Proper communication and advocacy is another role that the modern caregiver assumes when providing quality care (Carroll). It is in the role of patient advocacy and cost-cutting that most nursing leaders are directly involved with hospital policy. Technology has increased the ease and ability for adequate communication -- there are more translators, access to databases, etc. within the field, and certainly there is more information about healthcare available for the layperson. However, the manner in which modern medicine works -- the reality that it is the nurse as opposed to the doctor who tends to follow the patient throughout their care, lends greater credibility to the use of the modern nurse as a paradigm for successful communication and patient advocacy (Vesterinen, Isola and Paasivvra, 2009).

However, the realities of contemporary medicine always involve costs. Nursing leaders show that it is the responsibility of everyone involved in healthcare to help find ways to streamline procedures, waste less, and as part of the advocacy model help keep costs down by limiting excessive procedures whenever possible. Hospital care is certainly necessary, but also, in many circumstances patients do better released into their own, comfortable environment as quickly as possible. To that end, many nurse leaders believe that the United States homecare nursing professionals are both underrated and underutilized.

Clearly, each of these issues has a direct effect upon Dr. M's ability to recommend and effectively institute change management within this organizational structure. For instance, in Dr. M's previous situations, the locus of control for professional nurses allowed for management of patients on a 24-hour rotation; with each shift being responsible for their own particular patients. However, Dr. M. is aware that a professional nurse management staff has additional fiscal requirements that must be Board approved. There are, however, a number of additional ways that funding can come into the hospital to professionalize and improve issues identified within the SWOT.

Partnership with local community service groups -- Lions, Elks, Kiwanas, and other service groups are often more than happy to participate in awareness and fund raising programs that impact the community. The groups could individually or collectively sponsor a "Chair in Nursing," or any other medical field; or raise money to build a new Children's Center.

Investigate partnerships with educational...

If Dr. M. perceives that the first round of hiring should be nursing managers, a partnership with a nursing program and/or a competitive scholarship might be appropriate. The hospital could also work with groups to raise funds that might allow the "best and the brightest" to be hired and a portion of their student loan paid as part of an incentive program. Additionally, research grants are often given to academics but still require a professional medical program with which to test and/or implement.
National-based nursing organizations -- Dr. M. could work with national nursing associations, of which there are a number, to sponsor seminars, colloquia, and/or a nursing-based program that will both call positive attention to the hospital and allow for greater exposure of a particular seminar.

Partnership with pharmaceutical companies, medical equipment companies -- Possible beta-test center, or use of hospital personnel to drive marketing programs for drugs or new equipment (e.g. base a training center on "X" piece of equipment at the hospital and allow for training seminars in exchange for that piece of equipment to the hospital.

Work with city leaders -- to help in national search for CEO; make it a community effort, show that the hospital is integral within the community and can bring notoriety to the city in terms of conventions, higher profile medical trials, and a reputation for perhaps not the largest, but the best, in community care.

Seek out governmental programs that may serve minority or disenfranchised populations. Glean governmental funding to enhance reputation and draw appropriate talent as well as goodwill and positive press.

REFERENCES

Carroll, T. (2005). Leadership Skills and Attributes of Women and Nurse Executives -Challenges for the 21st Century. Nursing Administration Quarterly, 29(2), 146-54.

Gershenson, Moravick, Sellman and Somerville. (n.d.). Expert to Novice: A Nuse Leader's Evolution. Nursing Management, 49-52.

Kouzes and Posner. (1994). An extension of the leadership practices inventory management systema dn individual contributors. Educational and Psychological Measurement, 54(4), 959-66.

Vesterinen, Isola and Paasivvra. (2009). Leadship Styles of Finnish Nurse Managers and Factors Influencing it. Journal of Nursing Management, 17(2), 503-9.