We've all been there. That first semester of nursing school. Scared, excited, ambitious...no idea what really to expect, and a little curious to see what lies ahead. I remember one of my first days in nursing school, in fact, it probably was my first. Sonia, one of my first-level instructors, told us that many people that become nurses also considered being teachers at one time. This was true for me, anyway. (I had wanted to be a music teacher out of high school, and later a science teacher.) She went on to explain that this was not really surprising,and that if you didn't want to be a teacher, then nursing isn't for you, because nurses are teachers. I had no idea how much of my time would be spent teaching: patients, families, colleagues, new hires, and student nurses. A great deal of our time is spent educating others. Nurses really are teachers, like it or not. Now, some do a bit more than others, but you have to agree that nurses are the ones doing most of the teaching that goes on in an organization. So, if this is such an integral part of our job, why are many so resistant to this part of our profession? I think there are several explanations, and I will talk about a few.
Personality. This is an obvious one. Not everyone learns the same, and not everyone teaches the same...if at all. We cannot expect those that are "good nurses" to be "good teachers" as well. Sure, some may be, but not all will be. I think some of the best teachers may be the ones that really have to work to understand things. They know what it's like to need a bit of instruction, and time to let it soak in. Those that just seem to "get it" may understand things, but may not be able to articulate it well enough for others to understand in a meaningful way. It takes all kinds. Some have that perfect blend of understanding and skillfulness that makes them ideal teachers. There are some that love to teach others, and many that would rather slam their head in a door than have a student or new hire. Yet, I think we put new nurses with these people far too often, be it out of fairness to others, or perhaps out of belief that things will somehow "work out." There must be a conscious effot to place the right "personality" in the right situation if we ever hope to achieve any form of success. "Good enough" isn't acceptable, nor should it be.
Motivation. What "drives" you? What pushes you to achieve above expectations or minimum requirements? What makes you want to learn as much as you can about your clinical setting, and your professional role within it? The answer may vary with each individual...but perhaps more often than not, we may see themes such as "do what's best for the patient" or "need to know more", both of which are very important. We must always have that "need" to know more, to understand what it is we are doing, and moreover, why we are doing it. Additionally, whatever we do, we should have the patient in our focus, or we have lost sight of our ultimate goal. And to expand on that, in order for us to be effective, we must continually seek education and training in order to practice as we should. After all, not many people would want to go to a surgeon who stopped learning about his/her craft after becoming a surgeon. Why would we expect that patients would want a nurse that has failed to keep up on current evidence-based practice (EBP) and research? I wouldn't. In a previous blog post, I talked about nursing school being a "floor", not a "ceiling", and I truly believe that. Everything you need to know for the duration of your career was not provided during your time in nursing school...sorry to disappoint you. You are going to have to pick up a journal now and again if you want to be as effective as you think you already are.
Experience. Spend enough time in nursing, and you will most assuredly interact with an "experienced" nurse that loves nothing more than to eat you up and spit you out. And that's too bad. Why do we allow this? Why should we consider ourselves as anything less than professionals? Professionals do not tolerate this type of behavior. What good is education and experience if they are not shared? Not a lot, I can tell you. Those with a lot of "experience" may have just "punched the clock" a few more times than others, but that doesn't make them "valuable" resources, necessarily. Experience can be beneficial whether it is good or bad, especially when we opt to share it in a constructive and productive way. Otherwise, negative behavior is worthless, and is of no use to new nurses eager to learn from those before them. Share experiences, share stories, share your time. It is such a small price to pay for a world of difference.
Attitude. This one is key. If you have a great attitude, you will have a positive impact on others, even in the gloomiest of situations. A negative attitude often comes easiest, and most frequently, because it takes the least amount of thought or energy. Everyone has a bad day once in a while, but you do not need to share that with others. We must be much more conscientious of our actions and our interactions with others. Tearing others down to make one feel more powerful or in "control" is unacceptable, and should not be tolerated. We have all been there, new nurse in a new unit...new culture...and want nothing more than to "fit in" and "be accepted." "Eating our young" is what we have come to know and expect...and we need to break the cycle! We must speak up and take charge of our own career and our own ideas. We must be civil to one another, both as a colleague and as a human being. Everyone makes mistakes, EVERYONE. We are human, it's what we do. There are few things in this world that we can control, but our attitude is certainly one we can.
