We All Need to Slow Down

We All Need to Slow Down

Michael B. Grossman, DM, MSN, RN, NEA-BC, CNML 

Hummingbird Yesterday my daughter made a slow motion video of Lucy, her Rhodesian Ridgebacks puppy. I was  fascinated to discover that they don’t run like a horse, but more like rabbit; in terms of their back legs push off together. So I did a search on YouTube and apparently that’s where their energy comes from, which is also the way cheetahs and greyhounds run. Anyway, while viewing slow motion video’s I came across this one of hummingbirds, which I found interesting in terms of the concept of we need to slow down to appreciate our lives and work. When we’re always going at 100 miles an hour we miss a lot of life. If you can slow down for 2-minutes, check it out: Hummingbirds in Slow Motion

https://www.youtube.com/watch?x-yt-ts=1422411861&x-yt cl=84924572&v=Fouo6GKGBIM

What Happens When We are Constantly in High Speed 

            There are 1,440 minutes in a day. It doesn’t seem like taking 2 minutes to watch a video is that much time, when you put it that way. Likewise there are 168 hours in a week. Seems like a lot of hours, eh? But, when you start to break it down in terms of all the stuff we have to do, those 168 hours go pretty quickly. There are 720 minutes in a 12-hour shift, yet 60% of nurses are too busy to take a 15-minute break. They are willing to risk their license and own health by working fatigued, because they are too busy to take a 15-minute break. As an ethics professor I discuss the evidence based literature around 12-hour shifts and fatigue and what I have discovered is that most nurses are just not aware of the literature, because they’re too busy to slow down and read it. A colleague of mine told me recently, you know Grossman you’re the only one talking about 12-hour shifts. Nobody else sees it as a problem. See that to me is the problem. When we’re going at 100 miles per hour because we’re late for work, we don’t have the time to look over at the gas gauge and see that it’s almost on empty! Have you ever done that and then ended up stranded on the road and take an hour or two to get help…

The Impact of High Speed Change

White Water Rafting Peter Vaill (1996) is generally credited with introducing the concept of white water change in organizations. Vaill’s concept was that change in organizations has become like white water rafting, where we’re not even done with one change when another one gets piled on, like traveling through the rapids. Eventually, as Kurt Lewin (1997) suggested organisms can’t take anymore change and just shut down. Lewin called this re-freezing. My daughter’s puppy does this when we play fetch. After she chases her ball 15-20 times, she just shuts down and can’t do anymore. Even if I try to reward her with a treat, she’s just frozen and lays down on the sofa exhausted. Many nurses say they don’t get tired working 12-hour shifts. They say the work fuels their adrenalin and they actually become more energized, as long as they keep moving. But where is the point where they collapse? Is it 14 hours? 20 hours? Is it doing five 12’s in a row? The body, physically and emotionally cannot go on endlessly. Eventually it refreezes.

William Bridges (2004) another noted authority built his change model on the theories about grieving. When people are grieving loss they go through several overlapping phases of denial, anger, bargaining, depression, and finally acceptance (Kubler-Ross & Byock, 2014). Often a funeral serves as the time to slow down and incorporate what has just happened. The funeral often provides the time for reflection and symbolic closure of that chapter in our lives. Think of how often you leave a funeral making the promise to be a better person, spend more time with your family, and tell people how much you appreciate them. But, how quickly do we get back to our extensive to do list?

When organizations go through change they follow these same patterns. Most organizations are changing so quickly today there is no time to pause and reflect on what’s happening, let alone to review the evidence based literature on any particular topic. Like my daughters exhausted puppy most of us are so exhausted we can’t listen to one more speech about how this new program is going to revolutionize healthcare. However, Bridges message is that endings are more important than beginnings. Someone who just lost a loved one is not ready to appreciate the virtues of their death. Their focus is on how they’re going to live without their loved one. Likewise when the Joint Commission (2011) sent out a sentinel alert about the dangers of fatigue related to 12-hour shifts, the typical nurse couldn’t even listen because all she can think about is Oh no, they’re going to take away my 12-hour shifts. How will it fit everything into my workweek? How will I find a babysitter if I have to go back to working 5 days a week? What about my second job, and school? They are too busy to slow down long enough to hear the warning that 12-hour shifts don’t need to go away, nurses just need to take their breaks and the risk of fatigue disappears (Smith-Coggins, et al, 2006).

Pausing Long Enough to Listen 

            Years ago a friend of mine was going through a career crisis and could not decide what to do next. It was in the summer and he realized not many organizations were hiring anyway. So he decided to just take 3 weeks off to reflect. By reflect he meant not doing anything concrete, so he could actually reflect. Ken Blanchard (1988) told and interesting story about a guy he had take a train from California to Chicago to meet with him to discuss a major decision. He told the man to book a berth on a train and not read or speak to anybody for the 3 day journey. Just reflect on the topic. Basically he encouraged him to slow down. Einstein suggested that his greatest discoveries did not come from working endlessly in the lab long into the night. Instead he said his best ideas often came from putting down the research, taking a break, and then the ah ha insight would happen in the shower or out in his garden. Jim Loehr (2004), psychologist for the US Olympic team teaches athletes that the secret to peak performance is not managing your time as much as managing your energy by working in 90 minute blocks of time, followed by strategic breaks to rest, meditate, do yoga, or just pause to reflect. It makes sense when you think about it.

