Don't Meditate To Fix Yourself

This is one of my favorite teachings. Thank you Bob Stahl for introducing it to me and thank you Bob Sharples for writing it.

Don't meditate to fix yourself, to heal yourself, to improve yourself, to redeem yourself; 

Rather, do it as an act of love, of deep warm friendship to yourself.  In this way there is no longer any need for the subtle aggression of self-improvement, for the endless guilt of not doing enough.  It offers the possibility of an end to the ceaseless round of trying so hard that wraps so many people's lives in a knot. 

Instead there is now meditation as an act of love.  How endlessly delightful and encouraging.

Bob SharplesMeditation: Calming the Mind


Dealing With Life's Surprises as a Warrior

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Life is full of surprises and uncertainties, especially when we tune into the Presidential election, National and International events. It is nearly impossible to get through a work day without someone differing in opinion with you. Sometimes life's surprises are pleasant and sometimes not so much. This week I would like to invite you into the world of Pema Chodron and meet these moments like the warrior you are. Here is what she has to say about working with challenges:

"…feelings like disappointment, embarrassment, irritation, resentment, anger, jealousy, and fear, instead of being bad news, are actually very clear moments that teach us where it is that we’re holding back. They teach us to perk up and lean in when we feel we’d rather collapse and back away. They’re like messengers that show us, with terrifying clarity, exactly where we’re stuck. This very moment is the perfect teacher, and, lucky for us, it’s with us wherever we are." 

— Pema Chödrön

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How Not To Die In The Hospital

Imagine if this was your family member and the Nurse was responsible for other patients.

Imagine if this was your family member and the Nurse was responsible for other patients.

Imagine a world of safe medical care. A world in which your family and friends not only get adequate care but outstanding care. Medication errors, hospital acquired infections, wrongful deaths occur all too frequently in our current healthcare system. Hospitals are driven by cost containment and Healthcare providers are expected to do more with less. We are busier than ever.

I have had the good fortune of working in hospitals throughout The United States for over twenty-five years in various settings from Med-Surg, PACU, Oncology, Intensive Care and Obstetrics. I have had as many as thirteen patients on a shift and as little as one in the ICU. Working in specialty areas allowed the opportunity of safe patient ratios. Working in the forward thinking state of California has allowed me the opportunity to provider safer care than if I worked in another state.

You see, California saw the value of demanding that hospitals provide the safest care possible to it’s citizens. In 1999 they passed a law requiring hospitals to implement safe staffing ratios by 2004. Human beings will make mistakes, myself included but I am much less likely to make a mistake with safe patient ratios. This is what it would look like:

I probably will finish my Nursing career in California with adequate patient ratios. However, I feel passionate to wake our country up to the urgency of the future of healthcare. I am joining Laura Gasparis Vonfrolio and other dynamic Nurses to petition for National Safe Nursing Ratios throughout the country. If you are a Nurse, NP, PA, MD, you need to sign this petition. If you have ever been a patient or anticipate being a patient in the future, you should sign this petition. If you have friends or family members, you should sign this petition so they get the best possible healthcare.

Click here now and save some lives today.

ICU Nurse, Attorney, Conflict Resolver - Meet Debra Gerardi

How long have you been a nurse and what areas of nursing did you or do you currently work in? I have worked with healthcare organizations 1979 when I started as an ER admitting clerk when I was 19. After graduating from Creighton University in 1987, I worked as a critical care nurse until 2003.

What led you to pursue law and mediation? I became interested in health policy in nursing school and became involved in Bob Kerry's first senate campaign in 1988. My interest in working in the public health arena, particularly health policy as a means of improving patient care delivery led me to law school in 1989. During law school, I learned about a program in Preventive Law, fashioned after the public health model, and began to learn about mediation as a means of resolving disputes rather than litigation. At that time, mediation was not as widely used and it was just touched on in law school. That is not the case now where law students are routinely exposed to mediation and other alternatives to litigation. I moved to Los Angeles after graduation in 1992 and I did 40-hour mediation training through the LA County Bar Ass. in 1994.

Tell me your biggest concerns about nursing. In my work now as a conflict specialist and executive coach, I am most bothered by the difficulty of the work environments that nurses are working within and how depleted nurses are trying to provide care to patients within a compliance and cost driven system. The need for nurses to make intentional choices for their own self-care and to develop reflective practices to maintain their own resilience and stay grounded in the values that underlie the practice of nursing is growing. I love helping nurses develop practices to help them restore their own well-being so that they can better do the work they were called to do.

