Running head: POPULATION BASED NURSING LEADERSHIP ROLES 1

Transcription

1 Running head: POPULATION BASED NURSING LEADERSHIP ROLES 1 Population Based Nursing Leadership Roles Cheryl Howard NURS 340 Ferris State University

2 POPULATION BASED NURSING LEADERSHIP ROLES 2 Abstract This paper outlines the role of nursing leadership in the roles of public health in the areas of direct contact and population based nursing. The purpose of this paper is to explore leadership characteristics and apply the ANA standards of nursing practice to different nurse leadership roles. These concepts are illustrated within the Ferris State University (FSU) NURS 340 Community Health Nursing class group student project proposal titled Kent County fall injury prevention program. Analysis of the similarities, differences and skill implication of nurse leadership roles is presented. Brief overview is given of nurse leadership in relation to the political arena. The author then poses personal reflection into possible challenges and strengths and competencies for nurse leadership roles, in general and also within the constructs of the proposed student group project. Keywords: leadership, policy, standards, public health nursing, direct contact, population

3 POPULATION BASED NURSING LEADERSHIP ROLES 3 Population Based Nursing Leadership Roles The role of nurses in population based health care can vary depending upon the practice setting. There are many tasks and responsibilities that a nurse can perform for the benefit of community health. In most cases, community health nursing is a combination of both a direct care focus and a population focus (Harkness, 2012). Nurses need a wide range of skills in both direct care and leadership because community nursing positions are increasing in proportion. (Mancini, 2011). Community health nursing knowledge is important to know for today s nursing workforce. To illustrate the concept of nursing leadership roles, an example of student group project for a proposed fall injury prevention program in Kent County, Michigan will be highlighted in relation to direct care and population based community health care. This proposal includes a focus on primary, secondary and tertiary prevention tasks. In order to carry out these tasks, the fall injury prevention program will need nurse leaders and followers. It is essential in the nursing profession to have leaders, managers and followers. Leading, managing and following with meaning and purpose ultimately benefits patient care and organizational outcomes (Bleich, 2011). The role of nurse leadership is integral in conducting a community health initiative such as the Kent County fall injury prevention program, which is a project of FSU nursing students. Kent County Fall Injury Prevention Program The proposed Kent County fall injury prevention program will provide consultation, fall assessment, prevention education, and fall intervention activities in the Kent County area for population aged 65 and over. Prevention activities are directed at eradicating, eliminating, or reducing the impact of disease and injury on individuals and populations, thus promoting health instead of disease (DeMarco & Segraves, 2012, p.70). Primary prevention activities include

4 POPULATION BASED NURSING LEADERSHIP ROLES 4 community awareness promotion, education and advertising about fall prevention as it relates to injuries and health promotion. Secondary activities include promotion for screenings for fall risk in health care facilities, community based organizations, and home visits. Tertiary prevention includes fall prevention activities for individuals and health care facility patients who have a history of falls or are rehabilitating from a fall injury. This program could potentially be operated out of a community action agency, public health department or other heath care organization. All awareness, education and fall prevention activities will be directed and organized by nurse leader/manager and carried out by direct care nursing staff. There is potential for this program to grow if it proves successful after implementation. Population Based Nurse Leader/Manager Role Nurse leaders are needed to coordinate care across disciplines and settings in order to address issues for patients, communities and workplaces (Mancini, 2011, p.132). The role of nursing leadership in population based services can be varied. Nurses can be a community coalition builder, agent of change, policy advocate, culture broker, case finder or researcher (Harkness, 2012). Population based public health nursing requires strong leadership characteristics and skills based in the ANA s public health nursing standard of practice. Population Based Nurse Leader for Fall Injury Prevention Program The nurse leader in the fall injury prevention program would be instrumental as an agent of change. Implementing a new program like this would encourage change on a community and population level by helping the community recognize a need and then working together with others plan and implement that change. Related to being a change agent, the population based nurse leader would also be a coalition builder with this program because it would require

