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Nursing’s Leadership Role in Population Based IssuesKim A. KarwowskiFerris State UniversityAbstractCommunity public health nursing offers a unique opportunity to facilitate and to create change. By examining the nursing’s leadership role in a population based issue through both the direct and indirect nursing role, the author has gained a further appreciation for the many facets of nursing. The population based issue of childhood obesity in Kent County is the focus of the author and her classmates’ planned community change group project. The direct role of the school nurse and the indirect role of the American Nurses Associations’ [ANA] Director of the Department of Government Affairs [GOVA] have been explored in relation to their potential impact for the group project, their leadership traits, and their role’s link to the ANA standards of professional practice. A subsequent analysis and reflection on the two roles’ similarities, the differences, and the author’s potential competency in either role is also scrutinized. Ultimately an individual nurse may be limited in the advancement of an issue, but as a team member they may be able to lead changes for the future of nursing and the future of the community.Keywords: childhood obesity, nurse change leader, nursing roles, school nurse Nursing’s Leadership Role in Population Based Issues“Childhood obesity has more than doubled in children and tripled in adolescents in the past 30 years,” (Centers for Disease Control and Prevention [CDC], 2013). Jones, (2010) in a brief for the ANA compares childhood obesity to the “new tobacco” in relation to the type of public health and policy movement necessary to combat this rampant problem (para 13). Obesity puts children at risk for multiple health risks including cardiovascular disease, psychosocial problems, type II diabetes, and sleep disorders, such as sleep apnea (Harkness & DeMarco, 2012, p.221). The epidemic of obesity in the youth of Kent County is the focus for this author and her classmates’ planned community change group project. Exploring two aspects of community nursing, through the examination of the direct care nursing role of the school nurse, and an indirect care nursing role of the Director of Government Affairs of the ANA allows for the analysis and reflection of the impact of the nurse in population based health care.The School Nurse Community Nursing RoleThe role of the school nurse has evolved into a crucial role in part due to the diverse needs of the current student population. The school nurse provides an instrumental relationship “between the child, the family, and the education and healthcare systems,” (Harkness & DeMarco, 2012, p. 435). According to Harkness and DeMarco (2012) “school nurses: help encourage positive responses to normal development, help promote health and safety, help solve actual and potential problems, provide case management services, and work with others to develop student and family capacity for adaptation and self-management” (p. 434). The school nurse would provide a pivotal role for this author’s group project due to the relationships and collaborative resources available to adopt programs geared for combating youth obesity. These programs may include classroom health education classes on nutrition and exercise along with family seminars discussing the epidemic of childhood obesity; other measures directed at reducing long-term health risks would also be beneficial.Leadership TraitsFirst and foremost the school nurse acts in a managerial capacity. Harkness and DeMarco (2012) additionally list the qualities of the school nurse as requiring skills in health assessments, health promotions, and being a child health advocate (p. 435). The school nurse may work in an independent capacity yet need to draw from support teams or resources as applicable. The school nurse needs to act in a collaborative manner with members of the school health services team and the school district wellness team: the school health physician, school office staff, school counselors, school administration, and families (Harkness & DeMarco, 2012, p. 435). The school nurse would need to be confident in their delegating and teaching styles, yet be flexible to adapt their style to their audience. Keeping current on their own educational credits, evidenced-based practices, and changes in health trends and treatments are other essential traits and requirements. Board et al. (2011) discourses that the school nurse is committed to lifelong learning and should be at the baccalaureate level, yet “continue to pursue professional development and continuing nursing education” (para 6). ANA Standards of Professional PracticeThe importance of the role of the school nurse is such that the ANA along with the National Association of School Nurses (NASN) have its own edition of the Scope and Standards of Practice for Nursing titled School Nursing: Scope and Standards of Practice. In addition to those standards of practices required of the competent nurse in the former edition, the latter edition emphasizes the importance and unique competencies required of the specialty that comprises school nursing, such as school health service management. Bennett (2011) refers to the detailed statement regarding the scope of nursing practice answering the questions of “who, what, where, when, why, and how of school nursing practice” (para, 6). These defined guidelines for school nursing are important for understanding the full scope of the correlation between a student’s health and their ability to learn.American Nurses Association Nurse Change LeaderANA’s mission statement “nurses advancing our profession to improve health for all” highlights their role as primarily a nursing advocate, another statement listed is “when nurses talk, Washington listens” (ANA, 2014). The role of the ANA is to support and to foster nursing practice in the areas of: contribution, impact, facilitation, workforce issues, population health issues and their quality and efficiency in politics (ANA, 2014). The ANA Department of Government Affairs (GOVA) team represent nurses on capitol hill, offers support back in the individual states, and are involved as support for federal proposals and enforcements of new laws (ANA, 2014). Their inclusion into the proposed group project for childhood obesity would provide the support and backing of an authoritative body to affect, to support, and to adopt change. If the author’s group program proves to be successful, having the appropriate backing could be instrumental in establishing, advancing, and maintaining the program to fight childhood obesity. As some programs are already in place, such as the first lady’s campaign for healthier youth, adding specific programs at the local level could have an impact across the state and the ANA would serve as a voice to spread the word. The staff of the ANA is comprised of mostly nurses, with