[Sharon]

Think of a time you had an intentional leadership conversation

[Jacqueline]

I was approached by a colleague to share my story of my mother’s end of life journey with her palliative working group – it was a government funded group, a task force of local doctors, agencies and community members put together in each LHIN to review palliative care and help identify improvements. My mother became a patient at the dialysis clinic where I worked. Her condition deteriorated fast and her last few months before she died were quite difficult. When she decided to end her treatments, I fully supported her decision. She came to live with me for her last few days. I had thought we had all of the tools in place, all of the proper supports to help her. Health teaching patients was a part of each day at the clinic. I had talked to many patients and now my mother about end-of-life care and what that meant. I had answered questions about ending treatment, about what their transition would be like, talked about the support of the team. Needless to say, it was not a peaceful transition, there were many mistakes and many missed opportunities to make it better.
I was later asked to sit on the Palliative Committee as a family member, to share my mom’s story with other teams, with the hope of initiating a conversation to bring about change.
Some time later I received a letter from my mother’s medical clinic inviting me to sit in on a meeting with their board and clinical team to review my story and help identify changes and then later to review the changes they were implementing in their palliative care program. I was able to identify specific problems, help create action plans and help plan for a better patient experience through this process.
Overall, I felt I was helping to restore some of her dignity that had been lost. It was a bittersweet experience to be part of but knowing the changes that came after made it a little better.

I picked this topic to share as it is quite different from my current leadership role although has many of the same elements.
I had a topic to review, details to share, data to identify problems, together the team brainstormed solutions and put an action plan together to implement changes, later we reviewed the progress of the plan and then celebrated the success of the team.

[John-paul]

Jacqueline,

Thank you for sharing this heartfelt story. As a nurse with an interest in palliative care, I was inspired by how you have used a difficult life-circumstance to have a positive effect on the healthcare system, through your own personal experience.

[Jaclyn]

In order to improve the ‘climate’ in my workplace, our union had a 3rd party legal team collect information and conduct interviews on what each individual thought could improve our workplace environment. Having this opportunity to sit down one on one with an outsider was very refreshing and I felt optimistic that change was going to happen. We have been poorly managed and desperately need to see improvement to the lack of leadership we have experienced.

[John-paul]

Hi Jaclyn,

Thanks for sharing your experience. Although it sounds like there was some disfunction, do you think the information obtained from these interviews was used effectively to bring positive change to your work environment?

I would be curious to hear your thoughts!

[Veronica]

Unfortunately I could not think of a time where I had an intentional leadership conversation. As I mentioned before I was more of a follower than a leader but hopefully in the near future I can find my voice and be able to speak my mind freely and openly. In my current job I do not really see much opportunity for leadership role as I only work alone with only one client monday-friday. I rarely have contact with my healthcare team.

[John-paul]

Hi Veronica,

Thanks for sharing your thoughts. Although you cannot think of a specific time you had an intentional leadership conversation, remember that as a nurse you are a leader in many different ways. A leader is not always formal; by supporting your patients and other nurses you may come into contact with, you are likely using leadership skills you may not even think you had. It’s great that you are taking this course and learning how you can continue developing these skills now and into the future!

[Jacqueline]

Hi Veronica, hopefully after taking this course more opportunities will present for you to move forward in your leadership journey. Sometimes it just takes a small incentive or initiative to initiate change and you could be the one to start that moment.

[Josephine]

Reflecting on this weeks question to intentional leadership, the best example I can share is the time I was invested at our organizationals regional management conference. A selected group of Wellness Managers were asked to join at the conference to share the conflicts, challenges, barriers currently facing with meeting staffing levels and what organizationally can we do to close those gaps.

I was truly taken back by the invitation as I had been working short handed for months in fact, at one point I reached critical shortage staffing levels and an extra set of hands seemed miles and miles away. As a manager, I was over extending my staff and myself just to get by. I was scheduling staff on a day to day basis. I worked full time plus covered the floor to help the team out. I had to cancel/deny staff their vacation time. The energy, the moral of the team hit an all time low as you can imagine!

