Conflict Resolution Journal

Before class, I was expecting more of a discussion on conflict resolution directly in the workplace amongst coworkers or with management.  We spent the day talking about labor unions and how they are annoying and a little bit about how they are beneficial. It was interesting that they are so like a mafia in that they will turn your coworkers against you in order to strong-arm you into approving the union.  If a union is approved within your workplace, then you have to pay the dues, which can be hundreds of dollars each month.  The vote for a union can pass with just one vote over 50% approval.  They can be beneficial in order to protect the rights of the employees and they can work in order to gain pay raises, for example.  Any management above a charge nurse cannot be a part of a union.  All of these are things to consider in the future if i am faced with a decision to join a union.

Quality Reflective Journal

Before class, I was expecting to discuss the way quality is measured and achieved in a healthcare setting.  We discussed how to attain quality in healthcare.  This means communicating and inquiring about the expectations we have as employees and the expectations our patients have.  Some patients seem to have very high expectations about what treatment they get from their nurses while in the hospital while others don't expect the nurse to do very much for them.  We touched on patient surveys and how, when a hospital outsourced their patient satisfaction callers, they received lower scores than when the person was local or knew how to pronounce the name of the city, for example.  Also, scores were higher when they would say "excellent" more frequently with the patient.  We talked about how making changes upfront causes prices to be lower than when changes are implemented later on.  The costs could be time, money, or patient or employee satisfaction.  We addressed what Deming had to say about quality.  He had the view that the changes in a company should come from the bottom up, rather than having to go through management.  He has 14 key points to his theory about quality.  Finally, the toast video we watched brought up the fact that we need to make changes back at the point of the toaster rather than after the toast has been burned and then we try to make the burnt toast look nice.  That is referred to as acting to the special cause rather than reacting to common causes.
Our guest speaker was interesting because she was pretty different from our risk management guest speaker.  This speaker always wanted to be a bedside nurse and didn't have managerial aspirations.  With both of these ladies, however, it seemed as though they were almost handed their positions that got them to where they currently are.  They were hard workers, of course, and by being that way, they were impressive to superiors who offered them positions or suggested they go for a position they would have not applied for otherwise.  She mentioned that relationships are very important and to not burn bridges, because you need those connections.  Very interesting perspectives from the CNO.

Risk Management and Legal Responsibilities Blog Post

I expected to learn about what happens when legal action is taken against the hospital or any employee of a hospital.  Karie Minaga-Miya talked to us about the job of a risk manager and what kinds of decisions she needs to make.  There were a few scenarios that were no-brainers, but then others brought up in class that I'm not sure how I would make the judgement call.  From what we discussed, the risk manager is probably very concerned about proper documentation and facility protocol.  All the talk about legal issues makes me worry about documentation and getting sued.

Leaders as Educators/Future of Nursing reflective journal post

Before class, I was expecting to have class, but instead we had our combined class time and then no individual class time. Troy talked more about travel nursing and about teaching and why he chose to teach. We discussed tenure as well and how a teacher attains it. After discussing both of those topics at length, we ended our class time. I have never really considered teaching since the idea scares me, but it sounds like a better idea than doing bedside nursing for the rest of my life. With teaching, I would get the holidays and possibly summers off and the work wouldn't be as stressful physically.  Troy also mentioned that there is a lot of paperwork involved with a teaching position outside of grading papers. It seems that that is what happens when you have a position that requires a master's degree.

Strategic Planning Reflective Journal

Today, we had a guest speaker who works with Troy and she talked about how she became a nurse and how she did not like beside nursing, so advancing her degree to a BSN and then MSN has helped her go toward management positions.  She worked as a bedside nurse for 20+ years, but did not want to do it her whole life, which is something I will need to consider since the physical labor associated with bedside nursing is not always an option as a person ages.  Troy talked about his job in patient placement.  In our regular class, we discussed strategic planning.  That means that you plan with a goal in mind.  We did a project with the goal of getting more patients to our facility and then we did another group activity suggesting ways to get people to our BSN program.
I got motivated to pursue my MSN during the first part of class.  I currently don't like my job in psych nursing, but I hope that after a while, i will be able to determine which area of study I enjoy and then go into either an MSN or NP program. Right now, I would prefer to work while I figure all of that out since I haven't really enjoyed my nursing experience yet.

