1. Carlson, Elizabeth Ann

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This column reviews two books that are related to each other because they both have communication as the underlying issue. However, were you to read them, you would find that they are very different books about very different topics. One is a management book that offers a new manner of thinking and viewing work and working with employees. The second book looks at nurse communication with the patient and family at the end of life. Both are books worth looking into.


A few years ago I had the opportunity to attend an all-day workshop led by Cy Wakeman. She is a dynamic speaker and looks at life in the workplace differently than other speakers or authors I have encountered or read. She has written a book that mirrors her workshops. She also offers access to podcasts and blogs via the website:


Reality-Based Leadership: Ditch the Drama, Restore Sanity to the Workplace, and Turn Excuses Into Results by Cy Wakeman (Foreword by Larry Winget). San Francisco, CA: Jossey-Bass. (Hardcover, September 2010). US $27.95 or e-Book, August 2010, US$18.99) 161 pages.


So why do you want to read the book and explore the website? The subtitle of the book gives you a clue: Ditch the Drama, Restore Sanity to the Workplace, and Turn Excuses Into Results. Wakeman is very forthright in her discussion and ideas about how a leader needs to work with employees to get results for the organization. Wakeman states that "current leadership methods are not working, and it's time we admitted it" (p. 2). Wakeman draws from a 2008 "Gallup poll that showed that 71 percent of employees are disengaged to the point that they consider quitting their jobs about once a day" (p. 2). Wakeman points out that these same employees continue to report to work and be paid even though they have mentally and perhaps emotionally "clocked out." Wakeman's premise is that instead of achieving results, these employees are either "bitching, moaning and whining," what she abbreviates to outdriving their BMWs or they become self-righteous and judgmental of coworkers. Wakeman argues that the energy going into these negative behaviors drains employees of time and energy, thus reducing the results the organization deserves.


The examples given throughout the book are engaging and realistic and, I found, ones that I myself had created a story around. Throughout the book, there are "Cy's Bottom Line"; statements that summarize key points. Other features of the book are tools and exercises that relate to the topic discussed, enabling you to apply what you read to your workplace and employees.


This book is divided into three parts. Part 1, titled "Find Peace at Work," is further divided into three chapters. Chapter 1, "You Are the Source of Your Suffering-and That's the Good News," looks at the components of drama and its causes and why it should be "banned" from your workplace. The drama comes from your mindset about a situation. Wakeman illustrates how we jump to a judgment about a situation, add our beliefs to the mix, create a story about that situation, and thus create stress in ourselves. Wakeman states that our thinking about the job, not the job itself, needs to change. She stresses that in most stories around which stress is created, the story has few facts upon which it is based and many judgments and beliefs. Wakeman focuses on "embracing reality" and basing your actions on the reality of the situation, not the story developed around the situation. She states that if you "argue with reality," a barrier is created to peace and success for most people. One way in which we adjust reality is in terms of right or wrong instead of "fearlessly confronting what is" (p. 13).


Chapter 2 is titled "If You Argue With Reality, You Lose (But Only 100% of the Time): How to Health Your Relationship With Reality." The model of an event, leading to thinking, resulting in feeling, taking action, and obtaining results is used to illustrate how a story is created and reality ignored. Wakeman argues that we must respond to the facts, not the story. By reviewing the story created and the assumptions in the story, you can learn to interrupt arguing with reality. She talks about victim, villain, and helpless stories we create and how to ask yourself questions that allow you to step back from the situation, see things for what they are, and use the energy to get results. The reader is led through an exercise where you learn to edit your story. Chapter 3, "Would You Rather Be Right or Wildly Successful?" discusses how to reduce your ego and lead with humility.


Part 2 is titled "Restore Sanity to the Workplace" and begins with Chapter 4, "Lead First, Manage Second," where the differentiation between leading and managing is presented. Wakeman states that " is working on your business, and leadership is working on your people" (p. 50). Leadership is investing in employees and "calling (these) employees up to greatness" (p. 50). Wakeman presents six principles that help people learn to lead first and manage second. Wakeman provides pithy ideas she labels as "Cy's Bottom Line" throughout the book. In this chapter, Cy's Bottom Line states: "If you feel you have to over-manage or micromanage, it is because you are under-leading" (p. 64). Here she introduces what she terms a radical approach. Wakeman suggests that if you do employee surveys, "survey not only for satisfaction, but for accountability-and weigh the responses accordingly" (p. 65). She states that this will allow you to give credence to top performers' requests and critiques and less to employees with a mindset of resistance and learned helplessness.


