Karen L. Zimmerman, MSN, RN Trinity Health Chief Nursing Officer

1. Leadership, Professionalism, and Conflict Resolution for Today’s Nurse . . . What would Florence Do? Karen L. Zimmerman, MSN, RN Trinity Health Chief Nursing Officer Vice President Patient Care Services April 13, 2018

2. Objectives • Understand the impact of stress in leadership • Understand and apply negotiation styles during crucial conversations • Recognize the necessary skill sets applicable to professionalism and conflict resolution

3. Outline • Leadership (and professionalism) and its impact on you personally • Adding value to others without losing yourself • Maintaining composure when you don’t feel like it • Understanding the basic negotiation styles (where do you land) • Crucial conversations • Personal power and presence

4. Leadership (and professionalism) and its impact on you personally

5. You are a leader!

6. Why is this fundamental? • Why do I care if you see yourself as a leader? • Why do you care if the person working along side you acts professionally? • It’s actually pretty simple! We are the face of nursing. . .We can’t relinquish the responsibility we have to uphold the profession! • We have a professional obligation to: • value nursing and project that image daily • take ourselves seriously and dress the part • recognize the value of what we do • believe in ourselves and their colleagues

7. Specific action steps • Cultivate a professional image by the way YOU represent the profession • Define unacceptable workplace behaviors and holding YOURSELF and others accountable • Listen to patients’ and caregivers’ perceptions of nursing • Teach and practice communication skills, so YOU feel empowered to respond to negative colleagues in a manner that confronts and stops behaviors that affect OUR image • The time for us to redefine our image is now. By working together, we can help ourselves and the public see the nursing profession clearly.

8. “Real leadership is not about authority, control, or giving orders. It’s not about titles or executive benefits. Leadership is about taking the initiative to do a job in a more efficient way or a better way, treating others with respect and compassion, and thinking of ways to be helpful. Leaders assume responsibility for what happens in their work. They ‘own’ their work and perform a job with integrity, as an expression of themselves, their creativity, and their commitment.” Sister Mary Jean Ryan: On Becoming Exceptional: SSM Health Care’s Journey to Baldridge and Beyond

9. Characteristics of a leader (Who we are versus how we are seen) • Behavior (67%) • Communication (28%) • Appearance (5%) Source: Hewlett, S. A. (2014) Executive Presence. New York City, NY: Harper Collins

10. Formal versus informal leaders

11. Leaders without a Formal Title • Florence Nightingale • Her legacy: she gave nursing a highly favorable reputation and became an icon of Victorian culture, especially in the persona of "The Lady with the Lamp" making rounds of wounded soldiers at night. • Helen Keller • Her legacy: She was the first deaf-blind person to earn a bachelor of arts degree; she was a political activist; she was a lecturer . . .most importantly, she broke through almost complete isolation. • Alexander Graham Bell • His legacy: He only worked on his invention because he misunderstood a technical work he had read in German. His misunderstanding ultimately led to his discovery of how speech could be transmitted electrically.

12. Leaders without a Formal Title • Florence Nightingale • Helen Keller • Alexander Graham Bell • What did these three leaders have in common? • They didn’t accept the status quo • A commitment to process improvement • They questioned what could be done differently • They pushed through adversity • They persevered despite resistance and the “odds”

13. True or False? • Formal leaders have more influence than informal leaders • People’s power derives from personal relationships they have established with others.  • They may or may not be designated as “bosses.” • People consider them leaders as they help them accomplish THEIR GOALS.  • In both cases, leaders understand people and know how to leverage formal and informal authority. • There is no doubt that the best way to influence someone is to have both formal and informal authority. However, if you have little or no formal authority, you can still influence other people. To do that, you should earn informal authority.

14. Leadership and Professionalism • Professionalism isn’t how you look, but it is how you behave

15. Unprofessional Behavior • Being unresponsive • Blaming • Not keeping promises • Politics • Being fake • Putting profit ahead of customer needs • Poor communication (especially poor listening) • Lying and stealing • Not giving 100% • Thin skin

16. Characteristics that Demonstrate Professionalism • Keep your commitments • Use your language properly (minimize slang, don’t use inappropriate language) • Avoid drama • Hold yourself with strength • Practice ethical behavior • Do NOT bully • Avoid gossip and gossiping • Display a positive attitude • Be accountable • Control your emotions • Avoid dirty jokes and sexual innuendos

17. How is professionalism judged? • By how you communicate • By your image • By your competence • By your demeanor • By your respect for self and others • By your acceptance of responsibility

18. Professionalism is in the eye of the beholder ABC Clinic

19. “We judge ourselves by our motives whereas others judge us by our behavior.” ~AA saying

20. “The most valuable asset in your career is your reputation. Those who understand this fact of life do everything in their power to always display professionalism in every encounter. There are no compromises, and most of the time we never get a second chance to correct a bad impression. ”~Dan McCarthy

21. Easy Wins • Be friendly and helpful to others • “Manage up” • Celebrate successes • Help others feel appreciated • Do not embarrass or criticize • Do not gossip or talk negatively about others

22. Adding value to others without losing yourself

23. Be a value-add person • Maintain boundaries • Ask for help • Be willing to show vulnerability • Challenge yourself to be better • Love your job • Be willing to work hard • Make some sacrifices • Give Up feelings of entitlement • Think outside of the box • Go the extra mile (show initiative) • Continually look for improvements • Keep your technical skills current • Apologize when you are wrong • Don’t EVER stop working on communication • When in doubt . . .take the high road!

