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Nurse Leader Interview and AnalysisKelly GuttenbergFerris State UniversityNurse Leader Interview and AnalysisThe purpose of this project is to interview and analyze a nurse manager in the workplace. Included in this paper will be the nursing education, background, and experiences of the nurse leader that lead her to her leadership position. The nurse leader has the power to influence staff when based upon trust and collaboration. The nurse leader’s roles and responsibilities will be explored, as well as an analysis of her leadership, based upon the American Organization of Nurse Executive’s (AONE) competencies for managers. On October 3, 2017, J.W. RN, MSN was interviewed by the author of this paper. J.W. graduated with the author in 1982 from Northwestern Michigan College in Traverse City, Michigan with an Associate’s Degree in Nursing. She started her career in nursing at Munson Medical Center (MMC), also in Traverse City, on an orthopedics unit. She worked there for one year and then moved to the Cardiac Care Unit (CCU), which she really enjoyed. She was introduced to leadership there as a charge registered nurse (RN). Eventually there was a change in management, causing the functionality of the unit to be incompetent (J.W., personal communication, October 3, 2017). This caused staff dissatisfaction and high turnover rates of employment. She moved between different units for a while, until the new manager of CCU left and J.W. became interim manager in the late 1980’s. This interim position lasted ten years and lead to the incorporation of CCU with the Cardio-Thoracic Surgical Unit (CTSU) and the Cardio-Thoracic Unit (CTU) under her supervision. In 1990, she started working toward her Bachelors of Science in Nursing (BSN). She disliked it and only took one course, but finally returned to Ferris State University and completed her BSN in 1997. She later completed her Masters from the University of Phoenix. With her Masters, J.W. moved up to administration as the transfer coordinator for MMC. When Relationship Based Caring (RBC) began at Munson, she found her niche as a mentor of RBC, left MMC, and for the next five years worked for Creative Health Care Management (CHCM), the designer of RBC. J.W. came back to MMC in 2015, as she missed clinical nursing. She was talked out of a job in outpatient dialysis and accepted another interim management position in the Neonatal Intensive Care Unit (NICU), where she is the current manager.Roles and ResponsibilitiesCreating a culture of safety in any unit is an important role for a manager. It starts by ensuring the unit is adequately staffed with skilled, competent employees. This includes staff at all levels; nurses, techs, and unit assistants. J.W. is responsible for interviewing and hiring these individuals and ensuring they maintain their competencies, while working within their scope of practice. She oversees the daily operations of the unit within a budget set by the organization, and she helps to set policies and protocols for NICU, in order to keep up with best evidence-based practice. Another role she has is to help facilitate getting supplies so the staff can do their job, and she helps to remove barriers when they cannot. She also attends to staff, patients, and their families, in order to promote patient satisfaction and help with resolution of conflicts. J.W. is very influential in creating an environment where staff feels safe, valued, and encouraged to grow in their profession.J.W. has a role in quality assurance and strategic management for the unit. She is a magnet appraiser and caritas coach. The role of a caritas coach, as stated by the Watson Caring Science Institute (2013), is to assist others “in their personal evolution toward Caring practice and transforming institutional-organizational cultures to heart-centered-healing environments through living-out and modeling Caritas for self, practitioners, staff, and larger systems” (p. 2). J.W. follows the philosophy of MMC’s True North mission diagram, where the patient is always “the center of all we do” (Munson Health Care, 2017). (see Appendix A). The result is safe, quality patient centered care and is the focus within the health care team and operational performance. Parents are incorporated as part of the interdisciplinary NICU team into care conferences that concern their infant. MMC management has a pyramid structure of accountability. On the unit level, nurses, unit assistants, and unit clerks all answer to J.W. J.W. answers to M.S., who is the coordinator of maternal-child services and oversees four different units and departments. L.L. is M.S.’s superior, and she is also vice president of patient care services. The roles and responsibilities of J.W. encompass the nurse manager competencies, which lay within a framework of three domains. The domains are the science of managing the business, creating the leader within, and the art of leading the people. These are outlined by the AONE (American Organization of Nurse Executive, 2015).Human Resource Management and Leadership SkillsThe responsibilities for human resources lie within the science and art domains as human resource management and leadership skills. In relation to human resource management, J.W. is responsible for ensuring the unit is effectively staffed. This process includes recruiting, interviewing, and hiring staff, and developing and overseeing an orientation program for new employees. She also ensures that day to day staffing is adjusted to the acuity level of the patients. The NICU utilizes a float pool along with maternity and the pediatric/women’s health unit. J.W. collaborated with the managers from the other two units to set up practice guidelines for the staff who float to one of the other units. Skills, competency, and comfort level have to be taken into account to ensure patient safety and quality care. As a result, when staff is pulled to the NICU, they will either have a partner to work alongside them, or be responsible for no more than two infants who are stable, but do not meet growth or feeding standards to be discharged. That is J. W.’s commitment to the patients. She has used travel Registered nurses (RNs) in the past, but that is