Running head: ADVANCED NURSING ROLES IN NURSING ADMINISTRATION 1. Advanced Nursing Roles in Nursing Administration. Sample Paper. La Salle University

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1 Running head: ADVANCED NURSING ROLES IN NURSING ADMINISTRATION 1 Advanced Nursing Roles in Nursing Administration Sample Paper La Salle University

2 ADVANCED NURSING ROLES IN NURSING ADMINISTRATION 2 Abstract For years, The American Association of Colleges of Nursing (AACN) had defined advanced practice nurses as nurse who have completed specialized, advanced education, earning masters or doctorate degrees in nursing. The four most recognized roles would be nurse practitioner (NP), clinical nurse specialist (CNS), certified nurse midwife (CNM), and certified registered nurse anesthetist (CRNA) (DeNisco, 2015). However, as nursing has grown, many other advanced roles have developed. Clinical nurse leaders (CNL), informatics nurse specialist (INS) and public health nurses (PHN) to name a few. This paper will discuss the advanced nursing role of the nurse administrator (NA). The role of the nursing administrator in current healthcare fields continues to grow and change every day. Becoming a nurse administrator has proved to be a challenging yet rewarding career now recognized by the AACN, with most NA s earning masters and doctorate degrees (Becoming a Nurse Administrator). This paper will describe the role of the NA in today s complicated healthcare arena. The author will also present a recent interview with a nurse administrator, as well as discuss personal career goals, in effort to have the reader understand the significance of this evolving role.

3 ADVANCED NURSING ROLES IN NURSING ADMINISTRATION 3 Introduction Nursing Administration (NA) is a very important role for the Advanced Practice Registered Nurse (APRN). Nursing Administrators are not new, but their roles are expanding seemingly on a daily basis. Hospitals started using nurses as administrators back in the early 1900 s. Healthcare changed, offering many new opportunities for patients as well as nurses. Hospitals started providing medications, anesthesia, and advanced medical care such as surgery (Healthcare Administration, n.d.). This offered many opportunities of advancement for nurses. As more hospitals opened, the need for appropriately trained staff became obvious, and the indication for individuals to train and manage staff became apparent. Historic Development It is reported that the first advanced degree course for nurses came from the University of Chicago in 1934, when the school began to offer a Health Systems Management Program (Healthcare Administration, n.d.)the same university also offered the first advanced degree for nursing administrators, the Masters in Healthcare Administration. Minimal training was required compared to how APRN s are trained today. Today the APRN trained in NA has endless opportunities available, ranging from hospitals and clinics to nursing schools and pharmaceutical companies, the possibilities are endless. Healthcare administrators are not usually the first people you see in a healthcare organization, yet they are among the most important groups working behind the scenes to make sure everything runs smoothly. Description of Role Nursing administrators range from nursing supervisors to Chief Nursing Officers (CNO) to most recently health information nurse specialists. The main goal of the NA is to assure the best possible care if being administered to all clients, as well as handle all issues as they arise.

4 ADVANCED NURSING ROLES IN NURSING ADMINISTRATION 4 They are in the background, making sure everything runs as it should. APRN s including nursing administrators demonstrate a level of higher education, training and leadership skills required for advancing into the upper levels of healthcare, such as Chief Nursing Officers, offering a large opportunity for growth within the healthcare system. (Becoming a Nurse Administrator). Nursing administrators are in contact with staff, physicians, and patients. They are the go between to assure patient care is optimized in all situations. Ethical issues are a large part of the NA s role. The NA must assure the staff is comfortable talking about any ethical issues they feel need to be discussed, as well as be cognizant of the personal ethical issues of the staff by first having an open line of communication with all staff members, and making patients and family aware they are there for them as well (Pavlish, 2015). A good practice for any APRN is to lead by example, a good example of this would be arranging ethics education for all staff members in all departments. Ethical issues in healthcare are a big aspect of the nurse administrator s role. Staff may have concerns and they need to know they have someone who will listen in a nonjudgmental way and establish a balance of trust (Pavlish, 2015). It is extremely important all nurse leaders advocate for and support their staff, even if there is a conflict. Nurse administrators have the responsibility of establishing an environment of continuous learning, known as Transformational Leadership (Luzinski, 2011). The basic premise here is APRN s guide staff in a way to which changes are made to better the way things are handles from the perspective of the patient, family or staff member. They must be change agents in their organizations, in order to strategically increase productivity (Luzinski, 2011). The APRN will know an endeavor has been successful and quality leadership displayed when positive results are established.

