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Ban Affective Polarization in the workplace

By Thomas Davis, DNAP, MAE, CRNA

It’s been four years since our last presidential election, and now we are entering the final countdown toward election day 2024. Despite rhetoric from both sides pledging to unite the country, the current political season finds our population more polarized than ever. The emergence of social media as a primary means for gathering news only adds fuel to the fire.

Writing for Forbes magazine, author Tony Ewing notes that we all have thinking biases that distort our interpretation of the opinions of others. He states that topics such as politics, religion, race, and sexual preferences push emotional buttons that often lead to heated reactions and arguments between formerly congenial colleagues. This disruptive behavior polarizes the team and affects not only those who disagree with one another, but also others in the workplace who observe the behavior. In the end, teamwork, productivity, and patient safety are all threatened by workplace polarization.

What about freedom of speech?

For over 250 years the United States has thrived on the free exchange of ideas with open dialogue and debate between both individuals and political parties. Freedom of speech is so important for democracy that the first amendment to the constitution enshrined it as an American right. The founders of our country believed that democracy could only exist within an environment of open debate of the issues. Political disagreement was viewed as healthy all the way back to the early days of our independent nation when Thomas Jefferson introduced the two-party system. Historically, political opponents openly debated the issues yet respected one another and remained friends at the end of the day.

Affective polarization

Over the centuries, political debate has been taken to new levels and our society has moved from debate of the issues to affective polarization. Wikipedia identifies affective polarization as progressing from a disagreement on the issues to an emotional dislike and distrust of those with opposing opinions. Writing for Brookings, authors Overgaard and Woolley describe affective polarization as hostility and animosity toward those who disagree with your political viewpoint..

The American Psychological Association studied affective polarization in the workplace and note that 1 in 4 employees report being negatively affected by political talk during the election season. The APA study revealed that younger employees are more affected by polarization than older workers and that they report feeling stressed, isolated, and having negative views of co-workers who engage in political dialogue at work.

Ironically, behavior scientists have found that dogmatically promoting your political view causes the other person to dig in their heels and become more deeply entrenched in their position. You are not changing their mind but rather solidifying their point of view.

The bottom line is that affective polarization moves the interaction from “I don’t agree with you” to “I don’t like you.” Your political opponent then becomes a “bad person” and labeling them as ignorant, out of touch, or deplorable turns dislike into hatred. Behavior scientists find that most people have more in common than they realize, and that affective polarization needlessly drives a wedge between them. This is not what you want in your workplace.

Preventing workplace polarization

Creating a preferred workplace is a goal for every effective leader. Preventing political division from invading an otherwise collaborative and cohesive team takes foresight and courage. It is easier to prevent a problem than to rebuild a team, so guardrails must be in place, especially going into the upcoming election season. Author Roger Carbajal offers tips for controlling affective polarization in the workplace.

Establish a policy about political speech and signs in the workplace
Apply the rules consistently, without exception
Monitor workplace discussion
Periodically remind everyone of the rules

Regardless of your position on the team, be a champion for promoting collaborative teamwork and have zero tolerance for behavior that divides members of the group. Review the mission, vision, and values of the organization and most likely you will find that affective polarization does not align with the core values that are meant to guide employee behavior. Enforce and role model the core values of the organization. In the end, workplace team unity is more important than the outcome of an election.

Tom is an experienced leader, educator, author, and requested speaker. Click here for a video introduction to Tom’s talk topics.

Ace your video interview

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

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.

Discover the right job

By Thomas Davis, DANP, MAE, CRNA

follow @procrnatom on twitter

One of the most important aspects of rewarding and fulfilling employment is to find the right job; all too often people opt for a preferred location or higher paycheck only to find that they are in the wrong job.

At the August 2019 AANA annual congress, I presented a talk titled “How To Get The Right Job and Keep It” to a group of students who would soon be graduating and looking for employment. For those who missed the original talk, here are the keys navigating the maze of potential employment opportunities and locating the job that is right for you.

Know what you want

Before finding the needle in the haystack, it’s important to know what the needle looks like and it’s helpful to know which pile of hay to search. Likewise, you don’t want just any job; you want the right job and therefore you must know what you want before you can find it. Day dreaming won’t get the job done so it’s important to create a written list of the essentials for the new job to include your preferred location, type of practice, and lifestyle essentials. Also consider your personal values and the needs of those who are significant to you. If there are any deal breakers, such as location or lifestyle essentials, add them to the written list.

Know the characteristics of an engaging workplace

Finding the right job begins finding the right group dynamic. Many different workplace cultures exist, running the gamut from preferred to toxic. An organized search will help you eliminate the bad teams and zero in on the good teams to consider. Throughout the application/interview process, keep your radar active and learn all that you can about the following essential elements of a rewarding workplace.

Approachable leadership
Open communication
Honest feedback
Professional development
Collaborative teamwork
Alignment of personal and corporate values
Social interaction among staff

Know the leadership style of the boss

Working for the right boss will make or break your job experience. The Harvard Business Review affirms the adage that is found throughout human relations literature; people don’t leave a job, they leave a boss. Many leadership styles exist, and leaders often blend several styles into a format that works for them. During the application/interview process it is your job to discover how he/she runs the team. and how it may potentially affect you. In an ideal job, your boss will be:

Supportive
Understanding
Empowering
Respectful
Mentoring

Finding the needle in the haystack

After reviewing your written list of essentials and filtering the job boards, select several opportunities that look the most promising. Go online and learn about the organization, then activate your network of colleagues to find someone with inside knowledge about the job. A friend in the State association may be able to refer you to a current employee at that location. Don’t be shy, be a detective and discover what others know about the job.

