Do you ever wake and feel like your whole day is going to be great and then your entire morning falls apart? Sometimes we make plans for what we think our life should be like but then life throws a curveball. I travel locally for work in Gainesville, Brevard, Marion, Tampa, and Orlando region. I used to hate traveling and would never take jobs requiring travel, but about two years ago I took the plunge to work for myself. I am a nurse consultant and I manage clients who need medical attention after suffering injuries and clients who are homebound. I love what I do now as I can help clients get what they need.
So circling back to my perfectly laid out day that didn’t happen, I was not at peace with the world. All it takes is one rude comment, one complication, or really anything outside of our perfect plan to make our mood change. For me it was just that and as I drove in my car to see clients, I started to listen to my favorite Christian radio station z88.3 and the disc jockey shared the following verse “charm is deceptive, and beauty is fleeting, but a woman who fears the Lord is to be praised. ” Proverbs 31:30. This very verse is what is on my pageant business cards. Why I chose this verse is because as a pageant queen our exteriors can be all glammed up but our interior can be broken and we are just putting on a show to save face. So to me, this verse is a daily reminder that my job is to serve the Lord daily and not get hung up on how imperfect my day started. When I heard it on the radio today it spoke to my heart and reminded me that I need to pray.
As I drove to Melbourne today admiring the beauty of nature, I meditated on Proverbs 31:30 and prayed for forgiveness of ever doubting that God always steers us to His plan. Here is my view today as I wait on a client. I can feel the warm spring breeze gently rustling the leaves on the trees, the sun shining, and the absolute silence in this parking lot of a medical plaza. Not one person is seen walking here, no through traffic of cars; just silence. I think it was for sure a divine appointment for a reflection of my soul.
When I was a manager of a team of nurses and social workers, collaboration existed in my direct report team, and as a team, we functioned using critical thinking, interdisciplinary team approach and collaboration on cases together. But in the big picture of corporate America under the manager that I reported to, this was not acceptable, it was more along the lines of a multidisciplinary team. In this type of team, you only have individual thinking in the group, meaning their way and no other opinions. The focus would be on tasks and check off systems regardless if it was feasible to do (Rubenfeld & Scheffer, 2014).
Nurses do have the ability to be leaders, educators and changers of a system, if assertive enough to make that change, but in order to do so, a good team of interprofessional people is needed (Denisco & Barker, 2012). Because at the end of the day, the patient is who counts and why changes are necessary. If more companies were focused on having a management style that was transformational vs transactional, this would alleviate the unnecessary resignation of employees, corrective action plans and disgruntled employees.
In my team, for instance, a good way that we incorporated learning was to have one person do a case study every week. They would team up with another person on the team to present the case study on a difficult patient. During this time the team had the ability to comment on the case, make suggestions and also refer to our medical director for review. This allowed me to mentor the nurses and social workers during our weekly meetings so that we could continue to go over any other cases that may have been difficult or of concern to them.
Denisco, S. M., & Barker, A. M. (2012). 25. Advanced practice nursing: Evolving rules for the transformation of the profession (2nd ed., pp. 547-567). [Vital Source Bookshelf] Retrieved from https://campus.capella.edu/web/library/home
Rubenfeld, M. G., & Scheffer, B. (2014). Critical thinking and patient-centered care. Critical thinking tactics for nurses: achieving the IOM competencies (3rd ed., pp. 155-180). [Vital Source Bookshelf]. Retrieved from https://campus.capella.edu/web/library/home
I had the opportunity to interview Mary Alice Cullen, a Director of Patient Care Services. She oversees the Neonatal Intensive Care Unit (NICU), labor and delivery, pediatrics, maternity ward, and the women’s clinic. Mary graduated in May, 2016 with her Doctorate of Nurse Practice. Mary has always wanted to get her MSN. As she started to study to get her MSN, it opened her eyes to endless possibilities of what she could do with her degree. When she graduated with her MSN, the position that she was in opened up for her and she took on the job. As she went through her role she wanted to make more of an impact on the role and the clients and staff she was supporting. Mary decided to continue school for her Doctorate in Nurse Practice (DNP) with a concentration on Executive Doctorate in Nurse Practice, and this degree is also approved by the American Nurses Credentialing Center (ANCC). Her attributes are that of a caring leader, one that will work with her staff to encourage and teach them and empower them to be the best that they can be, even when they do not see that they can.
Mary does not often do hands-on care she is in an executive role. However, she does round daily. She provides support to her managers that manage the staff, in order to provide better care for the patients. Her leadership model is Kouzes and Posner, but if she is scrubbed in for surgery in labor and delivery, her transactional model side comes out. Meaning this is a time as a transactional manager, where following directions the same way every day is crucial. Mary most recently participated in a study that involved strategic planning of having single-family NICU rooms for the parents. These were her visionary plans and the hospital agreed after the research was completed, that having individualized patient rooms in the NICU, would benefit the staff and the parents of the babies.
