Wrap Up

1. What did you actually learn from the unit.
There was some confusion on our modules throughout the semester, so we ended up with just a few assignments this week along with exam 3. I was very grateful for this as I had a couple of big projects due this same week in other classes.
It was definitely a lot of busy work this semester, but assignments like modern healthcare weekly article reviews and “Who Stole My Cheese” were some of my favorites. I wouldn’t normally read modern healthcare by choice, but I found I was more aware of what is going on in the healthcare world thanks to this assignment.

2. Discuss your feelings/experiences from the team activities? Did it change your opinion on the subject? If so, how? If not, why?
I think I lucked out this semester with a pretty good group to work with. I think we lost 1 person along the way as we never heard from her half way through the semester. However, my other group members were really great at carrying their weight and being understanding if one of us was finishing our assignment at the last few hours before it was due.
We had exam 3 this week, and due to all the previous group assignments, I feel we answered the exam like a well oiled machine. I was able to access the questions in Canvas last week, so I created a google doc. We ended up finishing the exam in less than 4 days. I believe it’s not officially due until next week. It’s a huge relief to get everything done early with work and Christmas coming up. It would amazing if the grades were finalized quickly, but I highly doubt it.

3. How you will utilize the information learned in your nursing practice.
Conflict resolution is something I will need to work on as I am one who doesn’t like conflict. I try to get along with everyone, and I avoid anybody that is negative. Unfortunately, my answer is to walk away or let it go. I will try to have a polite and private conversation the next time I feel there is a conflict with a coworker. I will have to practice what will be said ahead of time, and of course always take into account what my part might have been in creating the conflict.

4. You personal feelings about the material covered.
There were great topics covered over the semester, but I wish as many assignments as we were given, the grades were posted sooner. I turned in a portfolio weeks before that had not yet been graded. My completed portfolio was due the next day before I was given any feedback on what needed to be corrected. This was difficult as I was juggling work, kids activities in school and sports, and other classwork. It was difficult waiting until the last day to fix it and turn it in.

Risk Management

1. What did you actually learn from the unit.

This weeks discussion focused on risk management of a unit. We discussed the problems that can occur and who is at fault as well as what needs to be done to remedy the situation and avoid problems with repeat circumstances in the past.

2. Discuss your feelings/experiences from the team activities? Did it change your opinion on the subject? If so, how? If not, why?

Our discussion this week was a scenario regarding an ED patient in restraints, but his attempt to use a lighter to get out of his restraints resulted in a fire and serious burn injuries leaving the patient severely injured. Protocol in this scenario called for security to check for contraband and place the patient in restraints. The ED nurse was to do Q15 min checks on the patient. My group agreed protocol needed to be revised to where the patient needed a one to one to watch him at all times and the ED nurse should have had less of a patient load with having to do 15 min checks on the patient. We also agreed protocol can have the security check for contraband again after the patient has been restrained. Thorough documentation, filing an incident report, and notification to necessary departments such as manager, risk management, etc should also occur right away.
There’s a lot more involved in risk management than I had anticipated, but I appreciate having them as a resource and that one of their goals to help do what is best for the nurse.

3. How you will utilize the information learned in your nursing practice.

As a nurse, my role in risk management is essential. First and foremost, monitoring and evaluating the patient care is pivotal. Proper utilization of incident reports is another important function I can do as a nurse. They can often feel inconvenient and time consuming, but they are extremely important. In short, incident reports should be utilized as one means to correct nursing care that does not meet the patient’s needs and that may result in injury or death to the patient.

4. Your personal feelings about the material covered.

It’s important to know all your resources as a nurse so you’re able to give the best care possible to your patients. It was an interesting topic this week. Risk management’s overall goal is to reduce or prevent any type of risk to the health care facility, and it’s important for nurses to know who they are and what they do.

Motivation

This week we discussed how important motivation in the workplace can be, and how having a good morale can really go a long way in retaining happy staff.  Our group came up with several ideas to boost employee morale, and we found it interesting many of our individual ideas coincided with one another. 

1. Talking with employees to find out WHY morale is low will be extremely helpful. It’s hard to fix the problem if you don’t know what it is.

