Analyzing a Nurse in a Leadership Role



Analyzing a Nurse in a Leadership RoleAmy LampenFerris State UniversityAbstractThis paper provides an analysis of a nurse in a leadership role. Michelle Doctor, director of hospital medicine at Holland Hospital in West Michigan, was interviewed to provide her professional background, description of her responsibilities and how she collaborates with others. Ethical issues, power and influence, decision-making and conflict management will be discussed using theory and current research. The effect of these areas on patients and the organization are also analyzed.Analyzing a Nurse in a Leadership RoleIn order to analyze a nurse leader, I interviewed Michelle Doctor, the director of the hospital medicine department at Holland Hospital in West Michigan. The purpose of this paper is to discover the “healthcare village” as it takes the whole system to achieve positive patient outcomes (Bishop, 2014).BackgroundMichelle Doctor is an LPN with clinical experience in a brain injury unit, pediatric home care and a pediatric pulmonary office. While home with her young children, she dropped out of a health sciences bachelor’s degree program and worked out of her home as a loan manager. As she took on extra responsibilities at the pediatric pulmonary office, she became the nurse coordinator for cystic fibrosis. She successfully turned around processes based on requirements and regulations prior to a cystic fibrosis audit.Doctor was asked to take over as practice manager on an interim basis and ended up staying on for three years. As Spectrum Health Medical Groups began to form, she acted as operational leadership for all the surgical practices. From scratch, she set up these practices by hiring staff and putting processes and policies in place.With restructuring underway at Spectrum Health, Doctor began serving as director for all non-surgical specialty programs. While at a venue for one of her presentations, the president of West Michigan Heart approached her with an opportunity for growth.Doctor made the switch to West Michigan Heart as the director of operations. Doctor recalls that it was a tough environment; 80-hour workweeks, receiving phone calls until midnight. After one year, she was approached to consider an opening at Holland Hospital with the hospitalist group. She interviewed with the vice president of nursing (VP) /chief nursing officer (CNO) and accepted the position as director of hospital medicine.Position ResponsibilitiesDoctor opines she had been promoted based on her work experience and her drive to question processes and correct issues. She also has certifications in project management and the Lean process. As advised, Doctor is working toward completing a bachelor degre in business administration with a second in healthcare management. She has long term plans to complete a master’s degree in business administration (MBA) or public health (MPH).Doctor’s main duty is operational strategy and financial responsibility for the hospital medicine department. This involves both day-to-day and big picture planning, budgeting, and approving, as well as scheduling and work flow areas. She is also involved in hiring, firing, corrective action, various monthly staff meetings and tracking of quality measures.Doctor reports to the VP of nursing/CNO. All staff from the hospital medicine department, including the clinical coordinator and the providers, report to Doctor. Although technically the physicians do report to her, Michelle uses a dyad leadership model with the department’s medical director. This type of partnership is shown by Patton and Pawar (2012) to support quality, safety and the initiation of evidence-based practices while ensuring success of the strategic plan. A strong nurse-physician dyad “when effective, can lead to a whole that is greater than the sum of its parts, with the partnership capable of delivering breakthrough results that would not be possible for either partner acting individually” (Patton & Pawar, 2012, p. 324).Role of CollaborationWithin the organization, Doctor collaborates with a variety of other health care professionals to achieve goals. In order to solve a problem, she will communicate with anyone; including floor nurses, managers, vice presidents or directors. Doctor will meet with others to determine any common problem areas that need to be solved. Yoder-Wise (2011) acknowledges that “collaboration among groups and individuals with common interests and goals often results in greater success in effecting change and exercising power in the workplace” (p. 188).Outside of the organization, Doctor is part of a group of professional women called Inforum, which is “focused on creating strategic connections and accelerating careers for women” (). Yoder-Wise (2011) advocates that professional membership demonstrates leadership and provides opportunity.Ethical IssueOne ethical issue Doctor is managing relates to end of life issues for organ donation. Determining the appropriate time to treat the organs, with Heparin or vasodilators for example, versus the patient is a precarious issue. Sometimes treating the patient does not allow the organs to remain viable for donation. These situations