5 POPULATION BASED NURSING LEADERSHIP ROLES 5 involvement of other players such as health care facilities, community leaders, charitable organizations, potential funding sources, government agencies and community members. This nurse leader position would require a research role because data and evidence based practice would have to be researched and implemented with the activities in the program. Data would have to be collected and evaluated to help determine outcomes, plan necessary changes within the program, report to funding sources and make the case for continuation of the program if it is successful. The population based nurse leader in this program would be responsible for oversight of the direct care nurse leaders. Population Based Nurse Leadership Characteristics According to Howard Gardner s theories of leadership, tasks in effective leadership include envisioning goals, affirming values, motivating, managing, achieving unity, explaining, symbolic serving, group representation and renewing (Valiga & Grossman, 2008, p. 195). The nurse leader of the Kent County Fall injury prevention program would need to possess these characteristics, especially in the area of envisioning goals, motivating, explaining and managing because these would be key areas of expertise when initiating and implementing a brand new program to the community. Population Based Nurse Leader ANA Standards of Professional Practice The ANA outlines the scope and professional practice standards for nurses. The ANA focuses on basic goals for competent behaviors in areas of ethics, evaluation, quality of practice, environmental health, resource utilization, collaboration, communication, leadership, evidencebased practice, research, and education (ANA, 2010). There are several specialty-specific publications for nursing practice, of which public health nursing is considered a specialty. The ANA states that public health nursing standards are

6 POPULATION BASED NURSING LEADERSHIP ROLES 6 a core resource for the nurses who focus their professional life in this area (McNamara & Stewart, 2007). Population based nurses need to have skills and competency in the ANA s eight domains of public health nursing practice: analytic assessment, policy development and program planning, communication, cultural competency, community dimensions of practice, basic public health science, financial planning and management, and leadership and system thinking skills (Harkness, 2012, p.9). The population based nurse leader of the Kent County fall injury prevention program would need to focus special attention to the public health nursing standard skills in program planning, financial planning, management, community dimensions of practice, leadership and system thinking domains. There would be considerable focus for the population based nurse leader to understand public health science as a whole in order for this program to be successful. Direct Contact Nurse Leader Role A direct service nurse in the field of public health nursing can practice in many different roles. Public health nurses working in direct services can be caregivers, case managers, advocates, educators, counselors, collaborators and information brokers (Harkness, 2012). Public health direct care nursing includes the components of leadership and followership (Bleich, 2011). The American Nurses Association (ANA) is the leading authority on the standards of generalist nursing practice as well as for the public health nurse. Nurse leadership characteristics are an important component of the ANA s standard of practice (ANA, 2010). Direct Contact Nurse Leader for Fall Injury Prevention Program The Kent County fall injury prevention program proposal includes the hands-on, direct contact nursing tasks of educating individuals, groups and agencies about fall injury and prevention tasks. Nurses will also be caregivers by conducting individual screenings and

7 POPULATION BASED NURSING LEADERSHIP ROLES 7 assessments on a case by case basis. They will counsel patients using a problem solving process, assist in implementing interventions and evaluating those interventions. A direct contact nurse leader will be required to oversee and manage these activities on an individual basis. Depending on how large this program grows to be there may need to be several direct contact nurse leaders working under the direction of the population based nurse leader of the program. The responsibility of direct contact nurse leader would be to ensure that nurses in the field are carrying out these duties competently and effectively. Direct Contact Nurse Leadership Characteristics Leadership includes the ability to plan, make difficult decisions, set priorities, provide resources, delegate and coordinate activities (Valiga & Grossman, 2010). Leadership characteristics are required for employee management, being a good teacher and employee evaluator in order to help direct other nurses in the workplace. A good direct nurse leader would be directing the front line workers on a constant basis be the eyes & ears for their supervisor. Direct Contact Nurse Leader ANA Standards of Professional Practice As stated previously, the ANA outlines the scope and professional practice standards for nurses. The direct contact public health nurses would be held to the ANA professional standards of a nurse as a well as standards specifically for the public health nurse. Public health nurse standards in the domains of communication, cultural competency, analytic assessment and community dimensions would be particularly important for direct care nurses due to their handson, continuous contact with patients and groups of people in the community. In order to be successful the direct contact nurse leader would require an exceptional strength in the public health nursing domain of leadership and systems thinking skills. However it must be made clear that even though there may be areas of specific strength for each nurse position, all public health

