March 9, 2010Nurses and patients use PowerPhrases to stop death by hierarchy
When Dr. Peter J. Pronovost of Johns Hopkins Hospital told staff,
- Doctors, we know you’re busy and sometimes forget to wash your hands. So nurses, you are to make sure the doctors do it. And if they don’t, you are empowered to stop takeoff on a procedure.
he thought he’d started WWIII. The nurses said it wasn’t their job to monitor doctors; the doctors said no nurse was going to stop takeoff. He said,
- Doctors, we know we’re not perfect, and we can forget important safety measures. And nurses, how could you permit a doctor to start if they haven’t washed their hands?
He continued with the offer that nurses could page him day or night and he would back them up. Infection rates dropped dramatically.
Pronovost went on to comment that every hospital has fallen prey to “death by hierarchy.”
I list eight reasons why people don’t speak up. Misplaced respect for authority is one. In hospitals, that can translate into death by hierarchy.
December 14, 2009Code white, change and the willingness to see things as they are
My book SpeakStrong divides the Speak Strong process into five steps. The first step is to be willing to see things as they are. I call it: Commit to code white.
That comes from a process that some groups of nurses apply, where if a nurse notices someone is verbally abusive to another nurse, she calls out a Code White. The nurses congregate around the offender and silently watch.
I demonstrated the power of Code White in a SpeakStrong seminar for inner city youth. I instructed my volunteer “nurses” in the code. I had a volunteer “doctor” unfairly criticize another “nurse.” I called a Code White, and my group of nurses gathered around and silently watched.
“Doctor Fisher” fell silent. I invited him to continue. “With all these people watching?” he asked. The point was as clear as it could be. There is power in quiet observation. Too often we perpetuate an offense by pretending it isn’t happening. Code White doesn’t solve all of our communication challenges, but it’s a strong first step. I have eight skill sets based on it in my SpeakStrong book. Why haven’t you ordered yours yet?
August 26, 2009Taylor’s “stroke of insight” was her real neuroscience teacher
Jill Bolte Taylor tells an amazing story of a massive stroke, that shut her brain functions — motion, speech, self-awareness — down one by one. An astonishing story.
She has become a powerful voice for brain recovery. I recommend her book or video “My stroke of insight” to help you understand the different functions in your brain.
What struck me most was her observation that she learned more about neuroscience from her own experience than she had from years of research.
How often do we study things and think we understand them, only to learn that the experience is not at all what our study leads us to believe?
Knowledge and experience support each other.
That’s one of the reasons why blog participation is so helpful and I am grateful for the feedback. It’s also a reason why we need to listen to our clients and learn from them.
August 25, 2009Alligators and empowerment: Speak Strong, Smart or Sweet?
Which would you rather be known for…Speaking Strong, Speaking Smart or Speaking Sweet? Would you rather people leave a conversation with you or a presentation you give saying, “I’m motivated!,” “I learned a lot,” or “I’m touched”? Would you like them to leave with action steps, insight or an epiphany?
My next question is: in reading my first questions, did it occur to you that I was asking you to make false choices? Did it occur to you that it might be possible, and even useful, to aspire to all three?
When I encourage audiences to SpeakStrong, Smart and Sweet, my greatest challenge is communicating that the three values do not necessarily negate one another.
This is particularly true when I talk about speaking sweetly with a group that has emerged from a oppressive situations where sweetness was the only avenue open to them. For example, some nurses in my audiences have struggled so long to be respected for thier knowledge and accomplishments that any referral to sweet speech seems like regression. Of course it would be, were I to suggest that they play down their skills or that they remain passive when a situation calls for assertivenss.
It’s ironic that many people who have emerged from sweetness stereotypes have finely-honed sweet speech skills. If they marry those skills with reason and logic, they speak circles around those who never experienced that kind of oppression. Unwillingness to incorporate sweetness limits them as much as it would limit, say, a hard-driving lawyer who decided to soften his/her ways and then refuse to make an appropriated show of power.
