It occurs to me that other people’s ego can stop us from operating at our best – at our highest level of capacity – and the other people can be your peers, other professionals or it can be your boss.
Since 2006 I have been working with nurses to advance their clinical capacity so they could see and treat the patients that presented to their emergency departments. This nursing model is known across Australia as the Rural and Isolated Practice Nursing Model (RIPRN). It gives these nurses the skills, confidence and authority to not only see and treat patients in their EDs, but also supply some of the drugs their patients need without having to defer to a doctor.
This is probably the biggest advance in the nursing profession since the Nurse Practitioner.
Now it makes sense to me that who does the role and makes the decisions about work, regardless of where they are, should be dictated by who is best placed to perform it when it is needed, and who has the skills. But what I have seen happening is that other people’s egos often determine who does what in a health setting. For example, a small rural hospital I work with trained up a few of their nurses as RIPRNs. They gave them the authority to see and treat patients, and supply drugs if they needed to. But then their Visiting Medical Officer (VMO) put the brakes on their advanced practice because it meant he would see fewer patients. Now I am not sure whether this was motivated by his worry that he would earn less money (fee for service) – or whether he was concerned about nurses eroding ‘his’ role or whether he was concerned that these highly skilled nurses would expose his own lack of skill. I can’t know any of this because he wrapped it in incredibly rational reasons – saying that he was not confident in these nurses clinical ability – and for the patient’s safety he should be called in for everything. Keep in mind these nurses had completed an incredibly arduous course of study and received an endorsement to practice by the Nursing and Midwifery Board of Australia!
Now the problem with this scenario is that he couldn’t be there for every patient, and he really didn’t have all the clinical skills needed to manage them anyway – so the patient lost out. The community lost out.
But I have seen this very same scenario play out between staff and managers, managers and managers. For example, nurses most certainly do have the capacity to learn how to build and manage their own budgets – we develop their skills to do this in our programs. And we know that when they take on this responsibility they spend less and find more revenue sources – and the budgets come much closer to reality. And yet so many unit managers are not allowed to. They are often given their budget which have been prepared by someone else – maybe the finance manager – and told to manage within it.
And I can’t help but wonder if this role is protected by the finance people or higher levels because they simply do not have the skills to support nurses to step up and take control of their own budgets – or if handing this over to the nurse unit managers erodes other managers own ‘roles’, leaving them wondering what they do instead.
The fact is that when responsibility for managing patients, people, issues and resources is pushed as close to the point of care as possible, hospitals become more responsive, they save more money, make more money and catch more problems before they escalate. They provide better patient experiences.
But it takes more than training to achieve this. It takes a letting go of responsibility and power by those higher up in the hierarchy. That means letting go of ego, letting go of ‘role protection’, stepping up a notch and creating systems that support individuals to operate more autonomously in collaboration with others. It requires a distributed organisational structure, processes and empowered leaders. If you want to know more about how to set this up, contact me.