I was going by best to recruit staff, I was following up on resumes and took an active role in the interview process but to my surprise, I found myself more than once waiting on the zoom call or by the phone for the applicant to show up. I was not getting anywhere! At one point, I had reached out to another Retirement Home within my organization to see if they had staff looking for more hours and wanted to work at my Lodge. I was willing to pay for their travel expenses, meals and accommodations. I got no bites. Just when I think things couldn’t get worse, my turn over of staff was tuning faster than I could keep up. Staff were leaving because they couldn’t handle the pressure, thy we’re leaving because they didn’t feel supportive, they were leaving because they found a better paying job . At this point, I had to make a call to my Regional Manager and make a case as to why I need to call on agency staffing.

I tracked thee number of vacancy shift, the number of shifts management (myself) picked up/covered on top of my full time job and on-call weekends. I prepared copies of my exit interviews and numbers of interviews / resume I followed up. I even reached out to the union to get approval to job share between sites, to revise my line list and to purpose accommodations. At this point I excused all options and needed help now! but was leaving work feeling stressed++, on edge not knowing if evening or night shift would come in or cancel last minute, above all I felt like I failed the team!

I took it upon myself to find a staffing agency to help cover the vacant lines. I presented the contract to the Regional Manager for approval. Once approved, I scheduled agency staff to help cover shifts and even booked them as extra hands on the floor to help relief and support my staff. You would think things would be better and staff would bee happy but no! staff were upset because agency staff were making twice as much as they were for the same job. I explained to staff, as your direct supervisor I can not change your wage but I can direct you to your union stewardship.

To make a long story short, I presented the above case at the Regional Managers conference and advocated in times such as these, agency staffing should be secured at an organizational level not explored in the middle of a staffing crisis. I should also not be up to the independent manager to secure a contract with agency. If not agency, then we as an organization should have a float pool ready of trained resident attendants ready to go site to site when a shift can not be filled.

I advocated for HR support with managing resume and interviews. If an applicant applies to one of our lodge but no vacancy is available at time of hire we as an organization should not turn the applicant away but off them a open position at another lodge.

I called for senior leadership to meet with union to negotiate wages, accommodations and incentives in an effort to retain. I called on senior leadership to budget for team building activities to reward and thank our front line staff.

I called for senior leadership to review the hiring process for medication training. Our pharmacy offers virtual training on the 1st Wednesday of every month. I explained so If I hired someone on March 6th, that means I would have to wait until April to get them medication trained. I strongly encouraged the idea of expanding the training to 2-3 times a month.

Above all, senior leadership was impressed with how I managed the gaps in care the the creative and reasonable solutions to address the problem at hand. It’s one thing to be heard, it another when your advocacy translates into action. I am pleased to say senior leadership reached out to pharmacy and negotiated training availably for medication administration to our unregulated health care professionals more than just once a shift! I continue to track the number of staff attending training on the alternative training dates to prove the need.

[John-paul]

Hi Josephine,

What an excellent story of perseverance. I could imagine that would have been very tough and often discouraging, however I am very impressed how you stood up to the plate and addressed the many difficult situations you found yourself in head-on. It would have been easy to give up in those situations, but you kept going and were able to find creative ways to support the staff you had left, and provide care to your residents. Thank you for all the hard work you put in – it sounds like your organization is lucky to have you!

[Josephine]

Thank you Jaclyn for sharing your reflection. Im curious, did the change occur? How was this measured? Did the situation open doors for you to explore your leadership ability?

[Josephine]

Thank you Veronica for sharing your reflection. Have you thought about expending your leadership ability outside of your role? Is it barrier to your role not to have contact with other healthcare team members? Perhaps this could be a window of opportunity to advocate for change.

[Alison]

I am often asked my opinion by the registered staff on the management team at my work. An example that comes to mind was during a discussion they were having about how to ensure PSWs a) give baths as assigned and b) document baths properly. They told me what they were thinking about doing (listing baths on the MAR for me to sign off). I suggested a print out that lists the baths with a place for the PSW to initial when they have completed the bath. Checking the signatures also means that when audited, it’s fairly easy to see who signed for what. I was happy to be asked my opinion and management was thankful for the input.

[Author]

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