This week is the last week I will be blogging for my Nursing Leadership Course. It is a bitter sweet moment for me because this marks the end of my schooling in pursuit of a Bachelors of Science in Nursing. I have worked so hard to get this point and I can’t believe it is here. This past year in the bachelors program has taught me about my role as a nurse beyond the bedside care that I was taught in the ASN. I was able to go on a trip to Samoa with UVU’s nursing and learn about the culture and help the people of Samoa with what we could. It was one of the most amazing trips I could’ve ever taken and is something that I will forever treasure as a nurse. On days where I am having a hard time, I try to remind myself of how blessed I am to have the resources to care for people in a way that does help them get better compared to the care that is given in a country like Samoa. They have the people who want to help but they don’t have the resources in the community or in the hospital to help them like they need.
This course has taught me a different perspective on the different leadership roles that nurses can grow into. It’s hard to realize the challenges that nursing leaders face and it’s easy to just put blame on them when something is changed that we do not agree with. The job they have is not easy and when someone grows into that leadership role they truly have worked toward it because it is not easy. I also learned how I can grow into a leadership role and still stay at the bedside. There are ways to get involved in helping with leadership changes and making my voice heard when I do not agree with the changes occurring. I also learned of the challenges that nursing leaders face and how they can be managed. It is not an easy job to have to solve issues that went wrong and implement changes that in the long run help prevent these same mistakes from occurring in the future. I am proud to be a NURSE and will continue to work toward helping others love nursing as much as I do.
This week we went over risk management. It is a topic that is actually kinda nerve racking for me. These situations occur where risk management has to be involved because an injury that could’ve been prevented occurred. It’s sad for the patient to have something like this occur. We went over a scenario where a patient had burns occur, but in the scenario I did not see anyone at fault. The nurse did what she was suppose to do and it’s hard to say if the security staff did what they were suppose to do. But knowing this I think a change in policy should still occur in this scenario so that future injuries do not occur.
While I was a resident student we had risk management team come talk to us about what they do and how they can help up. I think that we hear risk management and get nervous but the team did give us encouraging words about how they can help us in situations. I think that I can apply this in my career because I can learn to utilize the risk management team appropriately and get them involved with patients early on so that injury or risk doesn’t occur.
The semester is coming to an end. I have one more journal after this. It’s bitter sweet because I will be graduating after these courses. It is coming time to apply what I have learned in these bachelors courses and work toward a leadership position.
This week was focused on motivating employees and how to keep employees engaged and involved even when pay is not the issue. It is true, pay is not always a way to keep employees engaged and wanting them to work for a company or a unit. If the stress is high enough, the employees may not want to continue to go through that. For this week as a group we decided on a 7 step strategic plan for helping to keep employees engaged.
1. Communicate with staff about their concerns and what makes them unhappy. Knowing why is the first step in being able to solve the problem. Taking the time to ask is important, listening to those concerns is even more important.
2. Food is the way to an employees heart. Seriously though…working 12 hours is a long shift, and oftentimes it can be difficult to step away for long enough to grab something to eat, Providing meals occasionally for the staff would help to build morale.
3. Involve patients in showing gratitude for the hard work the nurses are putting in. This is why we do what we do! Hearing the gratitude would mean so much to the nurses.
4. Involve the staff in more than just bedside nursing. Let them lead, encourage them to lead. Let them make decisions and teach and influence others. Empowering nurses to be involved will give them ownership over their workplace and increase their satisfaction.
5. Celebrate accomplishments, no matter how small. Being recognized for progressing as a nurse and for doing a good job will incentivize nurses to put in even more effort, and do so gladly.
6. Assign nurses to mentor each other. Sometimes as nurses we can feel like we have to be able to do it all on our own. We can also feel lost at times. especially if we are new to the unit or the organization. Providing mentors will help the mentor feel more valuable and will help ease the mind of the person being mentored.
7. Resolve conflict and halt backbiting as soon as it becomes apparent. Nothing will crater morale more quickly than someone feeling as thought they aren’t welcome. We are a team and each member deserves to feel included and valued.
This is something that as a nurse now I can bring forth as a recommendation when going gets tough. If I were to be involved in leadership then I would want to be able to apply this so that I could help keep my employees engaged and keep the drama down on the unit. I think nursing is hard because we are in high stress levels as it is and to be surrounded by so many others it is important to keep employees working as a team and minimize the dram between them.
This week we reviewed conflict resolution and what to do in those situations. After discussion with my group we reviewed definitions of conflict, assertive communication and aggressive communication. We gave examples of each. My group had some great examples of each and one of them was how on units nurses can approach changes they do not like or agree with with assertive communication with managers versus having aggressive communication and nothing being resolved. On units, employees should communicate concerns they are having but also approach how they discuss it in a manner that will help the situation. We also gave good examples on how to deal with the situations: Start communication early on, setting up a meeting between conflicting parties to discuss the issues. Finding a good time and safe place to discuss the issues. Listen to each sides story and being an active listener. Work toward an agreement that works for everyone.