So, when you are asked to help train a new nurse or student, I hope you keep these things in mind. Please don't do it if you are not in the right mindset to be nice, be thoughtful, and be patient. If you are a new nurse, a student, or a seasoned nurse, make sure you never stop learning. We are not born with everything we need to know, and nursing school is definitely not an ending point for our training. Instructors, please create a culture of lifelong learning as a standard of practice, and nurses please continue this push in the clinical setting. These new nurses will be responsible for taking care of you and your families someday. They will train the generation following them, and so forth. A few extra minutes spent teaching is well worth the investment.
Thank you.
Steve
Sunday, September 18, 2011
Wednesday, September 7, 2011
Know your role
Healthcare is comprised of numerous professionals and ancillary staff that are all essential to the care of a patient within a system, no matter how grand or seemingly insignificant the scale. Nursing makes up only one of these roles.... Or does it? If you have read Notes on Nursing: what it is and what it is not by Florence Nightengale, then you probably know that the practice of "modern" nursing actually consists of many different roles...all focused on the holistic care of the patient. Florence, a public health statistician, did not attempt to provide a manual for nurses of her time, nor did she profess that her book be the end-all reference for nursing practice. What she did do, however, was blend her "calling" to help others with her analytical thought process, and began to make keen observations on the health and welfare of "hospitalized" soldiers during the Crimean War. She noted that certain factors, or an absence thereof, seemed to play a part in the successful recovery of these soldiers, physically and emotionally. For instance, Nightingale offers her "tips" to would-be nurses as to what is important. Among these "canons" of nursing are proper ventilation, pure air and water, efficient drainage, cleanliness, light, noise, "variety", proper nutrition, and observation. This is not an all-inclusive list, only an example of common-sense practices that were not so "common" in her time. If you have not read Notes on Nursing, I strongly recommend it. Florence was a very intelligent and dedicated woman, who truly made a lasting impact on nursing and public health practice. We must learn all we can from our profession, both past and present. We must always seek knowledge through science and reasoning, always guided by ethical and moral principles, aimed to serve a those within our community and those we will never know.
Florence recognized these varied factors to be very important to the wellbeing of patients and of the public. Take, for instance, the practice of handwashing. She recognized this simple practice to be extremely effective in the prevention of the spread of illness. Although she did not accept the "Germ Theory " as fact, she observed the basic principles of sanitation to be very effective in disease prevention. Today, ask any nurse about disease prevention, and they will tell you that handwashing is the number one way they can prevent the spread of disease from one patient to another. Nurses use to provide virtually all patient care duties: hygiene, meal preparation and assistance, cleaning floors, emptying trash, and even obtaining and evaluating laboratory specimens. Of course now there are many professional and ancillary service staff to provide these services...among numerous others. The point is, nursing has a very rich history, deeply seeded in the comprehensive care of patients. Nurses, and student nurses, truly use to "do it all". By today's standards, and with curent technological advances, it would be impossible-and unrealistic- to perform by the same standard as those before us. However, we should not soon forget what we are doing, and why we are doing it...for the patient. We can not know it all, we can not do it all, and we can not for one second think that we are capable of such a task. We are surrounded by a wealth of resources, there to assist in the care of the patient. We must know our resources, USE our resources, and coordinate all of these activities. After all, that is what professional nursing is all about: being the coordinator of care. Though we may not do it all, we should at least help ensure it gets done, all with the patient's best interest at the forefront of our minds. Florence was leading us in the right direction. It is up to us to maintain the course. So, was this about Florence and her contributions to patient care and organized medical and nursing care? Somewhat. The real reason I spoke so much of her is because in order to "know our role" we must understand what it is we do, and try and understand our beginnings. We must understand what we do and why we are doing it, otherwise we are not basing our professional practice in anything more than folklore and tradition. Evidence Based Practice (EBP) is what guides us today, and what we use to rationalize continuation or discontinuation of practice standards. We are a caring, intuitive profession guided by science and reasoning. If we lose this, we lose our identity as a profession. Observations guide research. Research provides evidence. Evidence support standards. Standards shape policy. Policy influences practice (among many other factors). In the end, we as nurses, are ultimately responsible