MANAGEMENT OF
PROFESSIONAL CONFLICT
IN THE PERIANESTHESIS AREAPresented to Nebraska Association of Perianesthesia Nurses
Alegent Creighton Bergan Mercy Medical Center
Presented by Michelle Homme March 23, 2013
GOAL: TO EDUCATE ON WORKPLACE
VIOLENCE AND HOW TO DEAL WITH THOSE
SITUATIONS SHOULD THEY ARISE.
The definition of workplace violence
Statistics
Forms of violence
Characteristics of attackers
Types of attacks
Confrontation levels
Specific attacks
Prime targets
Constant Change, LLC © @ItStartsToday
2
GOAL: TO EDUCATE ON WORKPLACE
VIOLENCE AND HOW TO DEAL WITH THOSE
SITUATIONS SHOULD THEY ARISE.
Needed elements
Costs
Why?
Lookout!
What can you do?
Prevention
Two for one
Coping
At the top of your game
Constant Change, LLC © @ItStartsToday
3
WORKPLACE VIOLENCE
Definition:
Violence or threat against people while they are at work
Forms of workplace violence
Threats
Harassment
Violence, including assaults
Damage to property
Mental anguish
Physical harm
Constant Change, LLC © @ItStartsToday
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WORKPLACE VIOLENCE
Statistics (reported)
Homicide is the third highest leading cause of death on the job (12% of all fatalities)
There was a one-third increase in workers who were killed on the job between the 1980’s and 1992
75% of all deaths in the workplace are the result of gun use
2012 SHRM workplace survey, 36% of organizations reported incidents
2 million employees are affected every year (OSHA)
Violence against women is increasing (perhaps related to more women working)
Bureau of Labor Statistics (2011) – Between 1992 and 2010, there were 13,827 victims (about 700/year)
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WORKPLACE VIOLENCE
Constant Change, LLC © @ItStartsToday
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WORKPLACE VIOLENCE
Statistics
Next to auto accidents, homicide is the leading cause of death
in the workplace.
There were 1,004 workers murdered in 1992 (33% increase since
the 1980’s.)
Workplace violence in healthcare
45% of all non-fatal assaults
1993-1999, 765,000 assaults resulting in time away from work
8 RN’s were fatally injured at work from 2003-2009
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MORE HEALTHCARE STATISTICS
4 days away from work was the average
reported by RN’s in 2009 who suffered
from 2,050 attacks
Non fatal assaults included being hit,
kicked or beaten, scratched, squeezed,
punched, and bitten
Patients caused 89% of those assaults
50% of Emergency Nurses experienced
assaults in 2009
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BULLYING IN NURSING
Also known as “lateral violence” or “horizontal violence”
Has been around for decades
Purposeful in inflicting mental harm on other nurses with verbal and non-verbal actions
Threatening body language and strong verbal abuse has been reported by student nurses (53%) and nurses, pharmacists, and others (48%)
Nurses also report being threatened as well
Effects include low morale, increased absenteeism, nurses leaving the profession
Patient care deteriorates
Additional stress and other medical issuesConstant Change, LLC © @ItStartsToday
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WORKPLACE VIOLENCE
One of the first terrorist attacks that made news
December 21, 1988
Lockerbie, Scotland
Pan Am Flight 103 – 243 passengers and 16 crew were killed in mid air
Most recent attack
Riverside Police Department, Riverside, California –
One officer was killed, another injured as they sat at a red light in their marked car. Alleged attacker – former LAPD Officer. February 7, 2013
Constant Change, LLC © @ItStartsToday
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WORKPLACE VIOLENCE
Rules & regulations (Nebraska)
It is unlawful in Nebraska to carry a weapon or a weapon concealed on or about the person, unless it can be shown that the person was engaged in lawful business, calling, or employment at the time the person was carrying any weapon, and the circumstances justify a prudent person carrying the weapon to defend his or her person, property, or family.
It is unlawful to possess a firearm in a school, on school grounds, in a school-owned vehicle, or at a school-sponsored activity or athletic event.
Nebraska is one of 18 states where penalties are increased for workplace violence against nurses and 9 additional states have laws in place requiring that workplace violence programs be in place.
