M O T I V A T I O N

It is so interesting to me that this week the topic was motivation and how to keep employees motivated while boosting morale. This week has been a rough one for me in that regard because work has been so crazy and I have been feeling extremely burned out. We have had really hard patients, tons of discharges with just as many admits and on top of it all we have been short staffed every shift making me feel like I’m stretched even more thin. I feel like motivating employees and keeping morale high is one of the hardest things for an employer to do. There are so many factors that they cannot control and in the healthcare world change is the only ever present constant and therefore it makes keeping people motivated really hard. I liked the article that talked about how to motivate employees in their twenties. Maybe I liked it because I fall into this category but I think some of these principles can be applied across the board. Everyone loves to receive affirmation no matter their age. People want to feel valued and like they are doing a good job. This should be done on a regular basis and on a one on one basis. This is something that can be really tricky to do when you have 70+ people on your payroll for your unit. Another point that this article made was to always teach your staff because they love to learn. I took this as over communicating. I find that people become really frustrated when they feel like they don’t know what they are doing or don’t fully know what is expected of them. If a manager can over teach and over communicate what expectations are and how to do things, lines of communication will be clear and people will know how to appropriately move forward. Another point that I really liked that a couple of articles made was to set an example. Attitudes are contagious and if a manager or leader has a good one, so will everyone else. There is nothing more disheartening in the workplace when a leader says something and then does not do it. For example, my manager rolled out a new matrix this past May and said if we didn’t like it we could go back to the old one after a month or two. Well after 4 months passed and multiple people talked with our manager about how the matrix wasn’t working he still didn’t go back to the old one. This was incredibly frustrating for everyone and made some people so upset that they left our unit. Managers have so walk their talk.

The group discussion was great this week. I full expected everyone to have the same list of things to boost morale and motivate employees to stay but everyone offered a new idea of some kind. We all agreed on the following plan. The consensus that we came to was this:

  1. Plan more group activities for the unit (including an upcoming Christmas party, and a monthly potluck and outside quarterly activities)
  2. Create an open door policy – this will include monthly and/or quarterly check in for employees. An anonymous suggestion box will also be included in this open door policy plan.
  3. More employee recognition – this part of the plan will include a success board in the break room, as well as an employee of the month. Shout out cards will also be included.
  4. Split shifts on all major holidays – only having to work 6 hours on all major holidays (unless you prefer to work a full 12 hour shift) to improve moral during the holidays and allow people to spend more time with loved ones.
  5. Extra paid day off – Perhaps offering a little bit of a break could help our employees catch a break without becoming frustrated and quitting.
  6. Lunches, meals or recognition meals periodically to reward hard working staff.
  7. Continued education opportunities, letting staff know we value their hard work and are willing to pay for them to progress in their education and skill set.
  8. Analyze the schedule – Identify if there are any issues with individuals getting fair amounts of vacations, holidays off etc. A good schedule can make or break the attitude of employees. Rework the current scheduling/staffing process.

When it comes to applying the things I have learned from this unit in my practice I have learned a few things. I have realized that I need to become more involved myself in my unit. Simply going to work, putting in my 12 hours a day and then leaving will not help me feel like I belong. I need to join committees, go to parties and get to know the people I work with so that I feel like I have a place. I think this will really motivate me to stay and boost my morale when times get tough and the work is exhausting. In the future, when I am a leader of some kind, I think he most important thing I do will be in the way I would treat my employees. I want to always make sure the people I work with feel valued and appreciated. I want to always treat everyone the same and be fair and kind. I also hope to set a good example and practice what I preach. These two things will be the best ways that I can help boost morale and motivate my staff to stay despite how hard things may get sometimes.

Reflecting on Conflict Resolution

Conflict Resolution is one of the most valuable and critical skills to develop in any aspect of life. Every class should have a unit on this. The reality is that when humans interact with other humans in any circumstance conflict can occur. People have different personalities and opinions that are shaped through their life experiences. When problems and situations arise people will want to respond according to their experience. That might not always be the right way. Because of this, conflicts will arise. How you respond to conflicts whether it be in an aggressive or assertive way can directly effect the outcome. It will either strengthen or weaken any relationship. The skills that you develop through your life to solve conflict you will carry through your whole life and use in all situations.

