NURSING: Interprof Org & Sys Leadership Essay

 

As noted in the Learning Resources, systems theory provides a meaningful and beneficial means of examining challenges in health care organizations. To do this effectively, however, it is essential to assess all system components, as some may be relatively healthy while others are problematic.NURSING: Interprof Org & Sys Leadership Essay

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For this Assignment, you apply systems theory to the examination of a problem in a department or a unit within a health care organization. (Note: You may use the same problem you identified for the Discussion as long as it meets the criteria for this assignment.)NURSING: Interprof Org & Sys Leadership Essay

To prepare:

· Review the Meyer article, “Nursing Services Delivery Theory: An Open System Approach,” in this week’s Learning Resources. Focus especially on the information presented in Table 1 (p. 2831) and Figure 2 (p. 2833).

· Reflect on your organization or one with which you are familiar. Within a particular department or unit in this organization, identify a problem the staff is encountering.

· Using Table 1 in the Meyer article as a guide, analyze the department or unit, identifying inputs, throughput, output, cycles of events, and negative feedback. Consider whether the problem you have selected relates to input, throughput, output, cycles of events, and/or negative feedback.

· Think about how you could address the problem: Consider what a desired outcome would be, then formulate related goals and objectives, and translate those goals into policies and procedures.NURSING: Interprof Org & Sys Leadership Essay

· Research professional standards that are pertinent to your identified problem.

· Reflect on the organization’s mission statement and values. In addition, consider how addressing this problem would uphold the mission and values, while improving the organizational culture and climate. (Depending on the organization you have selected, you may have explored these in the Week 1 Discussion.)NURSING: Interprof Org & Sys Leadership Essay

To complete:

Write a 3- to 5-page paper (page count does not include title and reference page) that addresses the following:

· Describe a department or unit within a health care organization using systems theory terminology. Include a description of inputs, throughput, output, cycles of events, and negative feedback.

· Describe the problem you identified within the department or unit using an open- systems approach, and state where the problem exists using the systems theory model (input, throughput, output, cycles of events, or negative feedback).NURSING: Interprof Org & Sys Leadership Essay

· Based on this information, explain how you would address the problem as follows:

o Formulate a desired outcome.

o Identify goals and objectives that would facilitate that outcome.

o Translate those goals and objectives into policies and procedures for the department or unit.

o Describe relevant professional standards.

· Explain how your proposed resolution to the problem would uphold the organization’s mission and values and improve the culture and climate.NURSING: Interprof Org & Sys Leadership Essay

Learning Resources

Required Readings

Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application (9th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.NURSING: Interprof Org & Sys Leadership Essay

Review Chapter 7, “Organizational Planning”

Chapter 8, “Planned Change”

o Organizational Change Associated With Nonlinear Dynamics

Read this section of Chapter 8 on planned change. Consider the role of leaders in effectively managing planned change.NURSING: Interprof Org & Sys Leadership Essay

Chapter 12, “Organizational Structure”

o “Organizational Culture”

There are many structures organizations take, and these structures influence how the organization functions. This chapter discusses many different organizational structures and provides insights into how these structures influence the change process, as well as leadership and management.

This week you will begin a group paper that you will develop over the next few weeks. By Day 3 of this week, you will be placed in a collaborative group and provided with a work area for your group (See the Groups area below Week 11 in the left-hand navigation bar. If you do not see your team area by the end of Day 3, contact your Instructor.)

Before you begin to work with your group, read the information below describing the paper. Then join your group, introduce yourself, and begin work on selecting a topic.NURSING: Interprof Org & Sys Leadership Essay

To prepare:

· Within your group, select a topic relevant to interprofessional leadership and the health care field on which to focus your group paper. The following are some potential topics for your group to consider:

o Matrix organizations

o Accountable care organizations

o Horizontal and vertical organizations

o Role conflict and ambiguity

o Employee recruitment and selection

o Interpersonal relationships in the C-suite of organizations (the relationships between the CEO, CFO, and CNO)

o Resistance to change

o Succession planning

o Whistle blowing

o “Just” culture

o Team Stepps

· When your group has selected a topic, the group facilitator will submit the topic to the Instructor for approval on the Discussion Board in the Week 5 Group Project Topic Forum.NURSING: Interprof Org & Sys Leadership Essay

· Conduct research on your topic using the Walden Library and other credible sources.

To complete:

As a group, write a 3- to 5 (page count does not include title and reference page) page paper that includes the following:

· Section 1: Introduction

· Section 2: Significance of the topic (based on literature that speaks to the relevancy of the concept selected in terms of interprofessional leadership)

· Section 3: Review of the literature related to the concept that the group selects (current best practices, positive or negative impact on leadership or health care organizations, etc.)

· Section 4: Application to nursing (e.g., implications or consequences for nursing leaders)

· Section 5: Conclusion

Learning Resources

Required Readings

Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application (9th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.

Chapter 19 “Organizational, Interpersonal, and Group Communication”

Chapter 19 covers many aspects of the communication process, including group communication. As you read this chapter, focus on the stages of group development (forming, storming, norming, performing) and group dynamics (group task roles, group building and maintenance roles, problematic roles). Consider how you can apply these concepts as you engage in group work.NURSING: Interprof Org & Sys Leadership Essay

Adams, S. L., & Anantatmula, V. (2010). Social and behavioral influences on team process. Project Management Journal, 41(4), 89–98.

In this article, the authors report on the effects of individual behaviors on project teams and provide a model that identifies the progress of social and behavioral development. For each stage, the authors provide recommendations for managing team members.NURSING: Interprof Org & Sys Leadership Essay

Chun, J. S., & Choi, J. N. (2014). Members’ needs, intragroup conflict, and group performance. The Journal Of Applied Psychology, 99(3), 437–450. doi:10.1037/a0036363

This study theorizes and empirically investigates the relationships among the psychological needs of group members, intragroup conflict, and group performance.

Haynes, J., & Strickler, J. (2014). TeamSTEPPS makes strides for better communication. Nursing,44(1), 62–63. doi:10.1097/01.NURSE.0000438725.66087.89

Teamwork and communication are the focus of this article and include the use of the TeamStepps model for Quality Improvement.

Hogg, M. A., Van Knippenberg, D., & Rast, D. E., III. (2012). Intergroup leadership in organizations: Leading across group and organizational boundaries. Academy of Management Review, 37(2), 232–255.NURSING: Interprof Org & Sys Leadership Essay

The authors of this article introduce a theory on intergroup leadership that is based on social theory and intergroup relations. This theory purports that intergroup performance relies on a leader’s capacity to create intergroup relational identities.

Kaufman, B. (2012). Anatomy of dysfunctional working relationships. Business Strategy Series, 13(2), 102–106.

Kaufman examines the impact of dysfunctional working relationships in an organization. She provides managers with tips that will allow them to identify early warning signs of dysfunctional behavior and to minimize its effects in the workplace.

Mind Tools. (2012). Forming, storming, norming and performing: Helping new teams perform effectively, quickly. Retrieved from http://www.mindtools.com/pages/article/newLDR_86.htm

This web article discusses stages of team development and provides strategies for moving through the early stages effectively.

Mind Tools. (2009). Team charters. Retrieved from http://www.mindtools.com/pages/article/newTMM_95.htm

This web page features helpful information about team charters. Before you begin work on the Week 7 Assignment, you may find it helpful to create a charter that can guide your group’s work together.

Ortega, A., Sánchez-Manzanares, M., Gil, F., & Rico, R. (2013). Enhancing team learning in nursing teams through beliefs about interpersonal context. Journal Of Advanced Nursing, 69(1), 102–111. doi:10.1111/j.1365-2648.2012.05996.x

This article examines the relationship between team-level learning and performance in nursing teams, and the role of beliefs about the interpersonal context in this relationship.NURSING: Interprof Org & Sys Leadership Essay

Table Group. (n.d.). Retrieved July 24, 2012, from http://www.tablegroup.com/

Patrick Lencioni is recognized worldwide for his work on teams. Under the Patrick Lencioni link, download and read articles related to addressing team dysfunctions.NURSING: Interprof Org & Sys Leadership Essay

Optional Resources

Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application (9th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.

The 2003 Institute of Medicine report titled Health Professions Education: A Bridge to Quality identified five competencies all healthcare professionals need to reduce errors, three of which are cooperation, communication, and coordination. [The National Academies’ Institute of Medicine was renamed Health and Medicine Division in 2016.] Providing safe, effective patient care requires that all members of the healthcare team, regardless of discipline, have expertise in their fields of study. But healthcare providers often fail to understand the educational preparation and practice of professionals in other disciplines.NURSING: Interprof Org & Sys Leadership Essay

Tami L. Jakubowski Why interprofessional collaboration?
To provide proper care and improve patient outcomes, today’s nurses must collaborate effectively with members of the healthcare team from other disciplines. That means working together as team members and team leaders. To do that, they must understand each member’s education, scope of practice, and areas of expertise. Learning the language, norms, and special foci of other disciplines fosters more effective use of resources and knowledge.NURSING: Interprof Org & Sys Leadership Essay

Tracy J. PerronIn 2009, six healthcare education associations in the United States established the Interprofessional Education Collaborative: American Association of Colleges of Nursing, American Association of Colleges of Osteopathic Medicine, American Association of Colleges of Pharmacy, American Dental Education Association, Association of American Medical Colleges, and Association of Schools of Public Health. Together, these organizations have worked to define interprofessional collaboration and four core competencies: 1) values and ethics for interprofessional practice, 2) roles and responsibilities for collaborative practice, 3) interprofessional communication practices, and 4) interprofessional teamwork.NURSING: Interprof Org & Sys Leadership Essay

To sum up these competency domains, embracing the values and ethics of interprofessional practice means working together while respecting the expertise of those in other disciplines. Being aware of the professional roles and responsibilities of other team members; communicating effectively with patients, families, and other healthcare professionals; and building relationships to plan, implement, and evaluate safe care all contribute to the health of patients and communities. The American Association of Colleges of Nursing has integrated these collaborative expectations into its “essentials” for baccalaureate, master’s, and doctoral education for advanced practice, and they are also included in the educational expectations of other healthcare disciplines.NURSING: Interprof Org & Sys Leadership Essay

In 2010, the World Health Organization issued a statement of support for interprofessional education—emphasizing that, to strengthen global healthcare, students must learn with, from, and about members of other health professions. In 2016, further revisions by the Interprofessional Education Collaborative established interprofessional collaboration as an overall focus of the four competencies and called for increased emphasis on population health.

Our interprofessional journey
As a pediatric nurse practitioner and a community health nurse who seek to improve the health of vulnerable populations, we have broadened our focus by collaborating with physicians, nurse colleagues, and other health professionals. For example, to improve the health of elementary school students, we formed an interdisciplinary community health collaborative.NURSING: Interprof Org & Sys Leadership Essay

Working with the school system offered, in turn, new opportunities to collaborate with others, both within and outside the healthcare system. An eight-week program by nursing, physical education, and exercise science faculty for second-grade children that involved undergraduate students, school administrators, nurses, physical education teachers, classroom teachers, and parents expanded to include collaborative partnerships with 10 community organizations that work together to improve child health in an urban community. By involving undergraduate students in our interprofessional project to improve patient health outcomes, we model interprofessional collaboration. Having a common focus enables multiple disciplines to combine their expertise.NURSING: Interprof Org & Sys Leadership Essay

Historically, interprofessional education was not included in the curricula for healthcare professionals. Instead, students preparing for each discipline were educated in isolation from students of other disciplines, and there was little knowledge of the educational requirements or scopes of practice of other health professions. Today, students are being prepared to be members of an interdisciplinary healthcare team and are learning to focus on each patient as an individual, rather than a treatment or diagnosis.

The future of interprofessional collaboration
Benefits of interprofessional collaboration—for nurses, other healthcare professionals, and patients—include improved patient outcomes, fewer preventable errors, reduced healthcare costs, and improved relationships with other disciplines. Enhanced communication among disciplines also leads to decreased workloads for all health professionals by minimizing duplicated effort and increasing knowledge. Building relationships with professionals in other disciplines leads to better understanding.NURSING: Interprof Org & Sys Leadership Essay

Are you ready to embark on an interprofessional collaborative journey? Before doing so, ask yourself these questions: What population are you focusing on? How can you collaborate interprofessionally? What opportunities exist for you to collaborate interprofessionally? What disciplines outside of healthcare could you collaborate with? What organizations could you collaborate with?

Tami L. Jakubowski, DNP, RN, CPNP-PC, CSN, is associate professor at Frances M. Maguire School of Nursing and Health Professions, Gwynedd Mercy University, Gwynedd Valley, Pennsylvania, USA. Tracy J. Perron, PhD, RN, CNE, CSN, is assistant professor in the Department of Nursing at The College of New Jersey in Ewing, New Jersey, USA. RNL

Editor’s note:
On Saturday, 21 July 2018, Tami Jakubowski and Tracy Perron will present two sessions at Sigma’s 29th International Nursing Research Congress in Melbourne, Australia: 1) “The Evolution of an Interprofessional Approach to Combatting Childhood Obesity in an Urban Setting,” and 2) “Preparing Nursing Students for Population Health Using a Community Engaged Pedagogical Approach.” Register here for congress.NURSING: Interprof Org & Sys Leadership Essay

Check out these additional articles by presenters at the 29th International Nursing Research Congress.

State-specific nurse practice acts, a defined registered nurse (RN) scope of practice, and nurse-led initiatives prepare nurses to lead in a meaningful and ethical way within the professional practice setting. However, barriers still exist that challenge the full RN scope of practice. One of these barriers is insufficient interprofessional collaboration among healthcare providers from multiple disciplines. We will briefly discuss the RN scope of practice and describe several evidence-based transition to practice programs and activities that are effectively helping to minimize these barriers. The article will also consider opportunities for interprofessional collaboration for RNs to implement evidence-based programs to support transition to practice, create interprofessional collaborative environments, and care for patients in a culturally competent way to minimize healthcare disparities. We conclude by offering recommendations to enhance interprofessional collaboration.NURSING: Interprof Org & Sys Leadership Essay

Citation: Moss, E., Seifert, C.P., O’Sullivan, A., (September 30, 2016) “Registered Nurses as Interprofessional Collaborative Partners: Creating Value-Based Outcomes” OJIN: The Online Journal of Issues in Nursing Vol. 21, No. 3, Manuscript 4.