This week I watched “The Guardian”, I must say I did cry! I knew something bad was going to happen and that I shouldn’t cry but when Senior Chief died I couldn’t handle it. I ended up crying. This movie gave some good examples of conflict between Senior Chief and Goldfish. They did not get along in the beginning but they actually had much in common. They both had lost their team and they both did not know how to deal with the loss that they were going through. They were about to talk about it and help each other cope. By goldfish getting stuck in the boat he helped senior chief move past the fears/flash backs he kept having in water and go save him. He chose saving goldfish instead of both of them dying. That takes huge selflessness.
Another activity we had this week was bargaining in a situation when you are negotiating with employees. It looks like most of us had close to 12-13%. After rolling the die we rolled a 4 or 5. Which dropped our percentage a little. We had a net gain for 3 years of $9,000-$12,000. After reading everyones discussion posts. It seems that we each did not realize about union bargaining and how that plays out in bargaining situations. A lot comes with bargaining and it does take strategic planning, forethought and a leader who knows what they are doing for the bargaining to be beneficial to employees and for the employer to not lose to much money.
I can apply what I learned this week by making sure I handle conflicts in there right way. I do not like conflict and it makes me nervous so working on my communication skills in conflict situations will help me as a grow in leadership.
This week was interesting regarding team activities, we came up with a change to a healthcare system so that we could work on planning as a team. I chose to expand advertising and eventually expand to a commercial. It was interesting to see what everyone was coming up with to expand the healthcare system and compete with the other health care system. I was able to think about what I think should be changed in the BSN program. It was hard to think of changes I think would be best not to make it easier but to build it up so students continue to learn and enjoy the program.
I feel like its hard to plan things for companies and it would be hard to be a manager making these operational decisions. I don’t have a lot of other stuff to ponder on this week but I will continue to work through thinking how to apply this to my career.
For this week I chose to interview Enrique Garcia, small business owner of G&L Diesel LLC. Here is the questions my team came up with regarding budgets.
- What actions are completed if a budget is exceeded? I have to review what happened and why I went over budget. I then review what can be cut for the following month so that I don’t go over my budget.
- How do you divide funds between departments? I don’t have much departments, I have my gas funds, parts funds, and a couple other funds. I have reviewed multiple times how much I spend in parts so that I could develop a budget. When I started my own business I did not have a budget until I realized how much money I was spending and I could see where I was spending the most money.
- What is the hardest thing when it comes to sticking to the budget? Its remembering I have a budget and I need to review my funds before I make a big purchase.
- Do you have a part of your budget that is consistently over budget? No I usually can stick to my budget pretty well, the only time that gets interrupted is when clients don’t pay me which doesn’t occur frequently
- What is usually the first area you look at when making budget cuts? If I cut budget in this area will it just cause me to go over budget in another area
- Do you consult with departments before making cuts to their budget? And/or is there anyone you consult with before making budget cuts? I don’t have departments or others to consult with so this doesn’t apply to me
- How often do you adjust your budget? Quarterly I review my accounts and how I am doing
- Do you give any incentives to staff members for meeting the budget? If yes, what? If not, what is used to motivate staff to hit the budget? Does not apply to me
- When planning a budget for a department or your organization, what percentage do you usually allocate for employees’ salaries? Does not apply to me
- What would you say most companies struggle with when budgeting? I think trying to stay on that budget and when many employees are involved that makes the budget harder to manage.
This week we also reviewed managing change. Change is part of our lives on a regular. Just this week I had to manage the change we are being faced with working at Utah Valley and moving to the new hospital. We are prepping for the move and what it will be like. We are training in the new building on how to manage codes and the layout. It’s hard to think we will be in a new building and trying to adapt to that change. After reading my groups posts we all seem to be on the same page about how it is hard for us to accept change right way. I usually have a hard time in the beginning when dealing with change. I have to really talk myself into accepting why the change will be better. I sometimes tend to overanalyze the change that may be occurring and am not always reluctant to the change. So that is something that I am working on now so that adapting to change doesn’t come so hard especially in my work life. I want to be prepared for change and move forward as quickly as possible. I am an ICU nurse and change occurs left and right when it comes to patient care so I want to make sure I can adapt to those changes and be ready.
