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Being a Nurse ManagerAnne M. HendricksFerris State UniversityAbstractThis paper explores the challenges of being a nurse leader or nurse manager in today’s healthcare system. Analysis of leadership and management was provided. Comparisons were made through personal communications with a nurse manager and research. Interviews with Carol Baker, nurse manager of C4 at Munson Medical Center, Traverse City Michigan provided much of the information. An introduction of Ms. Baker including her education, years in practice, and additional qualifications was provided. Analysis of Ms. Baker’s handling of cultural diversity on the unit, legal issues, use of power and influence, decision-making and problem-solving process, managing conflict, and participating in research were explored. The effect on the staff, patients and organization were included in the analysis. Comparison and support of Ms. Baker was provided from research from several sources. The project allowed me to analyze the challenges of being an effective nurse leader and to recognize how a good leader can affect staff, patients and the organization.Being a Nurse ManagerBeing an effective nurse manager/leader in today’s healthcare environment is important for many reasons. Patient satisfaction, employee satisfaction and success of the organization depend upon it. According to Ellis and Hartley (2009), a leader guides, teaches, motivates, and directs the activities of others toward attaining certain goals. A manager is an appointed person that coordinates and integrates resources through planning, organizing, directing and controlling to achieve specific goals within an organization (Ellis & Hartley, 2009). A manager is responsible and accountable for the goals of the organization. A good manager generally also possesses good leadership skills through the ability to empower others (Ellis & Hartley, 2009). Introduction of the ManagerI interviewed Carol Baker RN, OCN manager of C4 at Munson Medical Center Traverse City, MI. 49684. Ms. Baker introduced herself:I have been a nurse for 27 years, starting as an LPN on the oncology unit at Munson Medical Center. I received my Associates degree in 1986 from Northwestern Michigan College and my Bachelor of Science in nursing degree in 2001 from Graceland University. My focus in nursing has been in Oncology, both inpatient and radiation. In 1999, I became the Nurse Manager of a 21-bed oncology unit and cancer registry department. Last year I decided to begin a Masters in nursing program on the management and leadership track, I plan to graduate October 2011. I have been certified as an oncology nurse for twenty years as I feel very strongly that this adds to the profession of nursing, encouraging nurses to do the same (C. Baker, personal communication, October 21, 2010). Cultural DiversityAccording to the United States Department of Health and Human Services (USDHHS) (2001), culture is “integrated patterns of behavior including language, thoughts, communications, actions, customs, beliefs, values and institutions of racial, ethnic, religious, or social groups” (p.2). It is important for nursing to recognize that culture has an impact on health care beliefs, perceptions of health and illness, health practices and disease prevention (Ellis & Hartley, 2009). There are challenges to overcome in order to be a culturally competent nurse. Having the knowledge of clinical differences of health practices of different groups, and the ability to communicate effectively with different groups are two important tasks of the culturally competent nurse (Ellis & Hartley, 2009). The Smudging CeremonyPer our personal communication (October 21, 2010), Carol Baker stated that cultural diversity has been an issue on the oncology unit when taking care of many Native Americans at the end of life. Ms. Baker approached her superior to see if some of the rules of the hospital could be adjusted to perform the “smudging ceremony” (personal communication, October 21, 2010). The method for performing the ceremony is to burn certain herbs, take the smoke in one's hands and rub or brush it over the body, especially onto areas that need spiritual healing (Borden & Coyote, n. d.). The power of the herb is believed to cleanse the spirit (Borden & Coyote, n. d.). Native Americans believe that before a person can be healed, heal another, or die peacefully one must be cleansed of any bad feelings, negative thoughts, bad spirits or negative energy (Borden & Coyote, n. d.). The institution waived the non -burning rule for the ceremony to be performed (C. Baker, personal communication, October 21, 2010).Effect on patients. Developing trust is one outcome of culturally competent care (Ellis & Hartley, 