financially irresponsible if other options are present. One such option that she has utilized is contracting experienced NICU RNs for periods of time. This has proven effective in relieving high census times and summer vacations. They also have a member of the transport team available and on call when needed (Personal communication, J.W., October 3, 2017).One issue with staffing is retention of good qualified staff. Satisfaction with one’s job is tantamount to staying. J.W. has an open door policy in her office and is open and honest with her staff and their concerns. She listens attentively and respects what they have to say. She feels that she is there to make the jobs of the staff easier, which is why she makes sure they get the resources and equipment that they need to do their job effectively (Personal communication, J. W., October 3, 2017).Human resource leadership is also done in cooperation with a nurse educator that J.W. hired to help with maintaining staff competencies, education, and orientation. This educator helps to lighten the load that comes with management. Though J.W. holds accountability that her staff is up to date on their competencies, individual staff members are responsible to see that they are up to date themselves. Competencies are evaluated at end of each year during staff evaluations. J.W. helps to encourage personal staff growth through self-assessment of areas they would like to improve in, and she facilitates the setting of personal goals for the upcoming year. Performance Improvement and Strategic ManagementPerformance improvement and strategic management fall into the science of managing domain. Performance improvement is very important in healthcare today; from systems, to an individual standpoint, in order to make sure evidence based practice is being utilized. J.W. has a plaque in the unit with names recognizing all the nurses who have obtained and maintained certification in their specialty. Maintaining high quality standards in education is valued and recognized, and J. W. knows the importance of evidence-based care for these littlest of patients. According to Fisher and Sheeron (2014), “It’s becoming more evident through the research that the leadership behaviors of nurse managers and administrators play an important role in successfully transferring research evidence into clinical nursing” (p. 21). Performance improvement also includes patient and staff safety. Munson has a reporting system where staff is encouraged to file a report for any untoward occurrences, or even near misses, without fear of reprisal. Establishing a culture of safety is responsible for this and is defined by the ANA (2016) as “core values and behaviors resulting from a collective and sustained commitment by organizational leadership, managers and health care workers to emphasize safety over competing goals”. This culture of safety is promoted by J.W. She does not place judgement or blame when dealing with her staff or a unit issue. Her training in relation-based care and caritas ethos has helped to establish her as a safe haven to report to or talk with about safety concerns. The staff is at the forefront of patient care and they are the ones to observe unsafe practices or happenings. They must be encouraged and feel safe to report any issue with their or a patient’s safety (Personal communication, J.W., October 3, 2017). According to Lachman (2007), managers and executives are just as responsible for errors as frontline staff, for they are the ones making policy and setting the environment for care. Interdepartmental conflicts arise at times. Three different units with different priorities do not always stop to recognize the others’ perspective. J.W. has encouraged her staff to step back and make any disagreement an educational opportunity. “Lift the others up by teaching them, rather than complaining and criticizing” (Personal Communication, J.W., October 3, 2017). Strategic management helps gear healthcare toward the future. Change is constant in all aspects of life, and healthcare is not immune. It is management that can help ease the transition and plan for the future of change. According to Scott (2015), there are seven strategies managers can use to help support change. They include promoting acceptance by viewing the change as a positive, developing skills for supporting the change, reducing negative influences, mobilizing positive peer support, creating incentive and rewards, and making structure and process modifications to support the change. One big change that J.W. had to help her staff with was the change in staffing that has been happening since shortly before her arrival. Morale was low and she provided an open mind, active listening, and supportive attitude, acknowledging that their feelings and frustrations are real. She listened to suggestions and encouraged staff to form small committees to deal with issues, encouraging them to meet up after hours to release tension and strengthen relationships (Personal communication, J.W., October 3, 2017).J.W. is also looking toward the future of the NICU. It has currently outgrown its unit and there is no privacy for patients and family. She is directly involved with input toward the development of the new unit that is in the planning phase. The planning involves room for growth beyond the current needs, private and semi-private rooms for infants and families, and updated technology, as we have been keeping younger gestational infants at Munson rather than transferring them to a larger high risk hospital.Relationship Management and Influencing BehaviorsOne thing that is the most impressive about J.W. is her leadership in motivating change and growth. The previous management had the unit in turmoil, with unhappy and experienced competent nurses retiring early. With J.W. at the helm, morale is improving and the nurses that left have returned. When she was asked what she did to facilitate such a turnaround, she stated that her focus was on what was right and she encouraged the staff to do the same. J.W. promotes open honest communication, lifting her employees up. She believes supporting each other promotes success, and recognizes and accepts the differences in each of her employees. She also stated that she encouraged