First, a team consisting of a geriatrician, an advanced practice registered nurse APRN , and a social worker provides care at each of eight satellite centers on aging owned and managed by local hospitals and financially self-supporting through Medicare. The team follows its patients across settings—hospital, clinic, home, and nursing home—as needed.
Second, an education component supported by the tobacco settlement funds targets health professionals and students, older adults and their families, and the community at large. New patients usually see a physician for an initial examination. APRNs are responsible for health promotion and disease prevention—mammograms and flu shots, for example—as well as analyses of current drug regimens.
For patients with complex conditions, social workers make referrals and work with families on nursing home placement. Patients are quite satisfied with their care and with the team approach Beverly et al. Unpublished analyses of the areas around the centers show lower rates of emergency room use and hospitalization and higher rates of health care knowledge among elderly patients. Physicians at the eight sites report to Dr. She has hired a nurse with a doctorate and a geriatrician to act as associate directors.
Developing teamwork has been a priority. There have been some obstacles: There also may not be enough clinicians trained in geriatrics available. She said funding has been secured to further evaluate how best to use team members. The model has continued to evolve from the first center in Northwest Arkansas that Dr. That site is developing a program for the training of in-home caregivers, including home health aides and family members. Nurse Amyleigh Overton-McCoy explains to Bonnie Sturgeon how to manage the common health concerns associated with aging.
In community and home settings, nurses provide a direct link connecting patients, their caregivers, and other members of the health care team. Leadership in these situations sometimes requires nurses to be assertive and to have a strong voice in advocating for patients and their families to ensure that their needs are communicated and adequately met. Box describes a nurse who evolved over the course of her career from thinking that being an effective nurse was all about honing her nursing skills and competencies to realize that becoming an agent of change was an equally important part of her job.
Leadership does not occur in a social or political vacuum. Creating innovative care models at the bedside and in the community or taking the opportunity to fill a seat in a policy-making body or boardroom requires nurse leaders to develop ideas; approach management; and courageously make decisions within the political, economic, and social context that will make their solutions real and sustainable. A shift must take place in how nurses view their responsibility to those they care for; they must see themselves as full partners with other health professionals, and practice and education environments must socialize and educate them accordingly.
An important aspect of this socialization is mentoring others along the way. More experienced nurses must take the time to show those who are new and less experienced the most effective ways of being an exceptional nurse at the bedside, in the boardroom, and everywhere between. Technology such as chat rooms, Facebook, and even blogs can be used to support the mentoring role. A crucial part of working within the social architecture is understanding how leadership and practice produce change over time.
In the late s and early s, nurse Elizabeth Carnegie led the fight for the racial integration of nursing in Florida by example and through her extraordinary character and organizational skills. Her efforts to integrate the nursing profession were based in her sense of social justice not just for the profession, but also for the care of African American. Also in Florida, in the late s, Dorothy Smith, the first dean of the new University of Florida College of Nursing, developed nursing practice models that brought nursing faculty into the hospital in a joint nursing service.
Students thereby had role models in their learning experiences, and staff nurses had the authority to improve patient care.
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From this system came the patient kardex and the unit manager system that freed nurses from the constant search for supplies that took them away from the bedside. In the s, nursing research by Neville Strumpf and Lois Evans highlighted the danger of using restraints on frail elders Evans and Strumpf, ; Strumpf and Evans, Their efforts to translate their findings into practice revolutionized nursing practice in nursing homes, hospitals, and other facilities by focusing nursing care on preventing falls and other injuries related to restraint use, and led to state and federal legislation that resulted in reducing the use of restraints on frail elders.
Nurses also have also led efforts to improve health and access to care through entrepreneurial endeavors. For example, Ruth Lubic founded the first free-standing birth center in the country in in New York City. Her efforts have improved the care of thousands of women over the years. There are many other examples of nurse entrepreneurs, and a nurse entrepreneur network 2 exists that provides networking, education and training, and coaching for nurses seeking to enter the marketplace and business.