5 ADVANCED NURSING ROLES IN NURSING ADMINISTRATION 5 DeNisco (2015) describes Continuous Quality Improvement (CQI) as being the ultimate goal of all healthcare administrators. This concept involves a continuous process of evaluating and constantly updating the current policies and procedures in order to continuously be improving all aspects of care. The best example of how to demonstrate this would be to lead by example, do not expect others to do what you yourself would not do, and teach as you do, creating a constant learning environment (DeNisco, 2015). Nurse administrators should also be aware of and involved in Evidence Based Medicine (EBM). Basically, this concept involves informing the patient of all options and possible outcomes and involving them in the decision making process (DeNisco, 2015). It is the responsibility of all APRN s to remember the patient always comes first. Education and Certification Regulations for education of nursing administrators vary, and there are no specific credentials needed for the role. Most are APRN s with an MSN, however there are nurses holding nursing administration degrees with lower education levels. Most have been in their establishments for over 20 years and have not been required to go back to school for advanced degrees. This is becoming an issue if the establishment is applying for Magnet status, as they do require advanced degree nurses in higher roles. The American Association of Critical Care Nurses offers a certification for nurse administrators, the Certification for Nurse Managers and Leaders. The American Association of Nurse Executives has a 2 tiered certification process. The Certified Nurse Manager and Leader is for experienced nursing leader with a BSN degree. It requires 3 years of experience in the nursing manager role prior to taking the examination. The Certified Executive in Nursing Practice requires an MSN as well as experience in an executive role.

6 ADVANCED NURSING ROLES IN NURSING ADMINISTRATION 6 Supporting Organizations There are many organizations supporting this role. These include the American Association of Health Care Administrators, the American Governance and Leadership Group, and the National Association of Directors of Nursing Administration. Also, the local State Board of Nursing is very helpful. Specialties offer their own certifications, below certifications for nurse administrators in infertility and simulation will be discussed. Interview with Robin W, RN MSN Robin W is the Clinical Nurse Manager of a very busy fertility group in Virginia. Robin has been in her position for 15 years, and her responsibilities continue to expand as more procedures become available, more offices are opening and more staff, from receptionists to embryologists, need training. During our interview Robin was asked the following questions, with her answers provided below: 1. Where do you work? I work as a nurse manager for a busy infertility clinic, my position also incorporates the responsibilities of a practice consultant and marketing director. 2. What are your responsibilities? I oversee five physicians, four offices, and twenty eight employees as well as a marketing team of nine people outside of our office. Our clinical staff sees between thirty and sixty patients a day going through in-vitro fertilization (IVF). More than half our clients are self-pay, making them very demanding and time consuming for our staff. Our marketing team manages: radio, internet ads, social media, direct marketing to obstetricians, gynecologists, and urologists, and physician outreach programs. My

7 ADVANCED NURSING ROLES IN NURSING ADMINISTRATION 7 responsibilities also include oversite of residents, conducting webinars, producing educational videos and online support for patients, perspective patients, and new client coordinators. 3. What are the barriers/struggles you face? The biggest struggle I face is keeping educated, well qualified staff at our front desk. They have to deal with the clients on the front line as they say, and they have to understand the temperament of our clients and be able to maintain professionalism. An important barrier I am dealing with currently is trying to convince the physicians we need a better system for managing our increasing volume. We do not have EMR, which makes it very difficult to keep work flow organized between five offices. I m trying to work with all members of our practice, including physicians, lab techs, and nurses to find an EMR system that will help facilitate client care. Our clients are very demanding and often become emotionally unstable because of the hormones they must take for IVF. This is par for the course for our type of facility, and I struggle to keep my staff aware of this and not have them lose their cool with clients, which can easily happen! Most clients do not have insurance coverage for IVF or infertility treatments, so the cost of treatment contributes to their stress, and making sure they don t scam my staff for freebies is tough. Like most clinics we try to separate billing from clinical, but they sometimes overlap. Our nurses and doctors have to keep in mind the clients financial issues when making clinical decisions. This is something I bring up at every staff meeting.