Not to be content with one radical approach, Wakeman introduces another radical approach in Chapter 5: "Play Favorites, Work With the Willing." This concept goes against what we have learned since our youth but Wakeman's point is that leaders work with employees who want to be successful. This does not mean ignoring the other employees but through focusing your attention on the motivated employees you want to reward, the workplace culture will be influenced. Not only should the leader work with the willing but also compensate value not effort. Wakeman states: "Make it absolutely clear what gets attention from you, and your impressionable people in maintenance (mode) will start to go to where the love is" (p. 74). She discusses the role of feedback for employee change and how the lack of feedback and development creates resistant employees. The three types of resistant employees are described as well as how to deal with the resistance. Wakeman states that you cannot change a person but you can invite that person to change.


A theme throughout the book is that change is inevitable and impersonal. In Chapter 6, "Change Is a Fact of Life-Get Over It! How to Bullet-Proof Your Employees," Wakeman presents three core competencies that make people bulletproof. She also supplies phrases to use when confronted with change that will allow you to move to a neutral place and "plot your next move" (p. 85). Once you have assessed your new reality and accepted it, you move to succeed in spite of the facts. Cy's Bottom Line: "Bulletproof employees use change to their advantage" (p. 88). Competency 3 is the will to resolve and move through conflict very quickly. Moving your employees out of the victim mentality to resolution reduces the melodrama and the wasted energy.


In Part 3, "Lead Your Team to Results," Wakeman presents how to use what she has named Reality-Based Leadership to working with teams. The chapter titles are provocative: "Opinions No Longer Count-Actions Do!" (Chapter 7) ends with Cy's Bottom Line: "It is nearly always action-not opinion-that adds the most value" (p. 124). Or, Chapter 8, which discusses the golden rule of teamwork that one should "Stop Judging and Start Helping." The book ends with a conclusion that pulls together the key concepts and how to approach work. Three appendices are included consisting of a survey, test, and feedback frame.


I would highly recommend this book and the associated website and podcasts. Wakeman is a very engaging speaker that comes through in her writing and podcasts. Even if you do not agree with her approach, you will find that listening to her presentations is interesting.


The second book is Being Present: A Nurse's Resource for End-of-Life Communication by Marjorie Schaffer and Linda Norlander. Indianapolis, IN: Sigma Theta Tau International. 2009; $29.95; 256 pages. This may seem to be an odd book for a review in the Orthopaedic Nursing because most patients seen by orthopaedic nurses are not at the end of life. But that is why it is good to realize the resources available to you as a nurse because, regardless of where you practice, you do have the occasional privilege of serving patients and their families as they near death.


The authors indicate that they are public health nurses and that they think about death from a public health perspective. This perspective includes a healthy response to the dying process. As the authors state: "Activities such as discussions with patients and families about end-of-life care can be viewed as promoting health and facilitating growth at the end of life" (pp. x-xi). Healthy dying includes the opportunity for reflection on the "life experiences, contributions, regrets, meaningfulness of existence, and value of relationships" (p. xi) by both the patient and the family. Reduced stress, caregiver burden, and illness are positive outcomes of assistance and support given to patients and families facing death.


The book consists of 11 chapters and 2 appendices. Each chapter begins with a "Nurses' Story" that were gathered by Schaffer in 2005 in Norway while a Fulbright Scholar. Appendix A tells how Norway was selected and the questions and statements used to guide the nurse interviews. I found this aspect of the book the most engrossing aspect and, honestly, read all the stories before I went back and read the book. Each story "sets up" what the subsequent chapter discusses. These stories were both poignant and instructional. In addition, each chapter ends with more nurse stories illustrative of the chapter topic.


Other features found in the various chapters are definitions, key elements, ethical practice issues, key points, reflection questions, and references. Various chapters have features unique to the chapter content. For example, in the chapter on responding to cultural needs in end-of-life care, a list of questions (p. 171) to use to explore the person's preference for disclosure and decision making is given as well as the reference that supports the question content. Similar resources, in the form of nursing interventions, are given on page 186 to facilitate advance care planning. At the close of some chapters, tools and resources are provided on the basis of the chapter content.


The titles of the chapters encapsulate the topic of discussion in that chapter: "Being Present"; "Knowing What to Say and When to Say It"; "Responding to Patient and Family Wishes and Hopes"; "Understanding the Spiritual Journey"; "Responding to Conflict"; "Advocating-When Nurses Need to Take Action"; "Saying Goodbye at the End of Life"; "Responding to Cultural Needs in the End-of-Life Care"; "Advance Care Planning"; "Challenges in End-of-Life Communication"; and "Taking Care of Yourself." Although I recommend reading the entire book, each chapter does seem able to stand alone, allowing this book to serve as a reference as well as a textbook. I usually find one or more chapters in a book such as this as more useful than other chapters but not in the case of this book. Each chapter has useful information, depending on your area of need.


Overall, I highly recommend this book as an excellent text for learning or as a reference for end-of-life situations not commonly encountered. The authors have taken a topic that many healthcare providers find difficult to approach with the patient or family or to respond to patient and family questions and given useful information for providers to use.