Tag: Nursing leadership

The Emperor’s New Clothes; Lessons for leaders

By Thomas Davis, DNAP, MAE, CRNA

Born in Denmark in the early 1800’s, Hans Christian Anderson was a prolific writer best known for his fairy tales.  Among his famous fables, The Emperor’s New Clothes is a classic story that continues to be referenced two centuries later when the reality that we experience does not align with what we are told is “the truth”.  

In the story, two con men implement a plan to cheat a prideful emperor by manipulating his ego.  The men pretend to be weavers who have developed an amazing fabric that is invisible to those with a simple mind or unfit for their job.   Eager to have the best clothes ever made, the king was captivated by the ruse and hired the men to weave the fabric and make the clothes.  The men went to work pretending to weave fabric and make the clothing.  At intervals the emperor would send staff members to check on the progress and, knowing that only simpletons unfit for their position could not see the fabric, they reported that it was the most beautiful material ever made.  Finally, the tailors dressed the emperor in fake clothing and his staff marveled at the elegance of the new clothes.  Wanting to show off, the emperor paraded through the streets where everyone applauded and admired the beauty of the clothes…until a child called out…” but the emperor has on no clothing at all”.   Once the words were spoken, everyone, including the emperor, knew that they had been deceived and the embarrassed leader quickly returned home wearing only his underwear.

The most obvious takeaway from the story is that we must always trust what we see and experience rather than what we are told to believe by those who want to control the narrative.  Entering an election year, we will have ample opportunity to compare the reality of our lives to the narrative of the politicians and determine for ourselves whether the emperor is wearing clothes.

Leadership lessons from the story

Legendary football coach Vince Lombardi once said, “Leaders aren’t born, they are made and just like anything else, they are made through hard work.”   Becoming a respected leader takes effort and the story of the emperor’s new clothes contains a wealth of guidance for those who are leaders or aspire to leadership positions.  Here are some takeaways from the story.

Pride comes before the fall.  People aspire to leadership positions for a variety of reasons and, unfortunately, some seek power and position to boost their ego.  Authoritarian leaders use a heavy hand to maintain dominance and control over a workgroup and quickly silence those who challenge or disagree with them.  Workers learn very quickly to filter information and share only that which the leader wants to hear.  When open and honest communication is stifled, the leader is blinded from vital information.  Decision making without access to all the details ultimately results in failure.

Create the right environment.  Regardless of the leadership style, creating an environment based on open and honest communication ensures that the collective wisdom of the group is combined to formulate the best answer to a challenge.   Author Chris Voss notes that success is most likely when you enter a discussion with the mindset that you do not have all the information and that there is more to be learned.  By being receptive and rewarding feedback, both positive and negative, colleagues openly share their knowledge and trust is built within the workgroup.  When leaders value listening over telling, they are on the path to success.

Build the right team.  As an Air Force officer moving up through the ranks, I made it a point to observe my leaders and question what made the good leaders good versus what made the bad leaders bad.  Early in my career I observed that the worst leaders developed an inner circle of people who were most like themselves and shared the same view on most topics.  In contrast, the strongest leaders knew their strengths and weaknesses and built a team of individuals who could best cover the weaknesses.   Confident leaders delegate tasks and authority to those who are most skilled in that area.  The best leaders created a diverse team and actively sought out contrasting opinions.  A strong leader welcomes criticism and is willing to learn from mistakes.

Have realistic expectations.  Grandiose ideas set the leader up for failure when they cannot deliver on promises.   It takes more than imagination and good intentions to bring an idea to life.  A solid plan backed by resources, both materials and human, and a realistic timeline are all required for success.  In this story, the emperor foolishly believed that he could have whatever he imagined.

Learn from the Emperor

Whether you are a leader, worker or a citizen who desires to live in a just world, the lessons the emperor can be applied to your life.   Exposing yourself to contrasting opinions and listening to understand rather than to rebut will reveal information that is essential for decision making.   Avoid group thinking and once you have the facts, trust your instincts.   Trust what you see and experience and have the courage to say it like it is. 

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

Reverse mentoring; Unite and enlighten the workplace.

By Thomas Davis, DNAP, MAE, CRNA

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.

Had I known then what I know now; Wisdom gained from experience

By Thomas Davis, DNAP, MAE, CRNA

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.

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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. 
  8. 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.
  9. 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.
  10. 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.

How well do you know your patient?

By Thomas Davis, DNAP, MAE, CRNA

You know the type of surgery that your patient will receive, you have reviewed the lab work and history/physical and you have a sense about their basic health.  It’s time to meet the patient, assess the airway, explain what you will be doing and then get the case going.   You feel as if you know your patient, but do you know who they are as an individual?

The business community has learned that regardless of the product being offered or the knowledge of the salesperson, it is the consumer who makes the decision about what to purchase or pass up.  Over the past decade, the business community has become increasingly aware of the importance of understanding consumer intent.  Simply stated, consumer intent is the desired outcome that drives the person to purchase a product.  It is the foundational reason that creates the motivation to buy the item.  You may know your patient from a medical perspective, but you don’t truly know them until you understand what drives their desire to obtain medical care and their desired outcome.

How does consumer intent apply to us as healthcare workers? After all, we are in healthcare to provide a basic service and promote wellness.  Yes, we provide essential care, however patients have ownership of their medical records and are no longer geographically bound.  Our patients are free to travel either locally or to distant communities to obtain healthcare as they desire.  As a result, healthcare delivery has become competitive, and providers must be sensitive to creating a loyal customer base that generates the cash flow required to keep the doors open.  Becoming aware of customer intent builds a foundation for a trusting relationship and promotes two-way loyalty between the provider and the patient. 

On the institutional level

Healthcare organizations want to be at the forefront delivering state of the art, evidence-based care to their population base.   Introducing new lines of care and investing in technology to support emerging programs is expensive, therefore, upper-level leaders assess return on investment before moving forward.  Gathering information about consumer intent gives important insight into what services their client base want the organization to provide.  Writing in Loyalhealth, author Brian Gresh describes how healthcare organizations are using chatbots linked to artificial intelligence to assess consumer intent.  Prominently displayed on the company website is a chatbot with the Question, “How can I help you.”  Questions from patients are submitted and AI links to evidence-based information that answers the person’s question.  In the background, the organization captures the questions that are asked and gains valuable insight related to what is on the mind of the population that they serve. 

Consumer intent on a personal level

Reviewing information gathered by the company chatbot may be interesting, however, it is up to us to connect one on one with our patients and determine not only what they want, but also why they want it.  The task may sound daunting, yet by making a commitment to connect with each patient and following a simple plan, you will be amazed how easy it is to gain insight into the patient and their family.  Let’s get started.

Develop a routine.  We are creatures of habit and are less likely to forget something when it is part of our routine.  Review your order of events for doing the pre-operative assessment/teaching and create a space to learn about the patient as an individual including their expectations related to the desired outcome.  Create and ask personal preference questions at the same point during every pre-op interview. 

Develop open ended questions.  Establish one or two non-medical questions to assess who the person is as an individual.   Writing in the Harvard Business Review, Authors Awdish and Berry recommend questions that reveal individual preferences and expectations.   Rather than opening the pre-operative interview with questions about the person’s baseline health, introduce yourself and then ask, “What is important for me to know about your health, your preferences, and you as a person?”   If you listen attentively, you will gain valuable insight about baseline health as well as expectations.  A favorite question that I ask patients as we roll to the operating room is “Tell me something about you that is not on your medical record.”  Again, careful listening will give you insight into the things that matter the most to your patient.