DOI: 10.3912/OJIN.Vol21No03Man04

Key Words: interprofessional collaboratiion, value-based outcomes, transition to practice, diversity, culturally competent care, workforce data, nurse led initiatives, scope of practice

Members of the American Nurses Association (ANA) Professional Issues Panel (Panel) Steering Committee, Barriers to RN Scope of Practice, recently worked to identify barriers that prevent RNs from working to the full extent of their education and training. This Panel both explored the basis for barriers, and subsequently developed appropriate recommendations. Panel findings were divided into four key roles of RNs in the healthcare delivery system, specifically RN as professional, RN as advocate, RN as innovator, and RN as collaborative leader. This OJIN topic considers barriers to RN scope of practice from the perspective of each of these roles.NURSING: Interprof Org & Sys Leadership Essay

One barrier is insufficient interprofessional collaboration among healthcare providers from multiple disciplines.One barrier is insufficient interprofessional collaboration among healthcare providers from multiple disciplines. Interprofessional collaboration is the collective involvement of various professional healthcare providers working with patients, families, caregivers, and communities to consider and communicate each other’s unique perspective in delivering the highest quality of care (Sullivan et al., 2015). As leaders, all RNs are, or should be, invested as interprofessional collaborative partners in the creation of outcomes of value for the patients, families, and the community they serve. We will discuss several evidence-based transition to practice programs and activities that are effectively helping to minimize this and other barriers. The article will also consider opportunities for interprofessional collaboration for RNs to implement evidence-based programs to support transition to practice, create interprofessional collaborative environments, and care for patients in a culturally competent way to minimize healthcare disparities. We conclude by offering recommendations to enhance interprofessional collaboration.NURSING: Interprof Org & Sys Leadership Essay

RN Scope of Practice
Nursing has ranked number one in ethics and honesty, according to Gallup polls, for 16 of the past 17 years (Gallup, 2014). Registered nurses (RNs) advocate as they contribute to care of families, individuals, communities, and populations. Care by professional nurses helps to protect, promote, and optimize health and prevent illness and injury through the diagnosis and treatment of human response (ANA, 2016). RN practice is bound by a set of rules and regulations, known as nurse practice acts, which defines practice within the scope of the profession. These practice acts require licensed professional nurses to demonstrate a minimum requisite education and/or training and competence to provide services within the scope of practice (Russell, 2012).NURSING: Interprof Org & Sys Leadership Essay

The scope of nursing practice describes the “who,” “what,” “when,” “where,” “why, and “how” of nursing practice. The scope of nursing practice describes the “who,” “what,” “when,” “where,” “why, and “how” of nursing practice. All actively licensed and advanced practiced RNs describe “who” practices nursing. The definition of nursing describes a succinct characterization of the “what” of nursing. Nursing occurs “when” there is a nursing need for leadership, advocacy, caring, knowledge, or education anywhere. The “why” considers reasons why the nursing profession has ranked number one in ethics and honesty for 16 of the past 17 years. RNs respond to the changing needs of society to achieve positive healthcare outcomes in keeping with nursing’s social contract with society. The “how” is characterized as the ways, means, and methods that RNs use to practice professionally (ANA, 2015a; ANA, 2015b).NURSING: Interprof Org & Sys Leadership Essay

… all professional nurses should be implementing evidence-based programs to support transition to practice… Guiding documents in the profession prepare nurses to lead within the professional practice setting and the profession itself. Specific competencies establish actions required of RNs to influence policy to promote health; mentor colleagues for the advancement of nursing practice and the profession; encourage innovation in practice and role performance; and influence decision-making. Individual RNs must actively take responsibility to seek opportunities for developing leadership skills, as recommended by the Institute of Medicine (IOM; ANA, 2015b; IOM, 2015). Opportunities must exist for RNs to lead and diffuse collaborative improvement efforts and to lead changes to advance health (IOM, 2015). As the nursing profession moves forward in the 21st century, all professional nurses should be implementing evidence-based programs to support transition to practice and creating interprofessional collaborative environments. In addition, nurses should identify optimal opportunities to provide culturally competent care for patients; minimize healthcare disparities from a nursing care perspective; and develop a workforce reflecting the communities served.NURSING: Interprof Org & Sys Leadership Essay

Barriers to Full Scope of Practice
A common reason [for barriers] is differences among and between the states in their regulatory language for RNs… Barriers related to RN practice at the full scope stem from various sources. A common reason is differences among and between the states in their regulatory language for RNs (states individually regulate practice). These differences may be subtle or obvious. In each state, there is a unique nurse practice act (NPA) which serves as the definition of professional nursing practice. The NPA is supported by a board of nursing (BON) consisting of members appointed by an elected official (governor), a legislative body, or persons elected by the population at large (Russell, 2012).NURSING: Interprof Org & Sys Leadership Essay

The restriction of nursing practice by state regulation and subsequent organizational limits are highlighted in the ANA model of professional nursing practice regulation (ANA, 2015a; Fowler 2015). Nursing practice begins with a professional statement of practice and code of ethics to support decision making, but these core professional nursing tenets are then subjected to interpretation by each state, territory, and district. They become differing scopes of practice for RNs, based solely on geographic location. State-defined scopes of practice for RNs may be further restricted at the organizational level through enactment of policy and procedure.NURSING: Interprof Org & Sys Leadership Essay

Nurse leaders must decide on a uniform scope of practice that focuses on knowledge and is grounded in evidence. Nurse leaders must decide on a uniform scope of practice that focuses on knowledge and is grounded in evidence. The growth in participation in the Nurse Licensure Compact that has grown to include 25 states represents a movement in the direction of uniformity of practice (NCSBN, 2012), yet RNs must still adhere to individual state restrictions. Essentially, a nurse traveling a short geographic distance from one state to another may have a change in scope of practice unrelated to scientific evidence or individual skill. One agency, the Department of Veterans Affairs (VA) is an exemplar in its demonstration of uniformity of practice across states. RNs may seek employment at any VA location in one of all 50 states, the District of Columbia, and Puerto Rico and maintain only one active unrestricted state license (U.S. Department of Veterans Affairs, 2012).NURSING: Interprof Org & Sys Leadership Essay

One example of interprofessional collaboration is illustrated by a joint meeting of the Virginia BON and the Board of Medicine in the 1970s (Joint Committee, 1976). This enabled RNs in the operating room to serve as surgical first assistants and enhance their clinical leadership skills, thereby foreshadowing both expanded and advanced practice pathways for RNs. Whether nurses are practicing in a hospice or a hospital, it is important to recognize not only the intellectual basis of nursing, but also the importance of the technical skills that, properly managed and employed, make a significant impact on patient outcomes.NURSING: Interprof Org & Sys Leadership Essay

Differences in the entry level of RN practice and the related educational preparation (e.g., diploma, associate degree, or BSN) to become an RN are also relevant to any discussion of barriers concerning scope of practice. Educational curriculum and education accreditation criteria must focus on a knowledge-based scope of practice based on baccalaureate level preparation. Nursing leaders must be the ones to define professional scope of practice for those RNs graduating from an academic, knowledge-based, educational program.NURSING: Interprof Org & Sys Leadership Essay

RNs must be in key organizational leadership and decision-making roles to reduce restrictions to nursing practice. The nursing profession scope of practice should address RNs as team leaders and focus on nursing as a holistic clinical discipline (Folan et al., 2012). RNs must be in key organizational leadership and decision-making roles to reduce restrictions to nursing practice. Organizational leadership includes practice-based organizations (e.g., healthcare), federal entities (e.g., Centers for Medicare & Medicaid Services [CMS]), and private insurers. Organizational limits to nursing practice place unnecessary restrictions on RNs and limit availability of innovative and creative solutions to many of the problems encountered, understood, and resolved by RNs on a daily basis. However, before nurses can serve in leadership roles, they must achieve a successful transition to practice.NURSING: Interprof Org & Sys Leadership Essay

Transition to Practice
Socialization of nursing students is important to prepare graduates for interacting with a variety of professional and nonprofessional individuals in the healthcare setting. Socialization of nursing students is important to prepare graduates for interacting with a variety of professional and nonprofessional individuals in the healthcare setting. However, the emphasis in nursing education must alter from largely socialization among nurses to formation of professional nurses collaborating with others; specifically, from imitating or copying past practices to being a reformed process of interprofessional collaboration. Using dated approaches to nursing education and failure to adopt approaches when evidence has demonstrated significant successes is a barrier to achieving the goal of interprofessional collaboration (Benner, Sutphen, Leonard, & Day, 2010).NURSING: Interprof Org & Sys Leadership Essay

The majority of healthcare disciplines are educated at the baccalaureate level or higher. A 2-year curriculum, no matter how exemplary (and many are) cannot teach all components needed to prepare RNs to assume needed leadership positions. Over 50% of new RN graduates in the United States are prepared at the diploma or associate-degree level (Raines & Taglaireni, 2008) Integration into pre-practice level educational courses with other providers (e.g., social workers, medical or pharmacy students) is difficult, as students in such disciplines are not educated at community college campuses (American Association of Colleges of Nursing [AACN], 2008, n.d; Benner et al., 2010). The variety in nursing educational pathways for licensure contributes to graduates with diverse competencies. Because of this educational diversity, new graduates arrive at the workplace with widely differing abilities and skills that create additional challenges in the workplace.

Transition Programs
There are a variety of transition to practice programs, with several basic considerations integral to all programs. One important consideration is reflected in the Dreyfus’ Model of Skill Acquisition (Dreyfus, 1982). Benner (2001) adapted and applied this model to her concept of contextual learning. According to this model, a new graduate transitions from advanced beginner to competent practitioner, which enables the nurse to acquire:NURSING: Interprof Org & Sys Leadership Essay

Improved organizational ability and technical skills
Greater focus on managing the patient condition as opposed to accomplishing “tasks”
Ability to identify significant clinical signs and symptoms
Movement toward involvement and responsibility
…a successful transition to practice has important benefits to patients and families. The American Organization of Nurse Executives (AONE; 2010) guiding principles address the role of preceptors, mentors, and coaches. These principles emphasize that a successful transition to practice has important benefits to patients and families. The AONE guiding principles note that commitment to transition of newly licensed nurses into practice occurs across all organizational levels, including senior leadership and nursing leadership.NURSING: Interprof Org & Sys Leadership Essay

New graduate transition programs have been developed in response to beliefs that new graduate nurses were ill prepared for practice in the highly acute, complex, and rapid-paced hospital environment where most nurses are employed (Culley et al., 2012; Lofmark, Smide, & Wikblad, 2006). Health systems were further motivated by costs related to high turnover rates for new graduate nurses in the first two years of employment (Hayes et al., 2012; Trepanier, Early, Ulrich, & Cherry, 2012).

Transition programs build upon traditional orientation programs, which last from three days to six weeks (Theisen & Sandau, 2013). Traditional orientation focuses on skill acquisition, information systems, and specific organizational routines and policies. Retention, organizational, and individual outcomes from these traditional programs are often compared to outcomes of more comprehensive transition programs. Three specific examples of expanded transition programs are described below.NURSING: Interprof Org & Sys Leadership Essay

Nurse residency. National healthcare thought leaders called for the implementation of nurse residencies to reduce new nurse stress, practice errors, and turnover (Benner et al., 2010; IOM, 2011; Joint Commission, 2002). However, existing programs vary in content, length, and other essential elements (Barnett, Minnick, & Norman, 2014; Spector et al., 2015). Adoption of residency programs by health systems has been slow, although there is evidence that the rate of uptake is increasing (AACN, 2008). According to the National Council of State Boards of Nursing (NCSBN, 2014), it is the responsibility of healthcare systems to assure new RNs have experiential learning in the specialties where they are employed. Thus, customized transition programs are required based on practice specialty.NURSING: Interprof Org & Sys Leadership Essay

Recent efforts by health systems and academic stakeholders have produced evidence-based, programmatic transition programs. Recent efforts by health systems and academic stakeholders have produced evidence-based, programmatic transition programs. The University Health System Consortium (UHC) and American Association of Colleges of Nursing (AACN) Nurse Residency Program, Transition to Practice (TTP), was developed collaboratively by academic medical centers and baccalaureate schools of nursing (University HealthSystem Consortium [UHC], 2008). With funding from the Robert Wood Johnson Foundation (RWJF), a comprehensive evaluation plan was implemented to identify outcomes of the first two program phases. Program outcomes demonstrated positive improvements on retention rates, nurse confidence, competence, organization, prioritization, communication, leadership, and decreased perceived stress (UHC, 2008). The UHC/AACN team also developed a set of standards for accreditation of post-BSN nursing residencies. Accreditation is a criterion for reimbursement of residency costs by CMS. Furthermore, standards and accreditation are critical mechanisms for improving residency rigor and standardization.NURSING: Interprof Org & Sys Leadership Essay

Both TTP and established programs resulted in new graduates having higher overall competence, less stress, more job satisfaction, and fewer turnovers (Spector et al., 2015). In the limited programs, new graduates were more likely to report higher job stress and less job satisfaction, and were twice as likely to leave their position within the first two years of practice (NCSBN, 2014).NURSING: Interprof Org & Sys Leadership Essay

NCSBN (2014) offers a TTP toolkit that includes the following e-learning modules: patient-centered care; communication and teamwork; evidence-based practice; quality improvement; informatics; and preceptor training. Another program with goals similar to those of the TTP of UHC/AACN was developed by the Department of Veteran Affairs, Veterans Health Administration (VHA, 2011). The VHA designed a 12-month residency program with goals similar to the UHC/AACN program. The VHA also formulated strategies to combat the high cost of new RN turnover. Teaching methodologies included classroom education, preceptor clinical experiences, monthly meetings, group clinical debriefings, one-on-one mentoring, and an evidence-based project (VHA, 2011). The VHA pilot resulted in a 100% retention rate across facilities and formed the basis for a national launch. Reviews found that programs were effective when they spanned the first year of practice. Preceptorship was highlighted as an important component of program success (Spector et al., 2015).NURSING: Interprof Org & Sys Leadership Essay

