Reflective Journal lesson 16: Risk Management

This week we talked about risk management.  The lecture was from a risk management nurse guest speaker.  Her insights were very helpful in know how to handle incidents and what needs to take place.  One thing stood out to me about apologizing to the pt but not making any promises of payment or being able to fix anything.  Also to say things like I don’t know how this happened, we always to try to provide the best care.. etc.  I had a good reminder to never mention the incident report in your pt charting, and only state the facts.  

Our discussion looked a case study where many things went wrong in the ED.  One student who works in the ED knew a lot more about the protocols in place for pts in restraints.  Her insights were very helpful when it came to thinking about what changes should be made in the future to prevent the problem from happening again.  It was good to learn from the other students.  

As a nurse leader I hope I can handle these kind of situations with confidence and especially be able to help any nurse who has an incident get through it without feeling terrible.  And help them interact with the pt and family after so he/she is not criticized by them.  

Reflective Journal lesson 15: motivating

This week we discussed ways to improve motivation and moral among a unit.  It was kind of fun thinking of things that would help motivate others to work harder or just feel more appreciated at work.  It;s important for people to at least part of the time enjoy their job.  We want to improve their intrinsic motivation so they come to work ready to take on whatever challenges arise.  Even small gestures can make a big difference like notes of appreciation for employees.  I think I feel the most reward from my job when I am recognized either by a patient or by a supervisor that I’m doing a good job.  One memory I have in particular is while sitting on a 1:1 with a pt who was suicidal.  She was telling about her anxieties and worries.  She was terrified for her little granddaughter who was living with “irresponsible” parents.  I had a lot of empathy because I have young daughters as well.  Since I only had her to look after I was able to sit and talk an listen.  She cried a lot.  After a while she told me she really appreciated me listening to her, and I was a good listener which is quality she admired.  I merely shrugged and said something like I had all night so she could talk my ear off.  I’ve remembered her comments and they made a mark.  I like having one or two pts  because then I can give them more time and really listen to them.  It makes a difference for both of us.  

Anyway… we also did a bargaining assignment that, honestly, confused me.  I had to redo it at least once, but in the end it was a good learning experience to see what it really takes to meet the needs and wants of your staff.  I sympathize with managers or union leaders that need to ask for raises or anything knowing it can turn into a battle of bargaining.  I was glad we were able to share our results with our team as a discussion because it helped me understand the process others took. 

In my own practice I hope I can keep my staff motivated and communicate my appreciation effectively without breaking the budget.  I like team building activities, so I hope I can incorporate some good ideas for my unit.  

Reflective Journal: Conflict

This week we discussed conflict resolution.  One of my worst areas I think.. I’m a huge avoider of conflict, which usually means I don’t have much conflict.  But I can see if I were a leader I may have to deal with other peoples conflicts.  I think I’m so good at avoiding my own conflict, that I could come up with decent compromises or resolutions with other staff if I needed to help out.  We did learn about some steps to conflict resolution and types of communication that aid in conflict like assertive and aggressive communication.  Our team came to the consensus that assertive communication addressing the issues, not the people in a respectful manner is the best way to resolve conflict.  We all agreed on our resolution examples with much argument.  

In my own practice I will work on assertive communication and having enough confidence to approach a problem with a solution especially if I’m the one in a conflict (which doesn’t happen often).  My biggest area to improve is dealing with people who are aggressive in an assertive way, instead of passively or being aggressive back.  

Reflective Journal Lesson 13: strategic planning

This week we discussed strategic planning.  We gave our input about what courses should be included in the UVU BSN program.  We also discussed what kind of MSN program would do well at UVU.  Our team decided an FNP program would be successful even though BYU has one, they only accept 15 people per year.  I feel like there is a much greater demand that UVU could fill.  It would also take some of the burden off of current providers in the area as it is rapidly growing in population.  

We also started strategizing a plan to expand a health care program for a city.  We discussed adding more urgent care and physician plazas and I wanted to start a weight loss clinic run by physicians.  I was trying to utilize the airport in the area as to what travelling people would need, or how to use the airport to our advantage like offering cancer treatments and plastic surgery unavailable elsewhere and people could fly in.

I’ve learned that I like coming up with ideas, but I’m not good at figuring out details of how to implement the ideas.  I’m not very detail oriented in that sense.  I think I’d really enjoy a strategic planning retreat where I can turn off my stress mind and just relax and think of good ideas.  

