Reflective Journal 12

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. 

Reflective Journal Week 11

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. 

Budgeting Interview

Interview with Sandra Schulz owner of The Cake 

  1. How does one decide how to split up budgets? Do you split it up by dollar value or percentage?
    1. Percentages, because the dollar value changes each month depending on our profits. 
  2. Do you have investors? If so do you recruit them or do most volunteer themselves?
    1. 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. 
  3. Do you use a yearly budget or split it up to quarters and biannual budgets?
    1. Quarters
  4. Who decides on what the annual budget is?
    1. My husband and I do. 
  5. How big is the margin for overage and what happens when you don’t stay within budget?
    1. 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. 
  6. What is the disciplinary action when budgets aren’t met and where does the overage money come from?
    1. Since it is our own business, we lose the money. 
  7. Do you oversee multiple department budgets? If yes, how are they different?
    1. No. 
  8. If required to make budget cuts, where do you start? Do you prefer to cut employees or look for other options?
    1. 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? 
  9. What do you find most difficult about budgeting for a company?
    1. 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. 
  10. How does budgeting for a company differ from budgeting for an individual?
    1. 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. 

Reflective Journal Week 8

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. 

Reflective Journal Week 7

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. 

Performance Appraisal Interview

  1. 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).
  2. 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. 
  3. 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.
  4. 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.
  5. 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. 
  6. 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. 
  7. 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.
  8. 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.
  9. 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.
  10. 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.
  11. 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. 

Reflective Journal Week 6

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. 

Reflective Journal Week 5

This week we learned about performance appraisals and some of the reasons that we should have them. It was also very interesting to learn about the different strategies that could be taken with performance appraisals. At work, I have only had them at the end of the year when we were going over goals and about to get raises, but now we get them quarterly. At first,  I remember thinking that I was in trouble or thinking that I must not being doing great at my job, but it was good to find out that every one else was getting their performance evaluated as well. I had a good short talk with my boss, and I found out what I had been doing well, but also learned what I could do to be better. I actually ended up realizing the importance in evaluation, because if we don’t know what we are doing well, then how are we ever supposed to improve? During this unit during class, I liked learning about the different ways in which we could evaluate performance, and I decided that even though I am not a leader on my unit yet, I could use some of the strategies during my shifts. I get some students and orientees every once in awhile, and I decided that I am going to use the language that we learned in this unit during my education with them. I also think now I am going to be much more willing to listen to my evaluations and I am going to look at it as an opportunity. 

During my study this week, there was one post that I came along, and I thought that it would be very useful in my work as I come up with my own goals.

https://www.tinypulse.com/blog/sk-useful-phrases-performance-reviews

One thing that hit me this week was the fact that Sean said most nurses are disappointed to see that they are hitting a “3” or “average” in their job evaluations. I think that it is true, must of us are so used to going above and beyond at work, that it is hard to just see ourselves as average. I decided that I did not want to be seen as just average, so I went and asked others on my unit what they did to go above and beyond the call of their job. I asked them if it was actually worth it to take on extra responsibilities. I also asked them how they thought I could start to become a better nurse on the unit and contribute in a greater manner than just “average”. Most of the people I talked to told me that taking on leadership roles such as becoming a “super user” really showed your dedication at work. They also said that it was important to listen to the manager during our weekly meetings and listen to what we could do better, then that week or month just go above and beyond with that task. For example, this week our manager talked about using the 4 P’s when doing our hourly rounding and also updating the “what is important to me” board. I noticed that he had talked about it a lot, so I tried to do my best every single shift this week. I kept my board updated, and I made it a habit to ask every patient every single one of the P questions each time i was in the room. I don’t actually know if my manager will ever know that I have been working on it, but I think that it will be something that I can bring up to him during our performance appraisal and might be something that I can help others work on as well. 

Overall, learning about performance appraisals has been beneficial to me as an employee, even though I am not a leader on my unit yet. I hope that just knowing how beneficial they can be will help me be an “above average” or “excellent” employee. 

Characteristics of Leaders

1.       Leadership requires personal mastery – Nurses demonstrate leadership when they show competence and mastery in the tasks they perform. Nurses are deemed competent by means of a license to practice nursing (NLN 2010).