Hone your listening skills.  The questions in the previous paragraph are only effective if you actively listen.  Enter the conversation with a curiosity to know more about the person and a commitment to using higher levels of listening to gather insight.  Writing for The Black Swan, author Derek Gaunt describes five levels of listening:

  • Listening for the gist.  In a busy, high production pressure environment, who has time to effectively listen?  When you listen for the gist, you say “ya, ya” as the other person talks and all the while your mind is elsewhere.  If you check your phone for messages while another person is talking, at best you will get the gist of the conversation and no more.  Not only is it rude, but you also cheat yourself out of an opportunity to learn about what is on another person’s mind.
  • Listening to rebut.  Unfortunately, we spend too much time at this level of listening.  The entire time the other person is talking, your mind is on your reply.  When talking to patients, we don’t always rebut them, rather, we flip the conversation away from them and toward ourselves.  The patient opens the door with a statement, and you jump right in to tell the patient about your experience.  Suddenly, the patient is silenced, the conversation is about you, and you learn nothing new about the person.
  • Listening to the logic.  At this level of listening the focus is on the other person and you have a sincere desire to learn what they are thinking.  Whether you agree or disagree doesn’t matter, the important thing is to learn their point of view.  Keep the conversation alive by restating what you hear and say, “tell me more about.” 
  • Listening to the emotion.   When you achieve this level of listening, you are experienced at listening to what a person thinks and now you desire to learn why they think that way.  Again, use open ended statements such as, “that must have made you tense, frightened, happy…”  Then listen as they describe their feelings.
  • Listening to their point of view.  It is rare that we would get to this level of listening with a patient.  At this level, you learn where the person feels they fit into the global scheme of things.   It takes time and trust to get to this level of communication where it is safe to share political, religious, or personal preferences without judgement.

Why is connecting with patients important?

We work in a competitive market where many organizations vie for the healthcare business of our patients.  Connecting one on one with each patient and giving the impression that you understand them as an individual creates a loyal client base.  However, the greater benefits include higher patient and provider satisfaction, improved patient safety, and improved outcomes.  Simply stated, we tend to take better care of patients when we feel a sense of connection and, likewise, patients are more likely to comply with medical directions when they trust and feel connected to the provider.  Actively gaining insight into our patient’s consumer intent is a win/win for patients, providers, and healthcare organizations.

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

Production pressure; Tame the wild beast

By Thomas Davis, DNAP, MAE, CRNA

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.

8 simple steps to create trust in the workplace

By Thomas Davis, DNAP, MAE, CRNA

Trust is a glue that holds relationships together whether they be family, social, or work related.

Brittany has been a chief CRNA for almost a year and is struggling in the position.  As a colleague, she was a rising star on the team and when the Chief CRNA retired, she was quickly moved into the position.   Brittany is a person who likes to be liked and needs to be needed, therefore she avoids conflict by saying yes to every request that is made.  Unfortunately, “yes” often turned out to be a “false yes” leaving Brittany not trusted to follow through on her word.

Like Brittany, Jason is struggling as a Chief CRNA.  He is active in the clinical area and has frequent meetings with his team to assure them that he has their back and that he will not allow them to be abused.  However, when a surgeon, makes a request, Jason quickly bends policies to accommodate, and in the process, throws a team member under the bus.  Simply put, frontline workers cannot trust Jason to support them when disagreements arises.

Brittany and Jason are both in leadership positions and both have eroded the trust of the team.  When this happens, morale is poor and team members give up and move on. 

Leadership matters and trust is the foundation that must be created before a preferred workplace can be built.

What about you…are you a trustworthy person?  Whether you are in a designated leadership position, building relationships with colleagues, or interacting with others in your personal life, trust must be present before you can be fully successful.  On an intellectual level, we know the value of trust, but life happens and along the way we are vulnerable to losing the trust of others.  Increasing your awareness of the importance of trust and becoming sensitive to behavior that will either enhance or destroy it is the first step toward establishing yourself as a trustworthy person.

The Mindtools content team describes trust as “reliance on the character, ability, strength, or truth of someone or something.”   They note that trust is enhanced when the person leads by example, communicates openly and transparently, follows through on commitments, and doesn’t blame others.

“To earn trust, money and power aren’t enough; you have to show some concern for others.  You can’t buy trust in the supermarket.” ~His Holiness the Dalai Lama

Writing in the business blog, Jostle, author Fae Wai notes that trusting relationships are developed on two levels; practical and emotional.  Practical trust is developed by consistently showing up on time, doing what you say you are going to do, and working with others to get the job done.  Over time, people learn that they can count on you.  Emotional trust is equally important, takes time to develop, and is present when others know that you are on their side.  It grows from treating others kindly, respectfully, and in a non-judgmental manner.  Emotional trust can be sacrificed in an instant with an unkind word or false accusation.

8 Tips for building a trusting relationship.

  1. Tell the truth.  Veracity gives others a reason to believe that what you say is, in fact, correct.   Untruth and half-truth are always revealed and once exposed, it is difficult to believe anything the person tells you.   Trust is gone when you walk away from a conversation thinking, “I’ll take that with a grain of salt.”  A person who is not believable is not trustworthy.
  2. An honest NO is better than a false YES.   People want to be liked and accepted by others and therefore are susceptible to saying yes to gain the favor of the other person.  The problem is that once you say yes, the other person expects your action to make it happen.  Through strength of character and knowing your limitations, it is much better to give an honest NO rather than creating expectations that will not materialize.  When you say no, the other person may not be happy, but they walk away trusting that when you do say yes, you will mean it.
  3. Follow through.   This is living proof that you did not give a false YES when a request was made.  To create the practical trust, show up with a commitment to achieve a goal or keep a promise and you will be on solid ground.
  4. Set the standard.  Honesty, transparency, follow-through, and all the things that enable us to trust another person must set the standard for how we make decisions and interact with others.  If a colleague were asked to describe you, what would they say?  When you set a high standard for yourself, the other person will likely begin by describing you as a person who can be trusted.
  5. Be vulnerable and admit mistakes.   Despite our best intentions, we all make mistakes, however, our foibles do not necessarily kill a trusting relationship.  Quickly seek out the other person, admit your mistake, and do what is possible to correct the error.  Hiding a mistake shrouds the truth and creates a barrier to trust.
  6. Never blame or accuse.  A common behavior in a toxic workplace is the blame game.  In a trusting relationship it’s not about who did something wrong but rather, what happened and how do we fix it?  When you move beyond blaming, an error becomes fertile ground for creating trust by supporting the other person, correcting the problem, and ensuring that it is not repeated.
  7. Listen to understand.   People trust you when they sense that you understand them and are truly interested in them as individuals.  All too often we listen to the gist of what is being said so that we can formulate a rebuttal.  Move beyond superficial listening and listen with intent to learn how the other person feels and what motivates them in life.
  8. Be aware of how your words and actions affect others.  The words that we choose and the tone in which they are delivered determine whether the other person walks away feeling affirmed or chastised.   Interacting with emotional intelligence opens the door to a trusting relationship. 

Some who are reading this article are starting at ground zero with a new group and don’t have to worry about prior mistakes.   Others have made mistakes and want to rebuild trust in a stressed relationship with colleagues.  In either scenario, making a commitment earn trust and using the tips in this article to guide your interaction will create the reputation that you desire.  Soon when others are asked to describe you, they will begin by saying that above all else, you can be trusted.

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

Take charge of your professional development

By Thomas Davis, DNAP, MAE, CRNA

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.

Dr Angela Mund, DNP, CRNA; A leader leading leaders

By Thomas Davis, DNAP, MAE, CRNA

The leader is often a dynamic person who guides a frontline team to the completion of a task or goal.   In the traditional scenario, the boss is in a position of authority over the workers, and both know their position on the chain of command.   Breaking the traditional hierarchy of leadership, in 1992 coach Chuck Daly found himself with a unique challenge as the coach of the first US Olympic men’s basketball dream team.  Without doubt, every player on the team was a super star in his own right, now it was the job of the coach to unite the individual leaders into a cohesive team. 

In the workplace, as frontline leader climbs the chain of command, they may find themselves in a position where, like Coach Daly, they are leading a team of leaders.  Although basic leadership principles form the foundation for working with the team, modifications in leadership style are required when leading a group of leaders.

Writing in the Ivey Business journal, author Jeswald Salacuse notes that leadership is hard work and can be even more challenging when directing a group of leaders.  Jeswald notes that success arises from building a trusting relationship with everyone on the team.  Frequent, one on one interaction while keeping an open mind and using transparent communication is essential for success at all levels of leadership and especially important when leading leaders.

An online article by Ken Jacobs offers tips for leading leaders and agrees with other authors that it is important to develop a personal relationship with each member of the team and then learn the strengths that each person brings to the group.  A heavy-handed, micromanaging approach must be avoided when leading leaders, rather, the best results are obtained by ensuring that opinions of each person are both welcomed and used to strengthen the decisions of the group.   It is the role of the designated leader to set goals and then empower the others to discover creative solutions and attain the goal.   Believing in the talents of others and resisting the temptation to interfere is essential when leading groups of leaders.