…barriers can exist when RNs who might serve as preceptors come from different educational backgrounds. Preceptorship. Preceptorships have been a common transition program for new RN staff. Despite frequent use of preceptors, and evidence that this model provides an important component of success (Spector et al., 2015), challenges still exist for both new staff RNs and preceptors. For example, barriers can exist when RNs who might serve as preceptors come from different educational backgrounds. Expecting clinical RNs to have the competencies of skilled educators may not be a reality (Hautala, Saylor, & O’Leary-Kelley, 2007).NURSING: Interprof Org & Sys Leadership Essay

Student nurse externship. Nurse externships allow nursing students an opportunity to experience real-world clinical practice over a 3 to 12-week period using a nurse preceptor-student model (Friday, Zoller, Hollerbach, Jones, & Knofczynski, 2015). The major goals are to attract student nurses for employment upon graduation, reduce costs for employee recruitment, and improve new graduate nurse performance and retention. However, outcomes have been mixed. Both retention and professional satisfaction of new graduate nurses who participated in externships were slightly improved over nonparticipants in several studies (Cantrell & Browne, 2006; Friday et al., 2015; Steen, Gould, Raingruber, & Hill, 2011), although in one study, 2-year retention was markedly less than that of new graduates who participated in residency or preceptor programs (Salt, Cummings, & Profestto-McGrath, 2008). Numerous studies have indicated minimal or no improvement in ease of transition to practice, professionalism, and job performance in new graduate nurses who completed externship programs (Cantrell & Browne, 2006; Friday et al., 2015; Steen et al., 2011).NURSING: Interprof Org & Sys Leadership Essay

…continued attention to program development can provide experiences to maximize opportunities for interprofessional collaboration to create strong nurse leaders at every level of care. In sum, several transition to practice programs have been in place and have demonstrated some positive outcomes. However, continued attention to program development can provide experiences to maximize opportunities for interprofessional collaboration to create strong nurse leaders at every level of care.NURSING: Interprof Org & Sys Leadership Essay

Healthy Work Environments for Nursing Practice
A healthy work environment is one that is safe, empowering, and satisfying. It is not merely the absence of real and perceived physical or emotional threats to health, but a place of physical, mental, and social well-being, supporting optimal health and safety. Healthcare workers have a fivefold risk of experiencing workplace violence when compared to the overall workforce (National Institute for Occupational Safety and Health, 2013). The presence of overt and covert workplace violence, bullying, and incivility significantly impacts both the individual nurse and the overall work environment, including increased time away from work, higher turnover rates among RNs and other team members, and suboptimal patient outcomes.NURSING: Interprof Org & Sys Leadership Essay

…all leaders, managers, healthcare workers, and ancillary staff have responsibility as part of the interprofessional team to perform with a sense of professionalism, accountability, transparency, involvement, efficiency, and effectiveness. A culture of safety is paramount and must include everyone, including those who are transitioning into practice. In such a culture, all leaders, managers, healthcare workers, and ancillary staff have responsibility as part of the interprofessional team to perform with a sense of professionalism, accountability, transparency, involvement, efficiency, and effectiveness.NURSING: Interprof Org & Sys Leadership Essay All must be mindful of the health and safety of both the healthcare consumer and the healthcare worker in any setting providing care, offering a sense of safety, respect, and empowerment to and for all persons (ANA, 2015a). To do this with intent, genuine interprofessional collaboration that includes all levels of nursing practice must be evident in daily interactions. In the next section, we will consider opportunities for interprofessional collaboration specifically as they might apply to barriers to full RN scope of practice.NURSING: Interprof Org & Sys Leadership Essay

Opportunities for Interprofessional Collaboration
The landmark report, The Future of Nursing: Leading Change, Advancing Health (IOM, 2011), focused on the rapid changes occurring in healthcare and the critical role of RNs in developing policy, implementing changes, providing and coordinating patient care, and measuring healthcare improvements.NURSING: Interprof Org & Sys Leadership Essay

After the release of the 2011 IOM report, the Robert Wood Johnson Foundation (RWJF), in collaboration with Campaign for Action (2015), initiated a campaign to assist in the explication and implementation of the report recommendations. The RWJF also asked the IOM to examine changes and progress made after releasing of their report. The followup report (IOM, 2015) illustrated both significant progress and additional considerations for further study.NURSING: Interprof Org & Sys Leadership Essay

AACN, along with five other organizations, established the Interprofessional Education Collaborative (IPEC), which is committed to advancing interprofessional learning experiences and promoting team-based care. The IPEC mission is to ensure the current and new health professionals are proficient in competencies for community-oriented and population-oriented, patient-centered, collaborative, interprofessional practice (Interprofessional Education Collaborative, 2016).NURSING: Interprof Org & Sys Leadership Essay

In both the 2011 and 2015 IOM reports, considerable focus was placed on the importance of interprofessional collaboration and the valuable abilities of RNs to collaborate with patients, other clinicians, educators, and researchers. Targeted areas recommended for greater attention included:NURSING: Interprof Org & Sys Leadership Essay

Removing barriers to practice and care
Transforming education
Collaborating and leading
Promoting diversity
Improving data
Removing Barriers to Practice and Care
…collaborative practice models are not limited to APRNs… Although much emphasis in the IOM 2011 report focused on advanced practice registered nurses (APRNs), collaborative practice models are not limited to APRNs, and the IOM stresses that “all health professionals” (IOM, 2015, p. 2) can improve both quality and satisfaction. An associated recommendation stresses the importance of working with other colleagues and groups (e.g., policy makers, elected officials, professional organizations, and community groups). Engaging colleagues and assisting them to understand the benefits of expanding RNs’ scope of practice supports greater opportunities for RNs to initiate and lead innovative improvements in healthcare.NURSING: Interprof Org & Sys Leadership Essay

Transforming Education
Encouraging lifelong learning and obtaining higher levels of education were critical recommendations of the future of nursing report (IOM, 2011). Additionally, the complexity of the evolving healthcare system necessitates learning about new systems and procedures and incorporating new information and knowledge into the practice arena. RNs seeking to expand their education can benefit from programs that support not only obtaining a BSN but also eventually pursuing masters and doctoral degrees.NURSING: Interprof Org & Sys Leadership Essay

Nurse residency programs are designed to build on baccalaureate education. General goals of residency programs (Barnett et al., 2014; Spector et al., 2015) include:

Reduce medication errors
Minimize turnover and stress-induced burnout
Ease adjustment into clinical practice
Improve job satisfaction
Increase nurse confidence
Improve critical thinking
Develop care coordination and patient-centered care competencies and models
In this section we discuss several themes related to the IOM call (2011; 2015) for interprofessional collaboration skills for all RNs to further enhance full scope of practice.NURSING: Interprof Org & Sys Leadership Essay

Collaboration and Leadership
RNs provide a broad and deep knowledge and experience related to needs of healthcare systems in general, and patients in particular. RNs interact with physicians, nurse colleagues, technologists, administrators, researchers, regulators, accrediting representatives, and others who have an impact on patient and community outcomes.NURSING: Interprof Org & Sys Leadership Essay In addition to interacting with others within the healthcare system, RNs contribute to the development, implementation, and ongoing improvements in processes and products such as telenursing (e.g., e-ICUs) and electronic health records (EHRs). Connecting with influential leaders, expanding colleague networks (in both the work setting and national arena), being a good listener, clearly articulating idea(s), earning others’ trust (i.e., being accountable, keeping promises, and respecting confidences), and empowering others are some recommendations described by Sherman (2015) to boost individual level RN scope of influence.NURSING: Interprof Org & Sys Leadership Essay

Trossman (2015) described the importance of collaboration to develop an EHR. In addition to clinical colleagues, RNs work with information technologists, vendors, and nurse informaticists to develop a health record that promotes accurate documentation, and contributes significantly to greater ease and efficiency to document RN care. For example, a nurse informaticist observing RN documentation processes identified a variety of complicated and unnecessary steps: numerous mouse clicks, scrolling through multiple computer screens, a prolonged period of documentation, and documentation of information largely of use to other departments rather than patients under the nurse’s care.NURSING: Interprof Org & Sys Leadership Essay

Strong, collaborative interprofessional teams enable members to embrace patient care policies and protocols that are team-based and patient-centered. Strong, collaborative interprofessional teams enable members to embrace patient care policies and protocols that are team-based and patient-centered. RNs are excellent coordinators able to interact effectively with an intellectually diverse population of physicians, technologists, administrators, patients, and family members. This ability to RNs can be excellent coordinators able to interact effectively with an intellectually diverse population of physicians; technologists; administrators; patients and family members. This ability to communicate with individuals from various backgrounds, with different goals and responsibilities, is especially valuable within the complex healthcare environment.NURSING: Interprof Org & Sys Leadership Essay

Collaborative efforts between RNs and physicians at multiple levels… can offer additional opportunities for RNs to lead and influence process improvement and improved outcomes. Collaborative efforts between RNs and physicians at multiple levels (e.g., national, regional, local patient setting) can offer additional opportunities for RNs to lead and influence process improvement and improved outcomes. Whether professional organizational representatives from nursing (e.g., ANA) or medicine (e.g., American Medical Association) or academic partnerships between and among different schools, creators of policy initiatives can feature and incorporate contributions of RNs (AONE, 2012). The AONE (2012) and AACN (n.d.) developed guiding principles for academic/practice partnerships. Such relationships, whether illustrated by RNs serving on boards of directors, governmental committees, insurance companies, and/or advisory boards, can play an important role in effectively and successfully redesigning healthcare, revising payer systems, and reducing barriers that prevent RNs from working to the optimal level of their education (IOM, 2011, 2015).NURSING: Interprof Org & Sys Leadership Essay

Diversity and Culturally Competent Care
The IOM 2011 report and 2015 update noted that greater diversity among healthcare professionals (e.g., clinicians, educators, administrators, researchers) is important to reflect growing community cultural, religious, and racial diversity. Changing population demographics require reassessment and revisions to care protocols in order to meet optimal individual (and family) needs for care. These population changes necessitate diversity of ideas and illustrate the duty of caregivers to engage in lifelong learning about evolving patient care needs. Maintaining competence and professional growth is an important component of the ANA Code of Ethics for Nurses (ANA, 2015a). By virtue of direct exposure to diverse populations, RNs are suited to lead initiatives that improve care through patient-centric policies and procedures.NURSING: Interprof Org & Sys Leadership Essay

To ensure that nurses are well prepared for the diversity of population health, new standards of professional nursing practice and competencies were developed to reflect a dynamic profession and nursing practice. A new standard of culturally congruent practice was added to the Nursing: Scope and Standards of Practice (2015b) further delineating the role of the RN related to cultural diversity and inclusion principles and practice competencies (Marion, in press).NURSING: Interprof Org & Sys Leadership Essay This standard is vital both now and in future times of social change, as the number of culturally and ethnically diverse consumers increases. The new standard 8 sets the criteria for the registered nurse’s educational, legal, and societal accountability. While extensive discussion about Standard 8 is beyond the scope of this article. However, changes resulting from the revision of it will both enhance the scope of RN practice and increase opportunities for interprofessional collaboration via team leadership for all RNs in areas related to education, self-assessment, provision of care, and policy.NURSING: Interprof Org & Sys Leadership Essay

Data Collection and Improvement
It is difficult to initiate any proposed change in the absence of supporting evidence. According to the IOM (2015), considerable information is missing about health professionals, such as the number and type; practice roles; skill mix distribution throughout the healthcare system; optimal educational preparation; effect on patient outcomes; and impact on cost and efficiency. This creates a great need for additional research to support the operationalization of practice at the full RN scope. RNs, and their professional colleagues, are encouraged to work toward creating strong databases that can guide changes, measure RN impact, and monitor RN roles in the workforce. With the ability to access partner organizations and association databases, researchers and policy planners may have other extensive sources of information that can be employed to create new programs and initiatives.NURSING: Interprof Org & Sys Leadership Essay

Conclusion and Recommendations
The IOM has offered a clear and strong case for the collaborative role of RNs on interprofessional teams. The IOM (2011; 2015) has offered a clear and strong case for the collaborative role of RNs on interprofessional teams. This article has considered interprofessional collaboration as it relates to RN scope of practice, including discussion of both barriers and opportunities for interprofessional collaboration to address them. The authors, all members of the ANA Panel, Barriers to RN Scope of Practice, conclude by offering a summary of barriers to three important areas discussed (see Table): transition to practice, interprofessional environments, and culturally competent care. The recommendations will hopefully enhance collaborative efforts and highlight potential RN driven innovative and evidence-based strategies.NURSING: Interprof Org & Sys Leadership Essay

Table. Barriers and Recommendations for Enhancing Interprofessional Collaboration

BARRIERS

RECOMMENDATIONS

Barriers to evidence-based programs that support transitions to practice:

Insufficient residency programs
Lack of employer accountability for collaborative academic-practice programs
Insufficient research investment
Challenges to implementation of BSN-level education
Recommendations for evidence-based programs to support transitions to practice:NURSING: Interprof Org & Sys Leadership Essay

Establish a shared commitment for evidence-based programs that are sustainable and cost effective via the collaborative development, implementation, and evaluation of nurse residency programs.
Hold employers accountable to develop and evaluate transition programs in collaboration with academic partners.
Support employers and academic partners to invest in research about transition program designs that includes data related to return on investment (ROI).NURSING: Interprof Org & Sys Leadership Essay
Encourage employers to require BSN-level education as a minimum credential for preceptors.
Solicit funding to support BSN level education.
Barriers to culturally competent care:

Lack of cultural diversity
Insufficient recruitment efforts to achieve diverse workforce
Cultural, religious, and racial preferences not respected or understood
Desired workforce attributes no not include community diversity
Nurse-led initiatives for culturally competent care:

RNs create an environment and practice in a manner congruent with cultural diversity and inclusion principles.
Leaders in academia work to recruit diverse students to achieve a multicultural workforce and develop curricula to promote cultural competence.NURSING: Interprof Org & Sys Leadership Essay
RNs promote policies and organizational culture that ensures that cultural, religious, and racial preferences of patients, families and RNs are respected and incorporated into the plan of care.
Employers of nurses should invest in the development of a workforce that reflects the community they serve.
Barriers to effective interprofessional environments:

Little or no reflection of interprofessional practice in academic and practice models
Few nurse-designed collaborative models
Limited access to workforce data
Recommendations for creating/enhancing interprofessional environments:

Leaders in academia and practice should develop and test effective interprofessional practice collaborative models.
Nurses should drive and engage in research to develop and test interprofessional practice and academic collaborative models.
Establish a shared commitment to create infrastructures to collect and analyze data on current and future needs of the RN workforce.
Identify useful workforce data and consider joint collection and analysis of workforce and education data.NURSING: Interprof Org & Sys Leadership Essay
(AONE, 2010, 2012; Marion, in press).