The job interview is your best opportunity to reveal the culture in the workplace and the leadership style of your next boss. Unfortunately, applicants are often so focused on impressing the interviewer that they forget that the discussion is a two-way process. At some point you will be asked whether you have questions about the job and that presents you with an opportunity to control the interview and gain insight about your next employer. Candidates who are serious about the position will go armed with a list of written questions to help determine what goes on behind the scenes. Your questions should be non-threatening and open-ended to encourage your future boss to talk…and divulge the true working conditions. Try these questions to get started.

What are the most enjoyable aspects of the job? This is non-threatening and gets the discussion going. Empowering leaders will talk in terms of “we” and teamwork, whereas, authoritarian leaders will focus on “I” and tell you about their personal accomplishments. Caution; some leaders use we when they’re proud of something and they when they’re not.
What do your most successful people find satisfying about the job? This question opens the door for the leader to reveal his/her opinion about what makes a person successful. Is the worker successful because he/she is collaborative or because orders are followed precisely? Regardless, it provides a platform for the interviewer to list the positive aspects of the job.
How would your team describe your leadership style? Asking, “What is your leadership style?” is threatening. “How would your team describe you?” is not. It softens the question and opens the door for the boss to talk about his/her approach to leadership. Tune in for key words that indicate collaboration versus heavy handed guidance.
What type of training/professional development do you offer? Even poorer jobs offer a little money and time for continuing education, whereas preferred workplaces offer ongoing mentoring and opportunities for employees to gain experience in new areas. Spearheading a project or representing your team by participating in an interprofessional initiative are but two examples of leaders empowering team members.
Is there opportunity for promotion in this job? Authoritarian leaders are control freaks but empowering leaders constantly seek opportunities for rising stars to shine. In preferred workplaces, the leader has team members in designated positions to share management tasks such as scheduling, education or inventory.
How would you describe the work culture here? As the leader answers, tune into verbiage that would indicate high stress, production pressure, or strict compliance to directions. Do team members have each other’s backs, or do they independently follow regulations?
How are high achievers recognized and rewarded? This addresses the issue of fairness. If everyone receives the same reward regardless of contribution, the incentive to excel is removed. The question can also send the subliminal message that you anticipate being a high achiever.
What is the most important challenge that your team faces right now? This open-ended question could reveal deep seated problems with the institution, or it could give additional insight about the team culture. If the interviewer skims over or downplays an issue, follow-up by asking, “Tell me more about…”
A year from now we are discussing my first year on the job and I exceeded your expectations. Describe behavior that made the year exceptional. In order to answer the question, the leader must first imagine that you were hired and then did a superb job. It is a strong subliminal message to plant and one that may work in your favor when hiring decisions are made. Listen carefully to the answer because it will tell you about the behavior that the leader values the most.
May I tell you a little more about why I am attracted to this job? This is a polite way to get the interviewer to ask you to summarize your strengths as well as review how you are a perfect match for the job. Rehearse your 2-minute pitch ahead of time and make sure to connect your strengths to specific points in the job description. Give examples of how your personal values align with corporate values. Caution: If the interview is a bust and/or you don’t want the job, omit this question.

If you leave it to chance, it is likely that you will never find the needle in the haystack. In my role as a hiring manager, I found that applicants who were organized, knew what they wanted and discovered that our group was a solid match for them turned out to be the best employees. Arm yourself with a plan that starts with writing down the essentials of the new job then be a detective and discover all you can about the employer and the leader. When it’s finally time for the job interview, enter with confidence and don’t leave until your questions are answered. McJobs abound, even in healthcare; preferred jobs are hidden treasures that are reserved for those with the insight and tenacity to find them.

Note: If you are the hiring manager, these are the criteria that the best prepared and most talented workers may be using when they assess your job opening. Be ready for them. Build a workplace culture in which empowered collaboration is the modus operandi and high-quality applicants will enthusiastically get in line.

Tom is a noted author, speaker, educator, and dedicated clinical anesthetist specializing in leadership development and team building. Contact tom@prosynex.com to book a speaking engagement.

Feel the Burn

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

Last week a headline in the Linkedin daily update caught my eye; Millennials are experiencing job burnout at a high rate. My initial gut response was; “Really? You are too young and it’s too early in your career to be burned out.” When I stepped back and considered the topic, I realized that burnout is not tied to advanced age or a person’s position in the chain of command. “The physical or mental collapse caused by overwork or stress” is the full-blown Webster definition of burnout, and it can happen to anyone at any stage of his/her career, including millennials.

I recall talented athletes from my youth with parents who thought that with a little more effort, their kid would be wearing Olympic Gold. Even after Betsy upped her gymnastics practice to four times per week and Jason increased his swimming to two-a-days, neither made it to the Olympics. Both young people longed for high school graduation, not for the diploma, but for the termination of the unreasonable expectations for achievement. In short, what began as fun turned into a physical, mental obsession that took its toll and left both individuals flat, weary, and burned out.

Employee burnout is real, unrelated to age or years of experience and the affect can be devastating to both the employee and the employer.

