Sunday, October 14, 2012

Proposal to use Project RED for the Elderly

Hi everyone,
   Re-admission rates with the elderly with stroke is becoming the focus of Medicare and other insurances.  Very often the patient is sent home with instructions but no follow-up, and in 30 days, end up being readmitted to the hospital.  I propose using Project RED as a template for creating a plan of action for reducing the 30 day re-admission rates with the elderly with a stroke.


  Please click on the link below to access the power point:

http://www.slideshare.net/bayleecat/jms-power-point-readmission-rate-of-the-elderly-after-stroke-final?from=share_email








Saturday, March 3, 2012

Ineffective Leaders and Managers: Don't be one!

Hello class,
   Today we are going to talk about "Ineffective Leaders and Managers." I am sure many of you know one, or maybe even two of your managers or leaders being ineffective and function on something that we always called, "crisis management."  So, what is an ineffective leader or manager?
    Ineffective leaders or managers are people who follow other people's agendas and manage their life around pressing matters.  Just like effective leaders and managers, they have developed 7 habits that add to the inefficiency.  Let's think about "The 7 Habits of Effective People" as designated by Stephen Covey (2003), or should I say "The 7 Habits of Ineffective People: Don't Be One."
    In effective people :
         1. Be reactive, instead of proactive.  They do not take responsibility for their own lives and often feel victimized.  They feel that they are the product of circumstances that have happend and do not see themselves as being responsible for their own creative forces in their lives.  Reactive people blame others for everything, the parents for issues that cause them to have bad things, and even the environment is responsible for what is going on with them.  The famous words one hears with reactive individuals are "I can't, I must, if only..."
           2. Begin with no end in mind.  In other words, these individuals do not have a vision, nor have they developed a deep sense of personal meaning.  They live life based on society's values rather than their self chosen ones.  Ineffective managers and leaders have no goals or dreams.  There is no mission statement and no direction because they have no vision.
            3. Put the second thing in their lives first.  These are the crisis managers.  They are unable to focus on the higher tasks and be proactive.  The leaders and managers get pre-occupied with the past or with people and then they get caught up in the thick or thin of things.  Ineffective nurse managers and leaders tend to react to popular, pleasant, and pressing things that can cause priorities to shift, and they become disorganized and unfocuised on tasks.
             4. Tend to think win-lose instead of win-win.  There is a presence of the scarcity mentality.  Usually the seel life as a zero sum game, meaning they have nothing in their lives that is of value.  Ususally they are defensive and adversarial, and definitely have poor and ineffective communication skills.  Usually the thoughts run into the terms of either/or; either you are nice or you are tough and mean.  If these managers become high on courage, but low on consideration of others, then it becomes a win-lose situation.  These individuals borrow strength from power, and then become egocentric.  If they lose, then they subdue themselves to the point that it overtakes them and then frustration becomes the underlying motivation, and they vent.
            5.  Seek first to be understood, instead of trying to understand.  Their point of view is most important, and they are motivated solely on themselves.  These people do not think of others and don't even try to understand them.  Selective listening happens, and sometimes they only pretend to listen.  There is definite lack of empathic listenind as the energies are not focused on the other person.
             6. Compromise, fight or flight.  In other words they clone other people to be like them, becasue differences in others are looked upon as threats.  They tend to set upbarriers to success.  They use attack techniques to putting down the ideas because they are defensive and fearful.  In addtiion, the negativity is rampant and the common words used are "It won't work, it has not been done before, etc."
              7. Wear out the saw, instead of sharpening it.  Ineffective managers and leaders tend to lack a program of self re-newal and self-improvement.  The lose the cutting edge to their performance that they may have had at one time.  There is a limit or poor growth process when self renewal is absent.  There is also decreased productivity levels and inability to handle challenges and eventually they burn out. (Covey, 2003)
Well, after reading and seeing the different types of managers and nurse managers, I hope you will reflect on what is important to you, as you begin your journey into nursing leadership.  Leaders are needed in nursing and with the radical changes that are occurring in healthcare today, we need effective nurse leaders and managers.  Take a few moments, refelect on a time when you had to work under an ineffective manager.  How did you feel?  What did you do to make the work environment more palatable?  What about when you worked under an effective leader?  What was the difference?
Write your thoughts in a journal.  Ponder these questions carefully as in a few weeks you will be working for one of theses types of managers and leaders.
Till we meet again.

