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Analyzing a Nurse in a Leader RoleVivian M. Liverance Ferris State UniversityAnalyzing a Nurse in a Leader RoleA true leader has the confidence to stand alone, the courage to make tough decisions, and the compassion to listen to the needs of others. He does not set out to be a leader, but becomes one by the equality of his actions and the integrity of his intent. Douglas MacArthur (Goodreads, 2016). The leader discussed today is M.S. She is currently employed as the preventive health and immunizations (PHI) nursing supervisor at the St. Clair County Health Department (SCCHD). The purpose of this paper is to discuss and analyze her roles and responsibilities as a leader. This will be accomplished by exploring her managerial role as compared to the 2015 American Organization of Nurse Executives (AONE) nurse manager competencies. “The Nurse Manager Competencies are based on the Nurse Manager Learning Domain Framework and capture the skills, knowledge and abilities that guide the practice of these nurse leaders” (para. 2). This will be demonstrated by first discussing her background. Secondly, this paper will explore her roles and responsibilities within this organization by first discussing the organizational structure of her workplace and how she defines the philosophy of the organization. Secondly, how she fulfills her role in human resource management and human resource leadership skills. Thirdly, to explore her role in performance improvement and strategic management. Fourthly, to explore her role in relationship management and influencing behaviors. Next, discuss her personal and professional accountability. Finally, to discuss her role in financial management.HistoryM.S. began her college career directly after high school graduation in 1984. She attended Mercy College of Detroit receiving her Associates Degree in Nursing (ADN) in December of 1988. While still attending college in pursuit of her bachelor’s degree, she began working as a registered nurse (RN) at Mount Carmel Mercy Hospital in Detroit, Michigan. Here, she was employed on a medical unit caring for diabetic clients. In May of 1990, she received her Bachelors of Nursing (BSN) from Mercy College of Detroit. Following graduation, M.S. began working at Mercy Hospital in Port Huron, Michigan. Here, she began working in the intensive care unit (ICU), which lasted for one year. In 1991, M.S. decided to go in a different direction and began working for St. Johns Hospital & Medical Center in Detroit, Michigan. Here, she worked for three years on a cardiac surgical step-down unit. In 1994, M.S. quit working to enroll full time at Central Michigan University. In May, 1996, M.S. received her Masters of Science in Administration with a health care concentration (MSA). However, she did not return to working outside the home until 2006. She took this time to focus on caring for her family. As her children grew and became more independent, she decided to rejoin the workforce. Consequently, in February of 2006, M.S. accepted a job at SCCHD. She worked until 2012 as a public health nurse. She was then promoted to immunization coordinator. Two years later, in 2014, she accepted the position of preventive health and immunizations nursing supervisor where she presently remains.Role and Responsibilities When M.S. took the role of supervisor for the Preventive Health and Immunization Program (PHI), she felt unprepared for the position. However, she was willing to learn and work hard for her staff. Within her supervision role, she has numerous responsibilities and tasks to perform. “The nurse in the role of manager ensures that the day-to-day elements of the workplace are done correctly” (Yoder-wise, 2015, p. 45). M.S. is entrusted with interviewing prospective employees, as well as, supervision and discipline of current employees. She performs her responsibilities within the umbrella of the preventive health and immunization Program (PHI). This umbrella includes the immunization program, communicable disease reporting and surveillance, lead testing and clinic services. She orients new staff to policy and procedures of these programs. She plans, coordinates and evaluates the work of subordinate personnel. She supervises field staff, the execution of the medical orders, development of client care programs and nursing practices. M.S schedules program activity meetings and work assignments. She assists with preparation and maintenance of personnel records, reports. and in-service training programs. She assures success of minimum program requirements and State of Michigan accreditation requirements for programs supervised. While working on her day to day responsibilities, she also works in conjunction with the emergency preparedness coordinator (EPC) and outside agencies to assess community needs or threats. The nurse manager is responsible for creating safe, healthy environments that support the work of the health care team and contribute to patient engagement. The role is influential in creating a professional environment and fostering a culture where interdisciplinary team members are able to contribute to optimal patient outcomes and grow professionally (American Organization of Nurse Executives, 2015, para. 1).Although M.S. understands her supervision role within SCCHD, she was not aware of the AONE nurse manager competencies. Consequently, she reviewed the information from AONE and feels her role is compatible with the competencies