The Future of Mental Health Care

Imagine this…you are a nurse caring for a patient in their home....

 ...No big deal right? What if I told you though that your patient was diagnosed as having paranoid schizophrenia? Now what do you think?

It is estimated that approximately 57.7 million Americans experience a mental health disorder in any given year. 1-in-17 adults live with a serious mental illness such as schizophrenia or bipolar disorder (NAMI, 2013). Lack of access to mental health services and a shortage of inpatient beds is a huge problem in our country. The National Alliance on Mental Illness gave the United States and overall grade of a “D” for its mental health care in a 2009 report (USA Today, 2009). [click here to see how your state ranks]

I don’t know about you, but in my mind that is NOT a passing grade! So what can we do? It seems logical to me that a great way to go about treating mental illness is in the community. One type of community program is Assertive Community Treatment teams or ACT. ACT is a service-delivery model that provides comprehensive around the clock cares to patients with serious and persistent mental illness much like an inpatient hospital unit would. The difference, however, is that ACT provides care within the home of the patient. 

WHATS SO GREAT ABOUT COMMUNITY BASED PROGRAMS?

• Decreases hospital days by 85%
• Reduces jail days by 83%
• Creates patient and family centered care
• Patients are able to find and maintain employment longer
•  Decreases co-occurring substance abuse problems
• Creates greater compliance with medication and treatment plans (NAMI, 2013)

Health care is changing, and it is changing rapidly. Community based health care, especially in mental health hold the potential to change lives! Why not be a part of effective patient centered care? Are you ready to be part of the change?

The Basics of Financial Planning

 

I read an article recently discussing financial planning for nurses. Trust me, I understand that planning for retirement can seem daunting, especially with a MOUNTAIN of student debt staring at you! “A 2011 Fidelity Investments Nurses Study revealed that although 79% of nurses interviewed feel secure in their jobs and their financial futures, 71% do not think they are saving enough to fund their retirements”(Quinn-Szcesuil, 2013, p11). Anyone else see a problem with that?

Where do you start?

1.       Make a plan for loan repayment. This is the first priority, and possibly the most difficult, for new graduates. Pay more than the principle balance to help reduce interest and shorten the repayment period.

2.       Determine what you want from your future. It is important to determine if you want to return to school, travel, have children, or be mortgage free.

3.      Once you have indentified what your personal goals are, meet with a financial planner (or take a class). “A 2008 WISER survey revealed that only about 6% of nurses thought they had a strong grasp of financial planning issues, but nearly all thought it was important” (Quinn-Szcesuil, 2013, p12). It is important to choose somebody you trust. Examine all of your accounts, insurance plans and benefit packages to ensure that all data is up to date.

4.       Start slowly! While repaying loans it can be difficult to focus on saving money. By starting slow you begin to familiarize yourself with the retirement saving process. Even $10 per week into savings will add up to big results!

5.       Plan an emergency fund! Experts agree that an emergency fund is a necessity. Plann to save 3-6 months worth of income into an accessible fund to be prepared for financially difficult times.

6.       Save first! Saving for retirement should be a top priority! By saving now you can ensure stability and a quality of life for your future, and the future of your loved ones!

 

Quinn-Szcesuil, J. (2013). Financial planning 101: know your worth. Minority Nurse. Springer Publishing Company. Winter 2013.

Interdisciplinary Teams

The other day, at about four o’clock in the morning, I found myself sitting in the emergency room with a loved one. I would like to be able to say this is a rare occurrence, but in the past few years I have found myself in this situation many times. Each time I have experienced health care from the perspective of a family member. This time, however, I found myself being much more aware of the importance of interdisciplinary teams in health care. I am not sure if it is because of my nursing leadership course or if it is a result of something else, but this time I understood profound impact that a positive team can have on patient care.

According to Huber, interdisciplinary teams are “essential to an organization’s efficiency and effectiveness because collaboration and teamwork are essential to achieving high-quality work outcomes and cost control” (2010). Patient needs are increasingly complex and successful outcomes are dependent on interdisciplinary communication. Characteristics of a effective interdiscplinary team include:

• Communication Skills: both verbal and written
• Mutual Respect: between, and within, each discipline
• A common goal: patient centered care
• Effective conflict resolution
   

Nursing is in a unique position to provide profound leadership in this area. As the “eyes and ears” of the patient, we have the opportunity to communicate the needs of the patient and facilitate appropriate action.