Don’t Wait Till It’s Too Late

             I once had a nurse give a patient the wrong unit of blood. She was in a hurry and violated the hospital policy by picking up two units of blood, for two different patients at the same time. She was trying to save time! Another nurse asked a charge nurse if she was reading an order correctly. The charge nurse was too busy to slow down and listen to what she was saying. That patient died. Mary was rear ended at a traffic light by one of her co-workers on the way home after working a 12-hour shift, that had morphed into a 14-hour shift. Her co-worker fell asleep at the wheel. A plane crashed in France a couple of years ago because both the pilot and co-pilot had fallen asleep and the autopilot computer landed the plane, but someone still had to put on the breaks. So the plane coasted off the runway. People died. I can go on and on with stories, but the bottom line is this:

The most valuable result of all education is to make you do the things

you have to do, when it ought to be done, whether you like it or not.

It is the first lesson that ought to be learned. And however early a

man’s training begins, it is probably the last lesson that he learns

thoroughly (Thomas Huxley, 2001).

Why must we experience tragedy pause, reflect, and develop our personal meaning and approach to life? Try something today. It will take you just 30 minutes. Go to a co-worker at the beginning of your shift and offer to relieve them for a 30-minute break in the middle of your shift. Agree to take their patients. Then ask if they will do the same thing for you. Don’t take your break with anyone. Just push yourself to do some quiet reflection. I worked at a hospital in California last year that had a beautiful contemplation garden. You may not have that, but perhaps you can put some quiet music on your phone and listen to that for 30 minutes, in a quiet spot with earphones. Give it a try, don’t try and make a value judgment. Just take 30 minutes out of the 10,080 minutes you have this week. Think about slowing down the hummingbird in your mind and see what you come up with. Afterwards, you might even end up telling someone how much you appreciate them.

For further information go to: http://www.nurseleadershipbuilders.com/Dr. Michael Grossman, DM, MSN, RN, NEA-BC, CNML has over 35 years of nursing leadership experience and is a nursing leader, consultant, academician, and career coach. As a professor in the graduate schools of nursing at both University of Phoenix and Walden University, he specializes in healthcare ethics, leadership development, career coaching, mentoring, teambuilding, motivation, change, communications, and dealing with “difficult” people. He also teaches nursing leadership certification review courses and time management for busy clinicians. He can also be reached at 610-331-8470 or Mike@NurseLeadershipBuilders.com

References

Blanchard, K., & Peale, N. V. (1988). The Power of Ethical Management. New York:

William Morrow and Company.

Bridges, W. (2004). Transitions: Making Sense of Life’s Changes, Revised 25th Anniversary Edition. Cambridge, MA: Da Capo Press.

Huxley, T. H. (2001). Collected Essays of Thomas H. Huxley. Bristol, UK: Thoemmes.

The Joint Commission. (2011). Health Care Worker Fatigue and Patient Safety. The Joint Commission Sentinel Event Alert(48), 1-4.

Kubler-Ross, E., & Byock, I. (2014). On Death and Dying: What the Dying Have to

Teach Doctors, Nurses, Clergy and Their Own Families. New York: Scribner Publishing.

Lewin, K. (1997). Resolving Social Conflicts: And, Field Theory in Social Science.

Washington, DC: American Psychological Association.

Loehr, J., & Schwartz, T. (2004). The Power of Full Engagement: Managing Energy, Not

Time, Is the Key to High Performance and Personal Renewal New York: Free Press.

Smith-Coggins, R., Howard, S. K., Mac, D. T., Wang, C., Kwan, S., Rosekind, M. R., . . .

Gaba, D. M. (2006). Improving Alertness and Performance in Emergency Department Physicians and Nurses: The Use of Planned Naps. Annals of Emergency Medicine, 48(5), 595-604.

Vaill, P. B. (1996). Learning as a way of being: Strategies for survival in a world of

permanent white water. San Francisco, CA: Jossey-Bass.

 

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Nursing is the Most Trusted Profession and We’re Talking About 12-Hour Shifts?

Nursing is the Most Trusted Profession and We’re Talking About 12-Hour Shifts?

Michael B. Grossman, DM, MSN, RN, NEA-BC, CNML

Tired Nurse   In 2001 Alan Iverson, a player for the Philadelphia 76er’s basketball team gave an infamous speech after his coach disciplined him for not showing up at practice (http://genius.com/Allen-iverson-practice-press-conference-annotated). Iverson’s argument was that he should be judged on what he does on the playing court, not practice. Iverson said he didn’t agree with the coach that as the team leader he had a responsibility to be a role model to the other players, including attending practice. Iverson suggested that as long as he performed at his best during the game that is all that matters. It reminds me of a classic nursing argument: Suzie’s a good nurse, she just doesn’t get along with people.

Every time I hear nurse’s argue about how 12-hour shifts are an acceptable practice, I think of Iverson’s argument. But, before we continue take a moment to think of your own reaction to this topic? Are you defensive? Are you concerned about what you would do if 12-hour shifts went away? Are you thinking you would leave nursing if you couldn’t work 12-hour shifts. So, before you stop reading just take a few minutes to hear my arguments, as I am not suggesting 12-hour shifts go away. There is another solution, which we will discuss later.

There has been extensive research on the perils of 12-hour shifts without breaks since it was first identified as a factor in 90,000 estimated patient deaths per year due to medical errors (Institute of Medicine, 2000). Today, it is estimated that 400,000 deaths occur per year in healthcare due to preventable errors (James, September 2013). Those are staggering numbers! When nurses and physicians were administered a driving test at the end of a 12-hour shift without breaks their cognitive ability was equivalent to someone who was clinically drunk (Smith-Coggins, et al, 2006). The State of Washington took this issue so seriously they appointed a commission to look at nurse schedules and fatigue (Ellis, 2008). The Joint Commission has formally addressed the dangers of 12-hour shifts twice, once suggesting it was a factor undermining a culture of safety (Joint Commission, 2008) and then again in specifically addressing the issue of health worker fatigue and calling for every hospital to have a plan of correction (Joint Commission, 2011).