outlined by AONE. Organizational Structure and Philosophy M.S believes that that SCCHD is a facility with a strong philosophy of caring for the community. Specifically, SCCHD has a vision to work in partnership with the community. Also, to provide services to clients while treating them with dignity. SCCHD has a responsibility to respond to emerging threat issues, to collaborate with outside resources, and to provide the best care possible. “St. Clair County Health Department will be the trusted local expert in population and preventive health practices; encouraging effective community partnerships, eliminating barriers to health resources, protecting the community from health threats, and encouraging stewardship of the environment” (St. Clair County Health Department, 2016, para. 2). M.S. has confidence that the organizational structure of SCCHD supports this philosophy through specialization of each department. M.S. believes SCCHD has an organizational functional structure, grouping nurses per their specialty. “Functional structures arrange departments and services per specialty (Yoder-Wise, 2015, p.145). She feels the structure is simple in nature and it is easy to see the chain of command. At the top of the chart is the medical health officer. She directly oversees the administrator. Below the administrator are six program directors. One of these program directors is the director of nursing. M.S. reports directly to the director of nursing. Reporting to M.S. are two coordinators, nurses and clerks in the preventive health and immunizations and clinic services.Human Resource Management & Human resource leadership skills According to the AONE (2015) human resource management competencies, managers are responsible for staffing requirements. These requirements include evaluation of staffing patterns and staffing needs. Furthermore, managers must understand and utilize labor laws, ensuring employees work within the scope of labor laws. Managers are also responsible for the orientation of new staff. This includes developing, overseeing and evaluating the orientation process. Staffing is one of M.S.’s day to day responsibilities. “Nurse managers must make skilled staffing and scheduling decisions to ensure that safe and cost-effective care is provided by the appropriate level of caregivers” (Yoder-Wise, 2015, p. 256). Although staffing needs can quickly change, there are normal seasonal increases such as “back to school” time and flu season. To identify staffing needs in clinic services, past data reports are run within the electronic medical record (EMR) system to identify trends. M.S. follows union guidelines when staffing programs. These union guidelines are within the scope of labor laws. “Delegation and supervision are viewed legally as a part of the practice of nursing. Thus, nurses have a specific need to know and understand this area of nursing responsibility” (Huber, 2014, p. 25). According to the AONE (2015) human resource management competencies, managers are responsible for hiring and orientation of new staff. Furthermore, this included overseeing and evaluating the effectiveness of the orientation. When M.S. requires new staff, she selects them based on their ability to specifically meet program needs. M.S. does not believe experience is the most important factor for hiring. She believes a person’s desire to work in public health is important in employment consideration. Once a staff member is hired, orientation begins. M.S oversees the orientation process. “Orientation to the organization usually is a structured program that is generally applicable to all new employees” (Yoder-Wise, 2015, p. 283). M.S. states that an important part of orientation is looking at and understanding the policies and procedures of the facility. These standards are written to enable staff to work within their scope of practice. Following orientation, M.S. evaluates effectiveness of orientation through frequent questioning and observation. If needed, orientation is extended until the new staff member is comfortable in their position. According to the AONE (2015) human resource leadership skills, managers are responsible for performance management. This includes staff evaluation, monitoring for fitness of duty, initiating corrective actions and terminating staff. Following orientation, new employee evaluations are completed at ninety days. After the initial evaluation, M.S. evaluates all staff annually using a standard form. If a staff member receives a “did not meet expectations,” they will be reevaluated in 90 days to determine any improvement. As part of the annual evaluation, M.S. determines fitness of duty. This is monitored through observations from staff and administration, complaints from clients, and reported staff errors. “Nurse managers…have an overall responsibility to monitor and provide surveillance or vigilance regarding situations that can lead to failure to rescue, patient safety errors, or negligence” (Huber, 2015, p. 26). If staff members are determined unfit for duty or receive a “did not meet expectations” during evaluation, corrective action is considered. First, the staff member will receive a verbal warning, then a written warning. Discipline continues until termination is indicated. However, termination is a rare occurrence. According to the AONE (2015) human resource leadership skills, managers are responsible for staff development. This includes facilitating education, ensuring competency, promoting professional