Reference

Covey, S. (2003).  The 7 Habits of Highly Effective People Personal Workbook.  New York, NY: Simon & Schuster.                  
 

Friday, March 2, 2012

The 7 Habits of Effective Nurse Managers and Leaders

Before reading the post below, please click on this URL. http://www.voki.com/pickup.php?scid=5542949&height=267&width=200

Habits of effectiveness ar timeless principles that are in harmony with our natural laws.  People who live by these habits are guided by their own missions that they have set for themselves in their lives, and manage their lives according to principles.  Ineffective people follow other individuals'agendas and they manage their life around pressing matters, otherwise known as crisis management.  As upcoming nurse leaders, we must learn skills in being effective, not only with time, but with other elements as well.  Nurse managers who are effective can become effective nurse leaders.  Keep in mind as we move through this class, if leadership is seen as the ability to influence whatever qualities a leader must possess to be effective, then we must develop the qualities and behaviors that will make us become that effective nurse leader and manager (Whitehead, Weiss & Tappen, 2011)..

Effective people are:
  1. Proactive: Be proactive in that, do more than just take the initiative.  Recognize that we are responsible for our own choices and be accountable to them.  Proactive people are agents of change.  Life does not just happen, but rather it is carefully chosen so that every moment and every situation, there is a new choice.  Proactive people say, "I can, I will, I prefer..."
  2. Beginners with the End in Mind:  Shape the future by creating mental visions and purposes and commit to those principles and purposes in what matters the most to  you.  Effective people begin each day, task, or project with a clear vision of the direction f and continue to make things happen.  Just like the Kevein Costner Field of Dreams movie, "If you build it, it will come."
  3. Good at putting first things first: Recognize that in order to have a balance life, it is ok not to do everything that demands your attention.  Be clear about who you are and what you want.  Focus on the highest priorities.  Highly effective people do not manage time, rather they manage themselves and complete tasks according to one's priorties.  Prioritize is the main work and delegation is utilized frequently.
  4. Win-win:  Think in terms of trusting relationships and seek mutual benefit and respect in all interactions.  To be win win, think in terms of abundance and opportunity, where there is an exhibition of integrity, maturity and abundance mentality.
  5. Seekers, in that they seek to understand, then be understood: Listen with the intent to understand others rather than the intent to reply.  Have the courage, the consideration and the opportunity to understand others.  If you do not remember much of these principles as we go through them, at least remember one important fact.  COMMUNICATION is the MOST IMPORTANT skill in Life, no matter where you are and whom you are with.  If you would remember a bit of Maslow's that we have talked about in the past, next to physical survival, the greatest need of a human being is to be appreciated and UNDERSTOOD.  We truly underestimate the importance of communication skills in our personal life as well as in our nursing life.
  6. Synergizers:  A third alternative is always out there.  In other words, It is not my way or your way but a third way which would work better.  Think cooperation.  Create new alternatives to solutions .  This habit is the essence of leadership. This principle centered leadership celebrates teamwork, open mindedness and creating alternative solutions to issues that arise.
  7. Saw sharpeners:  No, not pencil sharpeners.(LOL).   Effective people constantlty renew themselves in four basic areas of life: physical, spiritual, mental and social/emotional.  By becoming self aware, effective people increase their capacity to become more effective in the day to day challenges that are faced, not only in the healthcare environment, but in the personal lives as well.  Becoming self aware, the direction and focus is into a meaningful progress through life (Covey, 2003).
Take some time this weekend and ponder these 7 habits of effective people, and see how you fit with the principles.  Remember as you read and evaluate yourself with the principles, that nurse managers have complex, responsible positions in healthcare today, and it is usually the effective nurse manager that can guide the staff to providing the higher quality of care to their patients.

