leadership role in nursing9th.pdf

Afdeling Verpleegkunde James Madison University Harrisonburg, Virginia Carolyn Lewis, PhD Assistent Professor Afdeling Verpleegkunde Angelo State University. Donna Molyneaux, PhD Associate Professor Department of Nursing Gwynedd Mercy University Gwynedd Valley, Pennsylvania LaDonna Northington, DNS.

PREFACE

Legacy of Leadership Roles and Management Functions in Nursing

Experiential learning enables management and leadership theory to be fun and exciting, but most importantly, facilitates retention of didactic material. Although many leadership and management textbooks are available, our book fills the need for an emphasis on both leadership and management and the use of an experiential approach.

New to This Edition

The Text

Features of the Text

Achieving the outcomes identified in the BSN Essentials will enable graduates to practice within complex healthcare systems and to assume the role of provider of care; designer/manager/coordinator of care; and member of a profession (AACN, 2008) (Table 1).

Liberal education for baccalaureate generalist nursing practice

Basic organizational and systems leadership for quality care and patient safety

Scholarship for evidence-based practice

Information management and application of patient-care technology

Health-care policy, finance, and regulatory environments

Interprofessional communication and collaboration for improving patient health outcomes

Clinical prevention and population health

Professionalism and professional values

Baccalaureate generalist nursing practice

Achieving these outcomes will prepare graduate nurses to lead change to improve quality outcomes, foster a culture of excellence through lifelong learning, build and lead collaborative interprofessional care teams, navigate and integrate care services across the healthcare system, innovate design nursing practice, and translate evidence into practice (AACN, 2011).

Background for practice from sciences and humanities

Organizational and systems leadership

Quality improvement and safety

Translating and integrating scholarship into practice

Informatics and health-care technologies

Health policy and advocacy

Interprofessional collaboration for improving patient and population health outcomes

Clinical prevention and population health for improving health

Master’s level nursing practice

Communication and relationship building
Knowledge of the health-care environment
Leadership
Professionalism
Business skills
Ethics
Culturally congruent practice
Communication
Collaboration
Leadership
Education
Evidence-based practice and research
Quality of practice
Professional practice evaluation
Resource utilization
Environmental health

Because the Standards of Practice for nursing administration describe the nursing process and thus intersect all aspects of nursing care, only the Standards of Professional Performance are included at the crossroads of this book (Table 4). The registered nurse collaborates with health care consumers and other key stakeholders in the direction of nursing practice.

TABLE 3 AMERICAN ORGANIZATION OF NURSE EXECUTIVES NURSE EXECUTIVE COMPETENCIES

Comprehensive, Integrated Digital Learning Solutions

Self-paced interactive modules utilize key instructional design strategies, including storytelling, modeling, and case-based and problem-based scenarios, to actively engage students in learning new material and direct student learning outcomes to real-life application. Pre- and post-module assessments activate students' existing knowledge before starting the module and then assess their competence after completing the module.

Closing Note

Built around learning objectives aligned with the BSN Essentials and QSEN nursing curriculum standards, every aspect of Lippincott RN to BSN Online is designed to engage, challenge, and cultivate post-licensure students. Used alone or in conjunction with other instructor-created resources, Lippincott RN to BSN Online adds interactivity to courses.

Introduction

Characteristics of a Critical Thinker
Traditional Problem-Solving Process
Managerial Decision-Making Model
Nursing Process
Integrated Ethical Problem-Solving Model
Critical Elements in Decision Making
Questions to Examine in Data Gathering
Strategies for the New Nurse to Promote Evidence-Based Best Practice

In addition, a scientific approach will greatly improve the quality of management/leadership problem solving and decision making. A purely scientific approach to problem solving and decision-making does not guarantee a quality decision.

KEY CONCEPT

The critical thinker pondering a decision is aware of the areas of vulnerability that hinder successful decision making and will expend his or her efforts to avoid the pitfalls of faulty logic and data collection. The critical thinker is aware of the areas of vulnerability that hinder successful decision making and makes efforts to avoid the pitfalls of faulty logic in his or her data collection.