Young workers are fresh out of college, excited to start a career and eager to pay off student debt. Most intend to pull their weight on the team and want to earn respect for ability and tenacity. What they find is a workplace that welcomes their enthusiasm by piling on the long hours, offering advancement by combining two jobs into one, and frequently offering inadequate support. Many young workers are running out of the energy that got them hired in the first place.

Burnout arises from unrealistic expectations and can happen when production pressure becomes excessive. Sometimes the burden is placed on the individual by the organization and other times the individual places unrealistic expectations on him/herself. Either way, as the burden becomes unbearable, the victim breaks internally and does one or both of two things: He/she pauses to refresh and/or moves on to a different job. Writers at Workplace Strategies for Mental Health identify the following as personal perceptions or actual causes of professionals becoming burnout victims.

Expecting too much of themselves
Never feeling that their work is good enough
Frequently feeling inadequate or incompetent
Feeling unappreciated for their work efforts
Working in a role that is not a good fit

Pushing employees beyond their mental or physical limit has consequences. In addition to fatigue, stress and anger/irritability, other health issues may develop. For the employee, high blood pressure, heart disease and type 2 diabetes are correlated with burnout as well as alcohol and substance abuse. Consequences for the employer include high employee turnover and the financial cost of filling vacant positions. Overall, there is a loss of productivity and a general deterioration of morale among the work group.

Extinguishing burnout is a shared responsibility and there are actions that both the worker and the leader can take to cool the embers.

What the worker can do

Ultimately, it’s up to you to monitor your stress level and make changes before falling victim and externally acting out at work or internally developing a physical illness. The Adult Health Department at the Mayo Clinic offers you these suggestions for assessment or prevention.

Evaluate your options both with your current job and finding a new employer.
Seek support from co-workers, friends, family or professional counselors.
Engage regularly in a relaxing activity such as yoga or meditation.
Exercise consistently to help you better deal with stress.
Value your sleep and let it restore your well-being.
Develop friendships with one or two colleagues at work.
Become mindful of your activity, energy, and feelings every moment.

Creating a culture of burnout is opposite of creating a culture of sustainable creativity…This mentality needs to be introduced as a leadership and performance-enhancing tool.

~Ariana Huffington

What the leader can do

There several behaviors that can be incorporated into your leadership style to take the fan off the flames and prevent the fire. Combined, all will elevate team morale, boost productivity and improve employee retention.

Provide clear expectations and ensure that they are understood by workers.
Make sure that expectations are reasonable and align with priorities.
Furnish necessary resources including the training required to meet expectations.
Enforce fairness in reasonable work hours including sending people home on time.
When overtime can’t be avoided, mandate that those who work extra hours are given time off to recoup.
Utilize mentoring and professional development to create a sense of personal value for the worker.
Strongly encourage breaks at work away from the workplace.
Encourage friendships and social support among the group.
Provide a sense of purpose by linking employee tasks to the greater mission of the organization.
Encourage physical activity by planning stretch breaks at work, encouraging gym memberships, and arranging group activities away from work.
Encourage employees to use rather than save their vacation time.
Know your team and adjust your leadership to a style that fosters collaboration.

Employee burnout is a very real equal-opportunity threat. Both the high school swimmer doing two a day workouts and an ICU nurse working 4 twelve-hour shifts per week (and being kept over at the end of the shift) can easily perceive that the work is never ending and whatever they do is not enough. Whether it’s a monster workload, a paucity of resources, or sense of being overwhelmed and isolated, burnout is a constant threat best addressed by frontline leaders who are directly linked to the team. Sometimes, the quick solution can be as simple as showing you care by providing resources and giving compliments where appropriate. The long-term remedy, however, must involve an emphasis on physical and mental well-being while instilling a sense of purpose and worth in each worker.

What was once thought to be the consequence of being in a job too long is now known as a threat to workers at any age or stage of their career. The cure for burnout starts with self-awareness within the employee and a commitment by leadership to create a climate where the workload is reasonable, resources are available, and employees gain a sense of self-worth from the work they accomplish. Look beyond the crisis of the day and treat workers today in a manner that leaves them fulfilled and wanting to return tomorrow.

Tom is a noted author, speaker, leadership developer and dedicated clinical anesthetist. Contact tom@prosynex.com to book a speaking engagement.

Your Professional Meeting: Plan the Adventure

By Thomas Davis, Lt. Col. (Ret.) CRNA, MAE, DNAP

follow@procrnatom on twitter

Professional meetings are a golden opportunity to socialize and expand your network of colleagues while updating your knowledge and skills. Originally published in 2018, this article has been updated to provide a roadmap for getting the greatest personal benefit from attending a state or national meeting.

If you’re one of those thousands of dedicated workers who’ve survived the intense summer heat, enjoyed and endured the daily demands of children on break and dutifully covered many extra shifts for your vacationing colleagues, it’s your turn to take a break. Attending your fall state or national meeting enables you to combine business with pleasure while renewing old friendships and making new ones. More importantly, planning for an upcoming meeting, places you in an advantageous position to learn more, to expand your network and to get optimal enjoyment during your post summer escape from the daily grind.