2009). Although there is no specific data recorded at Munson to support the Native American patient satisfaction, there are studies to support cultural care. Explanatory, compassionate healthcare providers who took into consideration Native American culture influenced the participants' sense of well-being (Lackner, 2009). Providing culturally congruent nursing care could reduce suffering, and decrease morbidity and mortality rates reported among Native Americans, thus decreasing disparities in healthcare outcomes among minority populations (Lackner, 2009).Organizational Support of Cultural Diversity According to the USDHHS (2001), organizations must be competent in caring for differing cultures. The areas of competence are cultural competence, language access services, and organizational support for cultural competence (USDHHS, 2001).Ms. Baker states that her unit has a book titled Culture & Nursing Care that is used frequently to help nurses attain cultural competence (personal communication, November 10, 2010). The hospital also has general education through Health Stream, which encourages awareness and resources to care for different cultures (Munson Healthcare, 2010d). All employees must complete Health Stream on an annual basis to remain employed ( C.Baker, personal communication, October 21, 2010). ?Caring for the elderly is a special consideration on C4 because a majority of the patients are geriatric (C. Baker, personal communication, October 21, 2010). In 2005, 17% of the Munson area was 65 years or older (Munson Community Health Department, 2008). This is about one third higher than the proportion for the State and the U.S. as a whole (Munson Community Health Department, 2008). Ms. Baker states that the unit is going to introduce a new program to focus on care for the geriatric patient (personal communication, October 21, 2010). The NICHE program (nurses improving care for health system elderly), is going to be introduced to C4 in the near future (Boltz, et al., 2008). The program will provide education to staff regarding care specifically focused on geriatric patient needs (C. Baker, personal communication, October 21, 2010).C. Baker states that, “Nurse Leaders have to be sensitive to issues related to culture, race, gender, sexual orientation, and economic situations among staff and patients” (personal communication, November 15, 2010). Munson supports cultural care and was awarded the Magnet designation recognizing excellence in patient care standards, respect of cultural and ethnic diversity, leadership of the nurse administrator in supporting professional nursing practice, and the management and philosophy of nursing services (Munson Healthcare, 2010c)Patient Safety a Legal IssuePatient safety is an area that requires much attention from management because it can lead to legal issues (C. Baker, personal communication, November 15, 2010). Medicare will no longer reimburse hospitals for a higher-paying DRG (Diagnosis-related group) when one of eight selected hospital-acquired conditions develops during the hospital stay (Clancy, 2010). Hospital falls and trauma were included as one of the eight conditions that the Center for Medicare and Medicaid Services (CMS) argues, “Should not occur after admission to the hospital.” (Inouye, Brown & Tinetti, 2009). The CMS heralded this move as an effort to align financial incentives with the quality of care, thereby promoting both quality and efficiency (Inouye et al. 2009).Some 3 to 20% of inpatients fall at least once during their hospital stay; these falls result in injuries, increased lengths of stay, malpractice lawsuits, and more than $4,000 in excess charges per hospitalization (Inouye et al. 2009). Each year, about one third of persons who are 65 years of age or older living in community settings fall at least once; the percentage is 50% among those 80 years of age or older (Inouye et al. 2009). Keeping Patients Safe on C4A patient safety initiative was piloted on C4 back in 2009. The program ARTT (ambulating, rounding, toileting and turning) was put in place as part of a national patient safety initiative (Munson Healthcare, 2010). The staff was required to round hourly on each patient and log the round on a chart kept on the patient chart. Other ancillary services also could record their visit on the chart. The amount of falls was then logged. Because of the pilot, C4 had a record setting 180 days without a patient fall (R. Stanton, personal communication, November 29, 2010). Effects on staff, patients and institution. The staff felt that the ARTT program cut down on interruptions because the rounds were planned and divided up among staff rather than unplanned (C. Baker, personal communication, November 16, 2010). The rest of the hospital adopted