24. Maintaining composure when you don’t feel like it

25. Keeping your cool when you’re hot(What makes me an expert?)

26. Keeping your cool when you’re hot(What makes me an expert?) • Don’t allow your emotions to get in the way – be aware of burst emotions • Don’t take things personally • Keep a positive mental attitude • Remain fearless (fear is a liar) • Respond decisively • Take accountability • Act like you have been there before • Find the purpose • Never assume (or if you do, assume benign intent) • PAUSE • Be vulnerable not defensive • If you have the tendency to lose your temper or flare up, people will have the notion that you are a very dangerous person or they will not be safe with you

27. Understanding the basic negotiation styles (where do you land)

28. Negotiation Styles Negotiation (defined) A process by which compromise or agreement is reached while avoiding argument or dispute. • Why start with negotiation? • Because we negotiate every day! • We negotiate to get out of bed • We negotiate to get our patients to take medication • We negotiate to get our children to eat their vegetables • We negotiate a job, our schedules, our evaluations

29. Negotiation StyleS Five main types • Competitors • Avoiders   • Collaborators • Accommodators • Compromisers

30. COMPETITORS • Results-oriented • Self-confident • Assertive • Focused primarily on the bottom line • Have a tendency to impose their views upon the other party • In the extreme can become aggressive and domineering • High in Assertiveness and low in Cooperativeness

31. AVOIDERS • Passive • Prefer to avoid conflict • Make attempts to withdraw from the situation or pass responsibility onto another party • Fail to show adequate concern or make an honest attempt to get to a solution • Low in Assertiveness and low in Cooperativeness

32. COLLABORATORS • Use open and honest communication • Focus on finding creative solutions that mutually satisfy both parties • Open to exploring new and novel solutions, and suggest many alternatives for consideration • High in Assertiveness and high in Cooperativeness

33. ACCOMMODATOR • Make attempts to maintain relationships with the other party • Smooth over conflicts • Downplay differences • Most concerned with satisfying the needs of the other party • Low in Assertiveness but high in Cooperativeness

34. COMPROMISOR • Aim to find the middle ground • Often split the difference between positions • Frequently engage in give and take tradeoffs • Accept moderate satisfaction of both parties’ needs. • Moderate in Assertiveness and moderate in Cooperativeness

35. Negotiation Styles • Know yourself and your style. . .know the person you are “negotiating” with! • Prepare.Prepare.Prepare. • Framing the conversation (CNO Academy) • Clergyman to his superior: “May I smoke while praying?” (Answer: No) • Clergyman to his superior: “May I pray while smoking?” (Answer: Yes)

36. Crucial conversations

37. Crucial conversations Source: Patterson, K., Grenny, J., McMillan, R., & Switzler, A. (2002). Crucial conversations. New York, NY: McGraw-Hill.

38. Before you go into a crucial conversation . . . • Do a pulse check • Are you in the right frame of mind • Do you have your tools available if the conversation turns south

39. When Crucial conversations go bad What happened? Step 1: Adrenaline Step2: Brain diverts blood from “nonessential” to high-priority tasks (hitting and running i.e. arms and legs) Step 3: Less blood to higher-level reasoning . . .i.e. brain gets less blood. Result: You face challenging conversations with the same equipment available to a rhesus monkey. What can you do? Eliminate the emotion. Breathe. Pause. Tell your brain this isn’t fight or flight. Source: Patterson, K., Grenny, J., McMillan, R., & Switzler, A. (2002). Crucial conversations. New York, NY: McGraw-Hill.

40. Personal power and presence

41. Managing Stress The Power of the Pose (Amy Cuddy) • High Pose versus Low Pose http://www.bing.com/videos/search?q=amy+cuddy+ted+talk&qpvt=amy+cuddy+ted+talk&view=detail&mid=5A2A22A1A7FC75C126C25A2A22A1A7FC75C126C2&FORM=VRDGAR

42. Assume a Power Position

43. Why does this matter? Testosterone (assertiveness hormone) • (resulted in an increase after a high power pose) Cortisol • (resulted in a decrease after a high power pose) So . . .who cares? Higher and more prolonged levels of cortisol in the bloodstream (such as those associated with chronic stress) have been shown to have negative effects, such as: • Impaired cognitive performance • Suppressed thyroid function • Blood sugar imbalances such as hyperglycemia • Decreased bone density • Decrease in muscle tissue • Higher blood pressure • Lowered immunity and inflammatory responses in the body, slowed wound healing, and other health consequences • Increased abdominal fat