Clinical Update for the Week of February 21

Managers sure go to lots of meetings! If you are not in a meeting, then you might be planning one! I got to go the managers meeting. It was interesting, they have it once a month; they also meet with corporate once a month. In this meeting, we reviewed scores, the budget, and speed rounding with the axillary services. The focus this year is service excellence. I was glad it was not my first budget I had ever seen. I still don't really understand them very well. I did learn that FTE means full time employee, they kept talking a lot about that. I got to help plan and present at the staff meeting today. It had a really good turnout. I was so happy to see the nurses start supporting bedside report. Looks like the unit is matching what the literature is saying. Managers are also problem solvers. They answer lots of emails, and help the staff and patients any way they can. My favorite thing about management so far, is that it has a greater flexibility for a work schedule. However, you have a different higher stress. You are constantly thinking about your unit & what you need to do to improve it. It is not a job you clock out and not think about until you clock back in, which I suppose is good and bad. Can't wait to see what I learn about next week!

Lesson 8: Nurse Manager’s Roles and Functions in Hiring, Team Building and Staffing, Career Development Stages and Personal Career Development

In your blog (Reflective Journal), thoughtfully record a personal career development plan.

I definitely viewed my job as a job not as a career until recently. Lately, I have been trying to increase my perspective. I definitely fall into the category like most new professionals who neglect long term career plans. I have big broad ideas. I know I do not want to stay on my floor forever. There are too many things in nursing that I want to try. I have always wanted to in pediatrics; I loved my clinical experience there. Right now, I am not sure what to do with my life. I'm not married and don't have any kids. I don't have all the pieces of the puzzle right now. I could be perfectly happy, working only 1-2 days a week, so I can be home with my kids. However, I don't know if this will ever be an option for me. I have applied to the University of Utah's DNP Family Practice program. I don't know if I really want to do it or not. I know that if I have to work full time and be a real bread winner, I would not like being a floor nurse forever. There already are parts of me that desires that next step up. I would like to be a DNP either on a Trauma Team or at a private clinicians' office. However, if I get to only work a little, I don't think I would get burnt out on being a floor nurse. Right now, I am happy being a floor nurse, there is still so much for me to learn. However, it feels so stressful that I want to do something else! If I am going to become a DNP, there is no better time than now. I have applied to keep my options open. Part of me really wants to get in, and the other part of me wants to just work and buy a newer car. I do know that I have to learn to make the job that I have now, more than a job, a step on my career ladder. I enjoy taking care of patients, but I get so sick of being the middleman with all the responsibility and at times it feels no back up from the docs. Nurses are the middleman that are greatly under appreciated. The patients do not have a clue as to what goes into organizing their care, and the docs often get frustrated with the nurses because of they do not like the way the system works.

So with all of this indecisiveness, how am I supposed to thoughtfully record a personal career development plan? Here it goes... I do have mentors on my floor; there are some really good nurses on the floor that I want to be like. I have set a goal not to grumble over education pieces, but to take every opportunity to learn that I can. I do keep a professional portfolio, which contains a career statement and personal goals. I want to be a good clinical nurse, but also a nurse who cares for the individual. Thereby practicing holistic nursing and evidence based nursing. I don't exactly know where my career will take me, but I can take these principles with me where ever I go. I also want to teach nursing someday. I never thought I would, but after working with my clinical educator I knew I would love teaching. My current plan if accepted to the DNP program, is to become a DNP now and also get a teaching certificate. Thereby, I will be able to fulfill both dreams. If I don't get in, I haven't decided whether or not I will try again next year or if I will wait maybe another 5-10 years and then try again. The good news is that I do not have to decide today. My personal career plan has some holes in it currently, but I am learning and growing everyday. I may or may not become a nurse practitioner ever, but it is up to me to turn my job into a successful, meaningful career.

Lesson 7: Managing Healthcare Resources

I find that I use my time much more effectively when I am busy than when I have all day to do a project. You waste a lot less time procrastinating. I think it is very easy to fall under the traps of whatever hits first, the path of least resistance, squeaky wheel, managing by default, and waiting for inspiration instead of actually prioritizing what you need to do. Sometimes a task seems so overwhelming, but when broken down into small manageable tasks it becomes much more "doable." Often we think we are wasting our precious time by writing down a list of what needs to happen and prioritizing that list. However, in the end it will save you time, and it will help you to accomplish truly what is most important first. Prioritizing has to happen all the time. Maybe what was most important 2 hours ago, is not currently the most important thing if something else comes up, so you have to be flexible. The manager I follow, usually starts the day by trying to clear off her desk of papers that people have left for her. This helps her see what things she didn't know about need to be done. One of the most challenging things for prioritizing in management is that you are constantly interrupted.  If you feel you do not have enough time to do everything you need to do, then looking at your internal time wasters will help you know how to reevaluate how to properly spend your time.