for our own practice, and being knowledgeable of the various policies, standards, and legislational guidelines that both entitle an circumscribe our practice. Again, we must "know our role" or we may be not only endangering our patients, but our legal license to practice. I said this in a previous blog: "Nursing school is a floor, not a ceiling." We must not stop seeking knowledge simply because we are not in an academic setting. We must be current on recommended practices and what research is available. We must be able to find this information and make sense if it. We must not accept everything as being finite. We must own our practice and our profession, living up to our dedication to our patients. We cannot be afraid of asking questions, and furthermore, of seeking the answers. In her book Notes on Nursing, Nightingale even indicates that her work was not meant to tell nurses what to do; she wanted them to teach themselves, through the use of her "tips." We should continually teach ourselves about nursing, because after all, we have yet to attain all the answers when we do not even know all of the questions. I will leave you with another quote from Florence:
What cruel mistakes are sometimes made by benevolent men and women in matters of business about which they can know nothing and think they know a great deal. ~Florence Nightengale
Florence recognized these varied factors to be very important to the wellbeing of patients and of the public. Take, for instance, the practice of handwashing. She recognized this simple practice to be extremely effective in the prevention of the spread of illness. Although she did not accept the "Germ Theory " as fact, she observed the basic principles of sanitation to be very effective in disease prevention. Today, ask any nurse about disease prevention, and they will tell you that handwashing is the number one way they can prevent the spread of disease from one patient to another. Nurses use to provide virtually all patient care duties: hygiene, meal preparation and assistance, cleaning floors, emptying trash, and even obtaining and evaluating laboratory specimens. Of course now there are many professional and ancillary service staff to provide these services...among numerous others. The point is, nursing has a very rich history, deeply seeded in the comprehensive care of patients. Nurses, and student nurses, truly use to "do it all". By today's standards, and with curent technological advances, it would be impossible-and unrealistic- to perform by the same standard as those before us. However, we should not soon forget what we are doing, and why we are doing it...for the patient. We can not know it all, we can not do it all, and we can not for one second think that we are capable of such a task. We are surrounded by a wealth of resources, there to assist in the care of the patient. We must know our resources, USE our resources, and coordinate all of these activities. After all, that is what professional nursing is all about: being the coordinator of care. Though we may not do it all, we should at least help ensure it gets done, all with the patient's best interest at the forefront of our minds. Florence was leading us in the right direction. It is up to us to maintain the course. So, was this about Florence and her contributions to patient care and organized medical and nursing care? Somewhat. The real reason I spoke so much of her is because in order to "know our role" we must understand what it is we do, and try and understand our beginnings. We must understand what we do and why we are doing it, otherwise we are not basing our professional practice in anything more than folklore and tradition. Evidence Based Practice (EBP) is what guides us today, and what we use to rationalize continuation or discontinuation of practice standards. We are a caring, intuitive profession guided by science and reasoning. If we lose this, we lose our identity as a profession. Observations guide research. Research provides evidence. Evidence support standards. Standards shape policy. Policy influences practice (among many other factors). In the end, we as nurses, are ultimately responsible for our own practice, and being knowledgeable of the various policies, standards, and legislational guidelines that both entitle an circumscribe our practice. Again, we must "know our role" or we may be not only endangering our patients, but our legal license to practice. I said this in a previous blog: "Nursing school is a floor, not a ceiling." We must not stop seeking knowledge simply because we are not in an academic setting. We must be current on recommended practices and what research is available. We must be able to find this information and make sense if it. We must not accept everything as being finite. We must own our practice and our profession, living up to our dedication to our patients. We cannot be afraid of asking questions, and furthermore, of seeking the answers. In her book Notes on Nursing, Nightingale even indicates that her work was not meant to tell nurses what to do; she wanted them to teach themselves, through the use of her "tips." We should continually teach ourselves about nursing, because after all, we have yet to attain all the answers when we do not even know all of the questions. I will leave you with another quote from Florence:
Were there none who were discontented with what they have, the world would never reach anything better.Thank you. Steve
Sunday, September 4, 2011
Leadership or Management?
