Chapter 22 Nurse Leader, Manager, and Care Coordinator

Charismatic Leader

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Role of Nurse Manager

-All nurses (working with others & influencing other to be their best) are in fact potential leaders

Mentorship

-An experienced person assists the less experienced person. New nurse moves into the leadership role in a more effective way. Mentors review the basics needed when new to a new organization. -Advantages: caring, stronger leadership skills (new person), valuable information exchange, growth & development, effective role model

Leadership Styles

-Autocratic -Democratic -Laissez-faire -Quantum -Transactional

Conflict Resolution Strategies

-Avoiding -Collaborating -Competing -Compromising -Cooperating/accommodating -Smoothing -Nurse managers frequently encounter conflict between employees and between themselves. Unresolved conflict can occur and lower morale and threaten quality of care. -Marquis and Huston (2012) discussed 6 styles of dealing with conflict... Which to use depends of situation, urgency of decision, power status of those involved, importance of issue, and maturity of people involved.

Management Structures

-Centralized Senior managers generally make decisions with little input from the group. -Decentralized Decisions are made by those who are most knowledgeable about the issues being decided. -Nurses are thus intimately involved in decisions concerning patient care.

Quantum

-Change is dynamic, ever changing, and continuously unfolding. The organization and its members are engaged and interconnected. Folks need to collaborate and work together. Change can be planned, but may take place very quickly and the organization and its people need to embrace and work with the change.

Leadership Qualities

-Charismatic -Dynamic -Enthusiastic -Poised -Confident -Self-directed -Flexible -Knowledgeable -Politically aware

Democratic

-Decisions and activities are shared among the employees and the leader-Group and leader work together to solve goals and resolve outcomes. -----Works well because groups are satisfied, they all work together with leadership towards a common goal. Does not work well if have quick decisions to be made.

Time Management is Key

-Establish goals for the day-What needs to get done -How will your goals help meet the needs of the patient,your team, work colleagues -Teamwork needs to be learned help each other -Establish a time line-allocate hours-correct what is going wrong quickly -Evaluation your success or failure- -May need to reorganize the following day.

Preceptorship

-Experienced nurse is selected and generally paid to introduce new employee to new responsibilities through teaching and guidance. Shows / discusses new policies & procedures New nurse: gains knowledge, skills, and support

Overcoming Resistance to Change

-Explain proposed change to all affected. -List the advantages of the change. -Relate the change to the person's existing beliefs and values. -Provide opportunities for open communication and feedback. -Indicate how change will be evaluated. -Introduce change gradually. -Provide incentives for commitment to change. (money, time off)

Types of Power

-Explicit: power by virtue of position -Implied: power due to other factors, such as personality

Cooperate accommodate

-IOU for future, positive outcome in future

Achieving Self-Knowledge

-Identify your strengths. -Evaluate how you accomplish work. -Clarify your values. -Determine where you belong and what you can contribute. -Assume responsibility for relationships.

Factors Prompting Change in Health Care Industry

-Increased number of chronically ill and older people -Increased role of government and industry in health care -Rising cost of health care -Changing patterns of health care delivery

Laissez-faire

-Leader is hands off—the workers are allowed to be the one to lead towards change and work through the issue. Works if the employees are self-motivated and have strong strength of leadership qualities. You have to understand what is going on and be ready to create that change. Rarely works, because each nurse and staff person has different strengths and abilities and all come with different experiences.

Lewin's Theory of Change

-Learn how to influence a person's thinking and behavior in order to help bring about change. -Unfreezing: The need for change is recognized. -Moving: Change is initiated after a careful process of planning. -Refreezing: Change becomes operational. -(1951)

Student Nurse Leaders

-Locally SNA -CT SNA -Run for office -Kappa Alpha Chapter: Sigma Theta Tau -Desire to learn and excitement to become -Educator role

Continuing education

-Many development programs for expanding role into leading others. Many state board of nursing require ongoing continuation of education credits for licensure

Developing Leadership Responsibilities

-Mentorship -Preceptorship -Nursing organizations -Continuing education

Why Do we Need Nurse leaders

-Neville E. Strumpf -Dorothy M. Smith -to oversees the nursing care given by others while retaining accountability for the quality of care given to the healthcare consumer -abides by the vision, the associated goals and the plans to implement and measure progress of an individual healthcare consumer or progress within the context of the healthcare organization -demonstrate a commitment to continuous, lifelong learning and education for self and others -mentors colleagues for the advancement of nursing practice, the profession, and quality healthcare -treat colleagues with respect, trust and dignity -develops communication and conflict resolution skills -participates in professional organization -communicates effectively with the healthcare consumer and colleagues -seeks ways to advance nursing autonomy and accountability -participate in efforts to influence healthcare policy involving healthcare consumers and the profession

Considerations When Delegating Nursing Care

-Patient's condition -Complexity of the activity -Potential for harm -Degree of problem solving and innovation necessary -Level of interaction required with the patient -Capabilities of the UAP -Availability of professional staff to accomplish workload -ANA (2012) released a position statement to promote safe and effective use of delegation titled: The principles for delegation by RN to UAP. -Delegation: transfer of responsibility for performance of an activity to someone else while still retaining accountability for the overall outcome. Cannot delegate elements of the nursing process itself. -Prior to delegation: know the Nurse Practice Act of the State in which they are working. Know the organizations policies and procedure regarding different levels of staff/scope of practice. Be part of the process that reviews policies and procedures concerning delegation of activities to UAP's. -UAP must be told about patient precautions, when to find help, what needs to be immediately reported to the staff/RN. -Not delegating correctly can affect and endanger the patient as well as the nurses' ability to practice -Understand the flow of the department in which you are working for. Understand the goals of the organization itself and the priorities for administration. Know the organizational chart-whom to communicate to.