This week I had the chance to really think through what I want of my future career in nursing. I thought through what I wanted and I have been debating if I want to persue Nurse Practitioner. I decided I do want to because of the hours that will be ideal once I start a family. I am getting married next year and starting to have kids will be a couple years after that. I love bedside nursing but we all know bedside nursing is changing. It is not the patient focused care we had before. Charting is taking so much time away from the bedside that nurses are rushed and cannot sit and just talk with patients like they once could. That being said I am wanting to continue my education after my two year mark in the ICU. That will be in January 2020. Many of my co workers have done programs online so that would be the route that I am going to look into.
This week I also learned about staffing and the different staffing methods in different units. My unit is testing the self schedule technique that the UVH ER uses. We are having a hard time with it and its just a testing schedule. Many people have their schedules and don’t want change. We are already moving to a new building so I think many are holding on to anything we can. I don’t mind the self schedule it just sucks for me because I will get the last of the pickings. A friend of mine who works in the ER says that she sometimes works one or twice a week because she didn’t have any shifts to sign up for that week. But the following week she works 5 shifts because she had to make up the week before. Being a 50/50 schedule person who just gets the left overs now, I am looking forward to a set schedule. I think it would be hard to be a schedule person. I think it works best if the schedule person is designated to the schedule and has the time to improve and work on the schedule. On my unit the scheduler is also a charge nurse and works regular shifts plus does the CCT schedule and RN schedule. We tend to find many mistakes and if any issue is brought up she gets frustrated. This usually is because of her busy schedule which I understand. That is why I think that the person who does the schedule should be able to devote all the hours she needs to the schedule.
I will apply this to my career by suggesting changes to how we do the schedule. I also will work toward the goals that I have made in my career development and making sure to stick to a plan to achieve these goals.
This week we watched a video talking about the plan for the future of nursing. It was an interesting presentation to watch because the different points that were brought up. The future of health care were making quality, compassionate, and patient-centered care accessible to diverse populations. All healthcare workers work in collaborative work. Intentionally promoting wellness and primary care and preventative care being a huge part of healthcare. Nurses would not have limitation on providing care they are capable of giving. Like the example she shared, many states do not let nurses practice to the full capability they are trained to perform, these states set limitations on nursing practice. The goals are: having nursing practice to their full extent that the education and training permits them. Nurses should get higher levels of education and have an opportunity to continue through that education smoothly. The next goal is for nurses to be considered partners with physicals and others of the health care team. Not being viewed as minority to doctors but being viewed as equals and opinions being viewed equally and taken into consideration the same. Lastly getting more data to improve the treatments given and policy making.
I think that I learned quiet a bit from the lecture and I want to apply it in my nursing career by trying to pursue my education. I want to be a leader of nursing and be able to encourage other nurses to pursue that. Nurses have so much to offer as leaders and on helping build other nurses. Taking those ideas that we develop from being on the bedside and expanding it to build our healthcare system and build the hospitals that we work in. We can provide better patient centered care.
For this week we worked on budgeting and figuring out how to make cuts on a budget for a med/surg unit. This actually turned out to be harder than I expected. But first, I interviewed Jeanie Vasquez, a manager at Fusion BPO Services PVT. Here is the interview on Firing/Disciplining Employees.
1. What is the number one reason you fire someone?
Because of the inconsistency in completing tasks and/or being to work on time
2. How many chances or warnings do you usually give someone before terminating them?
Twice, on the third time the employee is let go
3. What are your steps of discipling an employee? What do you start with and if that doesn’t work what are your next steps?
Warning is the first step, the second is a written warning as well as coming up with a plan to prevent future occurrence. The following time then the employee is terminated
4. Who else is usually involved in the firing process of an employee? HR, team lead of the person being fired and myself
5. Do you consult with other people before firing or disciplining an employee? If yes, who? I consult with other employees as well as HR to see if this is the right decision. Team leads are usually the first to be consulted with because they work more frequently with the employees.
6. Do you offer severance pay or any compensation for employees when they are fired? If yes, are there any circumstances where you wouldn’t offer anything? Not that I know of.
7. Does HR have to be contacted a certain period of time before firing an employee? Not a certain period of time, but we do notify them so that they are present or involved in documentation of the termination
8. Is it common for an HR employee or other management to be in the meeting when firing an employee?
Yes, I like to have an HR employee with me so they can witness the conversation and it can be recorded that protocol was followed during the firing
9. What is the most difficult aspect of having to discipline/fire an individual? I become friends with some of these employees and so it’s hard when you have to fire someone you have gotten to know
10. When having to discipline/fire an employee, do you find it hard to separate your personal feelings for that employee from the task at hand? Yes I do find it hard because I think about their personal life that I know of and how this could affect them. I get to know some employees more closely when I work with team leads and having to fire them makes it hard to not feel bad if they cry or something.