In my own practice I hope to learn how to plan improvements and growth with a detailed outline of how to succeed.  It is important to not only have goals but have a map of how to achieve them.  

Musculoskeletal journal review.

I read the article about multicomponent training for post menopausal women with pre diabetes or type to diabetes.  The study looked at the effect multifunctional training had on bone mineral density and not fat mass of postmenopausal women with diabetes or pre diabetes.  The test was a randomized trial with 10 trial members and 10 control members.   It lasted 8 months and consisted of water aerobics, land aerobics.walking, and dumbbell free weight exercise 3 times a week.  The results showed significant increase in non fat mass and significant increase in bone mineral density in Ward’s triangle, but no other tested areas.  The control group actually lost fat free mass over the 8 months.  

I supposed they tested diabetics because they are at higher risk for osteoporosis conditions, but I think the results would improve any post menopausal women.  The significant increase in non fat mass is encouraging too because it improves prevention of osteoporosis.  For a long time I have known weight bearing exercise helps prevent osteoporosis, but it’s encouraging to to see it can actually improve losses in some areas of bone.  I will use this information to encourage old ladies to continue to weight bearing exercises as tolerated and safely to prevent further loss of bone and increase their non fat mass.  It’s not too late to start exercising.  

The article appears credible because it published in a Journal of human kinetics. It’s relatively current published in 2014.  It’s very relevant to common musculoskeletal conditions, especially in older women.  The authority of the authors are from university Physical Education departments in Brazil. The trials was done well and the tools appear to be legitimate and accurate. The purpose is clearly defined and the results demonstrate the purpose accurately.   

Reflection lesson 12: change

This week we discussed change and how we deal with it.  We read or watched the “who moved my cheese” book which presents four types of responses to change.  Sniff, Scurry, Hem, and Haw.  We discussed who we thought we affiliated the most with.  I initially thought I most like Scurry, easily adapting to change and doing it quickly with out too much fuss or questions.  After reading my classmates discussions I thought Im probably more like Haw.  I adapt pretty well to change but I don’t do it blindly.  I usually weigh the pros and cons and recognize benefits to change even if it’s uncomfortable.  If the change is out of my control I usually just go along.  I might voice my opinion if I see flaws, but I don’t refuse to follow.  

I felt really frustrated with Hem, who refused to accept change and blamed all the problems on “someone” who moved the cheese.  He suffered greatly for it.  I see some people like that in life, and I feel the same way.  I learned I need to be patient with people who don’t like change.  I need to help them learn new systems and emphasize the need for change so they can see the benefits.  I could be more helpful instead of frustrated.  

I also want to be more like sniff who is constantly monitoring his cheese so he can anticipate when change needs to happen.  He can then plan the best way to make the change before it’s too late.  I think I do this ok with my kids and family life, but I may not pay as close of attention with my work and social life.  

I enjoyed this weeks lesson material.  I’m glad there was a video of the story because it’s much easier for me to watch a video and feed/hold my baby than to read a story.  I enjoy change, and I’m hoping I can help implement change for the better in my professional career.  I’m not creative with thinking of new strategies, but I generally know when a system is not working anymore and I hope I help create better practice where needed.  

budgeting interview: leadership 4500

I interviewed Joseph Danielson who is a  Multi-Functional Finance Manger for Lockheed Martin. 

Our questions: 
  1. Do you use a software program for your budget. If so, what program?

  2. If there isn’t adequate funding, what are the first 3 things you cut out of your budget?

  3. How would you handle a project that was running over budget?

  4. How do you handle unexpected expenses?

  5. When a budget decision has to be made, who gets together to make the decision?

  6. If you are under budget on a project, what happens with the money?

  7. What is your biggest budget expense?

  8. Do you usually stay within your budget for the year?

  9. Have you ever had to cut employees for over staffing or to make up for budget cuts?

  10. How much of the budget goes to medical coverage for employees? Is it worth offering? Would you consider good health initiatives for employees using coverage?