can cause emotional distress for staff caring for the patient and family.Some ethicists have suggested that certain interventions are unethical because they are meant to benefit the potential organ recipients rather than the patient the providers are actually caring for (Gries et al., 2013). “However, promoting the patient’s wishes to donate organs may be consistent with the provision of high-quality end-of-life care” (Gries et al., 2013, p. 106). Organ donation can be very meaningful for family at a time of loss.How these situations are handled reflect the compassion and integrity of the organization. Various schools of thought are brought about between the attending hospitalist, neurology, cardiology, legal groups and patient groups. Doctor points out that with various physicians involved, the decision of who is in charge and who orders what becomes obscured. Therefore, she is working toward establishing protocols as recommended by Gries et al. (2013) “that incorporate guidelines for determining death and use of ante mortem interventions that are consistent with this framework and local or national laws” (p. 106).Power and InfluenceDoctor uses her expectations and work ethic to affect the whole organization through the people she works with. She is able to influence certain people or departments to get the resources needed for a particular area. Prior to her arrival, we had difficulties getting the technology we needed to be efficient. Soon after she began to work to restructure our program, we had additional smart phones, computers and communication badges.Doctor exhibits the power that Yoder-Wise (2011) defines; “the ability to accomplish goals from that position” (p. 179) and the ability to empower staff and providers through collaboration. Ultimately, she is there to help the hospital medicine group to do what they do very well.Decision-Making and Problem-SolvingDoctor does not shy away from asking questions when making big decisions. In a previous role, she led several patient advisory groups. She considered the feedback from these patients prior to making big decisions that would affect them as well. From an organizational standpoint, she considers the financial impact without compromising quality care of patients.Doctor consistently uses the democratic or participative approach to decision-making. This approach has been proven to be successful because it brings the appropriate staff into the process. “Participative management has been shown to increase work performance and productivity, decrease employee turnover, and enhance employee satisfaction” (Yoder-Wise, 2011, p. 101).Conflict Management and ResolutionDoctor believes that addressing conflict as quickly and efficiently as possible is the best way to manage conflict. In support of fairness, her advice is to hear the issue, understand what happened, recognize a situation for what it is, close the loop with everyone involved and then move on. She believes a person should be given the latitude to have bad days but this should not change the environment of patient care. As part of conflict resolution, Doctor values the trait of listening and providing any resources or other sources to those involved.Elements of the conflict management process identified by The Joint Commission are in alignment with Doctor’s approach; meeting with the involved parties as soon as possible, gathering information regarding the conflict and working with the parties to manage and resolve the issue (Scott & Gerardi, 2011). The Joint Commission now has standards to address communication and conflict based on the findings that “unaddressed conflict can divert attention, energy, and resources away from a hospital’s efforts to ensure safe, high-quality patient care” (Scott & Gerardi, 2011, p. 60).ConclusionI have developed a great deal of respect for Michelle Doctor as a nurse leader for the hospital medicine department. She exemplifies positive traits of leadership and works well to contribute to the success of the organization as a whole in achieving positive patient outcomes.ReferencesBishop, R. (2014). Syllabus. Leadership in Nursing. Retrieved from , C. J., White, D. B., Truog, R. D., DuBois, J., Cosio, C. C., Dhanani, S., ... Halpern, S. D. (2013). An official American Thoracic Society/International Society for Heart and Lung Transplantation/Society of Critical Care Medicine/Association of Organ and Procurement Organizations/United Network of Organ Sharing statement: ethical and policy considerations in organ donation after circulatory determination of death. American Journal of Respiratory and Critical Care Medicine, 188(1), 103-109. , P., & Pawar, M. (2012). New clinical executive models: One system’s approach to Chief Nursing Officer–Chief Medical Officer co-leadership. Nursing Administration Quarterly, 36, 320-324. , C., & Gerardi, D. (2011). A strategic approach for managing conflict in hospitals: responding to the Joint Commission leadership standard, part 1. The Joint Commission Journal on Quality and Patient Safety, 37(2), 59-69. Retrieved from , P. S. (2011). Leading and managing in nursing (5 ed.). St. Louis, MO: Elsevier Mosby. ................
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