Lesson 12: Performance Appraisals and Dealing with Problem Employees

-Imagine you are a nurse manager and record ways of terminating an employee-

First of all, let me just put out there in the universe that I do not ever want to be in a situation where I have to terminate an employee. 

I feel the text hat some good idea of how things should go when an employee must be terminated. The four steps it outlines are:

1.  Calmly state the reasons for dismissal.

2.  Explain the employment termination process.

3.  Ask for employee input.

4.  End the meeting on a positive note, if possible.

I feel that this would be an ideal way to terminate an employee. The reality of this actually happening are dependent on the relationship that already exists between the employer and the employee. If the relationship is cordial, than I think the above steps could actually happen. I also believe that if an employee has reached the point of termination, it's most likely not going to come out of the blue. In most corporations or businesses, there are a series of steps that must be completed before termination and sot he employee would have been given time to modify their actions before being terminated. 

In a situation where the above steps were not possible, I believe it would be because the employee did not know the termination was coming. But, in reality i don't know how this is ever really plausible. If an employee has been dishonest in some way, and thereby circumventing the steps that usually occur before termination, they have got to have some idea that they are going to be caught sooner or later. The above steps most likely would not happen because the employee would start to rant and rave and blah, blah, blah....you know, the wicked take the truth to be hard.

Lesson 11: The Nurse Manager’s Role in Quality Control

What do you consider elements of quality care when receiving healthcare services?

 The biggest element of quality care when I am the patient is how the nurse makes me feel. Being the patient puts you in a very vulnerable position. I've had surgeries, emergency room visits, lots of tests,  and hospital stays and the thing I always remember is how the nurse treated me. A long wait in pre-op is made bearable by an attentive and caring nurse. The fear of tests that can be painful is lessened when the nurse really cares. The entire situation is affected by the nurse.

What do you consider elements of quality care as a professional nurse?

I think the biggest element of quality care on the nursing end also has to do with the attitud e of the nurse. Ensuring the patient receives the best care possible is my number one goal as a nurse, and I believe the core of the care is the atmosphere that is set by my attitude as I provide that care. I understand, more than I would like to, that medical care is a business and as such there are certain responsibilities. However, my patient does not care about that. All they care about is that they are being taken care of at a vulnerable time in their lives.

Are the two similar or different?

Obviously, I feel that the two are pretty much the same. I think what I consider as the keystone of quality of care as a patient greatly influences the care I give as a nurse and what I see as key to delivering quality care. I think had I not needed to be cared for nurses throughout my life, I would probably see things differently, and perhaps on a more clinical side of things. But the care I received greatly influenced the care that I give. 

Lesson 10: Conflict Resolution Collective Bargaining, Unionization and Employment Law

While  I was working at an upscale assisted living center as a nurse, a new nurse was hired to be our Enhanced Care Coordinator. The woman, who I will call Laurie, was a very passive aggressive person which was the cause of a large amount of conflict.

One time in particular, I had been charting in the new "nurses" office in our enhanced care unit. Lisa came in and said, "I want you to know that I'm fine with you using the office to chart, but Mary (the facility administrator) has asked that it be used only by administration. I'm fine with it, but if she sees you in here charting, she may say something." I said "Okay" and in my mind thought, "I'll just walk down and talk with Mary and get permission to chart in the new office." An hour or so later, after Laurie had gone home, another member of the staff said, "So I hear you were kicked out of the office." I stared blankly, not knowing what she was talking about. Turns out after her conversation with me, Laurie had gone to other staff and said, "I have told Somer in very clear terms that she is not to be in this office and she keeps pushing the boundaries and charting in here." Since I am not one to sit by when my reputation is being impacted negatively, I asked her about it the next day...

"Why did you say you were okay with me charting in the office and that Mary objected to it when you are the one who had a problem?"

She game me some run around about how I'm "scary" to talk to so she thought I'd take her more seriously if she used Mary's name. I asked her the next time she had a concern to please speak with me herself instead of talking about me behind my back. However, it didn't stop. Laurie continued to talk to other staff negatively about me behind my back, telling them things that were not true. Since I had already spoken with her directly to try and resolve the issue I took it to our director of nursing, the next step in the process. I explained the situation and asked that he please talk to Laurie.