Constant Change, LLC © @ItStartsToday
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FORMS OF WORKPLACE
VIOLENCE
Threats
Hostage situations
Property damage
Intimidation
Bullying
Mental harm
Physical harm
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FORMS OF WORKPLACE
VIOLENCE
Threats
Job related
Forms of aggression
Hostage situations
Need to be heard
Want something to be fixed
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FORMS OF WORKPLACE
VIOLENCE
Property damage Alfred P. Murrah Federal Building
April 19, 1995
168 lives lost, including 19
children
Cost: appox. $652 million
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FORMS OF WORKPLACE
VIOLENCE
Intimidation
Stalking
rumors
Bullying
Why has it escalated?
What can be done about it?
Constant Change, LLC © @ItStartsToday
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FORMS OF WORKPLACE
VIOLENCE
Mental harm
Additional stress
Sick time taken
Question one’s ability
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FORMS OF WORKPLACE
VIOLENCE
Physical harm
Most severe
Wounded
Lives lost
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CHARACTERISTICS OF POTENTIAL
ATTACKERS
Loners
Mental health issues
Emotionally charged
Intoxicated people
Big ego/control freaks/”untouchable”
Constant Change, LLC © @ItStartsToday
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CHARACTERISTICS
Loners
Never has
friends
Plays the
victim
Complains
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CHARACTERISTICS
Mental health issues
May not be known
Subtle signs where something is not
“right’
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CHARACTERISTICS
Emotionally charged
Life and death of loved one
Helpless feeling
Intoxicated
Indications include:
Slurred speech
Difficulty in following conversation
Level of speaking is louder than most conversations
No regard for attention that it brings
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CHARACTERISTICS
Big ego
No vanity or “God” like
Control freaks
Micro managers
Untouchables
Above the law
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CHARACTERISTICS
The ones you
don’t see
coming
Don’t fit normal
profiles
Keep things
hidden well
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THE 4 TYPES OF ATTACKS
Strangers
Terrorists
September 11, 2001
Politics
Assassinations of Abraham Lincoln and John F Kennedy
Customers
Educational locations
Columbine
Virginia Tech University
Employees
Postal workers
LA Police Officer
Relationship-based
Domestic violenceConstant Change, LLC © @ItStartsToday
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THE 4 TYPES OF ATTACKS
Strangers
Someone that has no known ties to the workplace environment
Random
85% of all attacks
Tucson, AZ January 28, 2011. US
Rep Gabrielle Gifford was among
the injured that left 6 dead.
Aurora, CO July 20,
2012. 12 dead and 58
injured
**side note: in
Omaha, a basketball referee was attacked and his glasses broken by an angry fan during the week of February 10, 2013 after a game between two church affiliated teams.
Constant Change, LLC © @ItStartsToday
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THE 4 TYPES OF ATTACKS Customers or clients
Someone who has used services/products from
the workplace
3% of attacks
Columbine High School,
CO April 20, 1999. 12
students and 1 teacher
were killed. 21 were
injured.
Virginia Tech University,
Blacksburg, VA. April 16, 2007.
32 were killed and 17 were
injured.Constant Change, LLC © @ItStartsToday
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THE 4 TYPES OF ATTACKERS
Employee or former employee
Someone who is a current employee or was an employee
Usually target authority figures (supervisors)
7% of attacks
Fort Hood, TX
November 5, 2009. 13
dead and 29 injured
“Going postal” First attack regarding postal workers was in Australia in 1926. Between 1991 and 1997, there were 10 shootings alone in the US, and the first one took place on August 19, 1983 where one person was killed and two were injured.Constant Change, LLC © @ItStartsToday
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THE 4 TYPES OF ATTACKERS
Personal relationship
Someone that comes to the workplace because of a
relationship with an employee at the workplace
Domestic violence – “Nationally, over 13,000 attacks against
women are made at work each year by partners.”
5% of attacks
Seal Beach, CA October 12, 2011. 8 killed. Alleged gunman’s former wife was an employee and victim.
Constant Change, LLC © @ItStartsToday
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LEVELS OF CONFRONTATION
Day-to-day
Moderate
Severe
July 7, 2005,
EnglandConstant Change, LLC © @ItStartsToday
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LEVELS OF CONFRONTATION
Day-to-day
Road rage
Inpatient
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LEVELS OF CONFRONTATION
Moderate
Someone who is upset about a situation
and you are the one they direct their
frustration towards
Constant Change, LLC © @ItStartsToday
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LEVELS OF CONFRONTATION
Severe
With weapons
Casualties
Millard South High School,
Omaha, NE January 5,
2011. Assistant Principal
killed. Principal injured.