Change Reflective Journal Entry

Before class, I expected to cover different ways staff adapts or doesn't adapt to change, much like the "Who Moved My Cheese?" discussion. In class, we discussed issues we face when there is a change. We also talked about how CEOs are hired to fix problems, usually budget issues. CEOs generally change the administration soon after they are hired so that they can put in their own people that they already know they work well with and that already know them and their vision. It seemed that budget is the biggest issue to be resolved in a for-profit hospital and it can cause a manager to get fired if they do not stick to their budget. We then discussed "Who Moved My Cheese?" and ways that staff can either go with the change or drag their feet and even go out of their way to hinder the process. At work, it's important to look at the positive aspects of change, but if it really is not working, I think we need to vocalize our opinions instead of just dragging our feet without saying anything.

Budget Interview

1. How often do you review your budget? Monthly, weekly, or yearly basis?

They do weekly profit and loss budget reviews via email with each department manager and then monthly meetings with each department manager in person.

2. If you are over budget, where are adjustments made first?

Cutting costs.

3. How do you determine how much of your budget will be allotted to employee pay, products, or other expenses?

Analyzing prior year budgets, sales forecasts and trends, etc.

4. If you have no problem areas of your budget, what would you say contributes most to being able to stay within your budget?

Continual review, accurate and realistic projections 

5. Are changes in the budget communicated to your employees and staff?

Yes 

6. Who is involved in the process of reviewing the company budget?

Mainly their Financial Controller.

After doing this interview, I don't think I would be very good at determining a budget. It's great that each department manager is involved in the budget and that the other employees and staff and notified of the changes. I have no idea of our budget where I work, but I would be interested to see it.

(I interviewed Jenny from Thrive Life.)

Budgeting Questions for Approval

1. How often do you review your budget? Monthly, weekly, or yearly basis?
2. Who is involved in the process of reviewing the company budget?
3. If you are over budget, where are adjustments made first?
4. How do you determine how much of your budget will be allotted to employee pay, products, or other expenses?
5. Do you have a particular area that consistently causes your business to go over budget? Or do you consistently come in under or at budget?
6. If you have no problem areas of your budget, what would you say contributes most to being able to stay within your budget?
7. Are changes in the budget communicated to your employees and staff?

Career Development and Staffing Reflective Journal

I anticipated discussing one of the aspects of possible career development that we had talked about having a guest speaker discuss. As for staffing, I expected to discuss how staffing changes are made and who makes those decisions.  In class we actually talked about master's and NP degrees and what that entails.  We also covered travel nursing and some of the specifics that go along with that, such as how long of an orientation travel nurses get, that they have to apply for RN license in each state, and that most agencies require 2 years of experience.  I also learned that there is an MSN and there is an NP, although they are bother master's degrees.  The NP degree is better when anticipating that you would like to do more clinical work.  Our staffing discussion was also interesting.  The dilemma was brought up that a day position opened up for application and usually the nurse manager offers the more desirable position to the most senior RN on night shift first; however, they need those senior nurses on night shift or else they would all be new nurses.  We also did a scheduling exercise.  I enjoyed these discussions since they were real-life examples and it gave me a greater appreciation for staffing.  I also was interested in learning more about NP programs and about being an NP, so this was a great way to find all that out.

Budgeting Reflective Journal Entry

Reflect on the unit topic. Type the following in your Reflective Journal/Blog.
1. Share what you had expected to learn about the topic before the class.
2. What you actually learned from the unit.
3. How you will utilize the information learned in your nursing practice.
4. Your personal feelings about the material covered.
When finished with your entry, place one sentence in this assignment stating your Reflective Journal/Blog entry has been made.

Before class, I expected to cover budgeting in percentages, for example, 2% going to office supplies.  We learned about budgeting and how some aspects of budgeting cannot be changed, while others can flow from one part to another more flexibly.  Hospitals have about 175 items for which they budget.  The budget is divided by revenue and expenses and the monthly budget is compared to the year-to-date budget and actual figures.  Acuities are an important aspect of budgeting for healthcare and can mean the difference between $500 and $2,000 per shift.  During our budgeting exercise, I learned that, unfortunately, the best and easiest way to cut the budget is to cut nursing staff or just nursing hours.  I will keep this information in mind if I am ever in a management position, but even as an RN without a higher position.  If budget cuts were necessary, I would hope that I have worked impressively enough that management would consider me too valuable to cut.  It was an interesting exercise and I hope I don't have to make those tough budgeting and possibly firing decisions.

