Conflict Resolution

I expected to learn as a manager how to manage conflict between employees and between managers and employees.

I learned that Troy thinks that most conflicts can be resolved on a win-win basis. That would be awesome if it were true, but people are too stupid. I also learned that there are different conflict resolution styles, and that most people want to be the cooperative type. But in real life that is not the case.

I will use the information to try and be more open to methods of resolving conflict.

Personally, I would have liked to have heard more about how a manager can resolve conflict where they work. I would have liked to have been given practical examples and real stories of how managers have been successful in this. I have nothing to look to because all of my managers through my life have been terrible at this, especially if they were part of the conflict. They tend to deflect, lie, use their power, ignore, or justify themselves. How should a good manager act when there is conflict between them and one or more of their employees?

Motivation

Prior to class I expected to learn how to motivate others.

I actually learned about what motivates people in the workplace. I also learned that while there are some main things that motivate, everyone has different motivators. A manager has to recognize that their employees will need to be motivated in a variety of ways in order to get everyone on board.

I will use this information by paying attention to what motivates me and paying attention to what motivates others. When in a managerial position, I will make sure to ask people what motivates them and pay attention to how each person reacts to different motivators.

My personal feelings about the material is that it was interesting but could have given us even more ideas of how to practically motivate others, instead of just theoretically.

Risk Management

Before class I expected to learn about situations that may arise that risk management would need to be involved in. I thought that we might talk about how to deal with these situations as they arise and how different organizations have their risk management departments set up.

I actually learned that most issues arise in the emergency department or L&D/MB. There weren't really any examples of much else so there must not be as big of an issue with other departments. I learned that while I still need to be careful, I shouldn't be as worried about lawsuits as I may have been in the past.

I will use this information by utilizing reporting systems to help improve patient care and always being honest about my conduct, even when I am embarrassed or afraid to speak out about something.

My personal feelings- I am very glad that we didn't have to stay for a full 3 hours. I was nervous when the speaker said she had planned 3 hours of material. Also, it was hard to concentrate with all the high-pitched noises that no one did anything about. The material itself was ok but kind of boring. There were parts that were interesting though.

Future of Nursing

Before class I thought we would talk about where we think the future of nursing is going and what we can do to be a part of it.

What I learned is that it doesn't matter what anyone thinks the future of nursing is or should be because nothing will happen about it anyway.

I will utilize this information by caring less about what happens to nursing as a profession so I don't get mad when everything stays status quo. Oh, and maybe one day I will lobby or try to start a movement for something that really truly matters- for instance not having reimbursement tied to HCAHPS. (completely insane).

My personal feelings....That people are stupid. I think people try too hard to decide on an ideal and try to create it.

Change

My attitude toward change: My attitude toward change is that it makes life more fun and interesting. I actually was offended by our class discussion because people implied that this can only be the case because I have never had to experience extreme change, and that I only like change when I like the change being made. These are both erroneous assumptions. I have had to deal with change in my life, one in particular that affected me adversely for over 6 years. And, I don't always like the changes being made, but I still like change itself. For example, I did not like the change in IV catheters that we were using, but enjoyed the challenge of trying something new. It was really hard for me at first because I was already concerned about my IV skills with the old catheters and assumed I would simply be worse with the new ones. Still, I did like having to relearn the skill. It probably sounds contradictory, but although I was afraid of and didn't "like" the change being made, I still enjoyed the new aspects and opportunities it brought. (this has been a short venting since I decided not to respond to the posts I found offensive to my personal character.)

What I thought we would learn: that healthcare is only changing faster and faster and we better learn to keep up with it.

What I actually learned: People respond to change differently. We have to consider everyone's reactions when making a change.

How I will apply it: continue to enjoy change and help others adapt.

My personal feelings: I was sad to see how others view me by their comments in the discussion. I like change. Whether I like the actual change or not, I like making adjustments. The only time I don't like change is when I clearly see why the new way is stupid, harmful, pointless, or simply a display of power.

