Nursing and Leadership Issues

Leadership for Advanced Practice Nursing
1
Staffing is not the main issue in elevating or containing costs: the main issue is retention. High turnover rates in nursing can drive costs up, but proper staffing with an appropriate ratio of nurses to patients can actually reduce costs over the long-term so long as turnover is not an issue. The reason is that appropriate staffing leads to improvements in quality care delivery (Martin, 2015). And as Rothberg, Abraham, Lindenauer and Rose (2005) point out, improving nurse-to-patient staffing ratios is a cost-effective intervention that—far from being detrimental to cost control—reduces costs because it enables patients to receive better care and reduces the risk of nursing errors being committed as a result of burnout.
Everhart, Neff, Al-Amin, Nogle and Weech-Maldonado (2013) show that in highly competitive markets, the better the nurse-to-patient ratios, the better the reputation of the hospital. The only markets in which increases in staffing has not been found to be impactful has been in non-competitive rural markets. In short, the law of diminishing returns only appears to kick in, both cost-wise and care-wise, in markets where nurses and facilities are not challenged to out-perform their competition. In markets where hospitals and health care facilities are required to be competitive, staffing does help to contain costs and increase the quality of care that patients receive.
2
Health care leaders can determine appropriate nursing and care delivery models to address rapidly changing populations by focusing on the models that will best serve the needs of the community. For instance, the transcultural model of nursing focuses on emphasizing cultural understanding and requires nurses to learn how different cultures create different expectations in populations (Maier-Lorentz & Leininger, 2008). In a rapidly changing population, there is bound to be an influx of cultures, whether because the population is aging, more ethnicities are arriving in the area, or for whatever reason; these various populations have to be understood as having unique needs, wants, desires and expectations. Therefore, by exercising some innovative leadership (Gliddon, 2006) and emphasizing the importance of recognizing cultural values among patients, health care leaders can determine the appropriate nursing and care delivery models to help their nurses address the needs of this population.
It is also important to look at the needs of health care providers: the nurses themselves may require some training and instruction and, as a result, could benefit from the implementation of specific models that would provide them with the right kind of guidance. Leaders must be able to communicate with their workers, listen, and identify issues and potential barriers to change. By creating a vision of what the organization is trying to achieve and getting all stakeholders on board, the right models will begin to fall into place as resistance to change is melted away.
3
As Lathrop and Hadnicki (2014) point out, the Affordable Care Act (ACA) helped to bring reform to the health care industry by focusing on “a preventive healthcare model that emphasizes primary care, funds community health initiatives, and promotes quality care.” This reform has created a demand for doctorally prepared APRNs who can deliver the kind of quality care in a primary care setting that is needed according to the ACA. Doctorally prepared nurses can provide leadership, guidance for interdisciplinary teams, and advocacy for future nursing reforms.
Another issue that has been introduced in recent years in states’ legislatures is the issue of who has the right to be called a doctor. As Zittel (2012) notes, “in January 2011, two U.S. representatives introduced H.R. 451, the Healthcare Truth and Transparency Act of 2011, designed to empower patients by increasing transparency in healthcare provider-related advertisements and marketing.” The goal of this bill is to make it clear to patients which care providers a medical doctors—aka physicians—and which are doctors of nursing. The bill aims at reducing confusion about who is a doctor—but the bill is actually only adding to the confusion. Doctor is an academic term, not a medical one. Doctors of nursing have just as much right to advertise themselves as doctors traditionally associated with the concept of medical doctor. This bill would make it so that nurses with doctoral training are viewed as less equipped and knowledgeable than medical doctors. That would be disadvantageous for APRNs because as the Institute of Medicine has pointed out, there is a need for more APRNs in primary care and doctoral nurses should be respected in the industry—not further marginalized by legislation that seeks to subvert their right to advertise as doctors of nursing.
4
A doctorally prepared advanced practice nurse can advocate for patients as well as the nursing profession simply by listening to what patients want (and what nurses want and need) and then communicating those needs and wants to policy makers, legislators, administrators and other colleagues to ensure that patients and nurses both have their desires satisfied, as they have a right to. Advocacy is about listening and supporting the rights of patients and professionals. By advocating for both, the doctorally prepared APRN establishes a symbiotic relationship between the two goals because ultimately what benefits the care provider will benefit the patient, and what benefits the patient is what the care provider should seek to achieve. By protecting through advocay the patient and the care provider, the APRN creates a union between the two that should exist naturally.