Hiring/Firing/Discipline Interview

I interviewed James at Thrive Life:

1. Does your company utilize “at will” employment policies?

Yes 

2. Are there any issues for which an employee would be fired immediately?

Yes, there are "out of bounds" immediate terminations for reasons like positive drug and alcohol tests, theft, etc.

3. How much of your hiring decision is based off of personal appearance of the candidate?

Technically, none of it should be, but personal appearance definitely makes a first impression in an interview.

4. When initially looking over applications, what are some reasons for which you would immediately throw out an application?

Vast grammatical errors, under-qualified for the position.

5. How would you deal with an issue between two employees that is purely based off of “he said, she said”, such as sexual harassment?

Take written statements from each employee to see if there are any disagreements, verbally discuss what happened and if they have disputes on the other employee's statement, talk about the severity and desired consequences from each employee, take necessary action (warning notices, termination, discussion in both personnel files), notify Manager if necessary.

6. Do you ask the same questions for every hiring interview?

No, it depends on the position.

7. Do you get references?  If so, do you call references?  How important are they in the hiring process?

We usually only request references for certain higher-level positions, and yes, we do call them once we've narrowed it down to a couple of candidates.  They play a major role in deciding between final candidates. 

8. Have you ever had to fire an employee?  If so, what was the process, if any, that you used?

Yes.  Explain why, provide proper documentation for their records, explain what happens next (final pay, etc.), return all company equipment (including credit cards, office keys, computer, etc.), remove all company access (logins, email, phone, etc.), escort out of the building, notify payroll and benefits of termination.  Mark reason for termination in personnel file and whether or not they are re-hirable.

9. Have you ever been involved in a lawsuit because of firing an individual?

No. 

10. Have you ever had a conflict while firing an employee and how did you handle it?

Yes, usually with proper communication (fully explaining the situation and why it happened), listening and resolving concerns, and sensitivity to their feelings.

11. Do you typically offer severance when firing an employee?

Generally only for salaried employees who are on good terms with the company.

       From this interview, I learned that health care businesses and hospitals are run much like other businesses, except for maybe a few small issues that are different from business to business.  I didn't realize how important references are, but I'm sure they are just as important when applying for a health care position as they are at other businesses.

Ethics Reflective Journal

Reflect on the unit topic. Type the following in your Reflective Journal/Blog.
1. Share what you had expected to learn about the topic before the class.
2. What you actually learned from the unit.
3. How you will utilize the information learned in your nursing practice.
4. Your personal feelings about the material covered.
When finished with your entry, place one sentence in this assignment stating your Reflective Journal/Blog entry has been made.

I expected to cover controversial, ethical issues we face in the health care world today and how hospitals deal with them.  In class, we had a panel that discussed a few cases, such as surrogacy, cultural differences, blood transfusions, possibly unnecessary procedures, and eugenics.  It was amazing to me the different opinions about each and how there really is no right answer.  When we were discussing eugenics, a guy on the panel said that the ethics committees decide on policy that they will allow for EVERYONE, not just the one case.  With that, there is a big discussion about, "where do we draw the line?" If this one couple wants the ensure their child won't have Huntington's Disease, then what about the couple that doesn't want their child to have Autism, or the couple that wants their child to be a boy?  I was also torn about the cultural case since there is a fine line between some cultural practices and abuse, even, possibly, in our culture from the eyes of another culture.  In my practice, I will be sure to communicate often with my coworkers and my supervisors if I even slightly suspect abuse since there are legal ramifications and it's my duty to take care of my patients.  I also am now aware that the nurse has the power to call an ethics committee.

Hiring/Firing/Discipline Interview Questions for Approval

1. Does your company utilize “at will” employment policies?

2. Are there any issues for which an employee would be fired immediately?

3. How much of your hiring decision is based off of personal appearance of the candidate?

4. When initially looking over applications, what are some reasons for which you would immediately throw out an application?

