Management: Nursing Leadership Overview: Using

Management: Nursing

Nursing leadership overview: using Orlando's theory in nursing practice, leadership, and management today

For the purposes of this assignment, I conducted a phone interview with Nurse B, a registered nurse in charge of managing and training several nurses on staff (personal communication, Oct 11, 2007). Her official title was that of a RN Clinical Manager responsible for Community Care. She was responsible for the leadership of her fellow nurses and other healthcare professionals, such as physician's assistants, and showing leadership in the community as an educator. She was involved in a hospital outreach treatment program, specifically developed to address issues of diabetes, inactivity, and obesity in the community.

According to Nurse B, RNs like herself are increasingly called upon to be both practitioners and leaders. Nurses must give quality care, yet give advice to patients on how to manage their treatment upon discharge, and help fellow nurses work at their maximum level of efficiency. Her experiences and outlook reflect some of the observations noted by Susan Valentine, professor of nursing theory at the University of Arizona. Valentine states that the nursing leadership paradigm most applicable to nurses called upon to fulfill a leadership role today is that of Ida J. Orlando's nursing middle-range theory. Orlando "concentrates on the process nurses' use to identify a patient's distress and immediate needs" (Valentine 2002). According to Orlando, whom Nurse B. had studied during her education an RN, nursing leaders must identify areas of organizational distress and patient distress, and strive to treat these areas in a way to enable patients to help themselves later on, and monitor and reduce their own distress.

For nurse leaders, Orlando's theory provides "a dynamic leader-follower relationship model. The theory is that the leader and follower exchanges are interactive. Both parties are vital to the success of the unit," and "the leader provides direction to the employee, not control, allowing for maximum participation by the employee or a dynamic relationship" (Valentine, 2002). Leadership is a dialogue, like a conversation. A nurse, for example, listens to a patient talk about his difficulty managing his diet because of his love of sugary foods that he cannot have because he has diabetes, and she can give suggestions for substitutes that are still affordable, and palatable given the man's tastes and the food culture. Giving every patient a standardized meal plan does not address the patient's in an interactive fashion and is thus ineffective.

A nurse cannot micromanage patients or staff, because she cannot be there when they make every decision that affects patient wellness. Rather, the nurse must give the tools of empowerment to other actors within and outside of the hospital environment and to the patients to implement quality care and self-care. Wellness promotion involves patient empowerment, as well as advocating and promoting wellness. It requires encouraging patients to make different lifestyle choices and to modify negative behaviors that reduce wellness and overall health.

One of the reasons community health programs such as the one she is involved in are necessary, said Nurse B, is that hospital stays have grown shorter in the era of managed care, and nursing staffs are smaller. This means that patients and patient's families must be as involved in the treatment process as possible. For example, before discharge, the patient must be aware of how to administer all medication, change lifestyle routines if necessary, and know how to introduce aspects of welfare-promotion to fully benefit from the hospital stay. Because professional staff will not always be on hand for the full duration of the recovery process, the patient, and if the patient is not capable, the patient's family must step in and give assistance. Community wellness and outreach programs can also provide support.

Diminishing a patient's sense of helplessness is a founding principle of Orlando's theory, and empowerment is important in ensuring that the patient does not feel lost after receiving a diagnosis and are being discharged. For example, Nurse B. recently treated a man who had been diagnosed with Type II Diabetes. He was afraid of becoming dependent upon insulin his entire life. Explaining how dietary changes and exercise, reducing his weight, and taking proactive steps of self-care could reduce his blood sugar helped the man regain a sense of control over his life. This does not mean that the patient must stand alone. Wellness is a dialogue between nurse, environment and patient. Stressing how professional resources such as dieticians were there to help manage his nutrition and involving the man's wife in the way family meals were prepared also had a great impact in diminishing his sense of helplessness (Chinn 1983, revised 2006: 77).

Nurse B. noted that many members of the staff were young and untrained, and often she had to use some helplessness reduction with her staff. Orlando stresses firstly: "What the nurse says to the individual in the contact must match (be consistent with) any or all of the items contained in the immediate reaction and what the nurse does nonverbally must be verbally expressed and the expression must match one or all the items contained in the immediate reaction; (2) the nurse must clearly communicate to the individual that the item being expressed belongs to herself [sic]; and, (3) the nurse must ask the individual about the item expressed in order to obtain correction or verification from that same individual" (cited by Chinn, 1983, revised 2006: 78).