8 ADVANCED NURSING ROLES IN NURSING ADMINISTRATION 8 3. Why isn t your office switching to an EMR? The physicians don t like change they don t want to deal with the hassle. They like things the way they are, and honestly any fines we receive for not switching will be far less than the cost of the actual process of implementing an EMR. Most small offices are choosing to pay the fines because they can t afford to switch. Again this is something I bring up every month and every month the doctors just say no. I am an advocate of the EMR, I know the changes it could make for our practice would be difficult at first, but I will continue to advocate for the change not because of the law but because it is the safest thing for our clients. 4. What barriers exist, if any, that make it difficult for you to implement your APN role? As I said above working with physicians to convert to an EMR is one of my highest priorities. It is difficult to explain to the physicians things they don t want to hear, and nothing that costs a lot of money and time to implement and involves a lot of training is something they want to hear. I won t give up on that, check back with me in a year The biggest barrier I face is too much growth in our practice, which leaves not enough space or time for each patient when three doctors are in one office at the same time. We need to be spending more time with clients, which we cannot do because the doctors are so overscheduled and are seeing too many clients too fast. We follow American Society of Reproductive Medicine (ASPP) for overall patient care but we rely on our own nursing guidelines (written and constantly updated by me) with regards to managing our patient flow and training new employees. ASRM recently reinstated an advanced specialty certificate for nurses working in the infertility field. We encourage

9 ADVANCED NURSING ROLES IN NURSING ADMINISTRATION 9 and pay all of our nurses to obtain this certification: Our staff must keep up with any changes within FDA guidelines for handling human tissue donation, and that includes being familiar with state laws and the difference in state regulations. We have offices in Virginia and Washington D.C., and there are some things we are permitted to do in one state but not the other, so we occasionally see the same patients in different offices. Again as I answer this I see the reason to further advocate for an EMR! In order to keep up with social changes we expanded our service to the LBGT community and we have started accepting male/male couples. However, during out first male couple treatment with an egg donor and gestational carrier, we discovered a little known law in Virginia that forbid using the sperm of an openly gay man. It was put on the books in the 1980 s to protect the blood supply, but in light of the legalization of gay marriage it seems out of place. We were able to create an embryo, but the couple had to ship said embryo to Canada for transfer. I was instrumental in making the process work despite all we had going against us, which is something I am very proud of. At least we were able to treat them but every day we are faced with these types of issues. We changed our policy based on ASRM guidelines, but being in Virginia and D.C. we still had to obey the law. It is my responsibility to keep us up to date and I will admit that is an increasingly difficult task as healthcare laws are changing so fast, it s difficult to keep up. We have many single and female/female couples that are denied insurance coverage while their married counterparts are eligible. A large part of my job is managing the out of the ordinary patients and I rely on ASRM, the Federal Drug Administration, and a bunch of overpaid attorneys to keep us from getting in trouble.

10 ADVANCED NURSING ROLES IN NURSING ADMINISTRATION What resources are available to assist you in implementing the APRN role? The ASRM is a great resource for many aspects of my career, there is a section for professional nursing groups, of which I am an active member. It is very useful for networking and keeping up with all the changes going on in healthcare. I also find support in the Association of Reproductive Health Professionals, their website is very up to date on current topics, policies and best practice standards. I also find the State Board of Nursing to be very helpful. Personal Development The more I read about the leaders not only in nursing administration but nursing in general, the more certain I am of my decision to pursue my advanced degree in nursing administration. History as far back as Clara Barton during the American Civil War and Florence Nightingale s story keep going back to the heart and soul of nursing, they remind us nursing is about caring for others basic care is at the root of everything we do (Colgan, 2013). Reading the book Advice the Healer had a major impact on me, it showed me that the ideas and concepts we are chasing now are not necessarily new, they are just improvements on the foundations established many years ago. I have worked in nursing since 1987, twenty eight years. It seems to have flown by. I started my career as a nurse extern at a hospital caring for post or patients and learning what it was really like to be a nurse. I did not know at the time I was experiencing what would later be called Evidence Based Medicine (EBM) (DeNisco, 2015). I was busy learning things did not always go as they told me they would in the books! But I loved it. I moved on to pediatrics, worked in homecare, became the night charge nurse of the CCU, and while I loved what I was doing with the patients, my passion was for the teaching I was involved