Recommendations listed in the Table are not an exhaustive list of the next steps. Rather, we hope to begin dialogue for the future of nursing related to nurses as interprofessional collaborative partners, especially in the context of enhancing RN scope of practice. Findings from the work of the ANA Panel suggest that three major goals for the nursing profession related to this topic should be: implementing evidence-based programs to support transition to practice; caring for patients in a culturally competent way to help minimize healthcare disparities from a nursing care perspective; and creating supportive, interprofessional collaborative environments. Achieving these goals will require a genuine, collaborative effort among academia, practice, and healthcare partner professionals from multiple disciplines who provide care for the patients they serve.NURSING: Interprof Org & Sys Leadership Essay

Acknowledgement
Portions of the research for this article were performed by an American Nurses Association (ANA) Professional Issues Panel entitled “Barriers to RN Scope of Practice.” The panel was composed of volunteers from a variety of nursing backgrounds who contributed through participation on the Panel’s Steering Committee and Advisory Committee. While the articles were generated by authors participating in a Professional Issues Panel convened by ANA, the conclusions and recommendations articulated by any author do not necessarily reflect those of the Association.NURSING: Interprof Org & Sys Leadership Essay

Authors
Edtrina Moss, MSN, RN-BC, NE-BC
Email: edtrina@comcast.net

Edtrina Moss has more than 18 years of nursing experience and expertise in dialysis, transplant, critical care, ambulatory care, nursing education, care coordination, utilization management, and leadership. She has served in the roles of nurse educator, transplant coordinator, nurse manager and program director.NURSING: Interprof Org & Sys Leadership Essay She is a member of the Texas Nurses’ Association Policy Council and serves as content expert reviewer for the American Academy of Ambulatory Care Nursing’s Care Coordination & Transition Management curriculum and certification. She is also a student at Texas Woman’s University – Houston Campus, where she has completed all course work for a PhD in Nursing. Her research focus is exploring differences of self-reported competence of certified and non-certified registered nurses. She is Board Certified in Ambulatory Care and a Board Certified Nurse Executive. Edtrina is employed with the Veterans Health Administration in Houston, Texas.NURSING: Interprof Org & Sys Leadership Essay

Patricia C. Seifert, MSN, RN, CNOR, FAAN
Email: seifertpc@verizon.net

Patricia C. Seifert has more than 25 years of experience as a perioperative nurse. She has been a clinical manager in cardiac surgical services and has developed four cardiac surgical programs. She has also functioned as an RN First Assistant on over 3,000 cardiac surgery procedures. Seifert is a past president of the Association of periOperative Registered Nurses (AORN), past Lead Coordinator of the Nursing Organizations Alliance, a member of Sigma Theta Tau International. She is a Fellow in the American Academy of Nursing. Seifert is the author of six books and numerous articles and chapters; she was a member of the writing group for the 2013 American Heart Association Scientific Statement: Patient Safety in the Cardiac Operating Room: Human Factors and Teamwork. She has presented educational programs locally, nationally, and internationally. Seifert has been the recipient of the Inova 2015 Ronald S. De Volder Memorial Award for participation in the Cardiac Surgery QI Team Project: “Patient Handoff from CVOR to CVICU and CVICU to CVSDU;” she also received the Inova Health System’s 2014 award for Service Excellence. Seifert has been recognized by her professional organization, AORN, receiving AORN’s first President’s Award (1991-1992), the 2003 Award of Excellence, AORN’s 2007 Jerry G. Peers Distinguished Service Award, and AORN’s 2014 Award for Mentorship.NURSING: Interprof Org & Sys Leadership Essay

Ann O’Sullivan, MSN, RN, CNE, NE-BC, ANEF
Email: aosullivan@brcn.edu

Ann O’Sullivan has 45 years of experience in nursing, including critical care, Clinical Nurse Specialist, Director of Nursing, and associate professor, and currently serves as Assistant Dean for Support Services at Blessing-Rieman College of Nursing and Health Sciences in Quincy, IL. Ann has served in many roles in the American Nurses Association, including state Board of Directors and President, chair of Health Policy, chair of Assembly Nursing Practice, and many others. She is currently Vice-President of ANA-Illinois and chairs the Illinois Expert Panel of Scope of Practice. At the national level, Ann served as chair of the Reference Committee, member and vice-chair of the Congress of Nursing Practice and Economics. Ann chaired the workgroup that revised the 2010 ANA Scope and Standards of Practice and was co-editor of Essential Guide to Nursing Practice (2012). Ann has also served in leadership roles in Sigma Theta Tau, Pi chapter, Illinois Organization of Nurse Leaders and the steering committee for the revision of the Illinois Nurse Practice Act. She is a Certified Nurse Educator and Certified Nurse Executive. Ann was inducted as a Fellow in the Academy of Nurse Educators. She has been awarded the Nurse Educator Award and Anne Zimmerman Honorary Member Award by the Illinois Nurses Association.NURSING: Interprof Org & Sys Leadership Essay

Strong leadership is critical if the vision of a transformed health care system is to be realized. Yet not all nurses begin their career with thoughts of becoming a leader. The nursing profession must produce leaders throughout the health care system, from the bedside to the boardroom, who can serve as full partners with other health professionals and be accountable for their own contributions to delivering high-quality care while working collaboratively with leaders from other health professions.NURSING: Interprof Org & Sys Leadership Essay

In addition to changes in nursing practice and education, discussed in Chapters 3 and 4, respectively, strong leadership will be required to realize the vision of a transformed health care system. Although the public is not used to viewing nurses as leaders, and not all nurses begin their career with thoughts of becoming a leader, all nurses must be leaders in the design, implementation, and evaluation of, as well as advocacy for, the ongoing reforms to the system that will be needed. Additionally, nurses will need leadership skills and competencies to act as full partners with physicians and other health professionals in redesign and

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reform efforts across the health care system. Nursing research and practice must continue to identify and develop evidence-based improvements to care, and these improvements must be tested and adopted through policy changes across the health care system. Nursing leaders must translate new research findings to the practice environment and into nursing education and from nursing education into practice and policy.NURSING: Interprof Org & Sys Leadership Essay

Being a full partner transcends all levels of the nursing profession and requires leadership skills and competencies that must be applied both within the profession and in collaboration with other health professionals. In care environments, being a full partner involves taking responsibility for identifying problems and areas of waste, devising and implementing a plan for improvement, tracking improvement over time, and making necessary adjustments to realize established goals. Serving as strong patient advocates, nurses must be involved in decision making about how to improve the delivery of care.NURSING: Interprof Org & Sys Leadership Essay

Being a full partner translates more broadly to the health policy arena. To be effective in reconceptualized roles and to be seen and accepted as leaders, nurses must see policy as something they can shape and develop rather than something that happens to them, whether at the local organizational level or the national level. They must speak the language of policy and engage in the political process effectively, and work cohesively as a profession. Nurses should have a voice in health policy decision making, as well as being engaged in implementation efforts related to health care reform. Nurses also should serve actively on advisory committees, commissions, and boards where policy decisions are made to advance health systems to improve patient care. Nurses must build new partnerships with other clinicians, business owners, philanthropists, elected officials, and the public to help realize these improvements.NURSING: Interprof Org & Sys Leadership Essay

This chapter focuses on key message #3 set forth in Chapter 1: Nurses should be full partners, with physicians and other health professionals, in redesigning health care in the United States. The chapter begins by considering the new style of leadership that is needed. It then issues a call to nurses to respond to the challenge. The third section describes three avenues—leadership programs for nurses, mentorship, and involvement in the policy-making process—through which that call can be answered. The chapter then issues a call for new partnerships to tap the full potential of nurses to serve as leaders in the health care system. The final section presents the committee’s conclusions regarding the need to transform leadership in the nursing profession.NURSING: Interprof Org & Sys Leadership Essay

A NEW STYLE OF LEADERSHIP
Those involved in the health care system—nurses, physicians, patients, and others—play increasingly interdependent roles. Problems arise every day that do not have easy or singular solutions. Leaders who merely give directions and expect them to be followed will not succeed in this environment. What is needed is

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a style of leadership that involves working with others as full partners in a context of mutual respect and collaboration. This leadership style has been associated with improved patient outcomes, a reduction in medical errors, and less staff turnover (Gardner, 2005; Joint Commission, 2008; Pearson et al., 2007). It may also reduce the amount of workplace bullying and disruptive behavior, which remains a problem in the health care field (Joint Commission, 2008; Olender-Russo, 2009; Rosenstein and O’Daniel, 2008). Yet while the benefits of collaboration among health professionals have repeatedly been documented with respect to improved patient outcomes, reduced lengths of hospital stay, cost savings, increased job satisfaction and retention among nurses, and improved teamwork, interprofessional collaboration frequently is not the norm in the health care field. Changing this culture will not be easy.NURSING: Interprof Org & Sys Leadership Essay

The new style of leadership that is needed flows in all directions at all levels. Everyone from the bedside to the boardroom must engage colleagues, subordinates, and executives so that together they can identify and achieve common goals (Bradford and Cohen, 1998). All members of the health care team must share in the collaborative management of their practice. Physicians, nurses, and other health professionals must work together to break down the walls of hierarchal silos and hold each other accountable for improving quality and decreasing preventable adverse events and medication errors. All must display the capacity to adapt to the continually evolving dynamics of the health care system.NURSING: Interprof Org & Sys Leadership Essay

Leadership Competencies
Nurses at all levels need strong leadership skills to contribute to patient safety and quality of care. Yet their history as a profession dominated by females can make it easier for policy makers, other health professionals, and the public to view nurses as “functional doers”—those who carry out the instructions of others—rather than “thoughtful strategists”—those who are informed decision makers and whose independent actions are based on education, evidence, and experience. A 2009 Gallup poll of more than 1,500 national opinion leaders,1 “Nursing Leadership from Bedside to Boardroom: Opinion Leaders’ Perceptions,” identified nurses as “one of the most trusted sources of health information” (see Box 5-1) (RWJF, 2010a). The Gallup poll also identified nurses as the health professionals that should have greater influence than they currently do in the critical areas of quality of patient care and safety.NURSING: Interprof Org & Sys Leadership Essay The leaders surveyed believed that major obstacles prevent nurses from being more influential in health policy decision making. These findings have crucial implications for front-line nurses,

1

Gallup research staff—Richard Blizzard, Christopher Khoury, and Coleen McMurray—conducted telephone surveys with 1,504 individuals, including university faculty, insurance executives, corporate executives, health services leaders, government leaders, and industry thought leaders.NURSING: Interprof Org & Sys Leadership Essay

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Suggested Citation:”5 Transforming Leadership.” Institute of Medicine. 2011. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press. doi: 10.17226/12956. ×
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BOX 5-1

Results of Gallup Poll “Nursing Leadership from Bedside to Boardroom: Opinion Leaders’ Perceptions”

Opinion leaders rate doctors and nurses first and second among a list of options for trusted information about health and health care.

Opinion leaders perceive patients and nurses as having the least amount of influence on health care reform in the next 5–1 years.

Reducing medical errors, increasing quality of care, and promoting wellness top the list of areas in which large majorities of opinion leaders would like nurses to have more influence.NURSING: Interprof Org & Sys Leadership Essay

Relatively few opinion leaders say nurses currently have a great deal of influence on increasing access to care, including primary care.

Opinion leaders identified top barriers to nurses’ increased influence and leadership as not being perceived as important decision makers or revenue generators compared with doctors, having a focus on acute rather than preventive care, and not having a single voice on national issues.

Opinion leaders’ suggestions for nurses to take on more of a leadership role were making their voices heard and having higher expectations.

SOURCE: RWJF, 2010a.

who possess critical knowledge and awareness of the patient, family, and community but do not speak up as often as they should.NURSING: Interprof Org & Sys Leadership Essay

To be more effective leaders and full partners, nurses need to possess two critical sets of competencies: a common set that can serve as the foundation for any leadership opportunity and a more specific set tailored to a particular context, time, and place. The former set includes, among others, knowledge of the care delivery system, how to work in teams, how to collaborate effectively within and across disciplines, the basic tenets of ethical care, how to be an effective patient advocate, theories of innovation, and the foundations for quality and safety improvement. These competencies also are recommended by the American Association of Colleges of Nursing as essential for baccalaureate programs (AACN, 2008). Leadership competencies recommended by the National League for Nursing and National League for Nursing Accrediting Commission are being revised to reflect similar principles. More specific competencies might include learning how to be a full partner in a health team in which members from various professions hold each other accountable for improving quality and decreasing preventable adverse events and medication errors. Additionally, nurses who are interested in pursuing entrepreneurial and business development opportunities need competencies in such areas as economics and market forces, regulatory frameworks, and financing policy.NURSING: Interprof Org & Sys Leadership Essay

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Leadership in a Collaborative Environment
As noted in Chapter 1, a growing body of research has begun to highlight the potential for collaboration among teams of diverse individuals from different professions (Paulus and Nijstad, 2003; Pisano and Verganti, 2008; Singh and Fleming, 2010; Wuchty et al., 2007). Practitioners and organizational leaders alike have declared that collaboration is a key strategy for improving problem solving and achieving innovation in health care. Two nursing researchers who have studied collaboration among health professionals define it as

a communication process that fosters innovation and advanced problem solving among people who are of different disciplines, organizational ranks, or institutional settings [and who] band together for advanced problem solving [in order to] discern innovative solutions without regard to discipline, rank, or institutional affiliation [and to] enact change based on a higher standard of care or organizational outcomes. (Kinnaman and Bleich, 2004)

Much of what is called collaboration is more likely cooperation or coordination of care. Katzenbach and Smith (1993) argue that truly collaborative teams differ from high-functioning groups that have a defined leader and a set direction, but in which the dynamics of true teamwork are absent. The case study presented in Box 5-2 illustrates just how important it is for health professionals to work in teams to ensure that care is accessible and patient centered.NURSING: Interprof Org & Sys Leadership Essay

Leadership at Every Level
Leadership from nurses is needed at every level and across all settings. Although collaboration is generally a laudable goal, there are many times when nurses, for the sake of delivering exceptional patient and family care, must step into an advocate role with a singular voice. At the same time, effective leadership also requires recognition of situations in which it is more important to mediate, collaborate, or follow others who are acting in leadership roles. Nurses must understand that their leadership is as important to providing quality care as is their technical ability to deliver care at the bedside in a safe and effective manner.NURSING: Interprof Org & Sys Leadership Essay They must lead in improving work processes on the front lines; creating new integrated practice models; working with others, from organizational policy makers to state legislators, to craft practice policy and legislation that allows nurses to work to their fullest capacity; leading curriculum changes to prepare the nursing workforce to meet community and patient needs; translating and applying research findings into practice and developing functional models of care; and serving on institutional and policy-making boards where critical decisions affecting patients are made.NURSING: Interprof Org & Sys Leadership Essay

Leadership in care delivery is particularly important in community and

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BOX 5-2

Case Study: Arkansas Aging Initiative

A Statewide Program Uses Interprofessional Teams to Improve Access to Care for Older Arkansans

Bonnie Sturgeon was an independent 80-year-old in 2005 when shortness of breath began to slow her down. She had been living on her own for decades, driving herself to church and singing in the choir. She went to the Christus St. Michael Health System in Texarkana, Texas, her home town, for a diagnostic workup. There she met Amyleigh Overton-McCoy, PhD, GNP-BC, RN, a geriatrics nurse practitioner with the Arkansas Aging Initiative (AAI).