We will continue tomorrow with what not to do, in other words, how to be ineffective as a nurse manager and leader.

References

Covey, S. (2003). The 7 habits of highly effective people.  New York, NY: Simon & Schuster.

Robinson, P. A. (Director). (1989).  Field of dreams. USA: Gordon.

Whitehead, D. K., Weiss, S. A., & Tappen, R. M. (2010).  Essentials of nursing leadership and management, (5th ed.). Philadelphia, PA: F.A. Davis.

Tuesday, February 21, 2012

Today we are going to finish this class with understanding Empowerment.   What is empowerment?  What does that word mean to you?  What does it mean when we use the word, self-empowerment?  When it comes to leadership and management, it is important for the nurse leader to understand the importance of self-empowerment and to support this feeling of competence in others as well .  When we talk about words, we need to understand the terminology used in dealing with power and empowerment.  Power refers to the ability and empowerment refers to feelings, and both of these elements are important and essential to nurse leaders as well as nurse managers (Whitehead, Weiss, & Tappan, 2010).

      Empowerment Ladder:
             1. Self-confidence
                 a. Ability to control life situations
                 b. Refuse to be a victim
                 c. Values self and others
            2. Competent
                a. Ability to do work well
                b. Caring about the quality of work
                c. Enjoying your work
                d. Feeling valued
            3. Becoming Empowered
                a. Show initiative
                b. Resolve conflict
                c. Make decisions
                d. Support and empower others

Your success as a leader not only depends on your self emowerment,but also in providing support to others.

Reference
Whitehead,  D. K., Weiss, S. A., & Tappan, R. M. (2010). (5th ed.). Philiadelphia, PA: F. A. Davis.Essentials of nursing leadership and management





 


Monday, February 20, 2012

Leadership and the Power of Words

 Today I would like to tell you a story.  A group of frogs were traveling along a fence near a barn.  There was a pail full of fresh milk at the end of the fence near the opening gate.  Two of the frogs fell off the fence into the pail. All the other frogs gathered at the edge of the fence and peered into the pail.  When they saw how deep the bucket was, they told the two frogs they were as good as dead.  The two frogs ignored the comments and kept paddling with all their might.  The other frogs kept telling them to stop, that they were as good as dead.  Finally one of the frogs took heed to what the other frogs were saying and gave up.  He sank down into the milk and died.  The other frog kept paddling as hard as he could.  Once again, the crowd of frogs yelled at him to stop the pain and just die.  He paddled even harder.  He churned and churned the milk until it turned into curds and created a ball of cheese. He jumped onto the ball and made it out of the pail.  When he got out, the other frogs said, "Didn't you hear us?"  The frog explained to them that he was deaf.  He thought they were encouraging him the whole time.
Click on the link to hear the moral of the story:
http://www.voki.com/pickup.php?partnerID=symbaloo&scid=5423839&height=267&width=200

Sunday, February 19, 2012

Leadership and Management: The Bases of Power

Click on the Url before continuing to the the text below:http://www.voki.com/pickup.php?scid=5423839&height=267&width=200

It is important as part of learning about leadership and management to identify bases of power that is used by others in a workplace setting. There are six bases of power (Patronis Jones, 2007).  At some point in time you will see all six of these bases.  If you are ever placed in a postion of power, it is important to remember them so that the one you choose is best for that situation and position,

 One of the most strongest power to have is known as Expert PowerThis power base is the most positive and nonaggressive way to have power because it is genuine and you have worked hard to get it.  This power indicates that you are seen as the best on the area yo comu work on.

The second most important power if it is not abused, is Reward Power.  This base is often used as manipulation, so if this power is used, be fair.  Usually this power is when one is in charge of schedules and raises.

The third power is Legitimate Power.  This bas is abour the power that is given to the individual in order to do the job, such as a DON.  It is based on knowledge, hard work and ability and it comes with a title given from the administrative department.

