The book will help students understand a current perspective of nursing leadership and management theories, concepts, and principles. College of Nursing University of Manitoba Winnipeg, Manitoba, Canada Maria Rosen, PhD, APRN-BC Assistant Dean.
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Health care policies and the health care environment are addressed and nursing leadership and management theories are presented. Finally, effective communication is reviewed and types of communication in a health care setting are discussed.
Foundations and Background
Core Competencies for Safe and Quality Nursing Care
Providing patient-centered care requires health care professionals to become excellent team players (Collaborative Panel of Interprofessional Education Experts, 2011). The IOM asserts that evidence-based management is essential to achieving safety in health care (Page, 2004).
Health-Care Environment and Policy
Private health care is the predominant form of health care for persons residing in the United States. There are mainly two routes through which health care can be accessed in the United States.
Access Denied
The ultimate goal of this law was to reduce the number of uninsured people in the United States by expanding Medicaid and implementing health exchanges. How Health Care Reform Affects Nurses Review ANA's information on health care reform at www.nursingworld.org/MainMenuCategories/Policy-Advocacy/HealthSystemReform. Medicaid provides health care services to low-income people (primarily for children, non-disabled adults, and pregnant women) and is one of the largest payers for health care in the United States.
These numbers equate to 5.2 million people nationwide who will be denied access to the new health care system (Kaiser Commission on Medicaid and the Uninsured, 2014). Nurses at all levels must be involved in health policy to advance health care in the United States. Nurse leaders and managers can contribute to health policy by serving as elected or appointed representatives in health care activities at the local, state, national, and global levels (ANA, 2015).
Nurses must be aware of the consequences of inadequate access to health care for patients. All nurses must have a basic understanding of the wider context of health care and health policy. Retrieved from http://www.rwjf.org/content/dam/web-assets/2009/08/how-does-the-quality-of-u-s—health-care-compare-internationally.
Theories and Principles of Nursing Leadership
In this process, all nurses at all levels of the organization are involved in decision making. Transformational leadership is seen as a type of effective leadership for nurses to lead the change needed to meet the demands of the current health care system. Relational leadership incorporates the needs of various stakeholders within the health care setting by recognizing and utilizing members' strengths and involving them in the leadership process (Lipman-Blumen, 1992).
In Nursing: Scope and Standards of Practice (2015) the ANA identifies leadership as a standard of professional performance for all nurses and states: "the registered nurse leads within the professional practice setting and the profession". The AONE (2015b) competencies for nurse managers outline the knowledge, skills and attitudes that nurse leaders and managers need to create safe and healthy environments that support the work of the healthcare team and promote optimal patient outcomes. One study proposed the concept that leadership is a co-construction of the leader and followers, and researchers.
It is this last member of the team that can distract from the performance of the team. A good follower is a team member who contributes to the success of the organization. Nurse leaders and managers will be challenged to stay abreast of the ever-evolving healthcare system while increasing patient and staff satisfaction and quality care.
Ethical and Legal Aspects
Ethics in nursing requires "the investigation of all kinds of ethical and bioethical issues from the perspective of nursing theory and practice, which in turn is based on the agreed core concepts of nursing, namely: person, culture, care, health, healing - ing , environment, and nursing itself” (Johnstone, 2009, p. 16). Related to the principles of beneficence and nonmaleficence is paternalism, which is "the intentional dominance of one person's preferences or actions by another person" (Beauchamp & Childress, 2009, p. 208) or, in the healthcare world, control a patient's choices. Utilitarianism is a form of teleological theory, from the Greek word telos meaning "the end". The basic premise of utilitarianism is the idea that moral action should increase human happiness and make the world a better place.
Nursing's Social Policy Statement: The Essence of the Profession defines nursing as "the protection, promotion, and optimization of health and capabilities, the prevention of disease and injury, the relief of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations" ( ANA, 2010, p. 10). According to these standards: "The registered nurse collects relevant data and information relative to the health or situation of the health care consumer" (ANA, 2015b, p. 53). According to the ANA (2015b) standards, " The registered nurse communicates effectively in all areas of practice” (p. 71).
