Nursing's Leadership Role in Population Based Issues



Nursing's Leadership Role in Population Based Issues

Nicholas Kurek

Ferris State University

Abstract

Tobacco use is a health problem. Many people, especially young adults, simply do not understand the ramifications of tobacco use. Education is the key. The 18-24 year old population is a difficult group to address. Nurses can be instrumental in the prevention and cessation of tobacco use in both direct contact and leadership roles. The differences and similarities of these two roles are explored within the defined context. Reflections and insight are offered on personal applicability.

The Group 1 community change proposal addresses tobacco use amongst 18-24 year olds in Kent County, Michigan. Tobacco use is the single most preventable cause of death and disease in the United States (U.S. Department of Health and Human Services [DHHS], 2012). The 18-24 year old population can be a difficult group to reach and address. Almost 4 out of 10 (36.3%) of 18-24 year olds in Kent County, Michigan who responded to a risk factor survey stated that they currently smoke cigarettes (Kent County Health Department, 2010, p.17). Upon further review of the data, it was realized that the vast majority of this population have a high school or less education, were low income, and culturally diverse (Kent County Health Department, p. 17). It was determined that primary and secondary prevention with a heavy emphasis on education could be effective in reducing tobacco use. Every nurse is professionally and ethically obligated to educate and promote health (American Nurses Association [ANA], 2010). Nurses in both direct contact and leadership roles can help potentiate a decrease in tobacco use.

Role of Direct Contact Nurse

Depending on their specialty, nurses have varying degrees of direct contact with the public and most deal with individuals and families. “Community/public health nurses also work with small groups, aggregates, populations, and organizations/systems within the community” (Maurer & Smith, 2009, p.11). The targeted age group can be a difficult group to reach. While every nurse can and should play a part in addressing tobacco use, the community/public health nurses in Kent County will most likely have the greatest contact with the target population. Maurer & Smith (2009) inform us that a “primary responsibility of community/public health nurses is teaching to promote health” (p.17).

Nurses working in the community/public health arenas need to be competent. Maurer & Smith (2009, p. 24) list nine leadership characteristics in community/public health nursing:

1. Ability to recognize and be present to human suffering.

2. Ability to create a vision of improvement in the health and well-being of people.

3. Commitment to action.

4. Ability to identify specific health problems and sources of suffering within a specific time and place.

5. Openness to possibilities to alleviate and prevent suffering and ability to develop a plan.

6. Ability to communicate with other people to enlist support and enroll partners.

7. Ability to create opportunities for people to help themselves.

8. Commitment to advocacy to affect change.

9. Patience and persistence.

The ANA (2010) sets the scope and standards of practice for all professional nurses. Harkness & DeMarco (2012, p. 9) provide us with the Eight Domains of Public Health Nursing Practice:

1. Analytic assessment skills.

2. Policy development and program planning skills.

3. Communication skills.

4. Cultural competency skills.

5. Community dimensions of practice skills.

6. Basic public health science skills.

7. Financial planning and management skills.

8. Leadership and systems thinking skills.

It is important to point out that community and public health nurses often work in the same arena and share similar goals; however, there is a difference between the two roles. Community-based nursing is an extension of illness care provided to clients and their families outside of the acute care setting; whereas, public health nursing is population-based practice (Harkness & DeMarco, 2012, p.8-9). These roles require different levels of education for entry. The baccalaureate degree in nursing is the educational credential for entry into public health nursing and a master’s level education, with a specific expertise in population-focused care, is required for advanced practice; whereas, an associate degree and/or diploma prepared registered nurses as well as licensed practical nurses also practice in the community as community-based nurses (Harkness & DeMarco, 2012, p.9).

In addressing tobacco use amongst the targeted population, education was determined to be the best primary and secondary prevention. Nurses need to educate about the effects of smoking. It is reasonable to consider that the target population may have different perspectives influenced by their education, experiences, environment and cultural upbringing. The nurses in direct contact with the targeted population need to attempt to engage in verbal education as well as suggest resources for follow up.

Role of Leader/Manager Nurse

The nurse leaders need to apply the nursing process in addressing the community health and well-being. They need to assess, diagnose, plan, implement, and evaluate projects. The educational requirements and characteristics are the same as mentioned above with the realization that those in leadership roles usually have a minimum of a baccalaureate degree and most have at least one advanced degree in addition to a specialty certification or two. It is preferable that the nurse leader has evolved from a more direct contact role as this enhances the understanding of the challenges and potential obstacles faced in the practical implementation of ideas. Nurses functioning in leadership roles are also required to adhere to the same ANA Standards of Professional Practice with additional competencies required for the graduate-level prepared specialty nurse and advance practice registered nurse (ANA, 2010). The focus of the leader is different in the fact that they are usually more removed from direct contact. The leaders and managers are responsible for planning, legislating, and securing funds for the implementation of projects along with the ongoing evaluation.

