Managing Through Work Style Differences in Healthcare

Professionals

““Why Working With Why Working With You Is Driving Me You Is Driving Me

NUTS!”NUTS!”

Terry S. Johnson, APN, RNC, MN, CLECTerry S. Johnson, APN, RNC, MN, CLECNeonatal Nurse PractitionerNeonatal Nurse PractitionerFounder, Lode Star Enterprises, Inc.Founder, Lode Star Enterprises, Inc.© Lode Star Enterprises, Inc.© Lode Star Enterprises, Inc.

Disclosure Statement• In addition to any clinical practice, education

and consulting services I provide– I am currently on the speaker's bureau and/or

consult with these industry partners• Prolacta Bioscience and Abbott Nutrition Health Institute• I receive financial reimbursement for those services

• Images & photographs used in this presentation come from publicly accessed sources

• I will make no recommendations for any off label use of any drug or medical device

• I am honored to be here with you today

Interpersonal Work Skills• "Simplexity"

– Why Simple Things Become Complex and How Complex Things Become Simple

• The science of redefining how we look at the world and using that new view to improve our work and lives

• “Simplexity” Interpersonal Issues in Nursing– Reality of Work Stress in Nursing

• Work Style Differences

• Communication Style Differences

• Intergenerational Influences

Klueger, J (2008). Simplexity: Why Simple Things Become Complex and How Complex Things Can Be Made Simple. New York, NY: Hyperion.

Interpersonal Work Skills

.

Dorothy DelBueno, 1980, Work Competency

Interpersonal Work Skills

• Nature of Work Place Conflict– Substantive Aspects

• Conflicts of Work Styles• Conflict of Communication Styles• Conflict from Intergeneration Influences

Conflict of Work Styles

• Why Do You Do That?– Comes from being “different”– “Hard Wiring” around tasks– Exists on a continuum – Expressed in work variables– Influenced by stress– Information & tolerance help

People

Socially Cautious Socially Assertive

People

• Socially Assertive– Increased need for people at work– Likes working with a crowd– Work is a social event– Emoting, feelings matter– Focus on the task….responds to people– “How are you doing?”– Gathers the troops

People

• Socially Cautious– Decreased need for people at work– 2 people at their bedside is a crowd– Work is work– Shares feelings rarely and selectively– Focus on the task….tolerate the people– “If you would quit talking so much….”– Retreats into a fortress

Environment

Stable Environment Dynamic Environment

Environment

• Stable Environment– Values routine, pattern and order– Systematic approach– “We’ve always done it this way!”– “That’s nice….now go away”– Conformity is everything!– Things are carved in stone

Environment

• Dynamic Environment– Values and seeks change– Flexible approach– “Whatever gets the job done!”– “I’ve been thinking….”– Just do it!– Written on an etch-a-sketch

Time

Monochronic Polychronic

Time

• Monochronic– Tends to compartmentalize tasks– Loses focus with interruption– Accused of being anal-retentive– Methodical– Low level of involvement with their work– “It’s done, copied, stapled, collated and I sent

it to you by email, snail mail….”

Polychronic

• Polychronic– Engages in multiple tasks at once– Stimulated by interruption– Accused of being disorganized– Impulsive– High level of involvement with their work– “It’s on my desk somewhere….”

Completion

Bottom Line PerfectionisticBottom Line Perfectionistic

Completion

• Bottom Line– Independent standards about “done”– Things change depending on the

circumstances– Results over form– “That’s what the next shift is for!”– “Get it done, we can clean it up later”

Perfectionist

• Perfectionist– Exact, concrete standards about “done”– Worship the 3 P’s -

• Policy• Procedure• Protocol

– Form is everything– “I can’t leave this like this!”– “There is only one way – the right way!”