Organize

Prior to departure, spend some time on a google search. You can select the meeting based on location, content, name-brand speakers or proximity and ease of travel, but during or after selection, do a google search. Activities in the area such as hiking, biking or walking may be appealing as well as dining, shopping or shows. Tours, walking, biking or by bus, are typically plentiful at destination locations, and attending sporting events or meeting at a sports bar may be the perfect venue for renewing friendships with classmates. Every community is unique and history buffs, amateur archaeologists and birdwatchers may all discover something of interest in their pre-travel search. If you’re including your family as part of a business vacation, be sure to include their interests in your google. Whatever your pleasure, it has become incredibly simply to research and reserve the activities that will make the memory of your experience more than a blip on the radar.

Note: Well before the flight, confirm your hotel and reserve transportation for arrival at and departure from the destination airport; review the meeting agenda and download the meeting app if there is one. During flight, spend your time reviewing information regarding the meeting and local community to ensure that you take full advantage of both.

Some attendees are sponsored by employers and are required to submit documents for reimbursement while others pay out of pocket and need documents to claim a tax deduction. Either way, “travel-by-tech” allows you to submit documents seamlessly. Here are some tech tips for organizing your travel.

Use your phone to organize travel information that you will want at hand. Upload flight information and boarding passes as well as the airline’s customer service phone number. Using the note pad app, store the address and phone number of the hotel where you will be staying to simplify the process when Uber arrives.
Use your computer to set up a folder in the document section specifically for the meeting. The folder can have sub-folders for travel, lodging and daily expenses and for personal expenditure. When you book your flight and hotel, immediately drop receipts in the folder. At the hotel check-out, request an email receipt and when it arrives, save it in your meeting folder. Excel has several pre-made templates for spreadsheets to collect travel expenses such as meals or Uber fare; download and use them to simplify the tracking of reimbursable expenses. I find it useful to create a word document that highlights flight, hotel and rental car information and then email the document to myself so that it is easily retrievable on my phone as I travel.
Stay current Functionality of our devices, especially phones, is developing and advancing almost daily. Yesterday it was email driven but today its app driven, and new phones and function are introduced annually. Stay ahead of the curve and don’t hesitate to try new and useful concepts.

Socialize

Your professional meeting offers the gratification of renewing acquaintances with former classmates and coworkers along with the networking opportunity to meet national leaders and those who are recognized in education, innovation or leadership. Your physical presence at a meeting makes it possible to match faces with names and achievements, as well as providing fertile ground for expanding your network of peers. Be social at gatherings, extend a hand to the leaders of the organization and open yourself to the concept of connecting with new people who may add depth to your network. Securing their information gives you more certainty that follow-up will take place.

Members of many professional organizations have created user groups on social media. If you belong to an online community, consider scheduling and posting a user group meet-up to interact with one another during your educational excursion.

Customize

Although there’s social value in “Hello” and a handshake, the real value of networking is in establishing a conduit for connection in the future. For starters, have business cards readily available. To avoid packing a stash of newly acquired cards, create a business card photo album on your phone. Once you’re back in your hotel room each day, take a snapshot of each business card you wish to keep and save them in your card photo album. To by-pass using business cards, simplify and facilitate the smooth sharing of contact information by adding yourself as a contact on your phone and then quickly exchange information by sending your contact information directly to those whom you meet. Remember, securing contact information gives both of you and your colleague more certainty that follow-up will take place.

Optimize

Prior to the meeting highlight the sessions that are most appealing and seem most beneficial based on your personal interests and educational needs. When two concurrent sessions capture your interest, enlist a friend to attend one talk while you attend the other, then share notes by phone call, phone mail, phone text or over a drink at dinner.

Scan the meeting room and try to sit with new acquaintances you have just added to your network. Getting out of your comfort zone adds to your confidence and satisfaction and enhances the stories you can tell when you return to work. Everyone has worked with, gone to school with or served in the Military or on a committee with someone who turns up at a meeting. Plan to enjoy the adventure and become part of the connection.

Optimize the time you spend with vendors by first assessing your department’s greatest needs for equipment before you travel then seeking out vendors with products that coincide with need. The larger the meeting, the more eager vendors will be to introduce innovative equipment and updates to existing devices. Sign up for samples and demonstrations and if you discover a must-have, collect vendor contact and follow-up quickly after the meeting.

Summary

Whether your autumn plans include a national meeting, a state gathering or both, your return on investment will be enhanced by pre-planning. Beyond earning continuing education credit, a live meeting provides a wealth of opportunities to connect and grow professionally, and to have a great time doing it.

Tom is a noted author, motivational speaker, superior leadership developer and dedicated clinical anesthetist. Contact tom@prosynex.com to book a speaking engagement.

Be a social (media) climber

By Thomas Davis, CRNA, MAE, DNAP candidate

Work completed for my DNAP degree and conversations with colleagues has taught me that just about everybody knows what social media is, and that many people use it in one form or another to socialize with friends, family or colleagues. What many people fail to appreciate is that social media is a powerful tool that can either enhance or kill your career. Leveraging the power of social media will position you to be recognized, rewarded and promoted within your profession.

Advancing professionally in all industry requires that you are known and respected by your peers for the quality of your talents and interests. Marketing is essential for the success of any venture and social media is a great launching pad for gaining recognition. Careerbuilder.com notes that over 50% of employers use social media to recruit the best talent, and that of those entities seeking highly qualified workers, 35% will not offer an interview to a person who has no online presence. To sell yourself locally and globally, it is critical to be seen online consistently creating a positive professional and social image.