The Nursing Reaction to 12-Hour Shifts

        I teach health care ethics at the graduate school level and have discussed the ethics of 12-hour shifts over the past 60 semesters I have taught. The topic raises a lot of emotional reaction and invariable several students give Iverson-like reactions in which they essentially argue that: We’re talking about 12-hour shifts, not taking care of patients, not all the unethical things going on in health care, we’re talking about 12-hour shifts. I go out there and die for my patients. I work 12, 13, 14 hours and never leave my patients side. I work five or six 12-hour shifts in a row and go to school full-time, and am raising 3 kids. I don’t take lunch break, I don’t go to the bathroom, I work overtime and never leave my patient’s side. But, you don’t talk about that. No, you want to talk about 12-hour shifts causing fatigue. What about the fact that nursing was just rated the most trusted profession by patients? What about that fact that I’m taking care of my patient? What about the fact that I care enough to never leave my patients side no matter how tired I am? But we’re not talking about that. We’re talking about 12-hour shifts. Not my nursing care, not my dedication, not that we don’t have enough nurses. We’re talking about 12-hour shifts, how silly is that?

What’s the Real Issue?

            There clearly are advantages to 12-hour shifts. Most nurses prefer them. Most nurses believe it provides them with a more balanced life and the ability to get a second job, go to school, raise children, or just have an extra 4 days off ever week. But the ethical question is whether 12-hour shifts, without breaks are safe for patients? No matter how much nurses like 12-hour shifts we cannot ignore the safety concerns?

If you were on the witness stand following a serious patient error that occurred in the 11th hour of a 12-hour shift, could you prove you were not fatigued? More important would the jury believe the argument that you prefer 12-hour shifts and didn’t believe you were tired that night? What if the prosecuting attorney presented research evidence that nurse who don’t take breaks on 12-hour shifts are equivalent to being clinically drunk (Smith-Coggins, 2006). What if the prosecuting attorney asked how your organization addressed the Joint Commission Sentinel Alerts around nurse fatigue (2008, 2011)? What if you said, well my adrenalin kicks in when I’m tired and the prosecuting attorney brought in a physiologist who said adrenalin sends blood to your limbs and away from your brain so critical thinking is impaired when adrenalin kicks in. Meanings when your adrenalin kicks in you are even more likely to cause a patient error.

What Happens When We Take the Time to Listen?

Ironically, in recent years Allen Iverson admitted his tirade about practice was an emotional, defensive reaction to his feeling criticized in public. Is that why nurses react to the question of fatigue and 12-hour shifts? Research has suggested that when people do not totally understand a topic they are not really capable of addressing the topic (Ehrlinger, Johnson, Banner, Dunning, & Kruger, 2008). In the 1970’s nurses defended smoking cigarettes right at the nurses station, because the research on second hand smoke was still too new and not fully accepted. Kuhn (1996) suggested all change is resisted the more closely people are tied to the history. From a change standpoint resistance to transitions is rarely about the virtues of the new innovation, but about what people are giving up (Bridges, 2004). Rogers (2004) suggested that only 15% of people are early adopters of any new innovation. Think of the adoption of electronic books. Ten years ago all you heard was but I like the look and feel of a book. Rogers suggested 34% of people are late adopters and need to watch others adopt the innovation before they test the water. This week my mother in law bought my wife a Kindle. I find it significant that an 85-year-old woman took years to accept the Kindle technology, then discovered the convenience and passed it along to her younger daughter. Finally 16% of people are laggards, according to Rogers. They will never adapt to change and are still talking about the convenience of paper charts. But that’s a topic for another time. So is there a solution to 12-hour shifts?

A Simple Solution

            Thomas Huxley (2001) suggested that the most valuable result of all education is to make you do the things you have to do, when it ought to be done, whether you like it or not. It is the first lesson that ought to be learned. And however early a man’s training begins, it is probably the last lesson that he learns thoroughly. Perhaps that explains why we learn by failing and must experience things to develop our personal meaning and ethical approaches to life. But does another patient need to get hurt for us to realize we need to do something about 12-hour shifts and nurse fatigue?

            One of the problems with any change is that change is more about loss than it is the transition. Indeed the issue around electronic books was the loss of that multi-sensory experience of sitting on the sofa and turning the pages of a good book that you could see, and feel, and smell. Nothing like the smell of a new book or a newspaper fresh off the presses with a good cup of coffee at the kitchen table. Covey (2013) suggested that communication does not take place as long as you are trying to push your view on the other person. Highly effective people first build trust and then seek first to understand the other person’s viewpoint. So here’s my viewpoint: 12-hour shifts do not need to go away. Smith-Coggins, et al (2006) found that when nurses and physician’s took an adequate break during their 12-hour shift they were as alert as when they arrived at work 12-hours earlier. There was no impairment of cognitive ability if they took an adequate break. So, can we change this discussion from doing away with 12-hour shifts to how can we make sure nurses get adequate breaks so they are not fatigued? Let’s change the topic of the conversation, then have an effective conversation about how to come up with a win-win solution so nurses get adequate breaks and 12-hour shifts don’t need to go away.

Dr. Michael Grossman, DM, MSN, RN, NEA-BC, CNML has over 35 years of nursing leadership experience and is a nursing leader, consultant, academician, and career coach. As a professor in the graduate schools of nursing at both University of Phoenix and Walden University, he specializes in healthcare ethics, leadership development, career coaching, mentoring, teambuilding, motivation, change, communications, and dealing with “difficult” people. He also teaches nursing leadership certification review courses.

