Analyzing a Leader - RN to BSN Portfolio



Analyzing a Leader

Jamie Kruger

Ferris State University

Analyzing A Leader

Effective leaders require certain skills that assist them manage, direct, and mentor their employees. In order to determine what makes a good leader, a helpful starting point is to interview a leader in order to analyze their style, expertise, and ability. I interviewed Shari Wilson, the director of Quality Services and Case Management at Mecosta County Medical Center (MCMC) in Big Rapids, Michigan. This interview took place at MCMC on September seventieth, 2012 at three o’clock in the afternoon.

Shari Wilson is a baccalaureate trained, registered nurse with a background in critical care and case management. The bulk of Shari’s nursing experience was in a critical care unit that specialized in neurosurgery patients. She eventually segued to case management, both in the hospital and office setting. During this time she obtained her certification in Case Management.

It was in 2008 that Shari obtained her first management role when she came to MCMC to become the director of Quality Services and Case Management. She oversees utilization review, social work/discharge planning, clinical documentation, risk management, quality services, emergency management, safety/compliance, and the medical staff office. Shari, in order to keep current and pursue a personal goal, started working on her Masters in Nursing degree eighteen months ago.

Shari’s job duties are to oversee the role of the individual sections by updating old and generating new policies. She establishes training programs for new hires within her department, and provides opportunities for continuing education for established employees. Shari ensures that each section in her department remains compliant with the standards of their individual licenses. Shari reports to the chief clinical officer who then reports to the chief executive officer. She collaborates with all of the other departments within the hospital. She collaborates with these departments through meetings and committees.

Analysis of Ethical Issue

Evidence

One issue that Shari managed in the past that has ethical implications concerns a patient that was admitted to the critical care unit from a nursing home. This patient was mentally challenged, elderly, and had a legal guardian. This patient, who was never able to make her needs known, was a full code. Both the guardian and the physician wished to pursue a no code status based on the patient’s medical condition, having been placed on a ventilator with multiple failed wean attempts. Shari convened an ethics committee meeting with hospital staff where legal and ethical issues were discussed. After the meeting, Shari allowed social work to petition the court to see if a judge felt it possible to grant the no code status. The judge did not allow the status to be changed, and tracheotomy and feeding tubes were placed. The patient was discharged to a long term acute care hospital.

Support

Effective leaders utilize many tools when arriving at decisions. They must see all aspects of the problem and formulate their decision based on sound practice. When ethical situations arise “the nurse manager must use all available resources, including institutional ethics committee, and communicate with and support all those involved in the process” (Wacker Guido, 2011, p. 91).

Analysis

In using an approach that involved staff members and the legal guardian, Shari was able to arrive at a decision where all parties were heard while following the letter of the law. She used all of her available resources, convened an ethics committee meeting, and communicated and supported all that were involved (allowing staff, physician, and guardian’s voice to be heard). The patient was advocated for within the scope of the law, and the organization was protected from any wrong doing.

Analysis of Power and Influence

Evidence

Shari is a firm believer in the team approach, and this shows in how she works with her staff. She feels that her department has the shared goal of achieving positive patient outcomes, and feels that staff can and should use each other’s expertise in problem solving. Shari creates an environment of empowerment where staff feel like they can generate ideas and be an important part of the team. There is an atmosphere of mutual respect where she provides direction, but allows staff to use their own talents to come up with solutions.

Support

Leaders that are effective are ones that get maximum output from staff with exerting little, if any pressure. Those that establish professional practice work environments will have staff that are engaged and take ownership in their jobs, producing improved outcomes (Adams, Denham, & Ramirez Neumeister, 2010). This leadership style is embedded in the Adams Influence Model (AIM). AIM’s foundation is based on the ability of the person influencing to use personal, interpersonal, and social systems to sway an individual using their knowledge base, authority, and communication (Adams & Ives Erickson, 2011).

Analysis

By Shari allowing staff to problem solve on their own and use their own talents to complete projects, she is asserting her power and influence in a way that allows staff to act independently from micro-management. It is shown that “empowerment contributes to more professional practice behaviors through self-efficacy, especially in the presence of strong leadership” (Kelly, 2011, p. 191). Shari uses a “kind of leadership that supports inner work (self-development) as well as team building and shared decision making that empowers others” (Horton-Deutsch, Young, & Nelson, 2010, p. 492). Staff that are valued for their contributions carry themselves with pride knowing that they are an integral part of a team. Patients are able to see the positive attitude from staff, and the organization is able to work together as a team.