  11. How do you encourage employees to follow money saving protocols that may be tedious?

  12. If you have to do layoffs because of lack of money, how do you decide who to layoff?

  13. Have you ever slacked on keeping a good budget? If so, what happened?

  14. What are the budgeting rules you live by, if any?

  15. Does someone else help you with budgeting? If so, how often do you follow up with them about the budget?

    Joseph’s answers: 

1. Most of our budgets are done in excel. We do track our actual cost in our financial ledger called SAP. When we create our budget we do look at where we’ve come in year over year using reports from that SAP system.
2. As I’m sure you can imagine it’s different depending on circumstances and how much we really need to cut. I would say the first thing we look at is if there is any material that we don’t need to buy or can move it out to the next year. This could be anything from just letting our inventory supplies get lower or pushing off the purchase or office equipment that we might not need to buy that year. Next we probably look at more capital type projects. This is where we are looking at large machines, large software packages, or upgrades to different equipment. Sometimes those projects will be pushed back as well or not done if there isn’t enough budget. Probably the next thing we look at is the employees and see what our staffing levels are and if they need to be changed.
3. The first thing I would probably try to do is a root cause analysis. That is, I would try to focus on what is really driving budget issues. Are we having troubles developing the product, are we not keeping to the schedule, are their personnel issues, management issues, or did we just create a bad budget. Most our projects are funded by the government. We give regular updates to our customers on where we are on the budget and schedules so we generally can find the problems pretty quickly. We then generally create an action plan to get back onto the budget. If we really see no way on getting back on the budget we will try to go back to the customer to get more funds if possible.
4. We try to have budget for unexpected expenses. Sometimes people call these rainy day funds or management reserve. No project goes exactly as planned, so you need to have some buffer in your budget for unexpected expenses. Sometimes it does mean giving up another aspect of the program or having certain people work less on it, but it’s pretty situational.
5. We have program managers and cost account managers. Basically the program manager runs the whole project and the cost account managers are in charge of their part of the budget and tracking it. (Generally it’s a small part of their overall job as it might be an engineer or someone like that). They generally get together with someone from the finance team and put together the budget, track it, and report any variances. 
6. It depends on the type of contract we have with the government. We have 2 main type of contracts with the government. We have fixed price contracts. These contracts are “hey I’m going to to give you a jet for 80 million dollars. I don’t care what it cost me. If I go over then I have to eat the cost. If I go under then I get to keep the money.” We also have contracts call cost plus contracts. On these contracts it’s more “Hey I’m going to develop an airplane for you. I think it’s going to cost 80 million. However if I go over you need to pay me for the extra cost. If I go under you can keep the money.” A lot of our development or support contracts are that second type of contract. We do have incentive to under run though because with those cost type contracts there is generally a fixed fee associated with the contract. Say for our 80M airplane we get 5M of fee/profit associated with it. If I under run the cost I have to give the cost back, but I keep the fee. This gives me a better return on my sales, which investors like to see. (this is probably more information than you want but I can talk about it a lot more if you want 😀) On the indirect cost side of things we would go to our finance director and Vice President of Operations to see if they approve of the increased expenses.
7.  Our biggest budget expense for our projects is usually the labor piece of it. When I work with our overhead budgets the biggest expense is probably our insurance expense.
8. We are generally conservative in our company culture. We usually have some budgets that are over and some that are down, but overall we are generally down.
9. I have not personally had to do the cuts to employees, but I have helped develop budgets for managers that need to make cuts by letting employees go.
10. My company is pretty protective about how much we spend on health insurance, so I probably can’t give you that percentage. We do feel that it’s worth offering as we feel our health insurance helps us attract and obtain some top talent. Our company has a lot of competition for smart engineers, so we feel our benefits are competitive with the industry. We definitely use health insurance companies that try to push good health initiatives. We have had health screenings, health coaches, benefits/money for meeting certain health goals. We have been able to earn incentives by having a pedometer and meeting certain goals. 
11. Generally if someone is in charge of any budget then it is part of their yearly evaluation which determines your raises. We also try to give employees incentives to come up with cost saving initiatives where they can get awards and cash for helping the company save money.
12. I haven’t been personally involved, but I believe first they look at what job and level they need to cut. Is the job essential or a nice to have. Then they look at the lowest performers. If there isn’t anyone who isn’t really performing poorly then they go to whoever has been there the least amount of time.
13. No. It’s my job to keep people to budgets and making sure they follow all our rules and regulations. I have had to raise concerns up to management for certain managers who don’t take all the steps to make sure they keep on budget after repeated warnings and discussions. Usually we can work it out, but once I take things to their manager things generally get resolved.
14. Spend less than you make. Make sure your budget is something you can really live by. Make sure you track you progress so you can make corrections before it’s too late.
15. For our indirect budgets I have two employees that help put together most of the charts and reports. I am generally in daily contact with them about the budgets and some analysis that needs to be done on them, and our normal monthly business rhythms. We do have a monthly meeting where we meet with all the budget holders to review their progress for the year.
 