Constant Change, LLC © @ItStartsToday
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SPECIFIC ATTACKS
Sandy Hook Elementary School
Newtown, CT
December 14, 2012
Lives lost:
20 students
6 staff
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SPECIFIC ATTACKSSeptember 11, 2001
The Pentagon, Washington, DC – 59 lives lost
World Trade Center, New York City, NY - nearly 3,000 lives lost
Shanksville, PA
– 44 lives lostConstant Change, LLC © @ItStartsToday
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SPECIFIC ATTACKS
Von Maur Department Store
Omaha, NE
December 5, 2007. 8 killed, 5 injured.
Constant Change, LLC © @ItStartsToday
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PRIME ENVIRONMENTS FOR
ATTACKS
Employees working
with the public are
at the most risk
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TOP 10 INDUSTRIES FOR ATTACKS
1. Manufacturing
2. Health care & social assistance
3. Professional, scientific, and technical services
4. Finance and insurance
5. Educational services
6. Transportation and warehousing
7. Public administration
8. Retail trade
9. Construction of buildings; heavy & civil engineering construction; specialty trade contractors
10. Accommodation and food servicesConstant Change, LLC © @ItStartsToday
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TOP 10 ENVIRONMENTS OF ATTACKS
January 2013Constant Change, LLC © @ItStartsToday
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HEALTH CARE ENVIRONMENTS
Why?
• Emotions are peaked
• Access to medications
• Mentally unstable people
Constant Change, LLC © @ItStartsToday
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NECESSARY ELEMENTS TO
VIOLENCE
• Emotional
• Involves people
• Location, location, location!
Constant Change, LLC © @ItStartsToday
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NECESSARY ELEMENTS TO
VIOLENCE
Emotional
Feelings get in the way
Not rational
There does not have to be an
explanation
Constant Change, LLC © @ItStartsToday
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NECESSARY ELEMENTS TO
VIOLENCE Involves people
Makes the biggest impact
We pay attention
It makes us angry
Senseless, regardless of the explanations
Constant Change, LLC © @ItStartsToday
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NECESSARY ELEMENTS TO VIOLENCE Location, location, location!
Where are the innocent?
Where no one would ever imagine it
happening?
Where is the biggest impact?
Constant Change, LLC © @ItStartsToday
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ASSOCIATED COSTS
$120 billion a year
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COSTS ASSOCIATED WITH WORKPLACE VIOLENCE
1. Management time
2. Loss of productivity
3. Replacing staff/turnover
4. Additional training expenses
5. Increased security
6. Debriefing with staff (after an incident)
7. Communication costs increase
8. Legal expenses are higher
9. HR expenses
10. Increased absenteeism
Constant Change, LLC © @ItStartsToday
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EXPLANATIONS OF WHY
Unfairly treated
Lost their job
Someone else is
responsible
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EXPLANATIONS OF WHY
Unfairly treated
It doesn’t have to make sense –
the person just has to feel like they
were wronged
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EXPLANATIONS OF WHY Lost their job
It doesn’t matter if it was legitimate or not
No future
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EXPLANATIONS OF WHY
Someone else is responsible
It doesn’t matter if they believe that they have
any part in what is happening or not
Holding onto what got them there instead of
how to make it better
Holding grudges
Constant Change, LLC © @ItStartsToday
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BE ON THE LOOKOUT!
Possible signs
Trust your gut
Ask for help
Constant Change, LLC © @ItStartsToday
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BE ON THE LOOKOUT!
Possible signs
challenges authority
Has no accountability
Stalks other employees
Disregard for normal accepted society
practices
Constant Change, LLC © @ItStartsToday
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BE ON THE LOOKOUT!
Possible signs:
Words used
References to violence or weapons
Enjoys making people nervous
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BE ON THE LOOKOUT!
Possible signs
Threatening demeanor
Changes in behavior
Abusing drugs or alcohol
Emotional state
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BE ON THE LOOKOUT!
Trust your gut Hide
Report
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BE ON THE LOOKOUT!
Ask for helpFind co-workers who will listen
Talk to law enforcement
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WHAT TO DO
Communicating
Stay calm (Breathe)
Don’t show fear (Breathe)
Don’t disregard their feelings (Breathe)
Indicate your willingness to help (Breathe)
Don’t argue (Breathe)
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WHAT TO DO
Keep your distance
Be on the same level
(don’t be sitting if they are
standing)
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PREVENTION
Have a plan
Access your surroundings
Address the situation immediately
Environment
Ask for help
Talk to law enforcementConstant Change, LLC © @ItStartsToday
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PREVENTION
Have a planUse technology
Send emails to all employees
Mass callout on all phone lines
Intercom system
Install cameras
Constant Change, LLC © @ItStartsToday
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PREVENTION
Access your surroundings
Are their triggers that might upset someone?