Build your online image

The first step in building your image is discovery and damage control. Even if you have never used social media or posted a comment online, you may appear online linked to your profession, employer or social group. Begin by searching yourself on google and click on any link that is connected to you. If you like what you see, update the content and make sure that others can find it easily by doing little things to ensure that the information is linked to you. Tom S Davis immediately pops up as CRNA while Tom Davis labels me as a former University of Iowa basketball coach! Even small changes like adding a middle initial to a common name will help direct readers and save time. After viewing what others see, take note of anything that is not flattering. If you don’t like what you see, rebuild or clean up all unflattering content. If you posted a blog years ago that is embarrassing to you or anyone else, take it down. If you posted a less than professional picture or used offensive language, delete it. A selfie from the college kegger will not score points when viewed by a potential employer. If some other entity controls the material you have previously posted, contact them and ask that the outdated material be removed. Your profile must be spic and span clean and professional.

After the D&D is complete, continue the rebuilding by making sure that current professional postings are easily linked to you. If you have completed a degree, published an article, or have recent pictures from a professional meeting, make sure they appear online and are linked to your name. Recognizing the achievement of others, garners their appreciation, elevates both of you in the online community and raises the level of activity on your own site.

Use multiple platforms

Because there is not a single best platform for creating a professional image online, gaining exposure requires that you appear on multiple platforms. Start by opening three essential accounts and update them frequently. Give time and attention to completing the profile information when establishing an account.

Twitter. Due to the 280-character limit on Twitter, tweets (posts) are short and to the point. Open an account, let colleagues know your username, and always being positive and professional when you tweet. You will earn a reputation for being a “thought leader” by posting URLs for articles that inspire colleagues and elevate your profession. Be sure to follow other leaders in your profession and “like” or “retweet” as the case may be.

Facebook/Linkedin. Originally, Facebook was designed as a social site and LinkedIn was viewed as a Facebook for professionals. Both now have user groups specific to just about any profession. Create an account on each platform and join at least one user group related to your profession. Read what others are posting, comment where appropriate, and when you gain a little comfort and courage, start posting original topics.

Professional site. Many professional organizations have online discussion boards where members of the vocation can share thoughts and debate issues. For nurse anesthetists, the AANA connect forum is an excellent place to interact with colleagues.

Social media is meant to be interactive, so don’t hesitate to add material or continue conversations. As you read other’s comments, your interest may be piqued and your intellect challenged, and you may wish to join the conversation to expand the topic and share your thoughts with the online community. Regardless of the breadth of your interaction, sometimes all you need to do is like another person’s comments and your name will be linked to the discussion thread.

Tips for posting on social media

Update your profile. Social media sites encourage you to create a personal profile and as you gain followers, your profile becomes your identity. Post a professional picture, accurate contact information and links to professional work that you have accomplished. You are creating an online identity so use your real name and get full credit for your contributions to the cyber world.

Be authentic. Online scholarly articles are not in short supply. Social media is your opportunity to show colleagues that you are informed in a less academic way. Be yourself and have a short conversation with your readers, leaving the lectures for the classroom. If your natural self tends to be academic, work on altering your language enough to sound relaxed and to be engaging.

Set the tone. Emotional intelligence is a current buzzword and a concept that encourages readers to look beyond the words and sense the emotion tied to the topic. As you post online, avoid sounding authoritative, dogmatic or robotic. You are a professional responding in a social climate so choose positive, empowering words with an optimistic tone, even when you’re addressing an industry problem or potentially heated topic.

Involve other posts. Jumping in to contribute to an ongoing discussion thread, or to comment on a blog post, creates an online presence. If you don’t have time to develop and post an original topic, make a quick remark or give a thumbs up to something that a colleague has posted.

Stay out of a rut. Always talking about the same topic is about as exciting as repainting the fence every weekend. Social media is fast paced and redundancy is guaranteed to turn off and turn away your readers. Likewise, always talking about yourself, or never talking about yourself, lowers reader regard and should be avoided. It’s okay to share your personal experience when it’s clearly appropriate to the conversation, but don’t be a prima donna (or primo uomo) by making yourself the focus of your social media post.

Don’t shoot yourself in the foot. What you post is out there for everyone in the world to see, including your colleagues and potentially, your next employer. Keep it professional and avoid trigger topics such as politics, religion or alternative lifestyles. Your readers have their opinions and you are unlikely to change any minds; however, you will be forever linked to dogmatic rhetoric. Never forget, bashing or otherwise bad-mouthing individuals whether they are coworkers, political figures or competitors of any kind (and whether or not you refer to them by name), is unprofessional, unbecoming behavior. Stay about of the mud and be squeaky clean.

Having a dynamic online presence does not guarantee employment, promotion or popularity; however, you are invisible without it. Social media offers many interactive platforms that enable you to create or reinvent a public identity as you connect with colleagues and promote your profession. If you have earned an advanced degree, achieved professional certification and been granted a license to practice, shine a light on yourself by joining the Global Country Club. As card-carrying, informed and connected member, you can tweet, blog, post online and harvest the rewards.

Tom is a noted author, enthusiastic speaker, committed leadership developer and superb clinical anesthetist. Contact tom@prosynex.com to book a speaking engagement.