staff to focus on the patients and successes rather than difficulties (Personal communication, J.W., October 3, 2017). The nurse manager’s style of leadership is known to have a direct relationship with staff satisfaction and intent to stay. This staff satisfaction, in turn, improves patient safety and quality of care (LeBlanc, 2014).When conflicts arise, J.W. practices the same principles as stated above. She listens and respects the individual person and tries to see things from their point of view. She stated it is a challenge sometimes to set aside her own agenda. Listening to complaints about others is difficult for her, and she encourages her staff to “take it to the right mailbox”, meaning talk directly to the individual they are having a conflict with, in order to resolve the conflict. Attendance is an issue she has had to deal with as well. “Staff does have family or personal issues that they need to be able to work around. But if it gets out of hand or they take advantage of the situation, you have to put your foot down. You don’t always get the full story though, and you have to be careful with family leave laws” (Personal communication, J.W., October 3, 2017). She tries to address any remediation in a constructive, rather than hurtful, way.Personal and Professional AccountabilityJ.W. recognizes the responsibility of being a good role model. She does not have clinical experience with NICU, but has a strong desire to help out on the unit. She is currently working alongside the RNs to learn the skills necessary to know what she is asking of her staff. She has always had a passion for the clinical side of nursing, and knows the importance of being able to be present and helpful in an emergency. She holds an NE-BC certification, which means she is Nursing Executive Board Certified through the American Nurses Credentialing Center (ANCC) (2017), a subsidiary of the American Nurses Association (ANA). She is a member of the ANA and the National Association of Neonatal Nurses (NANN). The mission of NANN is “To be the professional voice that shapes neonatal nursing through excellence in practice, education, research, and professional development” (NANN, n.d.). J.W.’s self-evaluation can be viewed in Appendix B. Financial Management“A budget requires managers to plan ahead and to establish explicit program goals and expectations” (Trepanier, 2015, p. 222). The role of a unit manager in financial management is not as exponential as staff may think. “Yes we are given the budget, but it is made by administration. We have little input into financial management. We can request certain things but we will not always get them” (Personal communication, J.W., October 3, 2017). This mainly applies to capital budgets. That being said, they still have to maintain the unit staff and supplies based upon their operating budget for the fiscal year, which can be frustrating. Planning is based upon speculations of the coming year on patient census, acuity, staffing needs, staff benefits, revenue, and other factors (Trepanier, 2015, pp. 224-225). J.W. advocates on behave of her patients to acquire the equipment needed to maintain safe quality care. On the administrative level, adjustments are made to the capital budget throughout the system to keep the organization on track during the fiscal year.ConclusionNurse Managers have a great deal of responsibility and influence over their staff and unit culture. J.W. shows great leadership skills that make her an effective manager. She has had a positive impact on the NICU team at Munson Medical Center, and her work with RBC and Caritas allows her to manage in a compassionate and impartial way that both of these theories represent. From AONE’s competencies, J.W. has shown expertise in the three domains of managing the business, creating the leader within, and the ability to effectively lead people. Writing this assignment brings a realization of all the different aspects involved with managing a unit. There is the business aspect of maintaining sufficient staffing, staff competencies, helping staff adapt to change, facilitating and planning for change, and working within a budget. The art of managing includes skills in influencing staff and patient satisfaction. The art of a good manager requires knowing when to lead, and when to follow. It is important as a manger to keep learning and to show your staff the importance of continuing to embrace new educational opportunities to develop the leader within. Nurses are the driving force to enact change and to promote safety and quality care for the patients.ReferencesAmerican Nurses Association (ANA) (2016). What is a culture of safety? Retrieved from CultureofSafety-JanuaryAmerican Nurses Credentialing Center (2017). Nursing Executive Board Certified. Retrieved from NurseExecutiveAmerican Organization of Nurse Executives (2015). The science the art the leader within: Nurse manager competencies. Retrieved from resources/nurse-manager-competencies.pdfFisher, C. A., & Sheeron, J. (2014). Creating a culture of EBP: What’s a manager to do? Nursing Management, 45(10), 21-23. Doi:10.1097/01.NUMA.0000453943.62534.03Lachman, V. D. (2007). Patient safety: The ethical imperative. Medsurg Nursing, 16(6), 401-403. Retrieved from MainMenuCategories/EthicsStandards/Resources/Patient-Safety.pdfLeBlanc, P. (2014). Leadership by design: Creating successful “TEEAMS”. Nursing Management, 45(3), 49-51. Doi:10.1097/01.NUMA.0000443950.21970.a9Munson Medical Center (2017). True north: Keeping the patient at the center of all we do. Retrieved from Association of Neonatal Nurses (n. d.). We are the voice for neonatal nurses. Retrieved from about/national-association-of-neonatal-nursesScott, E. (2015). Leading Change. In P. S. Yoder-Wise (Ed.), Leading and managing in nursing (6th ed.). St. Louis, MO: Elsevier.Trepanier, S. (2015). Managing costs and budgets. In P. S. Yoder-Wise (Ed.), Leading and managing in nursing (6th ed.). St Louis, MO: Elsevier.Watson Caring Science Institute (2013). Caritas coach education program (CCEP): Cohort 10 program syllabus. Retrieved from files/ohort10/CCEP_Syllabus_Cohort_10.pdfAppendix AMunson True NorthAppendix BJ. W. Values and Vision ................
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