Question

1-Select an aspect of nursing leadership and/or management

aspect of nursing leadership and/or management is staff satisfaction

2) Chose a specific type of healthcare organization/setting. For example you may wish to consider a local hospital, outpatient clinic, or rehabilitation center/nursing home on which to focus the paper. 3) Utilizing a minimum of 3 peer-reviewed, evidence-based references from materials found in the library, class, and your text books, apply nursing leadership and/or management concepts and theories to critically analyze the key aspect you have chosen. Discuss how the key aspect you have selected relates to the healthcare organization/setting you have chosen. 4) Consider the following questions as you develop your paper: a. What is the current state of the key aspect you have chosen in regards to the setting you have identified. Consider including its importance, change in value over time (has it become more or less important), and does it have a critical application to the healthcare organization/setting you have chosen and if so, what impact does it have on the setting? b. What are some current challenges/barriers facing nursing leadership and managers in this healthcare setting as it relates to the key aspect you have chosen to discuss? What would you do to overcome these challenges? c. What recommendations would you make to the organization/setting as to how they could apply this key aspect to improve the quality of patient care?

Answer 1

Ans1 Nurse managers need strong communication and leadership skills. They should be adept at coordinating resources and personnel and meeting goals and objectives. They must be effective leaders who can strike a balance between working with the nursing staff and the healthcare facility administrators.

Working as a nurse manager requires skills beyond clinical care. The job requires management skills, budgeting, and business acumen and leadership qualities. Communications and interpersonal skills are also vital. The following characteristics are common among successful nurse managers:
Effective Communication Skills – Part of being an effective leader is listening to staff and patient concerns and communicating needs. Nurse managers must be able to build a solid rapport with all staff members, from the janitorial staff to head administrators, as well as patients to create cohesiveness.

• Advocacy – In some cases, nurse leaders might have to advocate for staff to ensure a safe and reasonable practice environment. In other cases, they might have to advocate for patient safety and access to quality healthcare. Nurse managers should not be afraid of using their voice and position.
• Participation – With so many administrative demands, it is important that nurse managers balance business with patient care. Nurse managers must have superior clinical skills to ensure patient safety and wellbeing.
• Mentoring – Successful nurse leaders do not micromanage their staff. They encourage, empower, mentor, and find strengths. They boost creativity and mindfulness.
• Maturity – Nurse managers do not immediately take sides in squabbles or assess blame before knowing all the facts. They don’t let simmering emotions boil over. Instead, they meet conflict and work through it.
• Professionalism – Nurse managers follow their moral compass to ensure all aspects of the profession are met with honesty and integrity. They address people with respect and do not bully.
• Supportive – They don’t set the bar for expectations unreasonably high. Instead, they use supportive encouragement to challenge employees to success. They coach and mentor.

Ans2=at rehabilitation center =

General Responsibilities of the Rehabilitation Staff Nurse

• Possesses the specialized knowledge and clinical skills necessary to provide care for people with physical disability and chronic illness
• Coordinates educational activities and uses appropriate resources to develop and implement an individualized teaching and discharge plan with clients and their families
• Performs hands-on nursing care by utilizing the nursing process to achieve quality outcomes for clients
• Provides direction and supervision of ancillary nursing personnel, demonstrates professional judgment, uses problem solving techniques and time-management principles, and delegates appropriately
• Coordinates nursing care activities in collaboration with other members of the interdisciplinary rehabilitation team to facilitate achievement of overall goals
• Coordinates a holistic approach to meeting patient's medical, vocational, educational, and environmental needs
• Demonstrates effective oral and written communication skills to develop a rapport with clients, their families, and health team members and to ensure the fulfilment of requirements for legal documentation and reimbursement
• Acts as a resource and a role model for nursing staff and students and participates in activities such as nursing committees and professional organizations that promote the improvement of nursing care and the advancement of professional rehabilitation nursing
• Encourages others to become CRRN certified, obtain advance degrees, participate on committees, and/or join professional organizations
• Facilitates community education regarding acceptance of people with disabilities
• Actively engages in legislative Initiatives affecting the practice of rehabilitation nursing or the people in their care
• Applies nursing research to clinical practice and participates in nursing research studies