Quality Control and Improvement

• What do you consider elements of quality care when receiving healthcare services?
• Receiving care from someone who is caring and explains well and adjusts their routine to be the best for each individual patient
• What do you consider elements of quality care as a professional nurse?
• Clinical expertise and being able to perform accurate, helpful care within the context of each individual patient.
• Are the two similar or different?
• They are different in that as a patient what is most important tends to be bedside manner. As a nurse, I place more emphasis on knowledge and utilization of resources to ensure appropriate care. However, in both cases I think one of the most vital components is the ability to individualize care.

What I expected to learn in class would include the elements (or possible steps) of quality improvement. I thought we would talk about the best way to approach this topic.

I actually learned many ways not to do it, and subsequently a better approach to take. I learned how complex the issue is, and that I am not sure I ever want to have to deal with it! separating out so many things would be so exhausting and never ending.

I can apply this in the future by helping others to see the importance of reviewing the many complexities of an issue before taking action or making a decision. I can also remember not to react to normal variance and overcompensate.

I was a little confused by the videos because it seemed what they were saying is that trying to make changes is bad because you pull yourself further from your goal- however, doing nothing is bad too because over time you will drift from it anyway. So I wonder when are we supposed to intervene? Does this mean that there is no good way/time to make changes? How do you tell the difference between normal variance and a problem to be solved?

Strategic Planning

I expected to learn what it means to strategically plan.

I actually learned some of the importance of planning ahead and consistently evaluating what you already have going on. The world is in a state of constant change, so we need to change too.

I will be more open and responsive to efforts to plan for the future and create a strategy that will help whatever organization I am working for.

I fell like this was a necessary element to learn about but it wasn't the most interesting topic.

Budget Interview

I was able to interview William Heath, who works in human resources for Goldman Sachs. He is responsible for taking care of international employees, including moving them to and from their destinations. This of course involves working with and managing a budget.

As was expected, it was clear that the most difficult part of budgeting is sticking to it once it is set. Unexpected expenses as well as differences between anticipated and actual costs make this hard. However, there are a few things that can be done to help stay within the budget plan. One thing that can help is budgeting an amount that has no specific purpose except to buffer against these cases. Remaining open to and finding new sources for items and services needed can also help. Sometimes just sticking with the status quo is not the wisest or most prudent route. Another thing that can help from a management perspective is to offer incentives for others to remain within budget. When Will keeps expenses under budget for the year, the remaining amount is added to the bonus pool and divvied out to employees.

When planning a budget, there are "multiple first steps" that need to be taken. First you need to understand how much you are spending during the current year and what the original budget was. This allows you to understand how you are doing with the current budget. The second "first step" is to understand how much of the new budget is already allocated for use. This will help you understand how much budget you will need for the upcoming year. These are both part of the "first step" in planning because both are important and need to be looked at simultaneously in order to create the most accurate budget for the future.

Once the budget is planned, each component of the budget needs to be managed carefully. Fixed costs should be clearly understood and completely accounted for. Once allocation for fix costs have been made, variable expenses can be considered. Often each expense will be spent in several places through multiple businesses  Ensuring that each item in the budget is closely monitored through all of these expenditures will aid in remaining within the set limits. Throughout the process of planning and maintaining a budget, utilizing the previous year as a baseline can be a valuable tool.

When an increase in budget is needed, the reasons must be clear. Whomever is requesting the increase must defend their appeal. After discussions with those who would authorize it, the need can either be confirmed or shown to be unnecessary  Having open conversations and ensuring that a need is real before raising the ceiling on a budget helps to keep costs reasonable and competitive.

In addition to monetary budgets, there are sometimes other resources that need to be budgeted out. One of the things that Will does is look at technology upgrades for software, number of people required to complete the work, and if new relationships with companies are needed to accomplish the work during the year. This requires monetary resources but also allows him to look at work being done and understand how he can more effectively do the required work during the year.