For further information go to: http://www.nurseleadershipbuilders.com/

He can also be reached at 610-331-8470 or Mike@NurseLeadershipBuilders.com

Reference

Bridges, W. (2004). Transitions: Making Sense of Life’s Changes, Revised 25th Anniversary Edition. Cambridge, MA: Da  Capo Press.

Covey, S. R. (2013). The 7 Habits of Highly Effective People: Powerful Lessons in Personal Change. New York: Simon & Schuster.

Ehrlinger, J., Johnson, K., Banner, M., Dunning, D., & Kruger, J. (2008). Why the

Unskilled Are Unaware: Further Explorations of (Absent) Self-Insight Among the Incompetent. Organizational Behavior and Human Decision Processes, 105(1), 98-121.

Ellis, J. R. (2008). Quality of Care, Nurses’ Work Schedules, and Fatigue: A White

Paper. Seattle: Washington State Nurses Association.

Geiger-Brown, J., & Trinkoff, M. (2010). Is it time to pull the plug on 12-hour tours:

Part 1 The evidence. Journal of Nursing Administration, 40(3), 100-102.

Huxley, T. H. (2001). Collected Essays of Thomas H. Huxley. Bristol, UK: Thoemmes.

Institute of Medicine. (2000). To Err Is Human: Building a Safer Health System.

Washington, DC: National Academies Press.

James, J. T. (September 2013). A New, Evidence-based Estimate of Patient Harms

Associated with Hospital Care Journal of Patient Safety, 9(3), 122-128.

Joint Commission. (2011). Health Care Worker Fatigue and Patient Safety. The Joint

Commission Sentinel Event Alert(48), 1-4.

Joint Commission. (2008). Behaviors That Undermine a Culture of Safety. Sentinel Event Alert(40).

Kuhn, T. S. (1996). The Structure of Scientific Revolution. Chicago: University of Chicago Press.

Rogers, E. M. (2004). A Prospective and Retrospective Look at the Diffusion Model. Journal of Health Communication, 9(1), 13-19.

Smith-Coggins, R., Howard, S. K., Mac, D. T., Wang, C., Kwan, S., Rosekind, M. R., . . . Gaba, D. M. (2006). Improving Alertness and Performance in Emergency Department Physicians and Nurses: The Use of Planned Naps. Annals of Emergency Medicine, 48(5), 595-604.

 

 

 

Everything I Know About Developing People I Learned From My Puppy

Everything I Know About Developing People I Learned From My Puppy

Michael B. Grossman, DM, MSN, RN, NEA-BC, CNML

                                                                  Dogs are known as man’s best friend. This year, nurses were once again voted the most honest, ethical, and respected Lucy Monkey V2 (Riffkin, 2014). A misbehaved dog can impact people’s impression of dogs, just as nursing’s respect can quickly be erroded if people lose trust in nurses to be completely focused on the patient’s safety and well-being. Lucy is my daughter’s puppy, an adorable Rhodesian Ridgeback. They are also known as the Lion Dog as they were bred for hunting lions in Africa. They are a combination of a loving cuddly family coach potato dog, with an incredibly defiant attitude toward certain things they feel strongly about. Basically they won’t back down on certain issues, including a lion! In many ways Lucy reminds me of some of the more strident employees I have worked with: strong in their beliefs on certain topics, but incredible loyal, engaged, and great team players if they are treated with respect.

Studies have shown that 100,000-400,000 preventable medical errors occur every year in the U.S. (Institute of Medicine, 2000; James, September 2013). Unfortunately, people often do not know what they don’t know. Nurses and physicians have resisted make the changes needed to improve patient safety (Ehrlinger, Johnson, Banner, Dunning, & Kruger, 2008). A puppy doesn’t know what it doesn’t know and can’t learn on its own. Puppies need guidance from their owners to learn the acceptable behaviors to live in society. The following article is about the 10 most important rules I have learned from training a puppy; that can be incorporated in employee development.