West Virginia ANA 2017

Meeting review by TC & TD

Meeting Date: 3/31/2017

Meeting Location:

Oglebay Resort, Wheeling, West Virginia

Meeting sponsor: West Virginia Association of Nurse Anesthetists

Strengths of the meeting: Great mountain location with beautiful scenery, walking trails and abundant tame deer. Awesome speakers, great topics and lots of fun. With a reception the first night and a theme party the second, both providing dinner, this meeting offers the complete package.

Value for the money: 20 CEUs on a 3 day get away weekend with breakfast, lunch and dinner provided plus a reception. The West Virginia Association knows how to do it right! This is definitely on my list for next year.

Effective Leadership

Follow @procrnatom

By Thomas Davis, CRNA

For centuries, leaders in both the Military and civilian world have attempted to identify and define the perfect leadership style. As far back as 500BC Lao-Tzu wrote in the Tao Te Ching, “The highest type of ruler is one of whose existence the people are barely aware….when the task is accomplished and things have been completed, all the people say we ourselves have achieved it.” On a grassroots level, people are empowered, engaged and have the self-satisfaction of a job well done.

Leaders in both business and healthcare are modifying their management style to encourage employee engagement. As noted by Edward Hess in the Washington Post, “leaders of the most successful companies do not have a top down style of management”. Collaborative management to encourage employee engagement is the key to success regardless of the type of business to include healthcare. In reviewing leadership literature a common thread is advocating leadership through shared responsibility. Collaborative Leadership is a sharing of power which recognizes the contributions of each individual and helps them develop and perform at their highest level.

Over the past 3 decades, I have observed many styles of leadership described with many different names. Without exception, the most efficient organizations with the highest employee engagement and morale were those in which the leaders followed the principles of Serving Leadership and shared governance. Use the principles below to establish yourself as an effective manager of an engaged workgroup.

There are no unimportant jobs or people in an organization that embraces shared governance. As a manager, develop a one on one relationship with each individual. When people are respected and their views heard, they become empowered and will seek excellence. Both managers and front line workers recognize that mistakes will be made. By treating a mistake as a learning opportunity, lessons will be learned, and the organization will become stronger because each individual is allowed to take risk. The key to success is to keep the team focused on the common goal. One of the powerful actions described by Covey is “Begin with the end in mind” where the mission and vision of the organization are known and shared by all. High functioning workgroups are founded in trust, collaboration and holding one another accountable. By affirming the common goal and using mistakes as teaching moments, effective leadership can pave the way to success.

Work is accomplished through relationships and trust is the glue that holds relationships together. Trust begins with you. Begin your journey toward becoming an effective manager by looking within. What is your capacity to trust? What would happen if you approached every interaction from a baseline of trusting that you and the other person share common goals and seek common outcomes? Because you may disagree on a step in the process does not mean that your greater goals are different. In the book Trust and Betrayal in the workplace, the Reina and Reina suggest the following for developing trust in relationships:

Share information
Tell the truth
Admit mistakes
Keep confidentiality
Give and receive feedback
Speak with good purpose
Take issues/concerns directly to the person involved

Effective communication is essential in healthcare for patient safety, efficient workflow and employee morale. Empowering Leadership upends the traditional top down leadership pyramid and makes each team member an equal participant in patient outcome. The best decisions are made when opinions are solicited from a broad base of individuals who have a common interest in a positive outcome. As a trained professional and leader, your insight and opinions are needed when decisions are being made however not all opinions are openly welcomed and received. Grenny suggests the following when confronted with a difficult conversation:

Share your facts. Let the other person know what is behind your opinion.
Tell your story. Explain how you see things and why they are seen as they are.
Ask the other’s path. Openly solicit the other person explain why they see things as they do and listen to learn. Do not argue or confront as the other person explains their position.
Talk tentatively. Ask “what if” or “what would it look like” questions to suggest your remedy and then listen as the other person responds.
Encourage testing. Come to a mutual agreement on a next step with the agreement that it will be reviewed and can be tweaked.
Being an effective manager does not require an MBA or that you were born into a family of corporate executives. Put the micromanaging aside and trust in the abilities of your team. By developing relationships, building on strengths, and communicating effectively, you too can be “the highest type of ruler” where your team achieves amazing results without your heavy hand.

Build on individual strengths to raise the collective performance of the group. Each member of your team brings different strengths to the workplace. The person with the most creative ideas is not always skilled at putting the plan into action. Teaming with others who can organize and execute the plan enables the creative genius of each individual to come to life. No individual can effectively do it all.

Hess, Edward, April 28,2013. https://www.washingtonpost.com/business/capitalbusiness/servant-leadership-a-path-to-high-performance/2013/04/26/435e58b2-a7b8-11e2-8302-3c7e0ea97057_story.html
Dennis Reina and Michelle Reina, Trust and Betrayal in the Workplace.
https://hms.harvard.edu/news/safer-patient-handoffs
Grenny, Patterson and McMillan, Crucial conversations: tools for talking when stakes are high

Thomas Davis is an experienced leader, author, speaker and teambuilding coach.

Clinical Topic: Learning Ultrasound Guided Regional Anesthesia

Ultrasound guided regional anesthesia has quickly established itself as the preferred technique for placing blocks. Several models of ultrasound devices are available and each vendor touts their product as the best. Time for placement, success of the block and patient satisfaction all reinforce ultrasound guided placement as the method of choice for regional anesthesia.