Go outside your box
Know your fellow employees
Acknowledge those that are new
Learn people’s names
Assist strangers
Greet them
Make eye contact
Ask questions
Constant Change, LLC © @ItStartsToday
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PREVENTION
Address the situation immediately
Better to be safe
Take every threat seriously (you can
apologize later for a false alarm)
Treat every employee with respect
Constant Change, LLC © @ItStartsToday
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PREVENTION
EnvironmentDevelop relationships with nearby
businesses
Have well lighted parking lots
Advertise that even threats are taken
seriously
Hire security guards
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PREVENTION
Ask for helpDifficult but necessary
Expertise
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PREVENTION
Talk to law enforcement
Ask them to review your procedures
Have numbers close by
Evacuation
Do you have a plan?
Is it practiced?
How do you know that everyone is accounted for?
Constant Change, LLC © @ItStartsToday
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TWO FOR ONE!
Not only can you be a victim
of an attack, but you are
involved with victims of an
attack that took place
elsewhere.
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HOSPITAL STAFF ASSAULTS
St. Vincent’s Hospital
Birmingham, AL
December 15, 2012
Gunman walked in with a gun and
started shooting, injured 3 and
then was killed by an officer.
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TWO FOR ONE!
Keep emotions in check
Difficult
Think first
Ignore insults
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TWO FOR ONE!
Sudden, quick decisionsHave to react
Life and death related
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COPING
Employee Assistance Program
(EAP)
Writing
Talking
Reporting
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COPING
EAP (Employee Assistance Program)
Most employers have a program to help with work situations
Very inexpensive or no cost
Professionals
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COPING
Writing
Start a journal
Write letters you never mail
Why? To get it “off your chest”
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COPING
Talking
Family
Friends
Co-workers (compare
stories)
Helps to process
Becomes a teaching
momentConstant Change, LLC © @ItStartsToday
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COPING
Reporting
Statistics
Document the event
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AT THE TOP OF YOUR GAME
Why nursing?
You can make a difference
Helping others brings you joy
Monotony is not for you!!
Fast paced environment
No chance for errors
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RESOURCES
U.S. Department of Labor, OSHA
American Nurses Association
The National Institute for the Prevention of
Workplace Violence, Inc.
And many others!
Printed OSHA checklists & OSHA factsheet
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SOURCES
Society for Human Resource Management
OSHA
Bureau of Labor Statistics
US Dept of Justice
Violence and Theft in the Workplace, July 1994
National Traumatic Occupation Fatality Study,
1994
Workplaceviolence911.com
US Dept of Labor
American Nursing Association
Nursingworld.org
Neckerman.com (Neckerman Insurance,
March 19, 2012)Constant Change, LLC © @ItStartsToday
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HOW DO WE KEEP IT GOING? Truth is, workplace violence is a part of our
society it is very depressing
What did we learn?
What workplace violence is and how to identify it
The signs we need to look for to identify possible attackers and potential situations
What to do in case we are victims of workplace violence
How to deal with the after effects of workplace violence
How can we use this knowledge?
We can report ALL acts of workplace violence, regardless of how minor they may seem and if we feel anything changes
Prepare our work environment to be as safe as possible
Being better people makes better nurses
Constant Change, LLC © @ItStartsToday
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BEING A NURSE
Can you sell it?
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STRESS IS EVERYWHERE
Do you carry stress? How do you relieve it?
I carry it in my shoulders and I run to relieve it
How does it affect you?
I don’t sleep like I should
We cannot carry our burdens all of the time – we have to set it down
“Use what you have learned and then make a choice…you either keep it & let it weigh you down OR you lose it & never let it slow you down.”
Sayings to keep you grounded:
Accept the fact that some days you are the pigeon and some days you are the statue.
Always read stuff that will make you look good if you die in the middle of it.
It may be that your sole purpose in life is to serve as a warning to others.
Nobody cares if you can’t dance well. Jut get up and dance.
When everything’s coming your way, you are in the wrong lane.
We are like crayons – different colors, different shades, but all have to live in the same box
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WHY A NURSE? WHY A
PERIANESTHESIA NURSE?
