Page 6 • DNA Reporter February, March, April 2017 Patients and Families, Our Best Human Resources Ann-Marie C. Baker, MSN, RN-BC Ann-Marie Baker, MSN, RN BC is a Senior Program Manager for Patient Experience at Christiana Care Health System. A graduate of the University of Delaware BSN ‘92/MSN’13, she has worked clinically in critical care and trauma before moving into system education and leadership. Ann-Marie serves as an adjunct professor at Wilmington Ann-Marie C. Baker University in the Masters of Nursing program as well as an editor for Wolters Kluwer Publishing Company. She may be contacted at firstname.lastname@example.org What key human resources are there for us as nurses? People! Think back to a patient and family who vividly stand out in your career. We all have treasured memories of people we cared for who influenced our practice. As nurses we connect with people at times of great joy, fear, the great unknown, or sorrow. Often these experiences impact us as deeply as those we serve because of the inherent premise that nursing is the art of caring. The medical community has undergone many changes over the past few years secondary to healthcare reform, technology, and increasing demands. An intensified focus has been on the integration of patients and families through patientand family-centered care as a standard of nursing practice. Through engagement and support of patients and families nurses build relationships and trust that can establish mutually beneficial partnerships (Conway et al., 2006). Evidence has demonstrated that quality of care indictors, outcomes, and patient safety improve when nurses take the time to listen to patients, families and each other (Petras, Dudjak, & Bender, 2013). Additionally through personal experiences nurses may come to realize how true this is, but also how difficult it can be at times. With increased acuity of patients combined with increased pressure to improve clinical care, and provide an exceptional experience all while meeting fiscal goals, the demands placed on nurses’ time is overstretched. As nurses we should focus on the gift that patient- and family-centered care can provide to us amidst all this change if we can learn to engage differently with our patients and build on this human resource, we can change practice and healthcare. Strategy One-Listening How can nurses focus on patient and family centered care? We need to begin by listening, really listening with empathy and understanding. Evidence-based studies have demonstrated over the past 25-plus years that focused rounds improve patient outcomes, safety, and satisfaction (Krepper et al., 2012). This can be accomplished through purposeful rounding in patient care areas (inpatient and outpatient) to assess the experience of a patient and family or through leadership rounds with staff to listen to opportunities and strengths they see on the front line. Don’t get me wrong–asking patients about their experiences and perspectives can be daunting! In order to be successful and make a positive impact it must be done in a genuine, engaged manner. Nurses need to be present in the moment and be ready to react and show empathy. As nurses we strive to this every day and would not intentionally cause harm. But we do not always hit the mark and focus on what is important to our patients and mitigate their concerns. The routine of our environment is just that routine to us, but not to our families and patients. When we fail to acknowledge their emotions, requests or minimize their reactions we can inflict emotional harm. This is never our intent, but lack of awareness, lack of explanation or lack of empathy can cause harm. As nurses we need to make the time to connect with our patients and families as people, not just patients, to build trust. When we do this we can learn more than data alone can ever tell us. Strategy Two-Engaging One means of engaging patients and families in the work that nurses do is through patient advisory councils. When patients and families are a part of decision-making, procedure/policy development, and strategic planning ideas can be shared from the patient perspective. We won’t ever know how they feel unless we ask. By partnering nurses and patients together to share their voices and perspective innovation and transformation can occur. How do you find engaged patients and families who want to contribute back to our organizations? What do you share? What will they say? In order to gain a rounded opinion, nurses need to engage advisors as diverse as the populations served. Nurses also need to look within grievance and concern lists and engage patients that did not have an optimal experience, and turn their experience around to be part of the solution. At the same time, sharing expectations and being honest are key to building relationships when engaging patients as advisors. Patients have a voice, but not the voice. Notably, connecting with patients in ways that are meaningful and engaging may require innovation and creativity. For example, use of a closed Facebook group for new moms to share concerns, schedule meetings off campus or off hours to meet working families, or use of snail mail and email to meet the needs of those who may not have access or feel engaged with electronic tools. Strategy Three-Teamwork The final strategy to build on people as resources is to look beyond the walls of our individual organization and embrace teamwork within our state. A team of leaders from the healthcare organizations in Delaware are creating an innovative way to engage at the state level, through the development of the Delaware Collaboration Group for Patient Advocacy. This team is hoping to be a resource to exchange ideas, success stories, challenges and opportunities. Through this new group we hope to deepen our partnerships and assure we capitalize on the human resource capital within our state. By harnessing human resources at a number of different levels we can impact outcomes, trust and engagement. Our patients and families are the core of our work – let’s invite them in. References Conway, J., Johnson, B., Edgman-Levitan, S., Schluter, J., Ford, D., Sodomka, P., et al. (2006). Partnering with patients and families to design a patient- and familycentered healthcare system. Whitepaper: Institute for Family Centered Care and Institute for Healtcare Improvement., Cambridge Mass.Retrieved from: http:// www.ipfcc.org/pdf/PartneringwithPatientsandFamilies.pdf Krepper, R., Vallejo, B., Smith, C., Lindy, C., Fulmer, C., Messimer, s., et al. (2012). Evaluation of a standardized hourly rounding process (SHaRP). Journal for Healthcare Quality(2), 62-69. Petras, D., Dudjak, L., & Bender, C. (2013). Piloting patient rounding as a quality improvement initiative. Nursing Management, (7) 19-23.