2. As a supervisor, work among your employees more often. You will get an idea of the tasks and struggles that they may be dealing with. Because of this, you will be able to tackle these concerns and issues more readily.

3. Special occasion parties (birthdays, baby showers, holidays, etc.) is a super great way to unite a unit and help people build relationships in a non-stressful way that will carry over into the workplace.

4. Create a suggestions/concerns box, give it a cute name like the “Voice Box. Employees can voice their concerns, ideas, suggestions, wishes, etc. It can be anonymous or with their name. ALL ideas should be addressed in some way or another so that staff know they are being taken seriously. This will help to identify the issues that are causing employees to leave. It will also boost morale by allowing employees to feel heard and that their ideas/concerns are important to management.

5. Hold semi-annual family fun nights at a venue or rent out a place, like a trampoline gym or museum, for an evening or day for employees and their families. This shows employees that you care about them and their families and their personal lives. It gives employees a chance to re-energize with their families, and have some good wholesome fun, which is good for the soul and for morale!

6. Short Private/ confidential discussions/interviews with each employee. The reason morale is at an all time low has not been identified. Meeting with each individual will given them an open floor and space to share exactly what is concerning them. You may notice a trend that all employees are struggling with. Once you know the problem, you can start to create solutions.

#7- Provide opportunities for growth through tuition reimbursement, wage raise with higher education degrees.

It’s important for employees to feel valued and appreciated. A thank you note can go a long way towards boosting an employee’s spirits, and its important to having bonding opportunities such as holiday parties. It can be stressful at times and super busy, but it’s nice to have something fun and simple when time permits.  Sometimes we get into a routine and forget all the little pieces that go into keeping a hospital running smoothly. I’ve been fortunate to work for/with managers and coworkers who know how to balance stress, appreciation for one another, and fun. I’d like to continue what they have done for me on any future units I may have the opportunity be in a leadership role. 

Conflict in the Workplace

1. What did you actually learn from the unit?

This week we discussed conflict and various forms of communication in the workplace. We also discussed the conflicts involved in the move The Guardian with Kevin Costner and Ashton Kutcher.

Conflict – When two independent parties have a disagreement on a topic, direction, or goals to be achieved.

Assertive Communication – Being firm in your stance, message is delivered clearly and calmly, setting appropriate boundaries, express your point clearly and confidently, recognizing your needs matter as much as everyone else, compromise is possible.

Aggressive Communication – Being hostile in stance, refusing to see any other side of a conflict, can lead to shouting or aggression, talking over others.

2. Discuss your feelings/experiences from the team activities? Did it change your opinion on the subject? If so, how? If not, why?

As a group, we came to a general consensus of what we felt the best definitions for each of the words was by combining our definitions together. It helped us to collaborate and effectively work together on communication the appropriate way. I don’t feel like it really changed my opinion because we were on the same page from the beginning.

3. How you will utilize the information learned in your nursing practice?

In regards to the movie, you never know what other people are struggling with/through in their lives. Communication is key, and you never know what you might learn in return. I also learned I would like to become better with assertive communication. I have a tendency to avoid confrontations, and I’m not very assertive when I do communicate. There are times when assertive communication is appropriate, and I will strive to be better with this.

4. Your personal feelings about the material covered.

This is an important topic to discuss because it does happen. There are various types of conflict, and how you handle this in the work environment can influence the people around you.

Strategic Planning

1. What did you actually learn from the unit.

This week we discussed strategic planning in the work place and for the future programs offered at Utah Valley University. We agreed it would be beneficial to have a MSN program that focused on Nurse Practitioner specialty. I learned plans can fail due to false assumptions, not knowing the overall goal, not having enough alternatives, inadequate time or resources, and inadequate delegation of authority. I also learned to avoid the “group hug.” Trying to please everyone or take into consideration all ideas can delay the project and cause bigger issues.

2. Discuss your feelings/experiences from the team activities? Did it change your opinion on the subject? If so, how? If not, why?

Our activity this week was definitely outside my comfort zone. As a group, we were in charge of a community with a 100 bed community hospital. Our goal was to maximize profit by strategic building medical facilities through out the city. We were also competing against another team. It was intimidating to say the least, but the once I got an idea it lead to other ideas. It helped to think of the project sort of like the monopoly game where I want to purchase property and place hotels where I can gain the most profit. In this case we are looking for profit and how to offer the best medical care necessary that is also easily accessible.