I really enjoyed the discussions this week about conflict resolution. Like I said above, everyone has different experiences that contribute to how they solve problems and we can really learn from each other. I learned that placing blame vs pointing out the problem is one of the hardest things to do. When we think someone or something is wrong it is really hard to inform them of the mistake without saying things in such a way that their guard it up. By stating how you feel about something as opposed to pointing a finger can completely change how the interaction will occur. I also learned that aggressive communication is emotion driven. When we lose logic and reason, emotions take over and things spin out of control. It is so hard to master assertive communication but it is vitally to maintaining a professional relationship that leads to a positive outcome. Pulling people aside and talking on a 1 on 1 basis first is the most important first step to conflict resolution. When accusing someone in a group setting things never turn out well, the accused will have their guard and defenses up because they will feel embarrassed. By pulling them aside the problem can be resolved without others having to know about it.

By remembering the things I learned in the discussion and the conflicts that I have had to solve throughout my life and so far in my work will help me as I face conflicts in the future. I need to implement using assertive communication and always avoid aggressive communication. I need to let logic and patience control my response and never let my emotions take control. Dealing with problems one and one will also help solve problems with others. If the problem cannot be solved one on one then it needs to be escalated.

Honestly, the collective bargaining assignment, I did not like at all. I am not quite sure how it relates to nursing and how it will help me long term. It was hard for me to figure out and I kind of felt like everyone wasn’t sure what the point of it was.

Week 11 Reflection

This week’s content was honestly not my favorite. Strategic planning is something I am not really interested in nor am I very good at. I am a planner and good at it when it comes to myself but when it comes to a larger scale situation or plan I’m not quite sure what to do or where to start. When I look at the list of things for successful planning I think I can do all of those things. The list includes things like starting at the top, keeping it organized, not bypassing levels of personnel, having short and long term goals, knowing when to plan and when not to, setting realistic dates, gathering data appropriately, and having clear objectives. I think where I get in trouble when it comes to strategic planning I may have false assumptions or getting distracted from the goal and planning too big. I am also very OCD and stubborn about things so alternatives are not may favorite. Delegation is another area in which I struggle and I know that delegation is vital for long-term strategic planning. Despite that, this unit was helpful for me to realize where my strengths and weaknesses are and what I can do to be a better strategic planner.

The group discussion was interesting this week. Everyone was on the same page about UVU’s need to get in the game and add an NP program. I too think it would be very valuable for UVU to have nurse practitioner programs. It seems that most of the NP programs in the Utah are in the Salt Lake Valley and because of that, if UVU were to add NP programs in would set them apart in Utah Valley. UVU should have acute care, critical care, family practice and pediatric (especially because of the rate of growth in Utah County) nurse practitioner programs to fill the need. There is such a huge need for nurses with advanced education degrees, such as NPs and MSNs. Furthermore, there is a huge need for nurse educators. If UVU were to add these programs they would be opening the door for nurses who have wanted to become NPs or MSNs to do so. UVU’s nursing program has a very good reputation amongst hospitals throughout Utah, as such, it would only make UVU more valuable to jump on the NP program train.

The most important thing for me to do to utilize the information I learned this week will be to practice and develop may strategic planning skills. I need to work on delegating more often. I find myself sometimes getting overwhelmed with the things I need to do so if I can figure out how and when to appropriately ask for help it will help me long term. I also should develop a strategic plan for myself and my career so that I can learn to stay focused on my goals and what I want. If I can do that then I can apply it on a larger scale. Motivation is another factor for me. When work gets hard, sometimes motivation is hindered. Remembering why I do what I do and my long term goals in the moment, my motivation will not hinder. Being flexible to change is another thing I can implement and work on everyday to become a better planner.

reflecting on strengthening change

This week, the most prominent thing for me was the “Who moved my cheese” video. This had a great effect on me. It is a powerful analogy and working through life and adapting to change no matter what kind of life you are living and pursuing. After watching the video, I  realized that I need to adopt attributes of all of the characters. Hem and Haw understood that having a loving family with a good home life was most important, which is how I feel as well and one of the things that motivates the most in my life. They were driven by their emotions, which is me as well. Sometimes that can be a strength, while others time it can be a weakness. For me it is important to have my priorities straight and always remember what is most important. But at the same time I have to learn how to adapt to change and overcome. The mice recognized that change is something that is inevitable. I always try to live my life learning how to adapt to change. I want to be open to change. I need to always be hustling and trying to improve. 