5. How would you deal with an issue between two employees that is purely based off of “he said, she said”, such as sexual harassment?

6. Do you ask the same questions for every hiring interview?

7. Do you get references?  If so, do you call references?  How important are they in the hiring process?

8. Have you ever had to fire an employee?  If so, what was the process, if any, that you used?

9. Have you ever been involved in a lawsuit because of firing an individual?

10. Have you ever had a conflict while firing an employee and how did you handle it?

11. Do you typically offer severance when firing an employee?

Performance Appraisal Interview

I interviewed Jaclyn Price, the HR Manager at VitalSmarts.  

1. How often do you perform employee evaluations?
These are done twice a year.

2.  What categories do you rate your employees on?
The overall categories for which VitalSmarts employee are evaluated are goals, budget management, and attitude.
 
3. How important do you feel an employee evaluation is?
These are important for the employees because they determine pay increase or punishments for not meeting goals.
 

4. How long do your evaluations take you to prepare?  
Not very long, since the HR manager does not meet with the employees. The employees do a peer review and then meet with their direct manager. 

5. How long is each meeting with your employees?
The employees don't meet with the HR manager, but after they do the peer evaluation, they meet for 1 hour with their direct manager.


In conducting this interview, I learned more about what we learned in class concerning the different forms performance evaluations can take.  I like the idea of a peer evaluation since they work directly with you and managers may not see how you work, just when you work and your attitude when they happen to see you working.  That gives a more realistic view into how you work with others and how that influences the workplace.  That being said, if you don't have that many people that work with you, then you will know where the feedback is coming from and, if it's a poor evaluation, then some people could get offended. A meeting with the direct manager is how most companies complete evaluations, I believe, since HR representatives don't work with the employees.  It's important to know what form your company does evaluations so that you as the employee or as the manager can properly prepare.

Performance Appraisal Questions for Approval

1. How often do you perform employee evaluations?

2.  What categories do you rate your employees on?

3. Do you have any goals or plans that you discuss in your employee evaluations?

4. What factors during the evaluation determine raises?

5.  Are clear job expectations established upon hire?  If so, are these expectations discussed during evaluations?
6. How important do you feel an employee evaluation is?

7. If an employee has not done a satisfactory job since the previous evaluation, how do you approach the employee evaluation?

8. How long do your evaluations take you to prepare?  

9. How long is each meeting with your employees?

Power Reflective Journal Entry

Reflect on the unit topic. Type the following in your Reflective Journal/Blog.
1. Share what you had expected to learn about the topic before the class.
2. What you actually learned from the unit.
3. How you will utilize the information learned in your nursing practice.
4. Your personal feelings about the material covered.
When finished with your entry, place one sentence in this assignment stating your Reflective Journal/Blog entry has been made.


Before class, I was expecting to discuss more in class our assignment about whether men or women make better leaders.  I was also expecting to talk about traits that cause a person to be a more effective leader.  I learned that I probably will not be a manger. It sounds awful and I value family time over work and money. I might change my mind one day, but I see what my managers are dealing with right now and I do not envy them.  I also didn't know the chain of command, so that was interesting to see. We did talk about men and women leaders and the generalizations about men and women may be somewhat true, but we each have our strengths and it's best to decide on an individual basis. I enjoy being an RN right now because when I'm home, I'm home. I wondered why so many people are content to stay as "just an RN" but upper management are so busy and have so many responsibilities that it would start invading into their personal lives, and I do not want that for myself.

Performance Appraisal & Problem Employee Reflective Journal Entry

Reflect on the unit topic. Type the following in your Reflective Journal/Blog.
1. Share what you had expected to learn about the topic before the class.
2. What you actually learned from the unit.
3. How you will utilize the information learned in your nursing practice.
4. Your personal feelings about the material covered.
When finished with your entry, place one sentence in this assignment stating your Reflective Journal/Blog entry has been made.