CME meetings across the country are offering hands on workshops to teach anesthesia providers how to properly use this new technology. Likewise, Nurse Anesthesia training programs have added ultrasound guided regional anesthesia to the curriculum. Educators agree that mastering ultrasound technology is important but to date teaching techniques have not been evaluated.

A study by John Gasko, CRNA et al funded by the AANA Foundation and recently published in AANA Journal — August 2012 Supplement (Effects of Using Simulation Versus CD-ROM in the Performance of Ultrasound-Guided Regional Anesthesia) compares two techniques for teaching ultrasound guided regional anesthesia to Student Nurse Anesthetists. Students were divided into groups and were taught either by the use of CD-ROM based teaching or by simulation with human subjects. A third group was taught using a combination of both approaches.

The authors found that there was no difference in learning between those using CD-ROM versus simulation. However, the study found that a combination of CD-ROM and simulation was clearly more effective than either technique separately.

Click here to read the original article published in the AANA Journal

Click here to learn about how you can support CRNA research through the AANA Foundation.

Return to procrna.com and share your comments with your colleagues.

Clinical Topic: Ultrasound Guidance in Anesthesia

For nearly 60 years ultrasonography has been in use in clinical medicine. Over the past few decades the use of ultrasonography in anesthesia has increased. As imaging machines improve in technology and the use of ultrasonography becomes everyday practice, patients are benefiting in terms of safety, comfort and cost. The number of hands on workshops to teach anesthesia providers the proper use of ultrasonography is an indication of the importance and popularity of the technique.

An excellent article by Jonathan P. Kline, CRNA, MSNA titled “Ultrasound Guidance in Anesthesia” and published in the AANA Journal (AANA Journal, June 2011, Vol. 79, No. 3) gives a comprehensive overview of ultrasonography in Anesthesia. The author describes the history of imaging, scanning techniques and use of the Doppler mode. Most important, the author describes the use of the technique for the following specific procedures:

Central line placement
Spinal and epidural placement
Regional blocks
Perivascular injections

This comprehensive review reinforces the knowledge of those already experienced in the use of the ultrasound and tweaks the interest of those who have yet to learn the technique. As ultrasonography becomes main stream in anesthesia practice, patient expect their provider to be skilled with the technique.

Click here to read the original articles and view the pictures.

Research: Steep Trundelenburg and Postoperative Visual Loss

Postoperative visual loss is a rare but catastrophic event that has an increased in frequency with robotic surgery in the steep head-down position. Studies have been conducted and reported in the literature relating intraocular pressure to postoperative visual loss. One study conducted in the steep head-down position with laparoscopic surgery demonstrated increased intraocular pressure as time progressed. Normally, cerebral and ophthalmic circulatory autoregulation prevent increased intraocular pressure, however, this may not be the case during general anesthesia in the steep head-down position.

Research conducted by Bonnie Molloy, CRNA, PhD (A Preventive Intervention for Rising Intraocular Pressure: Development of the Molloy/Bridgeport Anesthesia Associates Observation Scale) and published in the AANA Journal (AANA Journal, June 2012, Vol. 80, No. 3) is a “must read” for any anesthesia provider administering anesthesia to patients in the steep head-down position. This comprehensive review of postoperative visual impairment following head-down surgery details the pathophysiology and describes observable, physical changes that will alert the observant provider that intraocular pressures are increasing.

Data obtained by the author revealed that increasing intraocular pressure in the patient in the steep head-down position correlates to increasing eyelid and conjunctival edema. These physical signs can be used to determine when it is advisable to level the patient and allow the intraocular pressures to decrease.

The result of this excellent, well documented study was the development of the Molloy/Bridgeport Anesthesia Associates Observation Scale. Using the signs of eyelid and conjunctival edema, the anesthetist can predict when intraocular pressures are increasing. The original work is complete with illustrations to guide the anesthetist in the use of the observation scale.

This original work was funded in part by a grant from the AANA Foundation and is essential knowledge for anybody routinely doing cases in the steep trundelenburg position lasting greater than 2-3 hours. Click here to view the original publication.

Clinical Topic: Handwashing Standards

New patient safety guidelines require increased vigilance in handwashing by healthcare providers. Previous guidelines established by OSHA required soap and water handwashing between every patient contact. Over the past few years, alcohol based handwashing agents have been introduced to the hospital setting raising the question about their efficacy and risk.

An article By Gina Pugliese, RN, MS; Judene Bartley, MS, MPH, CIC; Tammy Lundstrom, MD, reviews the topic of the use of alcohol based handwashing solutions. They state:

“The evidence is clear; HCW compliance with hand hygiene can reduce the 2 million healthcare-associated infections that occur in patients annually, as well as reduce the risk of infections transmitted to workers. But the use of these waterless alcohol-based hand antiseptics, the centerpiece of the new CDC guideline, has been perceived to be in conflict with existing healthcare safety regulations. These include, for example, handwashing requirements from the Occupational Safety and Health Administration (OSHA), flammability issues from the National Fire Protection Agency (NFPA), and corridor obstruction issues from Centers for Medicare and Medicaid Services (CMS).”