Angela Mund DNP, CRNA, is president elect of the AANA will begin her year as president in August of 2022.  Despite her decades of experience as an anesthetist, educator, and leader, she will face new challenges leading a “dream team” board of directors who are each recognized leaders and independently elected to the board.   Her success as the president of the organization will require a leadership style based on trust, collaboration, and recognition of the talents that everyone brings to the group. 

I recently had the privilege of recording a podcast with Dr. Mund and discussed the challenges that she will face in the upcoming year.  In our dialogue, she noted the importance of the leader going to the front and showing way rather than directing from behind.    Intending to base her interactions with the board on an inclusive leadership style, Dr. Munds said that she always enters a meeting with the willingness to be influenced and listens carefully to the points made by others.  In her year as president elect, Angela has had the opportunity to learn the personalities of others who will serve on the board of directors and welcomes the unique perspective that each brings to the table.  She noted that encouraging individual opinions and playing to the strengths of each person will be components of her approach to working with the board of directors.

Click here and listen to Dr. Mund’s podcast

Leadership is a full-time job that is dynamic, especially when you are leading a team of leaders.   Coach Daly did not have to teach NBA all-stars how to play basketball, rather, he was tasked with bringing them together as a cohesive team.   Likewise, Dr. Mund is tasked with uniting a team of proven leaders and creating a group committed to the common good of the organization.  Using emotional intelligence, listening skills, ongoing learning, and encouraging individual creativity, Dr. Mund will position the board of directors to follow the path of the dream team and bring home the gold for AANA.

Enjoy Dr. Mund on the prosynex frontline leader podcast

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

Develop leaders on your team

By Thomas Davis, DNAP, MAE, CRNA

Leaders don’t create followers, they create leaders.

~Ralph Nader

Having the right leader in the right position is a key to success for any organization regardless of the type of business or industry that they represent; but where do leaders come from?  Recruiting and hiring leaders is time consuming, expensive and a bit risky because you never know that the person is a good fit until he/she is on the job.  Often, a better option is to promote from within and that requires a pool of workers who have the necessary skills to be successful in a leadership role.  Developing leaders from within is a great opportunity for professional growth for both the current leader and the workers being groomed to step into a leadership position.

Writing for The Training Associates, author Rebecca Gendron notes that 77% of organizations are experiencing a leadership shortage due to the great resignation triggered by COVID and the retirement of baby boomers.  Her data estimates that by 2025, 75% of the workforce will be composed of millennials and surveys reveal that 63% of millennials self-report that they are not prepared to assume leadership roles.  Insightful leaders will jump on this opportunity and incorporate leadership skills into the professional development plan for the team.

Advantages of internal leadership development

  • Enhance your position as a leader.   John Maxwell’s classic book, The 5 levels of leadership identifies a fourth level leader as a people developer.  Placing emphasis on professional development to include mentoring future leaders elevates the team while taking the leader to level 4 on the leadership scale.
  • Improve staff engagement.  The Gallup Q12 has been the gold standard for measuring employee engagement for several decades.  A review of the 12 indicators of employee engagement as outlined by Gallup finds that 6 of the 12 markers are enhanced by developing staff from within.
  • Cost savings for the organization.  The process of advertising, interviewing, credentialing, and onboarding is both expensive and time consuming.   For licensed professionals, the cost of finding and hiring a new person can exceed their annual salary.  Internal leadership development takes time and commitment while saving money for the organization.

Identify your future leaders

Keep your eyes and ears open and your future leaders will identify themselves.  They are the ones with a positive attitude, solid work ethic and who are skilled in the use of emotional intelligence to connect with their colleagues.  A review of business literature identifies characteristics of the workers who will be your future leaders:

  • Aptitude for motivating others
  • Perseverance to overcome obstacles
  • Skill in building trusting relationships
  • Ability to create a culture of accountability
  • Insight to make balanced decisions that will benefit the group and the organization

Create an opportunity for growth

The key to successful leadership development is a sincere desire to enhance the strengths of the other person and the quickest way to knock the train off the track is to try to clone yourself.  Trying to make the other person a better version of you ignores the talents that they bring to the table and is a recipe for disaster.  Instead, connect with the other person, become aware of their talents, and then build on their strengths and interests. 

Leadership developer Michael Page identifies the following activities as great ways to stimulate leadership skills in others.

  • Create opportunities for wider exposure in the group and organization
  • Change their roles and responsibilities to create an opportunity for developing new skills
  • Challenge with increasingly difficult projects
  • Provide a support system that includes mentoring and coaching
  • Give frequent feedback
  • Reward completed projects

Professional development with a focus on leadership skills is a win, win, win for you, your team, and your organization.

Start the ball rolling by understanding that regardless of how good you are at your job, your way is not the only way.    Tap into the talent on your team by assigning tasks to those who show an interest.    Give guidelines, criteria, and determine the desired outcome then step back and allow others to solve the problem.  Make sure that resources are available and take an active role as a mentor when the person tackles the problem.  Appreciate and reward creative problem solving after criteria are met regardless of the approach chosen by the person.  Finally, reap the benefit as team morale skyrockets, your workload is shared with others, and the future leaders of the organization are ready to step in.   Down the line when members of your team are asked to remember the best boss that they have ever had, your name will be the first to come off their lips.

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

10 Behaviors that generate powerful results

By Thomas Davis, DNAP, MAE, CRNA

People are always looking for an edge; a way to position themselves a half step ahead of the crowd.  To that end, they throw caution to the wind, use money or power to get their way, and rationalize their extreme behavior because it justifies the results that are achieved.   For example, Lori Laughlin made the headlines when she was caught paying thousands of dollars in what is now referred to as the college admission cheating scam.

Leaders at all levels who are climbing the chain of command can fall into the same trap as Lori by using their current position to bully their way to the next level.  Ironically, instead of positioning themselves for promotion, their bullying creates a toxic workplace environment that becomes a roadblock and prevents promotion.  Rather than flexing political muscle or throwing money at a problem, the savvy leader wins the day with behavior that costs nothing.   Start on the road to success by eliminating negative behaviors and quickly follow with positive actions to affirm and unite your team.

Eliminate the negative

Travis Bradberry, author of emotional intelligence 2.0 notes several behaviors that generate ill will must be avoided by those who want advance in their career. Activities to be shunned include:

  • Overworking people
  • Lack of empathy for co-workers
  • Taking credit for other’s work
  • Banning socializing / punishing fun
  • Making stupid rules
  • Letting others struggle / withholding help
  • Controlling the agenda / ignoring feedback

Rather than using heavy handed authoritarian leadership to bully those on your team, ease up and remember that the most effective leadership behaviors are free.

It does not take a heavy hand, threats, and bullying to get the results that you want. An article in the archives of prosynex.com titled Scout for a promotion leveraged the boy/girl scout code of conduct with hot tips for grassroots leaders who want to create a preferred workplace  Similarly, an article by Molly Fletcher posted in Linkedin lists behaviors that require zero talent, are cost free, and enhance your position within the organization.  Combined, the two articles are a treasure chest of behaviors that are based on common sense and reap huge rewards.  Incorporate these principles into your leadership style and you will become a preferred boss.