More than two months passed and nothing happened. I went back in to the DON to explain that the back biting was still a regular occurrence and to follow up on why he had not taken any action. He explained that he liked to take an approach to "sit and watch" and that things would eventually work themselves out. Work our they did as I got tired of hearing daily reports from other employees on what had been said about me and found another job. Thankfully, my fellow coworkers knew me and did not put any stock in the negative things Laurie was saying about me on a daily basis.

Had I been a nurse manager, or the director of nursing in this case, I would have handled the situation completely different. If my employee had come to me with the same concern I brought to my DON, I would have first pulled Laurie into my office and explained that staff had a concern with her and there were reports of this specific behavior, and that the employee had reported that she had already approached Laurie with the concern and they felt like the issue had not been resolved. After listening to Laurie's side of the story I would encourage her to approach the concerned staff member to work things out. Then, if the situation still persisted, I would call both parties into my office and facilitate some open communication between them to see if the issue could then be resolved.

Lesson 9: Creating a Motivating Climate Organizational, Interpersonal and Group Communication

--Motivation: The force within an individual that influences or directs behavior--

So what motivates me to act? It depends on what the situation is. For some things it's obvious. If it's something I want the motivation is intrinsic. When the goal is to achieve something others expect of me, it's extrinsic. For the achieving of other goals, however, the motivation is not so clear. Take, for example, the completing of this reflective journal/blog. I feel it is mostly busy work. I don't feel that I benefit from it or that it contributes to my nursing abilities in anyway. So, there is definitely not any intrinsic motivation there. However, I want to graduate with my Bachelors degree, and to do so I need to pass this class, so there in lies some intrinsic motivation. Passing this class requires that I read the text and write these blogs, and that brings in the extrinsic motivation. 

With the majority of things in my life, however, the majority of the motivation comes from inside me. I have set goals for myself and I want to achieve them, so the motivation is intrinsic. Even with my career. I have always wanted to be a nurse and help people. The decision was never because of money, or scheduling, but because I have an inherent desire to take care of people. I think my classmates have heard me say at least 100 times over the last three semesters that if I could have provided for myself and family by remaining a CNA and providing the hands on bed side care that I love, I would have stayed a CNA forever. But, I do need to provide for myself and my family and so I require higher pay, which is definitely an external motivation. 

The way with which I perform my duties in my job are motivated intrinsically as well. Before starting my job at the boys ranch, I worked in geriatrics for almost 14 years. I worked hard and did my job to the best of my ability because I loved my residents and wanted them to have the best care possible. I did it regardless of pay or staffing. At the last facility I worked, the memory support unit had an RN that was the coordinator of care for that section of the facility. From the moment she started the moral of the staff, the residents, and the resident's families changed. This nurse did not know how to motivate effectively. She often cut employees down to others in the same position to try and motivate them to do better. Instead she only succeeded to violate the trust of the staff. When I approached her and directly brought this to her attention she became defensive and placed blame on the fact that she was new to the facility and trying to fit in. Things never changed and staff continued to distrust any praise she gave them directly as it was nullified by the things that were said behind their back. 

I feel that managers can have such a positive impact on motivating their staff. Simple words of praise and recognition can make a large impact on increasing the spirit of morale and a desire to do their best work. Also, when I work with other staff and team members who are appropriately motivated, it motivates me to work at a level that exhibits my best self and best abilities.

Lesson 8: Nurse Manager’s Roles and Functions in Hiring, Team Building and Staffing Career Development Stages and Personal Career Development

-Thoughtfully record a personal career development plan-

I always thought I had the path my nursing career would take mapped out. Go to school, graduate, pass NCLEX and get my RN, get a job at the hospital (preferably in labor and delivery).  Simple as that. I'd gotten every job I'd ever applied for...until I graduated from nursing school. I had applied to over 80 jobs and had only TWO interviews in the space of a year. I knew the economy for nursing jobs in UT was tough, so I wasn't too discouraged until one of my classmates who had never had a job, EVER, had interview after interview and was hired at UVRMC. Needless to say, the career path I had always imagined did not come to pass...

