By Rose O. Sherman, EdD, RN, FAAN
“The most important things don’t always scream the loudest.” Bob Hawke
Nurse managers are having challenges setting priorities. As one manager explained, We have been told to improve our patient experience scores, but I don’t even know where to start – there are so many things we could do differently. This manager is not alone – knowing where and how to spend your time in leadership is complex. A book that I have found really influenced my thinking about this topic was The One Thing: The Surprising Simple Truth Behind Extraordinary Results, written by the successful real estate entrepreneur Gary Keller. Keller suggests that based on goals in any area of your life, ask yourself, “What’s the ONE Thing I could do, such that by doing it, everything else would be easier or unnecessary?” Then, time block or create a plan to make it happen. It doesn’t have to be any more complicated than that.
Too often in our nursing leadership work, we have long task lists of goals that we want to accomplish. When we create these task lists, we can think that everything matters equally, but the truth is that it doesn’t. Success is sequential, not simultaneous. It’s one step at a time. ONE Thing at a time, Keller suggests. It’s not your only thing. It’s the ONE Thing right now.
Keller strongly believes in the Pareto principle or the 80/20 law of the vital few. This principle has research support. Using your efforts at work as an example, the law proposes that a minority (20%) of actions, inputs, and efforts lead to a majority of results, outputs, or rewards. In other words, small efforts in the right areas can lead to the greatest rewards. It would be best to look for an action leading to the domino effect. Trying to multitask and make many things happen simultaneously is overrated in effectiveness.
I have talked with nurse leaders about the ONE thing that, if they spent more time on, would have the greatest payback for them. The following are some of the answers that they have given me:
- Round more consistently and ask patients and families about their experiences
- Watch the communication my staff is (or maybe isn’t) having with patients and families
- Get to know my new nurses on a more personal level
- Spend more time coaching my staff
- Develop my charge nurse’s leadership skills
- Become more approachable
- Talk less and listen more
- Learn budgeting
- Return for my Master’s degree
- Become more proficient with technology
- Set better boundaries and leave the unit by 5 PM
Keller suggests, and I would agree with him, that the amazing thing is when people ask themselves the question, they are almost always accurate. People instinctively know what matters most. It is taking the next step that becomes important, which means going small for the fewer things that will have the most effect.
Keller, G. with Papasan, J. (2013). The One Thing: The Surprising Simple Truth Behind Extraordinary Results. Austin, TX.: Bard Press.
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