What throws you off balance and how do you know you are out of balance? What throws me off balance is when I have not paid attention to my own resilience and I find myself taking in too much of other people's energy into my own body. This depletes me and it makes it easier for me to be "hooked" by my own triggers or habits. This imbalance can lead me to move to far into a "rescue" mode and take on work that belongs to others. To rebalance myself I do a number of practices including: Journaling almost daily, working out (my goal is 5 times per week), regular sleep when I am not traveling, being in nature (I need a lot of this), reading poetry and authors who inspire me and give me a larger perspective, good nutrition and hydration (this works like magic!), and spending time with people who bring me joy and love to play! As you can see, rebalancing is a full time job for me!

What is the role of nurses, physicians, nurse managers and administrators in creating a healthy workplace? So often we adapt to the culture because "it's always been that way". Managers or administrators often are swamped with meetings to address what seems to be petty behavior or bullying. The role of all health professionals, and particularly those in leadership positions, in creating a healthy work environment is to first become aware of how they are personally contributing to an unhealthy work environment and to set an intention for how they might shift their own habits that may make things worse or at a minimum maintain unhealthy patterns. For example, interrupting the tendency to talk about someone rather than directly to them or remaining silent when there are behaviors that are compromising care are two habits that most of us have adopted as part of "the way we do things here." Understanding that I have choices in how I respond and intentionally choosing to respond in ways that align with my values and promote connection with others in healthy ways and then trying on better behaviors is the main way that cultures shift over time.  Leaders who do this can have a much larger impact because everyone is watching them to see how they behave in order to know what is acceptable.

Additionally, the emphasis on bullying and unprofessional conduct has taken on in many places a punitive approach or a compliance-based approach rather than a relational approach. By reframing how we engage, we have a broader range of options for responding in ways that are less about discipline and more about confronting individuals and groups with a mirror to help them appreciate the impact their behaviors are having on patient care and colleagues and then providing them with the choice to change their approach or choose another place to do their work. Often people who are behaving unprofessionally are unaware of the impact of their behavior, they are having trouble coping with the stressors in the environment, and they have poorly developed emotional intelligence. Providing support for development of these skills early in training is essential. For the small percentage of folks for whom this approach will not work, the more traditional disciplinary action can be used to further protect the work environment and the quality of patient care. Of course, this particularly applies to those in leadership positions who are doing the bullying or who are having difficulty coping with the stressors of their jobs due to their own diminished resilience.

What advice do you have for healthcare providers that avoid conflict or difficult conversations? Are there ways to start getting comfortable?  We all avoid conflict! No one likes stepping into an unpredictable situation in which there are strong emotions and if we are worried about retaliation, making things worse, or not seeing any benefits from taking the risk, then we are even less likely to take it on. Knowing when and how to engage are core competencies for engaging in conflict. Becoming more comfortable with engaging in hard conversations comes with practice and development of our intrapersonal capacity (knowing myself and my own triggers) and interpersonal capacity (knowing how I interact with others and how they respond to me). This requires self reflection and self awareness so that I can try on things and see what works. Learning how to listen openly, acknowledge what matters to the other person, reframing the situation into something we can work on together, looking for common interests, and using empathy are all tools that nurses have some exposure to and using them intentionally with colleagues and others helps us get better at engaging, just like practicing other nursing skills helps us develop mastery. Another important point is to appreciate that when we are fatigued or under resourced personally, we are less likely to choose to engage and if we do, we may not be our best self when we do.

You worked with JCAHO on sentinel events. What relationship does a healthy workplace have on patient outcomes?  The Joint Commission started tracking sentinel events around 1997. The data consistently points to the importance of teamwork and communication as essential for safe care. This has led to a number of standards and sentinel event alerts that highlight the need for conflict management and team training. What is missing is attention to how the work environments with the excessive attention to productivity and quantification of patient care are contributing to fragmented approaches to care and removing the time and connection necessary for health professionals to form relationships with patients and with colleagues. It is these relationships that are the source of quality care and that provide a feeling of having done meaningful work.

What advice would you give to new grads starting out? Be compassionate with yourself and others. Nursing is noble work and hard work, and it is one of the most sacred spaces you will ever inhabit. Make friends with your colleagues and support one another- no one does this work alone. Become a life long learner- things will change and there is always more to know- about nursing, the health system, your community and about yourself. Have fun! The work is serious and sometimes overwhelming but you have to find ways to have fun and enjoy what you do so that you can keep doing it for as long as it feeds your soul.