After over 4 decades of working as a CRNA, I have reached
“senior” status, and I am amazed at the challenges that we have collectively
faced and conquered over the span of my career. Back in the day, I was trained on the Ohio
2000 machine using pentothal for induction, Sux for intubation and Pavulon as
the primary relaxant. We’ve come a long
way. As practice changed, so did the
politics of anesthesia and the healthcare industry in general. Without exception, CRNAs stepped up and to
face challenges and leave our profession in a better position.
The adage that the only constant is change is just as true
now as when the words were first said.
So, what will change look like for the future of Nurse Anesthesiology
practice?
I have the privilege of teaching a healthcare leadership
course to SRNAs at the Medical University of South Carolina. At the completion of the course, students
were asked to speculate on the greatest challenges that our profession would
face in the upcoming years. Below is a
compilation of the responses from the students.
Full scope of practice. The top challenge for the profession as
perceived by the students is to attain full scope of practice for all CRNAs in
every state. CRNAs are highly skilled
anesthesia providers who are proficient in every aspect of providing anesthesia
care, including ultrasound guided nerve blocks, and should be allowed to use
the skills that they have attained.
Ongoing work must be completed in every state to remove the requirement
for physician supervision thus enabling CRNAs to independently care for
patients.
Promoting our profession. MUSC students perceive promoting the
profession as a critical activity to ensure the confidence of patients,
surgeons, and other health professionals.
Three avenues for promoting the profession emerged from student feedback. First, we live in a world that is dominated
by social media, podcasts, and headline news.
The students foresee individual CRNAs taking advantage of technology to
promote their practice and their profession.
In addition, the students identify leadership development as a means to
promote the profession. Finally, the
students believe that the best grassroots way to promote the profession is to
connect with each individual patient, let them know that we are nurse
anesthesiologists, and give them exceptional patient care.
Creating a positive workplace culture. The fast-paced, production-oriented
workplace can lead to burnout and disgruntled workers in short order. The students recognize the worth of creating
a positive workplace where diversity and inclusion are a way of life rather
than an annual learning module and where everyone is valued. Sensitivity to second victim situations and
support for colleagues who experience difficult cases was also identified as an
important component of a positive workplace culture.
Nurse versus physician anesthesiology politics. Despite the common goals and practice
techniques shared by the AANA and the ASA, political turf battles continue with
physicians constantly seeking to control and limit CRNA practice. The students foresee that this will continue
and that it is incumbent on each individual to work with state and national
organizations to stand united for the practice rights of CRNAs.
Use of Technology.
Technology drives the way that we live our lives and with the
exponential growth of artificial intelligence, the influence of technology will
become even greater. Students foresee AI
influencing every aspect of anesthesia practice, including needle placement for
ultrasound guided nerve blocks. The
potential for pharmacogenetic profiles to influence drug selection and dosage is
on the near horizon and will influence our practice. A personal concern that I have is that as AI
guides our practice, it narrows the gap between CRNAs and AAs.
The challenges above were identified by SRNAs in training
who have yet to become certified and work on the front line. What are the thoughts of those who work daily
providing anesthesia services to patients across the country? Do you agree with the student and what would
you add to their list. Finally, what
will you do about it? Will you become
involved with your state and national organizations to help face the challenges
and address the issues?
Tom is an
experienced leader, educator, author, and requested speaker. Click here for a
video introduction to Tom’s talk topics.
This article is written in mid-April when the cold winter
winds are being calmed by temperate spring temperatures and the snow is being
chased away by the warm rain that will awaken the trees and flowers. As the days get longer, people who vowed to
“improve health” as a new year’s resolution are doubling down in preparation
for summer activities. There is no
better time for a leader, regardless of the profession, to introduce wellness
to the balance of work-life that is essential when creating a preferred
workplace.
Wellness is a win/win
Promoting employee wellness brings benefits for both the
individual and the organization. Writing
in the Harvard Business review, authors
Berry, Mirabito, and Baun give several examples to support the benefits of
employee wellness to the overall organization.
Noted in their article, “A study by Towers Watson and the National
Business Group on Health shows that organizations with highly effective
wellness programs report significantly lower voluntary attrition than do those
whose programs have low effectiveness (9% vs. 15%). According to Vicki Banks, Biltmore’s director
of benefits and compensation, “Employees who participate in our wellness
programs do not leave.” In addition to
improved retention, other studies document the increase in productivity tied to
employee wellness.
It starts with you
Personal wellness starts with you and requires commitment to
both physical and mental health.
Initially, wellness will be something that you do however, over time,
repeated behavior becomes a habit, and wellness becomes who you are.
Physical wellness: The University
encourages physical activity and provides employer sponsored gym
memberships. In addition, healthy
nutrition is promoted by supplying healthy options in vending machines. Workspace is re-designed to accommodate
ergonomic flow that does not strain the body or eyes.
Mental: Leaders are trained to be
sensitive to the needs of employees and use emotional intelligence to recognize
stress and impending burnout. Schedules
and workflow are adjusted to support the capabilities of the employee.
Culture: The University expects leaders
to set a positive example and participate in wellness initiatives. In addition, incentives are provided for
employees who participate.
Get yourself going
Alter your daily routine and incorporate physical activity
three times per day. Get up a few
minutes early and do a brief warmup with a 5-minute walk in your house followed
by light stretching. If you have stairs
in your home, you have a built-in stair master…a few trips up and down will get
your heart pumping. Stairs can also be
used for stair push-ups. Weather
permitting, take 15 minutes to walk around the block before work.
Take your wellness commitment to the workplace and plan a
brief activity during your lunch break.
A brisk walk through the hallways followed by light stretching will
rejuvenate your body for the afternoon work ahead. Throw in a few flights of stairs to boost the workload
on your heart and legs. Take your own
healthy food for lunch and avoid high carbohydrate, fatty foods.
Writing for verywellfit.com,
author Ann Pizer describes workplace exercises that can be done at the
desk. CRNAs are very creative and, no doubt,
could adapt them to the OR workplace which include.
Neck rolls
Cat-cow stretch
Seated forward bend
Seated eagle
Seated spine twist
Wrist stretch
Standing pigeon
After work, continue to be active by taking an outdoor walk
or bike ride. A stop at the gym for
cardio revitalize the mind after work and keep the body moving. At bedtime, plan a 15-minute cool down to
include a few yoga stretches and meditation.
Get your workplace going
Build a culture of wellness in your workgroup by planning
team activities that encourage your colleagues to get up and go. Having a workout buddy creates accountability
and often leads to a personal friendship.
Encouraging the entire group to participate in planned activities not
only promotes wellness but also provides an avenue for teambuilding. In including the colleague and their family
members opens opportunities for family day activities. Here are some suggestions for memorable
gatherings that promote wellness.
Walk
Jog
Hike
Bike
Tennis
Pickleball
Swim
Log your step competition
Family days are fun and will
bring colleagues
together outside the workplace. Plan a
day at the park or beach. Find a central
location that is convenient for several activities so that some could walk a
paved path while others are hiking in the woods or riding bikes. Meet back in a central location for a
snack/cookout and other group activities such as volleyball or cornhole.
Workplace wellness has been proven to increase morale and
employee retention while reducing the number of days missed due to illness and
injury. Individuals enjoy better health
with a more robust lifestyle and organizations benefit from increased
productivity and reduced cost of turnover.
It is a true win/win for all. Be
proactive and push for wellness in your workgroup.
Tom is an
experienced leader, educator, author, and requested speaker. Click here for a
video introduction to Tom’s talk topics.
Love it or hate it, it’s tax time
and Uncle Sam is expecting you to ante up again this year. It’s quite likely that many people reading
this article have already filed their 2024 taxes, and some have received
refunds. Hopefully, the money that was
set aside was sufficient to cover your tax obligation and there was enough
extra to warrant some cash coming back to you…wahoo.
For W2 workers, the employer
tracks your income, withholds money from each paycheck for tax, and ensures
that social security obligations are paid.
At the end of the year, the employee receives a W2 statement to go along
with other tax documents and filing your tax return is simple. W2 employees tend to file early and often
receive a refund from the IRS.
Taxes for 1099 workers
The IRS refers to a 1099 worker as
a freelancer, independent contractor, or self-employed worker and many CRNAs
fall into this category of work. As a
1099 worker, you are not an employee of the organization, rather you contract
your services to them for an agreed upon fee.
Individual contracts specify the number of days to be worked, the
location, as well as who is to provide necessary supplies and equipment. In this scenario, the employer does not
provide benefits, and it is up to the individual CRNA to obtain their own
profession and medical insurance as well as contribute to their own retirement
plan. The employer does not withhold
taxes or pay social security fees, so it is incumbent on each 1099 worker to
pay those expenses from the compensation provided by the organization.
Because the 1099 worker is
essentially a business selling services, the individual is eligible for many
tax deductions that are not available to the W2 worker. The good news is that 1099 contracting opens
the door to tax deductions, the bad news is that it requires vigilance and
record keeping. Writing for Bonsai,
author Michael
Eckstein emphasizes the importance of consulting a tax professional who you
can work with you year around to ensure that you are capturing all available
tax deductions.
Commonly overlooked deductions
for 1099 CRNAs
Business expenses: As a
1099 worker, you are essentially a business of one person selling anesthesia
services to an organization. Because
you are a business, you are eligible for business deductions like those claimed
by others who sell services to the public.
Home office. If you have a designated area in your house
where you maintain your records and schedule work, you may deduct the space
from your taxes. The IRS allows
$5/square foot up to 300 square feet.
Phone: If your phone is essential for
scheduling work, a portion of your phone fee may be deductible.
Startup costs: If you decide to formally
establish an LLC or S-Corp, the startup fees are tax deductible. Talk to your
tax advisor and learn about the advantages of establishing an LLC or S-Corp.
Bank fees: If you are registered as an
LLC or S-Corp, bank fees related to a business account are tax deductible.
Malpractice insurance: Commonly, the 1099
CRNA must provide their own malpractice insurance. This is a tax-deductible business expense.
Health insurance: If you are working
under the umbrella of LLC or S-Corp, the cost of health insurance for you and
your family is tax deductible. However,
if you are not LLC or S-Corp, your insurance premium must exceed 7% of your adjusted
gross income to qualify for a deduction.
License/CME: CRNAs working as a 1099 are
eligible to deduct the expenses related to required continuing education and
licensure.
Equipment depreciation: In some cases,
independent practice CRNAs must provide their own anesthesia equipment. If this applies to you, the value of the
equipment that you own may be depreciated on an annual basis related to the
life expectancy of the equipment.
Social security tax payment: As an
independent contractor, you are required to make social security tax
payments. The fees that you pay for
social security are tax deductible.
Retirement tax shelters: Self-employed
workers are eligible to establish and fund retirement tax shelters. The personal 401K is a frequently used
platform for retirement funds, however there is a cap on the amount that you
can contribute each year based on your gross income. Your tax consultant will know how much you
are allowed to contribute.
Car: In some cases, the mileage on your
car may be deductible, however there are many requirements to qualify for the
deduction. If you are a 1099 worker
commuting to the same full-time location daily, the auto deduction may not
apply. However, if you are more mobile
and service many different offices on different days, the deduction may
apply. Your tax expert will advise you
on your specific situation.
Tax consultation/preparation: The fees
that you pay for tax consultation/preparation services are tax deductible.
The 1099 work arrangement is more
complicated than working as a W2 employee for an organization. Maximizing the benefits of independent
contracting requires time and vigilance.
Gaining full benefit also requires the expertise of an experienced professional
tax consultant. That said, those who
take control of their own finances, monitor their business on a frequent and
regular basis, and keep accurate records tend to come out ahead on taxes at the
end of the year.
Tom is an
experienced leader, educator, author, and requested speaker. Click here for a
video introduction to Tom’s talk topics.
Josh has been a solid frontline healthcare worker for 4
years, he is respected by colleagues and has developed a comfortable
workflow. His boss seems to be a little
aloof and although Josh does his job well, he is stagnant in his work and does
not sense an opportunity for professional growth or promotion. The corporation is at risk of losing a
qualified and productive worker.
Marsha is in her 50s, Josh’s supervisor, and is the
perioperative administrator in a busy 10 room suite of operating rooms. She skillfully moves workers like pieces on a
checkerboard to cover the hour by hour needs of the unit. Many of the workers on her team are in their
20s/30s, and Marsha does not understand why they complain about their
work. She believes that younger workers
lack the work ethic that she grew up with.
This workplace
has a toxic disconnect between management and workers which is taking a toll on
morale and productivity.
Harvard
Business Review tackled the question of why people quit their job and
offered these three primary reasons; 1) they don’t like the boss, 2) lack of
professional development or opportunity for promotion, 3) the offer of a better
gig elsewhere. In this case, Josh did
not sense a connection with the boss and experienced a void regarding
professional development. Suddenly, the
pop-up recruiting messages on his phone started to catch his eye and he noted
that others in his profession were not only making more money but also enjoyed
jobs that included professional development.
Two months later, josh submitted his resignation and moved on.
In contrast, Marsha was so driven by production pressure and
so focused on the immediate task at hand that she did not know or understand
the personal challenges of younger workers, nor did she have a concern about
their professional development.
Culture change
with a focus on professional development will convert this toxic environment
into a preferred workplace.
Professional development is one of the three key pillars of
a preferred workplace, the other two being emotional intelligence and
values-based leadership. Professional
development can be achieved externally through the effort of the individual
worker. However, in a preferred workplace, the leader ensures that
opportunities for professional growth are offered and encouraged within the
organization. An effective
mentoring/reverse mentoring program is a quick, easy, and inexpensive way to
connect individuals, develop young workers, and enlighten older workers to both
new technologies and the personal needs of the younger generation.
The advantages of mentoring are well documented. Author Nicola Cronin lists
benefits to the mentee to include:
Increased self-confidence
A sense of being valued
Increased self-awareness
Improved communication skills
Developing a personal network
Becoming a good listener
Exposure to new and different perspectives
Increased emotional intelligence
Reduced level of anxiety
Increased chance for promotion
Increased job satisfaction.
In the scenario above, an ongoing mentoring program would
have given Josh a support system and connection to a trusted person who was
committed to developing Josh’s talents and helping him to advance in the
organization. Josh would have developed
new skills and more importantly, he would have felt connected to the workplace
and loyal to his supervisor.
Reverse mentoring is equally important.
Mentoring is most thought of as a top-down sharing of
knowledge/skills from an older experienced person to a neophyte worker. Reverse mentoring is equally important and
often overlooked. Simply stated, reverse
mentoring is when a junior employee mentors someone more senior to them in the
organization. What can the apprentice
possibly offer to an executive that would improve the functioning of the
organization?
The modern workplace tends to be multigenerational and
multicultural. It is not unusual for the
executive suite to be filled with baby boomers while millennials shoulder the
burden of the frontline work. To further
complicate things, Gen Z workers are graduating from college and enter the
workplace with skills and expectations that are foreign to the Boomers in the
front office. Reverse mentoring closes
the generational gap, teaches the latest technology to high level executives,
and gives them a first-hand glimpse into issues that are important to young
workers. In contrast, young workers have
face time with executives and gain insight into the C-Suite and plans for
moving the company forward. In the
process, the junior employee feels valued and develops a sense of loyalty to
the organization.