the Director of GOVA being one who oversees the department in lobbying the Executive Branch and Congress.Leadership TraitsThe ANA (2014) argues that more is required of leaders than to “delegate, dictate, and direct,” they must also help others to reach their highest potential. The current GOVA Director, Rosa Iris Gonzalez, has a nursing practice background comprised of staff nursing, nursing manager of same day surgery, and nursing in long term care and home health. She currently serves on two other boards and is listed as being of Puerto Rican descent with a passion for addressing health care disparities (ANA, 2014). Ms. Gonzalez has a PhD in nursing with an expertise in health policy and legislative affairs (ANA, 2014). The role of director would most likely require good communication skills, effective leadership qualities, strong ethics, dedication, and creativity. As the director of the ANA’s GOVA, Ms. Gonzalez is involved in monitoring over 1,000 nursing and healthcare related bills across all states; she must lead dedicated teams that oversee these projects (ANA, 2014). Familiarity with the Healthy People 2020 initiatives and the state of Michigan’s specific statistics in relation to childhood obesity would be essential for the success of this group project initiative. The drive and dedication to educate others, to provide direction, and to foster change at a higher level of involvement including government agencies will assist in the continuation of planned change. As the population is the focus of the indirect nursing role, the ability to “see the big picture” would be essential to promoting change.ANA Standards of Professional PracticeThe typical ANA standards of professional practice may not apply in the traditional sense of competent nursing for direct patient contact; however the indirect nursing role is still bound to the guidelines and its tenets. Communication, leadership, collaboration, and evidenced-based practice and research are just a few that must be mastered to be an effective director. Additional focus on self-assessment and evaluation, with a focus on accountability and autonomy are vital in the indirect nursing role (“Nursing Standards,” 2010). The ability to analyze and to foster change at the local, state, and national level will allow the ANA director to accurately represent this author and her classmates’ planned community change group project.AnalysisThe nursing roles of both the direct and indirect contact nurses are overall similar in nature. Both roles require good communication skills, collaboration, the utilization of evidence-based research, and education. Both roles would require dedication and perseverance in handling any potential setbacks and stay focused on the end goal of healthier children with reduced health risks. Although not specifically stated, self-confidence would be a necessity for both the direct and the indirect nurse role. Each role would require the nurse to be adaptable and creative to foster change. Each is striving to use resources wisely and effectively. The nursing roles of the direct and indirect contact nurses have many differences too. The school nurse is primarily interested in the student body of their school district. Their audience focus would be on the direct care to the students, the school health services team, and the school districts’ wellness team. The director of the ANA would need facts to support implementing change in the entire school population and her audience would be those in pivotal government positions. The school nurse would be involved in the daily operations of health promotion, while the director would be more concerned with the evaluations and outcomes. The director would need to rely on the validity and veracity of the school nurse and their team to accurately monitor trends, outcomes, and effectiveness. The two roles would rely on each other to progress and expand any subsequent programs. ReflectionThe multitude of skills required for the professional nurse is vast. At a direct contact level the ability to accurately assess, diagnose, plan, implement, and evaluate a patient’s status is crucial to this author’s nursing practice. Through continued practice, this author has become more proficient in these areas and could adapt those same principles into the realm that is community based nursing. Delegation, professionalism, and collaboration are each areas this author is becoming more adept in while advocating change for her patients, their families, and as a member of her organization. A drive for success and the ability to stay focused will assist this author in achieving any goal she sets for herself at both the local and state level.Realistically the limitations of this author in taking on either the direct nursing role of the school nurse or the indirect role of the Director of the ANA are threefold: lack of education, lack of experience, and lack of determination. As an Associate Degree educated nurse, both of the discussed nursing roles would not be obtainable at this time as both require a more advanced degree than the author currently holds. She is however well on her way to the completion of her Baccalaureate degree in nursing which will assist in her future endeavors. Continued experiences at the direct level and adopting a more active role at the indirect level through her organization will provide her with the necessary experience to attempt other areas of advancement. At the direct contact level of the school nurse a familiarity with the school politics would be essential, and at the indirect contact level as the director of the ANA the familiarity of government politics would be crucial to success; at this point the author lacks familiarity in both areas. The author could very well progress her education, her experience, and her determination to become proficient in these areas to facilitate and adopt change for her nursing community, her local community, and her national community.ReferencesAmerican Nurses Association. (2014). About us. Retrieved from Nurses Association. (2011, April 20). American nurses association research agenda. Retrieved from , F. (2011, June 1). ANA, NASN announce upcoming school nursing standards text. The American Nurse. Retrieved from , C., Bushmiaer, M., Davis-Alldritt, L., Fekaris, N., Morgitan, J., Murphy, K., & Yow, B. (2011, April). Role of the school nurse. National Association of School Nurses. Retrieved from for Disease Control and Prevention. (2013, July 10). Childhood obesity facts. Retrieved from , G. A. & DeMarco, R. F. (2012). Community and Public Health NursingPractice: Evidence for Practice. Philadelphia, PA: Wolters Kluwer|Lippincott, Williams & Wilkins.Jones, T. (2010, June). Fighting childhood obesity: taking a stand to control an epidemic one child at a time. American Nurses Association. Retrieved from Standards. (2010, December 22). Retrieved from ................
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