Joseph seems to handle a budget for big engineering projects involving a large amount of money.  I can see he has good incentive to mange the budget under budget because they can usually keep the money saved if they are under.  Also if employees find money saving solutions they can get bonuses or rewards.  
It would be so tedious to keep up with the budget to make sure it stays on track.  He mentions they have to stay on track to catch problems early if it starts to go over budget.  
I struggled with our little budget cut project and had to figure out all the numbers and exact expenses and determine where to make feasible cuts.  It involved staffing ratios as well, which got a little confusing.  I’m glad we studied this a bit, because if I ever have to do budgeting for a large company with a lot of projects and employees I’ll feel a little more prepared now.  I haven’t done much budgeting in my personal life other than spend less than I make.  It is kind of fun to see where all the money goes and where I can make cuts.  I want to keep better records now.  

Reflective Journal: staffing and professional development.

This week’s assignment to come up with a staffing schedule, was tougher than I expected,  especially as a group.   We had a hard time deciding what kind of formatting would be best and how to set it up.  I eventually just set up the spreadsheet into a format like I see from work.  We didn’t know how many staff members we had available so we just allowed ourselves as many as we needed.  It was challenging filling all the requirements, and we probably have more PRN staff than really needed to help cover on call shifts.  

We also discussed professional development and what our future plans are.  I, of course don’t exactly what my future holds, but I’m suspecting I’ll go back to school for a master’s at some point, but I’m not jumping into it.  I need to be more available to my family and just work while my husband finishes his school.  For being 30 years old.. I feel like we are little behind in the education department.  I will try to advance within my job though.  I want to work on specialty certifications and more training.  

I’m glad we had this staffing assignment because it opened my eyes as to how hard it is to figure out a schedule.  I really feel for the managers who make ours at work with over 90 nurses to schedule, and 5 floors to cover.  I do feel a little better prepared if I have this responsibility in the future.  I will know where to start and how to best layout the schedule.  

Reflective Journal week 9: Future of Nursing

This week we watched a lecture of the future of nursing.  I though it was interesting and it looked at reasonable goals for the nursing profession to achieve.  Some of the goals included increasing leadership positions and trying to double the number of APRN’s.  Also having more states allowing APRN’s to practice independently at the level of their education.  also, increasing the number of BSN nurses to 80% seems more doable and hospitals are starting to require BSN level training.  We also want more diversity in nursing.  

We discussed as a team the goals and if we think they are achievable.  Most of us agreed with the goals and thought most of them were achievable except maybe doubling the number of APRN’s.  We also thought it would be easy to increase the nurse residency program to more hospitals.  A lot of ours around here are already doing a pretty good residency program.  

I felt like the nursing goals resembled my own personal goals.  I’m trying to get my BSN, and will hopefully get a graduate degree later.  I might be leaning more towards education, but I’m not decided yet.  I’m also looking to be in more of a leadership role when I have more experience.  

I thought the material we covered was interesting, and I feel more inspired to help progress the nursing community to meet these goals.  

Reflective Journal lesson 8: Budgeting

This week we focused on resources and budgeting.  Yes it was kind of tedious and boring, but I actually learned a lot.  And Im glad we went over this topic, because it’s not something I thought about when it comes to leadership positions.  I’m not a great budgeter for my own finances.  I typically just make sure we are spending less than we make.  It was interesting to see a budget plan and look at all the different expenses.  I actually spoke to a nurse manager, and financial advisor from a bank and both of them mentioned the area to save the most money was with cutting back employee expenses.  One thought was to make all extra staff meetings virtual in that employees could just look at notes and announcements on an e-mail or posting rather than paying all employees to attend a two hour meeting.  

I liked the idea of cutting back hours because the hospital we looked at was overstaffed anyways.  I feel like cutting hours is a better option than cutting wages.  If an employee has issues with fewer hours they can probably easily pick up shifts somewhere else. We discussed cutting back patient care materials, but that is hard to measure and predict how much money will actually be saved despite our best efforts to lightly stock patient rooms. 

The budgeting assignment definitely got me thinking differently, and calculating wages and hours more than i usually think about.   I learned about all the different possible areas to look at employee incomes and staffing ratios, etc.  I feel a little bit more confident in my ability to look at a budget and see the whole picture instead of just individual expenses.  I think with a little more experience I could be pretty good at budgeting.  I do manage all the financial stuff at home, I just do it loosely.  To be fair, we are in very little debt, and we usually come out on top every month.