I expected to learn about different ways businesses evaluate their employees and how a company can deal with a problem with an employee. In class, I learned about reasons an employer might fire an employee and how they go about dealing with issues presented by an employee's performance.  I never thought about the discipline and firing process before.  I thought that an employer could just warn or fire employees at will, but that they had to have a reason.  Interestingly, the employer doesn't even have to tell the employee WHY they are being fired, and that it's legal!  It's also interesting that, based on the facility's policy, an employee can have many first verbal warnings but never be written up or have anything in their record that would affect future employment within the company. We also discussed annual reviews and what they may include and how they may be scored.  It's interesting to consider the different scoring systems and how each manager grades their employees.  I was a little bummed I got an eval percentage in the 80s from my manager, but I heard scores from other staff and it made me feel a little better. It's important to know how your employer evaluates your performance and to always be setting goals for improvement.

Team Building Reflective Journal

 Reflect on the unit topic. Type the following in your Reflective Journal/Blog.
1. Share what you had expected to learn about the topic before the class.
2. What you actually learned from the unit.
3. How you will utilize the information learned in your nursing practice.
4. Your personal feelings about the material covered.
When finished with your entry, place one sentence in this assignment stating your Reflective Journal/Blog entry has been made.

 I did not know what kind of activities we were going to do in class, I just knew that we would be doing team building activities. I've done a few team building exercises at CLAS Ropes Course in Provo, so I suspected it would be something like that - working with a team to try and figure out the solution to a difficult problem.
I learned that there can be multiple solutions to a problem and it often takes creative and "out-of-the-box" thinking to come to a solution.  It's important to listen to your team members because they may have perspective and knowledge that you don't.
In nursing, I can use this information during staff meetings and interdisciplinary meetings, among other places, in order to find solutions to problems we are facing in the company. We just had a staff meeting for our adolescent unit and we were able to work through scheduling and time issues in order to make the work load more even for the night and day shifts. 
This was a fun exercise, it may have been better if we had known we would be crawling in the snow.  There are some issues that will be faced in the work place that don't have a great solution that makes it easy on everyone. Some perceived solutions will have to be worked out over and over again.

Hiring Reflective Journal Post

Reflect on the unit topic. Type the following in your Reflective Journal/Blog.
1. Share what you had expected to learn about the topic before the class.
2. What you actually learned from the unit.
3. How you will utilize the information learned in your nursing practice.
4. You personal feelings about the material covered.
When finished with your entry, place one sentence in this assignment stating your Reflective Journal/Blog entry has been made.

Before class, I expected to learn about the hiring process - what happens when you submit an application to the point you are either hired or not. I also expected to go over interview questions since assignments in our modules lead me to believe we would be discussing potential questions we may be asked.
From this unit, I learned that in most interviews, there will be about 2-5 people there to ask you questions. They can't ask personal questions, but if you bring up a personal issue, they could ask follow-up questions concerning that. Consistency is key if you are the interviewer - it's important to ask each candidate the same questions. There is such thing as a "protected age", so age cannot be a determining factor when you are hiring a person. We went over potential questions when we asked our classmates interview questions, and then we covered a few specific questions to go over what an employer is looking for and what they do not want to hear or see. We also gave some examples of questions to ask the employer if they ask, "do you have any questions for me?".  We talked about why it can take a long time for a position to be filled after a nurse quits. Finally, we discussed researching the company before an interview to be sure to include their company's buzzwords in the interview.

I will use this information when I am looking for a new job and if I happen to be in a position where I help interview potential candidates. It's important to be prepared for an interview and going over questions and preparing answers in advance can only help you focus on what you want to say and it will help you appear more confident and prepared.

As we went over the "red flags" of sample interview questions, I felt I had done way too many of them in past interviews. My approach when I was applying for PCT positions near the beginning of the program was to "wing it" and they would just like me. Interviews don't have to be the scary experiences they are often made out to be if you are PREPARED.

12 Characteristics of Leaders

Identify examples of Nursing Role Activities for each of the following 12 Characteristics of Leaders:

