Leadership and Ethics

The ethical situation that comes to mind this week is religious ethics.  This theory focuses on religion, which is depicted by the parent’s upbringing and the older family members typically.  One particular faith, Jehovah’s Witness, does not allow for blood transfusions.  This is very important when you have a baby in the NICU (Neonatal Intensive Care Unit) that is in need of the transfusion and the parent will not consent.  The treating neonatologist will need to get a court order to do the transfusions.  In an extreme emergency, if two doctors sign off that it is an emergency, then the baby will receive the transfusions while they await the court order.  As a parent of a premature baby myself, I could not imagine not doing everything I could to save my child.  But in this case, the religious code of ethics is based on the upbringing of the parent (Denisco & Barker, 2012).

The parent refusing to allow treatment of transfusions to their baby would be a hindrance to the baby’s care, while at the same time as nurses we are trying to promote a  family-centered type of care involving the caregivers in the decision making and treatment  (Meadow, Feudtner, Matheny Antommaria, Sommer, & Lantos, 2010).  When my baby was in the level 3 critical NICU, they had open rooms, because the babies were too critical to be in closed rooms.  I watched a baby in front of us get sicker by the day and hearing the nurses and the doctors speak about the need for a blood transfusion and other treatments.  By the time they gave the baby the blood transfusion, it was too late, and the baby was terminal.  You as the parent are watching and hearing this because, in this type of critical setup, there is nothing between you and the next bed except a curtain and in front of you there is not a curtain.  As a nurse I thought to myself, how can they be having this discussion right in the open this way? As a parent I thought, how can these parents watch their baby die? I thought about how those nurses felt and if I were the nurse in that situation, what would I have done?

With the use of religious ethics, we may not agree with the family, but as nurses, we need to respect the other person’s customs and beliefs as long as the baby is being taken care of and there is not a medical threat to the baby’s life. When I stop and think about the nurse manager that was supposed to be the example, all we heard from her was complaints about the parents and how ignorant they were.  A part of me agreed, however, the nurse part of me, the part that is compassionate with the parents dealing with a decision they probably hate to make came out.  I said to the manager, we are all very much entitled to our opinions and they may not be the views of our patients, but in this crisis, we just need to support the parents because the baby will receive a transfusion whether they agree or not by court order.

References

Denisco, S. M., & Barker, A. M. (2012). 25. Advanced practice nursing: Evolving rules for the transformation of the profession (2nd ed., pp. 569-581). Retrieved from https://campus.capella.edu/web/library/home

Meadow, W., Feduter, C., & Matheny-Antomennaria, A. H. (2012, April 13, 2010). A premature infant with necrotizing enetrosoliteis. Special Articles-Ethics rounds. http://dx.doi.org/10.1542/peds.2010-0079

 

 

Leadership Styles and Organizational Changes

In my previous employment, I went through some challenging issues that started at the leadership level.  I was a manager of case managers at the time.  The role of the professional nurse when implementing a change is to identify that there is a need for a change (Rubenfeld & Scheffer, 2014).  Once the need for a change is identified by the nurse, the next step is to implement a change in behaviors efficiently and with quality. When identifying the area specifically that needs the change, nurses need to be deliberate in stating the purpose of the change.  When speaking to the target group about making the change, it is important to keep their attention span with non-lecturing phrases.  As nurses, we are not always in our comfort zone to explain why changes need to be implemented.  We should be prepared to explain why this change is needed and what improvements these changes will make.

Generally, people will always be resistant to change.  But as professional nurses, our focus is to build trust and credibility.  The goal is to acknowledge that the change is coming and that you empathize with the feelings of the upcoming change (Rubenfeld & Scheffer, 2014).

Where I used to work, they were very involved with ACHA (Agency for Healthcare Administration), because we held a state contract.  Evidenced-based nursing was in a sense required as far as the patient care when our case managers were managing a case.  However on the same note, although our case managers were not performing hands-on care, they were required to know about all their diagnoses and treatments.  We had social workers and nurses alike seeing the same types of members.  The issue with nurses and social workers seeing the same types of patients is that the social worker is not able to use his/her critical thinking skills in their area of expertise.   They were required to assist members who had complex medical issues for instance, on a ventilator or more complex medical problems.   A suggestion was made when I arrived at my workplace to utilize the social workers in conjunction with the nurses to manage the social aspects of the patients, however, the decision was denied.  It was noted that ACHA is not paying the company to rethink how cases were managed and by whom because it was not hands-on care, it was case management.

