"Ability is what you're capable of doing. Motivation determines what you do. Attitude determines how well you do it" - Lou Holtz

Performance 
"Performance is defined as the execution of an action; something accomplished; the fulfillment of a promise, claim, or request" (Huber, 2009, p. 715). 

This week in our Leadership and Management in Nursing course we are reading about the concept of performance appraisals.  This blog will focus on how leaders can be an effective partner in establishing performance appraisals that are focused around organizational strategies to enhance employee performance instead of reflecting on negativity.
   
I do not personally have much experience with performance reviews or appraisals but the few experiences I have had were mainly revolved around peer reviews.  Peer reviews have positive and negative sides to them.   I say there are negatives sides to these types of reviews because in my experience I have worked within a small group where we all worked very well together and we were all were on a friendship based level where constructive feedback was not of the highest priority when completing the peer review evaluation.  Also, when the time of year came around for completing performance appraisals managers ask employees who, within other departments have we worked closely with, would be a good co-worker for completing a review.  This enables employees to choose peer reviewers who they know will give them good reviews that are not allows focused making specific adjustments in their role to meet or exceed performance expectations.   
  

"The nursing profession  must develop new leaders, and a powerful tool accomplish this is the performance appraisal.  Nurse managers who have learned to lead with reverence use the performance appraisal process as an opportunity to mentor and coach their staff into new experiences" (Huber, 2009, p. 720).

Leaders can develop methods for evaluating and improving performance continually, through out the year instead of using a once a year stressful meeting to evaluate performance by using the following methods:  

Coaching "as a management tool is ongoing, face to face collaboration and influence to improve skills and performance" (Huber, 2009, p. 717).  "This process involves all employees in improving their ability to do their job and increase potential.  Activities include role modeling, hiring carefully, encouraging growth, creating a positive environment, using praise, and encouraging stretch goals" ( Huber, 2009 p. 724). 

Counseling addresses problems helps employees to identify their weakness. 

Mentoring "the closer the link between the employee's needs and the mentor's

competencies, the more likely it is that the mentorship will be productive" (Huber, 2009, p.724).

The book highlights a specific program and evaluation tool designed to retain nurses. 

• The Vanderbilt Professional Nursing Practice Program 

Click HERE to view the Vanderbilt Professional Nursing Practice Program, Part 2 Integrating a Professional Advancement and Performance Evaluation System.  There are three parts to the program and Part 2 will examine the performance measurement and evaluation system created to support the program.

Reference

Huber, D. H. (2009).  Leadership and nursing care management. 4th edition.  Saunders, Elsevier Health Sciences. Maryland Heights, MO. 

 

NURSING STAFFING STRATEGIES

At my place of work, the issue around nursing staffing strategies has been of great concern lately. There are more and more days that are staffed with unsafe patient to nurse ratios.  Nurses are being over worked, working longer hours which required the use of more expensive labor, such as overtime and bonus'. As this issue has been increasing, a committee dedicated to safe nurse staffing and protecting nursing practice has been advocating for ways to increase the nurse's willingness to work more hours, for the short term, by offering incentives and negotiating for days off on days that are over staffed. This is a unique chance to advance policies that will help improve patient safety, increase access to high quality health care, and protect nursing practice  from the threat of profit driven health care. This issue also personally effects my current role by increasing the work load of everyone and passing along a unsafe role to other interdisciplinary team members.

Video: Nurse Staffing and Patient Safety

This video talks about one hospitals approach to nurse staffing processes.  "They looked at Different models for nurse staffing and how they influenced patient outcomes and if they have had an impact on patient outcomes. They found that when they use nurse staffing models that use higher levels of regulated professional nursing care provides this leads to improved patient outcomes.  Staffing the nursing team involves more the just the number of nurses, its about the right mix of education, experience, and skills.  We need to look at the experience of the nurses on the unit so that we can be bringing along the newer nurses and really recognize the value in those years of experience the more senior nurses bring"

How Can Nurse Leaders help?

By "Developing staffing strategies that not only met the clinical needs of patients but also address the personal and professional needs of the nurse.  By using an integrated and systematic approach, nurses can assist managers in the following" (Huber, 2009, p. 30).