Legendary leader Jack Welch, former CEO of General Electric,
was one of the first to promote reverse mentoring. In the 1990s, the internet was a new technology,
and the use of personal computers proved to be a challenge to upper-level
executives. Jack noted that new college
graduates were all experts on computer use and quickly set up a reverse
mentoring program connecting entry level workers with upper executives to help
the elders understand and become comfortable with the new technology. It was a win/win for GE.
Similarly, the modern healthcare workplace is a melting pot
where new technology updates and replaces older techniques and, as Jack Welch
noted in the 90s, the new graduate, junior employees, are the experts. The use of ultrasound in the practice of
anesthesia is but one example. As noted
by one of my colleagues, “anyone who has been out of school for over 10 years
needs to be taught how to use ultrasound to assess gastric volume, new
graduates know how and routinely use the technique…they are the best teachers.”
Senior workers who
openly seek mentoring from junior workers learn new skills and make personal
connections which promote increased emotional intelligence.
Published in the online
blog, Together, author Matthew Reeves identifies benefits for the senior
workers that arise from reverse mentoring.
Closing the generational gap. Each generation was raised at a different
time and grew up with different life experiences. For example, there is no way that a baby
boomer can fully appreciate the life experiences of those who used computerized
home schooling during the COVID crisis, nor do they fully appreciate the impact
of social media on the younger generation.
Learning is about sharing new knowledge that transcends top-down
teaching. With reverse mentoring, senior
employees learn new skills while junior workers gain a wealth of information
based on the experiences of the senior worker.
Supporting diversity, equity, and inclusion. Marian Wright Edelman said, “If you can’t see
it, you can’t be it.” The corporate
world has made a commitment to increasing diversity in upper-level positions
and reverse mentoring affords the opportunity for minority junior workers to
have one on one time with executives.
While learning new technology skills, senior workers become aware of
cultural challenges while junior workers are introduced to life in the front
office.
Millennial retention. Millennials (age 29-43) make up almost 40% of
the workforce in the United States and recently an increasing number of them
have negative feelings about their employers.
Workflow changed with COVID as did the expectations of the workers. Reverse mentoring re-connects millennials
with leadership, improves communication and aligns the company with post-covid
worker and customer needs.
Enhancing creativity, open-mindedness, and
innovation. Connecting with and
learning from a person of a different generation promotes learning about new
technologies as well as becoming sensitive to their cultural needs. Artificial intelligence is a concept to baby
boomers however it is an everyday reality for new graduates. AI and other technology are fertile ground
for senior managers to learn from junior employees.
Empowering emerging leaders. Young workers receive knowledge and technical
skills that did not exist when the Boomers were in school, yet the youngsters
are often intimidated by senior people who are high on the corporate ladder. Reverse mentoring allows the junior employee
to develop communication skills and self-confidence by mentoring senior leaders
in the organization. Once they realize
the value that they bring to the job, junior workers become eager to expand and
take on new and more challenging roles.
Mentoring is an essential component of a preferred workplace,
and the most successful workgroups view it as a two-way process. TED
talk speaker and author Chip Conley notes the value of merging the
knowledge of the young worker with the wisdom of older person when creating
solutions to modern problems. Regardless
of your position in the organization, the first step in mentoring is opening
your mind to the reality that others have something of value to share with
you. Seek them out, identify their
strengths, and actively listen with the intent to learn as they share their
knowledge with you. You will grow
professionally, and the other person will feel valued, which creates common
ground for trust in one another. Both
parties in the relationship will walk away feeling empowered…a win/win
situation for all.
Tom is an
experienced leader, educator, author, and requested speaker. Click here for a
video introduction to Tom’s talk topics.
“I wish I were a better person”, “I’m so helpless”, “I
always get the worst assignments”, “I feel as if I’m an imposter”, “Work is
sucking the life out of me”, “Nobody appreciates the stress that I have in my
life”, “I’m so disappointed in myself”.
Is your head filled with ANTS?
Psychologists estimate that the human brain has up to 70,000
thoughts per day and those thoughts determine how we interact with those around
us. At the heart of how we collaborate
and network with others is our ongoing inner dialogue of thoughts that guide
our behavior. ANTS, Automatic
Negative Thoughts, are a part of the internal dialogue and when
left unchecked, can undermine achieving happiness in life.
When negative thoughts pop up in moderation, they serve an
important role in protecting us from potential danger in the world. A baseline level of caution protects us from
con artists and scammers who prey on gullible victims. They also allow us to see potential
consequences and help us to establish boundaries with ourselves and with
others. In moderation, a blend of
negative thoughts with an otherwise optimistic attitude is a good thing.
However, all too often, negative thoughts dominate the inner dialogue and become the new baseline. When ANTS take control of the brain, a negative spiral develops, people view themselves as inadequate, and the world around them as a threat. Author and psychologist Jaoquin Selva notes that negative thoughts can be impactful and affect health outcomes as well as quality of life. Yale news reports that negative thinking and depression can shrink the brain and cause a loss of synapses. In addition, negative thoughts deplete the feel-good neurotransmitters serotonin and dopamine. While negativity shrinks the brain, the brain’s fear and emotional center, the amygdala, becomes enlarged. Buddha was correct when he noted, “nothing can harm you as much as your own thoughts.”
So, what’s in your head?
What soundtrack do you have running in the background as you move
through your day? Forbes leadership
author Christine
Comaford notes that 90% of our thoughts are repetitive and we tend to think
the same way today as we did yesterday. Put differently, many of us have ANTS in our
heads out of habit and not out of necessity.
Moving from a baseline of negative thought to a more balanced blend of optimism
and caution requires erasing the old soundtrack and developing new habits, but
as we all know from New Years resolutions, it takes more than good intentions
to make the change. Focused commitment
is required.
Exterminate the ANTS
Restoring a healthy balance of thoughts in your brain begins
with self-awareness. What is your
baseline? Does your mind automatically
see the downside to every encounter or are you upbeat and optimistic? Here
are some tips for those who want to exterminate ANTS, reduce anxiety, and
increase happiness.
Removing ANTS begins with changing the news feed that you
put into your head. Being aware of
negative thoughts allows you to question them and separate truth from unfounded
fear. When people wanted to pass
negative news to the ancient philosopher Socrates, he would ask three
questions: 1) Is it true? 2) Is it good?
3) Is it useful? If the answer to
any of the questions was no, he considered it to be gossip and would not
listen. When ANTS creep into your head,
ask yourself the same questions and, like Socrates, reject thoughts that are
not true.
TED
talk speaker Anthony Metivier reinforces the advice from Socrates and
suggests asking yourself two questions when experiencing negative thoughts; 1)
Is it true. 2) How does it affect my behavior.
I would add a third question…how does my behavior affect the behavior of
those around me? Attitude is contagious
and how you show up can either build up or take down the morale of the entire
work group.
Viktor Frankl, author of Man’s
Search for Meaning, states “in between stimulus and response is the most
powerful human freedom; the power to choose. Here are some suggestions for
stamping out the ANTS.
Increase your awareness of your baseline
thoughts and question whether they are true, if they are useful, and how they
influence the way you interact with those around you.
Find new evidence. Rather than focusing on your shortcomings,
make a list of your strengths. Never say
“I can’t”, rather say “I’ve not yet mastered that skill.”
Become aware of how the brain works. New neural
pathways are developed through repetition so bathe your brain in positivity.
Be kind to yourself. You are not obligated to focus on weakness or
demeane yourself in any way.
Know your personal values and be true to
them. There are several online values
assessment tools…select one and gain insight on the things that you value the
most.
Define yourself based on your strengths and
values. Don’t waste time trying to be
the person who someone else wants or expects you to be. Limit your time on social media.
Ignore ANTS.
Use Socrates questions and throw out thoughts that do not rise to the
standard of being truthful, good, and useful.
Meditate.
Start the day with a focus on positivity and end the day with a review
of the good things that happened.
Be receptive to help. If ANTS are so deeply embedded into your brain
you may need professional help. Connect
with a therapist who can give you practical advice for removing negative
thoughts.
We live in a fast-paced, media driven world complete with
pop-ups alerting us to every threat known to humanity. As stress increases, so does the potential
for an ANT infestation. In the process,
health and happiness falter and we are cheated out of the peace of mind that we
deserve. Removing the ANTS is a life
changer. Make a commitment to pest
control and shake the ANTS out of your head.
Tom is an
experienced leader, educator, author, and requested speaker. Click here for a
video introduction to Tom’s talk topics.
Time travel is a captivating theme for Sci-fi movie
enthusiasts. Wouldn’t it be fun to go
back in time 30 years knowing what you know now and be able to re-live the
decades knowing in advance what the outcome will be. If we had it to do again, we would all be successful…and
very wealthy people.
While we await the development of time travel capability,
there is another way to make decisions in our life that will open the door to success
as if we were looking into the future.
The approach is so simplistic that many will doubt its effectiveness,
however, listening to and building on the knowledge of successful people who
are at the end of their careers will pave the way for people at all levels to
advance themselves. Regardless of
whether you hold a leadership title, or if you want to be more effective in
your daily life, learning from those who have walked the walk is a great
starting point.
Published in Forbes.com, the article “15
Leadership lessons these leaders wish they had learned sooner” offers
wisdom gained through the school of hard knocks. Similarly, an article published by Christina
Desmaris in Inc.com, “17
things these successful leaders wish they had known years ago” adds to the
pool of wisdom meant to encourage the confidence of those developing their
human interaction skills. Reading
through the articles, I must admit that I have learned some of the same lessons
the hard way and only wish that I had known then what I know now. As you read through the advice offered by
experienced leaders, keep an open mind, and imagine that the advice is
true. Apply the advice to a current
challenge that you are facing and visualize success in the months and years to
come. Learning from others can be a
life-changing experience.
Things that leaders wish they had known earlier in
their life.
Leaders are there to help people grow
professionally and personally.
If you are in a leadership position, know your people as individuals and
focus on their professional development.
If you are a worker, let go of fear of your boss and assume that he/she
truly wants you to be successful.
Develop a relationship that will enable your growth and position
yourself to help others with their advancement.
Successful people can adapt to any
situation. We are all more
resilient than we think so open yourself to finding a creative solution and
don’t throw in the towel.
Self-awareness is the key to successful
interaction with others. Become
self-aware and be mindful of how you affect others. How you show up every day and your basic
attitude is contagious. Self-confidence,
upright posture, optimism, and a great smile set the tone for any interaction
that you engage in.
The leader isn’t always the smartest
person in the room. People who
are intent on alpha-dog dominance and insist that their solution is the best
tend to micromanage and stifle the creative thoughts of others. The most effective leaders surround
themselves with talented people, establish the goal, provide resources, let
them do their work, and are open to learn from them.
The best leaders are transparent. Transparency goes beyond basic honesty and
builds a foundation for integrity.
Transparent people freely share the reason behind decisions and admit
when they make mistakes. Being
transparent opens the door to revealing vulnerability which is frightening for
many people. Transparency requires
courage.
Confident people define themselves. Never change who you are based on who others
think that you are or want you to be.
Know yourself, your personal values, and your vision for the future and
then be true to yourself and your goals.
Great leaders listen to and respect
frontline employees. Diversity
of thought adds strength to any group or organization and must be actively
encouraged. Solicit creative thoughts
from others, actively listen with the intent of understanding, and then incorporate
new ideas into problem solving. Your
team members will feel validated, and your supervisor will be amazed and the
creative ideas you put forth.
There is a difference between leadership
and management. Leadership is
about people and management is about things.
People have personalities and individual needs, things do not. Use charts and spreadsheets to organize
things, use emotional intelligence to connect one on one with people.
Morality matters as much as competency.
Ralph Waldo Emerson said, “Who you are speaks so loudly I can’t hear what you
say.” Your honesty, integrity and
transparency are reflected by your behavior, and you will be judged on what you
do and not how intelligent you are or what you say.
Personal
growth is a lifetime process.
There is no single philosophy or leadership course that will ensure
success for the remainder of your career as a leader. As the world changes, so do the leadership
challenges and the approaches for solving them.
Regardless of whether you hold a leadership title, make a commitment to
being open minded, observant, and learning from every experience.
The ten pearls of wisdom listed above were compiled based on
feedback from experienced leaders. I am
now in my fourth decade as a healthcare provider, educator and leader and have
learned many lessons along the way myself.
Looking back over my career, the most important thing that I have
learned is that leadership is about the people, not the leader. Success arises from using emotional
intelligence to connect with those you supervise, those who supervise you, and
the population that you serve. True
success comes when you can align the personal goals of others with the goals and
vision of the organization to reach the point where, in the words of General
Eisenhower, “people do what you want them to do because they want to do
it.”
Tom is an
experienced leader, educator, author, and requested speaker. Click here for a
video introduction to Tom’s talk topics.
In November of 1999,
the Institute of Medicine shook America’s healthcare consumers when they
released their report “To Err is Human.”
The report noted that up to 98,000 patients were being harmed each year
by medical errors. The healthcare
community responded with an endless line of safety initiatives meant to protect
the patient, however in the past 23 years, the safety numbers have not changed
significantly. What is driving those
numbers and what can we do to make the operating room a safer place for our
patients?
Many factors
contribute to medical errors and two common causes that are high on the list
are production pressure and its byproduct, normalization of deviance. Understanding and controlling those two
important contributing factors will position you to become a leader in patient
safety.
What is production pressure?
Writing in the AANA Journal, authors Evans, Wilbanks and Boust define
production pressure as “the emphasis on increasing efficiency, output, or
continued productivity to increase monetary gain at the expense of patient
safety.” Writing for the Agency for Healthcare Research and Quality, author Pascuale Carayon PhD reinforces the
definition noting that production pressure involves both overt and covert
pressures and incentives to place production, not safety, as the primary
priority.
Definitions are nice
but as CRNAs we know first-hand what production pressure looks like. Being called in early to get the extra case
done before the posted schedule starts, being judged by how quickly the next
patient gets into the room, staying long after fatigue has set in to do the
add-on case. These expectations are
rationalized by the benefit on the bottom line of the organization through an
increase in case numbers. The
unfortunate downside is that increased productivity is frequently attained by
the risky practice of normalization of deviance.
What is
normalization of deviance?
Normalization of
deviance is the theory that minor deviations can be managed and tolerated. Writing for the Anesthesia Patient Safety Foundation, author Richard Prielipp notes “the
normalization of deviance process breaks the culture of safety and applies
equally to clinical anesthesia practice.
Production pressure is frequently cited as a major driver of
normalization of deviance and causes providers to work even when fatigued,
create workarounds for safety systems, stretch the boundaries of hospital or
departmental guidelines, and expedite patient care to the point of “cutting
corners in the interest of staying on schedule.”
Production
pressure, normalization of deviance and wrong site surgery.
When reviewing
literature related to normalization of deviance, the crash of the space shuttle
Challenger is a prime example of what can go wrong when decision makers bend
the established policy and thinking that nothing bad will happen. In the operating room, wrong site surgery is
equally devastating as the tragic explosion of the Challenger and leaves one to
wonder how it could happen.