In summary, all budgets are different and usually complicated. By using information from the past and consistently reviewing the current budget, it is possible that budgets can help you manage your money effectively.

Budgeting Questions

1. What is the first step in planning a budget?
2. What do you do with leftover funds when you are under budget?
3. What is the biggest challenge in complying with a set budget?
4. How do you adjust a budget for variable expenses?
5. Do you budget in extra cash for unexpected expenses?
6. How do you go about asking for an increase in budget?
7. Are you rewarded for staying under your budget? Does that reward motivate you to remain within it?
8. Do you budget any resources besides monetary resources? How does that differ?

Career Development and Staffing

I had expected to learn mostly about how to help others plan their career and the things to be concerned about with staffing. I thought we would skip the part about budgets because due dates weren't changed and no one said anything.

I learned that there are a lot of aspects relating to the management of personnel. I liked the part about delegation, and breaking down each tasks into parts. That really would help both parties work together better and achieve the desired results. I also gained a better appreciation for the importance of motivating employees and creating an evironment of empowerment. It is interesting to think of how to best give nurses more autonomy when their work revolves around following physician orders. But there are several ways to still give them that self governing they need. That need will likely increase as times goes on and nurses are expected to do more and more.

I will use this information to delegate better, help motivate those around me, and look for ways to motivate people on an individual level. Maybe it will even help me manage my time better.

I feel that the power article was terrible and should never be required again. I think the actual material covered in class was interesting and made me think more about time management for myself personally. It reminded me of when I was good at managing all my time, and how it truly helped me get so much more done.

Mock Job Interview

I learned that I can and should be very brief and specific in my responses. I often try to give a lot of background information or detail that is uncessary and detracts from what I am trying to put across. Most of the time I have a good response to the questions but fluff it up too much.

I also learned that I need to think of more experiences that can be applied to questions in a number of ways. I was lucky and wasn't asked direct questions that I didn't have an answer to, but there were a few that the other people were asked that I would have had no good response for. I need to consider all the experiences I've had and pick out a few that really show who I am. Then I can fit my experiences into the questions they ask, highlighting the aspects that will best answer the question.

I learned that one of my strengths is finishing a response appropriately in a way that indicates I'm done talking. I also learned some good questions to ask at the end of an interview that will be very helpful.

Budgeting

Before "class," I had hoped to learn anything about what we should be doing. Class was cancelled but we never got any information about what we should be doing to learn the material we would have covered. I had no idea what we would learn since there was going to be no class and only a portion of the learning would be from the other activities.

I learned that I just have to do stuff and hope that I don't get a bad grade for making a wild guess. I also learned a little bit about budgeting. One of the main things that caught my attention was the idea of including the costs of space to store supplies. I had thought of the costs to stock them (paying personnel to do that), but never the cost to have the space to keep them. Interesting idea. I also have a very, very slightly better idea of what it takes to manage a healthcare budget.

I will be able to utilize the information I learned by being more concious of budgets when I am working. Realizing there is more to money than I thought will help me be more respectful of it.

I feel that the power point had a lot of good topics with some information lacking. It would be nice to have definitions for the types of budgets, budgeting terms, and types of provider reimbursement. However, there were some other good points made in the powerpoint. Besides that, the articles were informative but pretty basic.

Hiring, Firing, Discipline Interview

Introduction

            Shelly Lusk has had managerial experience for about 30 years since she worked as a manager in a Payless Shoesource location at the age of 18. She was graciously willing to give of her time for this interview about the process and challenges of hiring, disciplining, and firing employees.

Hiring

            Her hiring process was very similar to others I have encountered. It included posting an add, carefully reviewing resumes, interviewing, and checking references. One step that I had not heard of before included a short phone interview prior to inviting the candidate in for a face-to-face interview. In this interview, she would go into more detail about the location of the office, the hours expected, and other requirements for the job, and find out if the candidate felt that they would still be interested in the position. She made it very clear that she wanted her prospects to very clearly understand the role they would be playing. In the phone interview and in face-to-face interviews, it is important to ensure the job being filled is clearly defined for each candidate. Sometimes she would even have a short shadowing period where someone interested in the job can follow another employee for about ½ an hour so they could truly see what they would be doing.