“Nurse leaders need to learn how to manage in a team-centered environment; staff nurses must learn how to be effective team players” (Huber, 2010, p226)

After hours in the emergency room, my loved was admitted to a hospital unit. Our greatest needs were not what would have been expected. Our nurse was able to utilize her communication skills to not only hear our needs, but to facilitate an appropriate course of action from the interdisciplinary team, leaving a profound and lasting impact. This nurse understood the importance of communication, working as a team, and being a leader in her role. As I strive to become a leader in my role, and hone my communication skills, I CHALLENGE you to do the same!

Huber, D. (2010). Leadership and nursing care management (4th ed.). Philadelphia, PA: Saunders Elsevier
Mickan, S. (2000). Characteristics of effective teams: a literature review. Australian Health Review. 23:3. Retrived from: http://www.unc.edu/courses/2008fall/nurs/379/960/65_604078165817-effective_teams.pdf

The Blind Men and the Elephant

 

We have all been in groups where communication is almost non-existent and conflict is through the roof. Conflict is one of the most difficult challenges to over come in the team setting. But why is there conflict? Is it a clash of personalities? A difference of opinion? Or could it be boiled down to perception? Chris McGoff of the ThePrimes.com discusses conflict in terms of perspective. 

BLIND MEN AND THE ELEPHANT

What I found powerful about this video, was that McGoff key into the fact that each individual has their own perspective. On top of that, their perspective isn't wrong, because for every reason that is their reality.

Knowing this…how can WE apply it to leadership or managing a team?

- Objectively determine the perspective of each team member

- Ensure everyone has access to the same information

- Focus on rationalizing each perspective rather than being drawn into an argument

- Use shared information to solve conflict

- Take time to see the benefit in each perspective

The Primes. (2011). Blind men and the elephant. Retrieved from: http://theprimes.com/index.php?option=com_content&view=article&id=110&Itemid=55&prime=4

Appreciation - Influence - Control

This past week I had the opportunity to be involved in a round table discussion on leadership with Dr. Dan Pesut. Dan is the director of the Katharine J. Densford International Center for Nursing Leadership at the University of Minnesota. Our discussion centered on the AIC (Appreciation, Influence and Control) model of power.

What is AIC?

“Appreciation, Influence and Control are the names given to the three fields of power that we use to accomplish any of our purposes, however small or large. It helps us to look at ourselves, our organizations and our world in a profoundly new way. It reveals the true sources of our power and how we can use them for the good of ourselves, others and the common good” (Smith, 2009). The concept of this model is to provide individuals with awareness of their power sources. The most effective leaders are able to maintain balance between the three fields.

In order to understand your personal AIC model, you must first take a quick quiz based on colors. Doing so will provide an understanding of your balance in the three areas of power. Click here to take the quiz.

Appreciation

 The appreciative phase goes beyond our perceptions of a situation. This phase reveals your future orientation. It encourages an awareness of the “BIG PICTURE.” This field affects your purpose, but you have no influence or control over it. The appreciative method relies on our mental, spiritual, intuitive and sensing capacities. This is where our ideals are represented.

Represented by: beauty, enlightenment, love, social, appraisal, spirit, discovery, equanimity, and pragmatism

Influence

The influence phase focuses on collaboration and cooperation and is represented through our values. Your present is represented in this phase. Influence affects your purpose, which you can influence, but not control. Influence draws on our thoughts and emotions to balance any differing values.

Represented by: diplomacy, science, sociability, technology, negotiation, and reason

Control

The control phase allows us to shape our purpose through the development of goals, based on our past experiences. This is the phase that allows you to affect your purpose through control. 

Represented by: Diplomacy, discovery, negotiation, economics, omnipotence, and truth

My Results:

Control: 54%   Influence: 22%    Appreciation: 24%

I was initially surprised by my results to the AIC model. I had a negative connotation associated with the word “control.” It elicited an image of a very authoritative leader (not someone I want to be). However, the more I thought about it the more I realized the truth behind it. I strive for perfection, to be an individual, and enjoy a certain amount of predictability. As a nursing student my schedule is very important! Without it I would NEVER accomplish anything, or show up anywhere. I prefer my work to stand for itself in terms of my success, not my powers of persuasion. There is a lot to be said for this area power.