• Demand planning: understand and quantify workload patterns, and identify day to day and seasonal variations
• Analyzing process and work rules: assess staff satisfaction with current staffing and scheduling process, and make suggestions for improvements.  This should also include suggestions for changes in work rules to support the changing demographic of the work force (e.g., the need for more part time opportunities and shorter shift lengths.

Nurses suggestions for retention strategies:

• Improvements in the work environment
• Establishing a culture of safety
• Supportive Supervision
• Involvement in organizational decision making
• Flexible and creative staffing/scheduling practices
• carved out roles (admitting/discharging teams, patient educators, preceptor-mentor roles)

Reference
Huber, D. H. (2009).  Leadership and nursing care management. 4th edition.  Saunders, Elsevier Health Sciences. Maryland Heights, MO. 

"Individual commitment to a group effort ? that is what makes a team work, a company work, a society work, a civilization work." ~ Vince Lombardi

In the health care setting, interdisciplinary teams are a matter of survival.  "Trust and communication are critical elements of building effective work teams.  Team members need to work collaboratively and interdisciplinary first before striving to work synergistically.  An infrastructure of open communication with an emphasis on information sharing enables team members to understand and believe in the team's strategies" (Huber, 2009 p. 224).

After personally reflecting on the concept of team, with my current role as a clinical support  associate I have been on both sides of the spectrum; a team and a pseudo team.  There is such a difference between the two types of work environments.  When a team is truly present it results in a positive work environment, more willingness to help others, less complaining and less conflict.  A true team can make going to work enjoyable.    

"The greater the performance, the greater is the advantage to the group and the organization" - (Huber, 2009, p.225)

Characteristics of a highly effective team includes a common purpose or goal, competent members,  a common approach for the work, commitment, complementary skills, collaboration, mutual accountability, standards of excellence and leadership.

Expectations for a successful team:

• Communicate in an open, honest and direct manner
• Give feedback when behavior creates uncomfortable situations
• Develop processes for conflict manage, decision making.
• Team members should be demonstrating support
• Demonstrating mutual respect for one another
• Pitch in gladly, provide help when available
• Be trustworthy as evidenced by honoring and meeting commitments made

Roles, Activities, Relationships and Positive Environment = high performing interdisciplinary teams

Reference
Huber, D. H. (2009).  Leadership and nursing care management. 4th edition.  Saunders, Elsevier Health Sciences. Maryland Heights, MO. 

"Some people change when they see the light, others when they feel the heat" - Caroline Schoeder

Changes

"Change is inevitable in health care, just as life is.  Nurses today are accustomed to change in their environments.  Many nurses have seen changes in the acuity of patients, changes in both practice models and skill mixes, a change to evidence based practice, changes in educational requirements and changes within their own role.  Nurses today must actively seek opportunities to make changes in ways that favorably affect their work and patient care" (Huber, 2009, p. 55).

However, there is still some resistance with change in the nursing world and leaders have the unique opportunity to be a change agent who can help with implementing change.  Just the other day, while at work, a veteran nurse was talking about her personal hatred for change and she stated "just wait till you get old".  I found that the older generations are more set in their ways and these are the nurses who may be more hesitate in accepting change.  This conversation about change started out when the nurse was looking for a red pen for her brain sheet.  She made the comment that she always uses red and black colored pens for her brain sheet and she hates change.  I found this interesting that she was so persistent in finding this red pen but with the constant change in her nursing environment this was one aspect of her nursing role that she could keep the same and have all control over.  

How can we assist others with accepting a positive attitude towards change?

Seven Stages were identified that people typically go through during a change.  The following stages are important when recognizing that there is process in accepting change and everyone will go this process at different times; the time spent in each stage with differ with each individual and their ability to accept change.

1. Lose focus: confusion and disorientation abound.
2. Minimize impact: deny or pretend the change is not significant
3. The pit: feelings of anger, discouragement, resentment, and resistance arise.
4. Let go of the past: energy returns as the end if the change process is seen
5. Test the limits:  more optimism is gained,and the individual tries out new skills or seeks new experiences.
6. Search the meaning: the individual  reflects on the change process and recognizes what was learned
7. Integration: the transition is completed, and the change is integrated into daily life: 

How can leaders help other deal effectively with change?