3. How you will utilize the information learned in your nursing practice.

I learned I need to be willing to be the bad guy in a work environment, but this can be difficult for me. I’m more likely to place myself where I’m in a “group hug” trying to make everyone happy.

4. Your personal feelings about the material covered.

I thought the strategic planning activity was creative and difficult as a group. Although there are five people in my group, two people have stopped participating in assignments the last few weeks. It’s frustrating, and this week was even more so when we have a big assignment like this to work on combined with a group exam.

Managing Change

What did you actually learn from the unit.

2. Discuss your feelings/experiences from the team activities? Did it change your opinion on the subject? If so, how? If not, why?

This week we discussed managing change, and I feel I do this fairly well thanks to my dad and my experience in sports. When I first started playing softball and opportunities began to present themselves, my dad taught me to always be open to change. It didn’t matter that I was already the number catcher for my age in the nation, we’re always looking to get better, and the only way to do that is to be open to change. He also taught me to give change time to work. It wasn’t something you try for a day, you have to really put effort and a positive attitude into it so you can say you really tried.
Another phrase I learned in college while playing softball for Sue Enquist at UCLA, was to try and avoid and try not to be an “energy sucker.” These are the people who are so negative that they affect your feelings and attitude.

3. How you will utilize the information learned in your nursing practice.

In five years I’ve moved to three different units out of the desire to learn various skills. For this reason, I feel I adjust well to change, and this is why I love nursing. There are so many opportunities in the nursing field. I will continue to strive to be positive, continue to learn, and try to avoid being an “energy sucker.” The lectures did mention people adjust to change better if it’s done slowly, and if they are given an explanation. As a floor nurse who has been through system changes along with unit changes, I do feel this is true. It’s easier for me to adjust if I understand why we are moving in this particular direction.

4. Your personal feelings about the material covered.

I particular enjoyed watching the video “Wo Moved My Cheese.” I can’t believe I have never heard of this before, but I enjoyed it. I found that although I see myself mostly in a combination of scurry and Haw, I can look back at my life and find moments where I have been one of the 4 characters at least for a moment. I feel I mostly resembled these two characters, because I’m ready to learn and move forward like scurry, but sometimes I may over analyze and have a tendency to be slow to move. I have also been like Haw where I have let friends or family affect my decision to move forward quicker because of their negativity.

Career Development and Staffing

1. What did you actually learn from the unit.

This week’s topic focused on career development and staffing a unit with all of the different needs that must be met to meet protocol for patient ratios and floor needs.

2. Discuss your feelings/experiences from the team activities? Did it change your opinion on the subject? If so, how? If not, why?

In the team activity this week we were assigned to staff a floor by making a two week schedule. There weren’t a lot of rules besides to staff it, but three nurses were on vacation and 2 cnas were in training. We started the assignment on a google doc and filled in the chart for nurses. I think most of us found this assignment one of the most difficult to do based on the limited information. Some people in my group have yet to work as a nurse so they felt they didn’t know where to go with this assignment. I’ve always found staffing to be complicated when watching my charge nurses work hard to put the puzzle together on the most complicated nights with limited staffing. It’s one of the reasons I have turned down the opportunity to be a charge nurse. I’m mostly just glad we got through that assignment. Some felt the nurses should have to pick up extra shifts to accommodate those on vacation. I didn’t think this was fair or appropriate. As a manger, the three nurses shouldn’t have been approved for the vacation time if we didn’t have the staffing to cover them. I decided to make sure we had enough staff to cover them since we weren’t told exactly how many RNs and LPNs were on the unit to start.

3. How you will utilize the information learned in your nursing practice.

I realize you can’t make everyone happy, but I feel being straight forward and honest is the best approach. If the staff on the unit understands the position we are in as a team and where we stand, they may be more willing to help out. They won’t be happy, but they may have less questions. I have learned from experience, that if the staff understands it’s a temporary situation because management is working on a solution or new hires are on their way, then they are more resilient. Staff also responds well to incentives.

