NRS 440 Describe advocacy strategies that you can use as a leader to create positive change in your current workplace

NRS 440 Describe advocacy strategies that you can use as a leader to create positive change in your current workplace

NRS 440 Describe advocacy strategies that you can use as a leader to create positive change in your current workplace

A formal role in nursing leadership is the CNO or chief nursing officer. This position is the highest-ranking job a nurse can hold within a healthcare system. Some of the essential responsibilities of a CNO are to manage nursing finances, implement up to date policies and manage the nursing care to provide up to date and successful patient care. “The National Academies of Sciences, Engineering, and Medicine identify ways in which nurses should work with other members of the interdisciplinary team to eliminate disparities in health care and move toward equitable care delivery” (Thomas,2022). There are many traits necessary for Chief Nursing Officers have in order to be successful in the role. “All 3 valued flexibilities, clinical expertise, administrative capability, and willingness to assist with patient care when needed” (Riesch et al,.2022). To be placed in this position you are required to have an advanced nursing degree, a masters or doctoral degree is required to be in such a high-ranking nursing position. A person in this position must lead by example and be well educated, informed and caring. These characteristics are in alignment with the Christian world view. It is necessary to maintain a strong and empathetic presents as the CNO to maintain a nursing system that is built for success. We as followers of God believe in doing good for those in need and as a nurse on any level from a staff nurse to the CNO of a hospital this belief should follow with you as a person of faith.

Reference:

Gertrude Thomas. In: Interdisciplinary Journal of Partnership Studies, Vol 9, Iss 1 (2022); University of Minnesota Libraries Publishing, 2022. Language: English, Database: Directory of Open Access Journals

Malak, Haroon M.; Lorman, William; Rundio, Al; Simion, Denise; Simion, Marian G.. In Journal of Interprofessional Education & Practice. September 2022 28 Language: English. DOI: 10.1016/j.xjep.2022.100517, Database: ScienceDirect

Riesch, Susan K.; Chiappa, Jennifer; Floyd, Naomi; Ponce, Mary. In Nurse Leader. January 2022 Language: English. DOI: 10.1016/j.mnl.2022.09.006, Database: ScienceDirect

A number of organizations recognized the value of a system chief nursing officer (CNO) in promoting

professional nursing practice, standards, and outcomes, but these initial roles typically focused on the acute inpatient care settings. A clearly stated vision by the system CNO that care and care delivery changes are based on evidence, not only promotes standardization, but also promotes efficient use of time by decreasing efforts and interventions that are known to be ineffective (Kingston, 2013).

The delivery of safe, timely, effective, efficient, equitable, patient centered-care is dependent on nursing, as the nursing department typically employs the highest volume of direct-patient care providers within a healthcare facility. Thus the leadership skills of the CNO are necessary to achieving high quality patient care and excellent clinical outcomes (Jones et al., 2017).The CNO in an academic medical center environment is often responsible for thousands of nursing staff members, has oversight for professional nursing practice in relationship to state boards and regulatory requirements, and is responsible for the clinical nursing care of patients. Usually, with a large scope of responsibility, the CNO must demonstrate a leadership style that contributes to positive clinical and operational outcomes. Improving the safety and quality of care delivered in our health care system environments is an ongoing challenge (Jones et al., 2017).The CNO in an academic medical center plays a key leadership role in crafting and implementing effective improvement strategies. 

Jones, P., Polancich, S., Steaban, R., Feistritzer, N., & Poe, T. (2017). Transformational Leadership: The Chief Nursing Officer Role in Leading Quality and Patient Safety. JOURNAL FOR HEALTHCARE QUALITY, 39(3), 186–190.https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=edswss&AN=000423902700009&site=eds-live&scope=site&custid=s8333196&groupid=main&profile=eds1

Kingston, M. B. (2013). The System Chief Nursing Officer: An Evolving Role. Nurse Leader, 11(3), 27–29. https://doi-org.lopes.idm.oclc.org/10.1016/j.mnl.2013.03.004

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I currently work from home as a Prior Authorization Nurse (PAN) for United Healthcare (UHC). I can help providers submit request correctly and give patients a better understanding of how authorizations are determined. For eligible Unitedhealthcare members a new health plan feature creates increased transparency for prior authorization, including by enabling online tracking of a request’s progress from start to finish (UHC, 2022). UHC does have nurse advocates available that assist patient with any questions or concerns about their coverage. This position was created due to the process being determined “behind the scenes”. It is more pleasing for the providers and members to have more transparency and provide other resources when requests are denied. Before becoming a PAN I would help patients submit requests for redetermination (these were forms patients had to submit) for continuation coverage for medication. Nurses always advocate for their patients to protect the safety and provide the best outcome. The outcomes of advocacy gives patients a sense of empowerment and satisfaction. A good nurse advocate is all things and more. They are the voice for the voiceless, a champion for the hopeless, and a force to be reckoned with in the healthcare system (GNA Admin, 2022).