I recently, like 8 weeks ago, started working as THE nurse at a residential treatment facility for teens. While I love my job, and I truly do, I have struggled with accepting the title of nurse in this role because it is not what I envision a nurse to be. When I pictured myself as a nurse I pictured myself in scrubs, walking the halls of the hospital, providing bedside care, and (ideally) helping to bring new lives into the world. Reconciling my current job with my identity as a nurse has been challenging, and the path I always envisioned and planned on my career following has taken an unexpected turn. So, currently my career path is under construction. I'm grateful to have a job that I love, pays the bills, and is willing to work with my crazy school schedule. The last few years have been so crazy and busy I'm excited to graduate and enjoy traveling down the career path on cruise control for a year or two. Then, I'll pull out the map and re-evaluate where I am and where I want to go.

Goal #3: Learn more about the balance the budget. What's involved? What are the different parts of a budget?

If anything turns me off of ever aspiring to positions of leadership or management, is the four letter word BUDGET. I learned, today, that the budget is something that Dave must think about on a daily basis. Each morning his secretary and right hand, Elaine, bring him a report of the employee hours. It lists how many hours each employee is allotted each pay period, how many they are working that day, and how many hours they are scheduled for the day. The purpose of the report is to help him stay on budget in the area of staff salary.

The topic of staff hours was a hot button issue today. the budget from the previous week showed that UVOC Surgical Center was 5 FTEs over budget. Before we could get anywhere, Dave had to explain to me what an FTE is. One FTE is worth 40 hours, so it is equal to one full time employee's hours. This means that for the week prior, the surgical staff had worked 200 extra hours. Not a good thing. Elaine came in and she, Dave, and I went over the prior weeks schedule to locate where the extra hours were worked, as well as the schedule for the coming month. It was really interesting and educational to see the process in motion. We found that one place a lot of time was being wasted was in the department of the anesthesia techs. On the days that there is a short shift, one tech comes into relieve another one. Time was being lost because the on coming tech was not as fast as they could changing into their green scrubs and getting report as quickly as they could. Then, too much chit-chatting was happening during report. Lastly, the leaving tech was not as quick as they could be in changing back into their street clothes and clocking out. After this was determined, Dave called the anesthesia techs into his office and had a short huddle to explain the situation and ask them all to do better.

So, today I saw just one aspect of the budget and staying within it. I'm sure there will be other opportunities to learn more....lots more.

Clinical: Day Three

Today Dave and I were, finally, able to discuss what I might do for my project and I think we've got it pinpointed! Back in January where there was a situation and a Code Red alarm went off. However, there was no overhead page, so the staff assumed it was a mock code and did not do anything. It wasn't until the fire department showed up that everyone new there was a real situation. Also, the PBX operators, that are in charge of notifying engineering and security, did not let anyone know that an alarm was sounding.
So, for my project, I'm going to rewrite the Code Red protocol for the surgical center. I think this will be a good project for me to work on. I'll need to meet with someone from the engineering department as well as PBX to identify where the communication breakdown are happening, as well as what should be happening during a Code Red situation.

Lesson 7: Managing Healthcare Resources

I struggle with the topic of health care budgets. I became a nurse because I want to help people. I know I've said it before, but the further I get into the bachelors program, the more I find out that nursing has evolved into an entirely new animal, and the less certain I become that I want to be a part of it. Healthcare is a business. I understand that it always has been, but it seems it's becoming more about padding the pockets of business men than serving others. Budgets are an important part of business, even a business that seeks to help others. However, I feel there has got to be a balance.

If I you'll allow me, may I illustrate with a story:

I started working as a CNA when I was 16. I worked at a 30 bed skilled nursing facility that had been owned by the same family for over 30 years. The owner, Maxine, did not actively work at the facility, but she was very involved. She knew all the residents and their families. Her daughters worked as nurses, and recreational therapists, grand kids worked as CNAs and kitchen help, and those of us that which were not family were made to feel like we were. Staff ate what the residents ate. Our pay was competitive. The best briefs on the market were used for the residents. The budget was maintained and the owner still made a good amount of profit and lived a comfortable life. Then, through some rather unfortunate and rather sneaky turn of events, the business was purchased by a couple of men who sought to create a chain of nursing homes. They wanted to make money. The new owners changed to a cheaper brand of brief, and increased cost to residents. The new brief were still considered within the guidelines of quality care, but they sucked! Funny I should remember the briefs the most. Food quality went down and staff no longer was allowed to eat food from the kitchen. To make a long story shorter, patient and staff satisfaction declined greatly and within 5 years the facility closed. I suppose this is what has embittered me to the money making side of health care.