Coercion Power  is considered a unhealthy power base in that the person who uses this base does not have the leadership serkills necessary for the job.  The main focus of this base is to hurt and punish others.  The person also does not have the clinical skills needed as well to do the job at hand.

Informational Power is a genuine source of power in which the individual does not gossip bur rather gives accurate information that empowers everyone.  Typically it is nurse managers that have this power because of their knowledge base.

Last, the power base that is a caring power is known as Reverent Power.  This base utilizes the skill of networking to  get to know people and are willing to assist them.  This power is a power that is kind and caring about others feelings, thoughts and ideas.

These bases of power defines the types of power that exist among us today.  It is up to each one of us as to which power to use.  Power can have very dramatic effects on people, whether it is used one on one or whether it is used in a group.    Over all, power commensurate with knowledge and expertise is needed to enable nurses to provide competent, humanistic, and affordable care to individualts and improve nursing, healthcare and health policy (Patronis Jones, 2007).

                                                                             Reference

Patronis Jones, R. A. (2007). Nursing leadership and management: Theories, processes and practice. Philadelphia, PA: F. A. Davis.

Saturday, February 18, 2012

The Use of Power: Do You know how to handle and control it?

As a nurse leader or even a nurse manager, one of the things that will be attained is power.  The use of power in healthcare takes many different forms, and it does not come all wrapped up in one little box to be taken out when it is to one's advantage.  So, I ask this question, what is power? What does it mean to you?  When you think of power, what feelings do you have? 

When thinking of power, many individuals have the feeling of uncomfortableness.  In fact, in some cases, it conjures a very negative feeling.  Power is actually a new concept for us nurses and nurse educators.  There is no agreement in the nursing community as to what the power is for nursing, just like critical thinking.  When I think of the word power, several things come to my mind.  I see the color red, I see a power struggle in which two people are engaged in an argument.  I see it is a great skill to have as long as one develops it and understands the value of it.  Power is the ability to influence others through the use of energy and strength (Anderson, 2010).  One of the important facts I would like to make is, that to understand power,  one has to understand the different types of pwer so that they can be identified not only in yourself, but in others as well. 

There are six different bases of power: Expert power, reward power, legitamate power, coercion power, informational power, and referent power (Anderson, 2010).  Each of these bases of power affects people in different ways.  We will talk more about this tomorrow.  For tonight take the quiz from quibblo to see what kind of leader you are.

Reference
Anderson, M. A. (2010). Nursing leadership, management, and professional practice for the LPN/LVN in nursing school and beyond. (4th ed.). Philadelphia, PA: F. A. Davis
http://www.quibblo.com/quiz/bvMdq2f/The-Four-Frames-of-Leadership

Thursday, February 16, 2012

Leadership and Management: How Well Can You Communicate?

Yesterday I witnessed a situation that I would like to talk about.  There were two people, a mother and a daughter at a table at the restaurant that my husband and I were visiting.  The mother, who was dressed as though she was in a professional, maybe managerial, postion, was on her phone talking to someone about a contract of some sort.  Her daughter, in her early twenties I would hazzard a guess, reminded me of my daughter, a college student, dressed in jeans and a pretty pink tee shirt.  Her hair was long and pulled up into a pony tail.  She was impatiently waiting for her mother to get off the phone.  As she was waiting, she was playing on her cell phone looking at Mom to "hurry up" the conversation.  Mom continued to talk until the food came.  At first, their conversation was blending in with the hum of the restaurant noise.  Soon, both my husband and I noticed voices becoming louder.  Mom was angry and the daughter was too.  Mom soon became verbally aggressive in an authoritative voice and refused to listen to the daughter.  The daughter, after responding defensively, clammed up and sat sullenly at the table while Mom either ignored her or spoke with harsh tones.  Shortly after the heated conversation erupted, Mom requested the bill and they both left.