Why do you keep coming back? What do you love
about nursing?
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MOMENTS OF INSPIRATION
Seeing you in action
1995 baseball game
2013 volleyball game
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HOW TO BE BETTER PEOPLE
Give more
Always have hope because miracles happen
Never give away YOUR power!
It Matters
Show MOXIE! (Making Ourselves Xtraordinary In Everything)
Positive ATTITUDE
It Starts Today!Constant Change, LLC © @ItStartsToday
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GIVE MORE
Give unconditionally…always
Give because you want to, not out of obligation
Give away a smile, compliment, or hug – they are free!
“No one ever wishes they had done less. They always wish
they had done more.”
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FIND INSPIRATION It will be where you least expect it
In a song, movie, or book -- or in everyday moments
My favorites are quotes (I get these from Pinterest)
How do you know if it is true inspiration? It touches you! You feel something and you remember it.
Constant Change, LLC © @ItStartsToday
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ALWAYS HAVE HOPE
Hope is what you have left to hold onto, despite what you have
in front of you
Sometimes, it is the ONLY thing you have
When do you see hope? When miracles happen!
Constant Change, LLC © @ItStartsToday
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NEVER GIVE AWAY YOUR POWER
What happens when something or someone upsets us?
We can let it ruin our mood and how we take on the world
Why are bullies successful? Because we allow them to be.
“No one can make you feel inferior without your consent.” -
Eleanor Roosevelt
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IT MATTERS!
Do you think it matters?
“Living with failure is easier than living with
regret.”
Because we NEVER know if something we
do or say can affect someone, we have
to believe that everything can.
Constant Change, LLC © @ItStartsToday
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SHOW MOXIE!!!Making
Ourselves
Xtraordinary
In
Everything
“To get
something
you never
had, you
have to do
something
you never
did.”Constant Change, LLC © @ItStartsToday
88
POSITIVE ATTITUDE
How do you get a positive
ATTITUDE?
Achieve
This
Through
Insight
Time
Understanding
Dedication
Empowerment
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IT STARTS TODAY
SUN MON TUES WED THUR FRI SAT
1 2
3 4 5 6 7 8 9
10 11 12 13 14 15 16
17 18 19 20 21 22 23
24/31 25 26 27 28 29 30
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TO INSPIRE YOU
Sara Tucholsky’s unforgettable
home run – April 28, 2008
A rendition of the National Anthem
I will never forget
A football player carries a
teammate off the field
The story of Shay
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ARM IN ARM, CROSSING THE FINISH LINE
June 5, 2012
Ohio Division III Girls
State Track Meet
3,200 meter runMeghan Vogel helps
Arden McMath cross the
finish line
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5 WAYS TO ENERGIZE!
Here are 5 ways to help you feel energized and that momentum will keep you riding the waves all day:
1. Exercise. Yes, we have all heard this one before, but it can truly change your outlook and "pump you up." You don't have to run a marathon in one day, but moving your body and pushing yourself to do what we all need is never a bad thing. Even if I walk in the mornings, by 6am I am so ready for what happens next!
2. Smile. I know, this one is easy too. But when you wish someone a "Good morning" with a smile or just say hello, you pass along your energy to someone else and that starts a ripple effect. This world needs more smiles.
3. Sing. And not just sing, but dance too. Who cares what everyone else thinks? Secretly, they are wishing they had your confidence to sing "Call me Maybe" as you drive your co-workers back to work. It's ok, I know who they are and yes, that was me. Give those people in the car next to you something to smile about too!
4. Find your joy. What gives you joy? It doesn't have to cost much and it won't consume all of your time. What do you love to do that fills your heart? I love to write and to give to others. When you find it, make your joy as much of a priority in your life just as everything else is because it makes dealing with everything else better. It just does.
5. Surround yourself with energized people. I know negativity when I see it and hear it. So do you. Make a conscious effort to be around people who bring you up, not down. Ask them what energizes them and some of it may actually surprise you. It is not difficult to be drawn to those that inspire you, but you do have to make an effort to seek them out.
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THANK YOU
Gayle Kiviniemi & Kristy Iwansky
Alegent Creighton Bergen Mercy Medical Center
Nebraska Association of Perianesthesia Nurses
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94
MICHELLE HOMMECONSTANT CHANGE, LLC
WWW.CONSTANTCHANGETODAY.COM
EMAIL: [email protected]
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