• Explain the rational for a change so that individuals understand it
• Allow emotions to be worked out (allow employees to go those all of the stages listed above)
• Give participants all the information they need
• Help individuals cope with change
• Foster your commitment to change and emphasize four practices of change: Empower, Shared decision making, Self direction, and Shared governance.

Reference
Huber, D. H. (2009).  Leadership and nursing care management. 4th edition.  Saunders, Elsevier Health Sciences. Maryland Heights, MO. 

Stewardship is Leadership: what's in your hand, a symbol of influence.

TEDtalks: Rick Warren: A life of purpose.

Pastor Rick Warren is the author of The Purpose-Driven Life and has become an immensely influential voice seeking to apply the values of his faith to issues such as global poverty, HIV/AIDS and injustice.
He teaches that doing good is the only way humans create significance in our lives.  Warren's mission is to attack what he calls the five "Global Goliaths", spiritual emptiness, egocentric leadership, extreme poverty, pandemic disease, and illiteracy and poor education.  Through his global focus and considerable platform, Warren has become a sought-after advisor to world leaders.

I really like and enjoyed this TED video.  Reasons why I like this video include Rick's dynamic speaking ability, his engaging personality and meaningful message.  I thought that the way he intertwined personal stories through out his message about leadership was intriguing and I was influenced to acquire characteristics of leadership.  I felt that his speech was very inspirational and his message needed to be passed on.  His message is to adapt a worldview and to live everyday though this worldview, this requires self reflection on what is truly important.

Aspects of his talk that spoke to me were how he explained that stewardship is leadership.  "Stewardship of affluence and stewardship of influence; essentially Leadership is stewardship.  If you are a leader, in any area you do not own it, you are a steward of it.  For instance, this is why he believes in protecting the planet.  This is not my planet, it was not mine before I was born and it will not be mine after I die, I am here for eighty years and that is it.  He asked the question If human beings are responsible for making the world just a little bit better place for the next generation? He believes that we are responsible and that his worldview.  You must understand what your worldview is. Your worldview determines the decision, relationship, level of confidence, really everything in our life.  What we believe determines our behaviors and our behaviors determine what we become in life" (Rick Warren, personal communication). I thought this message directly relates to nursing and how we can shape our futures in our nursing profession.  It is our responsibility to make the environment a better place for the next generation and we are responsible to shape and influence the next generation in producing the best patient outcomes.  We need to become leaders and help transition the nursing world to be the best it can be.

More Influential comments from Rick Warren:

"Look what is your hand, your identity, your influence, your income and say its not about me its about making the world a better place"

“Significance in life doesn’t come from status, because you can always find somebody who’s got more than you. It doesn’t come from sex. It doesn’t come from salary. It comes from serving.”

"The purpose of influence is to speak up for those that may not have influence." 

"Your net worth is not your self-worth and your value is not based on your valuables." 

"Being powerful is like being a lady, if you have to tell people you are you aren't" - Margaret Thatcher

One aspect of our current readings from the book Leadership and Nursing Care Management that I am focusing on is that of power.   Power is an aspect of organizational structure that has the potential to empower employees in a positive direction.  

"It is not the power to control or to dominate others.  Power refers to the ability to get things done, to mobilize resources.  The structure of power stems from access to opportunities, support and resources.  When power is monopolized, employees are empowered and organizations are more likely to benefit; more activity can be accomplished by organizational members, and the capacity for effective action is increased. Empowered work environments are those in which all employees have access to opportunities to learn and grow and to information, support, and resources necessary for the job" (Huber, 2009, p. 418). 

This part of the chapter was inspiring to read as it gave me a whole different outlook on the concept of power.  In essence, power can be the driving force that makes an organization or unit function on a respectful level as a whole.   Through my personal experience, work environments that I have been involved in functioned on both sides of power, control or empowering work environment.  Working in an empowering work environment inspires employees to be truly committed to the vision of the organization.        

Reference
Huber, D. H. (2009).  Leadership and nursing care management. 4th edition.  Saunders, Elsevier Health Sciences. Maryland Heights, MO. 