Lesson 6: The Nurse Leader’s Role in Managing Change

As is expected, I am resistant to change. However, everything changes. As the old adage says, the only thing constant is change. It usually seem I've just settled comfortably back into life when the winds of change blow again. Usually, it's not until after the page has been turned that I see the benefits of the change. the funny thing is I spend a lot of time and energy wishing and hoping for change. I seem to live my life waiting for change, for when school is over or when I have a better job, instead of living in the now. So I suppose I see change as a double edged sword. 

I have learned some tactics for embracing change more readily. One of which was even discussed in the book, so I must be on the right track! My preferred tactic for change is planning for change. If I am in control of the change, I always feel better. I can make my list, check it twice, and see the progress of the change. This same process works if I am not the one in charge of what is being changed as well. As the book points out, when I am included in the process I feel that I my opinion is valued and therefore, I am valued as well. It also allows me to plan, making the change to which I am resistant a little bit easier to handle.

Goal #4: Understand the role of the unit in promoting patient satisfaction including the best care

Funny that the clincal goal listed as number 4 is the first one I feel was accomplished. Today Dave showed me how patient satisfation is recorded in HCAHPS scores. These are reports that track the units deficiencies and goals met, and are based of the WOW cards that patients are asked to fill out before being discharged to go home.

After we reviewed the HCAHPS scores from January, Dave explained that there are certain steps he takes to help improve these scores. One way is by patient rounding. The nurse manager is responsible to round on a certain number of patients per week to find out the quality of care the patient has been given as well as offer any care that is needed at that time. During our rounding that day, most of the patient and family were so nice, but I was suprised by the few that had negative things to say about their time at the surgical center. It was then Dave's job to try and smooth things over so the patient would leave happy... and hopefully their stay would reflect positively in the HCAHPS scores.

Another thing that contributes to patient satisfaction are the "Thank you" cards that are sent to each patient. This is delegated out the the nurse responsible for the individual patient. At first I thought it was pretty cheesy to send out a generic card that everyone hurridly signs, but then I saw that the nurses were actually writing things that were applicable to each patient and the interaction they had with them.

The WOW cards are given to Dave daily and he sorts through them and analyzes what factors contributed to the patient be satisfied with their care. Some of them are reallly fun to read. The ones that aren't so WOW (I think they are OOPS cards) are usually for things beyond the control of any staff. For example, a surgery has run long so the next case ends up getting started late. If the OOPS cards are very disconcerning, I've seen Dave make phone calls to the individual families to apologize for their unpleasant experience.

So, overall, the until manager has a large part to play in promoting patient satisfaction.

Clinical: Day Two

Today I had an opportunity to see a bit about the various roles and responsibilities of the nurse manager. all I could think was, "Poor Dave."  It was also an example how one event has a ripple effect on all the areas of the surgical center.

It all started when Dr. A an additional case on his morning case load that the surgical center was not aware of. Apparently, t It wasn't a big surgery and would only take about 45 minutes to complete. So, the OR charge nurse let the SDS charge nurse know to make the pre-op patients aware that things were running a little bit behind. Then, the OR charge nurse called the next surgeon, Dr. B, to let her know that her cases would be starting about 30 minutes late, to which Dr. B replied she was going to cancel all her cases for the day. Turns out, this particular surgeon has done this before, and then called back and states she changed her mind after the patients had already been called and told their surgeries were cancelled. So, Dave gets busy calling Dr. Bigler (the surgical center's medical director) to explain the situation and the staff's concern that once they call and cancel Dr. B's patients for the day, she will again change her mind and they will be in a new mess. Dr. Bigler relay's that he had spoken with Dr. B the previous night and that she was having a difficult time finding a proctor to attend her surgeries and that he was surprised to learn she hadn't called and cancelled her cases the night before. Dave then get's on the phone with Dr. B to confirm that she is not coming in and find, in fact, that it is the lack of a proctor that is the problem and the 30 minute delay was the out she needed to cancel her cases. After speaking with all of the doctors, Dave then gets on the phone personally calling to cancel Dr. B's patients and apologize for the inconvenience.

