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Think About It
A forum for discussion of the latest news and ideas in nursing management and healthcare.
Thursday, August 21, 2014
Full disclosure, before the amyotrophic lateral sclerosis (ALS)Ice Bucket Challenge, I didn’t really know anything about the disease. I’d heard of Lou Gehrig’s disease, but didn’t realize the two were one in the same. I knew nothing beyond the name. Now that the ice bucket challenge is sweeping across social media, it was only a matter of time before I was called out to complete the challenge. When my time came, I respectfully declined, but donated money to the ALS Association and to an organization that works to bring clean water to international communities in need.
Social media is a powerful tool. The ice bucket challenge has helped raise millions of dollars for a charity many people never knew about—it’s pretty amazing. Of course, we also run into the negative aspects of this power, such as HIPPA violations, patient privacy breaches, and bullying.
Don’t underestimate the power of social media. Utilize it when you can, but don’t abuse it. Learn your organization’s policy about it, and maybe you can start the next big charity trend.
NM editor

Monday, August 18, 2014
As I'm sure most of us have heard, actor and comedian Robin Williams passed away last week. It's sad to receive such news, especially about someone as well-liked as this man. It’s also unfortunate that the passing of a well-known celebrity is what it takes to get people talking about mental illness. Robin Williams committed suicide last week raising a big question: how could a popular comedian take his own life? From the outside, he appeared to have it all. What causes someone in his situation to look to death as an escape?
Mental illness knows no bounds, and in the case of Robin Williams, according to those who knew him, depression was the illness that led him to a dark place. It’s up to everyone in the healthcare community, not just psychologists and psychiatrists, to recognize the signs and symptoms of mental illness, and to learn how to treat and advocate for patients suffering from them. We need to educate the public and our peers about the many faces of mental illness—even the ones that are smiling.
Here are just a few resources to use when educating yourself and patients about mental illness:
National Alliance on Mental Illness

Friday, August 15, 2014
Retail clinics are controversial in the healthcare community. The American Academy of Pediatrics issued a policy statement earlier this year calling them "inappropriate" and "detrimental." Strong words.
In the ideal world, according to pediatricians and other organized medical groups, all healthcare would be provided and managed by physicians in their offices. The public, on the other hand, appears to value the easy, less expensive, and generally satisfying experience of healthcare at retail clinics, provided by an NP and a pharmacist, for simple healthcare needs or issues.
It's hard to argue with safe and convenient care especially when an office experience can be difficult to schedule or inconvenient.
What are your thoughts? Would you go to a retail clinic for healthcare?
Rosanne Raso, MS, RN, NEA-BC

Tuesday, August 12, 2014
Every time I hear the phrase "creating a healthy workplace" I think about the best advice I ever received. It came from a therapist I worked with who was brought in to help the nursing faculty function more like a cohesive team. His advice, which I labeled the Three commandments for healthy communication, included:
Send the mail to the right address, avoid triangles. All too often, A has a problem with B and talks this out with C. Psychologists call this "triangled communication" and all too often nurses call it normal.
Ask for what you need, it ups the chances you might get it. Especially under stress, it’s easy to regress into old patterns of martyrdom, or learned helplessness, or even assume that others ought to know what we need if they really cared. I should add that this is also a good tip for improving one's home life!
Be true to your own intuitive sense. We’ve all regretted ignoring our intuition or letting ourselves be talked out of what we knew needed to be said or done. Shakespeare said it best: “to thine own self be true!"
Promise yourself that you’ll use these tips in some way every day both at home and at work, and in a month I will bet that you’ll agree with me--this is the best advice you’ve ever received!
Sharon Cox, MSN, RN, CNAA

