Risk Management

For the last unit of the course, this was a good one to bring some things together.  I always knew that part of the nurse manager’s job was putting out fires and dealing with problems, but I don’t think I really ever would have thought to call it risk management, but that is exactly what it is and what things escalate to require when not managed at a smaller level.  It was good to learn more about the risk management process and to look at ways to manage the problems that persist.  I have also come to realize the importance the risk management plays in health care, and how much it encompasses. 

I really liked the discussion and the lecture from the risk management person for the south region at IHC.  She helped to put some things into perspective.  She helped explain things in a way that helped risk management make more sense.  The discussion also helped to really make me think about how things happen and the ramifications of our actions.  The scenario is something that I have had to deal with, in the fact that I’ve had very combative patients that needed to be restrained, and I have had similar thoughts to the nurse in the scenario, I’m just glad that nothing happened, but it makes me think about the problems that can arise. 

This information, as I stated above, will have a number of uses in my career, whether I get into management or not.  This is definitely helpful for charge nurses, but also for the staff nurse, and thinking about the actions that we have.  As we are in health care, we will always be scrutinized and looked at through a magnifying glass.  We need to make sure to protect our licenses, as that is our livelihood. 

Motivation and Collective Bargaining

This was an interesting unit, as I don't think that I really knew how collective bargaining agreements worked, aside from the fact that it was between an employer and a union, which I learned from being a sports fan.  The thing that I liked the most was learning more about the unions and the pros and cons associated with it.  The employment laws will vary from place to place, but this is a good base to build upon or refer back to.  Motivating is important when it comes to the nurse leader’s employees.  The best ways to maximize motivation through leadership methods.  Also, I would have never known that a formal reward system would have to be taxed, but it does make sense and it is worth it from a leadership and employee standpoint. 

I really enjoyed the activities and discussions.  They helped to put the collective bargaining assignment into perspective of seeing the different sides (employees and employers). Also, the discussions were great to see the different perspectives that people can take on an assignment.  I am a big self motivator, so I think I had a hard time coming up with things that will help motivate others, but it was good to see how the girls in the group would motivate others, especially since most nurses are still women. 

I will use this moving forward in my career.  It will impact whether or not I work for a facility that has unionized employees.  As of right now, I don't think that I would want to be a part of one.  There are definitely a number of pros, but I mostly want to be able to stand up for myself and my own merits and I feel I will do much better for myself.  Also, I like trying to motivate my fellow employees to work harder to see how it would work. 

Each and every individual person has the right to feel however they want to feel, but we can definitely make a difference in the environment that surrounds us.  It is the responsibility of the nurse leader to establish a work climate that motivates others to accomplish organizational goals while addressing individual employee needs.  Hopefully all the employees will take it upon themselves to motivate each other and make the place of employment a better place to be.  I know I will. 

Conflict Resolution

I learned that there are multiple ways to handle conflict.  We all have a default way that we handle conflict which may be completely different from our neighbor or co-workers way to handle conflict.  We need to find what works for that individual.  I learned that conflict isn't always a bad thing.  Many times when we have a conflict in one part of our life it can spill over into other parts of our lives. 

                I really liked the activities associated with this section.  The discussion was a great forum to be able to express our different opinions about conflict and certain types of communication that are involved with conflict.  It was a great way to see how differently people view and perceive conflict and to help remember that this is the way it will be in the workplace.  I also liked the movie “The Guardian.”  It was a wonderful depiction of conflict and the ways that different people can view and deal with conflict and think that others don’t understand what they are going through. 

                I will utilize the information I learned by making sure I use effective communication techniques when I'm involved in a conflict with a coworker or someone at work.  I need to realize what battles are worth fighting for.  I need to make sure that I stick up for myself and not let people walk over me.  And I will be able to know that while we might all be working toward a common goal, many people will have different approaches to getting there. 

                As much as we would rather just think positively and believe that everything will just work out, it is necessary to know that conflict is everywhere around us.  Perception is a big part of conflict and being willing to work with other is important.  I have learned techniques that will be able to help me deal with conflict in the future.  

Strategic Planning

I expected to learn what strategic planning is and feel that I have a better grasp now.  I actually learned that there is a lot more to strategic planning than I thought. I learned that strategic planning has been used in multiple professions. Strategic planning has multiple elements that need to be considered.

I enjoyed the strategic planning activity as a team and helped me to understand what it takes to make a strategic plan.  The plan was more difficult that I originally thought and we had unlimited resources, so I can only imagine what it takes when there are limited resources.  It was also interesting to see the different perspectives that people have and the ways that people approach a strategic plan.  I also liked the discussion and the different views that people had on the types of classes and programs that should be offered. 

I will utilize the information I learned into my nursing practice by looking for strategic planning committees. I will look more into the graduate schools offered in the state. I will be most respectful and interested when changing is coming and how I can be involved in the planning.

Overall, I feel that this was an interesting topic. I had never really considered it before. I feel that there are so many elements and behind the scenes committees that make healthcare work.  It was cool learning about strategic planning.

Managing Change

I wanted to learn more about change and how it impacts different people in different ways.  I also wanted to learn more about the ways that change happens in the workplace and the best way to implement change to lessen the impact on the staff.  I do feel that I was able to learn quite a bit more about the ways that people are affected by change.  I learned that I like the book/video "Who Moved the Cheese."  I also learned there are people that actually like it when things change, and I think that I might have a little bit of that in me.  I like to see progression, and often times that means change is inevitable. 

I enjoyed the video of "Who Moved the Cheese," and the discussion that followed.  It was a great way to learn a bit more about my team and how they handle change and how they perceive change in the workplace.  I also liked the assignment related to the Power article.   It brought up things about men and women in the workplace and perceptions.  While talking about change, that is something that needs to be changed.  Both the stigma of men in nursing, and also women, in general, in the workplace being lesser then men.  Neither of those are true.  

