by Paula Manuel Staff Nurse Interest Group

Three years ago I keyboarded an entry as my nephew headed to Northern Ontario to embark on his nursing studies. My Auntie status embraced his entry into this most demanding of academic studies and the acquisition of numerous cognitive, tactile, and sentinel skills.

During my vacation I coordinated our schedules and with this nephew we spent the day on a golf course, a pursuit for the individuals who enjoy the outdoors and the chasing of a wee ball into a hole in so many strokes. (google Robin Williams and golf to learn more on the game). We spoke on a range of topics as he related his experiences as a Personal Support Worker at his local hospital; observing the RNs on the team and he has a plan to optimize his chances of spending his pre-grad in the Emergency department.

He pointed out that he had considered my advice to be in medicine for some time then specialize, but he is forging his own path. As I listened to his vignettes of experiences it was evident he is linking his knowledge, skills, and judgment. The poignant moment when the team called a Code Pink and he recognize the agonized scream of a grieving mother. He recognized the effect this event had on the team, that the manager acknowledged the team’s grief, and that the nurses processed the event individually and as a unit.

My vacation has been a recharge time to rest, recreate, golf, spend time with friends, to have alone time and enjoy the quiet of a summer evening. Make time for yourself and invite those who lift you up and pursue some fun, though it’s hard to imagine not everyone enjoys a round of golf. Namaste.

Nursing Week 2019

Welcome back and what’s new?

Well the wellness journey continues and I am grateful for my boss who has been supportive and truly is one of my top 3 bosses.

As I reflect on what I consider to be a good boss the word trust comes to the fore. Trust is a word used a lot and I wonder if anyone considers how complex trust is; it’s a behaviour, an outcome, a process within an employee and supervisor relationship.

The transformational leadership framework has establishing trust as a core process, without it the sustained changes needed in heart, mind, and soul will be a challenge. As you navigate this term trust you have to ensure a shared understanding exists about the term; what does it mean, how is it built, how is it broken, and how can it be rebuilt. So trust is not a destination you will find it is an issue, action, and it’s about growth of one’s emotional intelligence.

Now trust (Reina, 2017) can be seen as a capacity for trust and there are 3 C’s that contribute to making a complex term more concrete, practical, and sustainable.

Capability is to acknowledge people’s abilities and skills. As a leader you will allow people to make decisions, include others in the decision-making by seeking input, and this builds succession planning as people learn skills and want to apply them (Reina, 2017).

Character is integral to trust, (Reina, 2017) and when you can trust you can manage expectations, others will behave according to “the rules”. The team to be effective means they do what they say they will do, this mutual reliability includes boundaries, consistency, delegate prn and appropriately. Say no if you can’t do it, renegotiate the task and remain true to the relationship–honesty, faith, reliable.

Communication you need information, we all need truth, disclosure of truth, to admit our mistakes, to exchange constructive feedback, to maintain confidentiality and to to speak with good purpose (Reina, 2017)

We all know good teams from bad teams and unless you prefer uncertainty, inconsistency, turf wars, conflict, silos, workarounds, and hidden agendas to name a few. Consider how trust can provide you with a team that is accountable, adaptable, effective and efficient, happy, innovative and comprised of high performers to name a few attributes.

Final thought

  • Be impeccable with your word
  • Don’t take anything personally
  • Don’t make assumptions
  • Always do your best

These are great life values and I’ve tried to live to them since I read The Four Agreements and fit right into trust.

Nothing other people do is because of you. It is because of themselves. All people live in their own dream, in their own mind; they are in a completely different world from the one we live in. When we take something personally, we make the assumption that they know what is in our world, and we try to impose our world on their world.” – Ruiz Don Miguel


As a Registered Nurse with many years of experience my time as an individual with a long-term progressive illness had been relatively short–a mere decade.

At first the condition was more of an annoyance, but my physical decline in the previous five years correlated with increased dosages of necessary medications and side effects that impacted my well being.

Living with constant pain, compensating continuously for increased movements, fatigue, and countering the effects with exercise, body therapies, and energy healing. My life was about carrying on and coping with an altered dynamic health status. As one physician observed, you are extremely high functioning. Translation I worked full time in a demanding managerial role, mentored and led RNs and RPNs and influenced Allied Health team members.

The emotional toll evolved into the characteristics of depressive qualities, crying jags were not uncommon. When the offer came to be evaluated for an innovative surgical option I readily agreed.

Two years from initial assessment to receiving a date for surgery was a mixture of anticipation and concern. I mean this was a procedure to alter my brain function, to drill into my cranium and place electrodes and a computer with power source. Twenty years in development it still had the elements of new territory, it was comforting to be told I had a good brain. So my view was that even if a few neurons were lost in the process I would still be okay.