There was very little nursing involved in my job role, it was primarily reports and meetings to talk about reports and how to fix these reports.  It was an ideal job for someone that had an interest in the perfection of numbers and statistics.  Every other day, there was a new change that was being implemented. We often questioned why there was a change, but what we were told was that the change was immediate and mandatory.  For the staff case managers, these changes were difficult because the staff was in the field.  They may receive an email about something that needed to be changed as soon as possible, however, they may have just returned home at 4:30 or 5pm in the afternoon looking forward to the end of their day.  When the case managers check their emails,  they find deadlines on multiple items due.  These changes affect the staff because they have to work after hours to get the work completed timely. This kind of change caused many good nurses and social workers to resign.

As nurses or leaders, we tend to fall into the routine of lecturing due to the pressures that we are under.  However, two of the six dimensions of dealing with complex dynamic changes are creativity and intuition.  As a leader we should not just teach our group something, we should implement a way to bring creativity into the change and use intuition to know how to speak to our group.  The best way to implement a change is to get the group to commit to doing the new change and develop a smart goal with them that will allow them to measure their own goals.

The leadership theory that most resembles mine is the coaching leadership style.  The coaching leadership style allows me to work closely with staff at different levels and empower them to meet their goals and gain confidence in their strengths.  By being confident, they can focus on themselves as they work on their weaknesses.  In my previous job, the leadership style seemed like a dictatorship; however, for the purpose of the discussion here, it will be stated as coercive.  My manager’s favorite phrase was, “I gave a directive and everyone needs to follow it, any questions, 1 second wait time, no, good.  It’s due by close of business.”  If questioned on how to juggle that with all the meetings and other directives, the reply was always as a manager make it happen.  My manager always reminded me that she did not take lunch or breaks and she had “no life!” For fun,  she read the ACHA contract that was 350 plus pages because reading any other book was pointless (Barr & Dowding, 2012).

References

Barr, J., & Dowding, L. (2012). What makes a leader? In Leadership in healthcare (2nd ed., pp. 13-31). [Vital Source Bookshelf]. Retrieved from https://campus.capella.edu/web/library/home

Rubenfeld, M. G., & Scheffer, B. (2014). Critical thinking and patient-centered care. In Critical thinking tactics for nurses: achieving the IOM competencies (3rd ed., pp. 155-180). [Vital Source Bookshelf]. Retrieved from https://campus.capella.edu/web/library/home

 

Portrait, Dog, Animal, Suit, Business, Woman, Bitch

 

Leadership Skills Mentoring and Coaching

When I was a  manager of a team of nurses and social workers, collaboration existed in my direct report team, and as a team, we functioned using critical thinking, interdisciplinary team approach and collaboration on cases together.  But in the big picture of corporate America under the manager that I reported to, this was not acceptable, it was more along the lines of a multidisciplinary team.  In this type of team, you only have individual thinking in the group, meaning their way and no other opinions.  The focus would be on tasks and check off systems regardless if it was feasible to do (Rubenfeld & Scheffer, 2014).

Nurses do have the ability to be leaders, educators and changers of a system, if assertive enough to make that change, but in order to do so, a good team of interprofessional people is needed (Denisco & Barker, 2012). Because at the end of the day, the patient is who counts and why changes are necessary. If more companies were focused on having a management style that was transformational vs transactional, this would alleviate the unnecessary resignation of employees, corrective action plans and disgruntled employees.

In my team, for instance, a good way that we incorporated learning was to have one person do a case study every week.  They would team up with another person on the team to present the case study on a difficult patient.  During this time the team had the ability to comment on the case, make suggestions and also refer to our medical director for review.  This allowed me to mentor the nurses and social workers during our weekly meetings so that we could continue to go over any other cases that may have been difficult or of concern to them.