The situation was so frustrated and could have been prevented several ways. First of all there was a communication breakdown between Dr. A's office and the surgical center. Because UVOC didn't know of the additional case until the patient was checking in, that set things back about 30 minutes. Secondly, if Dr. B had called and cancelled her cases the night before, instead of waiting until 30 minutes before her patients were supposed to arrive at UVOC. I'm sure the patients were frustrated as well, because they had not eaten since midnight and had cleared out the entire day for their surgeries.

I was very impressed with Dave and how well he kept his cool and handled the situation. He communicated with his staff effectively and efficiently and I was also extremely impressed that he took the time to call the patients himself when it would have been easy to delegate, or pass it off, to one of his nurses.

Clinical Goals...

After my first clinical rotation, I feel I've been able to come up with some good goals.

1. Understand the organization of the UVOC health care team(s) and how they work together to meet the needs of the population they serve.
2. Understand the "path" of the patient receiving treatment at UVOC and how the nurse manager influences each step/what the nurse manager is responsible for within each step.
3. Learn more about the balance the budget. What's involved? What are the different parts of a budget?
4. Understand the role of the unit manager in promoting patient satisfaction including the best care.

Lesson 5: Organizational Structure, Power and the Role of the Nurse Leader

The patient care model that is used at the residential treatment program where I work is probably most like that of primary nursing. As the only nursing/medical position on staff, I am responsible for seeing that 100% of patient care is met. My position requires that I develop a relationship with each of the 44 student currently enrolled in our program so that I can get to know their needs specifically and individually and then make a plan to ensure those needs are met. It is my responsibility to communicate with other members of the professional community (including local physicians, dentists, and mental health professionals) and the other members of the treatment to to see that the students medical needs are met. I am also the liaison between the parents and all medical treatment, which also requires that I communicate all medical needs, treatment, and follow-up to the parents of each student.

Power: That which enables one to accomplish goals.
The book describes several different types of power:

• Reward power is gained by grant favors/rewards. 
• Coercive power is punishment power,  which is based on the fear of punishment (transfer, layoff, demotion, or dismissal).
• Legitimate (authority) power is obtained by a title or official position within an organization.
• Expert power is power through knowledge, expertise, or experience.
• Referent power is gained when others identify with that leader or with what that leader symbolizes. 
• Charismatic is personal power. Informational power is gained when people have information that others must have to accomplish their goals.
• Self-power (feminist power) is the power a person gains over his or her own life, which comes from maturity, ego integration, security in relationships, and confidence in one's impulse.

 I feel personal power increases naturally some degree through the process of maturing and growing up. I can help this process and increase my base of personal power as I continue to work to strengthen the personal relationships I currently have, as well as the establishing of new ones. I can further increase my sense of personal power by achieving better balance in my life between work and play. Also, the success seen after the successful accomplishment of newly acquired nursing skills definitely increases the feelings of personal power. I also believe that personal power increases when we aid in empowering another.

I've struggled with people in power in my life because they have often used it in an authoritarian and threatening manner. However, when I started working with mothers over coming substance abuse, a large portion of the psycho education groups were on reclaiming power over your life. I learned so much about myself working there. I think that is why I love the definition of power in the text as that which enables one to accomplish goals. I'm still working on allowing myself to be powerful and to see my goals come to fruition.

Clincal: Day One

I had my first day of clinicals today. I am working at Utah Valley Surgical Center at the Utah Vally Outpatient Center...also know as UVOC...with David Kay. I am grateful to have this opportunity, but at the same time, not nearly as excited as I was during the clinicals for my ADN. I really love hands on patient care and performing the tasks I associate with "being" a nurse. However, I know that I need to be exposed to the other areas and responsibilities of nursing. And, who knows, perhaps it will change the rather poor opinion I have of the business healthcare has become.