“When I first went to see Amyleigh, I was there an hour or more,” Ms. Sturgeon said. “She asked me every question she could think of, and I wondered how many questions could be asked?” But the intensive interviewing and testing revealed that she had three blocked arteries and had experienced a heart attack. Ms. Sturgeon was scheduled for a triple coronary artery bypass grafting procedure. Five years later, she credits Ms. Overton-McCoy with saving her life. “I’ve not ever been in her office that she hasn’t gone over the past visit, what progress I made, and if I’ve had any new problems, even the smallest thing.”

Patient centeredness, meticulous diagnostics, and wise counsel represent the kind of nursing that might provide a textbook definition of holistic care. This is the kind of care older Arkansans have been receiving since state voters passed the Tobacco Settlement Proceeds Act of 2000, which ordered that state monies from the Tobacco Master Settlement Agreement go toward health care initiatives, including the AAI.

This is not about making somebody live to be 100 or 110. This is about quality of life. You can make the end [of life] as great as the beginning. That’s my job.NURSING: Interprof Org & Sys Leadership Essay

—Amyleigh Overton-McCoy, PhD, GNP-BC, RN, geriatrics nurse practitioner and education director, Texarkana Regional Center on Aging, Texarkana, Texas

Affiliated with the Donald W. Reynolds Institute on Aging at the University of Arkansas for Medical Sciences (UAMS) in Little Rock, the AAI has two direct service components. 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.NURSING: Interprof Org & Sys Leadership Essay

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The AAI’s director, Claudia J. Beverly, PhD, RN, FAAN, said that these two components are funded separately but go hand in hand in practice. 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.NURSING: Interprof Org & Sys Leadership Essay

Almost all older Arkansans can now access interprofessional geriatric care within an hour’s drive of their home. Patients are quite satisfied with their care and with the team approach (Beverly et al., 2007). 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.NURSING: Interprof Org & Sys Leadership Essay

Physicians at the eight sites report to Dr. Beverly, who is also director of UAMS’s Hartford Center of Geriatric Nursing Excellence, which provides some funding to the AAI. She has hired a nurse with a doctorate and a geriatrician to act as associate directors. Developing teamwork has been a priority. “This is such a beautiful case study in how nursing and medicine can work together,” she said, “and how, together, we can do good things.”NURSING: Interprof Org & Sys Leadership Essay

There have been some obstacles: primary care services are dependent upon Medicare funding, and with an annual budget of $2 million to divide among eight sites, additional revenue is needed. There also may not be enough clinicians trained in geriatrics available. And although Dr. Beverly believes that APRNs “should have their own panel of patients,” they see only returning patients at the centers. She said funding has been secured to further evaluate how best to use team members.NURSING: Interprof Org & Sys Leadership Essay

The model has continued to evolve from the first center in Northwest Arkansas that Dr. Beverly started as a Robert Wood Johnson Executive Nurse Fellow. That site is developing a program for the training of in-home caregivers, including home health aides and family members. And a new telehealth project will allow patients and clinicians to “see” a specialist electronically. “Economically, this is going to provide a huge benefit to patients,” Ms. Overton-McCoy said.NURSING: Interprof Org & Sys Leadership Essay

Nurse Amyleigh Overton-McCoy explains to Bonnie Sturgeon how to manage the common health concerns associated with aging.
Nurse Amyleigh Overton-McCoy explains to Bonnie Sturgeon how to manage the common health concerns associated with aging.

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home settings where nurses work more autonomously with patients and families than they do in the acute care setting. In community and home settings, nurses provide a direct link connecting patients, their caregivers, and other members of the health care team. Other members of the health care team may not have the time, expertise, or first-hand experience with the patient’s home environment and circumstances to understand and respond to patient and family needs. For example, a neurologist may not be able to help a caregiver of an Alzheimer’s patient understand or curtail excessive spending habits, or a surgeon may not be able to offer advice to a caregiver on ostomy care—roles that nurses are perfectly positioned to assume. 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.NURSING: Interprof Org & Sys Leadership Essay

Box 5-3 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.

A CALL FOR NURSES TO LEAD
Leadership does not occur in a social or political vacuum. As Bennis and Nanus (2003) note, the fast pace of change can be managed only if it is accompanied by leaders who can track the context of the “social architecture” to sustain and implement innovative ideas. 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.NURSING: Interprof Org & Sys Leadership Essay

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.NURSING: Interprof Org & Sys Leadership Essay

A crucial part of working within the social architecture is understanding how leadership and practice produce change over time. The nursing profession’s history includes many examples of the effect of nursing leadership on changes in systems and improvements in patient care. In the late 1940s and early 1950s, 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

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citizens who had little access to a workforce that was highly skilled or provided adequate access to health care services. Also in Florida, in the late 1950s, 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. 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 1980s, nursing research by Neville Strumpf and Lois Evans highlighted the danger of using restraints on frail elders (Evans and Strumpf, 1989; Strumpf and Evans, 1988). 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.NURSING: Interprof Org & Sys Leadership Essay

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 1975 in New York City. In 2000, she opened the Family Health and Birth Center in Washington, DC, which provides care to underserved communities (see Box 2-2 in Chapter 2). 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 network2 exists that provides networking, education and training, and coaching for nurses seeking to enter the marketplace and business.

Will Student Nurses Hear the Call?
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.NURSING: Interprof Org & Sys Leadership Essay

Moreover, students should not wait for graduation to exercise their potential for leadership. In Georgia, for example, health students came together in 2001 under the banner “Lead or Be Led” to create a student-led, interprofessional nonprofit organization that “seeks to make being active in the health community a professional habit.” Named Health Students Taking Action Together (Health-STAT), the group continues to offer workshops in political advocacy, media

2

See http://www.nurse-entrepreneur-network.com/public/main.cfm.

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BOX 5-3

Nurse Profile: Connie Hill

A Nurse Leader Extends Acute Care Nursing Beyond the Hospital Walls

It was at a 2002 meeting at Children’s Memorial Hospital in Chicago that Connie Hill, MSN, RN, reviewed the chart of a child who had been on a ventilator in her unit for 2 years. She asked her colleagues why the child had not been discharged. “It wasn’t because she was not medically stable,” Ms. Hill said recently, “but because there was a lack of community resources to support her.” Inadequate community services existed for a child with special needs in Chicago, the third-largest city in the nation? “I was dumbfounded,” she recalled. “And I said, ‘We need to start a consortium. We need to invite policy makers, state agencies, community leaders.’ And people just looked at me, like, ‘Okay, Connie. How are we going to get that started?'”

As director of 9 West, the 30-bed Allergy/Pulmonary/Transitional Care Unit, Ms. Hill persisted, and in 2004 the Consortium for Children with Complex Medical Needs was formed. The 75-member coalition of parents, clinicians, advocates, and representatives of government agencies and insurance companies meets quarterly, with the goal of “networking, education, and advocacy” on behalf of the city’s special-needs children, some of whom may be on ventilators indefinitely. 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.NURSING: Interprof Org & Sys Leadership Essay

Connie Hill, MSN, RN
Connie Hill, MSN, RN

Ms. Hill never intended to be a leader. She was working as a staff nurse at the hospital in the mid-1990s when colleagues encouraged

training, networking, and fundraising. 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, 2010). The National Student Nurses Association (NSNA), initiated in 1998, offers an online Leadership University that allows students to enhance

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her to apply for a clinical manager position in 9 West. She followed their advice, and in late 2000 when her supervisor failed to return from maternity leave, she proposed a “shared leadership model.” After a year or so during which she and two other nurses shared the directorship, Ms. 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: “I wanted to provide a venue for all nurses to have a voice.”NURSING: Interprof Org & Sys Leadership Essay

With this goal in mind, Ms. Hill decided in 2008 that 9 West would be a good fit for Transforming Care at the Bedside (TCAB), a national initiative of The Robert Wood Johnson Foundation with the Institute for Healthcare Improvement. Communication between nurses and rotating medical residents was targeted in the hospital’s quest to improve the coordination of care (Quisling, 2009). As Ms. Hill said, “It’s disheartening when you receive a patient survey and a family says, ‘The doctor said this, but then the nurse told me that.'” A procedure was created for staff nurses to provide orientations to residents, who rotate monthly among units, to foster better team communication. Residents are now more likely to confer with 9 West nurses during rounds, Ms. Hill said, increasing satisfaction among nurses, residents, patients, and families.NURSING: Interprof Org & Sys Leadership Essay

As a doctoral student at the University of Wisconsin-Milwaukee College of Nursing, Ms. Hill is examining an often neglected population: teens born with HIV, a majority of whom are African American and Hispanic. Now that many HIV-positive children survive into adulthood, they mature sexually and face the stigma attached to the infection. Ms. Hill’s study uses PhotoVoice, which involves putting cameras into the hands of HIV-positive teens and asking them for a visual answer to the question, “Where do you see yourself in five years?” “They’re writing their own story” in photographs, she said, a story they can use to raise awareness in others and to remind themselves of their own strengths.NURSING: Interprof Org & Sys Leadership Essay

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.

—Connie Hill, MSN, RN, director of a 30-bed unit at Children’s Memorial Hospital, Chicago

Ms. 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.NURSING: Interprof Org & Sys Leadership Essay

their capacity for leadership through several avenues, such as earning academic credit for participating in the university’s leadership activities and discussing leadership issues with faculty. Students work in cooperative relationships with other students from various disciplines, faculty, community organizations, and the public (Janetti, 2003). Box 5-4 profiles two student leaders, one of whom eventu-

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BOX 5-4

Nurse Profile: Kenya D. Haney and Billy A. Caceres

Building Diversity in Nursing, One Student at a Time

Despite 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.S. population but only 12 percent of the registered nurse (RN) workforce, and just 7 percent of RNs are men (AACN, 2010). And diversity matters to patients: many studies have shown that a more diverse health care workforce results in greater access to care for minority populations (IOM, 2004). 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.NURSING: Interprof Org & Sys Leadership Essay

Kenya D. Haney, RN, was a married mother of two in 2004 when she was trying to decide between nursing school and law school. She had taken classes toward a bachelor’s degree in communications and knew she would need a more flexible program. She chose the associate’s degree in nursing program at St. Louis Community College in Missouri: it offered a part-time option and child care at $2 an hour, which her educational grants covered. If the child care had not been available, she would have waited until her children were older, she said, and then “gone back to finish the communications degree and gone on to law school. There’s just not a doubt in my mind.”NURSING: Interprof Org & Sys Leadership Essay

After graduating, Ms. Haney got a job in intensive care; entered the

Kenya D. Haney, RN
Kenya D. Haney, RN

bachelor’s of science in nursing (BSN) program for RNs at the University of Missouri, St. Louis; and joined the Breakthrough to Nursing initiative at the National Student Nurses Association (NSNA). 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. Ms. Haney became its director in 2008 and NSNA president in 2009. “You know, we’re not the answer to everything,” she said

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of Breakthrough to Nursing. “But we’re there for support. Maybe we’ll just say, ‘You can do this. You’re not alone, and you really are needed.'”

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.NURSING: Interprof Org & Sys Leadership Essay

—Kenya D. Haney, RN, student, University of Missouri, St. Louis, and immediate past president, National Student Nurses Association

Billy A. Caceres, BSN, RN, already had a bachelor’s degree in politics and communications and a job in event planning for a New York City nonprofit when he made the decision to pursue a BSN. 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. He applied and was accepted to NYU’s College of Nursing in its 15-month accelerated program for students with a bachelor’s in another field. Soon he became involved in the Hartford Geriatric Nursing Institute at NYU.NURSING: Interprof Org & Sys Leadership Essay

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. “I don’t get offended,” he said. “But sometimes I think, What if nobody else was around? What would you do? I’m just trying to provide care for you.” He has just begun his first job as a hospital staff nurse, in a New York City orthopedics unit, and hopes one day to merge his interests in geriatrics and health policy, he said.NURSING: Interprof Org & Sys Leadership Essay

Both Ms. Haney and Mr. Caceres intend to pursue graduate degrees,

Billy A. Caceras, BSN, RN
Billy A. Caceras, BSN, RN

perhaps even the doctorate. If so, they will be models for a new generation: only 23 percent of students in research-focused doctoral programs in nursing are from minority backgrounds, and only 7 percent are men (AACN, 2010). Regardless, the two have taken significant steps. As Ms. Haney said, “Sometimes it’s that initial barrier of getting into nursing school that can hurt so many. 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. Basically, it’s for the patient.”