Decision Making

Reflective ReactiveReflective Reactive

Decision-Making

• Reactive– You already know if you are– Decisions made in 3-10 seconds– Intuitive based over data based– “I have a hunch!”– Biggest fear is “no” decision– Will change decision as more information

becomes available

Reflective

• Reflexive– You’re still trying to decide if you are one– Decisions take time– Data based over intuitive based– “I need more information!”– Biggest fear is a “wrong” decision– Can’t decide….I’m still collecting data

Intra-Personal Stress

• Emotional aspects:Emotional aspects:

AngerAnger DefensivenessDefensiveness

DistrustDistrust ResentmentResentment

FearFear RejectionRejection

SS(Stimulus)(Stimulus) + + RR(Response(Response)) = = OO(Outcome)(Outcome)

Intra-Personal Stress at Work• “Communication problems are the

number-one cause of sentinel events.G. Porto, RNQRS Healthcare Event Advisory Board JCAHO Sentinel Event Advisory Committee

Sentinel Event Alert # 30

• Published July 21, 2004– 71 cases (now over 110 cases) of perinatal

death or permanent disability in a term, normal newborn

– Injury defined as

“ Any perinatal death or major permanent loss of function unrelated to a congenital condition in an infant having a birth weight greater than 2,500 grams”

Sentinel Event Alert # 30

• Maternal Characteristics– Mothers ranged in age

from 13-41 years– Over ½ of the mothers

were primiparas– Average gestational

age was 39 weeks

Sentinel Event Alert # 30

• Maternal Risk Factors– Lack of PNC (4%)– Maternal age (13%)– Previous C/S (11%)– Diabetes (4%)– Substance abuse (4%)– Placental abruption (8%)– Ruptured uterus (8%)– Breech presentation (6%)

Sentinel Event Alert # 30

• Delivery Risk Factors– Emergency C/S (49%)– SVD (46%)– VBAC (8%)– Vacuum extraction (21%)– Mid forceps delivery (13%)– Delayed C/S decisions (4%) – Failure to do indicated C/S (11%)

Sentinel Event Alert # 30• Root Causes Identified

– Staffing issues (25%)– Staff competency (47%)– Inadequate fetal monitoring (34%)– Orientation and training process (40%)– Physician unavailable or delayed (19%)– Unavailability of perinatal information (11%)– Unavailable monitoring equipment and/or drugs (30%)– Credentialing/privileging/supervision issues (30%)

Sentinel Event Alert # 30

• Root Causes Identified– Communication issues (72%)– Organizational culture (55%)

• Hierarchy• Intimidation• Failure to function as a team• Failure to follow the chain-of-command

Which Cortex Are You Using?

EpinephrineEpinephrine NorepinephrineNorepinephrine

CortisolCortisol

LanguageLanguage

MemoryMemory

Problem SolvingProblem Solving

Intra-Personal Work Stress

• Immediate Responses:Immediate Responses:

BreatheBreathe Minimize your speechMinimize your speech

Time outTime out Maximize your hearingMaximize your hearing

Walk awayWalk away Make eye contactMake eye contact

Speak slowlySpeak slowly Refrain from touchingRefrain from touching

Lower voiceLower voice Breathe againBreathe again

Resolving the Situation

• Response:

Deal With It!Deal With It!

Conflict of Styles

• Response:

Don’t expect spontaneous remission of different behavior!

Conflict of Styles

• Response:

Plan in advance –

you can’t wait for brilliance!

Conflict of Styles

• Response:

Avoid Triang-ling

The Rules About Styles• We’re all different and/or difficult some We’re all different and/or difficult some

of the timeof the time• It’s usually about how we process It’s usually about how we process

information – its not personalinformation – its not personal• When people are different and/or When people are different and/or

difficult we judgedifficult we judge• Judgment censors negotiationJudgment censors negotiation• Behavior under stress becomes Behavior under stress becomes

extreme!extreme!

Presenter

Terry S. Johnson, APN, NNP-BC, MN, CLECNeonatal Nurse PractitionerFounder, Lode Star Enterprises, Inc.

7709 Knottingham LaneDowners Grove, IL 60516

Phone: 630.881.2606Email: lodstar@mindspring.com