This week I learned about how budgeting works and how being in a leadership role can mean working on enforcing a budget or making budget cuts. I know that many of the meeting I have went to for work, my manager brings up how we are under budget or close to budget on something and how we have to be cautious with it. The beginning of each year consists of brining up how we must work on meeting budget requirements and if we are under budget at the end of the year, our manager will buy us pizza for day shift and night shift on a a night. Working in a leadership position where budget has to be thought of would be very hard for me. During the assignment this week I had to spend a lot of time analyzing the budget chart and trying to first understand how to be able to make cuts when reading the chart and then come up with reasons why. It was hard to figure out what is important and what can be cut.
I can apply this to my nursing career by being conscientious of the budgets that as nurses we are trying to maintain and how my part can influence the budget by being an example to other nurses and remind them to also be conscientious. I can also be empathetic to my manager and how much he is already dealing with as a leader and how he also has to focus on the money portion of healthcare not just the patient care. This week for sure was an eye opener for me how complicated budgeting could be and that is not even having to apply the hundreds of employees that the budget effect and trying to put the budget into effect.
For my interview this week I chose to interview Laura Torres, one of the HR employees at Centro de La Familia de Utah. This is the interview:
- How much impact does an employee’s performance appraisal interview have on their potential future raises and/or bonuses? Not much
- Before you conduct a performance appraisal, do you ever get feedback from their fellow co-workers on the type of employee they are? If so, how do you choose which co-workers to talk to? Yes
- Is there accountability on the part of management for their efforts in helping the employee improve? In other words, do you ask the employee how you could have better helped them improve their quality of work? Yes, we will provide professional development if needed .
- If you are at odds with an employee regarding your opinion of their performance vs their opinion of their performance, what ways have you found to appropriately address your concerns without just totally disregarding their feelings/opinion? with my experience I’ve noticed that talking about the positive feedback has been the best way to start the conversation and then of course bring up the negative where they’re lacking/failing not necessary let them know that they’re not doing a good job but to encourage them that there’s always room to grow/ improve and set some goals and deadlines schedule a follow up review
- Do you do all performance appraisals interview yourself or do you have other leaders on your staff perform some of them? If you do them all yourself do you involve your other leaders in other ways to help with the process? No, We have different supervisors that provides supervision in different departments so they will conduct the annual performance review.
- How often do you do performance appraisals with your employees? Why do you choose to do them this often? Annually, I don’t know it’s been like that since I have known
- How long do your performance appraisal interviews usually go? Between 30 minutes an hour and it depends on the performance review if it’s more positive it goes by fast but if there some feedback that we need to follow up with employee it might be a longer discussion.
- How much impact does fellow co-workers opinions have on the employees evaluation? it’s a big impact
- What kinds of questions/topics do you focus on when doing a performance appraisal interview? The performance review is based a lot on their job description and also the feedback of the supervisors and the role they have in the agency for example A teachers position and role and their tasks will be different from a bus driver position their role in their task and will use their job description to use as a guide to follow up if they’re doing what they’re expected to do.
- Do you have the same set of questions and/or topics for each employee? Or do you make the interview unique for each person you interview? They are all different do to there position
After talking with Laura, I learned that the job description that you receive when you first start your job does have an impact on expectation of how you perform. I also think that we don’t realize the opinion of others does matter and that our actions and how we get along with others is being evaluated all the time. Also in any job, we are a team with our co workers and we must show we are team workers and so if we are having many employees complain about us then it must be something with our performance and attitudes. I thought it was interesting how Laura stated that she tries not to just point out flaws of a person she makes it more of a positive interaction so that she can state that there is improvement in that area but not pointing out all the flaws. She then comes up with an idea on how to improve with a timeline so that they can re-evaluate after a certain amount of time. Working with the employees on how to improve but making it a positive experience is something that can keep encouraging employees and make them less afraid of performance appraisals.
Each week I continue to be challenged in my thinking when it comes to leadership. When I think of performance reviews I think of the anxiety I get and worried about what my employer may say. Changing my mentality this week, I had to think in the perspective of what I am looking for in a performance review but I also had to think of how I would want to conduct it to make it a positive experience. I also was challenged in my thinking regarding ethics and ethics committees. I have seen how ethics committees can have an impact in the care of a patient. The ethics committee did not believe that the care was ethical for the patient and continuing life was not ethical. I agreed during this time because I could se how much suffering the patient was going through but the family would not let her speak for herself. They continued making decisions even when she could no longer do it.
The team activities this week helped in making me think beyond my own opinions but to see how as a team we would have to agree on a consensus for a situation where we were an ethics committee. I think that we did well discussing but sometimes the situation is not as easy as we think and can take months of debate to come back with an answer. I can utilize the material learned by knowing that I can suggest the ethics committee when a situation does not seem right and with discussion with my manager I can voice my concerns and why I think it should go to the ethics committee. Knowing our resources in nursing is important.