1. I started with 2.5 FTEs.
    I had an administrative assistant, an e-learning developer, and an as-needed marketing graduate who had awesome technical skills and facilitated hospital orientation. I had no nurse educators. In fact, I had no actual educators except myself.
  2. When I started there, our department offered very limited services.
    We facilitated orientation to the hospital for new hires, e-learning for mandated regulatory education, and offered Basic Life Support (CPR). Each department provided its own orientation and education as it believed necessary. Some required programs were contracted out. Nothing was standardized, education principles were usually absent from program planning, development, and implementation, and instructor evaluations were the sole method of evaluation. Nursing units had considerable redundancy
  3. I began with my own organization and ground rules. Early on, I developed a color-coded calendar in Outlook and made sure my team knew which colors were flexible and which were not.
    I made my calendar open only to my department so only my employees knew what I was doing. I asked that they do they same. I set up a series of individual meetings with each nursing and clinical director, each unit or department-based educator (or whoever was responsible for it), and each of my employees to get to know the hospital, key people I would be working with, and help me identify strengths, gaps, and needs.
  4. I arrived at 7:15-7:30 each day because our department was officially open 7:30-4:30 daily. From my first day on the job until my last, I blocked my schedule in Outlook from 4:00PM through 5:30 PM
    This was not flexible. I wanted to protect myself from late day meetings with others who worked 9-5 or worked 50-60 hour work weeks. I did not intend to work more than 45 hours each week. I wrapped up what I was working on by 4:00. Then I spent the last half hour on the job reflecting on my work for that day, how well it aligned with my core department functions, and my goals. Then I planned my next day. This practice served me well over the years. It's so easy to get pulled off path.
  5. I reviewed all the committees I was expected to be part of (mostly because my predecessor had done so) to determine their relevance and value to my core department functions and goals. She was on 13 committees not including the 4 required management meetings held monthly with various members of senior administration.
    I only participated in meetings, teams, or projects relevant to my department or where I could add value based on the needs of the hospital, my department, & our goals. Otherwise, I explained to the chair I had a conflict, would no longer be participating, & asked to have the minutes sent to me. If nothing was relevant after a year, I stopped reading them. If our department was required to participate in a committee I found irrelevant or only marginally related, I delegated it to one of my staff
  6. I always did my best to consistently demonstrate my work ethic, values, and practices daily, and clearly verbalized my expectations to my staff. I worked very hard during the hours I was there, but I role-modeled work-life balance and self-care. And I nurtured my little team.
    I managed my time by prioritizing, delegating, and saying no when appropriate. I was open and authentic with everyone. I gave liberal praise when any of my staff met my expectations or mirrored my actions. If they did subpar work I waited until we were alone, stated my expectations, and where I felt they didn't meet them. I would stay positive and friendly, asking what they barriers were. I worked diligently to remove those barriers, to coach, & develop talent. I gave them credit for their work
  7. I set the example and expectation that they would take breaks, have lunch, and leave after they put in an 8-hour day. We put in extra hours only if there was a time crunch. Then I made that time up to them with Friday afternoon off, lunch off-campus, or something similar.
    I scheduled a weekly meeting for 45 minutes we called Coffee Talk. We met at the coffee bar, sat across from it in the lobby couches in full view of everyone, and enjoyed beverages and conversation with a no-work-related-talk rule. I intentionally wanted to publicly demonstrate my support of them. The purpose was also to make up for missed breaks. I scheduled meetings for lunch once a month, and potluck once a quarter. I met with each of them weekly at first to help them and get to know them.
  8. We had a Monday morning huddle over coffee/tea in our department to review everyone's schedule for the week. This way we each knew what the others were up to. When I delegated responsibilities, I was clear what my expectations were, who was responsible, what they should do, and by when.
    I would reassure them I was confident they could do it. I trusted them and I told them so. I would often say that I knew they wouldn't let me down. And they didn't. People rise to your expectations as long as they are clearly stated, achievable, and you provide support and encouragement.
  9. We went through inventory of our equipment, technology, and supplies soon after I started so I could document what we started with compared to budget.
    I found an $80K teaching simulator on a gurney in the back of a storage area covered with a sheet. No one knew how to use it & it had been laying there for 9 months gathering dust. I learned we had only 3 months left to use the training purchased with it by my predecessor. I invited 3 nurse educators from the nursing units to join my department for a 4-day on-site training program. We practiced together for awhile and soon offered basic simulation programs for assessing nurse competency.
  10. We found during inventory that thousands of dollars of training equipment was missing.
    We tracked down more than half of it spread among various departments that borrowed it and never returned it. The rest had to be declared a loss. This enabled me to get a private locked storage area for our equipment moving forward. Digging into the old budgets, I found 1.5 unfilled FTEs, one for a manager who would report to me. I immediately increased my as-needed employee to full-time because she was a whiz with software and I planned to train her to back up the e-learning developer.
  11. The e-learning developer did not fit in well. She was not open to change or cross-training. She was reluctant to keep her files on our shared department drive so we all could see and access them. She didn't want to open her calendar to the rest of us and I had to direct her to do so.