  1. Consistency-Everyone needs consistency. Nobody likes a boss who changes the rules. People and puppies perform their best when there are clear goals, rules, and rewards for the expected behaviors.
  2. Praise is Good-Ken Blanchard (1999) suggested your goal as a leader should be to catch people doing things right. Rath (2007) found that people perform best when their work is based on what they are strongest at doing. Lucy is a hunting dog, a hound. It’s what she loves to do. She loves to find things. Why not encourage that?
  3. Sometimes You Need Discipline- You can’t totally focus on rewards. Sometimes Lucy has to be told not to climb up on the kitchen counters. Likewise employees need rewards, but also need to know the clear boundaries of what is acceptable behavior. Sometimes the boss needs to point out which behaviors are unacceptable. Mission Statements, Visions, Goals, and Rules of Conduct excellent for making expectations clear, and reinforcing the acceptable behaviors.
  4. It Needs to Be Clear Who the Leader is-Dogs are pack animals and there is a clear pecking order as to who the pack leader is. Pure democracies are not effective because someone needs to make the final decision, especially at critical times in any organization. There are times for urgent decisions and in an emergency someone needs to be in charge and make quick decisions, not put it to a vote for everyone’s input. A puppy needs the pack leader to tell it not to run out into the street and when it’s time to go potty!
  5. Freedom With a Short Leash Till You Know the Rules-Situational Leadership is based on the concept that people need high direction when they are in a new situation they have never experienced before (Blanchard & Zigarmi (1999). A nurse orienting to a new field needs clear direction on how things are done, not asked to figure it out by trial and error. Puppies need clear direction and boundaries of acceptable behavior until they understand the rules to being a socially acceptable dog. They can’t figure this out on their own.
  6. Defiance is Unacceptable at all Times-Respect for authority is essential to living in society and having effective work teams. But, leaders also have responsibility to provide clear expectations, an opportunity for employees to do their best, provide recognition, listen to their opinion, and encourage their development (Buckingham, & Coffman, 1999).
  7. Getting Along With Others Means More Play Time-Puppies need to learn that good behaviors are rewarded with more play time. Teamwork (or the lack of it) has been show to have a direct relationship to patient mortality. Basically if a team does not get along well, patients are more likely to die (Aiken, Clarke, Sloane, Sochalski, & Silber, 2002). Effective teams work and play together well. Puppies need to know how to socialize with other dogs. It can be the key to survival in certain situations.
  8. Intermittent Reinforcement is More Effective Than Constant Rewards-Your puppy doesn’t need a treat every time they perform. In fact according to behavioral psychologists, intermittent reinforcement is more effective than constant rewards as the subject never knows when the reward is coming. Leaders need a proper balance between rewarding every behavior and providing feedback and rewards at key moments in time.
  9. You Can’t Be Constantly Working: Breaks Are Important to Effectiveness-Puppies never want to take a nap; they’re afraid they’ll miss something. But when puppies get tired, they become irritable, tend to nip, bite, and become uncooperative. Puppies also need to learn to take breaks to potty or they have accidents in the house. Fatigued nurses are more likely to make mistakes (The Joint Commission, 2011). Nurses are especially prone to trying to do everything themselves and studies have shown that as much as 60% of nurses do not take breaks and are under the impression that it is best to be with the patient at all times (Ellis, 2008). There is increasing concern about compassion fatigue of nurses who work in stressful situations for long periods of time (Hooper, Craig, Janvrin, Wetsel, & Reimels, September 2010).
  10. There is No Prouder Moment Than Being Complimented-Everyone loves positive feedback be they a human being or a puppy. People are more engaged when they work for a winning organization, with co-workers who are committed to quality, and receive praise frequently for good behavior (Buckingham, & Coffman, 1999). Nobody wants to go to a dinner party and hear horrible stories about their place of employment, just as nobody wants to be worried about people visiting their home for fear of an unmanageable dog.

Summary

 We have an epidemic of patient errors in this country and something needs to be done to correct the situation before the respect of nursing and the entire medical profession is further eroded. Some basic principles of training have been presented with suggestions to applying them to improve employee engagement, teamwork, and patient outcomes.

 References

Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., & Silber, J. H. (2002).

Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA, 288(16), 1987-1994.

Blanchard, K., & Zigarmi, P. (1999). Leadership and the One Minute Manager:

Increasing Effectiveness Through Situational Leadership. New York: William Morrow.

Buckingham, M., & Coffman, C. (1999). First, Break All the Rules: What the World’s

Greatest Managers Do Differently. New York, New York: Simon & Schuster.

Ehrlinger, J., Johnson, K., Banner, M., Dunning, D., & Kruger, J. (2008). Why the

Unskilled Are Unaware: Further Explorations of (Absent) Self-Insight Among the Incompetent. Organizational Behavior and Human Decision Processes, 105(1), 98-121.

Ellis, J. R. (2008). Quality of Care, Nurses’ Work Schedules, and Fatigue: A White

Paper. Seattle: Washington State Nurses Association.

Hooper, C., Craig, J., Janvrin, D. R., Wetsel, M. A., & Reimels, E. (September 2010).

Compassion Satisfaction, Burnout, and Compassion Fatigue Among Emergency Nurses Compared With Nurses in Other Selected Inpatient Specialties. Journal of Emergency Nursing, 36(5), 420-427.

Institute of Medicine. (2000). To Err Is Human: Building a Safer Health System.

Washington, DC: National Academies Press.

James, J. T. (September 2013). A New, Evidence-based Estimate of Patient Harms

Associated with Hospital Care Journal of Patient Safety, 9(3), 122-128. doi: 10.1097/PTS.0b013e3182948a69

The Joint Commission. (2011). Health Care Worker Fatigue and Patient Safety. The Joint Commission Sentinel Event Alert(48), 1-4.

Rath, T. (2007). Strengths Finder 2.0. New York: Gallup Press.

Riffkin, R. (2014). Americans Rate Nurses Highest on Honesty, Ethical Standards.

from http://www.gallup.com/poll/180260/americans-rate-nurses-highest-honesty-ethical-standards.aspx

Dr. Michael Grossman, DM, MSN, RN, NEA-BC, CNML has over 35 years of nursing leadership experience and is a nursing leader, consultant, academician, and career coach. As a professor in the graduate schools of nursing at both University of Phoenix and Walden University, he specializes in healthcare ethics, leadership development, career coaching, mentoring, teambuilding, motivation, change, communications, and dealing with “difficult” people. He also teaches nursing leadership certification review courses. For further information go to: http://www.nurseleadershipbuilders.com/ He can also be reached at 610-331-8470 or Mike@NurseLeadershipBuilders.com

Feel Like You’re Not Appreciated at Work?

I Did All the Work: Why Did They Attack Me?: Scapegoat Theory in the Workplace

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The purpose of this book is to identify the dynamics of scapegoat theory, a form of lateral violence. This book is purposefully less than 150 pages. The intention is for you to get an overview of the best body of knowledge about scapegoating, to identify your strengths, and areas you would like to learn more about. You will find a list of references at the end of the book, which will help you on your journey to being more effective in avoiding being scapegoated.

Click to Purchase

We Won: But Does it Matter How We Won?

We Won: But Does it Matter How We Won?