A lot of nurses get surprised that I have this interest in politics, but I think it’s okay to go into nursing as a second career.NURSING: Interprof Org & Sys Leadership Essay

—Billy A. Caceres, BSN, RN, staff nurse, New York University Langone Medical Center, New York

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ally became NSNA president; both represent as well the growing diversity of the nursing profession, a crucial need if the profession is to rise to the challenge of helping to transform the health care system (see Chapter 4).NURSING: Interprof Org & Sys Leadership Essay

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. To this end, a growing number of schools offer dual undergraduate degrees in partnership with the university’s business or engineering school for nurses interested in starting their own business or developing more useful technology. 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.NURSING: Interprof Org & Sys Leadership Essay

Will Front-Line Nurses Hear the Call?
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. NURSING: Interprof Org & Sys Leadership EssayTapping that potential will require developing a new workplace culture that encourages and supports leaders at the point of care (whether a hospital or the community) and requires all members of a health care team to hold each other accountable for the team’s performance; nurses must also be equipped with the communication, conflict resolution, and negotiating skills necessary to succeed in leadership and partnership roles. 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. If another nurse or a physician does not wash his/her hands or contaminates a sterile field, nurses must possess the basic leadership skills to remind their colleague of the protocol and stop the procedure, if necessary, until the checklist is followed. 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.NURSING: Interprof Org & Sys Leadership Essay

Will Community Nurses Hear the Call?
Nurses working in the community have long understood that to be effective in contributing to improvements in the entire community’s health, they must assume the role of social change agent. Among other things, community and public health nurses must promote immunization, good nutrition, and physical.NURSING: Interprof Org & Sys Leadership Essay

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activity; detect emergency health threats; and prevent and respond to outbreaks of communicable diseases. 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.NURSING: Interprof Org & Sys Leadership Essay

Community and public health nurses learn to expect the unexpected. For example, a school nurse alerted health authorities to the arrival of the H1N1 influenza virus in New York City in 2009 (RWJF, 2010c). 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. For example, when the town of Chehalis, south of Seattle, experienced a 100-year flood in 2007, a public health nurse called the secretary of Washington State’s Department of Health, Mary Selecky, to ask how to “deal with and dispose of dead cows, an unforeseen challenge [for] a public health nurse. The nurse knew she needed [to provide] tetanus shots and portable toilets but had not anticipated other, less common, aspects of the emergency” (IOM, 2010).NURSING: Interprof Org & Sys Leadership Essay

The profile in Box 5-5 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.

Will Chief Nursing Officers Hear the Call?
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. A 2002 survey by the American Organization of Nurse Executives (AONE) showed that 55 percent of CNOs reported directly to their institution’s CEO, compared with 60 percent in 2000. More CNOs described a direct reporting relationship to the chief operating officer instead. Such changes in reporting structure can limit nurse leaders’ involvement in decision making about the most important product of hospitals—patient care. Additionally, the AONE survey showed that most CNOs (70 percent) have seen their responsibilities increase even as they have moved down in the reporting structure (Ballein Search Partners and AONE, 2003). 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., 2008).NURSING: Interprof Org & Sys Leadership Essay

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BOX 5-5

Nurse Profile: Mary Ann Christopher

Cultivating Neighborhood Nursing at the Visiting Nurse Association of Central Jersey

At the Visiting Nurse Association of Central Jersey (VNACJ), president and chief executive officer Mary Ann Christopher, MSN, RN, FAAN, maintains a $100 million annual budget, a 4,000-patient daily census, and a 1,700-person staff. 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.NURSING: Interprof Org & Sys Leadership Essay Yet despite the size and complexity of the 98-year-old organization, Ms. Christopher’s primary objective has remained simple in her 27-year career there. “People need to know that you stand for what you say you stand for,” she said. And what the VNACJ stands for is local communities “driving” the services provided. 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.NURSING: Interprof Org & Sys Leadership Essay

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 nurse proposed that the VNACJ set up a

Mary Ann Christopher, MSN, RN, FAAN
Mary Ann Christopher, MSN, RN, FAAN

kiosk that would contain a telehealth monitor. The device would permit residents to check their weight, oxygen saturation, and blood pressure levels and automatically transmit the values to a cardiac nurse. If a patient’s indicators were outside the desired range, the nurse and patient would converse remotely, in real time, and patients needing a medica

Nurses also are underrepresented on institution and hospital boards, either their own or others. A biennial survey of hospitals and health systems conducted in 2007 by the Governance Institute found that only 0.8 percent of voting board members were CNOs, compared with 5.1 percent who were vice presidents for medical affairs (Governance Institute, 2007). More recently, a 2009 survey of

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tion adjustment would be visited. The VNACJ funded the idea, and outcomes are being monitored.

Ms. 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. After the telehealth kiosk was set up, for example, residents began paying attention to one another’s weight and blood pressure levels.NURSING: Interprof Org & Sys Leadership Essay

Ms. 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 mid-1980s by The Robert Wood Johnson Foundation and the State of New Jersey, it is now supported by local governments. The Mobile Outreach Program is the VNACJ initiative Ms. Christopher is the most proud of and the one, she said, that may be the most replicable.NURSING: Interprof Org & Sys Leadership Essay

In 1998 the Balanced Budget Act resulted in a 15 percent reduction in revenues and left the VNACJ with only $100,000 in reserve. Now, even with $24 million in reserve, Ms. 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. Still, she said that the agency’s focus on providing services the community values, even as those values change, has kept the association fiscally sound.NURSING: Interprof Org & Sys Leadership Essay

I make decisions within the context of really understanding the impact of service delivery. I think I can see opportunities quickly, because I’m seeing it more from a nurse’s perspective, but also a nurse who grew up on a community-based side [of health care delivery].NURSING: Interprof Org & Sys Leadership Essay

—Mary Ann Christopher, MSN, RN, FAAN, president and chief executive officer, Visiting Nurse Association of Central Jersey, Red Bank, New Jersey

Not all CEOs of visiting nurse associations are nurses (those in New York City and Boston, for example, are not). Ms. 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). As a result, the VNACJ has a turnover rate of less than 5 percent for nurses. Second, Ms. 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. She believes that her nursing expertise, keen sense of community, and fiscal responsibility give her “legitimacy at any table I’m at…being a guardian for what’s best for patients and communities.”

community health systems found that nurses made up only 2.3 percent of their boards, compared with 22.6 percent who were physicians (Prybil et al., 2009).3

3

It should be noted that, while there are many more physicians than nurses on hospital boards, health care providers still are generally underrepresented.NURSING: Interprof Org & Sys Leadership Essay

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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, 2007). A 2007 survey found that 62 percent of boards included a quality committee (Governance Institute, 2007). A 2006 survey of hospital presidents and CEOs showed the impact of such committees. Those institutions with a quality committee were more likely to adopt various oversight practices; they also experienced lower mortality rates for six common medical conditions measured by the Agency for Healthcare Research and Quality’s (AHRQ’s) Inpatient Quality Indicators and the State Inpatient Databases (Jiang et al., 2008).

The growing attention of hospital boards to quality and safety issues reflects the increased visibility of these issues in recent years. Several states and the Centers for Medicare and Medicaid Services, for example, are increasing their oversight of specific preventable errors (“never events”), and new payment structures in health care reform may be based on patient outcomes and satisfaction (Hassmiller and Bolton, 2009; IOM, 2000; King, 2009; Wachter, 2009). 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., 2007). This is one area, then, in which nurse board members can have a significant impact. Recognizing this, the 2009 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., 2009).NURSING: Interprof Org & Sys Leadership Essay

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.NURSING: Interprof Org & Sys Leadership Essay

Will Nurse Researchers Hear the Call?
Nurse researchers must develop new models of quality care that are evidence based, patient centered, affordable, and accessible to diverse populations. Developing and imparting the science of nursing is also an important contribution to nurses’ ability to deliver high-quality, safe care. 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-

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ery questions but also in translating research findings into practice and developing and setting the policy agendas. 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. If these projects and programs do not adequately track nursing inputs and intended/unintended outcomes, they cannot hope to achieve their potential.NURSING: Interprof Org & Sys Leadership Essay

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. Funding might also be secured from other government entities, such as AHRQ and the Health Resources and Services Administration (HRSA) and local and national foundations, depending on the research topic. 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. Mark Pauly, codirector of the Robert Wood Johnson Foundation’s Interdisciplinary Nursing Quality Research Initiative, argues that, for nursing research to achieve parity with other health services research in terms of acceptability, it must be managed by interprofessional teams that include both nurse scholars and scholars from methodological and modeling disciplines. 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.4

Will Nursing Organizations Hear the Call?
The Gallup poll of 1,500 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 5-1). By contrast, they believed that nurses should have more input and impact in areas such as planning, policy development, and management (Figure 5-2) (RWJF, 2010a). 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

4

Personal communication, Mark Pauly, Bendheim Professor, Professor of Health Care Management, Professor of Business and Public Policy, Professor of Insurance and Risk Management, and Professor of Economics, Wharton School of the University of Pennsylvania, and Codirector of the Robert Wood Johnson Foundation’s Interdisciplinary Nursing Quality Research Initiative, June 25, 2010.NURSING: Interprof Org & Sys Leadership Essay

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FIGURE 5-1 Opinion leaders’ predictions of the amount of influence nurses will have on health care reform.
FIGURE 5-1 Opinion leaders’ predictions of the amount of influence nurses will have on health care reform.

NOTE: Govt. = Government; Ins. Execs. = Insurance executives; Pharma. execs. = Pharmaceutical executives; HC execs. = Health care executives.

SOURCE: RWJF, 2010b. Reprinted with permission from Frederick Mann, RWJF.

for improvements in patient care. 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. Conversely, when nursing organizations and their members disagree with one another on important issues, decisions are not made, as the decision makers often are unsure of which side to take.NURSING: Interprof Org & Sys Leadership Essay

Quality and safety are important areas in which professional nursing organizations have great potential to serve as leaders. The Nursing Alliance for Quality Care (NAQC)5 is a Robert Wood Johnson Foundation–funded effort with the mission of advancing the quality, safety, and value of patient-centered health care for all individuals, including patients, their families, and the communities where patients live.

5

See http://www.gwumc.edu/healthsci/departments/nursing/naqc/.

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FIGURE 5-2 Opinion leaders’ views on the amount of influence nurses should have on various areas of health care.
FIGURE 5-2 Opinion leaders’ views on the amount of influence nurses should have on various areas of health care.NURSING: Interprof Org & Sys Leadership Essay

SOURCE: RWJF, 2010b. Reprinted with permission from Frederick Mann, RWJF.

Based at the George Washington University School of Nursing, the organization stresses the need for nurses to advocate actively for and be accountable to patients for high-quality and safe care. The establishment of the NAQC “is based on the assumption that only with a stronger, more unified ‘voice’ in nursing policy will dramatic and sustainable achievements in quality and safety be achieved for the American public” (George Washington University Medical Center, 2010).

ANSWERING THE CALL
The call for nurses to assume leadership roles can be answered through leadership programs for nurses; mentorship; and involvement in the policy-making process, including political engagement.

Leadership Programs for Nurses
Leadership is not necessarily innate; many individuals develop into leaders. Sometimes that development comes through experience. For example, nurse

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leaders at the executive level historically earned their way to their position through their competence, rather than obtaining formal preparation through a business school. However, development as a leader can also be achieved through more formal education and training programs. The wide range of effective leadership programs now available for nurses is illustrated by the examples described below. The challenge is to better utilize these opportunities to develop a greater number of nursing leaders.NURSING: Interprof Org & Sys Leadership Essay

Integrated Nurse Leadership Program
The Integrated Nurse Leadership Program (INLP),6 funded by the Gordon and Betty Moore Foundation, works with hospitals in the San Francisco Bay area that wish to remodel their professional culture and systems of care to improve care while dealing more effectively with continual change. The program develops hospital leaders, offers training and technical assistance, and provides grants to support the program’s implementation. INLP has found that the development of stable, effective leadership in nursing-related care is associated with better-than-expected patient care outcomes and improvements in nurse recruitment and retention. The impact of the program will be evaluated to produce models that can be replicated in other parts of the country.NURSING: Interprof Org & Sys Leadership Essay

Fellows Program in Management for Nurse Executives at Wharton7
When the Johnson & Johnson Company and the Wharton School joined in 1983 to offer a senior nurse executive management fellowship, the program concentrated on helping senior nursing leaders manage their departments by providing them, for example, intense training in accounting (Shea, 2005). The Wharton Fellows program has changed in many ways since then in response to the evolving health care environment, according to a 2005 review (Shea, 2005). For example, the program has strengthened senior nursing executives’ ability to argue for quality improvement on the basis of solid evidence, including financial documentation and probabilistic decision making. The program also aims to improve such leadership competencies as systems thinking, negotiation, communications, strategy, analysis, and the development of learning communities. Its offerings will likely undergo yet more changes as hospital chief executive and chief operating officers increasingly come from the ranks of the nursing profession.NURSING: Interprof Org & Sys Leadership Essay

6

See http://futurehealth.ucsf.edu/Public/Leadership-Programs/Home.aspx?pid=35.

7

See http://executiveeducation.wharton.upenn.edu/open-enrollment/health-care-programs/Fellows-Program-Management-Nurse-Executives.cfm.

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Robert Wood Johnson Foundation Executive Nurse Fellows Program
The Robert Wood Johnson Foundation Executive Nurse Fellows Program8 is an advanced leadership program for nurses in senior executive roles who wish to lead improvements in health care from local to national levels. It provides a 3-year in-depth, comprehensive leadership development experience for nurses who are already serving in senior leadership positions. The program is designed to cultivate and expand fellows’ capacity to lead teams and organizations. The fellowship program includes curriculum and program activities that provide opportunities for executive coaching and mentoring, team-based and individual leadership projects, professional development that incorporates best practices in leadership, as well as access to online communities and leadership networks. Through the program, fellows master 20 leadership competencies that cover a broad range of knowledge and skills that can be used when “leading self, leading others, leading the organization and leading in health care” (RWJF Executive Nurse Fellows, 2010).NURSING: Interprof Org & Sys Leadership Essay

Best on Board
Best on Board9 is an education, testing, and certification program that helps prepare current and prospective leaders to serve on the governing board of a health care organization. Its CEO, Connie Curran, is a registered nurse (RN) who chaired a hospital nursing department, was the dean of a medical college, and founded her own national management and consulting services firm. A 2010 review cites the growing recognition by blue ribbon panels and management researchers that nurses are an untapped resource for the governing bodies of health care organizations. The authors argue that while nurses have many qualities that make them natural assets to any health care board, they must also “understand the advantages of serving on boards and what it takes to get there” (Curran and Totten, 2010).NURSING: Interprof Org & Sys Leadership Essay

Robert Wood Johnson Foundation Health Policy Fellows and Investigator Awards Programs
While not limited to nurses, the Robert Wood Johnson Foundation Health Policy Fellows and Investigator Awards programs10 offer nurses, other health professionals, and behavioral and social scientists “with an interest in health [the opportunity] to participate in health policy processes at the federal level” (RWJF Scholars, Fellows & Leadership Programs, 2010). Fellows work on Capitol Hill with elected officials and congressional staff. The goal is for fellows to use their academic and practice experience to inform the policy process and to improve.NURSING: Interprof Org & Sys Leadership Essay

8

See http://www.executivenursefellows.org.