  1. Be on time.  Legendary basketball coach John Wooden had three rules for his team and one was punctuality.  He felt that being on time was an overt display of respect for others so he always started and finished workouts on time.  Being where you need to be in a timely manner creates a foundation of trust and finishing on time respects the personal needs of your team members solidifies their sense of being valued.
  2. Demonstrate an honest work ethic.  The most trusted grassroot leaders know the job and frequently pitch when needed.  Schedules, payroll, and supplies are important however working shoulder to shoulder on the front line to ensure that the mission is accomplished sends a powerful message and contributes to team morale.
  3. Give full effort.  Leadership is not an 8 hour per day job, rather, it is ongoing.  The best leaders pitch in and do whatever needed to support team members including responding to team member’s personal issues even when they arise in off hours.  Tireless work to guarantee that goals are met reflects positively on the team as well as the leader.
  4. Use appropriate body language.  How you show up in the morning matters, as does your aura that others perceive throughout the day.  Your appearance and behavior sets the tone for your team so stand tall, put a smile on your face and some pep in your step.  Let your image portray you as a competent and capable person.
  5. Increase your personal energy level.  Personal wellness is important for you and for each of your team members.  Adequate rest, healthy nutrition and focus on goals all combine to boost your energy, stamina, and positions you as a positive role model for your team.   Your energy level is contagious and will elevate the morale of your team.  Conversely, dragging in with low energy and a negative attitude is equally contagious and will draw your team down with you.
  6. Improve your listening skill.   Move beyond forming your rebuttal while listening and focus on hearing to understanding the message that is being sent.  It’s more important to grasp the other point of view than to defend yours.  You don’t learn anything new while you are talking; you only learn new information when you are receptive and listening.
  7. Focus on emotional intelligence.   Accept and appreciate how your words and actions affect the members of your team.   Face to face discussions, preferably without masks, allows you to view expressions and judge the reaction of others.  Email and texting quickly transmit information but blocks your awareness of the person’s emotional response.
  8. Be receptive to feedback.  Creating diversity in the workplace includes encouraging diversity of thought and learning from one another.  You hire the best and brightest people for your team and now it’s time to showcase their talents and encourage their creativity by being receptive to their ideas.  By actively listening, you may find novel ways to solve a problem and leave team members feeling as if they are valued.
  9. Role model loyalty.  Loyalty is a two-way process and starts with the leader being loyal both individually and collectively to team members.  Never take credit for the work of others and never throw a team member under the bus just to save your ego.  When you establish that you have their back, they will have yours.
  10. Have fun.   Nobody says that work can’t be fun.  Celebrate birthdays and holidays by decorating the break room and supplying a cake or other food.  Reward the team when goals are achieved.  Sponsor quarterly events that promote teambuilding and create and opportunity for team members to know one another outside of the work environment. 

Leadership can be lonely especially for an authoritarian boss who feels that success or failure rests exclusively on his/her shoulders.  Rather, use the tips above to connect with and promote the talents of your team members.  Being interested in the team rather than forcing them to be interested in you opens the door to diverse thinking and new solutions to old problems.  Being a great leader does not arise from your knowing all the answers, instead great leadership arises from the trust that develops when team members feel valued, and their ideas are rewarded.   Replace authoritarian power with common sense and watch your team soar to new heights.  It’s true, the best approach to leadership is free.

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

How COVID has changed the healthcare workplace

By Thomas Davis, DNAP, MAE, CRNA

COVID-19 has changed the way we live, work, and interact with one another.  For some, the hype and hysteria connected to COVID lifestyle changes are oppressive whereas to others it is viewed as the way we should have been conducting business all along.    I remember my early days in healthcare when being fitted for PPE was an annual event and something that did not really affect day to day life.  Fast forward to the present and PPE is the barrier that we demand and use daily to protect ourselves and ultimately our families from the dreaded pandemic.

In January 2021 President Biden signed an executive order directing OSHA to issue safety guidelines for businesses and created implications that transcend to the healthcare workplace. Writing for McKinsey and Company, author Susan Lund notes that work environments with the greatest physical proximity to clients will be affected the most by COVID changes.  The hands-on care that we deliver to our patients puts healthcare workers at the top of the list for proximity to clients.   Visit your primary care provider, lab, radiology, or surgery center and you will likely be greeted by a person wearing a mask while working behind a plexiglass barrier.  In come cases, you may be required to show evidence of a recent negative COVID test before receiving treatment.  Yes, delivery of healthcare is a one-on-one frontline hands-on environment that has changed to protect both providers and the patients we serve.

How the healthcare workplace has been changed by COVID

The physical environment has been re-defined.  Regardless of where you work, look around and you will see barriers and social distancing that was not in place pre-covid.  I work in a surgery center where the once crowded waiting area is essentially empty because only patients are allowed through the door.  Family members or drivers are on call for return to pick up the patient but not allowed to wait in a common area.  Once admitted, patients move to the pre-op area where every other bay is closed to increase social distancing.  Healthcare workers preparing the patient for surgery are all wearing masks, as are the patients.      Likewise, every other bay in the recovery area is closed to increase the distance between patients.   Once adequately recovered from anesthesia, patients are wheeled to the pickup area and helped into the awaiting car.  In discussions with CRNA colleagues from around the country I realize that the changes made in my workplace are not unique and have been adopted by many other workgroups.

The workflow has been re-defined.  Social distancing and PPE is the name of the game in the current covid environment.  We do not want healthcare workers to become COVID infected nor do we want our patients to become infected while under our care.  As describe above, distancing and wearing masks has become part of every-day life.  Once in the operating room, the greatest risk to anesthesia providers is related to airway management.   The N-95 has replaced the traditional OR mask for anesthetists working with airway management.  Likewise, the video laryngoscope has replaced the traditional laryngoscope in many workplaces and enables the anesthesia provider to maintain a greater distance from the patient while intubating. 

In some operating rooms, anesthesia providers use a plexiglass shield in addition to the video scope and create yet another barrier between the provider and the patient.   COVID has increased the use of the video laryngoscope to the point that many providers recommend it as a standard of care for all intubations.  When COVID goes away, the video blade will remain as a foundation for airway management.   Extubation at the end of the case requires similar precautions in order to prevent the potential spread of the COVID virus and some workgroups require a minimum number of room air exchanges before the doors are open and the patient is taken to recovery.

Leadership agility is essential.   Writing in the World Economic Forum, author Sarah Kirby notes that COVID has changed the way leaders interact with workers to include a new emphasis on leadership agility and transparency.  At the top of COVID related leadership challenges is dealing with worker fear and uncertainty.  Workers fear for their own welfare and that of their families and are uncertain of job security.  At the height of the pandemic, many anesthetists were given the choice of furlough or working in ICU when elective cases were halted.  As healthcare workers, collectively we are needed to provide many levels of care for those infected with the virus.  In addition, many healthcare workers face personal challenges created by home schooling for children.  Effective leaders, including Chief CRNAs, must develop the emotional intelligence to be sensitive to the needs of the workers and maintain the flexibility to alter scheduling to accommodate the new needs of the workers.   Trust and transparency are the keys to effective leadership in the COVID environment.  With mandates and regulations changing almost daily, workers must trust that their leaders will be honest and open with them regarding required changes and will always keep the welfare of the worker as a top priority when altering workflow.

Online interaction will continue to expand.   In the early stages of the COVID pandemic, many healthcare clients rejected the concept of connecting with providers online and vice versa.  Now, after more than a year of online appointments, many patients and providers prefer the format and appreciate that the video connection can be scheduled for a specific time, and eliminate travel and time in the waiting room. 

Professional development for healthcare workers has transitioned to an online format.  Those seeking doctorate level degree completion are doing so via asynchronous online education and others who need CME are finding it online rather than in-person meetings. 

In many cases, employers have converted to a video interview for prospective candidates with contracts being offered without an actual face to face meeting with the applicant.  The format offers a cost savings to the employer and protects the applicant from exposure to the virus while traveling.

Without doubt, COVID has changed our individual lives in many ways including how we interact in the workplace.  At some point, the COVID pandemic may be reigned in and reduced to the level of other threats such as the flu, however, the workplace changes triggered by the virus will remain for many years into the future.  As mandates and restrictions are eased, many workplaces will view some of the changes as the way we should have been doing business all along.  Regardless of your individual situation, remain vigilant, cling tightly to the changes that will protect you in the future, anticipate creative use of computer-based expansion of healthcare, and continue to develop your emotional intelligence skills which will enable you to connect with patients and colleagues.   COVID has changed how we live our lives and in many ways the changes have been positive.  Be safe.

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

Set boundaries at work and in your life

By Thomas Davis, DNAP, MAE, CRNA     

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.

Workplace Wellness: Important and achievable

By Thomas Davis, DNAP, MAE, CRNA

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“Leadership is the ability to get others to do what you want them to do because they want to do it.”

Effective leaders tend to be savvy resources managers and recognize that their workers are the most valuable resource that they manage.  The health of each team member is directly tied to morale, productivity, and retention, all indicators of effective leadership.  Therefore, the leaders who place value on team wellness tend to be the ones who gain appreciation from both their team members and the organization.