References:

independent Nurse Advocacy: The Remedy For Restoring Your Passion And The Perfect Career Move. (2022). Greater National Advocates (GNA)

How nurse advocates are helping to ease the prior authorization process. (2022). UnitedHealthcare (UHC). UnitedHealth Group Incorporated.

As I was thinking about this topic, I was thinking about the leadership responsibility of being a preceptor nurse. It is often challenging and scary teaching other nurses about the unit policies and the charting expectations required for the unit. Precepting new graduate or student nurses further increases the responsibilities as the new nurse is like a sponge, soaking up tons of new information. If the preceptor is not careful, they can pass along bad habits with the good habits. Preceptors can “utilize authentic leadership to help foster self-awareness and positive relationships and build capacity with student [ or new graduate] nurses” (Bryan & Vitello-Cicciu, 2022). 

As a new Charge Nurse in ICU, I find leadership a bit challenging. Though is it said that “every nurse is a leader”, I am not a born leader in my opinion and prefer to simply focus on my own patients (Whitney, 2018). I love being a bedside nurse but am happy to help with the charge nurse shortage in my hospital. I can think of a recent situation involving leadership that I might change in the future. I was charge one shift and was getting report on each of the patients from the previous shift charge nurse. We came upon a patient that had a small, known, pericardial effusion that was in the process of tamponading. It appeared that an additional echo had not been done in four days, so I followed up soon after finishing report. The patient become more fragile and was in A-fib RVR. The nurse was busy with the patient, so I called the cardiologist on call and then the hospitalist. A stat echo was ordered showing a large pericardial effusion with definite tamponade. I then spoke with the cardiologist and hospitalist again and it was decided that they were going to wait until the next day to intervene. This was tough to hear because it was clear that there was nothing we could do, and nothing I could do as a charge nurse to change the situation. The patient ended up being okay and not decompensating further so no harm was seen. In the future, I am not sure I will get as involved in individual patient situations. Though our job is advocating, I should have let the bedside nurse lead more in that situation instead of completely taking over. 

Does anyone have any advice for me in the future should a similar situation arise? 

References:

Bryan, V., & Vitello-Cicciu (2022). Perceptions of preceptors’ authentic leadership and final year nursing students’ self-efficacy, job satisfaction, and job performance. Journal of professional nursing. 41, 81-87. https://doi.org/10.1016/j.profnurs.2022.04.003

Whitney, S. (2018). Every nurse is a leader. In GCU’s trends in healthcare: A nursing perspective. https://lc.gcumedia.com/nrs440vn/trends-in-health-care-a-nursing-perspective/v1.1/#/chapter/5

Research has showed that there is a direct relationship between leadership and patient outcomes. Good nurse leadership is linked to patient satisfaction, decreased mortality rates, shorter hospital stays, enhanced patient safety and decreased readmission rates among other benefits. However, bad leadership in health care can cause unwanted/adverse events, health-care-associated infections, pressure ulcers, falls, unwanted weight loss, hospital readmission, mismanagement of feeding tubes, and inadequacies in daily nursing care among other negative effects (Akbiyik et al., 2020). To nurses, leadership brings job satisfaction. The nurse needs to understand the type of leader that they are. Knowing their leadership traits can help one to identify in which wards they can work better. For example, an autocratic leader can work best in an emergency department. This is because they are quick thinkers, can make good decisions on their own and they can appropriately delegate tasks (Sfantou et al., 2018). One of the duties of every nurse is to be a patient advocate. When one is in a leadership role, their responsibility extends to advocating for fellow nurses. There are a number of strategies that a leader can use to advocate for better outcomes. Nurse leaders can mediate conversations between patients and doctors. They can educate patients and suggest relevant available options. Nurse leaders also advocate for legal choices and policy changes. They can talk with a patient’s family and they can justify nurse actions on behalf of fellow nurses. Nurse leaders can negotiate with other leaders in higher offices to better working conditions and remuneration of other nurses (Stamps et al., 2021).

References

Akbiyik, A., Korhan, E. A., Kiray, S., & Kirsan, M. (2020). The effect of nurses’ leadership behavior on the quality of nursing care and patient outcomes. Creative Nursing, 26(1), e8-e18.