11 ADVANCED NURSING ROLES IN NURSING ADMINISTRATION 11 with involving our new nurses. Many of them had not yet learned things don t always go the way they teach you in school. I became a unit educator, participating in precepting new intensive care unit nurses, as well as yearly competencies. One day we opened a box and there was a baby, in the box. Not a real baby, a simulator. We could make the baby breathe, have pulses, cry, have seizures, become cyanotic, basically anything we wanted. This to me was the most amazing educational tool I had ever worked with, as I could now customize learning to meet the needs of the group I was educating. I would set up multidisciplinary mock codes right at change of shift with the simulator, with only my educators knowing it was not a real patient in distress. After being called some not very pleasant words the first few times, the team learned to love the simulations. Our outcomes improved, as well as the confidence of our team of nurses, doctors and respiratory therapists. They had the opportunity to practice low frequency high risk events without fear of doing anything wrong that would hurt the patient, because at the end of the day, the patient, in our case the simulator, would always be okay. I knew I wanted to become more active in simulation. I obtained an international simulation certification, becoming a Certified Healthcare Simulation Educator (CHSE), of which there are less than 500 in the world. My passion for education grew from there, and I knew I wanted to run a simulation center. I believe my background experience in critical care as well as extensive simulation experience will make me the perfect candidate to become a Director of Simulation. Huber (2000) states there are five instrumental concepts in becoming an influential leader, and reports autonomy, conflict management, job satisfaction, leadership ability and organizational climate as being instrumental in becoming an affective nurse manager. I believe with additional training, I can become a very strong nurse leader. Excellent leaders are open to learning and exploring new experiences in order to make better decisions in the future (Ferguson-Pare, 2003). I feel I have a passion for

12 ADVANCED NURSING ROLES IN NURSING ADMINISTRATION 12 teaching as well as learning, in addition I believe I am fair and most importantly, I listen. I have found that even if there are only two people involved in a situation, there are usually three versions of what happen, and it is important to let everyone be heard. My confidence is growing every day, as is my knowledge. I can identify learning needs for my desired role. While I am completely comfortable with the patient care, the scenario development and working with students in the simulation center, I am not familiar with metrics, budgets, or ROI. The business aspect of the nursing administrator role is something I am looking forward to learning more about. From hospitals to clinics to colleges, nurse leaders need to have a business background in order to successfully serve their staff (Ferguson-Pare, 2003). Additionally, I need to strengthen my skills in the IT department. I need to know how to work servers, remote cameras, and other aspects of advanced technology associated with simulation. I also believe I need to improve my confidence and belief in myself, which I am doing every day. Personal Development Goals: 1. Continue to obtain simulation knowledge via conferences and continuing education opportunities. 2. Have the courage to admit what I don t know and strength to continue to learn. 3. Follow the lead of leaders in nursing, from nursing mentors I currently work with to leaders in my desired specialty. 4. Continue education to include a post graduate teaching certificate as well as MBA after completing my MSN. 5. Obtain Certification for Nurse Managers and Leaders via AACN.

13 ADVANCED NURSING ROLES IN NURSING ADMINISTRATION 13 References Becoming a Nurse Administrator. (n.d.). Retrieved from Colgan, R. (2013). Advice to the Healer On the Art of Caring (Second ed.). Baltimore, MD: Springer New York. DeNisco, S. M. (2015). Advanced Practice Nursing (Third ed.). Burlington, MA: Jones & Bartlett Learning. Ferguson-Pare, M. (2003, March). Administration: What is nursing leadership? doi:10:12927/cjnl Healthcare Administration. (n.d.). Retrieved from Healthcare Administration- Historical Background : Huber, D. L. (2000, May). Evaluating Nursing Administration Instruments. Journal of Nursing Administration, 30(5), Retrieved June 28, 2015 Luzinski, C. (2011). Transformational Leadership. Journal of Nursing Administration, 41(12), doi: /nna.0b013e a71 Pavlish, C. e. (2015, June). Avenues of Action in Ethically Complex Situations: A Critical Incident Study. Journal of Nursing Administration, 45(6), doi: /nna

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