 

References

Denisco, S. M., & Barker, A. M. (2012). 25. Advanced practice nursing: Evolving rules for the transformation of the profession (2nd ed., pp. 547-567). [Vital Source Bookshelf] Retrieved from https://campus.capella.edu/web/library/home

Rubenfeld, M. G., & Scheffer, B. (2014). Critical thinking and patient-centered care. Critical thinking tactics for nurses: achieving the IOM competencies (3rd ed., pp. 155-180). [Vital Source Bookshelf]. Retrieved from https://campus.capella.edu/web/library/home

 

 

Leadership Theories and Attributes

I had the opportunity to interview Mary Alice Cullen, a Director of Patient Care Services.  She oversees the Neonatal Intensive Care Unit (NICU), labor and delivery, pediatrics, maternity ward, and the women’s clinic.   Mary graduated in May, 2016 with her Doctorate of Nurse Practice. Mary has always wanted to get her MSN.  As she started to study to get her MSN, it opened her eyes to endless possibilities of what she could do with her degree.  When she graduated with her MSN, the position that she was in opened up for her and she took on the job.  As she went through her role she wanted to make more of an impact on the role and the clients and staff she was supporting.  Mary decided to continue school for her Doctorate in Nurse Practice (DNP) with a concentration on Executive Doctorate in Nurse Practice, and this degree is also approved by the American Nurses Credentialing Center (ANCC). Her attributes are that of a caring leader, one that will work with her staff to encourage and teach them and empower them to be the best that they can be, even when they do not see that they can.

Mary does not often do hands-on care she is in an executive role.  However, she does round daily.  She provides support to her managers that manage the staff, in order to provide better care for the patients. Her leadership model is Kouzes and Posner, but if she is scrubbed in for surgery in labor and delivery, her transactional model side comes out.  Meaning this is a time as a transactional manager, where following directions the same way every day is crucial.  Mary most recently participated in a study that involved strategic planning of having single-family NICU rooms for the parents.  These were her visionary plans and the hospital agreed after the research was completed, that having individualized patient rooms in the NICU, would benefit the staff and the parents of the babies.

My leadership style is very similar to Mary’s in that I lead by example and I am not afraid to do the work that my staff does.  This makes a strong leader because the people who follow you will know that although you are in a position of higher authority, you will still be humble enough to do the job your staff does and be able to explain it from their side and understand the position that they are in.  Knowing your staff’s job by example, allows the manager to know the timeliness of things that need to be accomplished and the ability of each worker’s caseload and what they can manage. There are seven attributes to being a good leader and Mary possesses those in her character, her track record to be given assignments and projects that have been successful and in the skills that she shows handling her staff (Baer, 2012).

References

Baer, J. (2012). Theories of leadership. In Leadership in health care (2nd ed., pp. 45-69). [Vital Source Bookshelf]. Retrieved from https://campus.capella.edu/web/library/home

 

 

 

Why is Leadership Important to Nursing

Nurses are not often recognized for their professional expertise.  I know that when Florence Nightingale started the very first school of nursing her goal was to change how people viewed nurses by educating the nurses (DeNisco & Barker, 2013).

florence-nightingale

Leadership is important to nursing because without it, there is not going to be anyone to educate new nurses.  The baby boomers are retiring and we will need new teachers that are prepared to teach new nursing students as well as students at the graduate level.  Recent studies show that nurses that are prepared with their bachelor’s in nursing experienced less pressure ulcers, deep vein thrombosis and hospital acquired infections in their patients. It was noted that although an associate’s degree is less costly and provides the care needed to a patient; by the year 2020 the goals are 80% of nurses will have their BSN and doubling for nurses with their doctorate.

nursing-students

dnp-graduate

There are organizations that provide nurses of higher education grants to conduct research and be able to make difference.  In order for these research projects to be done, it is required that the nurse be able to write a solid proposal request for the grant.  This may require the skill of a grant writer, but the nurse must be knowledgeable in the project and what it entails in order to help the grant writer correctly write the grant to fund the project that the nurse wants to do (Laden, 2013).