Additional Learning Exercises and Applications

Ten Distinctions Between Leaders and Managers (Kerr, 2015)

Leadership is accountable to the entire organization; management is accountable to the team

Ten Fatal Leadership Flaws

A lack of energy and enthusiasm
Acceptance of their own mediocre performance 3. Lack of a clear vision and direction
Having poor judgment 5. Not collaborating

Common Leadership Roles
A Comparison of Traditional Management and Leadership Components

The stage of examining alternatives is often the most time-consuming part of the decision-making process. Fowler (2015) agrees and suggests that not only are the differences between leadership and management difficult to verbalize; for the clinical nurse, it is even more difficult to work out which particular "hat" you wear or should wear when trying to lead and manage a team through a busy shift.

Managers

Leaders

The theorists' views of what successful management is and what it should be have changed constantly in the last 100 years. As the cost of labor increases in the United States, many organizations are taking a new look at scientific management with the implication that we need to think of new ways to perform traditional tasks so that work is more efficient.

Strategies for Efficiency

Characteristics Associated With Leadership

As leadership theory developed, researchers moved away from studying what qualities the leader possessed and focused on what he or she did—the leader's leadership style.

Effective Leadership

Motivated by support when requested by group or individuals Provides little or no direction. Uses upward and downward communication between group members Distributes decision making throughout the group.

What Is Your Predominant Leadership Style?

Kouzes and Posner’s Five Practices for Exemplary Leadership

Modeling the way: requires value clarification and self-awareness so that behavior is congruent with values
Inspiring a shared vision: entails visioning which inspires followers to want to participate in goal attainment
Challenging the process: identifies opportunities and taking action
Enabling others to act: fosters collaboration, trust, and the sharing of power
Encouraging the heart: recognizes, appreciates, and celebrates followers and the achievement of shared goals

It is this idea that context is an important mediator of transformational leadership that led to the creation of a full-range leadership model (FRLM) late in the 20th century. The transformational leadership thus helps the full leader to motivate his team and gives the opportunity to see the leader as an example of what they can become.

Nine Factors in the Full-Range Leadership Model (as described by Rowold & Schlotz, 2009)

Although transformational qualities are highly desirable, they must be coupled with the more traditional transactional qualities of the day-to-day leadership role, or the leader will fail. Interactional leadership theory focuses more on leadership as a process of influencing others within an organizational culture and on the interactive relationship between leader and follower.

When Culture and Policy Clash

Full-range leaders evolve and adapt their leadership style based on what leadership styles are needed for a given situation, but require transformational, transactional, and laissez-faire leadership skills to be successful. Integrating leadership skills with the ability to perform management functions is necessary if an individual is to become an effective leader-manager.

Delineating Leadership Roles and Management Functions

Name at least five management functions and five leadership roles that you could also describe in this scenario.

What Is Your Management Style?

Leadership Challenges for Health-Care Leaders

Quiet at Night?

Identify five management strategies you can use to address the problem of excessive unit noise at night. Next, identify five leadership strategies that could be used to promote the adoption of the Quiet at Night initiative by all healthcare professionals on the unit.

Leadership as a New Nurse (Marquis & Huston, 2012)

Management's goal in this situation is to achieve an HCAHPS score on Always Quiet at Night that meets the accepted best practice benchmark, thereby ensuring that patients are getting the rest they need to promote their recovery. The aim of management is to promote a shared commitment among all healthcare professionals working on the unit to achieve the Always Quiet at Night goal.

Choosing a Leadership Style (Marquis & Huston, 2012)

Assessing Your Strengths-Based Leadership Skills (Ambler, 2015)

Is your team inspired by a positive future?

Do you select team members for their strengths in leadership as opposed to their knowledge and technical expertise.

Leadership

Jim Collins’s Level 5 Leadership

Highly Capable Individual

Contributing Team Member

Competent Manager

Great Leader

Defining Qualities of Servant Leaders

Another leadership theory gaining popularity in the 21st century is that of EI (also known as EQ). Assessing and expressing emotions in self and others Regulate emotion in self and others.

Five Components of Emotional Intelligence

A number of theorists have attempted to further define the theoretical construction of authentic leadership over the past decade. However, Avolio, Walumbwa, and Weber (2009) suggest that the general agreement in the literature is that there are four factors that cover the components of authentic leadership: balanced processing, internalized moral perspective, relational transparency, and self-awareness.