9

See http://www.bestonboard.org.

10

See http://www.rwjfleaders.org/programs/robert-wood-johnson-foundation-health-policy-fellow.

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the quality of policies enacted. Investigators are funded to complete innovative studies of topics relevant to current and future health policy. Participants in both programs receive intensive training to improve the content and delivery of messages intended to improve health policy and practice. This training is critical, as investigators are often called upon to testify to Congress about the issues they have explored. The health policy fellows bring their more detailed understanding of how policies are formed back to their home organizations. In this way, they are more effective leaders as they strive to bring about policy changes that lead to improvements in patient care.NURSING: Interprof Org & Sys Leadership Essay

American Nurses Credentialing Center Magnet Recognition Program
Although not an individual leadership program, the American Nurses Credentialing Center (ANCC) Magnet Recognition Program11 recognizes health care organizations that advance nursing excellence and leadership. In this regard, achieving Magnet status indicates that the nursing workforce within the institution has attained a number of high standards relating to quality and standards of nursing practice. These standards, as designated by the Magnet process, are called “Forces of Magnetism.” According to ANCC, “the full expression of the Forces embodies a professional environment guided by a strong visionary nursing leader who advocates and supports development and excellence in nursing practice. As a natural outcome of this, the program elevates the reputation and standards of the nursing profession” (ANCC, 2010). Some of these Forces include quality of nursing leadership, management style, quality of care, autonomous nursing care, nurses as teachers, interprofessional relationships, and professional development.NURSING: Interprof Org & Sys Leadership Essay

Mentorship12
Leadership is also fostered through effective mentorship opportunities with leaders in nursing, other health professions, policy, and business. All nurses have a responsibility to mentor those who come after them, whether by helping a new nurse become oriented or by taking on more formal responsibilities as a teacher of nursing students or a preceptor. Nursing organizations (membership associations) also have a responsibility to provide mentoring and leadership guidance, as well as opportunities to share expertise and best practices, for those who join.NURSING: Interprof Org & Sys Leadership Essay

Fortunately, a number of nursing associations have organized networks to support their membership and facilitate such opportunities:

11

See http://www.nursecredentialing.org/Magnet/ProgramOverview.aspx.

12

This section draws on personal communication in 2010 with Susan Gergely, Director of Operations, American Organization of Nurse Executives; Beverly Malone, CEO, National League for Nursing; Robert Rosseter, Chief Communications Officer, American Association of Colleges of Nursing; and Pat Ford Roegner, CEO, American Academy of Nursing.NURSING: Interprof Org & Sys Leadership Essay

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The American Association of Colleges of Nursing (AACN) conducts an expertise survey that is used to identify subject matter experts across topic areas within its membership; it also maintains a list of nursing education experts. Names of these experts are shared with members on request. These resources also are used to identify experts to serve on boards, respond to media requests, and serve in other capacities. In addition, AACN offers an annual executive leadership development program and a new deans mentoring program to further promote and foster leadership.NURSING: Interprof Org & Sys Leadership Essay

The National League for Nursing (NLN) has established an Academy of Nurse Educators whose members are available to serve as mentors for NLN members. NLN engages these educators in a variety of mentoring programs, from a National Scholarly Writing Retreat to the Johnson & Johnson mentoring program for new faculty.

While AONE does not have a formal mentoring program, it has developed online learning communities where members are encouraged to interact, post questions, and learn from each other. These online communities facilitate collaboration; encourage the sharing of knowledge, best practices, and resources; and help members discover solutions to day-to-day challenges in their work.NURSING: Interprof Org & Sys Leadership Essay

The American Academy of Nursing keeps a detailed list of nurse “Edge Runners”13 that describes the programs nursing leaders have developed and the outcomes of those programs. Edge Runner names and contact information are prominently displayed so that learning and mentoring can take place freely.14

The American Nurses Association just passed a resolution at its 2010 House of Delegates to develop a mentoring program for novice nurses. The program has yet to be developed.NURSING: Interprof Org & Sys Leadership Essay

Over the years, the National Coalition of Ethnic Minority Nurse Associations (NCEMNA) has offered numerous workshops, webinars, and educational materials to develop its members’ competencies in leadership, policy, and communications. NCEMNA’s highly regarded Scholars program15 promotes the academic and professional development of ethnic minority investigators, in part through a mentoring program. It serves as a model worth emulating throughout the nursing profession.NURSING: Interprof Org & Sys Leadership Essay

13

The Edge Runner program is a component of the American Academy of Nursing’s Raise the Voice campaign, funded by the Robert Wood Johnson Foundation. The Edge Runner designation recognizes nurses who have developed innovative, successful models of care and interventions to address problems in the health care delivery system or unmet health needs in a population.NURSING: Interprof Org & Sys Leadership Essay

14

See AAN’s Edge Runner Directory, http://www.aannet.org/custom/edgeRunner/index.cfm?pageid=3303&showTitle=1.

15

See http://www.ncemna.org/scholarships.asp.

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Involvement in Policy Making
Nurses may articulate what they want to happen in health care to make it more truly patient centered and to improve quality, access, and value. They may even have the evidence to support their conclusions. As with any worthy cause, however, they must engage in the policy-making process to ensure that the changes they believe in are realized. To this end, they must be able to envision themselves as leaders in that process and seek out new partners who share their goals.NURSING: Interprof Org & Sys Leadership Essay

The challenge now is to motivate all nurses to pursue leadership roles in the policy-making process. Political engagement is one avenue they can take to that end. As Bethany Hall-Long, a nurse who was elected to the Delaware State House of Representatives in 2002 and is now a state senator, writes, “political actions may be as simple as voting in local school board elections or sharing research findings with state officials, or as complex as running for elected office” (Hall-Long, 2009). NURSING: Interprof Org & Sys Leadership EssayFor example, engaging school board candidates about the fundamental role of school nurses in the management of chronic conditions among students can make a difference at budget time. And if the goal is broader, perhaps to locate more community health clinics within schools, achieving buy-in from the local school board is absolutely vital. As Hall-Long writes, however, “since nurses do not regularly communicate with their elected officials, the elected officials listen to non-nursing individuals” (Hall-Long, 2009).NURSING: Interprof Org & Sys Leadership Essay

Political engagement can be a natural outgrowth of nursing experience. When Marilyn Tavenner first started working in an intensive care unit in Virginia, she thought, “If I were the head nurse or the nurse manager, I would make changes. I would try to influence that unit and that unit’s quality and staffing.” After she became a nurse manager, she thought, “I wouldn’t mind doing this for the entire hospital.” After succeeding for several years as a director of nursing, she was encouraged by a group of physicians to apply for the CEO position of her hospital when it became available. Eventually, Timothy Kaine, governor of Virginia from 2006 to 2010, recruited her to be the state’s secretary of health and human resources. In February 2010, Ms. Tavenner was named deputy administrator for the federal Centers for Medicare and Medicaid Services. Like many nurses, she had never envisioned working in government. But she realized that she wanted to have an impact on health care and health care reform. She wanted to help the uninsured find resources and access to care.NURSING: Interprof Org & Sys Leadership Essay For her, that meant building on relationships and finding opportunities to work in government.16

Other notable nurses who have answered the call to serve in government include Sheila Burke, who served as chief of staff to former Senate Majority Leader Robert Dole, has been a member of the Medicare Payment Advisory Commission,

16

This paragraph draws on personal communication with Marilyn Tavenner, principal deputy administrator and chief operating officer, Centers for Medicare and Medicaid Services, May 11, 2010.

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and now teaches at Georgetown and Harvard Universities; and Mary Wakefield, who was named administrator of HRSA in 2009 and is the highest-ranking nurse in the Obama Administration. Speaker of the House Nancy Pelosi’s office has had back-to-back nurses from The Robert Wood Johnson Foundation Health Policy Fellows Program as staffers since 2007, providing a significant entry point for the development of new health policy leaders. Additionally, in 1989 Senator Daniel Inouye established the Military Nurse Detailee fellowship program. This 1-year fellowship provides an opportunity for a high-ranking military nurse, who holds a minimum of a master’s degree, to gain health policy leadership experience in Senator Inouye’s office. The fellowship rotates among three branches of service (Army, Navy, and Air Force) annually.17 During the Clinton Administration, Beverly Malone served as deputy assistant secretary for health in the Department of Health and Human Services (HHS). In 2002, Richard Carmona, who began his education with an associate’s degree in nursing from the Bronx Community College in New York, was appointed surgeon general by President George W. Bush. Shirley Chater led the reorganization of the Social Security Administration in the 1990s. Carolyne Davis served as head of the Health Care Finance Administration (predecessor of the Centers for Medicare and Medicaid Services) in the 1980s during the implementation of a new coding system that classifies hospital cases into diagnosis-related groups. From 1979 to 1981, Rhetaugh Dumas was the first nurse, the first woman, and the first African American to serve as a deputy director of the National Institute of Mental Health (Sullivan, 2007). Nurses also have served as regional directors of HHS and as senior advisors on health policy to HHS.NURSING: Interprof Org & Sys Leadership Essay

As for elected office, there were three nurse members of the 111th Congress—Eddie Bernice Johnson (D-TX), Lois Capps (D-CA), and Carolyn McCarthy (D-NY)—all of whom had a hand in sponsoring and supporting health care–focused legislation, from AIDS research to gun control. Lois Capps organized and co-chairs the Congressional Nursing Caucus (which also includes members who are not nurses). The group focuses on mobilizing congressional support for health-related issues. Additionally, 105 nurses have served in state legislatures, including Paula Hollinger of Maryland, who sponsored one of the nation’s first stem cell research bills. None of these nurses waited to be asked; they pursued their positions, both elected and appointed, because they knew they had the expertise and experience to make changes in health care.NURSING: Interprof Org & Sys Leadership Essay

Very little in politics is accomplished without preparation or allies. Health professionals point with pride to multiple aspects of the Prescription for Pennsylvania initiative, a state health care reform initiative that preceded the ACA and is also described in Box 5-6. As is clear from a detailed 2009 review, success was not achieved overnight; smaller legislative and regulatory victories set the stage

17

Personal communication, Corina Barrow, Lieutenant Colonel, Army Nurse Corps, Nurse Corps Detailee, Office of Senator Daniel Inouye (D-HI), August 25, 2010.NURSING: Interprof Org & Sys Leadership Essay

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BOX 5-6

Case Study: Prescription for Pennsylvania

A Governor’s Leadership Improves Access to Care for Residents of a Rural State

When Pennsylvania Governor Edward Rendell took office in 2003, one-twelfth of the state’s 12 million residents had no access to health care, 80 percent of health care expenditures went to treating chronic illnesses, and $3 billion was spent annually on avoidable hospitalizations of chronically ill patients. Pennsylvanians were 11 percent more likely than all other Americans to use the emergency room (ER).NURSING: Interprof Org & Sys Leadership Essay

If we look at the workforce and the health care needs of an aging population, we’re insane if we don’t try to figure out how we can make sure that we have an adequate number of [clinicians] with the skill and knowledge to work together.NURSING: Interprof Org & Sys Leadership Essay

—Ann S. Torregrossa, Esq., director, Governor’s Office of Health Care Reform for the Commonwealth of Pennsylvania

On his first day in office, Governor Rendell established the Office of Health Care Reform to begin to address residents’ access to affordable, high-quality health care. In January 2007 he announced a major new blueprint for that reform, Prescription for Pennsylvania (known as Rx for PA, www.rxforpa.com), which would promote access to care for all Pennsylvanians and reduce the state’s skyrocketing health care expenses.NURSING: Interprof Org & Sys Leadership Essay

In the 3-plus years since, many initiatives have been undertaken, including

expanding health insurance coverage for the uninsured;

improving access to electronic health information through the Pennsylvania Health Information Exchange;

establishing a chronic illness commission, which in 2008 recommended, among other proposals, the patient-centered medical home;

addressing workforce shortages through the Pennsylvania Center for Health Careers;

establishing seven “learning collaboratives” that involve about 800 providers and 1 million patients and teach a variety of providers to collaborate on primary care teams; and

expanding the legal scope of practice for physician assistants, advanced practice registered nurses (APRNs), clinical nurse specialists, certified nurse midwives, and dental hygienists (although legislation is still needed to allow APRNs to prescribe medications independently).NURSING: Interprof Org & Sys Leadership Essay

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This last strategy has had an impact on access to care, particularly for the uninsured and underinsured. There are now 51 retail clinics that use APRNs in urban, suburban, and rural areas, and they provide care to 60 percent of the state’s uninsured, said Ann S. Torregrossa, Esq., who in 2005 was named deputy director and in 2009 director of the Office of Health Care Reform. Ms. Torregrossa said that of 300,000 visits to such clinics, about half would have been ER visits. Retail clinics have been shown to reduce costs and improve access to care (Mehrotra et al., 2009).NURSING: Interprof Org & Sys Leadership Essay

Other outcome data after the first year of Rx for PA show an increase in the number of people with diabetes receiving eye and foot examinations and a doubling of the number of children with asthma who have a plan in place for controlling exacerbations (Pennsylvania Governor’s Office, 2009). There are about 250 nurse-managed health centers nationwide and 27 in Pennsylvania; many are affiliated with schools of nursing and provide care at a 10 percent lower cost than other models—including a 15 percent reduction in ER use and a 25 percent reduction in prescription drug costs (according to unpublished data from the National Nursing Centers Consortium [NNCC]).NURSING: Interprof Org & Sys Leadership Essay

Tine Hansen-Turton, MGA, JD, CEO of the NNCC and vice president of the Public Health Management Corporation, a nonprofit institute, said that nurses involved in Rx for PA have a great deal to teach clinicians and leaders in other states as they grapple with health care reform (Hansen-Turton et al., 2009). The nurse-managed health centers in particular offer a preventive care model that improves access to care. And Pennsylvanians have given high marks to the care they have received from APRNs, Ms. Hansen-Turton said, adding, “It’s all about access.”