A friend told me yesterday of an ancient initiation that involved throwing initiates in a pond of alligators to help them overcome their fears. Sometimes I feel like I’ve been thrown into a sea of alligators when I suggest that a PowerPhrase is as strong as it needs to be and no stronger – that a spoonful of sugar helps the medicine go down – that if chivalry and civility are dead, we need to resurrect them…without denouncing the logic and directedness we have developed.
I get thrown in to the alligator pond sometimes. Many of my readers go in every day. My hope is that my words help you safely navigate those waters without losing your humanity in the process. It makes sense, feels good and works to SpeakStrong, Smart and Sweet.
July 4, 2009Crossword puzzle poison phrase. ER helpers. Answer, nurse
“Saving Lives: Why the Media’s Portrayal of Nurses Puts Us All at Risk,”
From the NYT article:
“Helpers?” the writers asked with exasperated italics. That one word encapsulates their critique of how nurses are typically portrayed on entertainment television, in movies and in most journalism.
Nurses are not “helpers,” the authors argue. Nurses work with medical doctors, but not for them.
“One of nurses’ most important professional roles is to act as an independent check on physician care plans to protect patients and ensure good care,” they write.
Nurses are professionals. But as with many professions that are female dominated, the old stereotypes are dying hard.
Let’s give it a nudge from our end.
July 4, 2009Crossword Poison Phrase: “White cap wearer” answer nurse
Stereotypes die hard. From the book “Saving Lives: Why the Media’s Portrayal of Nurses Puts Us All at Risk”
May 18, 2009Poison Phrase: You didn’t ask for pain-killer
The nurse told Janet that her surgery called for pain killer every four hours. What she didn’t tell her was that Janet had to ask to get it. Janet had assumed from the comment that painkiller was an automatic part of the treatment.
After an agonizing night, the doctor explained,
- We didn’t give you pain killer because you didn’t ask for pain killer.
The irony was that Janet actually worked at the hospital where she received surgery, and she still had a painful communication breakdown. Her experience was an eye-opener for her. You many think your point is obvious, but if others don’t get your message, clarify.
May 18, 2009Reader Success Story: A united communication effort among nurses
I followed a doctor in his rounds who proscribed narcotics for a chemically-dependent patient. The nurse told him,
- My training says we shouldn’t put chemically-dependent patients on narcotics. I’m concerned about patient care.
The doctor was dismissive and I didn’t think too much about it. Later in rounds he proscribed narcotics again and the second nurse said exactly the same thing. Over the week I followed this doctor, I heard several nurses raise the same objection. It was clear to me that they had collaborated to respond that way – and it worked. By the end of the week the doctor no longer routinely proscribed narcotics for chemically-dependent patients.
May 11, 2009Poison Phrase: That’s a terrible idea
In an article about nurse – physician communication and collaboration a physician responded to a nurse’s recommendation by saying,
- That’s a terrible idea.
He went on to explain why. His warning stayed with the nurse, and she later passed on the same warning to another physician.
This story ended well. However, had the nurse been less emotionally mature, the harsh condemnation might have left her reluctant to offer suggestions in the future.
When the nurse later passed the warning to a physician, she spoke tentatively. I would have recommended stronger but not harsher wording.
Ironically, because of the power and authority differential, it’s more important for a physician to speak graciously to avoid shutting dialogue down.
Be sure to read my repost on nurse, physician communication.
I cannot allow my nurses to be intimidated
May 9, 2009PowerPhrase Cannot allow my nurses to be intimidated
Dr. Weiss was so unpleasant when the nurses on Robert’s floor called with questions that they were afraid to contact him. As a manager, Robert knew he needed to end Dr. Weiss’s tyranny. He asked Dr. Weiss to walk with to his office. On the way he said,
- You are one of the most respected Docs around here, but the nurses are afraid of you. They’re afraid if they call for clarification on something that you will holler at them. This could have a disastrous effect on patient care. I don’t want that, and I don’t believe you do either. If you need to holler at someone, come holler at me. I’ll do what I can to support you. But I cannot allow my nurses to be intimidated. How can we work together to solve this problem?
Dr. Weiss was unaware of the impact he had on the nurses, and was pleased to have an open channel of communication with the department manager to take his issues to. Robert’s conversation was effective.