Analysis of Decision-Making/Problem-Solving Process

Evidence

Shari believes when it comes to making decisions that affect the department, which in turn affect patient care, the best approach is to step back, evaluate, and become informed with all of the facts. She likes to gather opinions from other team members and seek counsel from others that may have more experience in that particular situation. She likes to gather all of the information, assemble a team, then brainstorm for possible solutions.

An example of a recent problem that faced Shari and her decision to act came in the form of trying to speed up the process of admissions from the emergency department to inpatient services. She gathered all of the information about the problem, spoke to the individuals involved, sought expert counsel from another facility and learned their methods for handling same, and then brainstormed for possible solutions with involved parties. She implemented the solution and then planned for follow up meetings for evaluation.

Support

Problem solving, like decision making, often follows a systematic approach. This involves identifying the problem, gathering data, analyzing that data, developing a solution, selecting a solution, implementing that solution, and then evaluating the results (Aguilar Welch, 2011). With a methodical approach to problem solving and decision making, all angles are explored and sound decisions can be made. Including staff in this process is indicative of participative decision making, which has been “shown to increase work performance and productivity” (Aguilar Welch, 2011, p. 101).

Analysis

Shari was able to solve the time crunch that occurred when the emergency department was ready to discharge patients to inpatient status. She used approaches to problem solving and decision making that allowed her to reach a suitable solution that made patient’s happier by decreasing wait times. “Patient satisfaction has a direct correlation to timeliness of care, which is reflected positively on an organization” (Welch & Dalto, 2012, p. 138).

Analysis of Management and Resolution of Conflict

Evidence

Shari least favorite part of her job is management and resolution of conflict. She likes to see if the parties involved are able to come to a conclusion without too much interference from herself. If she needs to step in, she likes to hear both sides of the story and help them find a solution that is good for all involved. If the problem involves patient care, then she believes the patient always wins.

An example of a conflict that Shari has had to deal with centered on two staff that shared an after hours on-call schedule. They could not agree on a schedule and Shari had to intervene. Her intervention was to listen to both opinions then tell both parties that if they could not come up with a schedule, she would come up with one for them and that would be set in stone. The parties were able to compromise, and come up with their own schedule.

Support

Leaders that take the time to listen to disagreements between staff are ones that show they care about their staff. “Managing conflict well in an environment helps to create a culture where staff feel valued” (Sherman & Pross, 2010, para. 25). This valuation is necessary to foster good working relationships amongst staff.

Analysis

Shari was able to guide the two parties involved into solving their own problem. She showed them that she was there if they absolutely needed her to be, but allowed them to work through the conflict and come up with an acceptable solution that fit both of their needs. She showed them that they were important enough to manage their differences. By having staff that are able to manage their own conflicts and work together, they are able to focus more time with patients and the organization.

Conclusion

Shari Wilson has demonstrated that she has many qualities that make an effective leader. She has continued her education throughout her career and strived to develop career goals and projects that benefit nursing at the level of patient and organization. She is someone that I would like to model my own nursing career after.

References

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interrelationship of leadership environments and outcomes for nurse executives:

A community hospital’s exemplar in developing staff nurse engagement through

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34(3), 201-201. doi: 10.1097/NAQ.0b013e3181e7026e

Adams, J. M. & Ives Erickson, J. (2011). Applying the Adams Influence Model

in nurse executive practice. The Journal of Nursing Administration, 41(4), 186-192. doi: 10.1097/NNA.0b013e3182118736

Aguilar Welch, R. (2011). Making decisions and solving problems. Leading and

managing in nursing (5th ed., pp. 98-115). St. Louis, MO: Elsevier Mosby.

Horton-Deutsch, S., Young, P. K., & Nelson, K. A. (2010). Becoming a nurse faculty

leader: Facing challenges through reflecting, persevering and relating in new

ways. Journal of Nursing Management, 18, 487-493. doi: 10.1111/j.1365-2834.2010.01075.x

Kelly, K. (2011). Power, politics, and influence. In P. S. Yoder-Wise (Ed.), Leading

and managing in nursing (5th ed., pp. 175-193). St. Louis, MO: Elsevier Mosby.

Sherman, R. & Pross, E. (2010). Growing future nurse leaders to build and sustain

healthy work environments at the unit level. The Online Journal of Issues in Nursing, 15(1). Retrieved from

Wacker Guido, G. (2011). Legal and ethical issues. In P. S. Yoder-Wise (Ed.), Leading and managing in nursing (5th ed., pp. 68-97). St. Louis, MO: Elsevier Mosby.

Welch, S., & Dalto, J. (2012). Improving door-to-physician times in 2 community hospital emergency departments. American Journal of Medical Quality, 26(2), 138-144. doi: 10.1177/1062860610379630

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