Advocacy is advanced effectively by adhering to a “complex process that requires skillful use of problem solving, communication, influence, and collaboration to achieve a solution to an issue. Often, advocacy is an incremental process of achieving change through a series of efforts that may take months or years to accomplish” (Tomajan, 2012, p. 4). By collaborating with colleagues and other leaders, communicating, raising awareness through publications and conferences, and engaging in problem solving, the nurse advocate engages in a process of advocacy that can be very helpful in resolving issues that are important to patients and nurses. Advocacy is most effectively advanced when it is promoted via an organized process united groups and individuals with community and organizational leaders with the goal being to produce a solution to a specific issue.
5.1
The reason behind the need for doctorally prepared advanced practice nurses to be politically active is that they are the leaders for other nurses: they have the training, knowledge, skill, expertise and contacts that enable them to use their voices in a positive and effective manner. Political leaders listen to the leaders of the public for guidance and ideas. Political leaders are representatives of the people and doctorally prepared advanced practice nurses are leaders of nurses—so it is natural for the two to get together to promote legislative changes that will positively impact the health care industry, help nurses and help patients. The Affordable Care Act is one example of a piece of legislation that benefited from APRNs being politically active. They served as one group of constituents advocating for the need for preventive care in medicine, and their voice helped shape the outcome of the ACA policy. When bills like the ones being passed in various states to clarify who is a doctor and who isn’t a doctor, it is important for APRNs to again be assertive and highlight the right of doctors in nursing to be able to use that title. So the doctorally prepared advanced practice nurse should be politically active because so much happens in the political arena that impacts nurses directly—and they are the leaders in the nursing industry so it is up to them to take charge. They can take charge by organizing groups or committees, meeting directly with legislators and representatives, hosting fund raisers, and holding conferences, seminars, work groups, and discussion panels to share ideas and raise awareness. Ethical and other considerations that must be taken into account as a nurse becomes politically active are the facts that the nurse is not there to represent herself but rather there to represent other nurses and patients so that the best practices can be promoted at the legislative level.
5.2
It is meaningful to have doctorally prepared advanced practice nurses as members of health care boards because they help to provide guidance, leadership and representation on those boards to ensure that nurses are protected, supported and empowered and that patients’ rights and privileges are also supported in line with the guidelines of nursing professional codes. The role of the nurse on these boards is to facilitate the development of relationships with other organizations, help to create policies that are effective for patients and health care providers and to strengthen orientation programs that use the boards for assistance (Walton, Lake, Mullinix, Allen & Mooney, 2015).
The nurse helps to make sure that nurses have their needs met by sitting on boards, as they represent their interests. For instance, with staffing needs, the doctorally prepared advanced practice nurse can provide information to help shape policies; the nurse can present the experiences of other nurses as anecdotal evidence to support promoting a staffing policy that helps to reduce the burnout among nurses. Being part of a board helps nurses to be involved in the decision making process within the health care industry, which is important because nurses make up a large part of the industry and their opinions, feelings, experiences and ideas should have a large role in shaping health care policy.
6.1
Servant leaders, as compared with leaders who follow the transformational model of leadership, manage organization dynamics and lead change to ensure the continued success of the stakeholders to be served by engaging in putting the needs of followers first. The basic tenet of servant leadership is that people come before profits: individuals have needs that have to be met, and this awareness is what motivates the servant leader to be at the disposal of the individuals—whether nurses, patients, colleagues or other stakeholders. Servant leaders are there to provide support, assistance, and help for whoever requires it.
Transformational leaders, on the other hand, focus more on motivating followers to achieve organizational goals (Doody & Doody, 2012). Transformational leaders first focus on creating or communicating a vision to stakeholders, including nurses, so that the overall objective of the department or organization is clear to all. The vision is then reinforced through the leader’s motivational communications and support; the leader provides a change mechanism to empower the nurses and achieve the goal set forward in the vision. The transformational leader inspires through force of personality and the ability to relate to workers and thus brings about positive change in the workplace. The servant leader on the other hand brings about change by focusing on the needs of the individuals and helping them to grow personally and professionally through personalized attention. Both transformational leadership and servant leadership can work well to ensure the continued success of the stakeholders to be served, as both focus on growth and development just in different ways. The leader’s own personal preferences and style will dictate which method is preferable.