One fun thing that happened today: David had a personal appointment to attend to for about an hour this afternoon, so I was able to go into the OR for a rotator cuff  repair. I was standing in the OR trying to stay out of the way as the patient was wheeled in and one of the nurses says, "Somerset! How are you?" I was caught so off guard! First of all, I was completely dressed in...the only part of my body that was visible were my eyes. Secondly, I had no ideas who's eyes were looking back at me. Turned out to be a girl that lived up the street from me until I left on my mission. When I asked how she knew it was me under all that green she said, "I'd know those eyes anywhere."

Lesson 4: Operational and Strategic Planning and the Nurse Leader’s Role In Health Policy

If you fail to plan, you plan to fail...

As I've chapter 7 it has become clear. Without proper planning more time is going to be spent in achieving few goals. The purpose of planning is to decide in advance what to do and how to do it. It is  purposeful and proactive. There are several different kinds of planning and after reading and reviewing each one, it seems to me that the most beneficial mode of planning is that of proactive planning. Instead of waiting until a problem arises or working to maintain status quot, proactive planning considers the past, present, and future in anticipation of a need or problem. When done properly, planning allows for the best use of resources, whether it be time or money, identification of short and long-term goals, and creation of objectives and the organization to achieve these goals.

Just as personal plans and goals are influenced by our personal values, the values and beliefs of an organization shape it's plans and therefore influence what goals are set. Determining the values and beliefs of an organization begins with defining their purpose, or mission statement; the reason the particular organization exists and what it aims to accomplish. The purpose of the organization as set for by the mission statement gives way to an organizational philosophy that further delineates the values and beliefs that direct the actions of the organization. After an organization has developed a set of values and beliefs by defining it's mission and organizational philosophy goals and objectives for achieving their purpose, as well as policies, procedures and rules that guide the way the goals are achieved.

The role of a nurse leader in planning and formulating policy for the organization they work requires they are creative and innovative in identifying goals and objectives so that policy reflects current practice but also leaves room to grow and incorporate views of the future. Because self-awareness influences the way one views the system of beliefs and values, it is also important that a nurse leader provide support staff with opportunities to grow and increase their self-awareness in their individual positions at the organization.

Another key point to being a successful nurse leader in an organization is to have a value system that is consistent with that of the organization. When individual values and beliefs are not congruent with those of the organization, it may result in confusion and anxiety. This internal struggle creates personal conflict and will ultimately lead to job stress and dissatisfaction and eventually job burnout.

Lesson 3: Ethics Ethical and Legal Responsibilities and the Role of the Nurse Leader as Advocate

Ethics, ethics, and more ethics....Sometimes it feels as though we're beating a dead horse. Professional Standards of Nursing was nothing but 16 weeks of the ANA Professional Code of Ethics. Nursing in Health Systems Policy tackled the ethics (or lack of there of) involved in the making of health policy. And now, here it is again. Ethics in leadership. And you know what? I learned something new. Well, I don't know that I really learned anything new, it's more like I had to think about ethics in a new light.

Ethics, according tot he definition in the book, is "the systematic study of what a person's conduct and actions ought to be with regard to self, other human beings, and the environment; it is the justification of what is right or good and the study of what a person's life and relationships ought to be, not necessarily what they are" (pg 68).  Ethics of a profession arise out of the purpose of that profession. For example, in nursing our goal is to protect life and our code of ethics evolved out of that goal. The point the book brought out is that management is a discipline and not a profession, so the previous rule does not apply. Instead, the ethical obligations of someone in management are tied to the purpose of the organization for which they work, which is tied to the function is aims to fill in society, and is further tied to the societal constraints placed upon it. Further evidence, or tick marks, under the "Why Somer doesn't want to be management" column.  Red tape frustrates me. I have a difficult time understanding the management aspect of nursing that is more concerned with budgets and cost cuts over what is best for a patient. I realize that to receive compensation and reimbursement from insurance companies, certain parameters must be met. I have a difficult time when those preset parameters are not what is in the patients best interest. I disagree, due to my personal ethics, that keeping a patient in the hospital for 3 days, when they are ready to go home on day 2, is right based on the fact that that is what insurance will pay for. This is why I could never be management.