development and encouraging leadership growth and staff satisfaction. M.S. encourages professional development in several ways: conferences, webinars, individual obtainment of contact hours of education (CEs), speakers, and numerous trainings. SCCHD employees attend mandatory professional development meetings every three months. M.S. closely monitors that staff members have obtained necessary CE’s and trainings as outlined by their program. “Continued development of the staff is a unique role for the nurse manager” (Yoder-Wise, 2015, p. 284). M.S. also assesses staff satisfaction from evaluation comments and staff verbalizations. She will immediately respond to any issues noted. She also takes time to thank staff members both verbally and via e-mail. In the past, she purchased thank you mugs full of candy and filled baskets with Keurig coffee, tea, and hot chocolate for the staff. M.S. feels that giving appreciation to staff is extremely important. “A balance between teamwork and autonomy, as well as perceived support and positive patient outcomes, appear to be common factors in job satisfaction” (Fraser, 2010, p.13).Performance Improvement & Strategic Management According to the AONE (2015) performance improvements, managers must demonstrate knowledge related to performance improvement, as well as, client and employee safety. M.S. believes the key performance indicators for staff include: immunization rates, sexually transmitted infection (STI) rates, disease outbreak rates and public health statistics. Some of these indicators are measured through the Michigan Department of Health and Human Services (MDHHS) and Center for Disease Control (CDC). The Center for Disease Control (CDC) publishes the morbidity and mortality report (MMWR). M.S. monitors publications and utilizes the information to guide practices. Furthermore, all policies and procedures are developed from evidence based research. M.S. monitors performance improvement by utilizing quality assessment (QA). Likewise, documentation requirements in the electronic medical record (EMR) are also monitored by QA. In CS, QA is done through quarterly peer chart reviews. “One of the methods most often used in QA is chart review or chart auditing” (Yoder-Wise, 2015, p. 375). In PHI, daily QA’s are performed by the immunization action plan coordinator (IAP) Coordinator. In Communicable diseases (CD) the CD coordinator reviews each CD case before completing it.Another important responsibility is patient satisfaction. Patient satisfaction is assessed using annual customer satisfaction surveys and review of yellow comment cards. Any issues identified are reviewed and discussed. If the client has a complaint, M.S. will attempt to find a resolution. Although patient satisfaction is important, patient safety is paramount. M.S. does not participate in root cause analysis regarding patient safety. However, she does participate in sentinel event reporting. The PHI department submits events to the Vaccine Adverse Event Reporting System (VAERS). CD reports events to the Michigan disease surveillance system (MDSS). The Region 2N Epidemiologist also receives alerts from MDSS, which informs her of when emergency room (ER) complaints rise above a set threshold. This is them reported to M.S. She also monitors trends from weekly school reports. In CS’s, the rates of STI’s are also monitored by MDSS. For all communicable diseases, a quarterly report is submitted to county providers where they are tracked for three years. Furthermore, M.S. maintains survey and regulatory readiness per state accreditation every three years. However, if an incident occurs in the facility an incident report is made. Incident reports are handwritten by the staff member and submitted to M.S. She then sends it to the director of nursing and administrator for review. If the person injured is an employee, an electronic accident report is filled out. To discourage employee incidents, safety policies and procedures are in place. Furthermore, Bloodborne Pathogen Training is completed annually. M.S. closely follows the regulations from the Michigan Occupational Safety and Health Administration. “The Michigan Occupational Safety and Health Administration strives to work collaboratively with employers and employees to better prevent workplace injuries, illnesses, and fatalities” (Department of Licensing and Regulatory affairs, 2016).?According to the AONE (2015) Strategic management, managers are responsible for project management, facilitating change, contingency plans, presentations, and facilitating meetings. M.S. believes change is inevitable and communication is the key to facilitating those changes. Furthermore, change can only happen when staff in involved in the process. M.S. encourages staff members to work as a team to implement changes. M.S. communicates changes to staff during monthly staff meetings or email. Staff is then given time to meet and discuss implementation of these changes or to evaluate changes already made. Changes are evaluated by through client and staff satisfaction surveys and feedback.Project management consists of program grants. M.S. works closely with administration to determine who will work on specific grants and what their role will be. She is not directly involved in setting timelines; they are determined by the grant. She does not allocate any resources of the grant; this is done at the administrative level. However, M.S. does work closely with the EPC. She assists the EPC in reviewing