Michael B. Grossman, DM, MSN, RN, NEA-BC, CNML

Referee & Cowboy     This week an important NFL playoff game was impacted by a referee’s mistake. As typically       happens in a situation like this the winning teams fans said, who cares we won, and the losing teams fans questioned the credibility of the sport. The former Commissioner of the NBA, Howard Stern said that he was concerned about controversy in basketball, whether it was real or not as it impacted on the overall integrity of the sport. One of the great questions asked this week was how will this weeks winning team feel if their team loses next week due to a similar referee mistake? Which brings us to the issue of credibility and integrity in all parts of society today. We have a challenge in the work place and as a nation in terms of the morals, norms, and rules we adhere to. Is anything acceptable as long as you win? In the following article we will look at the long-term implications of who cares how we won.

In the End it All Comes Down to Credibility & Integrity

As an ethics professor I have my classes explore the concepts of credibility and integrity through reviewing cases in their workplace and society at large. Deontology is an ethical process for decision-making built on moral rules and unchanging principles. The foundation of deontology is a concern for right and wrong, survival of the species, and social cooperation. From an ethical standpoint, humans should always be treated with respect and integrity and not just a means to achieve something. Human life should always have value. We should always tell the truth, and the foundation of an ethical society is to first do no harm (Morrison, 2011). Some of the contemporary issues in our society, beyond sports speak to these larger ethical issues:

  • Is it acceptable to torture our enemies in the interest of national security?
  • Is it acceptable for our enemies to use children as human shields and bombs in order to win their war?
  • Should the police be above criticism if they are trying to protect themselves from harm?
  • Do people have the right to protest if they feel they have been treated unjustly?
  • Should businesses follow ethical standards or is anything permissible as long is the business makes a profit?

What is the Next Generation Learning From What They See?

The founding fathers of the United States where primarily Mason’s, a secret fraternity grounded in the belief in a higher power and committed to creating a nation based on freedom of speech, equality of people, and separation of church from government, so people of any religion would be free to practice their beliefs. The founding father’s believed that it mattered how we conducted ourselves, and it was important to teach our children ethical principles. Cohen (2008) suggested that what you accept is what you teach the next generation, your employees, and society in general. There have been many challenges and changes to the constitution, but through it all, the resounding theme has been the way we win does matter. In 1864 a group of nations met in Geneva, Switzerland and established a set of humane rules to govern conduct during all future wars. We need rules, laws, and principles to guide our conduct as human beings even in wars, if we truly believe that the way we win matters. There were many questions asked after the stock market crash in 2007? Why weren’t their better laws in place to protect us from this? What are the boundaries of ethical business behavior? How do we protect the average citizen from personal harm?

Ethics in the Workplace

Nursing was again voted the number one profession in terms of ethical standards. Members of Congress came in last at only 7% credibility (Rifkin, 2014). This is a tribute to nursing, and a sad commentary on our government leaders. Yet few people are aware that the third leading cause of death in the United States is preventable medical errors, estimated to be as much as 400,000 patient deaths per year (James, 2013; Institute of Medicine, 2000). Yet even fewer people are aware of nursing’s role in patient errors. The majority of nurses work 12-hour shifts and do not take adequate breaks. Despite numerous studies and recommendations from the American Nurses Association and The Joint Commission to fix this problem, nurses continue to resist addressing the issue of worker fatigue and the resulting patient safety issues (Geiger-Brown, & Trinkoff, 2010). What are the ethical implications of this behavior and how will it affect the credibility of nursing when this information becomes public knowledge like it did with bankers and our government leaders? Most conflicts of interest are around perception of wrongdoing, more so than actual wrongdoing. It is important that we consider our behavior and how it looks to outsiders.

What are we Teaching the Next Generation? 

Today we have massive problems with cheating, bullying, and unfair competition in our schools, organized sports, and on the playground. Parents often ask, where are our children learning these behaviors? Nurses accuse the younger generation of being selfish and not team players. Yet, they are learning it from us and the comments we make when a team wins a game in an unfair way or nurses sacrifice patient safety for their own convenient schedule. Children learn when they see their parents cheat or use influence to get their children into the right school, or playing on the best team. Children learn from what they see on television, in books, and movies when cheaters do get ahead in life and when how we win is less important than winning. It is time for us to honestly and objectively look at our behavior and ask ourselves what we are teaching our children, and the next generation of nurses. How would you answer the question if a patient asked: Am I safe here? What are you doing personally to reduce patient errors?

References

Cohen, M. H. (2008). What You Accept is What You Teach. Minneapolis, MN: Creative Health Care Management.

Geiger-Brown, J., & Trinkoff, M. (2010). Is it time to pull the plug on 12-hour tours: Part 1. The evidence. Journal of Nursing Administration, 40(3), 100-102.

Institute of Medicine. (2000). To Err Is Human: Building a Safer Health System. Washington, DC: National Academies Press.

James, J. T. (September 2013). A New, Evidence-based Estimate of Patient Harms Associated with Hospital Care Journal of Patient Safety, 9(3), 122-128. doi: 10.1097/PTS.0b013e3182948a69

Morrison, E. E. (2011). Ethics in health administration: A practical approach for decision makers (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers.

Riffkin, R. (2014). Americans Rate Nurses Highest on Honesty, Ethical Standards. from http://www.gallup.com/poll/180260/americans-rate-nurses-highest-honesty-ethical-standards.aspx

Dr. Michael Grossman, DM, MSN, RN, NEA-BC, CNML has over 35 years of nursing leadership experience and is a nursing leader, consultant, academician, and career coach. As a professor in the graduate schools of nursing at both University of Phoenix and Walden University, he specializes in healthcare ethics, leadership development, career coaching, mentoring, teambuilding, motivation, change, communications, and dealing with “difficult” people. He also teaches nursing leadership certification review courses. For further information go to: http://www.nurseleadershipbuilders.com/ He can also be reached at 610-331-8470 or Mike@NurseLeadershipBuilders.com

Looking for Some Career Advice?