Leadership skills must be learned and mastered over time. Nonetheless, it is important to obtain a basic grasp of those skills as early as possible—starting in school see Chapter 4. Nursing educators must give their students the most relevant knowledge and practice opportunities to equip them for their profession, while instilling in them a desire and expectation for new learning in the years to come. Regardless of the basic degree with which a nurse enters the profession, faculty should feel obligated to show students the way to their first or next career placement, as well as to their next degree and continuous learning opportunities.
Moreover, students should not wait for graduation to exercise their potential for leadership. She asked her colleagues why the child had not been discharged. We need to invite policy makers, state agencies, community leaders. How are we going to get that started? For example, the group identified poor reimbursement of home health care as a serious obstacle, and the hospital established ties to agencies able to tackle the reimbursement issue. Now, some children can go home to receive care. Hill never intended to be a leader. She was working as a staff nurse at the hospital in the mids when colleagues encouraged.
Its annual leadership symposium convenes medical, nursing, public health, and other students statewide to learn about health issues facing the state and work together on developing potential solutions HealthSTAT, Hill was asked to become sole director some staff were uncomfortable with the decentralized authority, despite good clinical outcomes.
She did so, with a modest goal: With this goal in mind, Ms. Residents are now more likely to confer with 9 West nurses during rounds, Ms. Hill said, increasing satisfaction among nurses, residents, patients, and families.
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Hill is examining an often neglected population: Now that many HIV-positive children survive into adulthood, they mature sexually and face the stigma attached to the infection. I wanted to make the environment for the child and parents a place where they could feel safe, even though there was a lot of scary stuff going on around them. Hill has quite a story herself.
As a mother of a grown son, a pediatric nurse who endured many hospitalizations as a child, a researcher whose study is an outgrowth of her advocacy work, and an African American who strives to enhance access to health care for all, she is a woman of both practical ideas and lofty ideals. So when she saw that a child capable of living at home had been in her unit for 2 years, her natural response was to assemble a consortium. Today, that child is doing well at home. Students work in cooperative relationships with other students from various disciplines, faculty, community organizations, and the public Janetti, Box profiles two student leaders, one of whom eventu-.
D espite improvements to the demographic make up of the nursing workforce in recent decades, the workforce remains predominantly white, female, and middle aged. Racial and ethnic minorities make up 34 percent of the U. And diversity matters to patients: Two nurses, an African American woman and a Hispanic man, both under age 35, illustrate the growing diversity of the profession and the importance of offering various educational paths as an entry into nursing. Haney, RN, was a married mother of two in when she was trying to decide between nursing school and law school.
Louis Community College in Missouri: The NSNA initiative aims to increase the number of men entering the profession, recruit and retain nurses of diverse ethnic and racial backgrounds, support nursing students with physical disabilities, and increase enrollment of young and nontraditional students. It works toward these goals by making peers available to students in need of support.
Haney became its director in and NSNA president in If we could open up the doors just a little bit wider for foreign nursing students, mothers, nontraditional students, and men, that would make a world of difference to patients. Louis, and immediate past president, National Student Nurses Association.
As an undergraduate at New York University NYU , he had volunteered to raise awareness of sexual assault and substance abuse on campus and wanted to learn more about health. As a nurse, Mr. Caceres has encountered bias at times from patients, especially older women, some of whom feel uncomfortable being cared for by a man.
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What would you do? If so, they will be models for a new generation: Regardless, the two have taken significant steps. But the NSNA is a way to bring us together to see that we have one common goal, and that is to be professional nurses. Looking to the future, nurse leaders will need the skills and knowledge to understand and anticipate population trends.
Formal preparation of student nurses may need to go beyond what has traditionally been considered nursing education. Graduate programs offering dual degree programs with schools of business, public health, law, design, or communications take this idea one step further to equip students with an interest in administrative, philanthropic, regulatory, or policy-making positions with greater competencies in management, finance, communication, system design, or scope-of-practice regulations from the start of their careers. Given their direct and sustained contact with patients, front-line nurses, along with their unit or clinic managers, are uniquely positioned to design new models of care to improve quality, efficiency, and safety.