Writing in 15Five, author Pamela DeLoatch notes that both mental and physical health are important in an effective wellness program.  She notes that designing activities into the workflow that encourage movement and defuse stress are creative ways to infuse wellness into your workgroup. 

Building on the theme of workplace wellness, author Steven Aldana notes that lifestyle choices are correlated to 70-90% of chronic diseases challenging healthcare workers including stroke, cancer, heart disease and diabetes.  Creating wellness in the workplace begins with awareness and then, driven by motivation from leadership, morphs into a culture change that encourages healthy habits.   This all sounds great, but how do you create the culture change necessary to make wellness a priority in the workplace?  Read on.

Promote physical wellness.

Our bodies were meant to be active and in motion.  As healthcare workers, we are aware of the devastating consequences when ICU patients become immobile.  Similarly, over time, a sedentary lifestyle will impair the body’s mobility and eventually prevent the person from participating fully in activities that they once enjoyed.   Make a commitment to personal health and extend that commitment to practicing healthy habits both at home and in the workplace.  Here are some ways to improve physical wellness in the workplace:

  1. Eat healthy foods for lunch.  Pack a nutritious lunch from home and avoid the high salt/high fat fast foods at the drive-through on the way to work.  Skip the 800 calorie Starbucks super-deluxe beverage and drink more water at work.  Keep candy, cake, and cookies out of the employee lounge.  Challenge your team to a vegan challenge where only vegan foods are allowed in the break room for a week.
  2. Sit less.  Select a lunch spot on the other side of the building and enjoy a brisk 5 minute walk each way during your lunch break.  The change of scenery will give you a mental break and if you can find a sunny spot, you have the additional benefit of sunshine.
  3. Stretch.  Operating room workers sit for long periods of time during challenging cases and then race between cases to get the next patient going.  While in a long case, set your watch to alarm every 30 minutes, stand up, and stretch.  Touch your toes, stretch overhead, twist at your waist.   Stretch every 30 minutes each day for a week and note the increase in flexibility.
  4. Promote sleep awareness.  Use a team meeting to have a healthcare professional talk to the team about the importance of sleep.  Design work schedules to allow full recovery after a demanding night on call.
  5. Encourage sick employees to stay home.   If a person were in a car accident, you would figure it out and get the cases done.  Have the same consideration when a colleague is truly sick and should not be at work.
  6. Design group activities.   Have a monthly group activity on a Saturday or Sunday morning that promotes both activity and a sense of community.  Meet at a park for a hike, bike ride or swim.  Participate as a group at a local 5K race/walk or charity bike ride.   Have several members of the team take up a new activity together such as pickleball, tennis or volleyball.

  Promote Mental wellness

  1. Speak candidly about mental health.  Let your colleagues know that you are aware of the effects of stress on mental health.  Make it OK for others to express their anxiety or concerns by listening in a non-judgmental manner.  Avoid offering solutions or telling the person how to fix a problem and remember that they need a sympathetic ear, not a lecture.
  2. Invite a mental health professional to a team meeting.  Have the person describe the resources available to team members who are experiencing stress and how to access them in a confidential manner.
  3. Encourage walk breaks.   The surgical suite can be a noisy, hectic place that is driven by production pressure.   When possible, encourage colleagues to take a 5-minute walk break between cases.  Finding a hallway with windows that provide a sunny view is uplifting and provides the mental break that will put you back on track.
  4. Provide a quiet place.  Have one area where employees can quietly sit and reflect on the day.  Encourage meditation, yoga, or other activities to refresh the mind.
  5. Encourage relationships.  Colleagues who chatter with one another and share experiences unrelated to work form social networks that are essential during stressful times.
  6. Defuse production pressure.  This is a tough one and requires a culture change.  We are taught early on that the most important thing we do is to get the next case going.  We are encouraged to cut corners where possible and move as quickly as possible.  Leadership at all levels must value the safety of the patient and the mental health of the worker enough to slow the process and allow team members to move at a reasonable pace between cases.  Courageous leaders and workplace champions are necessary for this culture change to occur.
  7. Get outdoors.  Where possible, ensure that you and your colleagues spend time in the open air.  During good weather, encourage people to eat lunch outside and plan weekend gatherings at a local park.

Historically, wellness programs in the nurse anesthesia community were designed to prevent or treat those who developed an addiction to drugs or alcohol.  Over time, the concept of wellness has expanded to include the daily mental and physical health of workers.   Research has documented the positive effects of wellness programs on the morale and productivity of workgroups both in healthcare and the business communities.   As healthcare providers, we take pride in the application of evidence-based medicine in our practice.  Now it is time to apply evidence-based wellness programs in the workplace to protect our most valuable resources…our workers.

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

Emotionally Intelligent Teambuilding



By Thomas Davis, DNAP, MAE, CRNA

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A review of the literature from the business community reveals that having and using emotional intelligence is one of the most important skills of a successful leader, both at work and in the individual’s personal life.  Simply stated, emotional intelligence (EI) is the ability to recognize and control emotions in ourselves and in others.  Writing in PositivePsychology.com, author Elaine Houston notes that EI is the interface between the emotional and thinking centers in the brain.  Having emotional intelligence increases our capability for resilience, motivation, empathy, reasoning, stress management and communication…all desirable traits.

Think back and recall your favorite boss and then ask yourself what made that person stand out compared to others you have worked for over the years.  Most likely, your chosen best boss was a person who was easy to talk with and seemed to understand and accept you as a unique person. This person could probably sense your need for professional development and connectedness with the team.  In short, your favorite boss was most likely a person who was strong in the area of emotional intelligence.

Why emotional intelligence makes a difference?

Writing in the American Journal of Pharmaceutical Education, authors Romanelli, Cain and Smith reveal that those with strong EI skills are better able to make sound decisions, build and sustain relationships, manage stress, and adjust to change.  It is for those reasons that hiring managers across the country are assessing the EI capabilities of applicants during the interview/hiring process in hopes of building a strong and collaborative workgroup.

Recently I had the privilege of teaching a course for an exceptional group of nurse anesthesia students.  In a discussion with the program director, I learned that when evaluating students, the selection committee placed greater value on EI than academic credentials during the interview process and that the class of students was selected based on their emotional intelligence skills. 

Like the savvy program director, Chief CRNAs across the country are placing value on building teams filled with collaborative workers who are empathetic toward one another and resilient when faced with a challenge…emotionally intelligent teams.  Hiring managers have learned that it is better to leave a position open rather than fill it with a “bad apple” who will demoralize others on the team.  Gone are the days when positions were filled out of desperation and those who lack EI are finding it more difficult to find a job.

Tips for building an emotionally intelligent team.

Strong, collaborative teams don’t happen by chance, they are developed by leaders who can visualize what they want, develop a plan to achieve it, and stick to the plan without exception.  It takes foresight, preparation, and follow-through to achieve the desired results.  Let’s get started.

Truth in advertising.

When posting a job opening, include a job description that describes not only the work that is to be done but also the personality traits that you desire.  Weave the core values of the organization into the job description and state up front that you are seeking a candidate with a strong history of collaborative teamwork.

Check references.

Typically, applicants submit three references, forms are sent, and prior work is documented.  Basically, the form documents that the person held the job and was not fired due to incompetence or moral deficiency.   Take the next step by calling the reference and asking questions that would reveal the applicants EI abilities.  Ask “what is the applicant’s greatest strength?” and listen for indications that he/she works well with others.  Ask whether the applicant has overseen projects or mentored others and what was the outcome.  Talking with a reference gives insight into the applicant’s people skills.

At the job interview.

Start your interview with a review of the mission, vision, and values of the organization and clearly let the applicant know that if he/she is not in alignment with the values, this is not their job.  Rather than discussing case management and work schedules, use the interview time to learn about how the person interacts with others.  Ask leading questions such as:

  • Describe your ideal workgroup.
  • Which of the organizations core values do you most identify with and why?
  • Tell me about a time when you disagreed with your supervisor, how did you handle it?
  • Tell me about a time when somebody criticized your work, how did you handle it?
  • How would you resolve a dispute between two colleagues?
  • What was your greatest success in your last job?