What’s Next? Create Your Dream Job With a Plan B

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What’s Next? Create Your Dream Job With a Plan B is a great way to take a fresh look at your career. The ten chapters unlock the key factors to creating your dream job. This book is direct, yet comprehensive enough to cover all the essential elements to finding a new job or passion in your current work. You can read the book in less than 2 hours and spend as much time as you like working on the exercises to figure out What’s Next for you.

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Passion: Finding What Energizes Your Career

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Do you ever look at a successful person and wonder, “why can’t I find a job like that and be successful?” Every one of us is capable of living out our dreams. This book will help you map out your dreams in a step-by-step approach and to successfully achieve your goals to find passion in your work. Passion can be just finding a different way of approaching your current work, so that it is more meaningful. It all begins with finding something you are passionate about. When you look at successful people in any walk of life be it business, the arts, sports, or health care, the one consistent characteristic is that successful people love what they do. They wake up in the morning and cannot wait to get to work and jump into the day’s activities. You can achieve your dreams too, but in order to achieve them you must map out a plan.

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Thinking About Getting a Doctorate: How to Choose a Program

Choosing a Doctoral Program
Michael B. Grossman, DM, MSN, RN, NEA-BC

     I am often asked for advice on what doctoral program to enroll in. There are so many choices today for doctoral education it is almost like buying a car. Somehow you need to narrow your focus: do you want a sports car, a family vehicle, something that is economical, or something luxurious? Sometimes it is easier to catch people early in their educational journey when they have already explored the question of what they want in a doctoral program. But, if that’s not your situation, now is as good a time as ever to begin the journey. As they say, Today is the first day of the rest of your life. So, let’s begin looking at what’s next for you. A variety of authors have suggested that it is useful to have friends in your career journey that provide support, guidance, feedback, and hold you accountable to the goals you are setting (Ferrazzi, 2009, Ibarra, 2003, Rath, 2006). I follow a similar process for choosing a doctoral program to the approach I recommend for finding a new job in my two earlier books (Grossman, 2011a, 2011b).

Figuring Out Which Doctoral Program is Right for You

     People often need to do a little career planning before choosing a doctoral program, as a lot depends on what you want to do career wise with a doctorate. Once you figure what is next for you (Grossman, 2011a) and what you are passionate about (Grossman, 2011b), it will become clearer what path you want to take in terms of doctoral education. One question you need to decide is if you want to take a traditional approach or the road less traveled. Early in my education I was a psychology major and the graduate school I was looking to attend preferred people without an undergraduate degree in psychology. You read that correctly, they did NOT want you to have an undergraduate degree in psychology. They said they wanted people with varied backgrounds who brought that perspective to the field. Some of my favorite nursing professors had doctorates from outside of nursing, which I thought made them very interesting and contributed new ideas to the field of nursing. Of course you need to be comfortable with doing that. I don’t mind when people snub their nose at me because my doctorate is not in nursing. I think I bring a lot of valuable insights to the field I love; nursing.

Hermenia Ibarra, PhD (2003) did some interesting research about organizational dynamics and individual role transitions. Broe (2012) replicated her research showing how leaders transition to different careers. Both of their research is very interesting in that they debunk some of the conventional wisdom in leadership practice. Ibarra and Broe based their work on the results of qualitative studies of over 30 people who made career moves and the formula, which is somewhat counter intuitive to conventional thinking. Their suggestions are very much in line with my own experience in coaching people to make career transitions. Briefly Ibarra’s theory (with Grossman comments in italics) is:

  1. Take action; don’t just think about what’s next. (Actually this is the foundation of cognitive therapy: push the patient to take  action, rather than rehash why they think their mother didn’t love them when they were four years old. So you need to talk to people with doctorates and interview at some doctoral programs).
  2. Try different things in protected environments (e.g. With a career move I recommend people try development programs, action learning, pipelines to working in other areas, short term assignments to different units, projects, task forces, shared governance committee work. It is possible to try out a doctoral program. You can usually take a course or two at the university before enrolling in the program).
  3. Don’t try to look for one thing, that is the essence of you. Instead find a bunch of ideas and test them (e.g. Grossman always says, “create a vague vision and then test out jobs or assignment that have those attributes rather than find THE perfect job.” This same principle applies to doctoral programs. There may not be one perfect program, but one that provides the flexibility to achieve your dreams. I had an interest in organizational dynamics, leadership, and the challenges of working with emotionally difficult people. I was able to achieve all those objectives with my doctoral program).
  4. Build in a transition period (e.g. William Bridges, 2004 Neutral Zone concept), rather than jumping right into a new position. So try some things like part-time jobs or temporary assignments (e.g. again, see if you can take a couple of courses before formally enrolling in the program. Even if you do enroll in a program, and find you don’t like it, you can switch to a different program).
  5. Shift your network-Don’t focus on the tasks of the new job, but on people who do the kind of work you’re thinking about. Ibarrah says to never, ever expect your boss or the workplace to be invested in your transition! (This is complicated by the old saying, “You can’t be a prophet in your own land.” It is very difficult to make a school decision based on input from the people in your own environment. The people in your own environment may be worried that going back to school means you are going to eventually leave or get promoted. They may give you biased suggestions like, “Why do you need more education?” Find some people with doctorates from outside your environment and seek their advice and support).
  6. Don’t look for a BIG BANG to hit you over the head…ideally the transition is slow, with mini-steps and psychological transitions occurring every day! (What’s nice is if you have worked on a Plan B, you can refer back to it when you are having a bad day and feeling discouraged with your current work).
  7. Take time to step back and reflect. But, keep the breaks just long enough to reflect, put it all in perspective, and get right back to changing (Here’s where a coach can be useful in reminding you of your goals and keeping you on track).