As I thought about myself in a management position, or rather the reasons why you would never find me in a management position (I know. I know. Never say never.) I considered the type of ethical framework that is most congruent with my personal code of ethics. I feel, after considering each option, that I rely on a intuitionist's ethical framework. I feel that each case should be considered case-by-case to determine the goals, duties, and rights related to each individual situation. In my opinion, this ethical framework does not work with the role of a manager in nursing. From what I've learned, management requires more of a utilitarian approach to provide the greatest good for the greatest number of people...while saving the greatest amount of money, if I might add that in there.

So, I learned a lot from this reading...and this was just from Chapter 4. Chapters 5 & 6 had a lot of thought provoking information a well, but quite frankly, I'm just too tired to get into that.

Lesson 2: Successful Leadership and Management

Leadership vs Management. I've actually never given it much thought. I thought it was interesting that the text devoted a chapter to the defining of each. However, after the reading, it does make sense because, although I previously thought of them as interchangeable, they are very different.

Management is an assigned position. It is involved more with formal organization and the title is a source of legitimate power within that organization. Managers direct those who follow them both willing and unwillingly.The manager is the one who accomplish, has the responsibility, and conducts. Managers are held responsible and accountable for the success and failures of the departments and people that they manage.

Leadership is seems as though it is more of a mantle that certain people take on in a given situation, and not necessarily as part of a formal organization. Leaders are people who influence others and have an influence to guide and direct their opinions and actions. To be a leader, one must have willing followers. Leadership can be developed.

Interestingly enough, a good manager is not necessarily a good leader. Nor is a good leader necessarily a good manager.

I don't work with any other nurses at my current job, so I don't have a nurse manager to ask what they expected when they took a management position. I work with, and as part of, an interdisciplinary team at a residential treatment program.

I disagree with the Great Man and Trait theories. I think some personalities may take on the role of a leader more easily than others, however I think anyone can prove to be a leader, depending on the given situation. I also think that those who possess the ability to lead also know when to step back into the roll of follower to support others in the position to lead.

I like the idea of transformational leadership in that it aims to have leaders and followers who are lift each other up to higher planes of motivation and morality. I don't think it would be possible to be a transformational leader 100% of the time.

I think an effective manager needs to possess leadership qualities so that those whom he/she manages want to do so. I also think that a good leader/manager combines parts from each of the different theories of leadership and management until they find what works for them and makes them the best leader or manager they can be in the given situation.

Boooook!

Every time I've gone to get the book for Nursing Leadership, the book store is out of the. I'm told, "We've ordered them, they shipment should be in within 7 days." But, when I go back...it's not there. Until this last time. Last time there was note stuck in the spot where the book should have been.

This book is out of print. 

The next edition will be released February 11

February 11? I mean really! I am not waiting until 1 month into the semester to get the latest and greatest edition of an over priced book that I'll never use again...no offense Sean. But, what to do? It's difficult for even the most experienced craftsman to practice without the necessary books....even if that craft is WITCHCRAFT!

 After throwing open my own set of shutters and calling in vain, I set out to hunt for my book...taking to the web and searching high and low. And then I found it: Half.com! You know what I found there? You're right...I found my book. Not only did I find edition 6, but I found THE FIFTH EDITION FOR $5.00! I put out the call via the internet and it came...rush delivery. Now, the work can really begin.

Location...Location...Location

Have you ever noticed how you can randomly throw a rock in Utah County and hit a nursing student? I'm finding this is definitely not to my advantage. I'm currently trying to find a location to complete my clinical hours for Nursing Leadership and Development...and hopefully complete my Senior Project. However, with all the students out there looking for similar opportunities...pickin's is slim. Because of my current work schedule (10 hour days Monday, Wednesday, Thursday, and Friday) and school schedule (Tuesdays from 8 a.m. to 6 p.m.) I got special permission to follow a house supervisor during graveyard and weekend shifts. Now...if I could just get someone to return my calls.