the initiative on all units on March 19, 2010. The results are yet to be tallied, but patient satisfaction scores seem to support the hourly rounding (Munson Healthcare, 2010b). The Joint Commission passed the hospital and did recognize the patient safety initiative in July 2010 (Munson Healthcare, 2010a). According to Ellis and Hartley (2009), the Joint Commission has standards for all aspects of care, structure, process and outcomes that must be achieved in order to pass. Use of Power and InfluenceThe nurse leader should be a role model for staff as well as other managers (C. Baker, personal communication, October 21, 2010). C. Baker believes that her encouragement of nurses to certify, achieve clinical advancement as well as perform peer review has positive effects on the nursing unit (C. Baker, personal communication, October 21, 2010). Encouraging Leadership through Clinical Advancement Nursing staff should learn to be leaders and the career advancement system in the hospital encourages this (C. Baker, personal communication, October 21, 2010). The Clinical Advancement System was developed in 1989 to keep the expert nurse at the "bedside" in his/her specialty area (Munson Medical Center, 2010) Clinical advancement effects on staff, patients and institution. When a nurse successfully completes the Clinical Advancement System at Munson he/she is rewarded through a pay increase of $1-$2, depending upon level achieved (Munson Medical Center, 2010). The clinical advancement rewards nurses for taking on more responsibilities, which should lead to improved patient care. The system also keeps nurses in the same position for a longer time, rather than transferring to a higher paying job. This will save the institution money.Encouraging Leadership through CertificationC. Baker encourages all nurses to become certified and states certification is actually part of the clinical advancement ladder (personal communication, October 21, 2010). Ellis and Hartley (2009), state that certification is an indication of competence and suggest a positive relationship between certified nurses and patient outcomes. To achieve certification in any specialty multiple measures must be achieved which ensures competence in that area (Ellis & Hartley, 2009). C4 has study books, practice tests and peer support for certification and the hospital reimburses the nurse for the cost of the test upon successful completion (C. Baker, personal communication, October 21, 2010).Certification effect on staff, patients and institution. Many nurses have a goal of becoming certified because we have peer groups that talk about certification and encourage it (C. Baker, personal communication, October 21, 2010). Once a nurse becomes certified, he/she gets OCN (Oncology certified nurse) on their identification badge and a plaque on the wall with their name on it (personal communication, October 21, 2010). Patients see the plaques and mention that it instills confidence in the nursing staff on the unit (C. Baker, personal communication, October 21, 2010). The institution benefits by providing higher quality care and being approved by accrediting agencies (C. Baker, personal communication, October 21, 2010). Encouraging Leadership through Peer ReviewThe unit participated in a hospital-wide initiative for professional goal development to determine if clinical coaching, used as a form of peer review, has a positive impact on clinical practice, professional development, professional engagement, and patient outcomes (C. Baker, personal communication, October 21, 2010). According to Ellis & Hartley (2009), appraisal is a formal process of reviewing an individual against established standards. The American Nurses’ Credentialing Center (2008) “Describe and demonstrate that nurses at all levels routinely use self-appraisal, performance review, and peer review, including annual goal setting, for the assurance of competence and professional development”.Peer Review Effect on Staff and Institution. The results for the staff from this initiative were: positive affirmations and team cohesiveness (Fisher, Waycaster & Weaver, 2010). Some positive comments from staff were that less experienced nurses received support, and everyone became more goal-oriented and aware of educational opportunities (Fisher et al. 2010). Management noticed that more people were motivated to participate in unit based shared governance and provide encouragement to peers (Fisher et al. 2010). The overall outcome from the initiative was that nurses’ perceptions of professional development improved significantly in the coaching group (Fisher et al. 2010).The impact on the institution is that the study group recognizes that it needs to engage clinical coaching in leadership groups and that further