Leadership Assessment Paper
The following paper describes and summarizes the interviewed completed with Mrs. F. (BSN, RN, TNS, CCRN, NE-BC) who is a Registered Nurse with extensive experience in the field of nurse managing. Mrs. F.’s work experience and background education will be presented along with pertinent material to enrich the description and discussion of nursing, leadership, and administration. The sequence of this document follows a pattern through which Mrs. F. allow us to a glimpse inside the organization for which she currently works and performs as an administrator for nursing services. Description of the Healthcare System
The services are delivered for a facility with 500 beds for a variety of services rendering such as cardiovascular, pulmonary, certified stroke center, children specialized services, and the medical surgical area. More specific, this is a level 2 Trauma center in an urban area located in Northern Jersey. Although currently the health care system services have become more expensive to deliver, this organization is committed with the provision of services with continuous quality, and compassionate care for their community with special consideration for the poor and under served. Thus quality of care is intrinsic to the services provided regardless of the financial restrictions and the population served. Description of Administrative Position
The Nurse Manager credentials for the position in this organization requires completion of a Master’s Degree in Nursing and three to five years of pervious work related experience, plus three to six months of on-the-job training and orientation. The nurse manager profile coincides with the stipulations outlined in the website for the American Organization of Nurse executives (AONE): Valid and unrestricted license as a registered nurse; and either a bachelor of science in nursing (BSN) degree or higher plus two years of experience (minimum of 1,040 hours per year) in a nurse manager role or a non-nursing bachelor’s plus three years of experience (minimum of 1,040 hours per year) in a nurse manager role or a diploma or associate degree plus five years of experience (minimum of 1,040 hours per year) in a nurse manager role. (“Certified Nurse Manager Leader,” n.d.) Mrs. F. meets those requirements and licensure standards. She reports to the Director of the ICU department. The Nurse manager position is responsible for the 24 hours operation of this unit; the responsibilities hence embrace participation in yearly budget allocation meeting goals projected along with finance department and the Director. Such allocation of funds may include effective distribution of resources to ensure sufficient availability of equipment, staffing, new projects and staff training. Mrs. F. points out those fiscal responsibilities include wise distribution of labor according to fluctuating needs and demands in each department to avoid overuse of staff and to enhance flow of staff according to the health care system guidelines. In the same token, Nurse manager is responsible to create policies aimed to promote effectiveness in the recruitment and retention of staff. Mrs. F. indicates that her managing responsibilities include ensuring excellence and competency of the staff through evaluations, orientation of new nurses, and performance supervisions.
The Nurse Manager is responsible for interviewing, selecting, training, supervising, and evaluating employees. She originates personnel documents in accordance with Human Resources policies. She manages performance to achieve expected results. The Nurse Manager “conducts timely performance appraisals and feedback. She would interpret and enforce departmental compliance with regulatory standards (i.e. DNV, DOH, OSHA, EEOC, etc.)” (Mrs. F, personal communication, January 9, 2013) The Nurse Manager can also gather information on the effectiveness of processes or procedures and identifies areas that need improvement, while utilizing principles of continuous quality improvement. With this, she is contributing to improving quality services and productivity. Overview of Managing Responsibilities
This area of the management responsibilities refer to the specific administrative actions by Mrs. F. to ensure that the unit is functioning according to the standards and expectations outlined. This includes promoting the operation of the unit in a cohesive manner; that is, in a way that staff knows what to do, how to do it, and where to find the resources to do it. The Nurse Manager is responsible for the 24 hour per day, daily operation of the ICU department by managing all resources necessary to meet the patient needs, providing an environment conducive to employee growth and productivity and functioning within confines of regulatory requirements. Functions collaboratively and in partnership with Senior Administration to develop and implement strategic plan and to meet short and long term goals of the Healthcare System. “The Nurse Manager is a registered professional nurse who under the direction of the Nursing Director coordinates available resources to efficiently and effectively provide professional nursing care of a quality consistent with assigned Hospital Standards of Care to the patients assigned to her unit” (Mrs. F, personal communication, January 9, 2013).