The group discussion was also very interesting because we all identified with the same two characters, Hem and Haw. Though both of those characters had positive attributes we all wished that we also had some of the attributes of the mice. It was almost like we all wished we could be the mice. But I think we were all able to recognize that having different people in our world allows us to learn from others. It allows our world to be diverse. We all have different experiences that contribute to who we are and the lives we have. If we take the opportunity to get to know people and take their advice to improve our lives, we will all find our reward. We have to figure out our priorities and learn who we are so that as we make choices and have experiences we will be able to deal with the change that has the potential to strengthen our worlds. The discussion this week was great and gave me a lot of insights. Like I said, getting to know my team members and their perspectives I was able to learn things that strengthen my world.

The most important thing from this week that I can implement is the things I learned from the characters in “Who moved my cheese.” You have to always work for what you have and not “eat, drink and be merry.” Assuming that everything is always going to be okay, is not a good. Now, I’m not saying that you should be doom and gloom and negative about things. But, one thing that the mice did was that they expected a change or that the cheese would run out and when it did, they immediately started searching for me. They did not let the loss hold them back. Waiting around and not allowing change to motivate us, impedes our success and often times holds us back from true progress and happiness. If we all can do this, we will find the “biggest pile of cheese we have ever seen”. The reward will be greater than we ever had before.

BUDGET.

For this interview, I interviewed my grandpa, John Linton. He is the founder and former CEO of the School Improvement Network. His career has consisted of producing and developing professional development trainings for teachers and educators. He was a teacher before founding the SINET in 1991.

What are some of the most common areas in which your company goes over budget?

“The biggest was wages/salaries. Travel, sales expenses, software development, computer programming.”

What have you noticed works most effectively in cutting costs of these problem areas?

“Accountability return and report. clear lanes of responsibility.”

Have you ever had to lay people off as a result of consistently going over budget?

“Yes. We did everything we could to prevent it but sometimes the realities of money we could not fight. We had to keep the business open unfortunately at the expense of letting some staff go. We ran into the problem of our projections being too large and so we planned for that and then would not hit those goals and find ourselves with not enough money to pay the bills and had to lay some people off as result.”

Do you find it beneficial to keep employees aware of budgeting concerns?

“Yes, it is absolutely critical. They have to understand where we are at and where we are trying to go. By keeping employees in the loop they could understand why cuts had to be made or if people wouldn’t get bonuses in a particular year.”

Are there certain categories of your budget that seem to be unpredictable? (patterns of being over than under budget?)

“Revenue projections in sales. If you don’t meet them, it leads to other problems where we had to cut back.”

Would you see it beneficial to provide a cost breakdown of over budget areas?

“Yes. You can’t solve the problem if you do not what caused it exactly.”

How often do you spend time looking over the budget?

“Once a month. But the accounting department looks over it every day. One of the weaknesses that we have had, that we are working towards improving, but I don’t think we have looked over the budget enough. When you are so busy, it unfortunately seems to slip through the cracks on a daily basis and seem to only look at it at the end of the month. Budgeting is one of the last things that people want to spend their time on so sometimes it is put off.”

Do you include staff or other leaders in budget discussions?

“It depends. If it is the whole office, they need to understand budget concerns and the big picture. But, each department needs to go over in detail their budgets and give feedback back up the chain.”

What tools or programs do you use to stay on budget?

“Accounting applications. Strict accountability and reporting. One app that we use is YNAB, You Need A Budget. It’s a program that budgets every dollar that you have. Each dollar can be put in different categories and if you go over in one category, you have to pull dollars from another. We have found it to be very helpful.”

What concerns you more, keeping the month to month budget or the year to date budget?

“Month to month budget because by the time you calibrate the year to date budget, it is too late. You have to stay on top of the budget throughout the year otherwise you will get too behind.”

What has been your greatest success in keeping budget? What is a time when you erred in keeping budget?