My leadership style is very similar to Mary’s in that I lead by example and I am not afraid to do the work that my staff does. This makes a strong leader because the people who follow you will know that although you are in a position of higher authority, you will still be humble enough to do the job your staff does and be able to explain it from their side and understand the position that they are in. Knowing your staff’s job by example, allows the manager to know the timeliness of things that need to be accomplished and the ability of each worker’s caseload and what they can manage. There are seven attributes to being a good leader and Mary possesses those in her character, her track record to be given assignments and projects that have been successful and in the skills that she shows handling her staff (Baer, 2012).
I remember most recently having a bad reaction to zinc when I took it on an empty stomach (yes learned that lesson) and passing out with blood pressure and blood sugar bottoming out. I felt better on the ambulance ride to the hospital after some IV fluids. The paramedics stayed with me until they had a room to take me to for an exam. But the nurse then said since I was feeling better, I can get up off the stretcher and wait in the regular waiting room. They sent an orderly to walk me to the waiting room. I had my purse, winter coat, boots in one hand and my work bag in the other hand. The orderly did not offer to get a wheelchair to help me considering I had just passed out an hour ago. I thought to myself at that moment boy he is rude as he walked 20 feet ahead never looking back to see if I was okay and two, never offered to help carry anything. My husband arrived minutes later and was appalled at the treatment of a patient this way.
Now at this moment, I still have not been seen for any lab work or by a doctor. When I finally got into a room two hours later, the doctor did not come in for another hour and a half. When he came in, he was there a whole 2 minutes and said we are going to send you for some chest x-rays, lab work, EKG and put you on a heart monitor and watch you for 23 hours. I said wait, I had a bad reaction to a medication how do you derive at all this in a 2 minutes checkup? The best part is where they make you wait for 23 hours is an open room with many other patients looking at you from across the hall. This triage area does not have curtains, it is a holding area. I grabbed my things and said I will see my regular doctor thank you very much.
I cannot understand legally or ethically how patients can be treated this way. Is there not a policy in hospitals that they must follow to give better patient-centered care? As in the Colorado model, it states there should be a management leader looking out for the rest of the team to be sure that patients are being informed of things and being involved in their care as opposed to left alone for hours at a time and not a single explanation of care and why it is being ordered (Goode, Fink, Krugman, Oman, & Traditi, 2010).
Goode, C. J., Fink, R. M., Krugman, M., Oman, K. S., & Traditi, L. K. (2010, August 10). The Colorado patient-centered interprofessional evidence-based practice model: A framework for transformation. Worldviews on Evidence-Based Nursing, 96-105.
Most recently I was asked to comment on whether during the second stage of labor ( which is the onset of full cervical dilation) should be passive descent vs. pushing. In my opinion, it all depends on what policy the treating practitioner uses. I worked at a high level labor and delivery unit up North where women were flown in if it was an emergency or bad delivery anticipated or trauma. But we also were a Catholic Hospital and took care of the indigent. We had a teen obstetrics clinic in the area (not related to the hospital) but it was across the street. They handled all the teenage pregnancies that came through their doors. It was managed by two very caring midwives. At this clinic, the girls not only received prenatal care but they also received information on how to take care of their babies. The girls were referred to pediatricians to get healthcare for the babies and to school counselors to help them get their GED’s. But the best part was that these midwives taught natural childbirth at their clinic. When a girl came into labor, they went into the birthing room and they did perineal massage to do natural descent. They worked with the contractions. These girls rarely had any perineal tears.
One day one of the midwives was on vacation and the other one was in the clinic and could not get there this one time and one of their girls came in almost completely dilated and effaced. The resident on duty that evening was one of the most arrogant doctors I had ever seen, he had smart remarks before he even got in the room with her. He went inside to do her exam and he rammed into her and the girl nearly jumped three feet, I calmed her down as she was a scared 15-year-old girl. She screamed and he said listen you had something much bigger in there than my finger, I quickly stated, doctor that is enough. He said, yes she is dilated, get her in the delivery room, I said that the girls go to the birthing rooms and deliver there in a more holistic approach; his reply was, we don’t have time for that garbage, get her pushing and delivered. This poor child gave birth and had tears from front to back, she was in such pain, as she could not have an epidural or pain meds since she was already effaced and 10 cm. I did not have kids at that time, but could only imagine by the grips of my hand and the tears and screaming that she was suffering. I was barely 21 years old. The midwife came finally after she closed the clinic at 7pm to check on her patient and was so angry after the patient told her what happened. She brought up the incident to the hospital administrator who placed the doctor on probation. He had a few incidents with me and some other nurses and eventually was fired from the residency at that hospital. Knowing the hospital’s practice for each unit and also what the practitioner believes is very important (Denisco & Barker, 2012). Some doctors will approach labor and delivery with a more holistic approach. This would be an approach that Jean Watson’s theory on caring would fit in to.