February, March, April 2017 DNA Reporter • Page 7 Leadership Competency: Impact on Overall Organizational Success Jennifer Hargreaves, BA, MSN, RN, NE-BC M s . H a r g r e a v e s acquired a diploma in nursing from Beebe School of Nursing in 2001 and went on to be awarded her MSN in Healthcare Administration from University of Delaware. Currently she is working on her doctorate in nursing practice at Villanova University. Ms. Hargreaves has been with Beebe Jennifer Hargreaves H e a l t h c a r e s i n c e 2001 and provided patient care until moving into educational roles. She has served on several nursing leadership and patient care improvement councils, including the Nursing Review Board, Professional Education and Development Council, the Clinical Practice Council and the Global Council. Other activities include involvement on several advisory boards throughout the state, member of the American Organization of Nurse Executives education committee and the current Past President of the Delaware Organization of Nurse Leaders. In 2014, Ms. Hargreaves led the restructuring of clinical education at Beebe Healthcare and was named manager of the new Beebe Healthcare Educational Institute. Ms. Hargreaves has been recognized for her work through several nursing awards including the 2014 Delaware Excellence in Nursing Practice Award for Nurse Leader/ Manager. The focus of this article is the validity in driving organizational success through supporting nurse leadership competencies. This validity and/or success is being represented by improved patient satisfaction scores, increased staff engagement, improved reimbursement for care, and increased quality of care. In February of 2005 the original American Organization of Nurse Executive (AONE) Competencies were introduced. These competencies described skills common to nurses in executive practice regardless of their educational levels or titles and spanned all healthcare realms (AONE, 2005). Westonet al. (2008) recognized that the education of healthcare professionals focuses almost exclusively on the development of clinical competence and not on the enhancement of leadership skills. Today’s nurse executive is more challenged than ever to manage multiple, competing priorities in organizations with ever-diminishing financial and human resources (Stichler, 2006). Critique findings The following research was noted in relation to leadership competency. In both instances the study population did not have any active leadership competency structure in place. As part of a study conducted by Eddy et al. (2009), 23 nurse leaders were selected and divided into five nursing leader groups. Per the study guidelines leadership included unit managers, clinic managers, staff development professionals, and top-level administrators (Eddy et al., 2009). Through a semi-structured interview process narratives were collected about nursing leadership. Through an interpretative analysis themes were pulled from these narratives. The themes noted were: communication skills such as listening, conflict resolution, the ability to Cold Outside? Warm Inside! Work where we ensure our employees have a warm heart! A special place for special people. Our exciting news, We have opened our new State of the Art TCU Unit! If you would like to be part of our team, please go on line! Westminster Village • 1175 McKee Rd • Dover, DE 19904 www.psl.org communicate a vision, motivate, and inspire. Additionally, leaders needed technological adroitness, fiscal dexterity, and the courage to be proactive during rapid change (Eddy et al., 2009). Through the research findings a restructure of current course curriculums were completed in the leadership focus of the nursing master’s program. Nurse retention should be enhanced by better educated nurse leaders who are grounded, proactive and ready to provide a vision for the future (Eddy et al., 2009). Another identified theme found was to also reinforce that nursing leaders are as vital a need as the bedside nurse. This needed more clarification as it was only briefly gleaned on in the study without validation of what was stated to draw this conclusion. All the identified themes that mirrored the AONE nurse executive competencies also were identified as core competencies: (a) Communication proficiencies with emphasis on listening skills (b) Conflict resolution skills (c) Ability to communicate vision, motivate and inspire (d) Ability to use data and technology especially in decision making and to be fiscally savvy (e) Courage to be proactive in the face of change rather than to react in a crisis driven manner. Supamanee, Kraurujsg, Singhakhumfu, and Turale (2011) conducted a similar qualitative study that explored clinical nursing leadership competency of Thai nurses working at a university hospital. Utilizing interviews with 23 nurse administrators and a focus group of 31 registered nurses (RN) narratives were collected. Data analysis and theory development were guided by the Iceberg Model hidden characteristics, which is utilized to discover patterns of behavior and mental models. The model identified different events: motive (respect from the nursing and healthcare team and being secure in life), self-concept (representing positive attitudes and values, and traits (personal qualities necessary for leadership (Supamanee et al., 2011). The findings in this particular study noted that both the nurse administrator and RN had similar views about clinical leadership competencies. The use of the Iceberg Model to guide theory development in this study revealed two components: hidden characteristics and surface characteristics. The hidden characteristics comprised three elements of the RN: motives, self-concept, and traits. Results led to the implementation of a training program for