creates division and negativity. The only exception to this is if employees have specifically been assigned to a project where the group is jointly responsible for a single outcome. Even then, the approach is more about evaluating themselves on the value they add compared to the group as a whole and not individual members of the group.
- Do you use a rating system (I.e. poor, below average, average, above average, exceptional) or just let employees know how you think they’re doing (I.e. I like your work in this area, you’re a good employee)? Yes, but the rating system is where they fall on the performance measures compared to the stated expectations and key indicators.
- Do you believe it is effective to use a rating system to give employee feedback? Yes Why or why not? Employees should know what is expected and how they are performing in comparison to those expectations. This helps them to know and understand how and where improvements are needed and how their strengths are adding value.
- How do you discipline those who are doing poorly? This is intentionally not a part of the appraisal process. It is far more effective to handle substandard actions and attitudes as they occur and individually. How many warnings do they get? Disciplinary action should not be a one size fits all or cookie cutter approach. It should take into account all the individual factors relating to substandard behavior. It should be fair, specific, and swift.
This interview was done with Kirby Sommerfeld, who is the owner and CEO of an orthodontic device company, Orthobility. He offered great insight into how he did performance appraisals with his company. I loved that he has employees keep track of their progress and he said that performance review is not an event, but a process. I think that is a really good way to help people stay motivated over time. I also loved that he said that we should adapt to employees and that it is not a one size fit all kind of thing. I think that is something that I would adopt as a manager or nursing leader on the floor is deciding what employees need and helping fit their expectations and needs during the appraisals.
This week was focused on ethical dilemmas and the use of ethics committees in nursing in leadership. I was surprised by the fact that they are not used that often in organizations, so it made me wonder why exactly this might be. I started to think about some of the ethical dilemmas that have arisen in my practice so far as a nurse, because surely I haven’t had any big ones right? Well, after thinking about it for a minutes, I realized that I had a dilemma last week. I had a patient with dementia that I admitted from a skilled nursing facility because of a new femur fracture obtained from falling. Upon admission, I found that she had bruising in some concerning areas and also had a recent history of some concerning injuries. We got the physician and authorities involved and steps were taken to investigate the issue. The son, who lives in Idaho is her only living relative and so he had the say in her care. He believed that we were being overdramatic concerning the possibility of sexual assault and stated he couldn’t believe any one would do that to an old lady. Because he is the one that has a say in her care, we could not do anything when he chose to send her back to the same facility. I remember that all of us that had taken care of her were outraged, but I kept getting the same answer from social work, case managers, and her physicians..”there is nothing we can do”. I still feel so upset at this injustice done to her and I wonder if maybe our manager could have brought up this situation to an ethics committee, since everyone felt the same way. Before this class this week, I didn’t even consider ethics committees as a resource, but now I know that I can bring situations like this up with them.
As far as our team work this week, I feel like I didn’t really learn anything new or feel like it changed my opinion on anything. I think that it just added more work. I did think it was interesting to see some of people’s responses and opinions.