Such an undertaking is not done alone, my family, friends, colleagues, team, and the health care team at the academic tertiary hospital were all instrumental in my successful recovery from the surgeries. The unexpected outcome was severe sciatica that affected all aspects of my life.

Pain unrelenting, all consuming, agonizing, frightening, debilitating it affected me physically, emotionally, cognitively, and a significant frustration that I was not being listened to, even when I researched and defined the working diagnosis.

My family physician, truly a gem, who invested the time to carefully consider what options were possible referred me to a pain management clinic. There a physician was intrigued by the surgical option for my condition and how well I had responded other than the life altering pain in my “ass”.

What’s the status now? Injections into the lumbar region of the back to cool off the nerve that had been firing out of control, secondary to the stimulation by something and here I am 10 months later gaining more control of my body, pain has minimized, my outlook improved, and the desire to move the body. Let me rediscover the athlete within and prepare for the 2019 golf season. Stay tuned.

via Joy in work – pictorial 

To lead change  means you have given great thought to what the goal is for the team, indeed the alignment of the goal with the mission, vision, and values is significant.  The alignment with the team members is not always cut and dried, the process is dynamic and the experience can be exhilarating to frustrating, rewarding to having doubt.

A formal or informal leadership role the ability to recruit followers, engage and sustain their interest one needs multiple approaches, resiliency, optimism, flexibility, desire to learn and Emotional Quotient can be components in the toolbox.

The team I lead has employees who vary in motivation, self awareness, and possess variable critical thinking skills. and mixed with that are the elements of collective agreement content, legislation, standards of practice, and the organizational mission, vision, and values. The path to change a culture is not for the faint hearted, it requires vision, stamina, resilience, building trust, continuously build and sustain connections, scan the environment, respond not react, and foster mentoring behaviours.

The pillars of leadership (Stein, 2017)  that you can cultivate include authenticity, coaching, insight, and innovation.

Authenticity the real you is what needs to be shown in a consistent and credible way.  You need to be viewed by others as fair, consistent, demonstrate integrity and transparency, there is also another feature humility.  Leaders with authenticity are role models, inspire others to be fair and moral and you respect them; these are leaders who you esteem and are confident about.

Coaching is the ability to mentor and collaborate with team members; as a leader is not an enforcer that is the manager aspect of my job.  The coach walks around the unit, connects with team members, has one on one meetings and key is to act on concerns, needs, support team members and align actions that staff want to be on the team.

Insight is to truly understand what the team/organization is about, the core mission and values and know how to communicate those elements in a form that inspires staff, patients, and families.  Do you know your higher purpose?  I know that first and foremost I am a healer.  Whatever role is placed within my influence my core being is to heal others.

Innovation is to harness the energy of creativity, to learn how to take risks, to encourage autonomy, to provide ongoing opportunities to gain knowledge, and mistakes or failures are opportunities to learn from not punish individuals.

Are leaders born–no; there are intrinsic personality traits that can provide advantages, the true measures are mentoring, encouragement, opportunities, clarity of what is to be done, and mix in some resiliency, confidence, and you are really on your way.  Informal or formal roles there are ample opportunities to develop leadership skills and there is certainly room for our world to encourage authenticity, moral courage, and can do attitude.  Namaste

The previous blog post Brand New Year outlined a number of steps for anyone who desires to change some aspect of their life–incorporating a self assessment, re-scanning your environment, organizing your thoughts into the columns Purpose Practice Passion. 

Now you will notice it’s taken until September to enter this post and that reflects my work reality of gridlock, flu outbreak, day-to-day operations, and managing any myriad of projects, incidents, strategic planning processes, budget items, and the top tasks; payroll, scheduling,  well you get the idea.

Now Human beings management–coaching, debriefing, teaching, and prn discipline is definitely in the top 10.  Managing escalations whether staff related, patient care focused, and/or family members who are key to any patient’s status are not daily but certainly require time, effort, and stamina.

Now it’s not all work I have played golf fairly regularly, invested in lessons, had a vacation to recharge my physical and mental batteries. My backyard is a source for chores and a place to relax and watch the flowers grow (daresay also the rapid and lush growth of weeds).

So if you are a Type A you likely forged on your own to build goals, launched your plan, strived for utter perfection, and some have had success and others found their plan this week with dust on it.  If you have dear reader waited, my apologies for the delay you need to retrieve your document of thoughts……

Now you may have a few thoughts or many, the key is to choose one item/task/aspect of life and focus on this in a mindful way.  Yes it does mean using a format like SMART, specific, measurable, attainable, realistic, and time based (you can use other terms i.e. significant, stretching, meaningful, motivational, achievable, action-oriented, tangible, trackable).