Five Distinguishing Characteristics of the Authentic Leader

Thought leaders in the coming decade are likely to focus on persistent issues that continue to be of critical importance to nursing and health care and address new, emerging issues of importance. Choose at least one of the following technological innovations and write a one-page report on how this technology is expected to affect nursing and health care in the coming decade.

Using Reflections in Leadership

Many new management and leadership theories have emerged in the 21st century to explain the complexity of the leader-follower relationship and the environment in which work is done. However, a couple of the nurses in charge are quite rude and not very empathetic when they are grumpy and overworked.

Leadership Roles and Management Functions Associated With Ethics

Uses principles of ethical reasoning to define which beliefs or values inform decision-making. All of the cases solved in this chapter involve some degree of decision making using intuition.

Ethical Principles

The social issue of the last three statements of the code refers to the nurse's obligations to society and the profession (Exhibit 4.3). The nurse promotes, defends and protects the rights, health and safety of the patient.

Standards of Practice for Nurse Administrators

The nurse's primary commitment is to the patient, whether an individual, family, group, community, or population. The nurse works with other health professionals and the public to protect human rights, promote health diplomacy and reduce health inequalities.

Ethics

The mother says the child is emotional, cries a lot and doesn't like to be held. While you are on duty today, the child's father calls and inquires about her condition.

The MORAL Decision-Making Model

Thus, the responsibility for meeting the needs and wishes of new employees is shifted to the organization. He was aware of his values and applied what he learned in this decision-making process, intending to more closely evaluate the organization's hiring philosophy in relation to his own value system before accepting another job.

Strategies Leader-Managers Can Use to Promote Ethical Behavior as the Norm

In an effort to reduce the emotionality of the event and to give herself time to think, the supervisor sent Beverly home and scheduled a conference call with her for later in the day. One day each week, for the past 2 weeks, you work with Gina on the responsibilities of the position.

Leadership Roles and Management Functions Associated With Legal and Legislative Issues

Demonstrates vision, risk taking, and energy in determining appropriate legal boundaries for nursing practice, thus defining what nursing is and what should be in the future
Protects all patients’ rights to confidentiality under the Health Insurance Portability and Accountability Act
Ensures patients have reasonable access to information in the medical record, following established organizational processes
Secures appropriate background checks for new employees to reduce managerial liability 13. Provides educational and training opportunities for staff on legal issues affecting nursing practice

The first section presents the primary sources of law and how each affects nursing practice. Emphasizes the nurse's responsibility to be proactive in establishing and revising laws that affect nursing practice.

Nurse Practice Acts (one for each state and the District of Columbia) define and limit the practice of nursing, thereby stating what constitutes authorized practice as well as

Malpractice - the failure of a person with professional training to act in a reasonable and prudent manner - is also referred to as professional negligence. This infringement is demonstrated by calling other nurses practicing in the same specialty as the defendant to testify as expert witnesses.

Summary of Recommendations from the Executive Summary of

In the end, every nurse is always held responsible for his own negligent practice. If the defect in the device is not readily apparent, the risks are low that the nurse will be liable for the results of its use.

Guidelines for Informed Consent

As a rule, the healthcare provider allows such an examination during working hours within a few working days of the request for an examination. Passed in 1991, the PSDA required health care organizations receiving federal funding (Medicare and Medicaid) to provide education for staff and patients about issues related to end-of-life care and issues.

Analysis

Conclusion

Common Causes of Professional Nursing License Suspension or Revocation

For the past 2 years, you have been an evening nurse in the emergency department of Memorial Hospital. You called his doctor and he was very upset when he was woken up in the middle of the night.

Leadership Roles and Management Functions Associated With Advocacy

Speaks up when appropriate to advocate for health-care practices necessary for safety and quality improvement
Advocates for social justice in addition to individual patient advocacy
Appropriately differentiates between controlling patient choices (domination and dependence) and in assisting patient choices (allowing freedom)
Takes immediate action when illegal, unethical, or inappropriate behavior occurs that can endanger or jeopardize the best interests of the patient, the employee, or the organization

In addition, there is very limited literature on the extent to which health professionals engage in patient advocacy. Predicting patient advocacy engagement: A multiple regression analysis using data from healthcare professionals in acute care hospitals.