Wrong site surgery
is an event that should never happen, however, the National Institute of Health reports that wrong site surgery occurs up to
40 times per week. This statistic exists
despite the universal precautions of preoperative verification, marking of the
operative site and the surgical time out.
How does this happen? Production
pressure encourages cutting corners and when nothing bad happens, more corners
are cut until eventually a tragic event happens.
Be a high reliability organization
Author Amanda Bonser
notes that “high reliability” describes an organizational culture that strives
to achieve error-free performance and safety in every procedure, every time,
while operating in a complex, high-risk, or hazardous environment. Providing high reliability requires an
element of frontline empowerment where healthcare providers can slow the
process and ensure that policies and procedures are followed as intended in
every surgical case. In high reliability
environments, there is a reluctance to simplify or cut corners and exploring
the root cause and understanding a failure is more important than bragging
about the things that go well. At the
heart of a high reliability mentality is the refusal to be pushed to compromise
any part of the surgical process.
Likewise, it is equally important not to pressure others to make
compromises.
Develop a traffic circle mentality
For decades, traffic
engineers have sought to design intersections that eliminate the possibility of
death or major injury. Knowing that the
highest risk scenario is a left turn on a high-speed road, engineers are
installing traffic circles at high-risk intersections. When approaching a traffic circle, drivers
are forced to slow the pace, assess the danger of other cars in the circle,
make eye contact and coordinate with other drivers and then safely navigate
through the intersection. Even though
fender benders may occur, it is almost impossible to have a fatal crash in a
traffic circle.
Developing a
“traffic circle” mentality with each surgical patient requires that providers
slow the pace, assess potential risks to the patient, coordinate with others
and finally, successfully perform the surgical procedure. In such a scenario, safety is more important
than speed, the needs of others are recognized, and patient safety is the top
priority. Using a traffic circle
mentality in the operating room with an emphasis on slowing the pace while
communicating and coordinating with everyone on the team eliminates the need to
cut corners and makes it almost impossible for events such as wrong site
surgery to occur.
Every time you allow
yourself to be pushed or you push another person on the team to value
productivity over safety you are inviting a sentinel event in your operating
room. Develop a traffic circle mentality
and transform your workplace into a high reliability organization.
Tom is an
experienced leader, educator, author, and requested speaker. Click here for a
video introduction to Tom’s talk topics.
“It’s the most wonderful time of the
year
With the kids jingle belling
And everyone telling you be of good cheer
It’s the most wonderful time of the year”
~Song by Andy Williams
The earth is completing another trip around the sun and the
holiday season is rapidly approaching.
It is a time of the year when we are forced out of our daily routine and
thrust into glitz and glamor of the holidays.
Regardless of your culture or religious background, business as usual is
cast aside and festivities abound in our homes, workplaces, and
communities. In many ways, it’s the most
wonderful time of the year, however, along with excitement comes expectations,
obligations, and stress.
It’s the most stressful time of the year
Intrinsic to the holiday season are both internal and
external sources of stress, however, taking time to plan and prepare will
enable you to bypass many of the frazzled moments that commonly accompany
festivities. Like it or not, we are
creatures of habit and being forced out of a routine is known to cause anxiety
and frustration. Holiday obligations
disrupt the status quo and take time away from normal activities. Gatherings with the family or workgroup
require proper attire, hair, makeup, childcare, not to mention the hostess gift
and the dessert tray. In addition,
children have holiday events at school that conflict with a busy work schedule
and cause guilt if you ask for time off or guilt if you don’t.
My podcast interview with Cathy Horvath, DNP, CRNA and Chair of the AANA Wellness committee exposed the extent to which healthcare workers are feeling stressed. Her statistics reveal that 77% of our colleagues report frustration and exhaustion related to their work and 45-55% report feelings of stress and anxiety on a frequent basis. Even more telling, 50% of healthcare workers report feelings of depression with 13% stating that they have had suicidal feelings. The numbers are alarming, and the stress only increases during the holiday season.
Thinking that the workplace will provide a haven from the
chaos at home may lead to disappointment when work does not provide the escape
that is desired. Typically, patients have reached maximum co-pay by the end of
the year and are in a rush to get procedures done before the ball drops in
Times Square. The case load is high,
the vacation calendar is full, and your work hours are longer just as you have
a million other things to do. Yes, it’s
a stressful time of the year.
The Mayo
Clinic healthy lifestyle blog identifies the holiday season as a potential
source of significant stress and advises that we become attuned to our feelings
and acknowledge them. In addition, they
recommend that we remain realistic by not abandoning healthy habits and by saying
“no” to set boundaries. The
Johns Hopkins wellness blog advises that we keep sight of what really
counts and always respond with kindness, even when stressed. Building on the theme of reducing stress, author
Kaleigh Carter notes the importance of physical activity, meditation, and
sleep during the busy holiday season.
Regardless of the source that you reference, all agree that the holiday
season is stressful and that a combination of anticipation, planning, and
preparation will make the stress manageable…and may even re-infuse fun into
your life.
Practical tips for managing holiday stress
Ramp up your self-care. A healthy body is the first line of defense
against stress and your body’s basic requirements don’t change with the
season. Put differently, the body does not
need more calories and less sleep during the holiday season. Taking charge of the body’s basic needs
requires focus, discipline, and commitment.
Self-control is empowering.
Nutrition. The body’s basic need for high quality fuel does not change just because holiday parties are on the calendar. Essential nutrients are still required, and harmful foods are still harmful. Unless you become a mega-cardio gym rat, your calorie requirements remain the same during the holidays and extra food volume will give you extra work to do when “lose weight” appears on your New Year’s resolution list. Go heavy on fruits and vegetables while limiting foods that are high in fat and salt.
Exercise. Keep moving and don’t let distractions pull you away from your exercise time. Participate in outdoor activities when the weather permits and move indoors when the snow flies. A gym membership offers the opportunity for a social aspect to your workout. Buy a mat and use online programs at home to assist with stretching, yoga, and meditation.
Sleep. When things get hectic, it’s easy to sacrifice a few hours of sleep, however over time the lack of sleep will take its toll. Get into a bedtime routine and allow your body to relax by quietly reading or meditating before retiring for the day. Keep a regular schedule that ensures the proper amount of sleep.
Seek the sun. Seasonal affective disorder is described in the DSM5 as depression related to a lack of exposure to the sun. Military personnel returning from duty in Alaska will affirm the negative effects caused by the long periods of darkness during the winter months. Similarly, OR personnel drive to and from work in the dark during the holiday season with little opportunity for sun exposure. Be creative, walk to a different area of the building, find a sunny spot for your lunch, and you’ll get the added benefit of exercise.
Take a break. Rather than slurping coffee on the run, plan a mid-day break into your schedule. Get out of the lunchroom and leave the gossip to others. Plan a 5-minute walking route that includes going up and down one flight of stairs and passes through a sunny location along the way. Be creative and find a quiet location to put a mat on the floor and do some stretches at work. Both your mind and body will thank you.
Anticipate and prepare for external stressors
It’s always easiest to pick the low hanging fruit and taking
care of oneself physically is easier than dealing with all the external
expectations/obligations of the holiday season, however, by setting goals and
limits you can develop a plan to minimize stress. Here are some holiday stresses that may emerge
from the festivities and knock you off track.
Social gatherings with the workgroup and/or your family. Receiving an invitation to the annual office
party or family holiday gathering gives you a sense of inclusion and the
expectation of a joyful evening. The
invitation also creates an obligation to add another item to your already
packed schedule. Time, effort, and money
are required to get the right attire, arrange childcare and put together a
hostess gift. Once at the party, high
calorie food is abundant and alcohol flows freely, both are challenges to your
commitment for self-care. Here are a few
tips.
Eat a small amount of healthy food before going
to the party so that you are not ravenous when you arrive. At the party, commit to sampling a few items
rather than filling your plate several times with high calorie, high salt,
food. “All you can eat” does not mean
eat all you can.
Drink alcohol slowly and commit to alternating
each alcohol drink with a non-alcohol drink.
Make it about the people, not the
food/alcohol. You work with these people
daily, but do you really know them?
Challenge yourself to learn something new about each person at the
party. As you talk to colleagues, remind
yourself of something that they do particularly well or something about them
that you are grateful for.
Financial obligations. We criticize congress when they pass a budget
and then spend millions of additional dollars for “off budget” items. Often, during the holiday season we imitate our
government, throw caution to the wind, and throw “off budget” money at gifts
and parties. Establish a reasonable
budget for the holidays and stick to it.
Find low-cost activities such as a family hike through the woods to
replace the high dollar trip to the theater complete with twenty-dollar
popcorn. Make a hostess gift such as an
ornament rather than buying an expensive bottle of wine. When you finish buying gifts for the family,
be finished. That one extra gift or
stocking stuffer for each member of the family can add another $100 to the cost
of the holidays. The bottom line is that
unlike the Federal Government, you must pay your bills so pull the reigns and
spend wisely.
Create good cheer and positive vibes for the Holiday
season
The holiday season is a time for gift giving and the best gift that you can give yourself is an organized, low stress month filled with pleasant memories. Your internal dialogue sets the tone, and an optimistic and proactive attitude are building blocks for success. Start and end each day by practicing gratitude and think of three things that you are grateful for. The activity will reduce your negativity bias and help to remove the feeling of being victimized by the holidays.
The bottom line is that in addition to being the most wonderful time of the year, the holiday season can also be the most stressful time of the year. Be mindful of the tips put forth by Cathy Horvath in the podcast and use a combination of self-help activities, planning, and an optimistic mindset to set reasonable boundaries and ensure a memorable Holiday season.
The times they are a changing. Not long ago, applicants who lined up to compete for healthcare jobs hoped to be the lucky winner of the coveted position. Now, due to many factors including COVID burnout, healthcare organizations are competing to attract candidates to fill the void created by open positions. More than ever, employers are seeking ways to retain current workers while creating a positive reputation that will attract additional qualified people. In short, organizations have a new focus on implementing employee friendly activities and have discovered that professional development is a core element of a preferred workplace. Investing in all aspects of worker growth improves morale, engagement, productivity and retention.
Writing for Insperity,
author Celenia Estime identifies the following as characteristics of a great
workplace:
A sense of belonging
A sense of purpose
Allowing employees to have fun
Provide an opportunity for development and
advancement
Clearly, Celenia is in alignment with other writers who tout
professional development as an essential component of a highly desirable
workplace.
The Gallup organization has been collecting information
related to staff engagement for several decades and have refined their
engagement assessment tool to 12 basic questions referred to as the Gallup Q12.
Savvy employers note that many of
the twelve questions are designed to generate positive responses from workers when
the organization has an ongoing commitment to the professional
development. These questions from the
Gallup Q12 that support the importance of a robust professional development
program.
In the last seven days I have received
recognition or praise for doing good work
My supervisor or someone at work seems to care
about me as a person
There is someone at work who encourages my development
At work, my opinions seem to count
The mission or purpose of my company make me
feel as if my job is important
In the last six months, someone at work has
talked to me about my progress
In the last year I have opportunities to learn
and grow.
The Gallup team know that affirmative responses to these
questions indicates that the team is highly engaged in their work and are
likely to be both productive and loyal to the employer.
At this point, you may be all in for professional development but unsure about where to start. If your workplace does not have an ongoing staff development program, step up and look for opportunities to learn new skills and to share your knowledge with your teammates. An active combination of teaching, coaching, and mentoring will provide opportunities for personal growth for you and your colleagues as you learn and grow together.
“You will get all you want in life if you help enough otherpeople get what they want.”
~Zig Ziglar
In a podcast interview with Richard Wilson, CRNA, the importance of teaching, coaching, and mentoring are discussed. Although there is overlap between the three approaches, Richard discusses the subtle differences and offers insight into how to effectively apply each approach to introduce professional development to your workplace. Click on the podcast at the end of this article.
Teaching is designed to impart academic information
and instruction to a group of learners.
In most cases, the material is presented in a pre-determined manner and
is designed to fulfill a specific need.
Teaching is often confined to working with neophytes in the classroom
however when best practice guidelines are updated, opportunities for teaching
arise for experienced workers.
Coaching occurs in the actual work environment and is often an extension of the classroom. Typically, the coach builds on classroom knowledge by using his/her experience to teach hands on skills to less experienced people on the team. As Richard points out in the podcast, coaching moves the learner from understanding concepts to acquiring the skills necessary for completion of a task. When a leader arranges for an experienced person to coach a new member of the team, both the coach and the new hire have opportunities for professional growth.
Mentoring is a special relationship between two
people in which the senior, more experienced person helps the underling define
a vision, develop a plan, and achieve a goal.
Mentoring goes beyond teaching and coaching by introducing elements of
professionalism and networking to the process.
The mentoring relationship is built upon trust and often develops into a
lifetime friendship between the two individuals.
“Never
doubt that a small group of thoughtful, committed people can change the world.
Indeed. It is the only thing that ever has.”
– Margaret Mead, American cultural anthropologist
Professional development is the ultimate
win/win for the organization, frontline leaders, and individual workers. By actively engaging workers to participate
in professional development, an important step is taken toward creating a
preferred workplace that will attract and retain the best employees. Author
Trevor
Antley notes the following as positive outcomes related to professional
development:
Professional development expands your knowledge base.
Professional development boosts confidence and credibility
Professional development increases earning potential and hireability
Professional development can provide networking opportunities
Professional development keeps professionals current on industry trends
Professional development can open the door to future career changes
Congratulations if your workplace encourages and supports professional development because you landed a great job. However, when the boss does not provide avenues for personal growth it is time to step up and be a leader regardless of your seniority or position in the workgroup. Stay current with professional literature and freely share your ideas with your colleagues. Establish both formal and informal times to share what you have learned by teaching and coaching. Volunteer to be a coach for new hires and seek coaches for yourself when you want to learn a new skill. Seek out a mentor who will help you move into a leadership role initially in your workgroup and later in the organization. Look outside your organization and consider completing an advanced degree or gaining certification in a related area such as ultrasound nerve blocks or pain management. Finally, listen to the advice provided by Richard Wilson in the podcast.
A common theme of my leadership articles is emphasis on the
importance of creating a preferred workplace.
Both healthcare and business management literature reinforce the
connection between employee engagement/productivity and working in a favored
environment. Among the foundational
elements of a great workplace is professional development where the employer
actively seeks avenues for employees to gain new professional skills.
Unfortunately, not everyone works in a preferred
workplace. If your employer does not
promote expansion of you career skills, you have three choices; 1) stagnate
with the status quo, 2) find a new job, or 3) step up and take charge of your
own professional development. For
workers who are tied to their community and unable/unwilling to move, option 3
is the best choice.
When the employer can’t or won’t, step up and take charge
Personal development begins with awareness of its importance
and a sincere desire to gain new knowledge and skills independently when it is
not promoted in the workplace. Writing
in the blog
rgpm, author Elizabeth Harrin offers the following tips for starting your
own personal development program.
Make self-improvement a priority. Set a goal for improving your work skills and
make it specific. “I’d like to get better
at” doesn’t cut it. State the new skill
that you intend to develop or the current skill that you intend to improve and
then follow with “as evidenced by” and state specific milestones along the
pathway to accomplishing the goal.