4. Your personal feelings about the material covered.

I found it extremely interesting and inspirational to learn what my colleagues have planned as far as career development. For example, I’ve heard of Doctors Without Borders, but I never understood what it entails to be quality to work with Doctors Without Borders. There’s a certain level of expertise that is required but can only be obtained through experience. I also found some people in my group are like me where our lives at the moment are centered around our family, and at this time we do not want to sacrifice time with our kids. I would some day like to participate in a humanitarian project or maybe become a travel nurse, but while my children are young and active in sports, I do not want to miss out on a minute of where they are at now. Just another reason why nursing is an amazing field to be a part of. We have opportunities to be a part of patient’s lives during some of the most important times in their lives. We have the privilege to care for special patients and their families. It’s a field that is constantly evolving, and there are various places to be as a nurse both in the U.S, abroad, bedside or behind a desk.

Budgeting Interview

This interview was conducted with a Financial Analysist at an Aerospace company.

What steps do you take in the budgetary process in terms of developing, implementing, and evaluating your plan?
I look at the previous year’s budget and then compare the budget numbers to the actual numbers for the past fiscal year. I look and see what the variances are (the difference between the actual and the budget for each line item). Then I prepare account numbers for each department and list the actuals by account number. Then I ask them to put in a budget number for each account. When all department budgets are complete, I look at all the expense items and review the revenue accounts, and also review the revenue accounts. Then I determine what the revenues minus the expenses would be (profit or loss). Upper-management will determine what the return percentage ought to be and then we start whittling down expenses by account numbers, reviewing revenues to make sure the percentage profit is what upper-management wants to have.

Can you tell me more about the costs of your organization: fixed, variable, direct, indirect, controllable, and non-controllable?
Fixed – fixed costs are usually contracted amounts that do not vary from year to year. An example in our company is lease payments.
Variable – the variable cost would rise or lower depending on how many pieces of equipment are produced in a fiscal year. An example in our company is communication equipment (i.e., radios that go in airplanes).
Direct – direct costs are the costs of the parts and labor that go into each piece of equipment. An example in our company is the parts required to build radios.
Indirect – indirect costs would be machinery used to build the product, utilities, and other overhead expenses.
Controllable – controllable costs are expenses that a business has power to change. Some of these in our company would include payroll and materials to build the product.
Uncontrollable – uncontrollable costs are expenses that the business has no control over. An example of uncontrollable costs in our company are State and Federal taxes and benefits legislated by the Government.

What do you do when there is inconsistency between the approved budget and the actual expenditure of a department?
Quarterly, you compare the budget to the actuals. If there was an inconsistency, you can push to generate more revenue or more likely, you would have to start cutting expenses from labor to overhead type costs.

Do you have to oversee several different department budgets? If so, how do you prioritize your time between each department?
Yes. Depending on how many accounts each department has, you will spend a percentage of your time on each department. Monthly I prepare a variance budget report which compares the budget to actuals and explains what the variances are.

Have you been a part of a large budget cut? How did you implement that?
Yes. Generally your largest expense is labor. Once we had to lay off a number of employees. Businesses cannot lose money for very long and stay in business. Cutting labor and other expenses was necessary.

What is the most challenging part of budgeting?
The most challenging part is projecting what the actual expenses and revenues will be. It is best to underestimate revenues and overestimate the expenses.

When you have a big expense once a year, do you allocate it across twelve months? Or do you add it to that month’s budget only?
If the expense is going to transpire over the 12-month period, you would allocate 1/12th of it each month (i.e., if you are leasing a facility).

When you have a variable amount for an item in your budget, how do you handle it? Do you take the mean, or just the highest possible amount for the item?
Most businesses will come up with a variable percentage based on past years’ history. They will add up all the variable expenses and multiple the percentage assigned to each department on a monthly or quarterly basis. An example of this might be upper-management salaries.

Do you use a zero-based budget or do you use last years’ numbers as a basis so you can increase or decrease the numbers from there?
We use a zero-based budget. This means we start with zero and need to justify every expensed dollar requested.

Do you give budgeted salary increases based on a percentage for everyone? Or do you give performance raises, and do you budget for those raises?
We give performance raises based on yearly evaluations. There will be a calculated amount of funds for raises. This will be divided up based on performance.