“I can’t recall a specific example but when we involve all of the department heads involved and communicating regularly with accounting we have met or been able to go over budget less. We are trying to reign in our revenue projections so that they are more accurate. The biggest error that we made was in our revenue projection we were way off and ended up having to lay off 40 people in one day. It was one of the worst days of my career.”

This interview taught about the importance of monitoring and keeping budgeting on a daily basis. To me, in the past budgeting has seemed to be something someone else worries about. But the budget is something that everyone should worry about. If staff is included on big picture budget issues, then they can help make choices and have a greater understanding when cuts have to be made. Everybody has a part to play when it comes sticking to budget and helping to keep the budget. As a manager, you have the responsibility to communicate that with everyone.

staffing. the never ending problem.

I don’t know if this is something that I actually learned or if it was just reaffirmed to me but staffing is hard. It is such a complex, delicate issue because there are so many factors involved. For those that do staffing, they have to not only please the staff by giving them their requested schedule but to schedule them for the appropriate amount of hours. They also have to figure out how to distribute the staff evenly amongst the unit and if they have extra, how to help staff other units as needed. Furthermore, staffing involves keeping management and finance happy. There are certain regulations and guidelines from corporations that play a huge role into staffing and they have to be abided by. Intertwined with all of the patient safety is paramount. Staffing has to be done appropriately to protect all parties involved. It is a huge undertaking.

This week for the team activity, we had a good experience. Because all of us are such new nurses from all different areas of nursing we needed each others’ opinions to complete the assignment. Everyone came to the table with different insights which allowed us to staff the unit appropriately. For example, someone was able to assign staff for each shift evenly, while another person recognized that some people were being scheduled too much or for back to back shifts. And someone else pointed out, even after we had completed the assignment, that we had over staffed and need to make some adjustments before submitting. Everyone brought fresh eyes to the issue and it was helpful for me because if I were doing this on my own I probably would not have known really where to start. Staffing should be something a team or a few people do, instead of just one person. You need multiple sets of eyes with different backgrounds in order to staff effectively and smartly.

For me, the most important thing that I can do is be patient with staffers and staffing. I can do my part but requesting my schedule and show up for my scheduled shifts. I can also float with a positive attitude when I am asked to do so. I can’t control the numbers or the assignment but I can accept, hold my own and do my part. I have also joined matrix/staffing committee in an effort to improve and fix the problems that we are facing. We are trying to keep everyone involved safe and happy while sticking to budget and meeting our goals. It is a huge undertaking but it has given me a lot of insight into how leadership works in regards to staffing and staffing requirements. It has also helped me understand our staffing assignment this week and help participate in it.

the future of nursing

This week the biggest thing that I learned is that the future of nursing is bright and that there is hope. But, most importantly, I realized that the future of nursing is now. There are plans and things that need to be implemented now to make nurses and the field of nursing stronger so that patients can receive the very best care. This will take time and a lot of hard work but after all, nothing is worth having unless you had to work to get it. I learned from Dr. Gonzalez that nursing is heading towards nurses practicing to the full extent of their education and training, nurses should work towards and achieve higher level of education and training while participating in residencies programs with each new job/transition and nursing should also allow nurses to be full partners with physicians in practice and in redesigning healthcare in the US. In order for all of these things to happen the plan that she outlined must be implemented and followed. Nurses must start attaining higher levels of education and engage in lifelong learning. Nurses must rise up to the occasion and becomes leaders on their units and in their fields. And ultimately nurses must participate in improvement efforts and lead change to advance healthcare. By doing all of these things people will see how valuable nurses truly are. I believe these goals these goals are attainable because we are already working on them. Her plan is all about strengthening nurses and expanding their roles where they are at now. Nurses receiving lifelong education and participating in leadership are great things to work towards. The plan is about making  nurses a vital leading role in healthcare instead of just followers and I think that is great.

The group discussion this week was great because it allowed me to realize and pick up on things that were mentioned in the videos that I did not initially hear or make connections with. For example, Dr. Gonzalez says that the future of nursing is here should put some pressure on us. I think that was her intention. We have to start implementing this plan yesterday because things are rapidly changing and if we want to be part of the change and trajectory we need to do things that will make us stronger, better nurses and help the overall field of nursing. Also, someone pointed out that we are in the position and have the power to put pressure on decision-makers. I think that sometimes we fall into the trap of just doing our jobs and forget that we are the ones in the ring working hands on and hearts in with our patients and their families. We have to deal with the challenges and shortcomings in the nursing field. Thus, we are the ones with the hands on experience to fight for the changes we want to see. That means we have to put pressure on those who can actually make the decisions to see those changes.

