Tuesday, January 25, 2011
Lesson 4: Operational and Strategic Planning, CH 7
I wonder how many nursing managers are good at planning. Do they really plan out things or are they mostly reactive to problems? Do they have a long term vision for the floor? Where do their goals come from? I'm sure a lot of goals come from trying to improve patient scores. Planning evolves from values. I had never thought about a true value vs. a value indicator. I bet many people's "values" are really value indicators due to not actually actively living the value. Again, the things in the text make perfect sense in textbook land, but how are they really applied in the real world? It will be interesting to follow a manger and see....
Ethical Decision Making
I think we often come into situations where we face with ethical dilemmas without really realizing that they are. The most common practice of unethical behavior that I see on a regular basis is doing things without an actual order. Usually it is simple things, and things that the doctor would not care about, but you don't have an order for one so the nurse either just writes one, or just provides it to the patient. Have I done this? Of course, but mostly for very simple things like ordering a CPAP/patient uses one at home and RT won't allow it without an order. But where do you draw the line? I've had patients slipped a dose "contraband tylenol" after a fever of 38.8, in reality the doctor should have been called, but the night nurse did not want to disturb the doctor's sleep. Or another...the doctor admitted a Same Day surgery patient for observation for possible pain control problems and did not order their home meds, the night nurse told the patient just go ahead and take your normal medications. One of which was Kadian (basically oral morphine), so the patient did have good pain control. So what is the problem? Number One..no doctor order, and patients are not allowed to take their own meds without pharmacy reviewing them. The nurse is then practicing medicine by telling the patient its okay to take her medications. Number two: The medical record has no record of her taking her any medications. Number Three: The scheduled substances should be locked up down in pharmacy. Now have I ever looked the other way when a patient wanted to take a home med supplement that we don't carry and is not ordered, sure but this seems over the line. Ethical decisions often may have no right answer, and what is best varies from person to person. Why are we so scared to call the doctors? That is our job. We are the patients advocate, and should follow protocols or we cannot be protected in court. Ethical decision making happens everyday on the job...whether we choose to recognize it or not.
Wednesday, January 19, 2011
Lesson 3: Ethical and Legal Responsibilities and the Role of the Nurse Leader as Advocate
So it appears that complaining actually works! Well sometimes... Blackboard has decided to give me 2 sections right now so currently I can view the modules!
Well, these chapters were not particularly insightful (maybe it was because I read them while waiting for my mom's surgery to finish or maybe because they are blah blah blah). I've taken an Ethics & Values, so it wasn't really anything new. Theories are great, but in the real world I have a hard time seeing how they are actually used. Usually what I see in practice is the managers personal values applied in action. In general, I think the values match that of the company, but if this were not the case then problems would result. If it were simple, then we would not be discussing it in class. Life is not black and white, there is a lot of GRAY! And what is right and wrong changes according your standards/values.
One of the most challenging things for the nurse leader is that they are responsible for the actions of others, but do not often have very much control of the actions of others. The fear of being sued is always at the back of everyone's mind. In text I think utilitarianism is the best method, but when actually applying it is difficult. For what creates the best common good is not always agreed upon and who wants to be the individual that gets the shaft for the greater good? I loved what we talked about in class, it is not best to try to be fair (as it is impossible), but to strive for consistency (hard to do but the best policy!). Sometimes what is most ethical is definitely not the best legal option (like the case study of allowing the life partner at the bedside when she had no legal authority to be there). I think often managers are faced with many decisions that need to be discussed at length (for 2 heads are always better than one), but often are left to make the decision quickly by themselves. One of the best ways that manager's are effective in ethics & legal responsibilities is by being an advocate for patients, subordinates, and the organization. They help make policy decisions that have a great affect. Keeping the perspective as an advocate helps guide good decisions. It is easy in a manager position to forget what it is actually like on the floor. One day my manager had to take a team on the floor, she laughed and said that she thought all managers should have to do this! But don't quote me! Maybe that really would yield the best management!
Well, these chapters were not particularly insightful (maybe it was because I read them while waiting for my mom's surgery to finish or maybe because they are blah blah blah). I've taken an Ethics & Values, so it wasn't really anything new. Theories are great, but in the real world I have a hard time seeing how they are actually used. Usually what I see in practice is the managers personal values applied in action. In general, I think the values match that of the company, but if this were not the case then problems would result. If it were simple, then we would not be discussing it in class. Life is not black and white, there is a lot of GRAY! And what is right and wrong changes according your standards/values.