Specific W’s

What do you want to accomplish?   Why is this important to you?  Who will be included? Where will it happen? Which resources are needed and identify limits.  Money is a resource if hiring a personal trainer.  The more details you include builds within you a vision of just what you plan to change.

Measurable H’s

How will you know you are succeeding? How many steps are needed?  How will I track my progress?


It’s good to stretch yourself but beware of the desire to be perfect, none of us are and we need to be ready and kind to ourselves when lapses occur.  Being realistic indeed honest with yourself is key to transforming your life, constraints are a reality creativity can be tapped to overcome them.


As a word it fits in with achievable, so the real questions include; is this goal relevant to you, does it fit your values, is the timing right, do you have the skill, readiness, drive, indeed passion to make it happen?  Remember you have to retain ownership of your goal, you cannot assign your Purpose, Practice, Passion to someone else to do for you.  Change, real and sustained is what you provide in say sweat equity.  For example weight loss it’s you that has to move your body, change your diet, commit to a time and invest resources.


This goal, the start of many successful ones, need a target date for you to review your progress–to celebrate a milestone, specific timelines and targets keep your goal from being lost.  Everyday tasks, chores, demands, traffic, family and friends can overwhelm you so keep your priority in sight.  It may be a week, a month, keep it to three months max to review your progress.  Be kind to yourself it’s not a race but an evolution.  Time is time, it’s interesting our species lived a long time without measuring minutes, seconds, even hours, try living without a clock–gives one a sense of more time.


Brand New Year

2016 was much like an eye blink it came and went so quickly and I am thankful I have this ongoing blog to capture my perspectives, indeed grateful for so many aspects of my life and nursing practice.  Yes my every day job is a manager position but the template of my practice continues to be one of a registered nurse.  This fall into winter period was celebratory and perhaps some degree of wistfulness, as I witness my nephew transforming from layperson to a nurse.  His method of speaking, his thinking patterns are altering, along with balancing academic work and living away from home. His first semester was a success completing his final exams, passing his clinical lab and now he is back in his residence like so many developing professionals to start semester 2.

I have never been a proponent of New Years Resolutions the timing to change is an individual one and when I determine changes are needed, the best approach has been to follow a clear and precise process. The ability to change starts with recognizing there is a gap, dissatisfaction, discomfort, and/or by acknowledging a vision, inspiration, perhaps in a very literal sense a sirensong that invites you to transform where you are to a new place.  A change plan requires some work to be done before, during and after.   Note you need to literally build space to make a change whether it’s time, environment, emotion, etc.

A key step is to declutter my immediate area where I will reflect on exactly what I am going to change.  I find it therapeutic to collect, recycle, reassign, and discard what is no longer needed i.e. clothes, physical items, attitudes, bias, people, regrets, doubts.  I use specific items such as a notebook strictly for reflections, a good quality pen, and on the different pages list headings that frame the process used (allowing that at different times, different changes, the requirements can change).  Handwriting versus keyboarding it’s a matter of preference though my wise self emerges more readily when a pen moves across a page of paper.

  1. List of gratitudes whether people, abilities, places, blessings, provides an exercise to be thankful indeed be mindful of what my life is right now.  It’s more formal when written but it works equally well even mentally listing my gratitudes upon waking up or before sleeping.
  2. When I identify what needs to be changed I draft a chart that has headings for 90 days, 180 days, 360 days, 3 years,  7 years, and my changes fit into domains that I identify as priorities:  self, family, friends, professional, community, fun, finance, and if the pen is not moving on the page….
  3. I list 3 headings Purpose Practice & Passion and allow a veritable free form of expression to flow down the columns.
  4. A highlighter pen (consider multiple pens) as I review what is written it helps to highlight values, concerns, strengths, needs, assign a different colour for each variable.
  5. The wise self will emerge to guide the next step–identify the change needed, priority one, and/or reveal what is really bothering you?

Wise self? Your inner voice the real you, some of you may already be very connected to your voice of creativity, you may know of it as self-actualized.  That is where you may pause and consider that this aspect of your life requires support from a physical and emotional frame of mind that will optimize your mindset to be transformed, to make a leap, and appreciate it takes effort, sweat equity, engagement whatever road you need to access– to move from where you are now to a new sense of reality.  Still with me….

stay tuned for the next step ….this post will likely keep you occupied for a bit.  Namaste.

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