Nursing Values Central to Advocacy

Therefore, the extent to which HCPs engage in advocacy may be a result of a hospital's commitment to patient empowerment. King (2015) considers provisions 2 and 3 of the ANA Code of Ethics to be the most important when discussing advocacy.

Entry Points for User Engagement in the Health-Care System

King goes on to suggest that the code of ethics should be the basis for nursing advocacy work. The report went on to recommend entry points for user involvement at four different levels of the health system as shown in Display 6.3.

Common Areas Requiring Nurse–Patient Advocacy

Patient information disclosure (privacy and confidentiality) 11. Patient grievance and appeals processes
Cultural and ethnic diversity and sensitivity 13. Respect for patient dignity
Inadequate consents
Incompetent health-care providers
Complex social problems including acquired immunodeficiency syndrome (AIDS), teenage pregnancy, violence, and poverty
Aging population

Additionally, with the passage of the Patient Protection and Affordable Care Act in 2010, a new Patient's Bill of Rights was enacted to provide new patient protections in dealing with insurance companies (American Cancer Society, 2014). Department of Health and Human Services' mandate to protect the visitation rights of this patient's friends and significant others.

List of Patient Rights in California

Reasonable continuity of care and to know in advance the time and location of appointment and the physician providing care
Be advised if hospital/personal physician proposes to engage in or perform human experimentation affecting care or treatment. The patient has the right to refuse to participate in such research projects
Be informed by the physician or a delegate of the physician of continuing health-care requirements following discharge from the hospital
Have all patient’s rights apply to the person who may have legal responsibility to make decisions regarding medical care on behalf of the patient

Be briefed by the physician or a physician's representative on the requirements for continued post-discharge health care after discharge from the hospital. In addition, managers must assist members of their care team with ethical issues and work.

Guidelines for Blowing the Whistle

This process, however, must be modified when the immediate supervisor is the source of the problem. Much attention has been paid recently to nurses and the importance of the nursing profession and how nurses influence the delivery of health care.

Sample: A Letter to a Legislator

This is because too few nurses are willing to communicate with the media about key nursing and nursing issues. This is particularly unfortunate because both the media and the public have a high trust in nurses and want to hear about health issues from a nursing perspective.

Tips for Interacting With the Media

Avoid being pulled into inflammatory arguments or blame setting and repeat key points if you are pulled off into tangents
Provide the reporter with contact information for follow-up and needed clarifications

You approach the head nurse and she tells you to go ahead and do the interview if you want, but to remember that you are a representative of the hospital. Do you believe that the proposal "BSN as entry level" protects the advancement of the nursing profession.

Leadership Roles and Management Functions Associated With Organizational Planning

Role models proactive planning methods to followers
Actively participates in organizational planning, defining, and operationalizing plans at the unit level

Robotic technology and the use of prototype nurse robots called nursebots will serve as a supplement to scarce human resources in providing healthcare. One of the most common uses in healthcare organizations is SWOT analysis (identification of strengths, weaknesses, opportunities and threats) (Exhibit 7.2).

SWOT Definitions

Strategic planning predicts the future success of an organization by matching and aligning an organization's capabilities with its external opportunities. Strategic planning typically examines an organization's purpose, mission, philosophy, and goals in the context of its external environment.

Example of Abbreviated SWOT Process

Decision makers must then decide whether the goal can be achieved based on the SWOT.

Simple Rules for SWOT Analysis

Identify the organization's outside constituencies or stakeholders, then determine their assessment of the organization's objectives and activities. However, there is increasing recognition of the importance of subordinate input from all levels of the.

Sample Vision Statement

Sample Mission Statement

Potential employees should review the potential employer's mission statement and think about what it tells them about the organization's stakeholders and what beliefs and values are embraced. An organization must truly believe and act upon its mission statement; otherwise the statement has no value.

Sample Philosophy Statement

The philosophy flows from the purpose or mission statement and defines the set of values and beliefs that guide all actions of the organization. The nursing service philosophy in Display 7.8 builds on County Hospital's mission statement and organizational philosophy.

Sample Nursing Service Philosophy

The manager must provide a copy of the philosophy to the prospective applicant before the interview. A goal can be defined as the desired result towards which the effort is directed; it is the goal of philosophy.

Sample Goal Statements