One thing that I do not understand is that Medicare and Medicaid are the largest purchasers of managed care in the U.S, but they do not pay 100% of the bill. Why are they allowed to choose what they will reimburse? Legally you can't deny care, so the hospitals have no choice but to charge everyone else more. In reality we already are mostly socialistic when it comes to payment. A little needs to happen here...

I can't wait to ask my manager more about the budget. From reading the book it looks complicated and tricky. The three major types of budgets are personnel, operating and capital. The two most common budgeting methods are incremental and zero-based. I can't wait to see how this works in reality by following my manager more! I can see how budgeting would be stressful, for you have to do so much usually with so little!

I know I am guilty of often under-delegating. I feel bad to ask someone to do something that I am perfectly able to do myself. However, my aid cannot do everything I can do, so I do have to prioritize and delegate when needed. I have gotten better at it, compared to when I first starting being the RN, but there is always room for improvement. Delegation must follow the "5 rights" (task, circumstance, direction & communication, supervision & evaluation, person, )! Delegation for the manager is a necessity. My manager has an assistant manager and a clinical educator to help her. Often she delegates appropriate tasks to them. They also are very useful in covering for her when she is on vacation. My manager often states she is so grateful for the nursing team she gets to work with, for she couldn't do her job without them! Good management often leads the way to good teamwork.

A little side note...

Last week I took the textbook into the clinical educator and showed him the chapter about change. After skimming it, he did get some good insight. He stated that we definitely need to work on educating people on the benefits of bedside report. It was going to be very important to not allow the charge nurse meeting to not turn into a griping session. When the meeting did start heading in that direction, he was able to steer it away from that through his excellent leadership skills!

Clinical Update

Change is very hard. I was able to help present at the charge nurse meeting about the benefits of changing to bedside report. I made a poster board for it, and it will be left in the break room for more people to read. We are having a special staff meeting next week on bedside report. I also made the flier for the special staff meeting and I even made a banner last week encouraging staff to do bedside report. The charge nurse meeting was very hard because it is more of an informal meeting with very strong personalities. There was one charge nurse (one of the most experienced on the unit), who was very supportive about the change. She stated how in most of the changes she had fought now she wouldn't have those any other way, and this very well may be one of them. Another charge nurse was very discouraging and had the attitude of well they are making us do this so it doesn't matter what I think. Others were worried about the logistics of it all, but were willing to try it. I think after the meeting we will able to change the feel from complete resistance to let's try it and figure out how to make it work. It was hard to get out of the discussion mode and more into a presentation mode with it being more informal. We needed to teach people about why it was good before they could buy into it. The charge nurses are the leaders on the floor. Once we get them behind it, others will also be behind it due to the simple fact that they will follow their peer leaders. A unit must have leadership in management members but also in the leaders on the floor. It would not work without both sides. You don't have to be a "charge nurse" to be a good leader on the floor. Others follow good leaders, but that good or bad. Hopefully the leaders on the unit are also those behind you/management. Change is hard, but it can be very beneficial. We just have to not be afraid of new ideas and willing to try new things before we form an opinion about them, which can be very challenging!

Lesson 6: The Nurse Leader’s Role in Managing Change

What is your attitude toward change? Record your attitude in your blog, Reflective Journal.

No one likes change. We all resist against. But it is like the Who Moved Your Cheese? book, you can either starve or venture out into the maze in hopes of finding cheese! In health care, things are constantly changing. Often I feel, I just got one thing mastered only for it to change again. Sometimes change is for the better and other times it feels just like a major pain! Often we do not see the benefits of change until much later.  Other times it is only through statistical analysis that we are finally able to see the positive effect. As a new nurse, I feel I am more likely to be less resistant to change because I have not done it "that way" for years. Everything is new and I have to learn it. So what is one more thing to learn? But I can see how it would be very frustrating to a nurse to have to change her system after she has found a way to make it work efficiently for years only to have to learn another way.

The hardest thing about change is that usually it stretches people's comfort zones. Some people are better than others at trying new things and not getting stuck in a rut. I like consistency and have to fight the getting stuck in a rut phase! I am all for the change if I can see the positive benefits for it. I have a really hard time if I cannot see the "why" we need the change. You make me a believer of the "why," and I will full heartedly make the change.