Be the best at what you do. As busy healthcare professionals, we get into
a routine workflow and robotically move through the day as efficiently as
possible. Take time to reflect on what
you currently do and find ways to do it better.
For some it may involve organizing the workspace and for others, it may
be improving interpersonal relationships with patients or colleagues. Regardless, be the best that you can be.
Solicit feedback.
It is human nature to revel in praise and wilt in the face of criticism,
however, self-improvement comes from a “make me better” attitude where honest
feedback is important. In my practice,
cataract patients are usually scheduled to return to have the second eye
done. After the first eye I always ask,
“when you come back, what can we do differently to make your experience
better?” At the end of the day ask your
perioperative team, “do you have any suggestions for things that I can do to
help your workflow?” Listen, learn, and
don’t push back.
Get a mentor.
It may be a colleague or someone up the chain of command but there are
others who are skilled at the area that you want to improve. Tap into their expertise and form a mentoring
relationship with someone who truly wants to help you gain new skills. In addition to personal growth, you expand
your network and may even develop a friendship that will continue throughout
your career.
Become a trainer.
Your employer may not have a professional development program, but they
often introduce new technology to the workplace. When new equipment or computer programs are
introduced, volunteer to be a super-user and be the first to master the needed
skills.
Earn a degree/certification. Opportunities abound for healthcare workers
to gain certification in specific areas of practice such as ultrasound guided
regional anesthesia or pain management.
In addition, advanced degrees including a doctorate degree are offered
online and provide abundant opportunities for personal growth.
Taking charge
of your future is empowering
Personal growth in the workplace often involves a series of low-key
behaviors that boost your sense of self-worth and your value to the
organization. Put differently, you don’t
have to receive advanced training in new skills to experience personal
growth. The management blog career
Contessa offers additional tips for creating your own professional
development plan.
Organize your life.
Remove the clutter from your workspace, create a calendar with a daily
block of time for self-help initiatives, then make a list of things to
accomplish each day. End your day with a
feeling of accomplishment as you review the items that you completed and
checked off the list.
Create goals. Be
realistic and ensure that your goals are both attainable and things that you
will commit to accomplish. State the
desired outcome and make a list of tasks that must be achieved in route to your
goal.
Talk directly to management. Sometimes it’s not that
they don’t want you to have professional development, rather, production
pressure has kept managers too busy to focus on your needs. An honest and open discussion will let them
know that you desire growth in the job and position you to be selected to
manage the next project.
Ask questions and hone listening skills. Become aware of the issues that are of most
concern to management and offer to help create a solution. Listen and learn.
Use positive self-talk. We constantly have an inner dialogue going
and often it can take us places that drag us down. Rather than focusing on the negatives, recall
the things that you do well, congratulate yourself, and visualize ways to
expand those successes in other tasks.
Develop an asset-based mentality with a focus on what can be done with
the available resources.
Accept
responsibility for your personal growth and development
In an ideal workplace, your boss, and your colleagues care
about you as an individual and want you to have ongoing opportunities for
improvement. If you are in such a
workplace, cherish it appreciate the openings that it provides. However, if you are like many others who toil
in a less than ideal workplace, free yourself from the bonds of stagnation by
using the tips in this article to plan and implement your own professional
development plan. Your efforts will pay
big dividends as you master new skills and inspire your colleagues to follow in
your footsteps. Who knows, you may be
the catalyst to bring professional development into your workplace transform the
organization from “just another job” to being a preferred workplace.
Tom is an
experienced leader, educator, author, and requested speaker. Click here for a
video introduction to Tom’s talk topics.
Rising stars in the workplace and in the profession…we all
know who they are and the contributions that they make to group. It would be a cliché to say that those entering
a profession are the future of the organization, and we all know that it is
true. To ensure that nurse anesthesiologists
continue to be valued members of the healthcare community, a combination of
solid workers and rising stars are essential.
Ask any Chief Anesthetist who the “go to” people are in the workgroup,
and they quickly point out the all-stars.
Likewise, ask any program director to identify students most likely to
move into leadership positions at the State level and they will instinctively
point out the rising stars in the class.
What is a rising star and what do they look like?
Writing in the Inc.com
blog, author Scott Mautz discusses the characteristics of people who are
rising stars in the workplace or the profession
Ability to adapt (resilience) Rising
stars are always moving forward and are not stopped by speedbumps along the
way. Their vision for the future is more
important than a temporary setback and glitches only motivate the rising star
to find a solution.
Zeal for improvement The status quo may
be good enough for today, but rising stars have a vision for the future and
have a keen eye for establishing new policies and streamlining the
workflow. They move beyond having a
concept and develop a plan for implementing change.
Ability to influence Rising stars tend to
be the “go to” person in the group and are often referred to as the influence
leader. They may or may not have a
title in the group but they have a powerful influence on the mood and motivation
of the group.
Powerful presence When a rising star
enters a room, everyone knows it, usually in a positive way. The rising star instills confidence in others
and makes the group believe that challenges can be conquered.
Both EQ and IQ Emotional intelligence is
a buzz word in the business community and organizations are using EQ evaluation
when selecting new hires. In nurse
anesthesiology, many training programs are incorporating EQ assessment into the
selection process for students. The
rising star tends to be intelligent, visionary and can blend IQ with EQ when
working with others.
Solid decision-making Rising stars know
what they want to accomplish, believe that it is possible and are not shy about
making decisions to support the goal.
In 2016 I had the privilege of meeting a rising star in our profession. While attending an AANA leadership summit in Chicago, I was introduced to Julie Linton, a senior SRNA interested in leadership and doing a great job networking with others at the meeting. Three short years later while speaking at the West Virginia State association meeting, I became re-acquainted with Julie who was serving as the president of the West Virginia association. In three short years, she progressed from new graduate to State president. Recently, I recorded a podcast with Julie and learned about rapid journey to leadership. Click here to listen to the podcast.
Some people are born with an outgoing personality, but
nobody is born with leadership skills. Rising star status is something that can be
achieved through mindful practice. The biospace.com
blog offers tips for behaviors that will make you a rising star at work or in
your life.
Know when to listen. We live in an electronic world where
texting is easier than talking. Take
time for conversation and view it as a chance to listen and learn. You don’t learn anything new when you state
your opinion, you only learn when you listen.
Give credit when credit is due. When others have good ideas give them
full credit and then build upon the foundation that they have provided. Engage the other person as a collaborator
rather than a competitor.
Be agile.
Those who are agile can move through awkward situations gracefully. Be respectful of the feelings of others and
seek collaboration when dealing with difficult situations.
Be honest. Honesty is a value that is essential when
building trust between individuals. You
will never be trusted as a go to person or viewed as a rising star if you are
dishonest.
Come up with a new idea. There is a solution to every challenge
and the best ideas arise from many ideas.
Brainstorm with colleagues, listen and learn from others, and develop a
new approach to the problem.
Bring solutions, not problems. Asset-based thinking is built upon
identifying the resources that you have and doing the best that you can with
them. Avoid whining about what you lack
and create a solution with what you have.
Make yourself available. You must be present to win. Enter the room with a positive attitude and a
presence that inspires confidence from others.
Say yes when asked to participate and follow-up quickly when asked to do
a task.
Be a doer. Achieving is an active sport and requires
participation. You may have great ideas,
however, if you want to be a rising star you must put them into motion. The person who sits back and says “they ought
to” will never be recognized as an achiever.
My friend Julie Linton is a rising star, but she is not
unique. We are in a profession with many
talented and intelligent people who can take us into the future. Julie has mastered many of the traits listed
above and will be a great role model for future rising stars. Click
here and enjoy the podcast describing Julie’s experience as a rising star.
Tom is an
experienced leader, educator, author, and requested speaker. Click here for a
video introduction to Tom’s talk topics.
In his classic book, The 5 levels of leadership,
author John Maxwell notes that in the lower levels, people follow leaders first
because they must and later, if earned, because they want to. However, in the modern workplace, truly
memorable leaders take the next step and achieve level 4 status by shifting
their focus on developing the talents of members of the team.
The Gallup Q12 staff engagement survey is the gold standard
for assessing staff engagement in the work environment. Reviewing the content of the survey reveals
that aspects of teaching, coaching, and mentoring are present in half of items
assessed, which reinforces the importance of professional development in the
workplace. The Q12 survey reinforces the
concept that teams with Maxwell level 4 leaders who focus on developing the
strengths of its members are the groups with the highest morale and
productivity.
Take your team to the next level through teaching,
coaching, and mentoring
Teaching
Teaching is designed to impart academic information and
instruction to a group of learners. In
most cases, the material is presented in a pre-determined manner and is
designed to fulfill a specific need.
Communication is frequently one way and directed by the teacher. Presentation of information is focused on content
related to the goal. In the workplace,
leaders are called upon to assemble the team, explain changes in policies or
workflow, and solicit support from team members. In addition, teaching sessions may be held to
update the team on best practice guidelines for various procedures. Depending upon the size of the group,
discussions can open the door for feedback however the bulk of the information
is presented as one way communication from the leader to the group.
Coaching
Whereas teaching takes place in the classroom, coaching
occurs in the actual work environment.
Typically, the coach uses his/her knowledge and experience to teach
skills to less experienced people on the team.
Picture the little league coach who, in addition to teaching baseball
strategy and teamwork, works one on one with each child to improve their
personal skills at various tasks. In the
workplace, the level 4 leader works one on one with team members, or they may hit
a home run by matching the lesser trained person up with a senior person on the
team who fills in as the coach. In this
case the leader not only ensures that the newbie is coached, they also develop
the coaching skills of the experienced person assigned to be the coach. In this case, two people walk away with a
sense that the leader has an interest in their professional development.
Mentoring
Mentoring is a special relationship between two people in
which the senior, more experienced person helps the underling define a vision,
develop a plan, and achieve a goal. The
relationship is built upon trust and often develops into a lifetime friendship
between the two individuals. A key
element of mentoring is for the senior person to be committed to helping the
younger person achieve their goal. Often, effective mentoring enables the up and
comer to become a leader somewhere else in the current organization or with
another organization all together. One
word of caution, a relationship in which the senior person attempts to build a
clone of him/herself is doomed for failure.
The key to success is helping the other individual to be the best person
that they can be and encouraging their promotion.
“As we look ahead into the next century, leaders will
be those who empower others” ~Bill Gates
Frontline leaders are constantly pulled in many directions
at the same time and in the chaos of crisis management may find it difficult to
carve out time for developing individual members of the team. The savvy leader knows that accomplishing the
workload and staff development are not mutually exclusive. Through teaching, coaching, and mentoring,
members of the team are trained to pick up leadership tasks resulting in a
reduced workload for the leader and more time available for additional staff
development. The investment of time and
effort spent on developing others improves morale, increases productivity, creates
a pipeline of capable future leaders. In
addition, it elevates you to “best boss” status. Expanding the capabilities of others is a cost-effective
win-win activity for the team and the organization. Step up and capture the rewards of level 4
leadership.
Tom is an
experienced leader, educator, author, and requested speaker. Click here for a
video introduction to Tom’s talk topics.
It’s 11pm and you are finally ready to collapse into
bed…just another day in your hectic life.
You resisted the urge to smash the alarm clock at 5am, got out of bed
and hit the floor at full speed. The
clock is ticking. You have one hour to shower, dress, and get breakfast ready
before getting the kids up at 6am. At 6:30 your phone rings, an early case was
added to the schedule, and you live nearby so they assumed that you wouldn’t
mind doing it. You can’t disappoint
your colleagues, so you double the pace, drop the kids at pre-school early and
race to the hospital. At lunch your boss
flags you down… a policy must be revised, she is in a time crunch, and you
always say yes, so she gives you the job then drops the bomb… it’s due
tomorrow. You realize that your cases will
go until 4pm and that you will be spending your evening re-writing a
policy. At 3pm, a colleague lets you
know that there is an add-on case and he can’t possibly stay to do it because
his kids have a soccer game…you say yes again.
Finally leaving at 5:30pm your phone rings again, your neighbor is tied
up in a business meeting and needs you to pick up her kids on your way
home. On and on it goes until you are
totally burned out. What is the problem
with this picture? You have no
boundaries, and everybody knows it.
Something must change.
Writing in Forbes.com, author
Melodie Wilding notes that boundaries remove chaos and distractions from
your life and serve as armor to protect you from unwanted invasions on your
time, talents, and resources. It’s nice
to be helpful on your terms, but taking on the responsibility for solving other
people’s problems crosses the line and must be stopped. She notes that
establishing boundaries begins with self-assessment to include making a list of
areas where your life is being encroached by others and include the tasks that
you do but can and should be done by someone else.
The first step in re-defining your life is openly admitting
that the status quo is not working, and the second step requires making a
commitment to set boundaries knowing full well that there will be pushback from
those who enjoy your willingness to take on their responsibilities. Your commitment must be firm and not just
something that you try out for a short period of time.
Buying or selling property requires a survey of the land to
clearly mark the boundary between what you own (your responsibility) and what
belongs to others (their responsibility).
Take a survey of your daily life looking specifically at things that
cause you stress, make you feel uncomfortable, or push you to exhaustion and then
draw property lines to separate your responsibilities from those of
others. Ask yourself what it would look like if you
stayed on your own property and did not accept ownership for the problems of
others. Put up a fence and stop mowing
the neighbor’s lawn.
Set boundaries at
work and in your life
Identify priorities.
Earning a paycheck is essential and gaining professional recognition
and respect are very important for many workers. Beyond that, we all have things that are
essential for our wellbeing. Whether it
be connection with family/children, hobbies, activities or social interaction,
everybody has things that are crucial to their happiness and wellbeing. List your essentials and note areas where a
lack of boundaries has kept you from the things that are important for your
wellbeing.
Say NO and mean it.
Determine where you need to build fences to identify your property
line and then close the gates to keep intruders out. Without being an obstructionist, say no when
others want you to fix their problems.
To get you started with boundaries, here are three key phrases for
protecting your time and space:
What did you mean by that? When you sense that others are dumping work
on you, clarify by asking what they meant and exactly what they are requesting from
you. Make the other person verbalize the
work that they are asking for from you.
Hopefully, they will realize that they are imposing on you and will back
off.
That doesn’t work for me. This simple sentence says it all and is most
effective if it is stated decisively without an explanation of your reasons for
saying no. Just say no.
How am I supposed to do that? Delivery is everything with this phrase. Your tone of voice must send the message that
you sympathize, but the request is not reasonable. It is essential that you NOT sound sarcastic
when using this phrase. Use a monotone
voice and ask it as a simple question.
The three responses above work best when they are followed
by silence…for as long as it takes. Discipline
yourself and wait for the other person to respond. If you get uncomfortable with the silence and
start to defend or explain your position you lose your power and the statement
is meaningless.
Communicate clearly.