The Nurse Manager demonstrates the knowledge and skills necessary to make decisions regarding the provision of age appropriate care for the unit’s patient population. She is responsible to act as a role model in customer relations. This individual must participate in service and hospital-wide committees as assigned. The Nurse Manager is responsible to attend formal educational seminars to enhance her knowledge on both clinical and administrative issues. The Nurse Manager participates in the orientation program for new head nurses. She is also responsible for maintaining membership in a professional organization. Nursing Care Delivery
Mrs F. describes her organization, utilizes relationship based and primary nursing care as the nursing care delivery model of choice. The Staff RN is the primary nurse and is paired with a partner, which can either be a PCA or LPN. They work together throughout the shift to achieve the desired outcomes for each patient; the primary nurse delegates which tasks needs to be done to the PCA or LPN, which they can execute under their scope of practice. “Primary nursing refers to a client-focused care-delivery system, in which nurses manage the progress of a client through an episode of care in a nursing unit” (Gessner, 1998). Primary nursing increases patient’s satisfaction, quality of service and the nurse is more autonomous, consequently the nurse is accountable for the quality of care and the outcomes of their patient. According to Yoder-Wise (2011) Primary nursing brought the nurse back to direct patient care.
Leadership Style A Nurse Manager is considered a good leader when she can maintain balance by practicing time management. This is important especially when attending assigned committees. “Attending to matters as they arise, handling each question or piece of mail once and one at a time, and focusing on the task at hand without distractions are just some of the time-management strategies used by effective leaders.” (Yoder-Wise, 2011) Leaders must generate self-motivation to achieve and be able to energize others into action. They understand what drives individuals to take specific actions and create opportunities for them to meet personal and organizational needs at the same time. Giving performance appraisals on staff nurses and other allied nursing personnel are done by the Nurse Manager. This is very important in order to promote improvement in the unit. Leaders must have self-confidence in order to succeed. This correlation between leadership and self-confidence was addressed by Yoder-Wise (2011), she stated: “The more confident a leader feels, the more likely that success will follow” (p. 46). According to Porter-O’Grady, Hawkins, and Parker (1997, cited by Yoder-Wise, 2011), basic principles of shared governance include partnerships, equity, accountability, and ownership. “These managers are accounted to define objectives and strategies to meet organizational goals and objectives.” (Mrs. F, personal communication, January 9, 2013) They perform by reporting and documenting outcomes and status of operations without reminder. Nurse Managers hold the characteristics of self-governance that empowered them to participate in decision making, recognition of accomplishments, and evidence-based practice (Yoder-Wise, 2011). Shared governance is integrated in a Nurse Managers role by incorporating current research findings into clinical practice. Usually seen when assessing data reflective of each patient’s status and interpreting information needed in order to identify each patient’s age requirements relative to his or her specific care needs.
As a leader there is a requirement to follow a leadership style, such as transformational leadership. A transformational leader is one who “commits people to action, who converts followers into leaders, and who may convert leaders into agents of change” (Welford, 2002). Transformational leaders do not use power to control and repress the followers. These leaders instead empower the staff to have a vision about the organization and trust the leaders so they work for goals that benefit the organization and themselves. “Leadership is thus not so much the exercise of power itself as it is the empowerment of others” (Yoder-Wise, 2011). The goal is change in which the purpose of the leader and that of the unit creating a collective purpose. Due to their empowerment staffs become critical thinkers and are active in their roles within the hospital. A creative and committed staff is the most important asset that a leader can accomplish. “People are empowered when they share in decision-making and when they are rewarded for quality and excellence rather than punished and manipulated” (Welford, 2002). “When the environment is humanized and people are empowered, they feel part of the team and believe they are contributing to the success of the organization” (Welford, 2002). In nursing, empowerment can result in improved patient care, fewer staff sick days, and decreased in number of patient falls. Nurses who are transformational leaders have staff with higher job satisfaction and who stay in the hospital or unit for longer periods. “Today’s health care environment demands leaders who inspire others with the vision of what can be accomplished” (Welford, 2002). According to Medley and Larochelle (2011): Transformational leadership theory helps move workers toward self-actualization. Setting an example of visionary leadership that may help address the current crisis in our nation’s health care system. (p. 52) Communication Strategies
Communication with clarity is another integral part of being a Nurse Manager, she regularly meets with employees to ensure employees at all levels understand what the most critical issues are facing the unit and how employees can have an impact on such issues. A good Nurse Manager will demonstrate a willingness to share ideas and perspectives and to encourage others to do the same through participation and discussion. Optimal communication leads to the purpose of delegation to be more efficient; therefore, the tasks must be passed on or delegated to others, within their scope of practice. Head nurses possess this skill in order to provide effective communication strategies with physicians, staff members, and professionals to achieve desirable or acceptable patient outcomes. A good leader also posses good listening skills, this is important when listening to both sides of the story and making the best decision for the best interest of the unit. By doing this, the Nurse Manager will be able to resolve when issues arise regarding a problem or a complaint made between the patient and the staff nurse. She will then have the opportunity to come up with the right solution for the units’ sake. The Nurse Manager holds the power to protect her staff in situations like these. One can say that the Nurse Manager would act as an advocate for her staff members and represent the unit as a whole. The leader should always maintain a positive attitude in order for the followers to be able to believe in them. “Nurse Leaders need to support in-service education and training for all levels of staff involved in care provision, based on identified needs and continuing education development relevant to areas of practice” (Doody & Doody, 2012).