For example, one new quality and safety strategy requires checklists to be completed before certain procedures, such as inserting a catheter, are begun. Nurses typically are asked to enforce adherence to the checklist. And again, nurses must help and mentor each other in their roles as expert clinicians and patient advocates. No one can build the capabilities of an exceptional and effective nurse like another exceptional and effective nurse. Among other things, community and public health nurses must promote immunization, good nutrition, and physical.
In addition, they need to be prepared to assume roles in dealing with public health emergencies, including disaster preparedness, response, and recovery. Recent declines in the numbers of community and public health nurses, however, have made the leadership imperative for these nurses much more challenging. Community and public health nurses learn to expect the unexpected.
Likewise, an increasing number of nurses are being trained in incident command as part of preparedness for natural disasters and possible terrorist attacks. This entails understanding the roles of and working with community, state, and federal officials to assure the health and safety of the public. The profile in Box illustrates how nurses lead efforts that provide critical services for communities. The profile also shows how nurses can also become leaders and social change agents in the broader community by serving on the boards of health-related institutions.
The importance of this role is discussed in the next section. Although chief nursing officers CNOs typically are part of the hierarchical decision-making structure in that they have authority and responsibility for the nursing staff, they need to move up in the reporting structure of their organizations to increase their ability to contribute to key decisions. Not only is this not happening, however, but CNOs appear to be losing ground. More CNOs described a direct reporting relationship to the chief operating officer instead. CNOs face growing issues of contending not only with increased responsibilities, but also with budget pressures and difficulties with staffing, retention, and turnover levels during a nursing shortage Jones et al.
Services available to residents in 10 central New Jersey counties include home care, primary care, wellness services, mental health care, rehabilitation, homeless services, and hospice and palliative care. Yet despite the size and complexity of the year-old organization, Ms. Christopher has called it Neighborhood Nursing, a collaborative model in which nurses are assigned to specific neighborhoods so they and community members can respond to what they identify as the most pressing health issues.
As an example of the model, she cites a VNACJ nurse who noticed that many residents of a retirement community were exhibiting signs of congestive heart failure. The device would permit residents to check their weight, oxygen saturation, and blood pressure levels and automatically transmit the values to a cardiac nurse. Nurses also are underrepresented on institution and hospital boards, either their own or others.
A biennial survey of hospitals and health systems conducted in by the Governance Institute found that only 0.
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More recently, a survey of. Christopher said that the aims of such an initiative are both immediate and long term. In the short run, the VNACJ hopes to reduce rates of emergency room ER use and repeated hospitalizations—expensive and inefficient means of managing chronic illness. As for the long-term goal, the VNACJ nurses strive to give individuals as well as entire communities greater control over their health. Christopher has secured grants to test a wide range of such ideas. For example, the Mobile Outreach Program has reduced rates of ER use among deinstitutionalized mentally ill and homeless patients; funded in the mids by The Robert Wood Johnson Foundation and the State of New Jersey, it is now supported by local governments.
Christopher is the most proud of and the one, she said, that may be the most replicable.
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Christopher worries about declines in federal, state, and philanthropic funding, especially in light of the recent increases in un- and underinsured patients being seen as a result of the recession. I make decisions within the context of really understanding the impact of service delivery. Christopher said she can see why it matters that she is a nurse. First, she knows well what nurses can do. She has cultivated an atmosphere of honoring staff ideas such as the cardiac monitoring initiative.
Christopher is sought after to serve on governing boards and advisory groups and is the only RN on the board of trustees at the University of Medicine and Dentistry of New Jersey. It should be noted that, while there are many more physicians than nurses on hospital boards, health care providers still are generally underrepresented. While most boards focus mainly on finance and business, health care delivery, quality, and responsiveness to the public—areas in which the nature of their work gives nurses particular expertise—also are considered key Center for Healthcare Governance, A survey found that 62 percent of boards included a quality committee Governance Institute, A survey of hospital presidents and CEOs showed the impact of such committees.
The growing attention of hospital boards to quality and safety issues reflects the increased visibility of these issues in recent years. Given their expertise in quality and safety improvement, nurses are more likely than many other board members to understand the issues involved and often can educate other members about these issues Mastal et al. This is one area, then, in which nurse board members can have a significant impact. Recognizing this, the survey of community health systems mentioned above specifically recommended that community health system boards consider appointing expert nursing leaders as voting board members to strengthen clinical input in deliberations and decision-making processes Prybil et al.