One of the most challenging things for the nurse leader is that they are responsible for the actions of others, but do not often have very much control of the actions of others. The fear of being sued is always at the back of everyone's mind. In text I think utilitarianism is the best method, but when actually applying it is difficult. For what creates the best common good is not always agreed upon and who wants to be the individual that gets the shaft for the greater good? I loved what we talked about in class, it is not best to try to be fair (as it is impossible), but to strive for consistency (hard to do but the best policy!). Sometimes what is most ethical is definitely not the best legal option (like the case study of allowing the life partner at the bedside when she had no legal authority to be there). I think often managers are faced with many decisions that need to be discussed at length (for 2 heads are always better than one), but often are left to make the decision quickly by themselves. One of the best ways that manager's are effective in ethics & legal responsibilities is by being an advocate for patients, subordinates, and the organization. They help make policy decisions that have a great affect. Keeping the perspective as an advocate helps guide good decisions. It is easy in a manager position to forget what it is actually like on the floor. One day my manager had to take a team on the floor, she laughed and said that she thought all managers should have to do this! But don't quote me! Maybe that really would yield the best management!
Technical Difficulties...
SO it sounds like we get to start 2011 off with lots of problems... Clinicals are difficult to set up. The book store is out of books, fortunately I do have one. But I did end up buying an extra book since it was listed in book match, but it is not on anyone's syllabus... guess doing things early sometimes bites, but works out at other times... Blackboard hates me... every time I try to be good and want to look at the modules and actually stay caught up; it disappears! So I was going to blog about what I read from chapters 4-6... ethics in management... but i can't get in to see the questions... so hopefully things will start improving after a good complaint!
Thursday, January 13, 2011
Lesson 2: Successful Leadership and Management
There are many styles of leadership and management....
I think that is is very important to be an authentic leader. Without authenticity, how can the employees ever be expected to also uphold the values of the company? If the values of the leader are not congruent with the company, then problems definitely will result.
I think it would be hard to always be a good transformational leader, but it is very important to look beyond the day to day to the future with a vision of where the unit/company is going. Most employees I think are on the transactional level, but need to be brought up to the transformational level; the manager is the key person who can lift them up to that level.
Managers are not always good natural leaders, but leadership is a necessity to be a good manager. My favorite leaders are servant leaders. Just knowing that management has your back and is willing to help you however they can helps to boost the morale of the employees. Sometimes my manager cannot do anything to help me, but just having her ask me if there is anything she can do for me helps me get through a crazy shift.
I do not work very well under an authoritarian leadership style. Just because you are the boss and you say it is that way is not motivating for me. I have to know why ... changes are needed. If I understand the importance, then I will follow completely.
I think some people have very little emotional intelligence, but understanding emotional intelligence is a very important characteristic in the workplace.
Management can be key player in the role of cultural bridging.We definitely have generational issues. The younger generations have an attitude of entitlement, which does not mesh well at all with the older generations. It is also damaging to the company when they show little patience with difficult clients.
Thought leadership is very intriguing to me; by being an example of how risk taking and vision leads to innovation and others then can follow suit by example. Intermountain Health Care is a good example of a company set upon good thought leadership. We need more thought leaders in the world. Quantum leadership although a new theory, has clear application as management/environment definitely have an impact on productivity.
The future of nursing is dependent upon good leaders and managers. Health care has changed and will continue to change as it adapts to its needs. The guarantee for good outcomes always starts with good leaders and managers with extraordinary vision.
I think that is is very important to be an authentic leader. Without authenticity, how can the employees ever be expected to also uphold the values of the company? If the values of the leader are not congruent with the company, then problems definitely will result.
I think it would be hard to always be a good transformational leader, but it is very important to look beyond the day to day to the future with a vision of where the unit/company is going. Most employees I think are on the transactional level, but need to be brought up to the transformational level; the manager is the key person who can lift them up to that level.
Managers are not always good natural leaders, but leadership is a necessity to be a good manager. My favorite leaders are servant leaders. Just knowing that management has your back and is willing to help you however they can helps to boost the morale of the employees. Sometimes my manager cannot do anything to help me, but just having her ask me if there is anything she can do for me helps me get through a crazy shift.
I do not work very well under an authoritarian leadership style. Just because you are the boss and you say it is that way is not motivating for me. I have to know why ... changes are needed. If I understand the importance, then I will follow completely.
I think some people have very little emotional intelligence, but understanding emotional intelligence is a very important characteristic in the workplace.
Management can be key player in the role of cultural bridging.We definitely have generational issues. The younger generations have an attitude of entitlement, which does not mesh well at all with the older generations. It is also damaging to the company when they show little patience with difficult clients.
Thought leadership is very intriguing to me; by being an example of how risk taking and vision leads to innovation and others then can follow suit by example. Intermountain Health Care is a good example of a company set upon good thought leadership. We need more thought leaders in the world. Quantum leadership although a new theory, has clear application as management/environment definitely have an impact on productivity.
The future of nursing is dependent upon good leaders and managers. Health care has changed and will continue to change as it adapts to its needs. The guarantee for good outcomes always starts with good leaders and managers with extraordinary vision.
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