Setting boundaries involves establishing new rules for both yourself and
for others to follow. Just as you would
be upset if the speed limit changed and nobody posted the new maximum, others
will be upset if you change the rules without telling them. For people who frequently encroach on your
space, send a message that clearly states your new boundaries. Below is an example:
It’s really important to me to be able to prepare a
nutritious dinner and spend time with my children in the evenings after work,
and as a commitment to my family I will no longer be available to pick up
add-on cases at the end of the day unless it is my designated day to stay
late. I’m writing now so that you are
not surprised when I decline to relieve you at the end of the day to enable you
to attend your children’s events.
The message is clear but only has meaning if your action
follows your words…just say NO.
Don’t skip breaks.
It may seem like a small thing, but your breaks are earned and in many States
they are required by labor laws. When
you skip or rush through short breaks you open the door for people to take
advantage of you in other areas. Taking
a full break creates a boundary and tells others that you are off limits for
the duration of the break.
Prioritize tasks.
Regardless of how good you are, you can’t do it all and spreading
yourself too thin invites others to dump even more work on you. Learn to prioritize tasks and focus on what
is important while discarding the rest.
The Eisenhower
matrix recommends identifying urgent/non-urgent and important/non-important
when prioritizing tasks.
Limit distractions.
Setting boundaries starts with imposing limits on yourself. Identify things that distract you and
eliminate or greatly reduce them. In our
technology rich society, we are constantly being distracted by personal
devices. Things that pop up on your
phone invade your personal space and distract you from your priorities. Review the settings on your phone and turn off
notifications. Plan several times per
day to check for messages and email then stay off your device at other
times. Breaking the tie to your phone
will keep you from going down the Google black hole, will reduce stress, and
will free up your time.
If you sense that your life is out of control, it probably
is. If you blame others for causing your
life to be out of control, think again.
There will always be people who would be happy for you to take on their
responsibilities and the more you accept, the more they will give you. When you are overwhelmed, it is not because
others are bad, it is because you have not established boundaries. Follow the advice in this article to sort out
what is important in your life and use the simple techniques to build and
enforce boundaries. The only alternative
is burnout.
Tom is an
experienced leader, educator, author, and requested speaker. Click here for a
video introduction to Tom’s talk topics.
In 2004, the American Association of Colleges of Nursing
(AACN) announced a bold recommendation that the Doctor of Nursing Practice
(DNP) be established as the gateway for entry to practice degree for all
advanced practice nurses. Several years
later in 2007 the Board of Directors for the American Association of Nurse
Anesthetists affirmed the AACN proposal by recommending that all nurse
anesthesia programs be at the Doctorate level by 2025.
Why a doctorate degree and why now?
In response to the initiatives by both the AACN and the AANA
board of directors, the Council on Accreditation of Nurse Anesthesia programs
established a mandate that all nurse anesthesia education programs offer a
doctorate degree to every person graduating in 2025 or later. Over the past decade, most nurse anesthesia
education programs have upgraded to the doctorate level with the remaining
programs in the final stages for conversion to the new degree. Because nearly all programs require 36 months
for completion, new students starting their education in 2023 must be enrolled
in a program that offers a doctorate degree upon completion in 2025. Clearly the clock is ticking as the final
programs scramble to meet doctorate level accreditation standards.
Currently certified and actively practicing CRNAs will be
able to continue to deliver anesthesia care using their existing
credentials. However, many experienced
anesthesia providers desire an education level comparable to new graduates
entering the profession. Therefore, a
push is underway among veteran providers to upgrade their credentials by
participating in a degree completion program to earn a doctorate degree.
Be a student as long as you still have something to learn, and that means all of your life. ~Henry Doherty
Does the Doctorate degree make me a better anesthesia
provider?
Clinical competence remains the foundation for the safe and
effective of anesthesia care regardless of the type of practice. Student nurse anesthetists must learn the
sciences of physiology and pharmacology related to anesthesia practice, and in
addition, the neophyte must spend countless hours gaining the hands-on skills
necessary to acquire clinical competence.
History has proven that master’s level programs have done an exceptional
job preparing students to assume a role as an independent anesthesia provider.
The doctorate degree does not necessarily make the new
graduate more skilled at delivering clinical anesthesia, however, the degree
does make the person a more knowledgeable and versatile healthcare worker. The doctorate degree expands the curriculum
to include an understanding of leadership, healthcare policy, systems
management, and the application of evidence-based healthcare. Writing in the AANA
Journal, Hawkins and Nezat list the following as subjects learned while
earning a doctorate degree.
Scientific foundation for practice
Organizational leadership and systems management
Clinical scholarship for evidence-based practice
Information systems and technology
Healthcare policy
Interprofessional collaboration and networking
Healthcare policy
Advancing nursing practice
Which doctorate degree is best for me?
The type of terminal degree that is best for you depends
upon where you are currently working and your professional goals. Advanced practice nurses, including CRNAs,
have a variety of options when earning a doctorate degree. Although completion of any of the terminal
degrees will put Dr. on your nametag, they are not master keys that open every
door. For example, the DNP is the
preferred degree for those who want to teach in a school of nursing, the PhD is
more appropriate for those with an interest in scientific research. Writing in nurse.org, author Mariam Yazdi
recommends considering the following when deciding upon which is the best
degree for you.
Where do I want to work?
What are the credentials of others applying for
the position that I want?
Will a PhD make me more competitive than a
clinical doctorate degree?
Earning a doctorate degree builds upon clinical excellence
and positions the learner to be an expert in evidence-based medicine and healthcare
policy development. Consider the
following when applying for admission to the program.
PhD, Doctor of Philosophy The PhD is the most common type of doctorate
degree and is awarded by the majority of academic fields. The degree is earned by producing
sophisticated work that significantly adds to the body of knowledge for the
profession. In healthcare, the PhD
commonly requires completing, presenting, and defending original research.
EdD Doctor of education An EdD is an advanced degree designed
specifically to prepare the candidate to assume a role in educational
leadership. In contrast, a PhD in
education prepares the candidate to conduct research related to the education
process. The EdD is most applicable for
University teaching outside the schools of medicine and nursing.
DNP Doctor of nurse practice The DNP is designed to produce leaders in
clinical nursing and nursing education.
Graduates with this degree learn to influence healthcare outcomes
through effective leadership and organizational policy implementation. The DNP was identified by the AACN as the
preferred degree for nursing school faculty.
DNAP Doctor of Nurse Anesthesia practice The DNAP is a doctorate degree
specifically designed for practicing nurse anesthetists. The degree has a focus on utilization of
research to develop evidence-based practice, leadership for the implementation
of change, and business management related to nurse anesthesia.
DMPNA Doctor of management practice for Nurse
anesthesia This very specialized
degree builds upon a master’s degree in healthcare management and expands it to
a doctorate level practice management degree with a focus on the business of
nurse anesthesia and healthcare administration.
What is my next step?
For those who are content with the status quo, fear not, you
will continue to recertify for practice based on your current credentials. For those who seek to complete a terminal
degree, the process starts with self-assessment and a critical look at personal
goals and capabilities. Once done, the
second step is to select the type of degree that best positions you to achieve
your career goals. Finally, find and
apply to a University that offers the degree you desire. To
help you with your search, the AANA Council on Accreditation offers a list
of accredited programs. The key to
finding a program that welcomes practicing CRNAs is to look through the list
and search for the word “completion”. Online
doctorate programs are common and allow the working CRNA to remain on the job
and pursue the degree during personal time.
Whether your goal is to keep up with the newbies, expand
your knowledge, or position yourself for a leadership position, the doctorate
degree is readily available to those willing to put forth the effort to earn
it. Are you smart enough? If you can pass your certification exam and
safely practice anesthesia, you have the intelligence to earn a doctorate
degree. All that is required is time,
money, intellectual curiosity, and the tenacity to see the endeavor through to
completion. Go for it.
Tom is an
experienced leader, author, and requested speaker. Click here for a
video introduction to Tom’s talk topics.
“Halloween is not only about putting on a costume, but it’s
about finding the imagination and costume within ourselves.”
— Elvis Duran
Halloween is exciting and full of surprises; however, it is
no surprise that the festive event also contains several lessons which will
enhance team collaboration, staff engagement and the overall effectiveness of
the designated leader. Look beyond gawdy
makeup and treats in the lounge and heed the wisdom arising from Halloween
leadership lessons.
Identity matters.
At a costume party it is challenging to guess who the person is
concealed by the costume and not knowing the identity until the masks are
removed. In contrast, at the workplace, a team must
always know who the leader is in terms of the personal values and leadership
style. Honesty, integrity, and
consistency must be your hallmark characteristics and they must be apparent
regardless of the color of your hair or the funny glasses that you wear. If you want to scare and demoralize your
team, show up as a different person every day.
Creativity generates empowerment. Policies, procedures, and protocols; they are
essential but can leave workers feeling like robots. Give team members the latitude to decorate
the workplace and wear work-appropriate costumes on Halloween. Reward creativity and then let the spirit of
the holiday be a catalyst for the team to apply inventiveness to problem
solving. Not only will the mood of the
team be elevated, but the team will also feel empowered to resolve outstanding
issues.
You can be whoever you want to be. Once you decide the character you want to be
for Halloween, it is not difficult to find a costume and props to transform yourself
into the new person. Likewise, once you
decide who you want to be as a professional, a little time, effort and planning
will enable you to acquire the new role.
Halloween is a great opportunity for a leader to learn about the desires
of workers and then arrange professional development to take each person to a
new level of performance.
Ghosts can only scare you when you let them in. Do not let your workplace become a haunted
house by allowing evil spirits to mingle with your team. Fear and paranoia are paralyzing and kill
staff morale. Behaviors such as gossip, blaming, and passive/aggressive
activity are the evil spirits that make everybody leery about scary things that
could jump out at them. Ban gossip,
outlaw blaming, and diffuse fear by openly discussing problems; never ignore
the elephant in the room.
Collaboration fosters courage. In the famous scary movie, Nightmare on Elm
Street, Freddy Kruger only had power when people feared him, and he always
selected a person separated from the group to be his next victim. In the workplace, collaboration produces a
sense of community and knowing that others have their back inspires individuals
to address challenges that they otherwise may have avoided. Team members who work together to plan and
pull off a workplace social event will stand united to solve other workplace
challenges. Say yes to reasonable Halloween activities, then turn it into a
teambuilding event.
Teambuilding is enjoyable. The purpose of teambuilding is to enhance
personal relationships and foster collaboration among team members. Halloween is an occasion that begs for
workers to collaborate by decorating the workplace, donning an altered ego, and
planning a festive day. The best
workplaces reward strong performance by planning special days to recognize the
effort that the team puts forth daily.
Halloween is a holiday that can be spooky but do not let it
spook you. The gremlins and goblins who
lurk in the shadows are no match for a united group so focus on teambuilding reward
your team with a festive day. While you
are at it, plan for celebrations and teambuilding activities for the upcoming
Thanksgiving and New Year holidays.
Tom is an
experienced leader, author, and requested speaker. Click here for a
video introduction to Tom’s talk topics.
Core Competency: A
defining capability that distinguishes an individual or a company from
others. Mastery of an essential skill.
In the business world core competencies identify what
an organization can do better than anyone else and why. Similarly, in healthcare, core competencies
validate skills that healthcare providers have mastered; proficiencies that are
necessary for the delivery of safe and reliable treatment to each patient. Likewise, effective leaders must master
essential skills and competencies, and, as with professional proficiency,
leadership expertise can be learned.
Leadership
competencies are specific observable skills and behaviors that are necessary
for motivating a team to accomplish goals in a manner that aligns with the
company mission, vision, and values.
Throughout the healthcare industry, frontline leaders
are often promoted to their position based on demonstrated clinical
competency. Decision-makers in the
chain of command assume that workers with exceptional clinical skills will also
be great leaders, which may or may not be the case. Just as mastering core competencies is
essential for excellence in clinical practice, mastering leadership
competencies is essential for excellence for those who manage a team of workers. Gaining competency in the following areas
will position you for success in your role as a team leader.
Skillful
leaders have a vision. Develop the
ability to formulate a picture for your workplace of the future by
acknowledging where you currently are related to where you want to be. Look for areas where minor changes can
produce large results moving you toward the workplace you envision. For example, in my personal experience, I
visualize creating a preferred workplace, therefore, I am constantly seeking
ways to promote collaboration, mutual respect, and professional development
within the team.
Skillful leaders use
communication to motivate. Communication is the transfer of ideas and
highly effective leaders take this skill one step farther. They share information in an open and
transparent way ensuring that the listener both receives knowledge AND is
inspired to achieve the goal. Using good
humor, warmth, and civility to create a sense of imperative as you communicate
helps establish a can-do attitude
within your team
Skillful leaders are fully
committed. Meaningful change takes time and having the
capacity for all-in commitment is both convincing and contagious. Anything less than a commitment to achieving
the vision, regardless of the amount of time it takes to get there, will be
viewed by your team as a passing fad. An all-in
focus on achieving your vision for the team will inspire them to commit along
with you.
Skillful leaders resolve
conflict. When humans interact, occasional conflict
is inevitable. The best leaders are not
the ones living in a conflict-free zone.
They are the ones who quickly and confidently address issues and achieve
resolution. When faced with a disagreement, assemble all the parties, listen to
all sides, and discuss behavior/agendas in terms of how the vision and greater
goal of the group are affected. The best
solutions involve compromise and align with the vision that the team is working
to achieve.
Skillful leaders acknowledge and
reward success. Whether the project is big or small,
determine milestones and give recognition to those whose work was important in
achieving them. Plan rewards for the entire
team as well as for key individuals and take the time to celebrate. Public recognition of success is motivating
and makes your team eager to take on the next project.
Skillful leaders display
personal integrity. You cannot achieve your goal alone and the
quickest way to kill support from your team is to compromise your
integrity. Honesty, transparency, and
fairness every day in every interaction establishes trust. Integrity is both a value and a skill that is
foundational to leadership.
Superior
leadership is more than wearing a title; it requires demonstrating core competencies,
and also requires life-long learning to keep them current. The best leaders learn from every daily
interaction, constantly honing their skills at establishing a vision,
communicating a plan, motivating the team, and celebrating success. The workplace that you create for your team
of tomorrow starts with the leadership skills you employ today.
Tom is an experienced
leader, author, and requested speaker. Click here for a video
introduction to Tom’s talk topics.
I am an avid cyclist to the point of being
suspected of having a personal relationship with my bicycle; after all, we have
spent over 40K miles together on the road.
In addition, I have a deep interest in healthcare leadership development
and last weekend my two major interests collided while doing a bucket list bike
ride on the 150-mile Great Allegheny Passage bicycle trail from
Pittsburgh, PA to Cumberland, MD.
As our group of 10 loaded the shuttle van to transport us from Cumberland to Pittsburgh, it was evident that Greg, owner of 2wheel escapes and coordinator for the trip had his act together. Assisted by his wife Rhona and paid helper Lynn, each new person arriving for the trip received a warm welcome and, with efficiency, luggage, bicycles and passengers were loaded onto the trailer and van, respectively. In short order, anxiety of the unknown challenge ahead turned into lively conversation among the new group of friends.