Clinical Nurse Leader Role

-Position was created by the American Association of Colleges of Nursing (AACN) as a leadership role. -The CNL works collaboratively with the health care team to facilitate, coordinate, and oversee patient care. -The CNL should be able to clearly communicate with other health care professionals, integrate evidence-based practices into patient care, and evaluate patient risks and outcomes. -The person-centered focus of the CNL role includes functioning as a patient advocate, educator, and provider of patient care in complex situations. -The idea of this role was to have a positive effect on health care and to promote collaboration within the entire health care setting. -Some experts feels this new role overlaps with the roles of the Clinical Nurse Specialist and the Case Manager. -Programs in CT offer this opportunity - usually a master's degree

Nurses in leadership and managerial roles who wish to be effective change agents are sensitive to both the uses and abuses of power

-Power: ability to influence other to achieve a desired effect. Nurses in management positions within an institution have a certain amount of power within their anticipated roles. -Change: need key power players who can encourage other to become involved. Be proactive and not reactive. -Right timing: right time right place-create change -size of nursing profession: 3 million nurses in US—impressive voting block -Nurses' referent power; public high degree of trust and credibility -Increased knowledge and education: advance practice roles, keep education moving forward -Unique perspective: Caring part of nursing, evidence based practice, critical thinking is important. Affordable and safe quality of care. -Desire by everyone for access to, affordable, and safe quality care

Planned Change: An Eight-Step Process

-Recognize symptoms that indicate a change is needed and collect data. -Identify a problem to be solved through change. -Determine/analyze alternative solutions to the problem. -Select a course of action from possible alternatives. -Plan for making the change. -Implement the selected course of action to effect change. -Evaluate the effects of change. -Stabilize the change.

Factors Increasing the Power Base of Nursing

-Right timing -Size of the nursing profession -Nursing's referent power -Increasing knowledge base and education for nurses -Nursing's unique perspective -Desire of consumers and providers for change

Evidence-Based Strategies to Improve Leadership Skills

-Strive to become an authentic leader. -Develop leadership skills. -Promote a healthy work environment. -Engage staff to commit to their best effort at work. -Assist new graduates to transition into the RN roles. -No one truly is born a leader. With experience comes leadership qualities through observation and knowledge gained. With experience comes growth. -Nurses who feel they have more control over their work environment will be less likely to be frustrated -Clearly communicate your factual information which maintaining core values-tolerate different view points -Staff satisfaction, retention, improved outcomes depend on healthy work environment-help achieve satisfaction with job -When work environment healthy, staff feel in control and are more likely to be engaged and committed to work -New graduates need preceptors and mentors who support them during their first 12 months of practice.

Autocratic

-The leader is the one who does all the decision making for the group—the group complies. The workers have little opportunity to share or provide input into the decision making process. Used for a long time in some hospital administrations. ----------Emergency type of situation this might be good. --One person takes charge to safe a person's life.

ANA Principles for Delegating Care

-The nursing profession determines the scope of nursing practice. -The nursing profession defines and supervises -----UAPs involved in providing direct nursing care. -The RN is responsible and accountable for nursing practice. -The RN supervises any assistant providing direct patient care. -The purpose of UAP is to work in supportive role to the RN.

Reasons for Resistance to Change

-Threat to self -Lack of understanding -Limited tolerance for change -Disagreements about the benefits of change -Fear of increased responsibility -The nurse of leader must understand why there is resistance to change. What techniques need to be used to overcome that change.

Considerations for Planned Change

-What is amenable to change? -How does the group function as a unit? -Is the group ready for change and at what rate? -Are the changes major or minor?

Avoiding

-awareness of conflict situation-parties decide to ignore or avoid/postpone resolution-may resurface

Disagreement about the change

-clear up the information make it crystal clear.

Nursing leadership skills

-commit to excellence -problem-solving skills including a clear vision and strategic focus that allow movement forward toward a creative solution -commit to and passionate for ones work -trustworthiness and integrity -respectfulness -accessibility -empathy and caring -responsibility to enhance the personal growth of all staff

Smoothing

-compliment other party and focus on agreement rather than disagreement-reduce emotional impact

Leadership Skills

-empowerment -values -encouragement -vision

Transactional

-focus is task and reward. So if good salary and working conditions, the worker will comply with the leaders directions. -Reward good behavior and punish bad behavior—no room for interaction or idea sharing.

Collaborate

-joint effort to resolve conflict-win win—both determine new priority and responsibilities to get to the goal-repect, communicate, and shared decision making

Threat to self

-loss of self esteem, personal threats, social relationships will be disrupted.

Care coordination

-need to help patient prioritize their hospital stay. -Help them reach their outcomes. Person centered care.

Nursing organizations

-opportunity for leaders to learn their roles, gain management tips, develop their own role. American Organizations of Nurse Executives, Sigma etc.

Compromise

-relinquish something of value-otherwise may not feel they won anything

What Leaders need to Do

-success -team -motivate

Fear of increased responsibilities

-take on more complex role, may not feel prepared overwhelming feelings make it difficult to accomplish the goals.

Meaning of Leadership

-the ability to direct or motivate a person or group to achieve set goals -leaders have power, whether explicit or implied -eg. elected class leaders have explicit power by virtue of their position -by force of their personality, have more power to influence the class than designated leaders ; this is implied power

Lack of understanding

-why is the change needed or occurring.

Competing

-win for one at expense of other group (ethics/safety may need to be done)