            I feel like this aspect in hiring is not emphasized enough. I think that if more employers would utilize these or similar tactics, there would be fewer employees who are hired on only to hate their job or realize it doesn’t fit in with their life. While there are some people who will simply take any job, even if they are willing to leave after a month if they don’t like it, making expectations clear from the beginning would both help find the best applicants and build a trusting, open relationship from before a new employee even starts working.

            Along with choosing candidates, it is important to ask questions that will help you see truly how a person is. Giving them a chance to impress you, as well as asking experience questions can help you get to know the candidate and find out how they will respond under certain circumstances. According to Shelly, the three most important attributes in any employee are integrity, loyalty, and knowledge (with ability to learn). I think that if a manager identifies those qualities they most desire prior to initiating any contact with potential hires, they can better determine who will be the best fit for them.

Discipline

            Disciplining employees is all about communication. If there is a problem, talking with the person who needs correction is always the first step. Communicating that there is a problem without being condescending can help open the pathway to improvement. Working with the offender to discover why the poor behavior/performance is happening and what can be done to fix it is the best approach. However, if simple communicating is not enough, formal written warnings need to be initiated with clear penalties for lack of correction. Shelly involves human resources at the step prior to termination to ensure she is within the law, wording is correct, steps taken have been adequate, and documentation is sufficient.

            When handling complaints, it is also important to empower employees to fix their own problems. If they approach a manager with a problem, they should also come with a solution. Then the manager can watch for the bad behavior; chances are if the employee complaining is correct, the offending employee will have other indiscretions. Empowering the staff to help each other improve, as well as stepping in when need be are important aspects of maintaining peace in the workplace.

            Shelly admitted that she had overlooked poor behavior in the past because of high productivity. She identified this as a mistake on her part, and said that over time she realized that the person was so manipulative in all things that they weren’t even as productive as she had thought. She feels in the end it is never worthwhile to allow someone to display unscrupulous behavior regardless of their expertise or seemingly high qualifications to get their job done.

Firing

            Unfortunately, firing employees is a necessary duty of most managers. Occasionally, someone will be fired with no warning for few things such as stealing. However, even blatant disrespect can sometimes be worked on and corrected. For the most part, employees should be well aware that termination is coming because of the many steps in the disciplinary process. Even still, almost all of them will claim they had no idea it was going to happen, or that they don’t understand why it is happening. This is of course why proper steps and documentation are essential.

            There are occasionally instances when an employee needs to be let go simply because they are unable to perform the job. They may be wonderful to work with and try really hard, but simply cannot fulfill the needed task. This is a very unfortunate circumstance, and should happen rarely if the manager has done a thorough job through hiring process.

A General Note

            In any area of hiring, firing and discipline, personal feelings should never play a part. In fact, it is best for managers to refrain from “having a best friend at work” among their employees. This makes it more difficult to discipline when needed, and may cause actions to seem unfair to other employees. It is also important to realize that not all personalities mesh well. Despite this, people of many different temperaments can work together to achieve a common goal and create a productive workplace. In times of anger or shock, it is always best to allow yourself some time before making decisions, or even responding to certain things. Any time a situation becomes heated between individuals- whether co-workers, manager and subordinate, or any other combination- it is important to give everyone some time to think clearly before starting in on communication to identify and fix the problem.

Summary

            Communication is the main feature throughout all aspects of bringing in, dealing with, and letting employees go. Maintaining authority throughout employment while still remaining open and approachable can facilitate a team environment where people feel their opinions are heard and they are treated fairly. Diligent attention to aspects of prospective and current employees can help guide decisions.

