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Hierarchy of our work

Do exactly what is ordered Verify what is ordered Question what is ordered Request what should be ordered Implement directives Initiate procedures Delegate to others Prescribe orders Lead change So many of us struggle with not having the authority or power to make certain decisions in our work. Authority is scarce, and that’s what makes…

  1. Do exactly what is ordered
  2. Verify what is ordered
  3. Question what is ordered
  4. Request what should be ordered
  5. Implement directives
  6. Initiate procedures
  7. Delegate to others
  8. Prescribe orders
  9. Lead change

So many of us struggle with not having the authority or power to make certain decisions in our work. Authority is scarce, and that’s what makes it valuable.

I think there’s an even rarer, more valuable alternative to authority: taking responsibility.

Taking responsibility is about deciding that something isn’t quite right about your job, your role, your workplace, or the health care system – and changing it. 

Taking responsibility begins with changing something small, something that doesn’t need someone’s authority or permission, like organizing a potluck, hosting a small-group learning session, forming a new committee at work, or leading yoga classes with your coworkers.

And then finding something else to change, and doing it again, and again and again until you’ve earned the privilege and trust to create the bigger changes you seek.

You don’t need to go back to school or become certified to have more authority, or get better pay.

And you don’t need your boss’s permission, either.

You just need to decide, and be willing to accept the responsibility of fixing smaller problems along the way to achieving the future you want to see.

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The founder of hand antiseptic was a killer

Literally. In the 1800s, the story goes, there were two hospitals in Vienna nearly identical in every way, except that in one of them, women were dying at an appalling rate – for years. And no one could figure out why. Ignaz Semmelweis was an obstetrician in the hospital where women were dying. What he…

Literally.

In the 1800s, the story goes, there were two hospitals in Vienna nearly identical in every way, except that in one of them, women were dying at an appalling rate – for years. And no one could figure out why.

Ignaz Semmelweis was an obstetrician in the hospital where women were dying. What he realized was that labouring and post-partum women were dying because their doctors and medical students weren’t washing their hands before touching them.

It was only after relentlessly thinking about the extraordinary deaths that Ignaz realized he was the problem.

Turns out, the endemic cause of this tragic situation was cadaverous, infectious particles adhering to the hands of the doctors and students who worked with cadavers and labouring women.

Ignaz discovered that chloride antiseptic hand washings reduced the mortality rate to nearly zero in the hospital where he worked.

And yet, and yet it would take nearly twenty years before other doctors began to wash their hands.

No one believed him. The medical community rejected his findings. In fact, many doctors were appalled that he thought they should wash their hands. His painstaking research showed that hand washing reduced the incidence of childbed fever and death, but he couldn’t explain why.

“In consequence of my conviction I must affirm that only God knows the number of patients who went prematurely to their graves because of me. I have examined corpses to an extent equaled by few other obstetricians”.

The story of Semmelweis isn’t just about the history and importance of hand washing. It’s a story about taking responsibility, having the humility to see the truth and the choices available to each of us to make a difference in the world.

What would you do if you realized that your education, your actions, your behaviours or your attitude was killing people?

We need more people like Semmelweis, no doubt. People who care enough to look at themselves and the work they do, see problems, make a theory, support it,  figure out how to make things better – and do it again.

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A nurse’s journey

I have learned that what I have always wanted in life wasn’t to be educated, to travel, to be rich, or have authority, but to do work that matters to me. I have found that I have the least amount of interest in working with sick people. I have realized that I am finished with…

I have learned that what I have always wanted in life wasn’t to be educated, to travel, to be rich, or have authority, but to do work that matters to me.

I have found that I have the least amount of interest in working with sick people.

I have realized that I am finished with stifling my interests to work in a system that doesn’t fit me and most of the people it serves.

And I have started to wonder whether we all experience a similar journey in life before doing meaningful work.

A journey of learning, experiencing and seeing things we cannot unsee. A journey of sacrifices, failures and suffering, that teaches us important lessons, and shapes us to do the work we’re supposed to do.

