Issues in Contemporary Nursing Leadership PDF

Issues in Contemporary Nursing Leadership Chapter 15 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins  Objectives Identify relevant concepts in relation to nursing l...

Issues in Contemporary Nursing Leadership Chapter 15 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins  Objectives Identify relevant concepts in relation to nursing leadership and complexity theory Describe relationships between leadership and change Identify opportunities for leadership in your nursing work Describe how ethics and leadership are inextricably linked and lived out in relationships with others Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins  Complexity Theory and Leadership The idea that human beings and even organizations are living, changing systems that continuously transform with shifting circumstances and emerging situations. Amid the continuous shifting and sense-making about what is going on is the belief that things are not linear or predictable and what we think and want to have happen can influence what emerges. Relationships are critically important—the quality of our relationships enables change, innovation, collaboration, and growth. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins  Situating the Topic: The Nature of the Issue It is important to point out the difference between the idea that leadership is something that happens to us, rather than something that we participate in. One way to participate in leadership is to accept the authority of the designated leader similar to the mentorship model. Another way of being in a leadership relationship is to participate reciprocally so that the strengths of each person are drawn on and responsibilities negotiated. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins  Situating the Topic: The Nature of the Issue (cont.) Leadership and management: Some critique that too much attention is given to management and too little to leadership. – Thoughts? Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins  Situating the Topic: The Nature of the Issue (cont.) What do you think about the following statements? – “Leadership is not necessarily tied to a position of authority and each of us as a professional nurse has the potential and perhaps the responsibility to provide leadership.” – “Leaders who lack management skills, are as much of a liability to modern organizations and the communities they serve as are managers who lack the vision of leadership.” Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins  Situating the Topic: The Nature of the Issue (cont.) When people in positions of authority, regardless of their discipline, make decisions about clinical practice based on something other than the goals of professional practice, there is the potential to reduce the individual needs of the client. Competing goals for professional nursing practice are further complicated by the internal tensions within practice among nurses with differently informed goals; that is to say, nurses align with different loyalties in their professional practice. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins  Historical Analysis Efficiency too often replaces effectiveness as a standard of practice. Nurses find themselves measured against outcomes that bear little resemblance to the profession’s ideological values. Loss of purpose and autonomy has untoward consequences on the quality of care and delivery of services. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins  Social and Cultural Analysis As patients gain a greater role in decisions about their care, they often turn to alternative providers. The emergence of nurse practitioners testifies to a public willingness for nurses to expand their scope of practice; since patients often perceive nurses as social and economic equals, nurses enjoy special access in helping patients become informed consumers and managers of their health. The changes facing nursing reflect those occurring in the wider society, which appear ready to change the essence of healthcare delivery. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins  Political Analysis It is supported through research that “in fact, [there are] choices about how we will conduct ourselves and…that our present system is no more, but no less, than a humanly constructed set of possibilities.” Nurse leaders and managers run the risk of being caught between two realities: The professional practice knowledge of nurses and the privileged knowledge reflecting organizational goals. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins  Critical Analysis (Feminist and Postcolonial) A critical feminist analysis does not relate to the gender of a particular person, but rather to the ways that traditional structures based on gender divisions of power have influenced or shaped issues or events. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins  Economic Analysis Economic challenges are not new to nurse leaders: “Since the postwar years, at least nurses in Western industrial countries have had to negotiate among the sometimes-conflicting demands and obligations of their employers, health organizations, and those for whom they care.” As economic constraints intensify, nurses in professional practice find themselves with limited resources to respond to client situations and with a “limited capacity to exercise control over their practice.” Nurse leaders are caught in the tension between professional nurses’ practice needs and economic demands. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins  Barriers to Resolving the Issue If a sense of undervaluation lies at the center of nurses’ dissatisfaction, it also represents the major challenge facing nursing leaders. Barriers arise when there is dissonance between goals and visions of the organization and those of professional nursing practice. Leaders and managers face complex decisions of where and with whom to align professional nursing practice; they may feel obligated to support conflicting goals for the organization. Too much focus on short-term problem solving can inhibit leadership strengths. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins  Strategies to Addressing the Issue Meet with nurses, leaders, and physicians in the oncology program/unit to listen to their issues and concerns linked with research activities. Meet with research assistants involved in data gathering in the oncology unit. Spend time with them as they are speaking with patients and families about participation. Privately ask patients and families on the unit about their experiences, concerns, and issues relating to research participation. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins  Strategies for Addressing the Issue (cont.) Conduct analysis to determine if this trend is localized to the oncology unit or more widespread. Do nurses in other research intensive areas have similar or additional ethical concerns? Are there themes around one particular PI or is it every study? Gather details, facts, specific times, dates, names, study particulars, testimonials; try to avert a dismissal and accusations of emotional overlay; focusing on the facts helps to ground the discussion. Meet with research director, ethicist, and chair of ethics committee. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins  Strategies for Addressing the Issue (cont.) Following meetings and clarifications with nurses and other staff, prepare a brief statement of the issue (a one- page hand-out that clearly presents the issue, its scope, and consequences for patients and staff). Speak privately with the CEO, and share the one-page document to give him/her the “heads up” and to get a sense of whether or not there will be support at the top. Speak privately with the VP of Research, the Chiefs, or VP of Medicine to gain their perspective and see where possible tension points are. Do not air issues publicly before speaking with key players one-on-one. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins  Strategies for Addressing the Issue (cont.) Share a draft of the one-page statement of issue and ask for input and comments from other leaders—include their thoughts in the revised document. This way, it is no longer just Nazilla’s voice. Share the one-page document with the senior executive team and develop a plan to address the issue with the Medical Advisory Committee (MAC), the Patient Care/Quality Care Committee of the Board (PCC), the Research Ethics Board (REB), the Professional Advisory or Interprofessional Care Committee, and the Nursing Council. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins  Strategies for Addressing the Issue (cont.) Collaborate on defining a short-term strategy to limit threats to patient care, as well as a longer-term strategy with MAC, PCC, and REB to initiate plans to address the more systemic issues relating to research, staff involvement, and patient care. Conduct interviews or focus groups with patients participating in research and involve patient representatives and an ethicist. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins  Strategies for Addressing the Issue (cont.) Create a support structure—such as a discussion group or arts-based project with staff nurses to provide additional opportunity for conversation on the issues as well as to provide a place to try out different responses when coercion or intimidation is experienced or witnessed. Recognize that this may be a long journey and not a quick fix. As you have seen in thinking about complexity theory, change often comes in an instant when you least expect it. Keep on top of each incident that happens and bring the stories back to the senior team. This creates a sense of urgency and moral distress that cannot be overlooked long term. Breathe and stay true to yourself. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins  Summary Our views have been shaped by experience, education, nursing knowledge, and complexity science. Ideas aligned with complexity offer a meaningful way to think about nursing, leadership, and organizations. Ideas inspire us to look to the quality of our relationships for inspiring change and transformation. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins