Rosanne Raso

Why canʼt we all just get along

Games 4 Normal Form of a Game . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Simple Example: Rock-Paper-Scissors . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Extensive Form of a Game . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Perfect Information Example . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Imperfect Information Example. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Multiagent Decision Networks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Example Multiagent Decision Network. . . . . . . . . . . . . . . . . . . . . . . . . . 10

Maximizing your hire-ability, honing your entrepreneurial skills.

56 February 2010 Nursing Management Q My boss has told me that I need to be entrepreneurial in my approach. I currently manage an inpatient medical-surgical unit and I find it difficult to investigate business opportunities when I’m inundated with operational responsibilities. Any suggestions? This isn’t a quick fix answer; however, I have some thoughts on how to see the forest for the trees. We can easily bury ourselves in operational details due to the intensity and complexity of nursing management, but we must use our own personal strategies to rise above and allow for some creativity and strategic thinking. Entrepreneurial doesn’t necessarily mean starting a new business venture; it could mean approaching the job and organizational goals with a spirit of idea generation and innovation. For example, are you researching clinical or service ideas from published evidence, brainstorming ideas with staff members, and trying tests of change? Another example of entrepreneurship would be participating in your leadership team’s goal setting and planning, and then volunteering your unit for a pilot of a new intervention. Or you could attend a 1-day conference, taking the time to step back, listen to the speakers’ ideas, network with colleagues, and generate some ideas for change to bring back to your institution. You don’t have to do all the creative thinking yourself; engaging staff members and the team in the process nearly always yields wonderful ideas. I’d clarify with your boss the intent of the feedback. I suspect it’s the entrepreneurial spirit that’s desired. Inspiration is the first step, which requires openness and positivism. There’s also some risk involved in having an entrepreneurial approach, so you may need to work on any risk-averse tendencies you have (these aren’t uncommon). You may also need to hone your time management skills. Build on what you know and love, get some outside perspective, and engage staff members and colleagues and you’ll find yourself meeting your boss’s expectations while also enjoying your job more! NM Leadership Q&A

Back to school choices and the myth of self-governance.

56 October 2008 Nursing Management Q We have a shared governance model at my organization. Many of my staff members perceive shared governance to be self-governance. How should I explain the difference? Shared governance is a popular model described for over 30 years in the nursing literature. According to the Forum for Shared Governance, shared governance is “an organizational innovation that gives healthcare professionals control over their practice and extends their influence into administrative areas previously controlled only by managers.”1 Infrastructure varies from hospital to hospital. Some combination of unit-based and departmentwide councils is prevalent, usually functionally organized around clinical, education, quality, and management issues. Fifty percent of staff membership is minimally needed, and interdisciplinary teams are preferable. Self-governance, on the other hand, would be a model in which staff members are autonomous; not sharing governance, but governing themselves. It has been said that you can’t have self-governance as an employee, and I agree. Aspects of governance may allow for staff autonomy; however, pure selfgovernance isn’t commonly seen in nursing organizations. I would discuss with your staff members the shared governance principles described here, your structure, what’s in their circle of influence and what isn’t, and how decisions get finalized and integrated. There’s plenty of literature on positive outcomes. If your staff members want “self” governance, then they’re quite evolved along the readiness continuum and are most likely prepared to own more of your processes. You can make it clear that there are still bosses, regulations, bylaws, and more that govern our environments. It’s critical that your organization approaches shared governance not as a program that’s infusing staff into committees purely for lip service, but as a culture change. In your case, it sounds like you’re well on the road to success! NM

Make yourself indispensable; set your goals.

56 October 2008 Nursing Management Q I’ve just been promoted to nurse manager of a large tertiary care ICU. What should my goals be for the first 100 days? The first 100 days are an important time: It’s when your staff, peers, boss, and colleagues develop their first impression of you and your leadership style—an impression that lasts a long time. You’ll be setting the tone for your approach to unit management and the values with which you’ll lead. Your early objectives should be more learningand process-oriented than outcome-oriented unless your boss has already laid out specific expectations for immediate fixing. Find out the goals of your boss, the chief nursing officer, and the hospital and align your first 100 days to how you can support those goals. Meet with staff on all shifts, both individually and in groups, to let them know what to expect from you. Find out what they like and dislike about working in the unit and keep a running list of the dissatisfiers; with a little luck, you’ll have a couple of quick wins that are squarely within your sphere of influence to change right away. You’ll want to take advantage of these quick wins in order to show your responsiveness, to make the work environment better, and for your own personal sense of achievement because small successes set the groundwork for bigger and better ones. You’ll also want to set the tone for your values, especially the ones that are uncompromising; for example, zero tolerance of disruptive behavior, your decision-making style, or acceptable dress code. Remember, your staff will be watching you closely and will test you during your transition period. Set the climate for a collaborative environment. Meet with the unit’s medical director right away and set up regular meetings (for example, a weekly 30 minutes) to keep communication open and issues on the table and promote effective decision making. You want to be a united front from the first day on the job. I usually suggest to new managers to postpone meeting with support and ancillary department heads for at least a few weeks until you’ve had a chance to assess unit needs. It makes the introductory meeting as the new nurse manager more productive if you can talk about actual issues rather than just meet and greet. Armed with all the above, you’ll be ready to set your goals for the unit at the end of the first 100 days and you’ll have a staff that already admires you and will be engaged in achieving outcomes only possible by working together. NM Leadership Q&A