Thursday, August 07, 2014
Today, much of what’s taught and expressed in leadership is hopelessly out of date. The traditional industrial-age approach to management and leadership, which makes up the function and capacity of most of our leaders, is no longer relevant to what organizations are becoming in the 21st century. This creates a significant challenge as we attempt to confront the gap between what leaders know and express and what emerging organizations need from leaders in order to thrive.1 This challenge is clearly evident in healthcare.
All of us in healthcare leadership are currently watching the shift in healthcare structure and design. Healthcare institutions and organizations are now becoming large integrated networks such that some projections suggest that we’ll move from the over 4,000 hospital institutions currently in place in the United States to between 360 to 450 complex multi-service health networks.2 These networks will be organized much more horizontally as opposed to the traditional vertical structuring of healthcare within which many of today’s leaders developed, grew, and led. The design of service infrastructure and models will reflect this more collateral, linked, and integrated approach to serving episodes of care, and populations along a continuum of health-related services.
Nursing practice will be radically altered by the shifting landscape and organization of the future of healthcare. The construction of population or service-based transdisciplinary teams will represent a broad-based service partnership both within systems and between services that will create a much more effective service model.3 Nurse leaders will soon recognize that they’re positioned in these broad-based clinical teams as coordinators, integrators, and facilitators of the critical services they offer. In fact, the capacity to lead and facilitate teams will be the greatest emergent skill necessary for successful nursing practice in the near future. This will require a stronger emphasis and need for leadership development at every level in the nursing community. Nurses graduating from contemporary nursing programs will need to demonstrate a stronger more central emphasis on leadership and communication capacity as they increasingly assume the role of navigating, coordinating, and facilitating this multitude of clinical teams in a broader based healthcare delivery system.
Just as important will be the emphasis on particular leadership skills for those holding management and executive roles in these emerging health networks. Long gone are the days where control-based, directive management strategies will be successful when directed toward well-prepared, highly competent, uniquely skilled health professionals who have their own notions and sense of ownership with regard to decisions that affect what they do. This notion that management is a hierarchical and vertically oriented agent of organizational direction and control will simply no longer fit the essentially local, point-of-service based, provider/user driven approaches to clinical decision-making and service. Increasingly, the power of innovation and creativity, decision and action, and impact and outcome will all be grounded within service teams at the point-of-service and within the community. Managers will increasingly need to enable these processes and ensure that the infrastructure works to eliminate impediments to local control and action and that the essential tools necessary to facilitate these health professionals are available in a way that’s fluid, flexible, and just-in-time. The role of the manager will focus on creating an enabling an appropriate infrastructure which supports local empowerment, decision-making, and clinical effectiveness.
This is clearly a time of great innovation and creativity in the health system as it recalibrates itself for much more primary care structure and approach to the delivery of health services. The partnerships, relationships, and interactions between various disciplines and constituencies will be the essential framework for successful care delivery. The role of the manager in this equation is to ensure that there’s a good fit between the more informal, fluid, relationally-based interaction in the clinical environment and the system that supports it. This interface must demonstrate a critical fit between each and every component of the system in the service community, demonstrating a level of efficiency, effectiveness, and efficacy in a way that makes a difference in the health of American citizens.
Certainly this is the challenge of the time and the critical work of contemporary health leaders. The capacity to abandon attachment to old control models and more parental approaches to management expression may be a personal struggle for managers and executives. In a time of great change, the fear of risk accelerates and the temptation of leaders is to tighten control and to narrow exposure to risk. However, the elements and characteristics of effective innovation call for the capacity to embrace risk, minimize its negative impact, and capitalize on the energy that it generates in order to experiment, innovate, and create more effective and sustainable approaches to addressing issues of health. Nurse leaders at every level of an organization are at the center of this exciting call to new methods of leadership and new approaches to clinical service. The real challenge for all of us is our personal capacity to engage our own leadership journey by identifying what needs to change in our individual role and how we can support each other in creating an environment for effective clinical leadership and decision-making. By doing so, we make it safe for others to engage and embrace their own efforts at confronting change, and we model an appropriate level of awareness and openness and of vulnerability that makes it safe for all team members to fully engage in the challenges of change. It also allows us to support each other as we create a more effective and sustainable foundation for real health in America.
Tim Porter-O’Grady, DM, EdD, ScD(h), APRN, FAAN, FACCWS



1. Uhl-Bien M, Marion R. Complexity Leadership: Part I: Conceptual Foundations. Charlotte, NC: Information Age Pub; 2007.

2. Kulesher RR. Health reform's impact on federally qualified community health centers: the unintended consequence of increased medicaid enrollment on the primary care medical home. Health Care Manag (Frederick). 2013;32(2):99-106.

3. Ryan SA, Koerner J. Partnerships for population health: the neighborhood health network. Creat Nurs. 2012;18(1):7-12.

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Nursing Management
“Think About It” is an extension of Nursing Management. Here, you can read and discuss professional information geared toward helping nurses excel as leaders. This blog tackles important topics without the worry of print publication deadlines!

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