6.2
The application of servant leadership could appraised in a health care setting by using qualitative measures, which could be obtained through interviews with various personnel who come into contact with the servant leader. Because characteristics such as virtue, credibility and trust are variables that have to be constructed in order to measure, a quantitative measure could also be used, such as a survey, to obtain a sense of the construct. In either case, appraising this type of leadership in a health care setting is done by obtaining the effect of the leader based on the leader’s impact on the staff. Nursing peer review can also play a role in this appraisal.
Servant leadership is certainly plausible in the health care setting where a hierarchy of command for the safety of patients is required. Servant leadership sets an example of how nurses should approach patients. It gives them a sense of what it means to serve others and even if a chain of command is required, servant leadership does not distract from this any more than transformational leadership does. Both styles of leadership are appropriate in a health care setting.
7.1
All nurses should be considered leaders because they are all responsible for providing quality care to patients. They must all embrace the idea of accountability and responsibility, just as leaders do. They have to demonstrate strong communication skills to ensure good quality and continuity of care. They also have to be knowledgeable and empathetic towards patients. These are all characteristics that make a nurse a leader, and by working together as a team, they can lead the entire nursing department in a united effort to bring quality care to the patient.
The doctorally prepared advanced practice nurse collaborates with others for company resources by working within a collaborative environment and engaging in interdepartmental and interprofessional care processes so that all practitioners know what the other is doing and requiring for services. Additionally, the APRN can sit on committees and at the heads of departments to better manage resources and to guarantee that every group of nurses is receiving what they require. The APRN serves as the leader of nurse leaders and thus must be in constant contact with all stakeholders in the health care facility.
7.2
Reflecting back on this and all previous courses, my thinking about my DPI Project has changed in the sense that I now see numerous ways that I could strengthen it just by going back to the basics of nursing and looking at nursing problems in a simple way. For instance, how can nurses provide better quality care? What gaps in preventive care are leading to problems down the road? Simple questions like these lead to clearer insights into the practice of nursing, and give me new ideas about how to conduct the DPI Project.
What I will take from this course and apply directly to my DPI Project is my awareness of how the nurse is like and must be a leader in the health care industry. The nurse is so often on the front lines of care for patients and has to be seen as an authority who knows the relevant information but who is also able to stabilize patients, calm fears, ease anxiety, and convey important information in a timely manner. This course has really helped me appreciate the great tasks that nurses face and that they must be willing to take on for themselves. I plan to apply this knowledge directly to my DPI Project by crafting it so that it serves the nurse’s ability and intention to be a leader and bring greater quality care to the patient.
8.1
Ethical behavior is an integral part of the doctorally prepared advanced practice nurse’s role. All nurses must follow a code of ethics so as to prevent harm to the patient. Ethics must first and foremost be demonstrated by the doctorally prepared advanced practice nurse as this is where the example is set for other nurses. The doctorally prepared advanced practice nurse is considered a role model because of her experience, training, skill level, expertise, knowledge, discipline, and position of leadership. One displays the characteristics of a role model by communicating effectively, developing social and emotional intelligence skills, engaging in collaborative care, supporter nurses, and ensuring that quality of care is a top priority. A doctorally prepared advanced practice nurse does have a legitimate right and/or ethical foundation to interject their ideas into business practice because they have been trained to operate independently, as O’Brien (2003) has pointed out.
8.2
I do not see where any blank spaces have been left unmet by either programmatic or course-based assignment completion thus far. I feel that all program competencies have been met in my matrix and that there are no content areas that I need to address or strengthen based on instructor feedback. Instructor feedback has been very positive and helpful; however, a few areas where I personally would like to strengthen is in terms of organizing groups of nurses to ensure better advocacy as a nurse leader in the community.
My action plan for addressing this competency is to: 1) communicate my desire with a group of nurses that I am familiar with; 2) organize and plan a meeting place where we can discuss issues that are important in nursing; 3) prepare a plan for presenting these issues to administrators and other nurses in organizations that network throughout the industry; 4) communicate with stakeholders to obtain feedback with regards to our thoughts and plans; 5) prepare a communication with legislators to allow our voice to be heard and have an impact; and 6) continue my education so as to stay informed and abreast of any and all latest developments in the health care industry pertaining especially to nurses.
References
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Zittel, B. (2012). The right to the title ‘doctor.’ Retrieved from
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