It has been said, "You manage things....you lead people." I couldn't agree more.
There are a lot of "Managers" out there. Some manage processes, others manage groups of people. Being a manager means being "in charge", or perhaps, "responsible" for something, right? (some thing)? No doubt that there are many, many things that require someone to be responsible for: systems, budgets, workflow, logistics, information, etc. But what about the people? Do you manage people? I say no.
Sure, you can manage some situations that involve people, such as interactions/communications, environments, duties, or maybe even some aspects of behavior. Yet, no matter how complex of a machine or a system you may manage, it will never be as complicated or intricately-designed (or flawed) as a human being. For instance, a thing does not have thoughts, feelings, desires, hopes, dreams, emotions, or most importantly, a soul. You simply cannot manage these aspects. For that reason, you must have a completely different set of knowledge, skills, and talent: leadership.
A computer is programed to perform a certain set of tasks, given specific parameters, with identified variables and methods of input and output. And no matter how fascinating the process is, or how extraordinary the outcome may be, it will never be motivated to do more. And, to be honest, you really can't blame a computer for the outcome you get...because your results are precisely the end product of your specific instructions: you get out of it what you put into it. Yet, you will see managers repeatedly blame the output on others...an unfortunate hallmark of ineffective leadership. I believe it is a complete misnomer to identify a person in charge of other human beings as a "manager". You simply do not, and cannot, manage people.
It is by no fault of their own that some of the greatest leaders may have the title of "manager"...that is just our way of identifying a job duty or hierarchy of responsibility and influence within an organization. Anyone can put on a badge with "manager" in the title and be great at budgets and fiscal planning. But this person is not necessarily a leader simply due to the same qualifying identity. Again, "you manage things....you lead people." Emotion, personality, morals, and ethics are perhaps some of the biggest reasons you cannot manage people. People have goals, they have dreams, they have needs. They can be motivated. They can be made to feel worthless. They can trust and they can distrust. All of these factors require something much more effective than learning how to manage. You must understand how to lead.
I know that I will be much more likely to enjoy my job, work harder, and be more effective when I am motivated to do so. And to me, this occurs with positive reinforcement and opportunity to express ideas, thoughts, and concerns. Conditioning behavior within a workplace though negative reinforcement may provide short-term results, but it will pollute the very air it attempts to improve. If the main interaction you have with people is at the "giving-end" of a corrective action, then you will fail as a leader, even though you may manage a situation. You don't have to be friends, but you do not have to be the enemy. It doesn't have to be "us" against "them". Effective leaders know that to understand human behavior, you must be human. Humans are fallible. We make mistakes. It's a fact, and it cannot be ignored or avoided. We must learn form the mistakes, try to understand why we do what we do, and solidify our foundation upon that gained knowledge. We are human. It's time we treat one another accordingly.
Although I have talked about "people in charge" in terms of "superiors and subordinates", I think this would definitely apply to bedside nursing practice. Patients are not our "subordinates", but we do assume a great deal of authority and power over them whether we like it or not. We manage our care plans, our patients' information, and most of all, our time. But we will never manage our patients. We can manage symptoms, perhaps, by providing appropriate interventions, yet we cannot do the same with our patients' thoughts and fears. We must apply aspects of leadership to our everyday practice, understanding what drives people to do the things they do...what motivates them...and how we can use that knowledge to help them make more positive changes within their lives. Additionally, when we are working together as a team, we must understand that our coworkers will typically respond much more favorably if we treat them as humans and not things. A little communication goes a long way.
And, of course, there is a great lesson we can learn from the study of complexity science- actually there are a lot of lessons from it, but that's a different conversation. It is well known and observed that a single force, seemingly isolated and insignificant, can have a greater impact upon an entire system (small, large, near, or far) than we can ever predict. I am certain most of us can recall one or two individuals in our life thus far who have positively impacted us in ways we could have never known or understood. We all carry those people and those behaviors with us...we will never forget the way that person made us think or made us feel. It is because this person was a leader, and a leader leads people.