These questions will get the ball rolling…add others that fit your specific job situation.  Listen carefully and if you get a superficial stock answer, ask follow-on questions.  “Tell me more about” or “what happened next” are ways to reveal how the applicant works with others.  Listen for we versus I when the applicant answers questions.  Strong team players credit others for participating in success whereas those who lack EI brag endlessly about themselves.

Success.

Strong teams and preferred workplaces don’t happen by accident, rather, they are the product of insightful and effective leadership.  Screening applicants and hiring based on emotional intelligence will produce a highly productive and collaborative team that pulls together during stressful times and is a pleasure to supervise.

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



Cognitive reframing; Reduce stress and increase productivity



By Thomas Davis, DNAP, MAE, CRNA

Healthcare delivery is stressful for both leaders and workers regardless of the title behind the person’s name or their position on the chain of command.   Ever-increasing expectations from patients and their families combined with demands put forth by physician colleagues creates a high-pressure environment for leaders and workers alike.  Chief CRNAs, OR managers and rank and file workers all experience production pressure in a high stakes environment and are all susceptible to work related anxiety and depression.  Rather than succumb to the pressure, a little cognitive reframing creates a different perspective and changes the internal dialogue in the person’s mind.  Here is what you need to know.

What is cognitive reframing?

According to the Wikipedia, cognitive reframing is a process by which a person identifies and then changes the way situations, experiences, events, ideas, or emotions are viewed.   It is a process by which thoughts are challenged and then changed.   Simply put, it is looking at a stressful situation and consciously opting to consider alternative perspectives and then visualizing a positive outcome for the problem.  It is a process that requires changing the internal dialogue in one’s head and replacing negative, fear-provoking thought with options that support a positive outcome. 

Choose your thinking framework

We can’t always control the problems that are thrown at us, but we can control the way we respond to them.  You have choices as to how you mentally react when stressful situations emerge.

Asset-based versus deficit based.  Asset based thinkers step back, assess the resources that are available and consider ways to leverage them to achieve the goal.  In contrast, deficit-based thinkers focus on what is lacking and throw in the towel.

Proactive versus reactive.  Proactive thinkers take control, rally support from others, and implement solutions to the problem.   In contrast, reactive thinkers are at the mercy of others and often view themselves as a victim of the system.

Reframe your thinking

Whether in your personal or work life, the ability to reframe a stressful situation sets you free from being dragged down by the problem of the day.  Start by asking yourself, “If I knew ahead of time that things will work out OK, how would I respond?”  Then proactively assess the situation and intervene as appropriate.   The online resource leadership now offers the following suggestions for actions to take after you reframe your thinking.

Structural changes.  This requires looking at the process, redesigning the workflow, re-writing policies/procedures, and engaging colleagues to embrace the changes.

Coaching.  Assume that you are surrounded by good people, but not all are fully capable in every area.   View the situation as an opportunity for career development and either work with the person yourself or assign him/her to a supportive mentor.

Political.  When discord within the group is causing stress, step in as a peacemaker.  Review the mission, vision, and core values of the group and enforce a code of conduct that includes civility and bans gossip.

Motivation.  Teams function most efficiently when they have a sense of common purpose.  Reduce stress by creating goals and ensuring that the team sees the connection between the goals and the overall mission of the organization.  Generate milestones to assess progress and never miss an opportunity to celebrate success.

Take control

You can proactively ward off some situations however you can’t deflect every problem in either your personal or professional life.  Rather than viewing yourself as a hopeless victim, take charge and reframe your thinking.  Focus on what you can do with available resources, seek additional help, and focus on a positive outcome.  You will be amazed at how your productivity increases and your stress evaporates after you alter your outlook and confidently take charge.

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



The Doctorate degree: Do I need it?

By Thomas Davis, DNAP, MAE, CRNA

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 Leadership Lessons

By Thomas Davis, DNAP, MAE, CRNA

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“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 for Leaders

By Thomas Davis, DNAP, MAE, CRNA

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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.

5 ways to get more from your video meeting

By Thomas Davis, DNAP, MAE, CRNA

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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.

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.

Inclusion; The key ingredient for successful diversity



By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

Social media is abuzz with strong opinions about diversity, social justice, and equality for all.  Facebook, twitter, and professional discussion boards such as AANA connect display hundreds of comments from passionate people who want their opinions to be heard.  Overnight, diversity has become a hot topic for discussion throughout our society.  While cultural diversity is important, it is the assurance of inclusion, both in society and in the workplace, that adds equality to the equation.

Diversity versus Inclusion; what’s the difference?

Diversity

Throughout its history, the United States has been referred to as a cultural melting pot.  We are a nation of immigrants where most people found their way to our country seeking an opportunity for a better life while others were captured, enslaved, and brought to our shores against their wishes.  Regardless of the circumstances for immigration, every individual currently in our society adds a unique perspective to the diversity of the nation. 

Without question, we are a diverse nation; however, that does not ensure that all people are respected and treated equally.  The decades of struggle by women and African Americans to obtain the right to vote highlights an instance of segments of a diverse population that were excluded from full citizenship and serves as an example of diversity without inclusion.

Inclusion

Inclusion is living one’s life with the belief that all people are important and deserving of respect.  It is overtly manifested by behavior affirming that the best and most creative ideas arise from many ideas and mandates participation by each segment of our diverse population.  Writing for Forbes.com, author Dan Schawbel stresses the importance of workplace inclusion by noting, “Inclusion is a call to action within the workforce that means actively involving every employee’s ideas, knowledge, perspectives, approaches and styles to maximize business success.” 

On the job, behavior ensuring that every member of the team can participate fully and equally in creative thinking, problem solving, and the development of innovative practice protocols are examples of inclusion.  In an inclusive environment, all voices are heard, and all opinions are thoughtfully considered.

Creating inclusion in the workplace produces positive consequences as noted by The Denver Foundation;

  • Higher job satisfaction
  • Lower job turnover
  • Higher employee morale
  • Improved problem solving
  • Increased creativity and innovation
  • Increased organizational flexibility
  • Improved quality of applicants for open positions
  • Decreased vulnerability to legal challenges

There is no downside to a culture of inclusion in the workplace.

Avoid subtle forms of exclusion

Overt exclusion involves behavior that is blatantly discriminatory and is illegal in most workplaces; However, covert forms of subtle discrimination are more difficult to identify and occur more frequently.  Author Jane O’Reilly identifies behavior such as failure to respond to a greeting from a colleague or looking at the phone while talking to a person as being dismissive and are examples of social exclusion.  Psychology today author Lynne Soraya adds to the list of workplace behavior that exclude team members and increases polarization of the workgroup.  She identifies the following as killers of inclusion:

  • Publicly reprimanding of an employee
  • Selectively not inviting all stakeholders to a meeting
  • Using sarcasm / ridicule when speaking to another employee
  • Dismissing those who do not speak up quickly as having nothing to say
  • Judging a colleague as less than committed if he/she does not participate in off duty activities
  • Committing a colleague to travel or extra work without discussing it with them
  • Punishing an associate for speaking up truthfully when something is not right
  • Cutting off and dismissing a person if they have a complaint
  • Finishing a sentence or thought for another person if they speak slowly
  • Bullying in any form

Writing for Quill.com, author Lindsay Kramer adds isolation, minimizing, and ignoring to the list of subtle behaviors that exclude people from full participation on a work team; behavior that must be taboo in the workplace.

Build an inclusive workplace culture

Human Resources has done their job and staffed your workplace with a multi-cultural, multi-gender, and multi-generational team; they have created diversity.  Now, it is up to you to add the magic ingredient of inclusion to capitalize on the ingenuity that each person adds to the group.  Here are some behaviors that will promote inclusion and transform the culture of your workplace

Examine your assumptions and become aware of hidden bias that you may have.  Ask yourself, “What if the opposite were true?”   For example, instead of assuming that James is not capable of taking on a project, consider that he is fully capable but has never been encouraged or given the opportunity to show his talent.

Seek opinions and ideas from a broad range of people.  Move beyond the comfort zone of your inner circle and ask for opinions from staff members who will most be affected by your decision.  Have a small, diverse group of workers meet to discuss issues and go around the table to ensure that each person speaks.  Listen attentively and if someone does not express an opinion the first time around the table, go back to that person and ask him/her to comment on a suggestion made by another person. 