I began to wonder how would I have handled that same scenario.  I also wondered how the mother would have responded to a coworker or an employee, if she was trully in a managerial situation.  Then I thought about how we communicate in general. What is communication?  We know that communication is when one person sends a message and the other, the receiver, receives the message.  The receiver then sends the message back to the send, and this of course is feedback.  Back and forth it goes, either until the conversation is ended or the communication fails.  As we know, there are two types of comunication, verbal and nonverbal.  In the scenario described, the two types were used as evidenced by the mother and daughter's words and behavior. The part of communication that tends to get lost is the active listening that should take place between the two individuals.  Most of the time we hear the words, but do we really listen to what is being said?  Listening is crucial to identify not only the information being received, but also the emotions of the other person so that the response is appropriate (Anderson, 2009). 

As the healthcare environment becomes more complex and diverse, communication becomes an essential skill for the nurse leader and the nurse manager. In addition, there will be a need to communicate effectively, not only with other healthcare members, but with patients and their families.  As a manager, or as a nurse leader, you have the responsibility of accomplishing work and goals through others, and part of how to make this happen in the clinical environment is through successful communication (Covey, 2004).

Please watch the video and take a few minutes to think about how we communicate when we are at work, in the classroom or with our family members.  Please see the next blog for the video.  Thank you.

References
Anderson, M. A. (2009). Nursing leadership, management, and professional practice for the LPN/LVN in nursing school and beyond, (4th ed.). Philadelphia, PA: F. A. Davis
Covey, S. R. (2004). The seven habits of hightly successful people. New York, NY: Simon & Schuster

Video posting "Why is Communication So Hard for Healthcare Professionals?"

Sunday, February 12, 2012

Leadership and Critical Thinking: What does this mean to nurses?

Today I was thinking about critical thinking as I was preparing for a classroom activity.  We know critical thinking is important to nursing, but how important is it?  How does an instructor teach critical thinking, especially to those who have no concept of what it actually entails.  Do our leaders critically think?  Does someone in a leadership role critically think?  How do we get those in leadership to learn how to critically think?
 What exactly is critical thinking?  The term critical thinking is often used to mean problem solving, decision making and creative thinking in nursing, and yet there is no widely accepted definition of critical thinking. (Fero, Witsberger, Wesmiller, Zull, & Hoffman, 2009).  So with that as a basis for critical thinking, how then can we as educators teach the next generation of nurses to learn to "think out side the box" or "creatively think" when placed in leadership roles, if we can not teach them that skill to functiona as a nurse generalist?  In critically thinking, it helps one to understand that why solutions to particular issues have failed is part of the subset of these skills necessary to think in a critical manner (Fero, et al, 2008).  With the world of nursing changing almost everyday, and with patients becoming more complex, it is important for nurse eductors to to teach students to critically think and how to practice competently in a variety of situations in which there is no clear solutions to the problem presented (Kaddoura, 2011). 
 Nursing needs leaders that can critically think.  Nursing needs leaders to improve the nursing profession and become more forthright in the provision of patient care and safety. A study by Fero and team (2009) found that approximately 25%  new graduates were not meeting the expectation of having developed critical thinking skills, and these deficiencies included problem recognition, reporting of essential datat, initiating independent nursing interventions, anticipating relevant medical orders, and providing relevant rationale to support decisions.   It seems frightening that we are releasing graduate nurses to the world, and they have very little skills in critical thinking.  Nurse educators need to find ways of equiping the nursing skills that would promote critical thinking to solve complex problems (Kaddoura, 2011).  In order to do this, educators can promote active learning and a provide prudent preparation for clinical practice by useing case-based learning (Bradshaw & Lowensteing, 2011).
  Having students learn through case studies allows them to think about the big picture and to come up with all possible solutions to that particular issue.  They can brainstorm together and look at the solutions and put it into role playing practice.  They can also role play with the issue at hand to as to develop the critical thinking and problemsolving that wourl be a necessary skill when working with complex patients.
   How do you see critical thinking?  What does this term mean to you?  Do you think you have the skills of critical thinking and leadership?  Can one exist with out the other?
Judi
                                                                                           Reference
Bradshaw,  M.  J., & Lowenstein, A. J. (2011). Innovative teaching strategies in nursing and related health professions (5th ed.). Sudbury, MA: Jones and Bartlett.