research is needed on other units/organizations (Fisher et al. 2010). The ultimate goal being a published research article and continued improvement in support for clinical coaching as a form of peer review (Fisheret al. 2010). ??Decision Making or Problem Solving Process Analyzing and making decisions on the unit is a daily occurrence that often can be uncomfortable, it is imperative to take time and understand all sides of an issue before jumping to conclusions (C. Baker, personal communication, October 21, 2010). Involving staff in decisions such as hiring, environmental changes and unit processes will take the sole ownership off the manager creating a sense of community in the department (Ellis & Hartley, 2009). C. Baker states that her unit does this through staff meetings quarterly and with newsletters when things come up in between, daily huddles and annual discussions (personal communication, October 21, 2010).? The unit also has a shared governance group that meets regarding unit processes (C. Baker, personal communication, October 21, 2010).Daily CommunicationThe unit has started a practice called the “huddle” which allows all members of a shift to meet for ten minutes at the beginning of their shift to coordinate patient care issues and to disseminate all of the daily communication issues and changes (C. Baker, personal communication, October 21, 2010).? The charge nurse or manager run the discussion, all of the information is kept in a log on the unit, and the staff is expected to read and be responsible for the information (C. Baker, personal communication, October 21, 2010). Huddle Effect on Staff, Patients and Institution. The daily huddles bring more team cohesiveness among the staff allowing them to work together toward a goal (C. Baker, personal communication, October 21, 2010). The huddle also allows for better continuity of care for our patients (C. Baker, personal communication, October 21, 2010).Annual DiscussionC. Baker is currently meeting with all staff one on one for annual discussions (personal communication, October 21, 2010). The evaluation is performed with clear criteria and a checklist of staff performance (C. Baker, personal communication, October 21, 2010). The staff is given a sheet to fill out prior to discussion that includes this year’s accomplishments, goals for the next twelve months, and an area that they can discuss any issues they choose (C. Baker, personal communication, October 21, 2010). Annual Discussion Effect on Staff, Patients and Institution. According to Ellis and Hartley (2009), an effective performance appraisal improves the functioning of the organization, fosters personal development of the employee, and follows clear criteria. Performance appraisal allows for open communication regarding goals and recognition for accomplishments (Ellis & Hartley, 2009). Receiving recognition motivates an employee to continue working hard, which benefits staff, patients and the institution (Ellis & Hartley, 2009).Management of ConflictAccording to Ellis and Hartley (2009), conflict is dissension occurring when two or more peoples view things differently. The most effective way to deal with conflict is through negotiation and mediation (Ellis & Hartley, 2009). Negotiation, according to Ellis and Hartley (2009), is conferring with another to resolve an issue. Mediation is intervention between two parties to resolve an issue (Ellis & Hartley, 2009). Conflict among StaffC. Baker feels that certain situations should not be tolerated in the workplace such as feeling unsafe, bullying and anger (personal communication, October 21, 2010). Staff understands that any type of disagreement needs to be discussed away from patients (C. Baker, personal communication, October 21, 2010). C. Baker follows the rules of assessing the situation before reacting to it by trying to gather as much information as possible before confronting (personal communication, October 21, 2010). C. Baker encourages staff to attempt to communicate with each other but offers mediation as necessary and corrective discipline as required (personal communication, October 21, 2010). Ellis and Hartley (2009) support this management style with their definition of behaviors for confrontation, which are assessing the situation prior to confrontation, conducting the confrontation in private to prevent embarrassment and showing the other party respect (Ellis & Hartley, 2009).For severe conflict, issues there are steps that must be followed to terminate the employee (C. Baker, personal communication, October 21, 2010). The steps are defined in a Corrective Action Policy, which requires two counseling notes, one written warning and then termination (C. Baker, personal communication, October 21, 2010). Careful documentation