As we traveled toward Pittsburgh, Greg openly
shared his vision with our group explaining that the trail is beautiful, but it
is the support provided for the riders that converts the ride into a memorable
experience worth repeating. He explained
that his goal is to be the number one GAP trail tour organizer and create an
experience that people would want to repeat and that they would recommend to
friends. Everything from that point
forward was designed to bring his vision to life. We were told up front that his services were
intended to be second to none and that it was up to us to make him even better…please
offer suggestions.
Greg put words to action and delivered on the pledge that he made to the group. Every aspect of the trip was on time and as promised, often exceeding expectation. The format for our journey included camping overnight; Greg set a high standard and only stayed at campgrounds with flush toilets and hot showers. Because COVID has closed many restaurants, 2wheel escapes provide an exceptional dinner on site every evening followed by an ample hot breakfast in the morning. Each day started with a briefing and a printed list of landmarks along the way. The scenery was different every day and particularly magnificent in the Ohiopyle area, however, riding into the campground each day consistently found Greg and Rhona set up and ready with afternoon snacks for the hungry riders. They aimed to please and hit the bull’s eye.
As I pedaled toward the Eastern Continental
divide, I could not help thinking about the importance of creating a positive
and memorable experience and then extrapolated the concept to healthcare. The outcome of my amazing weekend was much
more than rolling along a wooded trail, it was having an experience that I am
eager to repeat. Likewise, a positive
healthcare encounter requires more than a nice facility and creates a
responsibility on healthcare workers to deliver a positive and memorable
experience for each patient.
Having a positive experience is important in healthcare and this
is why
Builds trust Creating a positive experience requires
healthcare workers to connect one on one with each patient and learn about what
is important to them. Taking Greg’s
attitude of “make us better” sends the message that what is important to the
patient is also important to the provider.
The experience of feeling valued creates trust that the other person has
your back.
Enhances confidence Most patients do not have a medical
background and do not fully understand best practice guidelines; they are at
the mercy of the healthcare provider.
Those who have a positive experience and trust the provider are more
likely be compliant with treatment protocols and achieve a better overall
outcome.
Improves patient safety A
solid, trusting relationship between patient and provider creates a bond where
both are more vigilant, communicate more frequently and ward off problems
before they arise. Writing in BMJ, Authors Doyle et. al. affirm the connection
between the patient’s experience, safety and ultimate outcome.
Job security Greg knows that to earn a profit in a
competitive market, he must deliver the goods reliably and in a manner that
generates repeat business. Similarly,
in the past, patients were tied to their local community for healthcare,
however, our digital world has broken geographical barriers and opened the door
to shop anywhere for medical services.
Healthcare is a competitive market and by creating a positive
experience, a loyal customer base is developed.
Patients share their experiences, both good and bad, on social media so
the environment that we create will be revealed to the world. Ultimately, those who create the positive
experience for the patient will thrive and those who do not, will not survive.
My weekend ride did a lot more than check off
an item on my bucket list, it opened my eyes to the importance of creating a
dynamic and memorable experience. Taking
an interest in a patient and placing value on the feedback that you receive is
the first step in creating a culture that knows the importance of the patient’s
overall experience. Be bold and create a
bucket list experience for each of your patients.
Tom is an
experienced leader, author, and requested speaker. Click here for a
video introduction to Tom’s talk topics.
Well known for vacation meetings at resort hotels across the country, Encore Symposiums has temporarily converted to an online format due to COVID 19 restrictions. Although participants are not able to enjoy the luxury hotel, the quality of the meetings has been preserved by knowledgible and dynamic speakers giving live presentations via the Zoom platform. Participant response has been positive as indicated by the comments below.
Nancy LaBrie and the Encore faculty look forward to returning to live meetings as soon as restrictions are lifted.
“I attended my first “webinar conference” this past week; Encore Symposium Aug 3-6, 2020. While I prefer an in-person conference, I was pleasantly surprised at how well it was done and how easy it was to participate. I think attendees were more apt to participate and dialogue in an on-line “chat” discussion vs in person at a face-to-face conference. I will strongly consider the webinar venue again. I have attended several, and often recommended Encore Symposiums to other colleagues. Nancy always has excellent speakers and a wonderful potpuri of interesting topics and when in person, the venue is unmatched. My favorite portion of the Encore’s conference is always the legal presentations. The attorney speakers are consistently phenomenal. “
From AS. ” I recently attended the Newport virtual seminar. Speakers were excellent and with wealth of knowledge. I will definitely attend encore seminar again. Hopefully it’s in person next time. “
Social changes put into motion by the COVID 19 virus have
mandated that we find innovative ways to conduct both personal and professional
business, including how continuing education is delivered. As a result of travel restrictions and limits
on the number of people allowed to congregate in one place, providers have
either cancelled or moved meetings to an online format. Although traditional meetings have been put
on hold, the requirement for continuing education has not, and those in need of
recertification must obtain the required education credits. Responding to the ongoing need for continuing
education, many CEU providers have quickly shifted to an online format with the
intent of providing a high-quality learning experiences equal to that presented
at live meetings.
A personal conversation with Nancy LaBrie, owner and
director of Encore Symposiums revealed a deep commitment to continue service
those who have been loyal to her organization for over 20 years. To ensure the ongoing flow of continuing
education, Nancy has temporarily moved to an online Zoom format with live
presentations with her faculty covering the identical content provided at
in-person meetings. In addition, she
hired a technology expert to moderate the meetings and eliminate technical
glitches. Nancy is not alone in her
dedication to provide continuing education in the face of COVID restrictions as
evidenced by State and National organizations that have converted to an online
format.
The recent AANA annual congress scheduled to be held in San
Diego was converted to an online meeting.
On the downside, social networking and renewal of acquaintances was
absent, however, the video format enabled every CRNA in the nation to
participate if they so desired. The
annual business meeting that previously was restricted to those in attendance
at the meeting was offered online to the entire membership of the
organization. Those who chose to
participate were able to vote on critical issues and to receive valuable
continuing education credit for the online learning sessions.
Likewise, many state meetings have converted to an online format
until in-person meeting restrictions have been lifted. Hawaii and Maryland are but two of the many
states that have made the switch.
“Tell me and I forget. Teach
me and I remember. Involve me and I learn.” —
Benjamin Franklin
Missing out on a well-deserved vacation meeting does not
mean that you must settle for second best when obtaining continuing education
credit. Regardless of the effort that
the sponsor makes to ensure a top-notch educational offering, participants must
actively engage in the process if they are to receive the full benefit of the
program. With a little preparation, you
can enhance your knowledge and obtain continuing education credit from the
comfort of your home office without sacrificing the quality of the experience. Here are some tips.
Know the technology.
My recent article, Ace your video
interview, stressed the importance of becoming familiar with the video
conference platform ahead of time and the same is true when attending a video
meeting online. When you register for an
online meeting, the sponsor will send login information which will identify the
platform that is being used. Well in
advance of the meeting, take the initiative to google “how to” information
about the selected format. If an
account is required, sign up and obtain a password several days before the
meeting. Waiting until meeting time to
login to a new platform places you at risk to miss the first part of the
session.
Make your own meeting room. When attending an in-person meeting, you
dress for the occasion and expect the facility to be comfortable and
inviting. You expect to see the screen,
hear the speaker, and have space to jot down important points. Attending a meeting via a personal computer
does not change those requirements.
Prepare your space by removing clutter including things that will
distract you during the online presentation.
If you will be visible to others, position a desk lamp so that it
illuminates your face and position your camera at eye level. Use the selected video conference platform to
do a dry run with a friend and make sure to test your camera and
microphone. If your computer has a
built-in camera at the base of the screen, consider buying a small camera to
plug into a USB port and position it at eye level.
Do your homework prior to the meeting. Know as much (or more) about the speakers
and content for the video meeting as you would for a live meeting. Obtain the agenda, objectives and speaker
biographies then use the time saved by not traveling to search online and
prepare yourself for the meeting. Know
each speaker’s background as well as best practice guidelines related to the
scheduled topic. Prepare a list of
questions that you would like to have answered and either submit them prior to
the talk or post them to the speaker if there is an opportunity for audience
participation.
Be mindful of social graces. You would not show up late, chomp on a wad
of gum or slurp coffee if you were at a live meeting so hold yourself to the
same standards when meeting online. Mute
your microphone when not speaking; I have personal memories of the sounds of
toilets flushing, dogs barking, babies crying, and chips being munched during
online meetings. Focus on the speaker
and the topic being presented. Do not do
anything in the privacy of your home office that you would not do if you were
sitting in a room filled with your professional colleagues.
Follow-up after the meeting. Ensure that you receive credit for attending
the meeting by completing meeting evaluation forms and submitting any
documentation required by the meeting sponsor.
Obtain contact information for speakers and follow the session with a
personal email with feedback and questions that you have about the topic. Quick and thoughtful feedback opens the door
to a dialogue with the speaker and could potentially expand your network of
contacts. Finally, visit the Meeting review page on
procrna.com and complete an online review of the meeting.
Like awaiting the return of flowers in the spring after a
harsh winter, participants eagerly anticipate the return of live meetings at
fabulous getaway vacation resorts; however, until restrictions are lifted,
virtual education is a reality that need not compromise quality. Although not as fun or relaxing as a trip to
a sunny beach, education via computer-based learning provides the safety of your
home, eliminates public travel, and saves both time and money. Virtual meetings are today’s reality so
prepare and ensure that the quality of continuing education remains high in our
COVID restricted environment. Stay home
and stay well.
Tom is an
experienced leader, author, and requested speaker. Click here for a
video introduction to Tom’s talk topics.
The role of boss is a daunting proposition that causes self-doubt
in some but motivates other individuals to master the skills required for
successful leadership. Your ability to
manage the inevitable surprises that pop up frequently will determine your
ultimate success, and with a little self-confidence and focus, you can do it. Finding those key behaviors necessary for
inspiring a team to achieve greatness is like Harrison Ford seeking the holy
grail in the 1989 Indiana Jones movie classic. And like the movie, becoming successful at
leadership is a challenging journey that requires commitment and focus while
navigating through a maze of complicated barriers. The holy grail for leadership does not exist;
however, there are behaviors that, when mastered, will make you and your team
champs. Forget about winning the leadership
lottery or gaining overnight success; rather, spend time and attention to mastering
the 3 B’s to improve your effectiveness as a leader.
“Your job as a leader is to stay as close in
touch as possible with those closest to the action.”
~Kat Cole
Be present
To be a leader, you must have followers. The title you have as the designated boss
gives you the authority to implement policy, but you cannot truly lead a team
without its consent. Becoming the person
whom the group wants to follow requires that you have an active presence
with the team. Writing for Forbes
magazine, author Carol Kinsey Gorman notes that it is not about how you
perceive yourself; it is about how others perceive you. Having a presence with your team requires
interaction daily and a special connection with each person. As you interact with your colleagues, here
are a few behaviors that will help you to be present:
Set the tone for your workgroup by showing up
every day with a positive attitude. Your
mindset and energy level are contagious and will be imitated by your team. Do a self-check, put a smile on your face and
some pep in your step before welcoming your team to the workday.
Personal relationships create a foundation for
trust. Be as interested in the person
doing the job as you are in accomplishing a task. You do not have to be best buddies but it is
important that each employee know that he/she is unique and appreciated.
Use body language to display confidence in
yourself and your team. Stand straight,
hold your head high, pull your shoulders back and put a pleasant look on your
face. When you own your space, your team
will feel as if you can protect theirs.
Use the word “because” when making a request. It may sound trivial but when you simply tell
people to do something, they feel micromanaged; however, when you tell them why
it needs to be done, they feel privy to inside information, see that their work
is important, and are more likely to willingly comply.
People will not always remember what you say,
but they will never forget how you make them feel.
Be empowering
Show me a workplace with extreme productivity and high
morale and I’ll wager that employee empowerment is a part of the culture. Workers
who perceive that they are empowered feel as if they are vital and that their
effort supports the goals of both the team and the organization. In addition, empowerment creates a bond of
trust between the worker, the boss, and the organization. Here are some steps that you can take to be
an empowering boss:
Clarify goals and guidelines. Having a goal creates a common purpose for
your team and gives them something to collaboratively work toward. A former friend who was active in his church
explained that adding a room to the church gave his parish a goal, united
church members and injected energy into the group that had previously been
lacking. Clearly communicate goals so
that all oars are paddling in the same direction.
Create opportunities for workers to take
charge. Workers are empowered when they
are given responsibility for a task and then given guidelines, resources, and
the latitude to complete a task without the fear of micromanagement. By allowing a person to be responsible for an
assignment or an entire project, you are saying, “I trust you,” and he/she will
likely take ownership.
Assign authority along with responsibility. There is nothing more demoralizing than to
be given responsibility to complete a task without being given the authority to
do what needs to be done. When assigning
tasks and projects, make sure that the person has the resources and authority
to bring the assignment to closure.
Encourage communication. Healthy teams have open communication at all
levels. When brainstorming, all voices
must be welcome, and creativity must be rewarded. Equally, there is a place for small talk that
promotes socialization in the workplace.
Through casual conversation, workers create friendships that will pay
dividends later when they work together on a project.
Promote mentoring and coaching. Professional development is high on the list
of characteristics in an empowered workplace.
Coaching is a process to teach practical skills to new workers as they
join the team or to experienced team members as technology changes. Mentoring can be a long-term partnership in
which an experienced person shares knowledge and life experiences with a rising
star on the team. Coaching can be a short-term interaction to teach a specific
skill. Both coaching and mentoring send
the message that you care about the worker and want him/her to reach their full
potential.
Encourage self-improvement. Anything that expands the knowledge or skills
of a worker adds depth to what they can contribute to the team and supporting
their effort shows that you care about their personal growth. A former colleague signed up for a Russian
class at the local community college.
The leader adjusted the schedule so that he could be out early every
Wednesday to attend the class. Not only
did the person learn a language, the mood of the entire team was lifted when
they saw the support that was given to a colleague.
“A hero is an
ordinary individual who finds the strength to persevere in spite of
overwhelming obstacles”
~Christopher Reeve
Be resilient
Despite our best efforts, not everything can or will go
smoothly and you must be resilient if the train is to be kept on the
tracks. Resilience is the ability to
meet adversity and then recover and restore business as usual. The healthcare workplace is constantly
changing as are the personal needs of team members. Sometimes a head-on collision is inevitable
and you, as the leader, may be part of the collateral damage. Setbacks can shake one’s self-confidence and
create a sense of personal hopelessness.
If left unchecked, your negative vibes will transfer to the team and
kill its morale. Here are some
behaviors that will help you to develop resilience.
Learn from mistakes. Conflict seldom just happens; someone or
something put the problem into motion, and it came to a head under your
watch. Take ownership of the problem
then step back and reflect on the flawed process that caused the event to
occur. Creatively think of ways to avoid
recurrence of the problem, develop a plan, and implement the needed change.
Have positive self-talk. Your internal dialogue is a powerful tool
that will empower you to solve the problem or will stifle your self-confidence
and ensure your demise. A problem does
not make you a poor leader or a bad person; it gives you an opportunity to
resolve an issue. Remind yourself of
your strengths, sources of support and your expectation that you are up to the
task of implementing a solution. Use
confident body language, assure yourself that you are highly qualified, and then
fix the problem.