I am a nurse; I am a leader.
Thank you.
Steve
There are a lot of "Managers" out there. Some manage processes, others manage groups of people. Being a manager means being "in charge", or perhaps, "responsible" for something, right? (some thing)? No doubt that there are many, many things that require someone to be responsible for: systems, budgets, workflow, logistics, information, etc. But what about the people? Do you manage people? I say no.
Sure, you can manage some situations that involve people, such as interactions/communications, environments, duties, or maybe even some aspects of behavior. Yet, no matter how complex of a machine or a system you may manage, it will never be as complicated or intricately-designed (or flawed) as a human being. For instance, a thing does not have thoughts, feelings, desires, hopes, dreams, emotions, or most importantly, a soul. You simply cannot manage these aspects. For that reason, you must have a completely different set of knowledge, skills, and talent: leadership.
A computer is programed to perform a certain set of tasks, given specific parameters, with identified variables and methods of input and output. And no matter how fascinating the process is, or how extraordinary the outcome may be, it will never be motivated to do more. And, to be honest, you really can't blame a computer for the outcome you get...because your results are precisely the end product of your specific instructions: you get out of it what you put into it. Yet, you will see managers repeatedly blame the output on others...an unfortunate hallmark of ineffective leadership. I believe it is a complete misnomer to identify a person in charge of other human beings as a "manager". You simply do not, and cannot, manage people.
It is by no fault of their own that some of the greatest leaders may have the title of "manager"...that is just our way of identifying a job duty or hierarchy of responsibility and influence within an organization. Anyone can put on a badge with "manager" in the title and be great at budgets and fiscal planning. But this person is not necessarily a leader simply due to the same qualifying identity. Again, "you manage things....you lead people." Emotion, personality, morals, and ethics are perhaps some of the biggest reasons you cannot manage people. People have goals, they have dreams, they have needs. They can be motivated. They can be made to feel worthless. They can trust and they can distrust. All of these factors require something much more effective than learning how to manage. You must understand how to lead.
I know that I will be much more likely to enjoy my job, work harder, and be more effective when I am motivated to do so. And to me, this occurs with positive reinforcement and opportunity to express ideas, thoughts, and concerns. Conditioning behavior within a workplace though negative reinforcement may provide short-term results, but it will pollute the very air it attempts to improve. If the main interaction you have with people is at the "giving-end" of a corrective action, then you will fail as a leader, even though you may manage a situation. You don't have to be friends, but you do not have to be the enemy. It doesn't have to be "us" against "them". Effective leaders know that to understand human behavior, you must be human. Humans are fallible. We make mistakes. It's a fact, and it cannot be ignored or avoided. We must learn form the mistakes, try to understand why we do what we do, and solidify our foundation upon that gained knowledge. We are human. It's time we treat one another accordingly.
Although I have talked about "people in charge" in terms of "superiors and subordinates", I think this would definitely apply to bedside nursing practice. Patients are not our "subordinates", but we do assume a great deal of authority and power over them whether we like it or not. We manage our care plans, our patients' information, and most of all, our time. But we will never manage our patients. We can manage symptoms, perhaps, by providing appropriate interventions, yet we cannot do the same with our patients' thoughts and fears. We must apply aspects of leadership to our everyday practice, understanding what drives people to do the things they do...what motivates them...and how we can use that knowledge to help them make more positive changes within their lives. Additionally, when we are working together as a team, we must understand that our coworkers will typically respond much more favorably if we treat them as humans and not things. A little communication goes a long way.
And, of course, there is a great lesson we can learn from the study of complexity science- actually there are a lot of lessons from it, but that's a different conversation. It is well known and observed that a single force, seemingly isolated and insignificant, can have a greater impact upon an entire system (small, large, near, or far) than we can ever predict. I am certain most of us can recall one or two individuals in our life thus far who have positively impacted us in ways we could have never known or understood. We all carry those people and those behaviors with us...we will never forget the way that person made us think or made us feel. It is because this person was a leader, and a leader leads people.
I am a nurse; I am a leader.
Thank you.
Steve
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