Fero, L. J., Witsberger, C. M., Wesmiller, S. W., Zulio, T. G., & Hoffman, L. A. (2009). Critical thinking ability of new graduate and experienced nurses. Journal of Advanced Nursing, 65(1), 139-148. doi:10.1111/j.1365-2648.2008.04834.x.

Kaddoura, M.A. (2011). Critical thinking skills of nursing students in lecture-based teaching and case-based learning. International Journal for the Scholarship of Teaching and Learning, 5(2). Retrieved from http://www.georgiasouthern.edu/ijoti

Sunday, February 5, 2012

Leadership

I would like you to take a few minutes to sit and think before you go too far into reading this post.  Think about the tape recordings that run through your mind on the different issues that you have come in contact and how you handled those issues.  In many instances our tape recordings in our mind play over and over again and they influence not only our reactions to situations, but how we are when we are faced with similar issues.  Think about  what your greatest fear about becoming a leader contains.  Do you have pictures of great managers and leaders that you have come in contact with?  I  know I do.  For all of us to understand and use management and leadership prinicples, we need to understand ourselves and what is improtant to us.  Leadership and management, two very distinct terms that are often blended in the minds of our students, colleagues and even ourselves, without a clear and defined picture of what either term means.  One of the more finite definition that I have learned of leadership is that leadership is a collection of personal traits that is present in order to establish a vision and goals for a particular group and implement them, whereas, management is more along the lines of organizing, motivating and making sure the plan of action is carried out.

So, what are you?  Are you a leader or are you a manager? What characteristics do you believe a person needs to be a leader? When do you think the roles of a manager and a leader could conflict?  Take a few moments and pause on these questions.  We may find our answers if we take a few moments and reflect on them.

"What lies behind us and what lies before us are tiny matters compared to what lies within us." Oliver Wendell Holmes.

Monday, January 30, 2012

Leadership and Professionalism

With the fast pace of healthcare and society, and the rapid growth of technology, professionalism and leadership skills are becoming a dying are in the nursing profession.  We need to bring both of these skill sets back to the forefront of our nursing education so that our upcoming nurse graduates could have the neccessary skills to become leaders and professionals in the nursing community.
With the rise in technology, many of our younger generation of nurses do not know how to communicate professionally, as they are used to texting, and thereby using abbreviated words, being unaware of the tone of voice nor understanding the impact of what and how words are said to the listener.  As a nurse educator, I have become appalled at the lack of professionalism and leadership skills that are exhibited, or not exhibited as I probably should say, among our colleagues.When one can say a person acts “professionally”, for example, we imply that the person is conscientious in actions, knowledgeable in the subject, and responsible to self and others, including civility. (AACN, 2008  ).  In addition a postive image is essential to be a nurse as we spend time with patients, familiesm managers, public officials and even administrators within the community (Larson, 2006).  As a nurse educator, how can I convey to students the importance of not wearing fake nails, dangling earings, thick necklaces, colorful but inappropriate shoes and color in the hair?  How do I as an older professional, keep reminding the next generation the importance of acting, and looking professional and becoming a leader for their generation of upcoming nurses?  Professionalism and leadership is a course that truly needs to be offered to all nurses of every discipline.

  In the upcoming weeks we will be discussing leadership and professionalism and how we can teach the next upcoming generation of nurses these much needed skills.  Please take the time to reflect and share your thoughts on what leadership means to you and also how you view professionalism, in a nurse, a nursing student or even a healthcare provider.  How does both of these skills affect the care of the patient?

American Association of Colleges of Nursing, (2010). The essentials of a baccalaureate education for professional nursing practice. Retrieved from http://www.aacn.nche.edu/education-resources/BaccEssentials08.pdf

Larson, S. E. (2006). Create a good impression; Professionalism in nursing. Retreived from http://www.nsna.org/Portals/0/Skins/NSNA/pdf/Imprint_NovDec06_Feat_Larson.pdf