Leadership: Igniting Passion

For my leadership and Management course I was asked "What is your leadership style?".  This question was difficult to answer, especially before defining the difference between a leadership role and a management role.  Before understanding the difference, these two terms were interchangeable for me.  It seemed that you could not have leadership without a management role, however is not the truth.  "One must remember that leadership is not necessarily tied to a position of authority and that each of us has the potential, and perhaps the responsibility, to provide leadership in our specific area of practice, our institution, our professional organization, our community, and our profession as a whole" (Grossman & Valiga, p.1, 2009). 

I would say that my current leadership style would fall under a democratic and transactional leadership style.  Transactional leadership involves a relationship where leaders get a job completed and followers get promotions for the accomplishment of tasks.  This type of leadership style is seen throughout many health care organizations and it can also be applied to the relationship between a teacher and their students.  After reading further, I realized how important it is for our leaders to develop a transformational leadership style. Transformational leaders and followers "lead one another to higher levels of motivation and morality.  This motivation energizes people to perform beyond expectations by creating a sense of ownership in reaching the vision" (Grossman & Valiga, 2009, p.63).   Transformational leaders are charismatic, able to instill motivation in others, commit people to action, convert followers to leaders and convert leaders into agents of change.  "Transformational leaders have the spirit that creates special leader-follower relationships and promotes individual and group growth"  (Grossman & Valiga 2009, p.64).  We need more nurse to acquire the characteristics of transformational nurse leaders to effect patient outcomes in a positive way.  Now that we are committed to acquiring transformation leadership qualities. where do we start in this process? 

It was found that following behaviors indicative of credibility were characteristics that admired leaders possess. The following behaviors reflect characteristics of a credible, transformational leader:  supporting, having the courage to do the right thing, challenging, developing and acting as a mentor to others, listening, celebrating good worth, following through on commitments, trusting others, empowering others, making time for people, sharing the vision, opening doors, overcoming hardships, admitting mistakes, advising others, honesty, competency, inspiration and being forward looking (Grossman & Valiga, 2009). 

Each of us have the potential to provide leadership that will create new futures, we just need to realize our leadership potential and commit to a vision that encompasses the element of stewardship.  "Stewardship is to hold something in trust for another and being responsible for something more than just oneself.  It has to do with serving others, rather then serving our own self interests or attempting to control others, and it involves balance of power.  In essence, stewardship incorporates "engendering partnerships and empowerment and it occurs when one leads with soul" (Grossman & Valiga, 2009, p. 11).

Personally expanding on this concept,  I will reflect on my past orientation experience which was about learning  skills that only established skills to meet the jobs minimum exceptions.  I will strive to continue to establish a more transformational leader style in my current role as a clinical support associate by role modeling behaviors that are committed to excellence and producing the best patient outcomes. In hopes that this will give me experience with transformational leadership skills that I take with me into my nursing profession.  Working along side nurses, gives nurse assistants the unique opportunity to learn skills within their scope of practice that will allow performances that practice at the top Licensure.  I am committed to a establishing a spirit that is committed to group growth, empowering others to implement a common vision and igniting passion.

Reference:
Grossman, S. C., & Valiga, T. M. (2009). The new leadership challenge: creating the future of nursing, 3e.  Philadelphia: F.A. Davis Company. 

" Desire is the key to motivation, but it's the determination and commitment to an unrelenting pursuit of your goal -- a commitment to excellence -- that will enable you to attain the success you seek " - Mario Andretti

I am a Clinical Support Associate at Children’s Hospitals and Clinics of Minnesota. Children’s is a private, not-for-profit organization specializing in pediatric health care. Prior to joining the nursing team at Children’s I worked as a Human Resources Representative for Children’s Human Resources department. I hold a Bachelors of Science degree in Interdisciplinary Health Services from Western Michigan University. Currently, I am completing my Bachelors of Science in Nursing (BSN) degree at Minnesota School of Business/Globe University. I will graduate with my BSN in June of 2013 and have hopes of continuing my employment for Children's Hospital as a RN.

My goals for this blog are to provide awareness around leadship roles and to inspire peers to find characteristics of leaders within themselves to affect positive change in all of aspects of their lives. To lead others in pursing the advancement of pediatric health care and to present evidence based practice recommendations for advancing pediatric health care; as pediatric nursing is my true passion.

MY VISION

To be a leader in advancing the health of children and providing family centered care of the highest quality.

MY MISSION

To empower children and families through patient advocacy and education, transdisciplinary collaboration, and excellence in my nursing practice.