More CNOs need to prepare themselves and seek out opportunities to serve on the boards of health-related institutions. If decisions are taking place about patient care and a nurse is not at the decision-making table, important perspectives will be missed. CNOs should also promote leadership activities among their staff, encouraging them to secure important decision-making positions on committees and boards, both internal and external to the organization. Nurse researchers must develop new models of quality care that are evidence based, patient centered, affordable, and accessible to diverse populations.
Additionally, nurses must serve as advocates and implementers for the program designs they develop. Academic—service partnerships that typically involve nursing schools and nearby, often low-income communities are a first step toward implementation. Given that a nursing school does not exist in every community, however, such partnerships cannot achieve change on the scale needed to transform the health care system.
Nurse researchers must become active not only in studying important care deliv-. Their leadership is vital in ensuring that new state-and federal-level policies are based on evidence and will help increase quality and access while decreasing costs and health care disparities. The Affordable Care Act ACA provides opportunities for demonstration projects and pilot programs directed at various elements of nursing.
Nurse researchers should seek funding from the National Institute for Nursing Research and other institutes of the National Institutes of Health, as do scientists from other disciplines, to help increase the evidence base for improved models of care. To be competitive in these efforts, nurses should hone their analytical skills with training in such areas as statistics and data analysis, econometrics, biometrics, and other qualitative and quantitative research methods that are appropriate to their research topics.
For nurse researchers to achieve parity with other health services researchers, they must develop the skills and initiative to take leadership roles in this research. The Gallup poll of 1, opinion leaders referenced earlier in this chapter also highlighted fragmentation in the leadership of nursing organizations as a challenge. Responding opinion leaders predicted that nurses will have little influence on health care reform over the next 5—10 years see Figure By contrast, they believed that nurses should have more input and impact in areas such as planning, policy development, and management Figure RWJF, a.
No one expects all professional health organizations to coordinate their public agendas, actions, or messaging for every issue.
But nursing organizations must continue to collaborate and work hard to develop common messages, including visions and missions, with regard to their ability to offer evidence-based solutions. Once common ground has been established, nursing organizations will need to activate their membership and constituents to work together to take action and support shared goals. When policy makers and other key decision makers know that the largest group of health professionals in the country is in agreement on important issues, they listen and often take action.
The Structuralizer provides the How. Leaders have to ultimately connect and engage with their teams. Even the most quiet, introspective leaders have an ability to relate deeply with their people well, good leaders have that ability When you play the role of the Socializer, you're creating an atmosphere of mutual accountability and collaboration. In this role, the most important thing a leader can do is to be empathic. That starts with curiosity--ask your employees how they're feeling. Find out where changes need to happen. Your employees need to feel engaged with leadership and their colleagues, and as a Socializer, you set that tone.
The Socializer understands Who is needed for success. This is the most traditional view of leadership, but in many ways the most difficult--it's about seeing where you need to go, setting the vision , and rallying the company around the future. Employees expect this kind of thinking from leaders, but it doesn't come naturally to many of us.
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The Conceptualizer's role is to ensure that people can step out of the day-to-day and understand that their work is critical and important to achieving the overall goal. Its playing the Steve Jobs role In the role of Conceptualizer, leaders need to create a place of openness so that employees feel connected to the vision and able to bring their own ideas.
The Conceptualizer shows where you need to go. These roles are not mutually exclusive. As a leader you may need to play different roles with different audiences. Coach Yourself to a New Career: Be Bold and Win the Sale: Learn Like a Leader. The 5 Steps to Peak Performance. The No Excuse Guide to Success.
Unleashing Your Inner Sales Coach. Live Life with No Regrets. Your Life Is Calling. The High Achiever's Guide to Happiness. Not Your Average Cup of Joe. Today We Are Rich. Maximize Your College Experience: The Voice of Your Dreams. What Are You Waiting For? Average Is an Addiction. A Handbook for Life. The Best Shift of Your Life. The New Heart at Work. Find an Old Gorilla: Pathways Through the Jungle of Business and Life.
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