    She struggled to accept that her work belonged to the hospital, not to her. I had counseled her twice and if she failed to open her work to others or failed to help cross-train others she was on the verge of a written warning. She transferred to one of our sister hospitals. I was sorry the director of education there did not contact me first for a reference. However, I was also happy she was gone because she was a problem employee. I later learned she applied for my position and did not get it.
  12. Simulation is a great method for assessing skills and decision-making in a controlled setting where you can learn from mistakes without harming anyone.
    The nurse educators from the individual units & I were increasingly busy using our simulator. He was computer controlled, and we could program him with life-like symptoms. We could simulate breathing, heartbeat and rhythms, blood pressure, etc. We could start IVs on him, insert other tubes, use life support equipment, and have him respond realistically We were also using many of the static mannikins I had uncovered or purchased, such as an IV arm and male and female pelvises.
  13. I had also started chatting up nurses and doctors on the units to determine how diabetes education was being provided. I learned it was supposedly done by the bedside nurses. I discovered the nurses considered providing written information to be sufficient education. I was a Certified Diabetes Educator but I was very busy. But patients come first.
    Diabetes education is a specialized field requiring knowledge about nutrition, medications for diabetes, blood sugar monitoring at home, and most importantly, being able to apply this information to individual circumstances. Hospital nurses lacked sufficient training or time to provide this and I understood their situation. I spread the word that I could help ONLY with patients who were newly-diagnosed with diabetes or new to insulin use. I was VERY busy and needed more help.
  14. Since the demand for diabetes education and simulation had significantly increased, I filled the e-learning developer position with a nurse educator to cover these aspects of education for our hospital. Her knowledge was basic but she had great potential and my little team liked her.
    Over the next few years I mentored her and coached her and she became a Certified Diabetes Educator (CDE). We developed our program enough to become accredited. I sent her to conferences & workshops related to diabetes and did the same for simulation. She and I worked together very well. When I left after 6 years, we had the original simulator plus 4 more - a female who was similar to our original simulator but easier to use, a pregnant female that could give birth, an infant, and a child.
  15. I filled the manager position with an experienced PhD nurse educator with management and education knowledge and experience. She also had been a CDE in the past.
    She was responsible for overseeing day-to-day operations, inventory, scheduling, etc. This was only taking about 10 hours a week of my time because I trained the administrative assistant to manage most of it. We still lacked in-house programs for new graduate nurses and a standardized preceptor program to orient new hires and new hires. I made these additional responsibilities of the manager. We supported new grads through their first year of nursing to improve retention, competence, and safety.
  16. With many burdens lifted from my shoulders (providing diabetes education for the most needy, developing simulations, and individually coaching and training staffs) I reevaluated the hospital's education needs and costs.
    I had the originally part-time technical assistant trained to use the e-learning and other education software. She worked with health professionals to obtain accurate content and then developed the programs. We also trained her to coordinate the hundreds of students and observers we had in the hospital to track their required orientation, immunizations, and placements. She became a CPR instructor to help with those classes. She did everything well and with enthusiasm.
  17. I determined the hospital still needed a better system for providing life support education and lacked any leadership orientation or development programs. I addressed the life support education first. We needed standardized training for basic and advanced life support of adults, children, and infants based on the role and department.
    After extensive literature review, cost evaluation, and site visits, we selected a robust e-learning system developed by the American Heart Association. It combined interactive online case studies with skills evaluation by specially-designed simulators. Our entire department including the administrative assistant was trained to help staff as they completed the programs. Implementation was long and difficult because it was a huge change from instructor led classes. We accomplished it together.
  18. The second and third years I was there we began cross-training within our department so that at least one other person, preferably two could cover the essential aspects of each position in case any of us was on vacation or leave of absence.
    We had a lot of fun doing this and it eased the stress that many people experience when they go on vacation. You work like a dog to get everything done that someone might need while you're gone, then return and work like a dog to catch up. We experienced a much milder version of this once the cross training was complete. Plus people began to appreciate that each member of our team worked just as hard as they did. They started helping each other more frequently. We had genuinely bonded.
  19. I tackled leadership and nursing staff development in my second and third years. I worked closely with the VP of HR and the VP of nursing.
    We developed an orientation for newly hired and newly promoted managers and paired each with a mentor for a minimum of six months. I developed some leadership development programs myself. The HR manager, a clinical director, and I were trained so we could also provide Covey Programs. I worked with the nursing unit educators to provide nursing continuing education and staff development programs for nurses. I was having a blast!
  20. I am not using anyone's names of course, so this sounds so impersonal. But we were a great team. I loved each person in our department and told them so. Other leaders thought I was crazy! It was true and I was not afraid to tell them. They worked their butts off for me and I did everything possible to back them up.