Re-define your purpose or goal. When problems arise in the workplace, often
it is because people have lost sight of the purpose of the organization and the
team. Pause to reflect on your goals and
question whether they have changed. If
so, update them to reflect the current reality.
If not, the team must be brought back into alignment with the
goals. Regardless of the source of the
glitch, decisively communicate targets and expectations to the team.
Be a champion for the cause. Show your resilience by becoming the person
to champion the changes necessary to ensure that the problem does not emerge
again. Determine a desired outcome and
focus your activity on achieving it. Use
your energy and position to create grassroots support among team members and
solicit their help as you move forward.
Be a realist.
Avoid giving a knee-jerk, fix it now response to a situation. Rather than coming in with guns blazing,
first visualize a best-case scenario for resolving the issue and then temper
the vision by assessing resources. An OK
plan that can be quickly implemented is better than an idealistic plan that is unrealistic
and doomed for failure.
Leading a healthcare team presents challenges that are quite
different from those experienced by Indiana Jones; however, like the
archeologist, the three B’s will help you navigate the traps that would defeat
a lesser person. Being present gives you
visibility and enables communication that will bond your team into a collaborative
unit. Being empowering ensures that
creativity is tapped and that the team works toward a positive goal rather than
being paralyzed by the fear of making a mistake. Being resilient enables you to climb out of
the pit, regain your composure and continue your quest to find the holy grail. Use
the three B’s to be all you can be.
Tom is an
experienced leader, author, and requested speaker. Click here for a
video introduction to Tom’s talk topics.
Social distancing requirements related to COVID 19 forced
many companies to close the office and develop an entirely new workflow to
include working from home. Major
organizations such as Facebook, Uber, Reuters, and Google have extended working
remotely and some jobs may never return to the traditional office. Successful companies are conducting busines
through online marketing followed by email and video conferencing. Technology is filling a void and using video
conferencing for virtual recruiting is becoming the norm for many
workgroups. Rather than fearing the
prospect of a long-distance interview, embrace the opportunity to demonstrate
flexibility and your comfort with technology.
Ace your virtual interview
All job interviews require preparation; however, a virtual intervieweliminatesa lot of logistics, giving you more time to prepare and total control of the meeting environment. Leverage the home court advantage that you have been given by removing distractions, creating a professional interview room, and learning all that can be determined about your next employer and the job that you will be expected to do. Here are seven simple ways to set yourself up for success in a virtual interview.
Take the interview seriously. Before the interview, learn about your future employer and become familiar with the organization’s mission, vision, and values. Read and jot down key points on the job description. Prepare a list of questions with the anticipation that at some point you will have the opportunity to ask them.
Learn the technology. Although platforms such as Zoom and GoToMeeting are popular for video conferencing have a large user base, other lesser known platforms such as Join.me, Ready Talk, and OnStream meeting offer fully functional alternatives. Your future employer will send you an invitation to the video conference and identify the platform. It is your job to go online and learn to use the format well in advance of the interview. Do this by establishing a subscription, soliciting a trusted friend to do the same, and recording a mock interview as a test of the technology prior to the formal interview.
Prepare the environment. Many people opt to do video interviews from home, others arrange office space for the event. If you have a friend or relative with an office that appears professional, ask to “borrow” it for the afternoon. If you are planning to use a dedicated office at home, remove all clutter from the desk, arrange your professional books on the shelves and remember to straighten all the wall-hangings.
Those who have created work/study
space in a bedroom must prepare it as if your next boss were doing an
inspection of your personal work area.
Make the bed meticulously, remove clutter and memorabilia, and make sure
the closet and bathroom doors are closed.
If your office opens to common space in the house such as a hallway,
make sure that there is no traffic or noise during the interview. Review the mock interview and examine it
closely for visible or audible distractions in the background.
Lighting is extremely important
and should be positioned to illuminate your face. Place a lamp in front of you and
behind your computer so that it brightens your face. Overhead lights or lamps behind you will put
your face in a shadow and make you less visible on camera. Different types of
light bulbs (daylight, soft glow, warm, relaxed, etc.) produce quite different
effects. When reviewing your mock
interview, take note of the lighting and change bulbs if necessary.
Dress for success. Dress as if you were meeting in person. Business clothing will help you develop a professional mindset and boost your confidence, as well as impressing your potential employer with your sincerity and business sense. Do not make the mistake of wearing professional attire from the waist up with the assumption that nobody will see the gym shorts under the desk. To do so is deceptive, makes the interview feel less formal, and if it comes into view, is not a good way to break the ice with your future boss.
Personal hygiene is even more
important during a video interview because the camera will show the leftover
lunch between your teeth and the hair in your nose. Hands and fingernails must be clean and
excessive makeup or jewelry should be avoided.
Make a strong first impression. The reputation that you create begins with those who work behind the scenes to arrange/facilitate the video interview. As a Chief CRNA, my administrative assistant did all the logistical work to arrange applicant interviews. She kept me informed when applicants “just didn’t get it” and had to be given the same information several times. When you coordinate your video interview with the facilitator, ask all your questions at once, take notes and get it right the first time.
Bring it all together at the interview. On interview day, be tech savvy and on time. Smile and be upbeat from the first connection and speak loudly and clearly. If you have anything to display during the interview, have it minimized on your home screen so that it can be easily located and presented as a screen share. Remain positive, upbeat, relaxed, and pleasant. Look directly into the camera while speaking and avoid the temptation to watch your computer screen. Be mindful of your hands and do not create a distraction by fidgeting, playing with a rubber band or clicking a pen. Have a clock next to your computer and do not look at your watch during the interview. Use a book stand to hold a clipboard with your cheat sheet or other interview notes and keep them out of view of the camera.
Follow-up after the interview. As you approach the conclusion of the interview, ask about your next step and their timeline for filling the position. If additional material is requested, send it promptly at the end of the interview. If you are instructed to complete an online job application, do it the same day.
Finally, have a touch of class and
send a handwritten thank you note for the opportunity to interview and the
interest that they have shown in you. An
immediate email is okay but will be more effective if you follow it with a
written note on a high-quality blank card in the
regular mail. Caution: this is a thank you and not a platform for you to
restate your strengths.
“The difficulty lies not so much in developing new ideas as in escaping from old ones.”
~John Maynard
Keynes
COVID 19 has changed the way mainstream business is conducted
and innovative uses of technology, such as the video interview, will be with us
long after the viral threat has subsided.
Regardless of the format, the personal interview will remain an
important part of assessing applicants for a position and successful candidates
will be those who show self-confidence and professional competence via the
video platform. Follow the Seven Simple
ways to ace the video interview and land the offer.
Tom is an
experienced leader, author, and requested speaker. Click here for a
video introduction to Tom’s talk topics.
For everybody, even those who hold advanced degrees from prestigious business schools, great leadership is built upon life experiences. Growing from lessons learned in kindergarten and subsequently validated throughout one’s personal journey, life’s lessons provide a solid foundation for decision making and for relating to others. The release of Robert Fulgham’s book in 1986, All I really need to know I learned in Kindergarten, prompted chuckles, head nods and words of agreement from those who read the popular book. Now, almost 35 years later, readers of his updated book continue to appreciate the life skills that they learned as a 5-year-old. Several of the life lessons identified by Fulgham include:
Play fair
Don’t hit
Share everything
Don’t take things that aren’t yours
Clean up your own mess
Say you are sorry when you hurt somebody
Take a nap every afternoon
You are only a
leader if others are willing to follow
Toddlers who initially learned the golden rule from parents and then learned entry level social skills in elementary school got a great start, however, the wouda, shoulda, coulda moments experienced by each of us during the course of our life solidify concepts that, when heeded, propel us into a successful future. There is a lot to be learned from the school of hard knocks, but it is always better to learn from the misfortune of others rather than making mistakes oneself. Here are a few of life’s lessons that you can incorporate into your behavior to enhance your leadership abilities.
You must be present to win
John Maxwell, in his book The
5 levels of leadership: proven steps to maximize your potential, describes
level 2 as leadership by permission in which the team wants to follow
the leader. It is based on trust and
confidence that develops over time through transparent interaction. Being both physically and mindfully present
is essential. Having a physical presence takes commitment
and requires the leader to schedule time every day to mingle with workers. Being mindfully present necessitates centering
on the other person to ensure that he/she is not only listened to but
heard. A workplace
survey conducted by Bain & Company revealed that centeredness arising
from a connection between workers and the boss was the number one attribute of
a successful leader.
Protect your reputation
In the words of Benjamin Franklin, “It takes many good
deeds to build a good reputation and only one bad one to lose it.” Your reputation is your calling card and in
the digital world it can be handed out to hundreds of people with a few
clicks. Recently during a procedure, the
surgeon harshly and unfairly made false accusations and chastised the circulating
nurse in front of her peers. Before the
procedure ended, every nurse in the building knew about the incident (text
networks operate at laser speed) and to date, none of the nursing staff trust
the surgeon. What you say and do is
seen, known, and shared by others.
Determine the reputation that you want for yourself and align your words
and actions accordingly. You will be
watched and discussed; make sure people have positive things to say.
Be good to people and build good relationships
In the business community, success comes at the speed of
developing confidence through honest and open relationships. Author Jonathan
Okies writes “It doesn’t cost a penny to be nice to someone” and encourages
people to smile and strike up a conversation with at least one new person each
day. Vendors of all types, including those
selling orthopedic devices, know that their survival is not based on the
product, but rather on the relationship they develop with the surgeon. If you are a leader, your team deserves no
less. Get to know those you work with
and offer mentoring and verbal encouragement daily. When members of your team know that you have
their back, they will give you their trust.
Your attitude toward life will determine life’s
attitude toward you
In the words of Samuel Goldwyn, “The harder I work, the
luckier I get.” Leaders at every level
set the tone for their workgroup, set expectations, and influence productivity. Author Liminita
Savuic applies the law of attraction to life’s experiences and notes that
we attract the things we focus on. If
you think that life is unfair, you will constantly be in the role of a victim
whereas believing yourself to be competent and capable will attract a steady
flow of opportunities. If you want good
things to happen but you are not fully confident in yourself, fake it until you
make it. Visualize someone who is
successful and play the role until it becomes who you are.
Establish your health early and maintain it for life
It doesn’t matter how smart or competent you are, when your
physical health is gone, your work career is over. It is
important to have a healthy body and mind as noted by 17th century
English bibliographer William London, who advises “To ensure good health; eat
lightly, breathe deeply, live moderately, cultivate cheerfulness and maintain
an interest in life.”
As described in my prior article, Welcome to club 85,
those who neglect their health acquire co-existing diseases which require
medications that suppress the immune system and, in turn, increase
susceptibility to the COVID virus.
Establish healthy habits while you are young and maintain them
throughout your life. To paraphrase my mother,
“it’s easier to stay healthy than to get healthy.”
Invest wisely
When asked about life lessons that have propelled his
career, Warren Buffet replied, “invest wisely.” Author Drew
Hendricks notes that Mr. Buffet was not talking about buying stocks, bonds,
or businesses, rather, he was talking about investing in ideas and then finding
the right people to convert them into a reality. Leaders are resource managers and two
valuable resources are time and energy. Whenever
you say yes, you are committing time and energy that cannot be used
elsewhere. Follow Warren’s advice and
invest yourself sparingly only after considering the cost/benefit ratio. Before making a promise, assess the ROI and
take on only those projects that offer benefit to you, your team, and your
organization. Without exception it is
better to give an honest no than a false yes.
Millions of dollars are spent each year on books, videos, webinars, and courses in leadership that, when stripped of the glitter, really come down to the application of life’s lessons. The principles of emotional intelligence are founded in the lessons learned in kindergarten and the value of collaboration and empowerment arise from the time-proven lessons we learn from our successes and failures. We all make mistakes, that’s a given; gaining knowledge from them and applying the lessons to future situations is the difference between being a great leader versus an average manager. As you walk the path of life, look up and appreciate every experience that is offered along the way. Live, learn and enjoy life one day at a time.
Tom is a published author, skilled anesthetist, proven leader, and frequently requested speaker. Click here to view current topics ready for presentation.
Some people want it to happen, some wish it would happen, others make it happen ~Michael Jordan
My colleague, Dr Eric Shepard, MDA, had a strong desire to
ensure that our staff was able to continue to function in the COVID environment
with the least possible exposure to the deadly virus. In his research he located a scuba facemask
used by the Italian military and envisioned replacing the snorkel port with a
filter that would remove 100% of the airborne virus. Tirelessly, he worked on developing an
adaptor that would accommodate a filter which removed the COVID virus from
inhaled air. After developing a design,
he consulted a local engineer and together they produced a prototype adaptor
that would fit into the mask. He then
coordinated with the manufacturer in Italy who eagerly welcomed the
modification and produced samples. Next, Eric applied for and received approval
from the FDA to use the mask in the United States. Eric’s creative idea at the beginning of
March resulted in a new barrier to COVID by mid-April. As a result, NAPA anesthesia purchased 2000
of the masks and distributed one to each healthcare provider in their
system. Without persistent effort, a
valuable concept would have died on the vine.
Similarly, Diane Miller, CRNA, had a vision for a device
resembling a toy that would make inhalation induction of anesthesia more fun
for children. She, too, worked
tirelessly to develop prototypes followed by testing. Based on feedback from colleagues and the
reaction of children using the experimental device, she tweaked her model to
make it user-friendly for the anesthetist and fun for the child. She spent months obtaining a patent, testing
the device, and gaining FDA approval for marketing the gadget. Diane located a person to manufacture and
package the product and investigated marketing strategies. Without the creator’s consistent and
committed effort, the Pedia
pediatric anesthetic device would not exist.
In contrast to those who do achieve their goals, some people
work extremely hard, are fatigued at the end of the day but have little or
nothing to show for the effort. They are
busy but not necessarily productive.
Here is the difference.
Busy people are always in
motion working on something. They want
to be good at everything and continually multitask which ensures that no
project gets their full attention. They
frequently feel rushed, so their efforts to make what they are working on a
little better often leaves the project undone, awaiting one more tweak. Busywork is ongoing and is seldom completed.
Productive people remain
focused while working with a sense of purpose.
Because they have a clear concept of what they want to accomplish, they
do not become distracted nor discouraged.
They tend to be less frantic than their “busy” colleagues and have a
relaxed concentration and optimistic interest in the task at hand. Because they are determined to achieve the
desired outcome, they will not be deterred until the project is brought to
closure.
How to Achieve Results
Numerous times throughout my career, I have heard a friend
or colleague groan when a new device was introduced saying, “I thought of that
years ago…I’d be rich if I had followed through on my idea.”
Transforming yourself from wants it to happen “trier”
into the makes it happen “doer” requires a clear knowledge of what you
plan to achieve. With the outcome in
mind, you will need a commitment of time, effort, and resources in order to get
the ball rolling. Applying your focus to
the project requires you to narrow your perspective and remove
distractions. Peter Landau, writing for
the Projectmanager
bog, offers several suggestions for removing distractions, including the
following.
Develop a schedule and keep it
Ensure proper nutrition and sleep
Use physical and emotional barriers such as room
dividers and relaxing music to block other activities
Have a clean workspace
Turn off your phone
Let others know that you are working and accept
emergencies only
Once distractions have been removed, the pathway is open to
move your project forward. Keep in mind that what you are doing may affect
others and, if so, it is important to get their feedback early on.