In Orlando, we have the Florida Nurses Association.  It is an organization that will support nurses from the student level through the advanced level.  The organization is involved in many things especially any that are legislative where a nurse wants to make a difference.  The Florida Nurse’s Association has subgroups called Special Interest Groups ( Sigs), these groups will benefit the members because they are formed to specialize in something that a particular group wants to see changed.  For example there is a group called Nurse Entrepreneur Special Interest Group, this groups supports nurses that have an entrepreneur business that they want to start or have started.  If there is a group that you want to start for a particular interest  that you have and it is not a group already listed here, then after speaking with leadership in the group, if they approve it, then you could start it.  The group is responsible for having ten members in it in order for the group to work. A master’s and beyond prepared nurse would be able to conduct research needed for any new programs that need to be implemented.

nurse-entreprenuer

 

References

DeNisco, S. M., & Barker, A. M. (Eds.). (2013). The slow march to professional practice. Advanced Practice Nursing (2nd  ed., pp. 6-17). [Vital Source Bookshelf].

Ladden, M. D. (2013). The Case for Academic Progression: Why Nurses Should Advance Their Education and the Strategies that Make this Feasible. Retrieved from http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2013/rwjf407597

 

 

Working Your Staff Unsafely

This week has been the week of speaking with different professionals on training and how companies place employees in jobs that are not properly trained in their skill set to pay them less and get more out of them.  I used to work for a large insurance company that employed over 80,000 people.  I worked in the long-term care department which had about 400 staff from administrative assistants to presidents. I was the manager of case managers which consisted of RN’s, LPN’s and Social Workers.  They all did the same job and got paid different salaries to do it, however the job description and responsibility was the same.

chw-1 nurses-1

I felt that this policy of having nurses and social workers working on the same cases needed to be changed. Having all the staff doing the same exact work and paying them differently based on their degree and expecting the same level of skill, was inappropriate.   Nurses have a different skill set than social workers.  If a patient has a medical issue, the social worker that is visiting that member in the home completing an assessment may not be able to capture that the member has been retaining water in their ankles and think to ask if they are on a diuretic.  Much like the nurse that goes in the home setting and sees a patient that has issues paying their light bill won’t know where to call to find a resource for them.  The patient may be concerned because they are on oxygen at home; they wonder how they will pay their light bill and what they will do if the power is turned off. This can be a liability to any staff member but also a disservice to the patient.

oxygen

In contrast, I worked for another company that did case management. I loved that job, until federal cutbacks came along for the program during the new Obama administration.   The company employed RN’s, MSW’s, CHW’s, Nutritionists and Behavioral Health Specialists.   The cases were assigned only to nurses and there were two tiers of nurses, regular case managers and those that were more experienced received complex care patients.  The other staff MSW’s, CHW’s , Nutritionists and Behavioral Health Specialists were consulting on the files that the nurses referred to them.  They would work as a team with the nurses. This team work gave the patient a more well-rounded form of care.

illu_home_team01_xxl

There are several leadership styles in companies, autocratic, democratic and laissez-faire.  In the large insurance company that had all the workers regardless of skill set do the same job,  the leadership was autocratic.  The department maintained total control in all decisions and no opinions or suggestions were accepted from others. There was no opportunity to make a change due to the leadership style.   In my prior job, where everyone worked on a tiered team,  there was a democracy; decisions were made after consideration of input from the staff (Mitchell, 2013).

A team of medical professionals  gather for a daily meeting to discuss the elderly patients at the “Acute Care for Elders” unit at the University of Alabama Hospital, Birmingham. (Hal Yeager for KHN)

There are some days that as a professional you want to see changes implemented or at least considered, however the leadership does not support that.  If you are the type of person that works for the better of seeing changes in a situation, get involved in the departments or committees that have a say in policy writing, this will be the only way to see changes that can be discussed for the betterment of the company.

References

Mitchell, G. (2013, April). Selecting the Best Theory to Implement Planned Change. Nursing Management, 20(1), 32-37. Retrieved from http://web.a.ebscohost.com.library.capella.edu/ehost/pdfviewer/pdfviewer?sid=4ba42c53-9a6d-4ec5-b6bb-2f078e04b7c7%40sessionmgr4001&vid=1&hid=4204