You know, the kind of journey where you hit rock bottom.

Here’s mine:

From age 30 to 32, my family and friends will tell you that I was miserable. During that time I hustled as a nurse practitioner in a small rural town, working 50 hours a week, hiding from every problem I saw. I was constantly stressed, unable to sleep, and too afraid of what might happen if I spoke the truth. I spent every day trying to catch up from the day before, only to fall further and further behind. At one point I was hypertensive and handed a prescription for Amplodipine… and yet I couldn’t stop. No one could stop me. 

I was powerless to quit until one day, it ended. 

I recall the exact moment when I couldn’t fathom living another day distracting myself from problems and doing work that didn’t matter, just to make a pay check.

The moment when I was done with saying “my boss won’t let me”.

The moment when I suddenly understood who I was, who I wasn’t, and what I was meant to do with my life.

I survived the ordeal of burning out from the realities of working in a broken health care system. And I wouldn’t have it any other way.

Hitting bottom changed me forever.

When we know that the pain and suffering we’ve experienced was worth it, and when we believe everything that’s happened to us was only getting us ready to be our true selves, and do what scares us – that is when a nurse’s journey begins.

A nurse’s real journey is about doing the work that chooses us. The time before is a rehearsal preparing us to thrive when our plans fail, and plans almost always do.

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Applying for work

Is a competition for attention. Getting hired requires you to tell a true story that resonates with the people who are hiring you. A story about how you can help solve their problems, meet their needs and achieve their goals. Sending out a bunch of the same cover letters and resumes to different health care…

Is a competition for attention.

Getting hired requires you to tell a true story that resonates with the people who are hiring you. A story about how you can help solve their problems, meet their needs and achieve their goals.

Sending out a bunch of the same cover letters and resumes to different health care organizations isn’t the greatest way of getting hired anymore. Not for the best nursing jobs, anyways.

In a connected and competitive marketplace, people look for reasons not to hire you. If you have spelling mistakes, average work experiences, no remarkable achievements or a poor reputation, you may not get the attention you want.

Today, getting the best jobs requires you to be vulnerable and do what your competition isn’t doing. What if you:

  • attach letters of recommendation with your resume?
  • share a project you’re working on?
  • provide a copy of a book you wrote?
  • show a website you own?
  • tell a story about a program you developed?
  • write a manifesto about how you’re transforming health care?

Nurses who land the best jobs get far because their past and their reputation echoes with the people they hope to work for, not because of their resume.

Standing out is seriously underrated, and fitting in won’t get you where you want to go. The only person stopping you from daring to be different is you.

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Thriving as a nurse in today’s world

Demands us to do things differently. Apple wan’t the first company to build the personal computer, and Amazon wasn’t the first online store. The reason Apple is Apple and Amazon is Amazon is because they’ve done things their competitors chose not to do. In nearly every industry, the most successful people and organizations are making a difference by doing…

Demands us to do things differently.

Apple wan’t the first company to build the personal computer, and Amazon wasn’t the first online store. The reason Apple is Apple and Amazon is Amazon is because they’ve done things their competitors chose not to do.

In nearly every industry, the most successful people and organizations are making a difference by doing things that haven’t been done before. They’re thriving because they look at the status quo and do the opposite. On purpose.

Unfortunately in health care, many providers fight to maintain the status quo of a system that isn’t working by prioritizing quantity over quality. It’s not that they can’t see fewer people or increase the amount of time they spend with them, it’s that they won’t slow down long enough to think about how they could provide the kind of care people really need. 

But there are health care providers who do choose to focus on quality rather than quantity. It’s not that they can’t see more people more quickly, it’s that they won’t short-cut care.

As more people have more choices about who provides their health care, success will come to those of us who obsess about the ways in which we will help them.

Now, more than ever before, having credentials and being first matters less than the work we actually do. Today’s world rewards people who have the guts to do what other people won’t.

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