Ibarra and Broe’s work has huge implications for most fields, especially those that need a next generation of leaders. It also has huge implications for selecting a doctoral program. Frankly I don’t know many fields that have a surplus of good leaders and well educated people. The number one take away message for me is that people need coaches, mentors, and structured action learning experiences (LaRue, Childs, and Larson, 2004) in order to test their theories of what they would like to be in the future.

Why Can’t You Just Do the Work on Your Own?

     You can do a lot of the career development work on your own, but what is difficult is being objective about your strengths, growth needs, and holding yourself accountable. It is too easy to get busy with your current work responsibilities and slowly
the days, weeks, and months pass you by without any progress toward your new career or school decision. It is also hard to push yourself toward loftier stretch goals. Here’s where a mentor or career coach using a formal structured process is useful. Ferrazzi (2009) suggested it is a lot easier to be successful in life if you have other people help you. Ferrazzi suggested that good relationships are based on intimacy, generosity, vulnerability, and candor. A true friend helps you to build your dream, gives you honest/realistic feedback, and holds you accountable to achieve the goals you have set. That’s what he calls having your back. It is not always easy to find good friends like that. Tom Rath (2006) suggested that it is difficult to find one perfect friend who meets all your needs in life. Instead Rath’s research with the Gallup Corporation showed that most successful people have different friends for the different pieces of their life.
I have a network of friends in my academic career, other people who provide me with clinical support as a nurse, artist friends who support my cartooning career, and my sports fanatic buddies who I go to the ballgame with. Bringing this back to Ibarra’s work, you can not always expect the people around you to be invested in your progress. They may not want you to leave them alone in your old work environment, they may be jealous of your career success, and they may not want to take on the work you leave behind. Much of this is not conscious, but comes out in discussions with friends and work colleague’s. Which, is why Ibarra suggests you talk to folks in the field you envision yourself moving to, not the people in your current work environment. I was always interested in on-line learning, leadership, and organizational dynamics. Unfortunately I often asked the wrong people for advice. I spoke to my friend who had a traditional PhD. He said the hallmark of doctoral education was face-to-face interactions. I spoke to another friends father, who was a dean at an Ivy League College. He said on-line learning was just a fad. So, I dropped my dream for a few years, till I realized I was speaking to the wrong folks. Then I switched my approach and started talking to people with on-line degrees, who told me it was the wave of the future. I often sabotaged myself by talking to
people in my own organization who had left academia or consulting for the comfort of
working in an organization. What kind of advice do you think they gave me? You
guessed it, stay in the organization and not pursue a degree. The more I networked with with people in the kind of academia and consulting where I wanted to be, the more support and encouragement I received to take the leap.

Formalizing the Process

     One approach to choosing a doctoral program is to make it into a formal process like many people do with other important decision like buying a car or purchasing a house. Make a list of 5 questions and interview 5-10 people with doctorates. Here are some good questions to start:

  1. What was your goal in getting a doctorate?
  2. Why did you choose the program you went to?
  3. What did you like about the program you choose? What do you wish was different?
  4. I appreciate why you went to the program you went to. In my field what sort of doctoral program will be the most valuable in the future?
  5. What surprised you the most after you had your doctorate that you hadn’t thought about ahead of time?

Another approach is to hire a career coach, who will lead you through a formal process, and whose only investment is in having you be successful and find a new career or educational opportunity you feel passionate about. That structure can be very instrumental in exploring your strengths and building a business plan to make your next move. A good coach can also hold you accountable and remind you when you are making forward progress so you don’t get discouraged.

Dr. Michael Grossman, DM, MSN, RN, NEA-BC is a nursing consultant, academician, and career coach. As a professor in the graduate schools of nursing at both University of Phoenix and Walden University, he specializes in healthcare ethics, leadership development, career coaching, teambuilding, motivation, change, communications, and dealing with “difficult” people.
He can be reached at 610-331-8470 or Mike@Nurseleadershipbuilders.com

References

Bridges, W. (2004). Transitions: Making Sense of Life’s Changes, Revised 25th Anniversary Edition. Cambridge, MA: Da Capo  Press.

Broe, S. (2012). Leaders in Transition. U.S.A.: CreateSpace available on amazon.com.

Ferrazzi, K. (2009). Who’s Got Your Back: The Breakthrough Program to Build Deep, Trusting Relationships That Create   Success and Won’t Let You Fail. New York: Broadway Business.

Grossman, M. B. (2011b). What’s Next Create Your Dream Job With a Plan B. Bala Cynwyd, PA: Nurse Leadership Builders @ http://tinyurl.com/d47t4uo

Grossman, M. B. (2011b). Passion: Finding What Energizes Your Career (1st ed.). Bala Cynwyd, PA: Nurse Leadership Builders@ http://tinyurl.com/d47t4uo

Handy, C. (2002). Elephants and Fleas: Is Your Organization Prepared for Change. Leader to Leader, 24.
Ibarra, H. (2003). Working Identity Unconventional Strategies for Reinventing Your Career. Boston, MA: Harvard Business School Publishing.

LaRue, B., Childs, P., & Larson, K. (2004). Leading Organizations from the inside out unleashing the collaborative genius of action-learning teams. Hoboken, NJ: Wiley Custom Services.

Rath, T. (2006). Vital Friends: The people you can’t afford to live without. New York: Gallup Press.