internal disaster and emergency planning/execution policies and procedures. Likewise, she assists with drills and data collection. She attends several county meetings on emergency preparedness. M.S. frequently does presentations within the HD and the community. She assists in answering media questions, writing press releases, and appearing on radio and television. M.S. also facilitates meetings in the community and within the HD. Relationship management and influencing behaviors According to the AONE (2015) relationship management and influencing behaviors, managers are responsible for self-awareness, good communication skills, ability to effective use dialogue to improve team dynamics, perform conflict management and negotiation. M.S. performs informal self-assessments, using this information to establish an action plan. She has studied books related to improving leadership abilities. Although, M.S. acknowledges she is still learning. she continually improves as a leader. Further, she believes the communication is the key to good leadership. Consequently, she promotes consistent communication between the staff and herself. She also describes herself as a prolific e-mailer. “Healthcare communication is a two-way process of informing, persuading, and sharing ideas using the most appropriate medium for the situation and for the participants” (Parsons, 2001, p.11). To enhance communication, M.S. also promotes an open-door policy with her staff. However, even with excellent communication, conflict can arise. M.S. encourages staff to work out conflicts between themselves. However, if a conflict cannot be resolved she addresses it quickly using negotiation techniques. Furthermore, situation management is on a case by case basis. M.S. relies on common sense and flexibility to address conflict situations. “Unresolved conflict among nurses is a significant issue resulting in job dissatisfaction, absenteeism, and turnover” (Yoder-Wise, 2015, p. 432). M.S. continually promotes team dynamics by promoting unity. Staff is always referred to as a team. She does not officially mentor staff or colleagues but attempts to lead by example. She believes she can influence others by being a role model of professional behavior. Similarly, she assists others with developing problem solving skills.Personal and Professional AccountabilityAccording to the AONE (2015) personal and profession accountability, managers are responsible for advancing education, practicing ethical behaviors, membership in professional organizations and certifications. Accordingly, M.S. is a member of the Michigan Public Health Association (MPHA). She participates in several CE programs, including conferences and webinars. “One of the keys to maintaining competence and versatility is continued learning” (Yoder-Wise, 2015, p. 556). She is certified in mental health first aid and has several advanced certifications related to emergency preparedness. M.S. practices ethical behaviors and works within her scope of practice. Financial management According to the AONE (2015) Financial management, managers are responsible for understanding the importance of revenue and budgets. M.S. recognizes that without reimbursement the HD cannot function. Medicaid and Medicare are the most commonly used insurances in the facility. Beyond insurance companies, the PHI program works with the vaccines for children (VFC) and the vaccine replacement program (VRP). Most programs receive money through grants and the state of Michigan. To keep this funding, M.S. ensures the program meets the requirement of the grants. Budgets are made at the administrative level. ConclusionIn conclusion, M.S. has demonstrated that she fulfills her managerial role as compared to the 2015 AONE nurse manager competencies. M.S.’s education background has given her a strong basis for leadership. M.S. clearly understands her role and responsibilities as a manager, while working within the defined philosophy of the HD. She has demonstrated how she has fulfilled her role in human resource management, human resource leadership skills, performance improvement, strategic management, relationship management and influencing behaviors. She has continually demonstrated her accountability both personally and professionally. Although she does not participate closely with the financial management of the facility, she is cognizant of the importance of revenue to the continuation of her facility.ReferencesAmerican Organization of Nurse Executives. (2015). AONE Nurse Manager Competencies. Chicago, IL: Author. Retrieved from Psychological Association [APA]. (2010). Publication manual of the American Psychological Association. (6th ed.). Washington, DC: Author.Department of Licensing and Regulatory Affairs. (2016). Michigan Occupational Safety and Health Administration. Retrieved from Fraser, S. (2010). Influencing outlook: The importance of nursing staff satisfaction. Nursing Management, 41(9), 12-16. Doi: 10.1097/01.NUMA.0000387092.80316.22Goodreads. (2016). Douglas MacArthur?quotes. Retrieved from, S. L. (2014). Leadership and nursing care management. (5th ed.). St. Louis, MO: Elsevier.Parsons, P. (2001). Beyond persuasion the healthcare?manager's?guide to strategic?communication. Chicago, Il: Health Administration Press.?St. Clair County Health Department. (2016). About us. Retrieved from , P. S. (2015). Leading and managing in nursing (6th ed.). St. Louis, MO: Elsevier. ................
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