    Because of the extra training the technical assistant completed she took on additional responsibilities. I was able to get her promoted to a higher level position that raised her salary a significant amount as a result. I was also able to get a small salary increase for the administrative assistant. I praised and talked up my department everywhere and never criticized anyone in front of anyone else. If they messed up I would say we messed up or I messed up. Mistakes were always forgiven.
  21. We also had a lot of fun.
    We celebrated birthdays, accomplishments, and holidays. Sometimes we did things in the department and sometimes we went out and I closed the department for a few hours. I implemented a rule that we would not schedule any programs on Monday mornings or Friday afternoons unless there was no other opening or classroom available. So they always opened and closed their week in a gentle way. Sometimes I sent them all home a few hours early on Fridays and I covered the office.
  22. I delegated lots of things so that I could lighten my own workload to develop new programs, people could gain new skills, they could get out of the office and classrooms, and they could meet other people in the hospital. They came to appreciate this when they got to know me better.
    I believe that when people get to know other people's jobs they interact better. I always emphasized that we were a service department there to serve the hospital and it's staff. I wanted everyone to feel comfortable throughout the building, not just the nurse educators who had plenty of clinical experience. I set up observation hours for the non-clinical staffs to spend some time in various departments to learn what went on there. They got to see a lot of people outside the classroom
  23. About once a week or so I would make what I called education rounds. I would start at the top or bottom of the hospital and systematically visit as many departments and nursing units possible. As I went, I would check in with people and ask how things were going for them with our department.
    I used this time to get to know people and inquire about their education needs. I would ask if they were happy with the schedule of programs, the variety of programs, and the simulations. I would ask for suggestions. I would ask nurses on the units if they felt we were meeting the diabetes education needs of the patients. Pretty soon I had contacts all over the building. Then I started to bring a member of my department with me on rounds occasionally. We were very visible and available.
  24. I always considered myself a working director in all three of my education director positions. Instead of spending most of my time in meetings and committees like other directors, I got rid of a lot of those responsibilities in the beginning. I only participated in those if it helped the hospitals' education needs or if I was required to be there.
    Once my department was established and all my positions were filled, I spent about half my time in the classroom facilitating programs, teaching, and facilitating simulations. I spent the other half preparing for and developing these programs. When the diabetes educator was out I covered for her. I helped facilitate our simulation and computer-based life support programs along side my staff. They loved it and I loved it! If they had a difficult employee in the office I stepped in to deal with it
  25. About my third year there the education manager and I wanted to revamp nursing and clinical orientation to be evidence-based instead of the same old way that everyone did it. However, review of the literature revealed almost no research had ever been done. So we went about the work of getting approval and funds to conduct our own study.
    We used interviews, observations, and surveys to evaluate orientation before and after we changed it. To gather evidence about what was needed, we conducted focus groups and interviews with recently hired staff, preceptors who oriented new staff, unit and department educators, managers, directors, and upper level administrators. We gathered some evidence from nearby hospitals to gain greater perspective.
  26. We gathered evidence regarding the content that belonged in nursing and clinical orientation, the priorities, the teaching methods preferred, and the timing and delivery of orientation. Then we designed our program.
    It's took us six months to create a design that included the evidence gathered. Nurses and clinical staff both had two consecutive days. Nurses had a third day of clinical orientation as a group. After that everyone had unit based orientation for one week. Everyone reconvened for one day one month later, and again right before the 90 day window of probation ended. During the two follow up days we reviewed areas of critical importance, clarified misinformation, and added additional information.
  27. The new revised orientation was very different than the old one. The old one consisted mostly of speakers in front of the room with PowerPoint presentations they basically read. Content was what was required by regulatory agencies and what people thought was a good idea. There was almost no active learning
    The new orientation involved mostly active learning with group activities, case studies, simulations, games, and reflective writing. Participants had no opportunity to zone out and text while orientation was going on. They were actively involved. Content that served no purpose was removed. Participants had to apply regulatory information during the sessions. New content gained through the focus groups and interviews was added. Orientation was no longer crammed into 5 consecutive days.
  28. The results were overwhelmingly positive. Our employees were so much better prepared and orientation information was retained instead of being forgotten. The results were so astounding that we shared them immediately with all of our sister hospitals.
    We were offsite frequently in the next year helping to redesign the program to fit the differences in some of the other hospitals. Eventually the program was universal in our hospital system. My surgery and subsequent disability prevented us from ever getting it published. After I left, the budget for education was slashed and my position was not filled. It left The manager overwhelmed and the department in chaos. Over the next two years people gradually resigned and were not replaced.
  29. Of my team, only the administrative assistant remains. She is miserable but the job is convenient for her. Now the department is basically the same as when I got there. The administrative assistant and one other person facilitate the computer-simulation-based life support programs.
    E-learning covers regulatory info, & a nursing director is responsible for the department. Everything else is gone. No diabetes education, no new grad, improved orientation, or preceptor programs, & simulators in storage unused. Other programs were farmed out to unit educators or managers or contracted out. So much work & effort ended up going down the drain. But for six years we had a thriving, successful, & productive department to be proud of. And we are all still friends. Life goes on🤷🏻‍♀️