In the targeted population it may be highly efficacious for the nurse leaders to advocate a more media marketing approach to affect tobacco use. Education is essential. Television commercials, a potentially viral you tube educational posting, blogging, billboards, and fliers may actually reach the targeted population best. One thought revolves around the effects of tobacco use on sexual health and performance. A series of ads, billboards, and/or a cute viral computer post could be very advantageous. While this approach is figuratively hitting below the belt and may draw some criticism, it could bring attention to the issue and may be just the proverbial wake-up call that potentiates change.

Analysis

Ideally every nurse continues to learn and become more competent and capable. The realization of the above mentioned standards enable the nurse to fulfill their charge. The roles are very similar with the same goals/outcomes yet different focuses and emphasis to achieve the desired outcomes. In order to effectively reach and potentiate change in the targeted population, it is essential that the nurses planning and implementing the education are culturally competent. The nurses also should possess a functional level of emotional intelligence (defined by Tubbs (2009) as a combination of intrapersonal communication (personal competence) and interpersonal communication (social competence)). The practical application of ideas coupled with the ability to adapt to and overcome obstacles will help enable both the direct care and leader nurses achieve desired outcomes.

The State of Michigan passed the “Dr. Ron Davis Smoke Free Air Law” in 2009 (State of Michigan, 2009). The bill prohibits smoking in public restaurants, bars and businesses to reduce the general public’s exposure to secondhand tobacco smoke (Michigan Department of Community Health, 2011). Interestingly, this has also decreased first and third hand exposures. The Act passed in 2009 is one example of the State of Michigan’s health initiatives for the citizens of this state. Tobacco use is being addressed on city, county and state levels. The current legislation provides positive political reinforcement for smoking cessation for all tobacco users.

Nurses in both direct care and leadership roles are charged with the continued advocacy for tobacco cessation. Those in leadership roles deal more directly with politicians, legislation and funding. The leaders provide the means which enable the direct care workers to accomplish the task at hand. Currently, the political arena clearly advocates for a healthy and smoke-free lifestyle.

Reflection

Upon serious cognitive reflection and rumination, I realize that currently I am more of a direct care nurse. I enjoy working at the hands on level. Over the years I have had a variety of experiences which have enabled me to comprehend and empathize with folks. I realize that I will not always be able to physically work in a direct care role and have returned to school to position myself for an eventual and inevitable more removed role. I managed an intensive care unit for a couple years and am somewhat hesitant to get back into the politically charged atmosphere of the leadership role.

I firmly believe that one of the greatest problems nursing faces today is a loss of focus. I think that the vast majority of nursing leaders are so far removed from direct contact that they simply no longer understand the obstacles direct care works face in attempting to complete their duties. Ironically, I realize that nursing needs folks who do comprehend where the direct care nurses are coming from and work to better enable them to accomplish their tasks in a more efficient many. I am former military and strongly believe in leading from the front. I could not and would not ask those under me to do something that I could not or would not do.

I can see myself becoming a strong advocate for the direct care nurse. In fact I would like to introduce a requirement that every nurse who holds a license practices or volunteers a specified number of hours in a direct care capacity within their abilities every year as a requirement for license renewal. I have realized the importance and priority that must be placed on achieving a higher level of education and certification. I understand the importance of remaining current and the difficulties in returning to school to do so. According to the literature, current trends in nursing continue to call for higher degrees and more certifications. In fact it appears that many specialties may even push the bar to a doctorate which is more frequently being referred to as the “terminal degree”.

References

American Nurses Association. (2010). Nursing: Scope and standards of practice (2nd ed.).

Silver Spring, MD.: Author.

Harkness, G. A., & DeMarco, R. F. (2012). Community and public health nursing: Evidence for practice. Philadelphia, PA.: Wolters Kluwer Health/ Lippincott, Williams, & Wilkins.

Kent County Health Department. (2010). 2008 Behavioral risk factor survey.

Retrieved from:

Maurer, F. A., & Smith, C. M. (2009). Community/public health nursing practice: Health for families and populations (4th ed.). St. Louis, MO.: Saunders Elsevier.

Michigan Department of Community Health. (2011). Michigan’s smoke free air law. Retrieved from:

State of Michigan. (2009). House bill No.4377. Retrieved from:

Tubbs, S. L. (2009). A systems approach to small group interaction (10th ed.). New York, NY: McGraw Hill.

U.S. Department of Health and Human Services. (2012). Healthy people 2020: Tobacco use.

Retrieved from:

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