Before you start a project, step back and review your
intended outcome, resources, and personal talents. You may have the vision and the energy to
push a project forward yet lack the expertise that is required to complete each
individual step of the process. Diane
was able to develop a prototype of her pediatric device but needed help from
others to obtain a patent, FDA approval, production of the device and
marketing. Eric was able to design the
adaptor for the airway filter but needed an engineer to help produce the
prototype. Stay true to your goal, seek
advice where needed and persistently push your project to the next level. If you do not know the solution to removing
an obstacle, find someone who does. When
consulting with others, ask game changing questions and always strive for
excellence. Never settle for less than
best.
Keys to transforming yourself into a highly productive
person include believing in yourself and taking ownership for creating the
result. Courage is needed to put
achieving your vision above your fear of failure or humiliation. When you take ownership, your desire to
achieve a goal will become stronger than the roadblocks that you will
encounter. Anticipate setbacks and have
the resiliency to convert deal breakers into deal makers. Don’t be a trier who
works at things; be a doer who gets things done.
If you still have a few more miles to travel on your
personal journey from busy to productive; use the tips in this
article to grease the wheels and supercharge the engine. Implement a functional
schedule with measurable tasks toward a worthwhile goal and commit to it until
each task is completed and the goal is achieved. Stay optimistic, resist
distractions, be relentless and convert yourself from “busy trier” to
“productive doer.”
Tom is an
experienced leader, author and requested speaker.
There are many paths to leadership; some people want to be
leaders and plan a career progression that positions them for the nod when it
is time for a change. Others become leaders
out of necessity when effective leadership is lacking and a team is
suffering. For example, some years ago a
group of 47 CRNAs serving a large hospital had a leader who was just putting in
time until his scheduled retirement. Because
he didn’t want to make waves, he kept a low profile and simply put the team on
autopilot. The boss was disinterested with no goals, the team lacked direction
and felt abandoned, morale was low, and recruiting was difficult. One team member stepped forward. Using a
two-pronged approach, he simultaneously assumed responsibility as the lead
recruiter for the group while working with colleagues to find ways to make the
job more attractive for applicants. As
a result, morale improved, open positions were filled, and the responsive team
member was subsequently promoted to the position of Chief CRNA.
Leadership is important at all levels. The CEO of an organization takes charge of
public relations, interacting with other leaders, and reassuring both the
workers and the public that resources are being obtained and the staff is fully
prepared to meet the challenge. The
middle manager organizes logistics and brings together unit managers to ensure that
staffing is adequate, training is completed, and sufficient supplies are in
place. The frontline leader establishes
the mood for the group, sets goals, provides reassurance, facilitates
collaboration, communicates the latest updates and protects team members from
harm. A crisis enables an effectual
leader to stand out among peers but, unfortunately, while some leaders
flourish, others falter. The ones who flourish will appreciate help that is
offered by the team. But those who falter will need to be rescued for the sake
of both the team members and the patients.
Across the leadership spectrum there is ample opportunity for motivated workers
to step up and share a slice of the leadership pie.
If leadership is lacking, it’s time for you
to stand up and be a champion for your team
A workplace
champion voluntarily takes an extraordinary interest in a cause, policy or
project that will promote the success of the team. Often, the champion is considered by
colleagues to be a go to person on the team; a person with knowledge,
expertise and a willingness to help others in need of guidance. Champions are opinion leaders who are
uniquely positioned to influence groupthink and steer the team in one direction
or another. When there is a crisis and
the designated boss is unable to provide effective leadership, it is often the
team champion who fills the void. If all
eyes turn to you when the chips are down, draw on these behaviors to help you
to be a successful non-titled leader.
Maintain ties with the boss. Your goal is to step up, help where needed,
and ensure that your team safely weathers the challenge at hand. It should not be your intention to incite
mutiny and create a mini crisis embedded in the larger crisis. As you see and do what needs to be done, keep
your boss in the loop and do not challenge his/her authority. Rather, focus on what needs to be
accomplished, engage your fellow team members to help, and know that others
notice and appreciate your efforts.
Connect with the chain of command. If your boss is in total absentia and you are
picking up the pieces, make sure that your activity is known and was approved
by the next person in the chain of command.
Work often crosses department lines and supervisors must be in the loop
as you initiate activities with your team.
Be decisive. As the saying goes, a good plan today is
better than the perfect plan tomorrow, so assess the situation and quickly come
up with a viable solution. Openly communicate with your colleagues and bring
them on board with the plan.
Be resilient. Not everything that is tried will work out as
thought out. Rather than throwing your
hands in the air in frustration, take setbacks in stride, re-focus on what you
are trying to accomplish and develop a new plan. If you are filling a leadership void, your
team does not need yet a second person to go absent.
Be consistent and available. A crisis, such as the one we are experiencing
with COVID,upends workflow and interpersonal relationships leaving
workers feeling hopeless. You may not be
able to make the virus go away, but you can bring stability to the group
through consistency. Maintain a visible
presence and, where possible, establish and stick to a schedule. Have a positive attitude and do not allow
yourself to make emotional responses when glitches arise.
Use emotional intelligence. People
are emotional creatures and often respond and make decisions, good or bad,
based on emotions. Emotional
intelligence involves becoming aware of your emotions as well as sensing the
emotions of others, and then interacting in a manner that affirms the feelings
of the other person. Saying, “I sense
that you are uncomfortable with this plan,” affirms the person’s emotions and
opens the door for discussion. Feeling
understood has a calming effect whether you are interacting with a colleague,
patient, or family member.
There’s no end to stories of team members stepping up to the
leadership plate during a time of crisis:
When the platoon leader is killed on the battlefield, a sergeant takes
command; when the all-star quarterback injures a leg, the backup runs on the
field and wins the game; when communication is lost with headquarters during
911, the paramedic takes charge and moves a group of patients to safety; when
the ICU nurse steps up and takes charge because her boss is overwhelmed by the COVID
crisis and is paralyzed with anxiety, lives are saved. The workplace is full of heroes who have stepped
in to fill the void left by a leader gone AWOL, and you can join their ranks. Whether absence of leadership is caused by a
crisis, a lack of skill, or loss of the leader’s personal motivation or any
other reason, you can be the one to carry the flag if the leader flags.
Tom is a skilled
anesthetist, published author and frequently requested speaker
Claiming over 110,000 lives worldwide, COVID 19 is still
dominating the news, and rightly so.
Back in the 1990s when working at the University of Kansas and
developing the first distance education program for nurse anesthetists, I could
not imagine the of online education 25 years in the future. While computers keep the education process
rolling, they also promote a sedentary lifestyle where a playground game of tag
is replaced by video games. Over time, a
lack of physical exercise combined with an excess of calories, salt and fat
ushers in coexisting diseases, which require medications, which, in turn,
suppress the immune system and make the individual less able to fend off COVID
19 or any other infection.
Healthcare providers are playing catch up and finally getting
a grip on COVID 19 while vowing to be fully prepared for the next pandemic
should it ever occur. Warehouses will be
refilled with necessary supplies, and best practice guidelines will be
developed. On a logistic level, we will
be prepared for the next pandemic threat, but on a personal level, is your body
tuned up to fend off the next viral threat?
Club 85
Updated daily, today’s data listed on The Johns Hopkins COVID dashboard indicates that approximately 3.5% succumb to the virus and die.” The percentage of people with full recover is more difficult to to determine, however, whitehouse briefings place the number at 85%. To date, there is no mention of what happens to those who neither fully recover or die. News reports reveal that the virus has its most deadly effects on the elderly and those with coexisting disease; however, this week’s watchdogs warn not to underestimate the potential deadliness of the virus for killing people at any age. Conversely, at 104 years, Italian Ada Zanusso proved to the world that a healthy body at any age can beat the virus. We may not be able to personally establish policies that prepare the nation for the next infectious event, but there are several steps we can take individually to increase the probability that when the next pandemic hits, you and I will be among the 85% with full recovery.
Scientists are working around the clock to develop a vaccine
for COVID 19 and individual physicians are trying existing medications “off
label” to improve outcome;however,
it is the victim’s immune system
that often makes the difference between life and death. Data collected and analyzed by Worldometer
affirms the premise that mortality increases as the age and number of co-existing
diseases increases with a sharp in crease in the death rate if the individual
is age 60 or above. Co-existing diseases
that are linked to increased mortality include cardiac disease, diabetes,
chronic respiratory disease, hypertension and cancer. Those with coexisting disease are most likely
to be on medications, and many medications suppress the immune system.
According to an AARP
survey 75% of Americans over age 50 are on medications. Of those who take drugs, 80% are on two
medications and 50% are on four or more.
However, one does not need to be over age 50 to have co-existing disease
and be on prescription drugs. These are
the 10
most frequently prescribed drugs in America as identified by Becker’s
Hospital review, most of which suppress the immune system.
Atorvastatin (Lipitor) suppresses the immune system by inhibiting HMG-CoA
Levothyroxine (Synthroid) does not suppress the immune directly, however, thyroid disease often has an autoimmune component and, therefore, the person may have altered immune function.
Lisinopril (Prinivil, Zestril) lowers vitamin E levels and depletes Zinc which is needed for a healthy immune system.
Gabapentin (Neurontin) suppresses lymphocyte T proliferation and changes cytokine profile release which alters the inflammatory response and inhibits the immune system.
Amlodipine (Norvasc) is known to suppress T cells, mast cells and macrophages.
Hydrocodone/Acetaminophen (Vicodin, Norco) suppresses the activity of NK cells, decreases helpful T-lymphocytes, decreases T-cell function, inhibits B-cell activity and enhances the growth of tumors that may be present.
Amoxicillin (Amoxil) Generally speaking, antibiotics do not weaken the immune system. However, some scientists believe that as organisms develop resistance to antibiotics it leaves the host more susceptible to future disease.
Omeprazole (Prilosec) Proton pump inhibitors do not directly suppress the immune system; however, they alter the intestinal flora which alters the uptake of nutrients and may indirectly affect the immune system.
Metformin (Glucophage) There is no evidence that Metformin weakens the immune system. However, those taking the drug are pre-diabetic and may have other issues that alter the body’s defense to the virus.
Losartan (Cozar) reduces the white cell count and suppresses T-cell activity.
Like our intentional multi-modal approach to pain control, nine
out of ten of the “most frequently prescribed” drugs create the potential for a
multi-modal approach to weakening the immune system. If your prescription drug is not in the top
10, it still may have immunosuppression as a side effect. Take the time to look it up and become aware. Is it any wonder that those who are on
multiple medications are the least able to fend off COVID 19 or any other
infection? The known threat of a
weakened immune system should motivate healthcare workers who are obese,
hypertensive or pre-diabetic to regain a fit body and get off the
immunosuppressing drugs.
Connect the dots
Joining the 85% club starts with having a healthy body. There’s little ROI from buying fire insurance
the day after the house burns down, or having good intentions for getting your
body into optimal condition to survive the next virus unless you follow through. Preparation for fending off the next pandemic
starts today with a focus on reversing coexisting disease, and
reducing/eliminating daily medications that suppress the immune system. It may sound daunting, but with a few lifestyles
changes, you can prepare for prevention.
Preparation
for Prevention
Exercise
Your body was meant to move and be active; just look at the
non-stop movement of a preschooler. The high
energy of a child slows when he/she becomes an adult and enters the
workforce. The pickup game of hoops
morphs into watching videos (while munching high calorie snacks) and over time
weight increases and metabolism drops, and the door opens for co-existing
disease. The cure; get up and move. The Mayo
Clinic reports that a combination of aerobic exercise, strength training
and flexibility exercises will improve the following conditions: obesity, heart
disease, diabetes, asthma, back pain, arthritis, and dementia. Get outside for a walk or bike ride. Convert the spare bedroom or empty basement
space into a home gym. Take elastic
bands on your walk and anchor them at a light pole for some resistance
exercises. Success comes from commitment
to daily exercise and as your weight comes down, you’ll get a boost of energy, you’ll
regain self-respect, and be more productive in the other areas of your life.
Nutrition
Millions of dollars are spent every year on sophisticated
diet plans to support the latest weight loss gimmick. Save your money; it’s not difficult to give
your body the nutrients that it needs instead of the junk food we’ve been
brain-trained to want. Whatever you put
in your shopping cart lands in the larder, so take charge when you shop, and
you’ll be in control when you eat. Harvard
Health publishing recommends a diet high in fruit and vegetables for strengthening
the immune system and its fight against infection. EatingWell affirms the Harvard
recommendations and notes that a high fiber diet promotes weight loss and cuts
the risk of type II diabetes. Eat lean
red meat in moderation and use chicken or fish as primary sources of
protein. You can increase nutrients and
fiber by eating a large, colorful salad at least once a day. The food
revolution network advises eating a rainbow of vegetables daily, pointing
out that a palette of colors provides the variety of vitamins and trace minerals
you require, nutrients that are lacking in prepared and packaged food. Who needs a multivitamin pill when vitamins
come in a salad?
Hydration
Water is essential for cellular function and life
itself. Lucky we are to live at a time when
our drinking water is the safest in the history of the world, and it’s
delivered to the kitchen faucet at a relatively low cost. Yet, many people live in a state of relative
dehydration that does not allow the body to function at its best. Explore
Health online notes that diabetes, low carb diets, stress, aging and eating
too few fruits and vegetables can all contribute to cellular dehydration. The solution is to put down the coffee mug
and pick up the water jug. Be mindful to
limit salt and refined sugar which also dehydrate the body’s cells. Healthline
recommends a minimum of 13, 8oz cups of water per day for men and 9 cups for
women to normalize hydration and promote efficient cellular function.
Sleep
Improving exercise, nutrition and hydration are a good
start, but if you are burning the candle at both ends, your body will not be at
its best under stress. Follow the recommendations of sleepfoundation.org,
and put yourself on a regular schedule for both bedtime and awakening, and
ensure that you get 7-9 hours of sleep.
Plan so that the time leading up to sleep is caffeine and stress free. Yoga, stretching and meditation are all excellent
bridges from the working day to restful sleep.
Value your rest as much as you
value your work.
Hindsight provides insight but only proactive planning
followed by action will change the outcome the next time we are faced with a market
crashing, mind-blowing showstopper like the one created by COVID 19. For those who are obese, hypertensive or
diabetic, now is the time to step up and take action to improve your health and,
hopefully, wean yourself from drugs that weaken your immune system. For those who are disease free but sedentary,
now is the time to establish a lifestyle built upon activity, nutrition,
hydration and rest to ensure that you stay in club 85.
Final note: Even with all you may have done personally
to boost your immune system via a dedicated healthy lifestyle, and all that you
and your employer have done collaboratively to
prevent your being exposed to the next “pandenemy,” it’s possible you
may still be diagnosed with COVID 19. If
you should test positive, and you’re girded by excellent health and a strong
immune system, I’ll bet my COVID cleaned, best pressed scrubs that you will emerge
to become a member of Club 85.
Tom is an
experienced leader, author and requested speaker.