I will use this information gained in this lesson to be able to help those around me at work and other places to realize that change is bound to happen and realize it is better to embrace it than fight against it, because all it will do is leave us unhappy and dissatisfied with life.  While change isn't always easy to take, it is important to continue to progress forward.  

Budgeting Interview

This week, we had to conduct a budgeting interview.  I chose to interview an individual that is in charge of business operations and finances at a small electronic hardware company.  His name is Steven and he is also co-owner.  My team came up with the following questions for our interview:

1. What is the most difficult aspect of budgeting?

Taking the time to do it.  Doing a budget isn’t rocket science, he said. It is merely creating something and sticking to it.  He said they weren’t very good at it when they first started about 12 years ago, but they have gotten to where it doesn’t take nearly the same amount of time as it used to. 

2. What areas of the budget are the first to be affected when making cuts?

He said that there are standard costs that have to be done every month, such as required supplies, rent, utilities, and salaries.  The first things that get cut are marketing expenses, part-time employee hours, and the owners pay. 

3. What do you enjoy most about creating a budget?

He says that he is a self-proclaimed nerd.  The thing he enjoys the most is the numbers and the spreadsheets.  He said that it sounds dumb, but it still gets him excited to make a new budget.  Also, when he sees how well they are doing, it makes him happy. 

4. How much flexibility do you allow in your budget?

Steven said that this question depended on the definition of flexibility.  If it means to spend more than what is budgeted, then no flexibility.  If it means that midway through the year, the budget can be altered to for something specific following a meeting of those that need to be involved, then there can be a lot of flexibility.  As long as the individuals who oversee the spending and budgeting are aware of the changes that need to be made, then it is important to feel free to make changes as they arise so as to always be working with the best information. 

5. What are your feelings on making annual budgets widely available for publicly traded companies?

They are a pretty small outfit, so he didn’t really know much in terms of that.  He and his business partner have talked about making their budget known to the staff of their employees, but they chose not to, as it wasn’t really necessary.  Also, each department knows what they have to work with within the budget and can always requisition for changes. 

6. How many previous years’ budgets weigh into the decisions for the current year's budget?

Definitely 1 year, and sometimes it is good to look another year or so for comparison.  It is good to see where things were, so that plans can be made in terms of expectations.  It is also important to take into account all of the reasons for the budget and year doing what they did in the past. 

7. How accurate do you budget; do you budget down to the penny or do you tend to be more liberal with your budget?

He said that they place a cushion in most areas, but that cushion has gotten smaller and smaller the better they get at budgeting.  It isn’t down to exact pennies in the budget unless it is an expense that never changes.  The budget is round numbers based on information gathered and then the actually spending is obviously tracked to the exact penny. 

8. How does going over the budget affect you or your team?

Steven said that going over the budget is not an option.  Aside from the first few months in business when they were working out the kinks in the budget, they have never gone over budget and it is because that is a priority that was made a long time ago. 

9. How much influence do you have on your budget versus getting it handed down to you from corporate?

He and his partner have full decision making abilities in regard to the budget since they are the highest up that it goes.  They do not have a corporate entity to answer to. 

10. How would you change corporate’s budgeting style?

As he is a small business, this question didn’t apply to him.  There isn’t a corporate to report to. 

11. What do you do when you go over your budget?

They have a once a month budget planning meeting and a once a year meeting to look at previous months and years and make decisions based on current business and projects that are in the works.  They also look at marketing and planning for the future.  They will also hold a special meeting as needed to make any changes to the current budget if there is a need expressed to do so. 

12. What does corporate do when you go over your budget?

As they are a small operation, this question did not apply to him or his business. 

13. Has the budget ever been so restrictive that it prevented you from doing the job properly?

He doesn’t feel that a budget is restrictive.  It is more freeing.  It is what allows you to do things, because it has been budgeted to do that thing, whatever it might be. 

14. How important is staying in the budget?

One of the most important things about running a small business is being able to stay within a budget.  His estimation is that not staying in the budget is probably one of the top reasons a company will go out of business. 

15. What are some things in your budget that may not typically be thought of as important to include in a budget?

He initially said toilet paper in jest, but said that if money is going to be spent on something then it is important and needs to be included in the budget.

From this interview I learned that there is a lot that goes into budgets.  I discovered that I don't want to work in the budget department.  There is too much pressure to make sure the money is going to all the sources that it needs to be going.  I get a headache just from figure out my own personal budget.  I respect the people that do work with budgets though.

Staffing and Career Development

This week, I expected to learn more about helping myself and others to develop a plan and a career.  I also wanted to learn more about staffing and what it takes to staff a unit in the hospital, and the role that the nurse manager plays in that process.  Most importantly, I wanted to take a introspective look at my own career as it is in the beginning stages and make some plans for the future.  

The group assignment on staffing was a fantastic way of looking at what it really takes to staff a unit.  It is not as simple as it might initially seem, and while realistic, it was even easier than real life.  It showed how much time it can take to do staffing.  The staffing discussion was also good to look at the ways that different places do staffing and see the pros and cons of each type.  The career development discussion and activity was good to see what others are planning to do and to be a help in coming up with things they might not have thought of in their own plans.  

In my current nursing practice, I will have much more respect and appreciation for my manager and those that work on the schedule for my unit.  It is very time consuming and everyone will ultimately not ever be pleased with the decision.  You just need to do what is best for the unit and try to accommodate as many as possible while making the staffing the priority.  I will also always have a plan for my nursing career and life in terms of moving forward, so my career development doesn't become stagnant and suffer.