must be done when performing corrective action to prevent litigation (Ellis & Hartley, 2009). Effect of management of conflict on staff and patients. Employees know that conflict is not tolerated, which lends itself to a more cohesive and peaceful work environment (C. Baker, personal communication, October 21, 2010).As a Participant or Interpreter of ResearchIn addition to the clinical coaching for peer review, as mentioned in the Encouraging Leadership Through Peer Review section of this paper, evidence-based practice was used to discontinue the neutropenic diet on C4 (C. Baker, personal communication, October 21, 2010). In an effort to implement the use of evidence-based practices into our oncology center, a committee of nursing staff formed to review the literature (C. Baker, personal communication, October 21, 2010). The literature review of evidenced based articles stated the diet was not effective in preventing infections in the immune-compromised patients therefore it was discontinued (C. Baker, personal communication, October 21, 2010). Effect on Patients, Staff and InstitutionSince the implementation of the non-neutropenic diet, standard monitoring of monthly infection rates continues, with no change noted (C. Baker, personal communication, October 21, 2010). Patient satisfaction regarding meal choices has increased and staff feedback regarding implementation of the change has remained positive (C. Baker, personal communication, October 21, 2010). It has not been a full year so results are yet to be tallied but similar results were found in the research (C. Baker, personal communication, October 21, 2010). Tarr and Allen (2009), support Ms. Baker’s statement in their results of patient satisfaction with meals going from 42.9% to a high of 75%. ConclusionThe project allowed me to analyze the challenges of being a nurse leader/manager. Management affects staff, patients and the organization. Further research is needed before I take a management position, but this process has shown me the skills needed to do so.ReferencesBoltz, M., Capezuti, E., Bowar-Ferres, S., Norman, R., Secic, M.,…Kim, H. (2008, June 1). Changes in the geriatric care environment associated with NICHE (nurses improving care for health system elders) [Electronic version]. Geriatric Nursing, 29(3), 176-185. Borden, A., & Coyote, S. (n. d.). The smudging ceremony. Retrieved October 22, 2010, from , C. (2010, October 1). Patient safety and medical liability reform: Putting the patient first. Patient Safety & Quality Healthcare. Retrieved November 19, 2010, from , J., Waycaster, G., & Weaver, J. (2010, October 15). Nursing excellence through positive, affirming peer review. Number 732. 2010 ANCC National Magnet Conference, Munson Medical Center.Gardner, A., Mattiuzzi, G., Faderl, S., Borthakur, G., Garcia-Manero, G., & Estey, E. (2008). Randomized comparison of "neutropenic" and non-neutropenic diet in patients undergoing remission induction therapy for aml. General poster session, leukemia, myelodysplasia, and transplantation. Asco Annual Meeting. Abstract retrieved from , S. K., Brown, C.J., & Tinetti, M. E. (2009, June 4). Medicare nonpayment, hospital falls, and unintended consequences. New England Journal of Medicine, 360, 2390-2393. . Retrieved from , R., Fletcher, K., & Jennings, B. M. Reducing Functional Decline in Hospitalized Elderly. Retrieved November 27, 2010, from Community Health Department. (2008). Community health assessment project. Retrieved November 21, 2010, from Healthcare. (2010a). Magnet recognition program. Magnet Force. Retrieved November 19, 2010, from Healthcare. (2010b). Munson medical center ethics. Patient services. 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(2001). National standards for culturally and linguistically appropriate services in health care. Office of Minority Health. Retrieved November 19, 2010, from SubmittedAbstractType your abstract here. Usually, Abstracts should be no more than 250 words.Retype Title HereStart typing the text of your paper here.ReferencesInsert References Here – place the cursor at the beginning of this line, and then, on the CiteWrite menu, click Format, Write Bibliography. For more help with your references, click Start, Programs, Dr Paper, Dr Paper Help, and go through the instructions under Using CiteWrite for your References. If you just have one or two references, you might want to just type them by hand, following these examples:Hall, K. G. (2005, August 29). Web page title. Website title. Retrieved from , A. (1999). Article title. Journal name, 8, 243.Wilson, J. B. (1999). Book title. Place of publication: Publisher.Make sure you delete this text before you turn in your paper! ................
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