Who is involved in evaluating/implementing changes to the budget?
The CEO, the Finance VP, the CFO, the Controller, and the Budget Director all work together to develop an annual budget including evaluation and implantation of changes to that budget.

Do employees have access to the budget? Is the budget transparent to everyone in the department?
No, the Director of each department oversees the budget. Not every employee is involved in the budget planning or development.

What I learned from this interview:
Budgeting is a very complicated process to oversee in a company. It takes a specialist with training and an eye for seeing the overall picture. Good budgeting takes time to check and double check the numbers. One small mistake can play a huge part in a financial mishap. I also didn’t know how many people were involved in a financial budget plan. Everyone from the CEO, the Finance VP, The Controller, etc. all play a part in evaluating where money should be spent and where it can be shaved off. I have gained an enormous amount of respect for those who deal with finances in a business. It is a complicated matter that I don’t foresee myself being very involved in anywhere in the near future.

Week 8: Leaders As Educators

1. What did you actually learn from the unit.

This week’s topic was on Leaders as educators/future of nursing. We discussed the direction that we see the medical world heading, specifically in nursing.

2. Discuss your feelings/experiences from the team activities? Did it change your opinion on the subject? If so, how? If not, why?

Each of us felt there is so much potential for nurses in the future that it’s actually a pretty exciting time to be in this field.  Patient needs are so much more complex. Nurses are having to make more critical decisions associated with care for patients that are sicker and more frail. There’s a huge need for nurses in various capacities and roles so the push for more education is important. As nurses are expected to help patients manage chronic illnesses, prevent acute care episodes and disease progression, we have the ability to contribute so much if we can get the proper education and are able to practice to our full potential.

3. How you will utilize the information learned in your nursing practice.

I think it is important that we speak up for what we believe to be important in the field of medicine. The nursing profession is the largest segment of the nation’s health care workforce, and the potential for nurses is incredible. The best thing I can do for myself is to continue in my education to achieve higher levels of nursing, and look for opportunities to improve my skillset, and practice to the best of my education. My overall goal is to become a nurse educator so that I can influence other students to become caring and compassionate nurses.

4. Your personal feelings about the material covered.

I do agree that nurses should play a larger part in the changes that are occurring and need to occur in healthcare. I found many of the statistics in lecture quite astounding. I had no idea that nurses made up that large of the total population of health care workers. With such a large number of us, and growing, we have opportunities to help change healthcare if we speak up and take a more active role.

Reflective Journal Week 7

This week included a budgeting assignment and discussion. We were to find a way to cut out about 10% of the budget doing our best to avoid laying off employees.  We each found that this was not a possible thing to do unless all of the employees took a pay cut or decreased the number of hours they worked each month. This week’s assignment was more challenging for me, because it was difficult for me to consider cutting employees’ hours. Budgeting might be one of my bigger challenges if I were to become a manager of a unit.

I think our team is working really well together. We’re getting in a groove of things, and we usually find it easy to get along or come to a consensus. We’re all pretty good at caring our own weight. We also interviewed someone in regards to discipline or firing an employee. I interviewed a regional closing manager for a mortgage company. Their employees usually did really well in regards to correcting their mistakes or any issue with work, but their biggest issue was in regards to attendance, specifically tardiness. I learned most companies will give a verbal warning the first time, but the second time they are usually written up. In the case for this company, the would give them 15 days to straighten up their act, but sometimes, if it was at month end when it’s their busiest, they may give the employee 30 days to do better. However, if the employee is given 30 days to clean up their act, then there aren’t any additional chances after that. They could be fired after those 30 days if they are still tardy or have too many unexcused absences.

Any time an employee needs to be written up or fired, there are always two managers in attendance. This really protects them from any conflicts or “he  said/she said” issues. They’ve never had anyone react in an aggressive manner during a firing, because the steps have been layed out very clearly. The employee was well aware of the situation. However, they did have a time where the person they “let go” was negative in her PTO. Human resource contacted them to notify them the employee that was “let go” needed to pay back the PTO. This of course came out of her last paycheck.

Ironically, from what I learned, I found the budgeting was more daunting than disciplinary meetings.