The best thing that I can do in my own nursing practice right now is to learn everything I can. As a new nurse, when I signed on with IHC I agreed to get my Bachelor’s degree by July 2021. That is exactly what I am doing now. Because the new norm is for nurses to have a minimum of a Bachelor’s degree I believe more will strive for even higher education than that. Right now my goal is to get my Bachelor’s and get good experience. Then, maybe after a few years I will consider more advanced education. There are also many education programs and requirements that nurses do every quarter to ensure they are always learning. I do those as well. Each quarter I re-certify my CPR training. Additionally every quarter there are education modules and trainings that I complete to make sure my skills are evidence based and that I am practicing at least to par. Doing all of these things will help me advance my learning and contribute to the plan now. I have also joined different committees on my unit to help participate in decision making to help improve my unit overall.

The Budgeting Reflection

The most important or valuable thing that I learned this past week is that budgeting is HARD. I did not ever realize how many different, little elements and things there are that go into budgeting. It really is a huge and can be a completely complicated mess. But, if done right, it can make or break a unit/team. I think it is really easy as an employee to judge a manager when a new matrix is implemented or when supplies are cut because we are just seeing the change and not necessarily the reason. There is not a lot of transparency when it comes to budgeting because money is messy but I think there should be. I, for one, know that if I was able to see the numbers or at least the basics of the numbers I would understand better why things had to change and where the unit needs to go to stay within budget. 

Through the group discussion this week I was really able to see that some of my group members have real strengths when it comes to budgeting. Some of my team members had really great ideas about where to cut the budget with solid reasoning to back it up. I thought it was interesting how we all agreed that cutting the budget in new ways might not be the best idea. Instead, we should trim the fat and try to stick within the original budget. I also appreciated that everyone did not want to jump immediately to lay offs or dramatically changing staffing. Staffing, is one of the hardest things I think every unit has to deal. I think it directly correlates with caregiver happiness and burnout. Because of that it is tricky. So it was nice to see that everyone wanted to maintain the integrity of the units current staffing ratios and cut areas that were also over in hopes that staff satisfaction would remain in tact.

I think the biggest thing that I can implement into my nursing practice because of the things that I learned this week is to be patient with my manager. I personally do not want his job when it comes to budgeting. Not only does the budget deal with supplies and tests and things like that but it deals with people who all have very strong opinions. I do not need to be one that makes his job harder because of budgeting constraints. My manager implemented a new staffing matrix this past May in hopes that it would help cut the cost of staffing because we have been over budget the previous few months. Now, I’ll admit I hate the new matrix It has made night shift, especially really hard on everyone. We are all feeling serious burnout because it seems we are always short staffed.  I know that his intentions are good but there has to be a better solution. And my manager knows that. Because of that, he has formed a committee that will help create a new matrix that will benefit everybody. I volunteered to be on the committee because I want to see a change. We meet for the first time this week so it’ll be interesting to see how it goes. 

reflection a week late

When it comes to ethics there are so many different opinions on every subject and things can get heated quickly. In the world of healthcare there are so many ethical dilemmas that we see everyday. Sometimes it takes 1 or 2 people or parties to solve the issue. Other times an ethical committee will have to come together to make incredibly difficult decisions that go beyond those involved. But that is what they are there for. In certain situations there my not necessarily be a right or a wrong. Some issues may result in one outcome and a similar issue may have a completely different result. Regardless of what the issue or outcome is, there must be mutual respect for what people feel, believe and decide on. We all have different life experiences that have shaped our beliefs, because of that each of us has a valuable perspective. Ethical issues will always cross our paths and as such we must be prepared to deal with them.

During the team discussion this week I was slightly worried that things might get a little bit heated. When ethics are involved, no matter the subject, opinions can differ immensely across the board. I thought everyone picked really important issues when it came to the issues they see in healthcare today. I chose to talk about participating in abortions when its against a nurse’s will or beliefs. I thought some people maybe might not agree because they either support abortion or think that because we are healthcare workers we are obligated to serving our patients. But everyone could agree that we can respect the rights of our patients but the tings we do should not infringe on our own personal beliefs. As healthcare workers we have rights just like our patients do.