registered nurse leaders at the study site, and the formation of a preliminary clinical nursing leadership competency model (Supamanee et al., 2011) Limitations for both studies were similar and included those common with qualitative research due to being narrative and subjective as well as results that may reflect regional variations in nurse leadership. Nurse leaders knew each other which led to potential concern for conflict of interest general lack of ethical diversity as well. Evaluation & Implications for cost-benefit Analysis Lack of leadership development and skills often leads to employee frustration, disenfranchisement from the healthcare organization, and in some cases resignation from the health care system (Weston et al., 2008). The turnover is also costly to organizations in terms of quality of patient care, sustainability of the professional nursing organization, and both direct and indirect financial costs (Ulrich, Krozek, Early, Ashlock, Africa, & Carman, 2010). Leadership competencies can also be used by aspiring nurse leaders in planning their personal career pathway and growth. Health care organizations may utilize them as a guideline for NEW CASTLE COUNTY VOCATIONAL TECHNICAL SCHOOL DISTRICT Real Learning for Real Life Teach the next generation of Medical Assistants and Nursing Techs! An unencumbered and active RN license is required. For career opportunities visit our website: www.nccvotech.com Contact: Mr. Gerald Allen, 1417 Newport Rd. Wilmington, DE 19804 EOE email@example.com job descriptions, expectations, and evaluations of nurse leaders, as well as nurse educators can utilize them as a curriculum guideline for the educational preparation of nurses seeking expertise and knowledge in executive practice. Accountability for ensuring positive patient outcomes, productivity goals, financial targets, retention quotas, customer and provider satisfaction goals, and other performance metrics demands that contemporary nurse executives possess and demonstrate well-developed leadership skills and organizational management competencies (Stichler, 2006). Leadership is an important factor that influences the quality of care to improve patient outcomes (Cook, 2001; Cook & Leathard, 2004) and is a key element supporting quality care and patient safety under limited resources (Wright et al., 2001). Without clear data on the impact of leadership development, it is difficult to continue to devote limited funds to this effort (Marlin & Krejeci, 1997). Thus more data collection must be done as we integrate a stronger leadership competency structure into selected organization and identify how this would impact the organization from a financial as well as an improvement of quality of care. Other considerations would be the initial upstarting cost for such items as materials, time budgeted for education, potential need for new equipment and or support. Conclusion Leadership is experiential. There are many skills and expertise that can be developed through formal learning (Batcheller, 2012). Part of this learning is the acceptance and incorporation of the AONE nurse leadership competencies as standard part of leadership growth and development. Every nursing graduate should leave his or her education with the skill and, more importantly, the expectation to provide leadership for a new health care system (O’Neil, 2011). It is critical to realize that the ability of an RN to organize, plan, and provide safe and competent nursing practice cannot take place without appropriate, visionary, and competent leadership (Supamanee et al., 2011). Through more support and promotion of nursing leadership and the role played not only at the bedside but also in the decisions around healthcare reform, it is vital to support the growth and standardization through evidence based practice of nurse leadership competencies as a standard of practice transition. References American Organization of Nurse Executives (2005). AONE nurse executive competencies. Nurse Leader. 3(1):50-56. Batcheller, J. (2012). Learning how to dance: Courageous followership a CNO case study. Nurse Leader, 10(2); 22- 24. Cook, M. (2001). The renaissance of clinical leadership. International Nurse Review, 48(1): 38-46. Cook, M. & Leathard, H. (2004). Learning for clinical leadership. Journal of Nurse Management, 12(6): 236- 444. Eddy, L., Doutrich, D., Higgs, Z., Spuck, J., Olson, M., & Weinberg, S. (2009). Relevant nursing leadership: An evidence-based programmatic response. International Journal of Nursing Education Scholarship, 6(1); 1-17. Marlin, S. & Krejeci, J. (1997). Theoretical base for effective leadership training and development. Unpublished manuscript. Stichler, J. (2006). Skills and competencies for today’s nurse executive. AWHONN, 10(3): 255-257. Supamanee, T., Kraurujsg, M., Singhakhumfu, L. & Turale, S. (2011). Preliminary clinical nursing leadership competency model: A qualitative study from Thailand. Nursing and Health Science, 13(4); 433-439. Ulrich, B., Krozek, C., Early, S., Ashlock, C., Africa, L., & Carman, M. (2010). Improving retention, confidence, and competence of new graduate nurses: Results from a 10-year longitudinal database. Journal of Nursing Economics, 28(6), 363-375. Weston, M., Falter, B., Lamb, G., Mahon, G., Malloch, K., Provan, K., Roe, S., & Werbyto, L. (2008). Health care leadership academy: A statewide collaboration to enhance nursing leadership competencies. Journal of Continuing Education in Nursing, 29(10); 468-472. Aquila of DE. Inc. seeking a Psychiatric Nurse Practitioner for our Georgetown, DE. Clinic to perform psychiatric evaluations and prescribe medications. Pay, benefits, and hours negotiable. Contact April Lathbury, Program Director at 1-302-856-9746.
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