The third provision of the AKSH Code of Ethics for Nurses with Interpretive Statements states, "the nurse promotes, protects and protects the health and safety, rights of the patient" (AKSH, 2015a, p. 9). The sixth provision of the ANA Code of Ethics states: "The nurse, through individual and collective efforts, creates, maintains and improves the ethical environment of the work environment and employment conditions that are favorable for safe and quality health care" . (AKSH, 2015a, p. 23). Advocacy for the profession is addressed by provision seven of the ANA Code of Ethics (2015a): “Nursing in all roles and settings advances the profession through research and scientific research, development of professional standards and generation of nursing and health policies. ” (p. 27).
He must not have anything around his neck!” The family is very upset and tells Mr. There are two necessary components to informed consent: "The patient must be fully informed and there must be voluntary consent" (Guido, 2010, p. 152).
Critical Thinking
Nurse leaders and managers who engage in reactive thinking use automatic, thoughtless responses to solve problems, often resulting in errors or ineffective decision-making. Encouraging critical thinking in nurse leaders and managers creates a legitimate foundation for accurate and effective decision making in the unit (Porter-O'Grady et al., 2005). Nurse leaders and managers use data to support and improve decision making and document issues, problems, or trends to help determine an individualized plan.
Decision-making tools provide nurse leaders and managers with a systematic way to collect and manage necessary data and help visualize alternatives. By using a decision-making tool, nurse managers and leaders can approach decision-making in an organized and systematic way. The role of the nurse manager and manager shifts from making all unit-related decisions to designing effective shared decision-making processes.
According to the ANA's Nursing Administration: Scope and Standards of Practice, nurse leaders and managers are encouraged to develop shared decision-making skills (ANA, 2016). This article provides nurse leaders and managers with a real-life example of the use of shared decision making and appreciative inquiry in nursing. Effective nurse leaders and managers develop healthy critical thinking and decision-making skills and encourage open communication and give voice to staff by encouraging shared decision-making.
Effective Communication
As George Bernard Shaw once said, “The greatest problem in communication is the illusion that it has taken place” (Shaw, n.d.). To be an effective communicator, nurse leaders and managers must also adapt their communication style based on the individual's ability—whether a patient, family member, or staff member—to process and understand the interaction (Smith, 2011). Downward communication reflects the hierarchical nature of the organization (eg, sending information from administrators to nurse managers and managers or by nurse managers and managers to staff).
Interprofessional communication requires nurse leaders and managers to communicate with all members of the healthcare team, as well as with patients and their families. The patient and his family also have the opportunity to meet all members of the medical team. After rounding the teams, nurse leaders and managers are responsible for communicating the results of the interprofessional team rounding to all members who are not present and for communicating feedback to the team as needed.
Nursing leaders and managers can learn from this project how important it is to recognize paraprofessionals as members of the interprofessional team. Two hours after admission, the patient continues to complain of abdominal pain, stating "This is the worst pain I have ever had." Her abdomen remains firm and soft with no bowel sounds. Communication is one of the knowledge, skills and attitudes that nurse leaders and managers – and indeed all nurses – must use with utmost competence.
Promotion of Patient Safety and Quality Care
Improving and Managing Safe and Quality Care
Safety management is based on rules and regulations: The organiza- tion sees safety as an external requirement imposed by regulatory bodies, and
Good safety performance becomes an organizational goal: Safety is perceived by leadership and management as important, but safety perform-
Safety performance is seen as dynamic and continuously improving
All of these patient safety initiatives can have a positive impact on the overall quality of healthcare. In 1994, the ANA launched an initiative to examine the impact of health care restructuring on the safety and quality of patient care and the nursing profession (Montalvo, 2007). WHO launched the Patient Safety Program in 2004 with the belief that every patient should receive "safe health care, every time, everywhere".
WHO defines patient safety as "the absence of preventable harm to a patient during the health care process". She has been called "the woman who discovered quality" (Meyer & Bishop, 2007, p. 240), and she could also be considered an evangelist for performance improvement. However, she was quick to inform those she reported to that "hospital mortality statistics have so far provided little information about the effectiveness of the hospital, i.e. the extent to which it is fulfilling the purpose for which it was established, because there are elements of the hospital's existence, as such statistics have hitherto not taken cognizance of” (Nightingale, 1859, p. 5).
Quality improvement (QI), as it is used in healthcare today, was first used in industry in the early 1900s. Nurse managers and leaders may lead the team or designate a nurse or other healthcare professional to facilitate the QI team. One of the most popular frameworks for assessing quality in healthcare is the Donabedian model.