When it comes to my own personal nursing practice, the best thing I can do is know where I stand on the issues. There are so many ethical dilemmas that surround the healthcare world, and there will continue to be. I know what I believe and I know what I will and won’t do. I just have to develop the confidence to do so. I can be shy and intimidated in front of others, especially large groups of people because of that it is imperative that I develop the strength to stand for myself. Working in a career that requires I give so much of myself, I must be sure not to compromise myself in that service or process. By learning of the issues and standing for myself I will be able to contribute to the ethical issues that cross my path and help find a solution. Now I will be in certain roles or positions where I must defer to a committee or maybe my opinion is not appropriate to give. But in all situations I am an advocate, whether it be for my patients or for myself. I will not be able to solve or decide on the ethical issues all the time or maybe not quite yet. As I learn and grow in experience and in life I will continue to develop opinions and beliefs that will help determine the course of my career.

Firing&Disciplining

For this interview, I interviewed Brady MacKay. He spent 25 years as a Drug Enforcement Administration Special agent. Following his retirement from the DEA, he was the CEO of Magnum Fortus, a law enforcement agent professional development company. He currently works as the Director of Corporate Security and as the Director of China operations for BGZ Brands. Over the course of his adult life in his different jobs he has hired and fired near 1000 individuals.

1. What is your process of steps to take before firing an employee?

“-Give them ample opportunity to improve and let them change by understanding expectations.

-Make sure they have a way to account for fulfilling those expectations

-Regular reviews of their expectations

-Necessary warnings given, if they fail to meet them

-Training provided to help them succeed

-Disciplinary steps when they fail to meet them”

2. Who else is involved during the firing process? 

“You would want to involve the head of HR and their manager.”

3. How many steps are involved from first offense to dismissal?

“It depends, if it is a major breach of integrity, it would be a single offense, but in other cases there may be a couple of warnings with the second one have a punitive action.”

4. What does your disciplinary plan usually look like?

“Layout expectations, monitor, account for expectations, correct if necessary, point out failures to meet expectations with employee with encouragement and consequences explained, warnings to include disciplinary action all the while documenting every step of the way.”

5. Do you collect anything from the employee before termination?

“Company property, access cards, codes, computers etc…”

6. Do you offer warnings before disciplinary action or dismissal is taken?

“Yes, to be fair to people. You have to give them ample opportunity to correct their actions. No employee should ever be surprised when they are terminated.”

7. If disciplining or firing someone goes wrong, or the employee responds inappropriately, how would you handle that?

“Point out their inappropriate behavior/response. Review with them once again the expectations they agreed to. Remind them they are an employee and what that means, they are subject to the management of he company. Escort them out, if need be.”

8. Do you give the employee an opportunity to “defend themselves”? Do you offer second chances based on what they say?

“You give them a change to defend themselves but by the time they are terminated they’ve already had second chances.”

9. After firing an employee, how do your other employees typically respond?

“If they are close with that employee it will shake them emotionally. But if its an underperforming employee, in many cases they are happy they are gone.”

10. After disciplinary action is taken or someone is fired, how do you motivate your other employees? How do you keep your other employees accountable?

“Give them a pep talk on the mission and purpose of the company and how we are all working towards. Get them excited to work for the company and the standard that everyone is expected to meet.”

The most important thing that I learned through the interview was the importance of communication between manager and employee. It really stuck out to me when he explained that no person should be surprised when and if they are terminated. There should be clear expectations from the very beginning of what is expected for the employee during their employment. Because of that there is a clear path to performance and behavior that each employee should and must follow. I also appreciated how Mr. MacKay discussed the importance of warnings. Despite the expectations that are outlined, people are not perfect and that they will fail at times. Because of that, giving people warnings allows them to learn and hopefully get better so that termination does not have to occur. If they do fail, regardless of warnings, they will know why. People will be terminated and so it is important to clearly communicate with the other employee and keep them focused on everything the company stands for and is striving to do. This will keep moral up and help keep people motivated.

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