1. Leadership requires personal mastery - Nurses demonstrate leadership when they show competence and mastery in the tasks they perform. Nurses are deemed competent by means of a license to practice nursing.
2. Leadership is about values - A nurse needs to have high standards of behavior when dealing with patients and coworkers. Patient satisfaction is a way that nurse's can be held accountable and employers can ensure their nurses are acting according to the values of the company.
3. Leadership is about service - Service is a key aspect of nursing. Nurses are important leaders in the community of ensuring that the community is educated and has the resources available to them for proper health.
4. Leadership is about people and relationships - Nurses deal with people no matter the department or area in which the nurse works. Nurses can be leaders within the area they work with respect to their professional relationships with coworkers and with their patients.
5. Leadership is contextual - Nurses can be leaders depending on the context. They may not have leadership position amongst their superiors in the sense that they get rid of weaknesses in the company, but they could be leaders in the aspect of influencing attitudes.
6. Leadership is about the management of meaning - While I have no idea what this means. It may possibly refer to the fact that the nurse leader should know the roles of others.
7. Leadership is about balance - An effective nurse demonstrates the "balance" aspect of leadership by maintaining balance in her own life to ensure she is ready to give the best care to her patients.
8. Leadership is about continuous learning and improvement - Nurses have many opportunities for learning and growth within the nursing field. Leaders seize opportunities to learn more.
9. Leadership is about effective decision making - Nurses demonstrate the leadership skill of effective decision-making when they start their shift and prioritize which patient needs to be seen first and which tasks need to be completed the soonest.
10. Leadership is a political process - An effective leader is one that can gain favor with their people they lead, and this goes for nurses with respect to their coworkers and patients.
11. Leadership is about modeling - Nurses display modeling when they show their patients how to perform tasks and when they themselves are living the principles they are teaching.
12. Leadership is about integrity - Nurses display integrity when they chart that they performed a certain intervention, when they chart that they checked on a patient, when they report any issues with the patient that need to be reported, and so on.

Managers expectations of their role

If you are working, ask your manager or supervisor what their expectations were when they assumed a management role. Record what you learned in your "Blog"

(Waiting on my manager to email me back).

Leadership and Management Theories

Think about how theories of leadership and management impact nursing leadership and management roles. Record your thoughts on your "Blog" 
Each person has different views on what it means to be a leader or a manager. Assuming I am understanding the topic we are to write about, I think that these differing ideas shape the expectations of leaders and managers for a position. It is also the interpretation of the individual that achieves these positions that can shape nursing leadership and management roles. Each company has its own theory on leadership and management. This can influence the success of the company. From the perspective of nursing, a nurse manager, for example, will be hired if her characteristics line up with the expectations of the business. That nurse manager's perspective of management and how she acts as a manager then becomes what the coworkers come to expect from all managers.

Leadership Reflective Journal Entry

Before class, I thought that we would be discussing ways to encourage staff and keep morale up (like the leadership students from high school) and how to set a good example for staff.In class, we compared leadership to management and defined each. Communication seemed to be a key aspect of leadership - communicate the responsibilities of the staff members, communicate goals, failures, and successes, and make sure all members within a leadership positions are on the same page about changes and goals. Management positions deal more with the running of the organization, such as dividing up and ordering resources.
As a nurse, the only person that reports to me is the care tech, but I can still be a leader. I can be an influencer and set a standard for others to follow. I can be sure that, at the beginning of every shift, the care tech knows his or her responsibilities for the day and I can communicate any special needs and considerations needed by an patients so we are on the same page. I can also set a goal with the care tech for the day.
I feel like leadership and management can often overlap. When we defined the two topics, it seemed so cut-and-dry, but this morning I read several pages of my husband's book "The One-Minute Manager" and the book also discussed autocratic and democratic styles, but about management rather than leadership (as we did in class). The book talked about how it is important to include both styles. I think that a manager can be a leader and the roles can overlap. It is all very interesting, although I am not looking forward to completing all the assignments related to this topic.

Mock Job Interview Thoughts

This mock job interview went much better than the previous mock interview we did in fourth semester. I felt as though my very few experiences from my preceptorship and my current job added relevant and more impressive substance to my responses. One question I struggle with is, "tell me about yourself". I don't know how much personal information to share, but Dan pointed out that it's best to keep it relevant. In an interview, I need to remember to keep eye contact and try not to ramble, even when the interviewer isn't giving any verbal or physical responses. I was proud of myself for not saying, "and, yeah" or "so, yeah" at the end of my responses, because I have done that in interviews before and it really bothers me.
Some questions we came up with to ask the employer at the end of the interview were:
"When can I expect a response from you about the position?"
"Can I have your business card?"
"What caused this position to become available?"
"What is the nurse-to-patient ratio on your unit?"