Nurse Managers are leaders because they have undergone training as well as additional professional education in order to take on the roles regarding nursing management. They are in charge of the overall daily operations of the unit. In the organizational chart, the Nurse Manager would represent the administrative part, the higher part of the hierarchy. The Nurse Manager is responsible to provide the staff nurses with access on the administration as well as on the higher ranks of the nursing services. This is why it is so important for Nurse Managers to maintain optimal communication skills. Negotiation and Conflict
Mrs. F. points out she always attempts a win-win situation, tries to ensure the problem does not linger. “She allows staff to try to work on things out amongst themselves before getting involved; if this does not work, then she meets with them both individually first to get each side of the story and then together to try resolve the issue” (Mrs. F, personal communication, January 9, 2013). Collaborating allows for open discussion of issues, evaluation of circumstances and allocates a resolution for the underlying conflict. According to Yoder-Wise (2011):
Collaborating is both assertive and cooperative because people work creatively and openly to find the solution that most fully satisfies all important concerns and goals are achieved. (p. 473)
Discussion of Standards Nurse Manager Mrs. F, implements the ANA standards by doing monthly chart audits, data collected goes to quality management department. Ensure practice guidelines are current and evidence based. Collaborates with other departments to ensure work is efficient and make corrections as needed. Participating in interdisciplinary meetings which include staff; weekly meetings with Medical Doctors, Case Managers, and Social Workers to discuss long term patients or patients with social issues. Auditing is another very important role for the Nurse Manager. “Assignments reflect appropriate utilization of personnel considering the scope of practice, competencies, patient needs and complexity of care” (Mrs. F, personal communication, January 9, 2013). In order to perform such tasks, Nurse Managers are well rounded in terms of skills and knowledge regarding the unit’s set up and work culture. Being a Nurse Manager is one who combines leadership with the nursing process when it comes to delivering safe and effective nursing care. A Nurse Manager is liable for the actions of each personnel working under her. She is responsible for communicating to doctors when something unusual to the patient arises in order to perform in collaboration with all health team members. She assists in the development and implementation of new and ongoing service programs to ensure quality nursing and patient care programs consistent with hospital mission and patient needs. “She leads by example and assures all employees promote the mission and philosophy by displaying behavior consistent with the core values of excellence, dignity, justice, and stewardship; respects the cultural diversity of the organization. She will most likely meet all required competencies for department, unit, and hospital” (Mrs. F, personal communication, January 9, 2013).
Summary In conclusion, it is essential for the Nurse Manager to encompass the following criteria to be a thriving leader and administrator. The Nurse Manager must have the body of knowledge to communicate effectively to her staff and supervisors, by communicating clearly and listening successfully. It is imperative for the Nurse Manager to recognize how to handle conflict and negotiation skills when interacting with staff. The Nurse Manager requirements are fundamental for the position to be completed as part of their daily functions.
References Bowles, A., & Bowles, N. (2000). A comparative study of transformational leadership in nursing development units and conventional clinical settings. Journal of Nursing Management, 8(2), 69-76. doi:10.1046/j.1365-2834.2000.00151.x Curtis, E., & O’Connell, R. (2011). Essential leadership skills for motivating and developing staff. Nursing Management - UK, 18(5), 32-35. Doody, O., & Doody, C. M. (2012). Transformational leadership in nursing practice. British Journal Of Nursing, 21(20), 1212-1218. Gessner T.L. (1998) Job design and work processes in patient care. In Nursing Administration: Managing Patient Care, 2nd edn (Dienemann J.A., ed.), Appleton & Lange, Stamford, CT, USA, pp. 359–402.
Mrs. F. (2013, January 9). Nurse Manager. ( Interviewer) Welford, C. (2002, July 4). Transformational Leadership in Nursing: Matching Theory to Practice. Nursing Management , pp. 8-10. Yoder-Wise, P. S. (2011). Leading and Management in Nursing . St. Louis: Elsevier Inc.