The article goes on to discuss the fire risk related to the use of alcohol based handwashing solutions. As CMS tightens enforcement of handwashing in the healthcare workplace, this information is essential for CRNAs. Click here to read the article and return to PROCRNA.COM to share your comments. ( If the link takes you to an ad, wait about 5 seconds and it will go on to the article)

The Sticky Situation of Adhesion

Submitted by Pamela Chambers, MSN, CRNA, EJD

Click here for Lex Terrae consulting

Two years ago, Joe Sixpack was admitted to your facility to undergo vasectomy. His clinical course in your fine medical center was uneventful. Today, you are seated in the office of the facility mediator and all relevant parties are present: Joe Sixpack, Mrs. Sixpack, little baby Sixpack who will celebrate his first birthday next week, and everyone involved in the clinical care of Mr. Sixpack on that fateful day 2 years ago.

Before beginning the mediation process, the facility’s attorney presents the admitting forms that Joe signed upon arrival to the facility and prior to receiving any sedation for his procedure. One of the forms, a two sided form, contains an explanation of the procedure that Joe has requested on side one, along with the risks, benefits, and options of the procedure and several blank lines at the bottom of the form in case Joe wanted to add anything to the form. Side two of that same form contains the following statement “I hereby release Smallville Medical Center and it’s employees and contractors, from all liability arising from any injury to me resulting from my requested therapeutic procedure to be performed by Dr. Kuttemup and his staff at Smallville Medical Center.” Immediately after this paragraph is Joe’s signature with the date and time the form was signed.

When a healthcare provider has this type of statement in a contract for services for the express purpose of limiting liability relating to the provision of those services, this is termed an exculpatory clause. When this type of clause is a condition to obtaining the requested service this creates a contract of adhesion. While most courts attempt to enforce contracts by trying figure out what the parties intended when the contract was written; courts often find contracts of adhesion unenforceable as a matter of public policy (Weaver v. American Oil Co., 257 Ind. 458, 276 N.E.2d 144 (1971).

The contract to provide health care services is not usually between 2 similarly situated (i.e. equally knowledgeable) parties. If a contract is deemed grossly unfair to one party it will usually be held unenforceable in court. Consider the following release from Olson v. Molzen (558 S.W. 2d 429, Tenn., 1977) “…I therefore release Dr. Molzen and his staff from responsibility associated with any complications that may come up or be apparent in the next 12 months…” The court in this case found the exculpatory clause particularly distasteful because an individual in such a profession, a physician, should not be permitted to hide behind such a shield as a license to commit professional negligence.

Regarding all contracts, there lies a duty to read. This is small comfort to a plaintiff but a court will evaluate the parties intent to contract by evaluating the terms of the contract. Terms that appears grossly unfair (i.e. unconscionable), violate public policy (i.e. one cannot receive the healthcare service with out agreeing to the term), or lack true assent will likely lead to a ruling that the contract is unenforceable.

About the author: Pamela Chambers is a staff CRNA a Central Texas regional trauma center and the affiliated Children’s hospital. Ms Chambers received her MSN in 2000 while on active duty in the U.S. Army; then received her Executive Juris Doctor (EJD) in Health Law in 2008 from Concord Law School. Ms. Chambers owns Lex Terrae Consulting a health law research and consulting firm and also teaches Legal Nurse Consulting for Kaplan University. Ms. Chambers is not an attorney. The information provided is legal research and should not replace consultation with an attorney or physician when warranted.

ivNOW Fluid Warmer

Patient temperature at the end of the case is an important marker of compliance with SCIP indicators of quality anesthesia care. Achieving the goal of temperature maintenance in the anesthetized patient requires the use of several techniques including warm blankets, forced air warming, the use of a HME in the breathing circuit, and the administration of warm fluids.

To assist the anesthetist with patient warming, Enthermics has developed the ivNOW fluid warmer. Each cavity has a control and L.E.D. display. A sensor in the heating plate detects the presence of a bag and engages the heating mechanism to quickly warm the fluid. Two temperature sensors continuously read the temperature of the fluid bag to engage the heater as necessary to maintain the fluid temperature within +0/-2ºC (+0/-3ºF) of the set point temperature. The electronic control monitors the length of time the bag has been held at temperature, displayed additionally by a status button. The control alerts users when a fluid bag has been held at temperature longer than 14 days.

Click here to go to the ivNOW web site and review the manufacturer’s product information. If you have experience with this product, please leave a comment on PROCRNA.com and share your experience with your colleagues.

Clean Machine for MH patients

What do you do when you learn that your next patient is MH succeptible? Do you have “clean machine” sitting in the store room or do you change the absorber, turn up the flows and let the machine air out? Studies have shown that it can take over an hour of high flow to sufficiently reduce the residual gas in the machine to acceptable levels. Vapor clean is a product which eliminates trace gases from the circuit immediately.

Prepare Any Anesthesia Machine for Susceptible Patients in Less than 60 Seconds

Newer anesthesia gas machines contain plastic and elastomeric components that absorb volatile anesthetics and then release residual vapor during subsequent anesthetic procedures. The anesthesia gas machine requires high flows and a lengthy time period to remove most of the vapor before the machine can be used for a patient that cannot tolerate breathing trace amounts of volatile anesthetic vapor. The Vapor-Clean filters absorb the trace amounts of isoflurane, sevoflurane and desflurane so that anesthetic vapors do not reach the patient.

Placement of the Vapor-Clean filter canisters on the anesthesia machine allows the machine to be immediately vapor-free (less than 5 parts per million of vapor).

Click here to go to the manufacturer’s web site and review the product information. If you have used this product or have any other information to share regarding safe administration of anesthesia to MH patients, leave a comment.