2.       Leadership is about values – Nurses demonstrate leadership when they determine important values to act upon. Nurses are encouraged to act on values by demonstrating the honesty and trust through the care they give. One example is by maintaining HIPPA even when it is difficult.  

3.       Leadership is about service – Nurses can demonstrate service by going above and beyond the call of their job description. Nurses can demonstrate service by taking extra time to distract a patient from their pain by finding their favorite tv show or helping them dial their family on the phone. 

4.       Leadership is about people and relationships – Nurses demonstrate leadership by focusing on relationships with coworkers and patients alike. They demonstrate their care about people by being engaged in conversations and listening to patient’s concerns. 

5.       Leadership is contextual – Depending on the situation, leadership styles might need to change to fit what is most appropriate. A nurse demonstrates the ability to do this by assessing a situation continually and working with his or her team to help solve a problem. 

6.       Leadership is about the management of meaning – As stated above, a key part of nursing is interpersonal relationship. In order to have therapeutic communication, a nurse must demonstrate their ability to change the ways in which they communicate depending on the needs of the patient. 

7.       Leadership is about balance – A nurse must be a master of all things balanced; balancing time, balancing relationships, balancing priorities and tasks, balancing needs. 

8.       Leadership is about continuous learning and improvement – Nurses demonstrate their ability to continuously learn by participating in continuing education formally and also informally. They are aware of what is going on with the latest evidence based practice and work on applying this to their own practice. 

9.       Leadership is about effective decision making – A nurse is continually faced with decisions to make during their time at work. Many of the times they must decide which patients have priority over others, which treatments are most important, and what problems they must solve. They demonstrate effective decision making by applying the nursing process to their practice. 

10.   Leadership is a political process – Nurses demonstrate leadership by being involved in both governmental and facility politics. They stay informed on laws, rules, and practices where they practice and are involved in standing up for their rights and their patient’s rights. 

11.   Leadership is about modeling – Nurses are appropriate models in leadership because of their ability to demonstrate example of the other attributes of leaders. 

12.   Leadership is about integrity – Nurses demonstrate integrity because they are usually required to work autonomosly and are put in situations in their every day practice that could compromise their integrity. One such example is a nurse that administers narcotics and does so appropriately without stealing or administering the wrong amount, even if their could be financial gain. 

DISC personality test

This week I took the DISC personality test that distinguishes between Dominant, Influential, Steady, and Conscientious personality types. Out of the 15 possible options,  I scored 9 in the first type, the Dominant personality. 

According to the test “A dominant person generally is a direct, positive and straightforward person. He likes to be in charge, do things fast and wants immediate results for his efforts. He is a determined, independent person who likes to solve problems and face challenges.

People who belong to this category are probably the sales superstars and the kind of strong, entrepreneurial leaders. They are people you want to have around in your organization. They are very results oriented and you can expect to see things getting done efficiently. However, they have very low patience and you must continually engage them to keep them in the organization.

They will stay with you to the extent that they feel that following you helps them to achieve their personal goals for their life. Also, they might be cause for some conflicts between people because they’re more task oriented and they would probably step on some toes along the way. Be careful about putting two Ds in the same team, conflict will always arise from two strong-headed individuals.”

I feel like I already basically knew that I was this type because the words that people have always used to describe me are “strong willed” and “impatient”, so I figured that would be the type I am. I always feel like I have pushed back against being a “red” personality trait because I think that the words all describe like an overbearing and rude person. I have tried to look after some of the positives in the trait and tried to develop some of the desirable traits in each of the categories. Overtime I guess I have just come to accept that there are things that make me good at certain tasks with this personality trait. For example, I get stuff done. I am quick and efficient and this really helps me in situations such as emergencies in nursing. During the codes I have been a part of, I am always good at quickly assessing the situation and doing what is necessary quickly and thinking fast. I have found that I am always a couple steps ahead during these types of situations, so it makes me a good person to have on a team. 

I understand that I usually clash with leaders that are the dominant personality trait, so when I think of myself as a leader I try to make sure that I am not dominating the situation and try to allow others to express their opinions and make their own contributions as well. 

I honestly think that there is more to leadership than just the 4 personality traits, but I think it is a good start to realize where we tend to lean and work on gaining good attributes from each type.