Roles and Duties of the Rehabilitation Staff Nurse

Teacher

• Shares information about the disease processes underlying disabilities and teaches nursing techniques to help clients and their families develop the self-care skills necessary to move toward wellness on the illness-wellness continuum
• Prepares clients and their families for future self-management and decision-making responsibilities by fostering clients' independence and goal achievement
• Reinforces the teaching done by specialists in rehabilitation and other healthcare disciplines, provides resource materials for clients' changing needs, and provides on-going patient education after discharge
• Provides in-service education for healthcare team members and members of the community regarding the prevention of disabilities

Caregiver

• Assesses the physical, psychological, sociocultural, and spiritual dimensions of clients and their families, as well as their educational and discharge needs in order to formulate nursing diagnoses
• Plans nursing care while acknowledging that rehabilitation nursing is practiced within a dynamic, therapeutic, and supportive relationship that is constantly changing, as nurses and clients influence one another
• Implements a plan of care by providing nursing care and education directly or through ancillary personnel, as needed, to maintain and restore function and prevent complications and further loss
• Evaluates the nursing care that is being provided and modifies the plan, as needed, to achieve measurable goals and objectives

Collaborator

• Develops goals, in collaboration with clients, their families, and the rehabilitation team, that are oriented to wellness behavior and are reality based and that encourage socialization with others, and promote maximal independence for patients with disabilities or chronic disabling conditions
• Participates in the interdisciplinary team process at team conferences and other team meetings and offers input into team decision making
• Intervenes with team members and other healthcare professionals to ensure that the optimal opportunity for recovery is made available to the client, the most significant member of the rehabilitation team
• Collaborates with team members to achieve cost-effective care by utilizing appropriate clinical measures to meet emergent physical, psychosocial, and spiritual situations

Client Advocate

• Actively listens, reflects, and guides clients and their families through the stages of the grieving process to mourn the loss of abilities and roles while also "instilling hope"
• Advocates for policies and services that promote the quality of life for individuals with disabilities and participates in activities that will positively influence the community's awareness of disabilities
• Contributes to a safe and therapeutic environment and supports activities that promote the clients' return of function and prevent complications or chronic illness
• Intervenes on behalf of clients to ensure that medical professionals and nonmedical professionals work to maximize clients' success when they return to work or school

Ans3=Nursing is conspicuous in its absence from lists of national leaders. National con-
sumers do not perceive nurse leaders as having power. The healthcare system has
failed to recognize nurses as professionals who have knowledge that is useful in
creating solutions to complex problems. The Institute of Medicine’s (2011) report
on the future of nursing further underscores the need for nurses to be at the table
by being better educated and by being full partners with physicians and other
healthcare professionals in redesigning health care in the United States.
Historically, nurses have avoided opportunities to obtain power and political
muscle. The profession now understands that power and political savvy will help
achieve the goals to improve health care and increase nurses’ autonomy. Also, if the
healthcare system is to be reformed, nurses must participate individually and col-
lectively. Nurses need to find ways to influence healthcare policy making so their
voices are heard. Milstead (2013) believes that nurses have the capacity for power
to influence public policy and recommends the following steps to prepare:
▪ Organize.
▪ Do homework to understand the political process, interest groups, specific
people, and events.
▪ Frame arguments to suit the target audience by appealing to cost contain-
ment, political support, fairness and justice, and other data that are relevant
to particular concerns.
▪ Support and strengthen the position of converted policy makers.
▪ Concentrate energies.
▪ Stimulate public debate.
▪ Make the position of nurses visible in the mass media.
▪ Choose the most effective strategy as the main one.