….however, there is also a lot to be said for appreciation and influence (which also had negative connotations for me) as well. The great thing about the AIC model is that it not only shows where you rank in each of the three powers, but also explains your strengths and weaknesses in each of these areas. It is through the examination of these strengths and weakness that we are able to utilize the knowledge behind the model in order to become great leaders.

What did you discover?

Smith, W. (2009). The meaning of the three circles. Retrieved from: www.oodi.com

Emotional Intellegence

If you were to ever Google what is needed to be an effective leader, many qualities and attributes would show up. Some of them would be humorous, some helpful, insightful, and others would not be helpful at all. According to Peter Borner, there are ten things that all outstanding leaders share:

1.     A clear vision

2.     A strong mission

3.     Expert communication skills

4.     SMART goals

5.     A high degree of competency

6.     Strong interpersonal skills

7.     A strong team

8.     A “can do” attitude

9.     A strong ability to inspire

10.             A driving ambition

All are important. All are important characteristics of a leader. However, The New Leadership Challenge suggests Emotional Intelligence is almost twice as important as any other leadership attribute. Emotional intelligence evokes a more productive and effective result from team members. It is recommended that leaders be self-aware, be able to self-regulate, be motivated, have empathy, and possess social skills. “Leaders can maximize their successes as well as facilitate others’ achievements by fostering and environment more conducive to using emotional intelligence…” (Grossman & Valiga, 2009, p.66). 

What is your opinion? What do you feel makes an effective leader?

Borner, P. (2012). What does it take to be an outstanding leader. Pete Boner: Thoughts from a Process Centric Leader. Retrieved from: http://www.peterborner.com/2012/05/13/what-does-it-take-to-be-an-outstanding-leader/

Grossman, S. & Valiga, T. (2009). The new leadership challenge: creating the future of nursing. F.A. Davis Company. Philadelphia, PA.

Effective Team Communication

To work in health care means to work as part of an interdisciplinary team. As I am sure we can all attest to, working as part of a team is not always an easy task. Personality and communication differences can lead to conflict, burn out, and hurt feelings. Nursing leaders act as a facilitator for many interdisciplinary groups. While it is important to highlight the positives in our behaviors when working as a group, sometimes it is equally important to highlight dysfunctional behaviors as well. Common types of dysfunctional behaviors:

Compulsive Talkers: these individuals are continuously giving their opinion and often end up guiding the conversation
How can the nurse leader deal with this situation? Thank them for their input and ask for input from other team members. Help guide the conversation so each member of the team feels heard and valued. Allow time for this individual to discuss the topic at hand in further detail later.

Non-Talkers: these individuals listen to the team discussion and often hesitate to give their opinion. How can the nurse leader deal with this situation? Ask them to write their opinions down. Specifically ask them questions to gain their insights. Allow them the opportunity to think and formulate their opinion.

Interrupters: these individuals are often seen as lacking self control. They can leave other team members feeling discourage, self conscious, and unappreciated.
How can the nurse manager deal with situation? control the situation by stopping the interrupter and asking the other team member to finish. Then ask for their opinion as soo as they are finished. Try saying “I like your thought process, but lets finish hearing what Jessica was saying.”

Squashers: these individuals will discount opinions and ideas before they have a chance to be entirely formulated. They are often seen as resistant to change or afraid to take a risk.
How can the nurse leader deal with the situation? State that the group will first hear all ideas before gaining pros and cons. In certain situations it may be important to allow them to express their reservations for a period of time before asking to move on. Ask them to determine positives as well as negatives to each situation

Busybodies: these individuals are often not entirely committed to the task at hand. They do not come prepared to group meetings, show up late, and leave early. They are meeting their own personal needs by attending the meeting.
How can the nurse leader deal with the situation? Find creative ways to engage the team member. Give them concrete assignments with a high level of accountability. If the team member is not able to commit, it may be necessary to consider disciplinary action. 

When it comes to working as a team, it is important to be aware of positive and negatives of human behavior. As a nurse leader, pay attention to the members of your team and how they respond to group task. 

I challenge you to contemplate which of these team members you are. How can you alter your behavior to be a better team player?