Sfantou, D. F., Laliotis, A., Patelarou, A. E., Sifaki-Pistolla, D., Matalliotakis, M., & Patelarou, E. (2018). Importance of Leadership Style towards Quality of Care Measures in Healthcare Settings: A Systematic Review. Healthcare (Basel, Switzerland), 5(4), 73. https://doi.org/10.3390/healthcare5040073

Stamps, D. C., Foley, S. M., Gales, J., Lovetro, C., Alley, R., Opett, K., Glessner, T., & Faggiano, S. (2021). Nurse Leaders Advocate for Nurses Across a Health Care System: COVID-19. Nurse leader, 19(2), 159–164. https://doi.org/10.1016/j.mnl.2020.07.011

Some advocacy strategies for my workplace include being available to the patient, most patients want to see how committed and involved the nurse is in their care. Secondly, supplying effective communication will help the patient feel at ease and relax, then usually the patient will start to share their feelings and information, which helps the patient have better outcomes. Another area I would foster in patient advocacy is actively listening to them, patients tend to want the nurse to listen to them without any input from the nurse, the patient needs to be comfortable just venting their situation and feelings, this approach will advance the nurse patient trust relationship and displays empathy (Grenuk, 2021).

In response to peers, describe a time when you provided leadership and the outcome. 

Home Health care leadership for me consisted of my being a nurse lead on two cases for 4 years. This was before the use of tablets in the home, my job entailed stopping at the local office to pick up necessary paperwork, supplies such as gloves, hand wash to stock in the client’s home. Other duties were to check the communication log and make sure the patient and family’s concerns were addressed, appointments scheduled with confirmation, transport services were arranged and confirmed checking to see if the visit was completed then checking if the after-visit summary was faxed to the office. All the above duties were followed up by the Director of Nurses to which my position had to answer and made accountable as well as to the organization. Once the tablet became available after year 2, it was no need to relay the information and do the follow-up with the (DON) because it was documented in the tablet. Technology has enhanced the nursing process and I believe it is necessary to understand and implement into nursing (Krick, et. al., 2019). 

Was there anything that you would do differently?

No, at the time I was nurse lead the organization was not using electronic tablets till later so there is nothing I could have done differently. The experience was great and now in my stored knowledge, I also learned how important it is to the organization to be competent and available. 

Krick, T., Huter, K., Domhoff, D. et al. Digital technology and nursing care: a scoping review on acceptance, effectiveness and efficiency studies of informal and formal care technologies. BMC Health Serv Res 19, 400 (2019). https://doi.org/10.1186/s12913-019-4238-3  

Grenuk, S.J. (2021) 6+Benefits of Effective Communication In Nursing. https://tigerconnect.com/blog/six-ways-nurse-communication-improves-deliver-healthcare/ 

When it comes to the workplace, leaders should always be the ones who push for improvement. Such an example may be seen in the healthcare industry, where nurses play an important role in promoting lobbying efforts (Bowles et al., 2018). Advocacy is defined as the act of arguing for, or speaking out in favor of, another person or cause. This means mediating between two parties as well. Care for patients, and the delivery of that care is where advocacy really shines. Everyone should be able to receive treatment that is fair, efficient, and effective. An advocate is necessary since patients and their loved ones are often perplexed and worried about their treatment plans. Regardless of the patient’s gender, social class, cultural origin, or anything else, the nurse’s primary duty is to advocate for the patient when problems arise that threaten their care. According to the American Nurses Association (ANA) Code of Ethics, nurses are obligated to provide care to patients without regard to their race, religion, gender, sexual orientation, socioeconomic status, or the nature of their health problems (Helbig, 2018).

Having a collaborative, effective communication and listening attitude is one of the main advocacy techniques I employ to bring about positive change in my current workplace. In doing so, I am able to collaborate with other medical experts for the benefit of my patients and gain insight into important decisions that affect my field. It also gives me the chance to hear my patients out and respond to them in a way that is both comprehensive and tailored to their own situations and needs. Inter-professional communication in patient care is greatly aided by individuals with good listening skills and the capacity to express themselves clearly and with compassion.

Reference

Bowles, J. R., Adams, J. M., Batcheller, J., Zimmermann, D., & Pappas, S. (2018). The role of the nurse leader in advancing the quadruple aim. Nurse Leader, 16(4), 244-248. https://doi.org/10.1016/j.mnl.2018.05.011.

Helbig, J. (2018). Dynamics in nursing: Art & Science of professional practice. Retrieved from https://lc.gcumedia.com/nrs430v/dynamics-in-nursing-art-and-science-of-professional-practice/v1.1/#/chapter/5