Patient Care Model/Power

PATIENT CARE MODELS
Where I worked, our patient care model was defined by the physician. Once the physician mapped out the plan of care, nurses came in to fill in the gaps. In order to do this, nurses had several means to help them.

1. Collaborative Practice Guidelines- This was a database full of policies created by evidence-based practice and what is considered to be best practice. This included instructions for minor procedures (such as central line dressing changes), basic nursing care for certain diagnoses (such as diabetes), instructions for care of ongoing interventions (such as indwelling catheters) and more. Nurses were expected to use and follow these guidelines. These are very useful but sometimes don't represent how things are actually done. For instance, Coke is often used to declog NG tubes, but is explicitly prohibited in the CPG. Also, the information is only as useful as much as people actually look at it.
2. Patient Care Plan- The cardex was to be kept in every chart and filled out every shift. The idea is to keep current care up-to-date and easily identifiable. It also helps to see the course a patient has taken and the changes that have been made. The biggest downfall with this system is that nurses usually don't fill it out, and even if they do, they don't use it in their care or in report.
3. Care Management Meetings- each day the primary nurse, charge nurse, case manager, social worker, and pharmacist meet together to discuss primarily non-medical needs (such as discharge planning). This is very beneficial and has helped a lot of people make sure they have the care they need when they are discharged.
4. Teamwork- nurses are expected to work together and help each other. Asking questions and asking for/offering help are essential to quality patient care. Where I worked, this was usually the area our unit excelled in the most. Because everyone worked together so well, we were truly able to offer better care for our patients.

TYPES OF POWER

1. Coercive (formal)- threatening or conveying that a bad outcome will occur if expectations are not met (firing, demotion, etc)
2. Reward (formal)- Promising rewards for compliance (raise, promotion, etc.)
3. Legitimate (formal)- actually having the position within a company that warrants power- and having employees recognize that power.
4. Expert (informal)- power that comes from knowing and possessing skills necessary for the job being done. Others look to you because you have the expertise needed to do a good job
5. Referent (informal)- being liked, trusted and respected; that giving us power to help direct other people

Strategies to increase my power base: Learn how to be more likable. Continue to improve in my knowledge and abilities. Obtain a position of power to better influence others through formal forms of power.

My thoughts about power: Power is an essential characteristic of effective leaders. Without the power to motivate or force others to perform, the leader is not leading anyone. Power is also a very tricky thing, because of its tendency to corrupt. Sometimes, people with a lot of power truly help people, work ethically, care for those under them, and strive for greater accomplishments. Other times, however, the powerful start to believe their power makes them better, and that they need more of it. Then rather than leading people, they try to capture them into a system where they can never leave. They also try to obtain more people to control and expand their power wherever they can. Rather than doing good, their efforts are focused and gaining as much power and controlling as many people as they can.

It is unfortunate that this happens, but it does. Then again, most things have positive and negative things about it. Power is just something that matters a lot because it can influence a lot of people for better or worse depending on whose hands control it.

Questions for Hire/Fire/Discipline Interview

11.     Describe your overall hiring process.

22.     Describe your interview process.

33.     When you choose interview questions, do you select questions that look at both potential performance and potential for poor behavior?

44.     In your opinion, what are the most important attributes you look for in candidates for hire?

55.     What is your most common source of applicants? Do you rely very much on networking?

66.     How do you handle progressive discipline? What steps do you take?

77.     Do you discipline formally and informally, or is there a standard procedure that everyone goes through?

88.     How to you weigh complaints from co-workers, managers, and others involved? How to you determine truthfulness of complaints?

99.     At what point do you decide that an individual needs to be fired?

110. At what point in discipline/termination decisions do you consider involving an HR department?

111. Do employees have to sign something when they are fired? What happens if they refuse to sign it?

112. How much does your personal like/dislike of a person play into your decisions on hiring, firing, and discipline?

113. How do unions affect your actions in hiring/firing/discipline?

114. Are there times when you will allow or tolerate unscrupulous behavior because of productivity?