8 POPULATION BASED NURSING LEADERSHIP ROLES 8 nurses, regardless of specific roles and responsibilities, are accountable to uphold every domain and standards in the scope of professional nursing practice (Harkness, 2012). Analysis There are similarities and differences between the roles of the direct contact nurse leader role and the population base nurse leader role. The similarities are that all roles in public health nursing have a responsibility to uphold the ANA standards of practice for both for general nurse and the public health nurse. Effective communication skills are key for both of these positions because of the high degree of interaction between individuals and community groups. Leadership skills are important for both roles in the respect that these positions would require significant ability to motivate and inspire others to envision the goal toward the importance of fall injury prevention. Leadership skills in education and explaining would be required in both which is an extension of the ANA public health standard in the communication domain. The differences in the roles of direct contact nurse leader and population based nurse leader are based mainly in the focus goals of each role. The direct contact nurse leader in the fall injury prevention initiative would be focused on employee performance and quality of nursing interventions to individuals and groups. The population based nurse leader would be more focused in a global direction on research, outcomes, community partnerships, planning and funding. The population based nurse leader is charged with the responsibility to promote health of a larger population on a grander scale that would promote lasting change in public health. The power of nurse leaders in political action and policy making can be profound in causing lasting change (Kelly, 2011). Policy is a plan for action related to an issue that affects a group s well being (Kelly, 2011, p.177). There is potential to be involved politically with the Kent County fall injury prevention program because nurse leaders may need to appeal to

9 POPULATION BASED NURSING LEADERSHIP ROLES 9 policymakers and local governments for funding, approval, partnership or endorsement of the project. Leadership skills of communication, education and being an agent for change would be used to advocate for the public health and well being for the entire population of Kent County senior citizens age 65 and over who are at risk of injury or death from falls. Nurse leaders could advocate for public or health system policy changes to help this program to grow into the entire state or nation which could potentially affect the entire elderly population. Reflection From a personal perspective I feel that I would be well suited for a nurse leadership role in both direct contact or population based leadership. Researching and developing this community program proposal has been exciting to me and I sincerely feel that an initiative like this has potential. I enjoy inspiring others, educating and creating positive changes. I have good communication skills and work experience in community leadership before I began my nursing career. The downfall that would be a stumbling block for me is that even though I have 20 years of work experience and working with communities, I have been a nurse for less than a year. I feel that I really do need some time to practice in the nursing field and become more seasoned. Another challenge for me would be that I have difficulty dealing with conflict. This is a skill that I am improving with but it is sometimes hard for me to think on my feet when face to face with a difficult personality. I need time to process the best course of action. If I had to choose what role I would be best suited for, I think that I would be better at a population based nurse leadership role rather than direct contact leadership. I have a tendency to think globally toward the impact of actions as a whole rather than individually. I have a good understanding of the importance of networking, community partnerships and funding. I find satisfaction in creating order out of chaos and using a teamwork approach in reaching a goal.

10 POPULATION BASED NURSING LEADERSHIP ROLES 10 References American Nurses Association [ANA]. (2010). Nursing: Scope and standards of practice (2nd ed.). Silver Spring, MD: Nursesbooks.org. Bleich, M. R. (2011). Leading, managing and following. In P. S. Yoder-Wise, Leading and managing in nursing (5th ed., pp. 3-23). St. Louis, MO: Elsevier. DeMarco, R. F., & Segraves, M. M. (2012). Frameworks for health promotion, disease prevention, and risk reduction. In G. A. Harkness & R. F. DeMarco, Community and public health nursing (pp ). Philadelphia, PA: Wolters Kluwer Health/ Lippincott Williams & Wilkins. Harkness, G. A. (2012). Community and public health nursing: Present, past and future. In G. A. Harkness & R. F. DeMarco, Community and public health nursing (pp ). Philadelphia, PA: Wolters Kluwer Health/ Lippincott Williams & Wilkins. Kelly, K. (2011). Power, politics, and influence. In P. S. Yoder-Wise, Leading and managing in nursing (5th ed., pp ). St. Louis, MO: Elsevier. Mancini, M. E. (2011). Healthcare organizations. In P. S. Yoder-Wise, Leading and managing in nursing (5th ed., pp ). St. Louis, MO: Elsevier. McNamara, M., & Stewart, M. (2007, January 26). ANA publishes newly revised public health nursing standards [Press release]. Retrieved from American Nurses Association website: /ANP-PR_PublicHealth aspx Valiga, T. M., & Grossman, S. C. (2008). Leadership. In R. Kearney-Nunnery, Advancing your career (4th ed., pp ). Philadelphia, PA: F.A. Davis Company.