Act in a timely fashion.
▪ Maintain activity.
▪ Keep the organizational format decentralized.
▪ Obtain and develop the best research data to support each position.
▪ Learn from experience.
▪ Never give up without trying.
Nurses in leadership positions are most influential in organizational, systems,
national, and international changes that impact global policy initiative

Ans4(a)

STRATEGIC LEADERSHIP

self-assessment tool for determining strategic lead-
ership is available in the cited publication. It includes the following skills: antici-
pate, challenge, interpret, decide, align, and learn. Each skill includes methods to
improve strategic leading; some examples are as follows:
▪ Anticipate: The actions include talking to customers, suppliers, and other
partners to understand their challenges, and conducting market research
and business simulations to understand competitors’ perspectives, gauge
their likely reaction to new initiatives or products, and predict potential
disruptive offerings. Additional activities might include scenario planning
to anticipate possible futures and prepare for the unexpected, and viewing
trends and fast-growing rivals by examining strategies they have used that
are surprising.
▪ Challenge: Leaders can improve by focusing on root causes, applying the five
whys of Sakichi Toyoda, encouraging debate by creating safe-zone meetings
that facilitate open dialogue and conflict, including naysayers in decision-
making processes to discover challenges early, and capturing input from
persons who are not directly affected by a decision who may have a good
perspective on the repercussions

Interpret: Strategies include listing three possible explanations for observa-
tions, inviting perspectives from diverse stakeholders, and supplementing
observations with quantitative analysis. Additional strategies may include
stepping away to get a fresh perspective, going for a walk, listening to unfamil-
iar music, looking at art, and other activities that promote open-mindedness.
▪ Decide: Leaders can reframe binary decisions by asking team members
about other options for decision making, dividing decisions into chunks
to understand component parts and reveal unintended consequences, and
tailoring decision criteria to long-term versus short-term projects. Leaders
can be transparent about decisions by letting others know if they are seek-
ing divergent ideas and debate or if they are moving toward closure. It is
also important to determine who needs to be directly involved and who can
influence the success of the decision.
▪ Align: Leaders should communicate early and often to keep the two most
common complaints in organizations from becoming a reality: no one ever
asked me, and no one ever told me. Additional strategies include using
structured and facilitated conversations to expose areas of misunderstand-
ing or resistance and reaching out to resisters directly to understand their
concerns and then address them.
▪ Learn: Useful strategies include creating a culture in which inquiry is valued
and mistakes are considered learning opportunities, conducting learning
audits to see where decisions and team interactions may have fallen short,
and identifying initiatives that are not producing as anticipated and examin-
ing their root causes

Ans4(b)

Top Four Challenges for Today’s Nurse Administrators

It’s clear that health care is undergoing huge changes and growth, and will continue to do so for the foreseeable future. Nurses are at the forefront of this transformation. Nurse administrators hold much of the responsibility for responding to challenges and integrating new solutions to ensure that patient care is efficient and supports positive outcomes. Below are a few of the main challenges nurse administrators have to face today.

1. A Multi-Generational Workforce
Today’s nursing workforce spans several generations. Nurse administrators have to manage nurses who have different attitudes, work habits, and communication styles. Nurse administrators have to learn how to identify generational differences, make sure nurses of different generations are able to communicate clearly about expectations and habits, and minimize conflicts.

The range of ages and experience among nurses is an asset, but only if nurse administrators can remove the obstacles to collaboration and learning among nursing team members. For example, younger nurses can learn from older nurses’ years of experience dealing with potential problems and issues, while older nurses may learn newer and more efficient ways of caring for patients from younger nurses.

Nurses with strong interpersonal and leadership skills can build opportunities and environments in which nurses from different generations feel supported about their abilities and empowered to grow and learn.