Governor Edward Rendell speaks about the important role of nurses in improving access to health care in Pennsylvania.
Governor Edward Rendell speaks about the important role of nurses in improving access to health care in Pennsylvania.NURSING: Interprof Org & Sys Leadership Essay

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starting in the late 1990s. Even some apparent legislative failures built the foundation for future successes because they caused nurses to spend more time meeting face to face with physicians who had organized opposition to various measures. As a result, nursing leaders developed a better sense of where they could achieve compromises with their opponents. They also found a new ally in the Chamber of Commerce to counter opposition from some sections of organized medicine (Hansen-Turton et al., 2009).NURSING: Interprof Org & Sys Leadership Essay

Hansen-Turton and colleagues draw three major lessons from this experience. First, nurses must build strong alliances within their own professional community, an important lesson alluded to earlier in this chapter. Pennsylvania’s nurses were able to speak with a unified voice because they first worked out among themselves which issues mattered most to them. Second, nurses must build relationships with key policy makers. Pennsylvania’s nurses developed strong relationships with several legislators from both major political parties and earned the support of two successive sitting governors: Thomas Ridge (Republican) and Edward Rendell (Democrat). Third, nurses must find allies outside the nursing profession, particularly in business and other influential communities. Pennsylvania’s nurses gained a strong ally in the Chamber of Commerce when they were able to demonstrate how expanding regulations to allow nurses to do all they were educated and demonstrably capable of doing would help lower health care costs (Hansen-Turton et al., 2009).NURSING: Interprof Org & Sys Leadership Essay

Perhaps the most important lesson to draw from the Pennsylvania experience lies in the way the campaign was framed. The focus of attention was on achieving quality care and cost reductions. A closer examination of the issues showed that achieving those goals required, among other things, expanding the roles and responsibilities of nurses. What drew the greatest amount of political support for the Prescription for Pennsylvania campaign was the shared goal of getting more value out of the health care system—quality care at a sustainable price.NURSING: Interprof Org & Sys Leadership Essay The fact that the campaign also expanded nursing practice was secondary. Those expansions are likely to continue as long as the emphasis is on quality care and cost reduction. Similarly, the committee believes that the goal in any transformation of the health care system should be achieving innovative, patient-centered, highvalue care. If all stakeholders—from legislators, to regulators, to hospital executives, to insurance companies—act from a patient-centered point of reference, they will see that many of the solutions they are seeking require a transformation of the nursing profession.NURSING: Interprof Org & Sys Leadership Essay

A CALL FOR NEW PARTNERSHIPS
Having enough nurses and having nurses with the right skills and competencies to care for the population is an important societal issue. Having allies

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from outside the profession is important to achieving this goal. More nurses need to reach out to new partners in arenas ranging from business, government, and philanthropy to state and national medical associations to consumer groups. Additionally, nurses need to fortify alliances that are made through personal connections and relationships. Just as important, society needs to understand its stake in ensuring that nurses are effective full partners and leaders in the quest to deliver quality, high-value care that is accessible to diverse populations. The full potential of the nursing profession in care, leadership, and research must be tapped to deal with the wide range of health care challenges the nation will face in the coming years.NURSING: Interprof Org & Sys Leadership Essay

Eventually, to transform the way health care is delivered in the United States, nurses will have to move not just out of the hospital, but also out of health care organizations entirely. For example, nurses are underrepresented on the boards of private nonprofit and philanthropic organizations, which do not provide health care services but often have a large impact on health care decisions. The Commonwealth Fund and the Kaiser Family Foundation, for instance, have no nurses on their boards, although they do have physicians. Without nurses, vital ground-level perspectives on quality improvement, care coordination, and health promotion are likely missing. On the other hand, AARP provides a positive example. At least two nurses at AARP have served in the top leadership and governance roles (president and chair) in the past 3 years. Nurses serve on the health and long-term services policy committee, and the senior vice president of the Public Policy Institute is also a nurse. AARP’s commitment to nursing is clear through its sponsorship, along with the Robert Wood Johnson Foundation, of the Center to Champion Nursing.NURSING: Interprof Org & Sys Leadership Essay

CONCLUSION
Enactment of the ACA will provide unprecedented opportunities for change in the U.S. health care system for the foreseeable future. Strong leadership on the part of nurses, physicians, and others will be required to devise and implement the changes necessary to increase quality, access, and value and deliver patient-centered care. If these efforts are to be successful, all nurses, from students, to bedside and community nurses, to CNOs and members of nursing organizations, to researchers, must develop leadership competencies and serve as full partners with physicians and other health professionals in efforts to improve the health care system and the delivery of care.NURSING: Interprof Org & Sys Leadership Essay Nurses must exercise these competencies in a collaborative environment in all settings, including hospitals, communities, schools, boards, and political and business arenas. In doing so, they must not only mentor others along the way, but develop partnerships and gain allies both within and beyond the health care environment.NURSING: Interprof Org & Sys Leadership Essay

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REFERENCES
AACN (American Association of Colleges of Nursing). 2008. The essentials of baccalaureate education for professional nursing practice. Washington, DC: AACN. Available from http://www.aacn.nche.edu/education/pdf/BaccEssentials08.pdf.

AACN. 2010. Enhancing diversity in the nursing workforce: Fact sheet updated March 2010. http://www.aacn.nche.edu/Media/FactSheets/diversity.htm (accessed July 1, 2010).

ANCC (American Nurses Credentialing Center). 2010. Program overview. http://www.nursecredentialing.org/Magnet/ProgramOverview.aspx (accessed August 25, 2010).

Ballein Search Partners and AONE (American Organization of Nurse Executives). 2003. Why senior nursing officers matter: A national survey of nursing executives. Oak Brook, IL: Ballein Search Partners.

Bennis, W., and B. Nanus. 2003. Leaders: Strategies for taking charge. New York: HarperCollins.

Beverly, C. J., R. E. McAtee, R. Chernoff, G. V. Davis, S. K. Jones, and D. A. Lipschitz. 2007. The Arkansas aging initiative: An innovative approach for addressing the health of older rural Arkansans. Gerontologist 47(2):235-243.

Bradford, D. L., and A. R. Cohen. 1998. Power up: Transforming organizations through shared leadership. Hoboken, NJ: John Wiley & Sons, Inc.NURSING: Interprof Org & Sys Leadership Essay

Center for Healthcare Governance. 2007. A seat at the power table: The physician’s role on the hospital board. Chicago, IL: Center for Healthcare Governance.

Curran, C. R., and M. K. Totten. 2010. Expanding the role of nursing in health care governance. Nursing Economic$ 28(1):44-46.

Evans, L. K., and N. E. Strumpf. 1989. Tying down the elderly. A review of the literature on physical restraint. Journal of the American Geriatrics Society 37(1):65-74.

Gardner, D. B. 2005. Ten lessons in collaboration. OJIN: Online Journal of Issues in Nursing 10(1):2.

George Washington University Medical Center. 2010. NAQC: Nursing alliance for quality care. http://www.gwumc.edu/healthsci/departments/nursing/naqc/ (accessed August 25, 2010).

Governance Institute. 2007. Boards x 4: Governance structures and practices. San Diego, CA: Governance Institute.NURSING: Interprof Org & Sys Leadership Essay

Hall-Long, B. 2009. Nursing and public policy: A tool for excellence in education, practice, and research. Nursing Outlook 57(2):78-83.

Hansen-Turton, T., A. Ritter, and B. Valdez. 2009. Developing alliances: How advanced practice nurses became part of the prescription for Pennsylvania. Policy, Politics, & Nursing Practice 10(1):7-15.NURSING: Interprof Org & Sys Leadership Essay

Hassmiller, S. B., and L. B. Bolton (eds.). 2009. Transforming care at the bedside: Paving the way for change. American Journal of Nursing 109(11):3-80.

HealthSTAT. 2010. About us. http://www.healthstatgeorgia.org/?q=content/about (accessed June 29, 2010).

IOM (Institute of Medicine). 2000. To err is human: Building a safer health system. Washington, DC: National Academy Press.

IOM. 2004. In the nation’s compelling interest: Ensuring diversity in the health care workforce. Washington, DC: The National Academies Press.NURSING: Interprof Org & Sys Leadership Essay

IOM. 2010. A summary of the December 2009 Forum on the Future of Nursing: Care in the community. Washington, DC: The National Academies Press.

Janetti, A. 2003. NSNA leadership university: A practicum in shared governance. DEAN’S Notes 25(1).

Jiang, H. J., C. Lockee, K. Bass, and I. Fraser. 2008. Board engagement in quality: Findings of a survey of hospital and system leaders. Journal of Healthcare Management 53(2):121-134; discussion 135.

Joint Commission. 2008. Behaviors that undermine a culture of safety. Sentinel Event Alert (40).

Page 253
Suggested Citation:”5 Transforming Leadership.” Institute of Medicine. 2011. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press. doi: 10.17226/12956. ×
Add a note to your bookmark
Jones, C. B., D. S. Havens, and P. A. Thompson. 2008. Chief nursing officer retention and turnover: A crisis brewing? Results of a national survey. Journal of Healthcare Management 53(2):89-105; discussion 105-106.

Katzenbach, J. R., and D. K. Smith. 1993. The wisdom of teams: Creating the high-performance organization. Boston, MA: Harvard Business School Press.NURSING: Interprof Org & Sys Leadership Essay

King, S. 2009. Channeling grief into action: Creating a culture of safety conference call, February 25, 2009, Hosted by Institute for Healthcare Improvement.

Kinnaman, M. L., and M. R. Bleich. 2004. Collaboration: Aligning resources to create and sustain partnerships. Journal of Professional Nursing 20(5):310-322.

Mastal, M. F., M. Joshi, and K. Schulke. 2007. Nursing leadership: Championing quality and patient safety in the boardroom. Nursing Economic$ 25(6):323-330.

Mehrotra, A., H. Liu, J. L. Adams, M. C. Wang, J. R. Lave, N. M. Thygeson, L. I. Solberg, and E. A. McGlynn. 2009. Comparing costs and quality of care at retail clinics with that of other medical settings for 3 common illnesses. Annals of Internal Medicine 151(5):321-328.

Olender-Russo, L. 2009. Creating a culture of regard: An antidote for workplace bullying. Creative Nursing 15(2):75-81.

Paulus, P., and B. Nijstad, eds. 2003. Group creativity: Innovation through collaboration. New York: Oxford University Press.

Pearson, A., H. Laschinger, K. Porritt, Z. Jordan, D. Tucker, and L. Long. 2007. Comprehensive systematic review of evidence on developing and sustaining nursing leadership that fosters a healthy work environment in healthcare. International Journal of Evidence-Based Healthcare 5:208-253.

Pennsylvania Governor’s Office. 2009. Governor Rendell thanks “pioneers” for making Pennsylvania the national leader on chronic care management and creating patient-centered medical homes. http://www.portal.state.pa.us/portal/server.pt?open=512&objID=3053&PageID=431159&mode=2&contentid=http://pubcontent.state.pa.us/publishedcontent/publish/global/news_releases/governor_s_office/news_releases/governor_rendell_thanks__pioneers__for_making_pennsylvania_the_national_leader_on_chronic_care_management_and_creating_patient_centered_medical_homes.html (accessed July 1, 2010).NURSING: Interprof Org & Sys Leadership Essay

Pisano, G. P., and R. Verganti. 2008. Which kind of collaboration is right for you? Harvard Business Review 86(12):78-86.

Prybil, L., S. Levey, R. Peterson, D. Heinrich, P. Brezinski, G. Zamba, A. Amendola, J. Price, and W. Roach. 2009. Governance in high-performing community health systems: A report on trustee and CEO views. Chicago, IL: Grant Thornton LLP.

Quisling, K. E. 2009. Resident orientation: Nurses create a program to improve care coordination. American Journal of Nursing 109(11 Suppl):26-28.

Rosenstein, A. H., and M. O’Daniel. 2008. A survey of the impact of disruptive behaviors and communication defects on patient safety. Joint Commission Journal on Quality and Patient Safety 34(8):464-471.NURSING: Interprof Org & Sys Leadership Essay

RWJF (Robert Wood Johnson Foundation). 2010a. Nursing leadership from bedside to boardroom: Opinion leaders’ perceptions. http://www.rwjf.org/pr/product.jsp?id=54350 (accessed May 14, 2010).

RWJF. 2010b. Nursing leadership from bedside to boardroom: Opinion leaders’ views. http://www.rwjf.org/pr/product.jsp?id=54491 (accessed August 25, 2010).

RWJF. 2010c. Unlocking the potential of school nursing: Keeping children healthy, in school, and ready to learn. Charting Nursing’s Future July(14):1-8.

RWJF Executive Nurse Fellows. 2010. Overview. http://www.executivenursefellows.org/index.php?option=com_content&view=article&id=1&Itemid=34 (accessed September 28, 2010).

RWJF Scholars, Fellows & Leadership Programs. 2010. Robert Wood Johnson Foundation Health Policy Fellows. http://www.rwjfleaders.org/programs/robert-wood-johnson-foundation-healthpolicy-fellow (accessed September 28, 2010).

Page 254
Suggested Citation:”5 Transforming Leadership.” Institute of Medicine. 2011. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press. doi: 10.17226/12956. ×
Add a note to your bookmark
Shea, G. 2005. Developing the strategic voice of senior nurse executives. Nursing Administration Quarterly 29(2):133-136.

Singh, J., and L. Fleming. 2010. Lone inventors as sources of breakthroughs: Myth or reality? Management Science 56(1):41-56.

Strumpf, N. E., and L. K. Evans. 1988. Physical restraint of the hospitalized elderly: Perceptions of patients and nurses. Nursing Research 37(3):132-137.NURSING: Interprof Org & Sys Leadership Essay

Sullivan, P. 2007. Rhetaugh Dumas, 78; nurse rose to become NIMH deputy director. The Washington Post, July 27.

Wachter, R. M. 2009. Patient safety at ten: Unmistakable progress, troubling gaps. Health Affairs 29(1):165-173.

Wuchty, S., B. Jones, and B. Uzzi. 2007. The increasing dominance of teams in production of knowledge. Science 316(5827):1036-1039.NURSING: Interprof Org & Sys Leadership Essay