Focus, listen, and ask questions when you are speaking to others.  Even the quietest people among the team have opinions and often they are quiet due to a history of being marginalized.  Actively listening and asking questions to expand the person’s train of thought sends a clear message that they are valued and builds a sense of inclusion.

Defuse drama and have zero tolerance for gossip or bullying in your workplace.  Drama focuses on a problem, creates a victim and is divisive to a team.   Instead, focus on finding a solution and encourage mentoring and coaching.  My previous article, 4 keys to eliminating disruptive behavior has additional tips for leaders who actively fight drama in the workplace.

Showcase the achievements of each team member and tie their individual accomplishments to the success of the team.  Demonstrate your belief that all jobs are important and praise grassroots workers for their commitment to the job and the team.  Post a Kudos Board in the break room and spotlight each team member several times per year and turn all birthdays into special days hailed by the entire team.

Promote cultural awareness by celebrating ethnic special days.  Plan festive displays in the break room for Cinco de Mayo, Kwanzaa, St. Patrick’s Day, Ramadan, and other holidays that are celebrated by individual members of the team. 

Encourage multigenerational collaboration among team members.  The Boomers on your team were born and raised in a world without cell phones or computers whereas the youngsters cannot imagine a world without them.  My previous article, Older workers strengthen the team,notes that combining the street sense of the elders with the tech savvy of Gen Y & Z is a great formula for success.  In a highly productive workplace, mentoring is two way and trans-generational with each demographic learning valuable lessons from the other. 

Build a gender-neutral environment where rewards and recognition are based on achievement.  Harvard Business Review author Tara Sophia Mohr advises against listing qualifications for a job because women don’t apply unless they meet 100% of the items whereas men apply when they meet 60% of the qualifications.  Rather, list the desired behavior and achievements expected from the new person and more women will apply.  Writing in Forbes Magazine, author Peggy Yu advocates gender neutral language in all management policies to include pay and benefits.  In addition, she notes that gender friendly bathrooms complete with pads and tampons promote an inclusive culture.

Diversity and Inclusion

Several centuries of American history have documented that diversity without inclusion marginalizes segments of the population and sets the stage for the protests that we are currently witnessing across the country.  Politicians can pontificate and pundits can tell us what we ought to do, but meaningful change will only happen at the grassroots level.  I cannot change the world, but I can change my world starting with my workplace and that mandates a culture of inclusion.  It is time to stop talking and get to work.

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



Setting the Standard

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

Standards are essential

High quality patient care must be delivered in a consistent and safe manner; professional organizations set standards to define it, institutions develop policies to provide it, payors demand it and patients deserve it.  Frontline workers must deliver it.

The history of standards for patient care can be traced to the 1800s when obstetrician Ignaz Semmelweis demanded handwashing by those providing medical treatment.  Several decades later, surgeon, Ernest Codman, became a relentless champion for hospital standards and the assessment of outcomes.  Legendary nurse, Florence Nightingale, identified the link between living conditions and death rates among soldiers and became a powerful advocate for basic nutrition of soldiers and setting sanitation standards for the barracks.  In each case, a healthcare  champion pushed the medical profession to set standards – a minimal expectation below which care cannot be allowed to drift.

Throughout the 20th and into the 21st century, there is an ongoing focus on improving patient safety and outcomes through the development and enforcement of standards for care.  The topic of reliable evidence-based medical treatment has gained front page prominence and is now included in the AMA Journal of Ethics for physicians.  This, from the ethics journal:

  • Standards of quality are statements of the minimum acceptable level of performance or results and what constitutes excellent performance.
  • Medical practice guidelines are evidence-based statements to assist practitioners in their decision making.
  • Medical review criteria are statements used to assess the appropriateness of specific decision, service, and outcomes in the delivery of care.
  • Performance measures are observable and measurable criteria that indicate compliance with medical quality standards

In 1965, Congress passed legislation that created the Medicare and Medicaid programs intending to create a medical safety net for the elderly and those who were otherwise uninsured.

Authors Youssra Nariousa and Kevin Bozic. note that along with entitlements, the bill established “conditions for participation,” conditions which, in subsequent years, evolved into a mandate for the establishment of standards of care; criteria that must be met if reimbursement for service is to be obtained.  By default, the Center for Medicare and Medicaid services became a powerful force demanding the creation and enforcement of standards of care in healthcare.

Professional organizations and patient safety advocacy groups also play an important role in the establishment of standards of care for practice.  The American Medical Association and the American Nurses Association collectively set practice standards that are applied broadly to the healthcare industry.  Sub-specialties in medicine and nursing also have professional organizations that establish performance criteria for providers in their sub-specialty.   For example, anesthesia related organizations establish practice standards that affect the entire perioperative area.

Specific to the practice of anesthesia, the American Association of Nurse Anesthetists, the American Society of Anesthesiologists, and the Anesthesia Patient Safety Foundation have all established minimum criteria that must be met to ensure safe practice.  Although each organization’s differing views on supervision may affect the wording, most of the standards are essentially the same between the three anesthesia specific groups.  Current standards for the delivery of anesthesia include:

  1. The constant presence of a qualified anesthesia provider.
  2. Adequate oxygenation including continuous analysis of the fresh gas flow, pulse oximetry and clinical observation
  3. Adequate ventilation as evidenced by continuously observing the level of expired carbon dioxide during moderate sedation, deep sedation or general anesthesia.  Verification of correct placement of any artificial airway device.  The use of ventilatory monitors as indicated
  4. Physiologic monitoring of blood pressure, heart rate and respiration with documentation at least every 5 minutes.  Monitors must have audible alarms that are turned to a pitch that is easily heard by the anesthesia provider.
  5. Cardiovascular monitoring to assess the patient’s heart rate and cardiovascular status.
  6. Thermoregulation when clinically significant changes in body temperature are intended, anticipated, or suspected. 

Although specific hands-on techniques have changed due to the threat of COVID-19, standards of care remain in effect and must be met.

Look beyond the horizon

As cutting-edge technology becomes routine evidence-based practice, standards of care are updated and the baseline for minimal acceptable care is elevated.  For example, the pulse oximeter was introduced to clinical practice in the mid-1980s and by 1987 rapidly became a standard of care for the administration of general anesthesia in the US.  The sudden elevation of monitoring requirements created a scramble to obtain the necessary equipment for meeting the new criteria.

Therefore, before morphing into a standard of care for the profession, new technology and techniques that are safe and effective are often introduced as local policy and evolve over time into a new minimum requirement.  Rather than waiting for requirements to change, be a workplace champion and elevate your practice by developing local policies that exceed current minimum standards.  Once done, push to make your elevated level of care a standard for the profession.

Future standards of care

Implementing new standards of care must be done judiciously and within the capability of providers to comply with the mandate.  Once a standard is set, those who do not meet the requirement are legally liable and might not be reimbursed for their services.  Stay ahead of the curve by considering these items for inclusion in the policies that govern your workgroup.

Video laryngoscope   Fiberoptic endotracheal intubation was introduced to clinical practice in the 1960s and by the 1980s became the first line of defense for a difficult airway.  Now, the video laryngoscope has proven itself to be faster, lighter, and equally reliable to the technology of the 80s making fiberoptic intubations a rare event.

With the outbreak of the COVID-19 pandemic, anesthesia providers are seeking ways to separate themselves from the patient’s airway and many who intubate opt to use the video laryngoscope to create distance from the patient’s face.  Because the video scope has proven itself to be an exceptionally reliable first backup for a difficult airway and offers the added protection of distancing the provider from the airway, many anesthetists believe that the video laryngoscope should be a standard of care for the future.

Ultrasound for nerve blocks   Anesthesia providers toward the end of their careers can remember the days of seeking paresthesia while placing a peripheral nerve block.  Not only were results of landmark guided blocks less reliable, actual damage to the nerve was not uncommon.  Currently, ultrasound is being used to visualize the placement of local anesthesia in the space surrounding the nerve and has reduced the incidence of nerve damage associated with administering the block.  The improved patient safety and reliability of ultrasound guided nerve blocks will mandate this technique as a standard of care.