2. The Business of Health Care
The increasing costs of medical care and the corporatization of health care have transformed the industry. Nurse administrators are often tasked with providing care and trying to ensure positive patient outcomes with limited resources, such as less time available to spend with each patient and dwindling budgets.

Nurse administrators must create realistic strategies and plans for effective patient care maximizing the resources available, both equipment and employees. Skills in budgeting, information technology, organizational leadership, and human resources are vital elements in their toolbox.

3. Ethics
As medicine and technology advance, humans have to contend with their ethical implications. Nurse administrators need to have an understanding of ethical principles, be aware of available resources related to ethics, study how to apply them in practice, and learn how to communicate them to the nursing staff, patients, and patients’ families.

Given their direct experience at the bedside, nurse administrators play a pivotal role in ethics consultation, education, and policy development and review. They move back and forth between policy and practice: they communicate information and experience from the practice side, presenting those findings to ethics review boards and/or helping incorporate them into ethics policies, and then communicate those policies and create strategies for putting them into practice.

4. More Competition for Nursing Talent
Nursing is facing pressure from several fronts. According to data compiled by the American Association of Colleges of Nursing,1

• 55 percent of the RN workforce in the United States is age 50 or older, pointing to a potential flood of retirements in the next several years.
• Nursing schools and programs are facing a faculty shortage and have had to turn away thousands of qualified applicants for baccalaureate and graduate nursing programs.
• The U.S. population is aging, indicating a need for more nurses to care for the elderly, a population with significant health care requirements.
• Stress from having to care for larger numbers of patients due to financial or staffing shortages is driving more nurses out of the profession.

In addition, the Affordable Care Act has provided more people with access to health insurance, resulting in a greater demand for health care services.

Nurse administrators may have to deal with managing nursing shortages in their own departments or facilities, as well as having to spend significant time and effort recruiting, interviewing, and courting a shrinking pool of qualified nurses.

Considering the many hats nurse administrators wear today, it’s clear why so many of them choose or are required to earn a nursing degree, such as a Master of Science in Nursing. The responsibilities of nurse administrators run all across the spectrum, from business to technology to leadership. A graduate degree in nursing provides invaluable insights and skills that can be difficult to pick up on the job and ensures they are prepared to take on the challenges of nursing practice and health care in the 21st century.

Ans4(c)

Improving healthcare quality can be viewed on both a macro and a micro level, as something that will require sweeping, systemic change of the entire healthcare system and as something that individual physicians can practice for their patients.

For instance, the healthcare industry could dramatically improve healthcare quality by instituting greater transparency and requiring practitioners to use patient-centered EHRs that are readily accessible to all care providers and the patients themselves. By the same token, physicians can improve healthcare quality for their patients by following protocol to keep patients safe from infection, following-up more regularly, or connecting their patients to better resources.

We believe that primary care providers are actually best positioned to impact the quality of care at the source. When used correctly, primary care providers can act as the hub for patient-centered care. Primary care physicians tend to be more connected to their patients and better able to understand the individual patient’s needs and health journey.

Here are five steps primary care providers can take right now to improve quality healthcare for their patients:

1. Collect Data and Analyze Patient Outcomes.

If you can’t measure it, then you can’t manage it. The first step to improving the quality of care at your organization is to analyze your existing data to understand where opportunities exist. You should analyze both your patient population and your organizational operations to identify areas for improvement. Then, use this data to establish a baseline for patient outcomes. Ideally, the wealth of available data and IT-based systems ought to enable more patient-centered, connected care. While Electronic Health Records (EHRs) were supposed to fulfill this promise of more patient-centered care, in reality most focus on documentation, better billing, and increasing revenue. If your organization wants to improve quality healthcare this is the place to start: Be as rigorous about tracking patient wellness as you are about tracking billing. Use EHRs, outcomes studies, patient satisfaction surveys, and other data sources to closely monitor the health, outcomes, overall wellness, and costs for individual patients across the entire continuum of care.