This has been very interesting to watch in clinical. The hospital is switching to bedside report. When I first heard about it, I thought this is so stupid! It will take so much time! I hate it when administration gets an idea, and we all have to suffer! But as I have done my research I have found how beneficial it is. When I actually tried it, I realized it was really painless. I just have to get used to it.

Other nurses on the floor have had a similar response. Others are stuck in the anger phase right now. Others have been onto the denial phase, replying that they will "bite the bullet come March" (when it becomes mandatory). I think it will help once the staff meeting comes, where the reasons for bedside report can be taught. The best way to  motivate change is through knowledge. The power of education is great. This is what I was discussing with the educator. I loved reading about rational-empirical strategy because that is what I was telling him basically (the resistance to change comes from a lack of knowledge and humans are rational beings who will change when given factual info supporting the need for change). The book states that before any change can occur, people must believe the change is needed. Right now that is definitely the problem! If the educator can help people see it is needed, then we will be able to transition to bedside report successfully. I do believe that it will take a good 3-6 months (like the book says) before people start seeing the difference and truly become comfortable with the change.

I also really like how the book says that change should not be viewed as a threat but as a challenge and a chance to do something new and innovative. I want to be like that!

In my clinicals I have got to go to a lot of meetings. It is impressive to see all that the administration does to keep the hospital striving for excellence. Attending these meetings has made me more grateful for the company that I work for. I am so glad that I get to work for them! I even got to be involved in a planning meeting for a charge nurse conference. I love how much strength there is when you pull people with lots of experience together!

All my experiences following my manager has made me think more about how to take my nursing from just a job to a career. There is a real difference. Right now I treat my job just as a job. Between work and school that's how I have coped, I guess. I need to change my ways.... oh that word change again!!!

Lesson 5: Organizational Structure, Power and the Role of the Nurse Leader

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  • Discuss in your blog, “reflective Journal”, the patient care models used in the organization where you are employed. What works well in the model? What doesn’t work so well?
  •  I work under a functional method to deliver nursing care. I work in a team with a Patient Care Tech (PCT). On days, the RN is assigned 1 PCT to help deliver care. The PCT is responsible for bringing me vitals, doing I/Os, hygiene, ADLs, etc. What works well is that this is cheaper. It is nice to have to 2 people assigned to the team, to help reposition/walk often takes 2. What doesn't work so well, is if the PCT is not very good. For example, if they do not tell the nurse that a BP is low or high/the RN does not find out about it until later, which can be problematic. Overall, I really like this team approach.
  • In your blog, “reflective Journal”, Differentiate among the different types of power and identify strategies to increase your personal power base. What are your thoughts about power and how it is used? 
  • Reward power is gained by grant favors/rewards. Coercive power is punishment power,  which is based on the fear of punishment (transfer, layoff, demotion, or dismissal). Legitimate (authority) power is obtained by a title or official position within an organization. Expert power is power through knowledge, expertise, or experience. Referent power is gained when others identify with that leader or with what that leader symbolizes. Charismatic is personal power. Informational power is gained when people have information that others must have to accomplish their goals.  Self-power (feminist power) is the power a person gains over his or her own life, which comes from maturity, ego integration, security in relationships, and confidence in one's impulse.
  • The five driving forces to increase nursing's power base are: timing, size of the nursing profession, increasing knowledge base and education for nurses, nursing's unique perspective,  and desire of consumers and providers for change. Strategies to increase my personal power base include stop acting like a victim, build coalitions within and outside of nursing, support nursing leaders, pay attention to mentoring future nurse-leaders and leadership succession, and promote greater research to strengthen evidence-based practice. Personally I can maintain my personal energy, increase professional skills and knowledge, use experts and seek counsel, be flexible, maintain a sense of humor, empower others, & learn the language and symbols of the organization.
  • I have a hard time under an authoritarian power. I need to know the why before I am willing to follow. I do not do well under the I told you so regime. I need a manager who is good at empowerment; luckily my manager is!I thought that the struggle over power is a major cause of burnout in the nursing field. The power struggle is between the doctor, the nurse, the patient, and time. They often conflict at times. The best way I can increase my power base is to number one have confidence in myself, two stay up on my education, three laugh when it becomes overwhelmingly stressful, etc. No one thrives when they feel complete suppressive power. The best to increase your power/confidence is by empowering others. It will also build you up. Power hungry people often eat up power unnecessarily. Power must be used appropriately!!!
  
  Clinical Update:
  
  Started my clinicals this week. I got to sit in on interviews and help pick who to hire. It was very difficult but a good experience! I do not envy the manager's job of hiring! I also got to see how she forms schedules and comes up with the masters. We also got to play around with schedules to try to work up to the employee's ideal schedule.