Multimodal pain therapy   The spectrum of sedation through general anesthesia does get the patient safely through the surgical procedure but it does not provide adequate analgesia for the immediate postoperative period.  Multimodal pain management uses a combination of different classes of analgesics which opens the door to comfortable, opioid-free recovery from surgery.  The effort to eliminate addiction to opioid drugs will mandate that multimodal pain become a standard of care.

Change the status quo by raising your standards

Quality healthcare is a platitude that arises from the C-suite; however, it is a way of life for the frontline workers delivering hands on service to clients.  To ensure positive outcomes, standards of care draw a line that quality patient care must not fall below; however, they do not necessarily represent the optimal treatment options available.  Healthcare providers in every specialty can raise the bar and exceed minimal requirements by constantly developing policies and procedures that exceed existing standards.  Anesthesia providers implement policies that require the use of new technology to protect the provider and improve the safety of the patient.  Surgeons implement policies that provide effective, opioid-free pain control postoperatively.  Perioperative nurses alter workflow policies to ensure the delivery of high-level care while maintaining social distancing. 

Today’s policies will become tomorrow’s standards.  Be a champion for your profession by constantly updating policies and procedures to reflect an elevated level of care and then be an advocate for establishing them as a new standard of care.    You may be on the frontline, but your initiatives will have a greater impact on healthcare than all the slogans coming from the front office.

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

Life lessons for leaders

By Thomas Davis, DNAP, MAE, CRNA

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.

Can you hear me now? Communicating in the COVID workplace

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

Communicate, communicate, communicate…a message that has been drilled into all of us as a key ingredient for effective leadership, patient safety, teamwork, and the future of mankind.  Collaborative teamwork requires that the vision of the leader be understood by the team and empowered workers deserve to know exactly what is expected of them.   Partial or ineffective communication sets the stage for disaster regardless of knowledge or level of experience of those involved, as evidenced by the greatest loss of life in aviation history.

On a foggy morning in 1977 on the island of Tenerife, just off the coast of western Africa, KLM flight 4805 was awaiting clearance for takeoff as PanAm flight 1736, still on the runway, was rolling toward the nearest exit point.  Pilots in each plane and the controller in the tower were all speaking in English, a learned second language for each person.  Fog prevented visual contact from the tower to the runway so verbal talk in a non-native language via a radio was the only way to communicate the positions of the planes.  Interpreting a message from the tower as clearance for takeoff, the KLM flight went to full throttle, accelerated, and hit the PanAm plane killing 583 people.  Communication failure cost many innocent lives that day on what was otherwise a beautiful vacation island.

Communication is equally important for safety in healthcare.  The Institute of Medicine published a report in 1999 stating that up to 100,000 deaths occur annually in the United States due to medical error.   Current statistics published by the CDC and CMS indicate that death due to medical error has not been reduced in the past 20 years and root cause analysis of closed claims prompted the Anesthesia Patient Safety Foundation to list communication errors as a major risk for patient safety.  Poor communication in healthcare does not leave hundreds of people dead on a runway; however, the results are equally devastating to the family and friends of the injured person.  Just as in aviation, effective communication among healthcare providers prevents errors and saves lives.

Shrouding the body in plastic, masking the face, and shielding the head stops more than the COVID virus, it muffles sound and removes visual ques.

The threat of the COVID 19 virus mandates that healthcare providers utilize personal protective equipment (PPE) for their own security as well as the safety of friends and family that they interact with after work.  Along with the protection provided by the PPE barrier comes the unintended threat of patient harm caused by difficult communication among those wearing full PPE.  For example, recently a surgical technician in our break room commented, “I’m glad I know his routine because I didn’t understand half of what he said to me.”  My personal experience while wearing PPE is that I find myself speaking louder, standing closer and asking people to repeat themselves frequently.  The option of being like the KLM pilot and acting based on what was thought to have been said rather than seeking clarification is not acceptable in healthcare.

An internet search related to communicating while wearing PPE revealed the story of a nurse who was hard of hearing, dependent upon lip reading and was forced to retire when masks became a requirement in her workplace.  No doubt, many of our elderly patients, with or without COVID, share her inability to fully understand words spoken through a mask and face shield.  Even when word are heard and understood, masks present a barrier to developing trusting relationships with patients as evidenced by a study by Wong et al (2013) published in the BMC Family Practice journal.  The study revealed that family practice physicians who wore a mask while interviewing patients were less likely to create an empathetic, trusting relationship.  The findings reinforce the importance of removing the facemask if possible when around non-COVID patients while maintaining strict social distance rules.

Am I suggesting that we should NOT be using PPE?  Emphatically NO because PPE is crucial for provider safety; however, we must take steps to ensure that PPE is not a barrier to collaborating with colleagues or connecting with patients.  Here are some tips for effective communication while wearing protective equipment.

Communicate clearly in the COVID workplace

Use closed loop communication.   Advocating for patient safety, the CDC recommends closed loop communication while wearing PPE to ensure understanding.  With closed loop communication, the sender initiates the message, the receiver acknowledges the message by giving feedback, and the sender verifies the feedback.  For example, one person may ask another to draw up 0.5 mg of atropine.  The second person repeats, “I will draw up 0.5 mg of atropine” to which the sender says, “yes, 0.5 mg of atropine is correct.”

Use technology.  We live in a digital world and technology abounds to assist communication.  When words are muffled, mobile devices can be used for typing and sending messages to others while wearing PPE.  Always protect devices in a plastic wrap and wipe them frequently with disinfectant.  In addition to personal devices, walkie-talkie type gadgets can be worn under the PPE garment and provide a channel for clear communication.  The Vocera system is but one example of an electronic device designed to provide effective communication while wearing PPE.

Create trigger words and signs.  Pre-arrange both verbal and non-verbal ways to bring the team to a halt if something is not understood or is not correct.  Make a large sign that says “STOP” or have a red card to hold up for all to see when immediate help is needed.  Agree on a hand gesture such as the “timeout” signal given by a football referee or the “halt” sign given by a police officer to stop any procedure that you feel is unsafe.  Next, consider other supplies that are needed or events that happen frequently where a sign would be appropriate for informing colleagues.  Make sure that signs are appropriately cleaned between uses.

Use body language and facial expressions.  Writing in Health News Hub, author Ken Harrison offers advice for using the body to enhance communication while wearing PPE.  Recommendations include maintaining a relaxed posture and using hands and arms to reinforce the words that are spoken.  Stand where you can see one another’s facial expressions.  Psychology Today author Karen Krauss Whitbourne notes that the eyes tell the story when it is difficult to hear words.  Joy, fear, anxiety, and excitement are all expressed through the eyes and eyebrows add emphasis.  Use them to your advantage when your words are difficult to understand.

Gestures and nods.  Several years ago, I was told that traveling in Italy is easy because Italians talk with their hands; just ask for directions and watch their hands.   When in PPE, do as the Romans and use your hands to reinforce your words.  If you need two syringes, hold up two fingers. When a patient needs to move to a new position, use your hands to indicate what you want the patient or your assistant to do.  While talking to another person, use head nods to indicate understanding of what was said.

Flash cards and pictures.  Being sick, fearing death, and receiving treatment from people in space suits can be very frightening.  Take and print a picture of yourself, wrap it in plastic and pin it to the outside of your gown to let patients know that there is a human inside.  Create flash cards for instructions that are frequently given to patients and hold them up as you talk to the patient.  As above, use your eyes, gestures, and body language to reinforce the message you are sending.

The COVID crisis has caused healthcare workers to pause and re-define their workflow to ensure that patients receive effective treatment while solidifying the safety of providers.  The first step toward safety is to become aware that others may not understand what you say, and the second step is to immediately halt the other person and ask for clarification if you do not understand them.  With some thought and pre-planning, the barriers put in place to protect providers need not pose a threat to those in need of their care.  Rather than behaving like the pilot sitting on a foggy runway and taking action based on a garbled message, use all your resources to creatively ensure that messages are accurately sent and received.  Who knows, learning to speak loudly while using facial expressions and hand gestures might position you for a career on stage when theaters reopen.   

Tom is a published author, skilled anesthetist, proven leader, and frequently requested speaker.  Click here to view current topics ready for presentation.