2. Set Goals and Commit to Ongoing Evaluation.

Once you’ve analyzed your patient population data to understand their risk and studied your practice operations to identify areas for improvement, it’s time to prioritize those areas and set goals. If you need some help, there are several health organizations with established quality and consistency measures that could guide your goal-setting process. The Quality Payment Program, the National Quality Forum, and the Agency for Healthcare Research and Quality all publish evidence-based guidelines and measures. Next, your organization must commit to ongoing evaluation. Improving quality healthcare isn’t a one-time, “set it and forget it” event—it’s an evolving process. The key to accelerating any quality improvement process is known as the PDSA (Plan-Do-Study-Act) cycle. First you plan a change, then you enact that change, then you observe and analyze the results, and, finally, you act on what you’ve learned. This model was developed by the Associates in Process Improvement and is a powerful tool for improving quality in clinical settings.

3. Improve Access to Care.

Having access to care is the single most important factor for improving quality healthcare and patient outcomes. Patients must have access to the right care at the right time in order to get the right results. Unfortunately, close to 15 percent of the population is still uninsured, which dramatically reduces these patients’ access to timely care, makes them go without preventive or primary care, and forces them to rely on higher cost (and, therefore, lower value) services. For example, research shows that underlying chronic diseases account for 75 percent of annual health spending in the United States, but Americans access preventive care at half the recommended rate. Of course, improving access to care doesn’t only refer to efforts to get patients to visit their primary care physician regularly or use preventive services such as early detection screenings. It can also mean improving how and where patients are able to access care. Many experts have argued that today’s health care system is far too fragmented to serve patients well—and that any efforts to connect, collaborate, and share information across organizations in order to make care more convenient for patients will also improve patient outcomes. The emerging trend toward onsite clinics and robust workplace wellness programs is one example of more convenient, accessible care. According to Deloitte’s recent report, The Future of Health 2040, the healthcare industry is on the “brink of a large-scale disruption” driven by greater connectivity, interoperable data, open platforms, and consumer-focused care. Primary care providers that are already innovating to provide more convenient and connected care for their patients will be ahead of this emerging trend.

4. Focus on Patient Engagement.

Patients can be the best advocates for their own health, but first they have to be engaged and taught to be proactive healthcare consumers. This is not an easy task, but it’s one that primary care providers are particularly well-prepared to undertake. Primary care physicians are better set up to see the patient’s entire healthcare journey than medical professionals who work at hospitals, specialist care centers, or urgent care facilities. You could say that primary care physicians are in a powerful position when it comes to overall quality of care. They are able to act as the glue that holds all the different aspects of care together and supports the patient through the entire care continuum. Patient engagement shouldn’t stop with the patient, however. For true engagement in healthcare, primary care providers should think more holistically and find effective ways to connect and encourage communication between families, physicians, other care providers, insurance providers, and social services throughout the patient’s entire healthcare journey.

5. Connect and Collaborate With Other Organizations.

Finally, healthcare organizations that truly want to improve their quality of care should regularly research and learn from other organizations—both in their own region and across the country. Go back to those areas for improvement you identified and goals that you set and look for other healthcare organizations that excel in those areas. To find these organizations, keep your ear to the ground about healthcare facilities that are experiencing success in a certain area, attend conferences, read the literature, and research online. Next, reach out to the organizations you’ve identified and find out what you can learn from them. Most organizations are happy to share to improve the lives of all patients. In addition to implementing changes at your own practice, you may find healthcare organizations you can partner with to improve patient outcomes. Patients today are less limited by geography and often benefit from opening up their care options for major procedures. Even for day-to-day care and routine procedures that you typically handle in-house, primary care providers are uniquely positioned to connect patients to additional services that will increase their success, proactively follow-up on care plans, engage patients across the continuum of care, and close the communication loop with other healthcare organizations. In other words, primary care providers are best able to take responsibility for individual patients both inside and outside the clinic walls

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