21 st -Century Nursing: The Demand for Leadership

Transcription

1 21 st -Century Nursing: The Demand for Leadership Angela Barron McBride Distinguished Professor-University Dean Emerita Indiana University School of Nursing Chair, Board Committee on Quality & Safety Indiana University Health

2 Overview of Presentation The 21 st -century nurse Some dated distinctions Paradigm shifts in health care and academia The demand for nurse leadership External demand Orchestrating a full career Some reflections on ICN s strategic plan

3 The 21 st -Century Nurse Doesn t have to talk about the promise of nursing; can produce evidence in support of nurses making a difference, e.g., Aiken s work Doesn t just support primary-care provider, but is increasingly the primary-care provider Doesn t play same role for entire work life, but assumes different responsibilities over time, including inter-professional responsibilities Nurse Helper..Nurse=Leader

4 Some Dated Distinctions Leadership=administration There is one kind of real nurse Constructive feedback is less necessary as one becomes expert Mentoring is only necessary during school, orientation, or tenure-probationary years The effective administrator largely operates from a command-and-control framework

5 Some Paradigm Shifts: Health Care 20 th -Century 21 st -Century Care episodic Integrated delivery systems/managed transitions Fee for service Care shaped largely by educational background of providers Capitated payment; bundled services Care shaped increasingly by evidence-based protocols and who has defining expertise

6 20 th -Century 21 st -Century Wring out unnecessary variation Care reliable and tailored Care individualized at margins Process-oriented (what Outcomes oriented (value professional does) of what is done) No time/place limitations Workarounds/variation the norm Care time and place bound Value teams of experts Emphasis on providerpatient relationship Value expert teams Emphasis on improving context so therapeutic relationships can thrive

7 Some Paradigm Shifts: Academia 20 th -Century 21 st -Century Faculty: sage on stage Faculty: guide by side Learning facts Learning to learn Faculty knowledgeable Emphasis on getting degrees Ever-escalating costs Process-oriented Time and place bound Career counseling focuses on entry into nursing Faculty expert Emphasis on continuously learning Bend cost curve Outcomes oriented No time/place limitations Career counseling over professional lifetime

8 20 th Century 21 st Century Disciplinary silos Nursing service and education separate Research shaped by personal interest Emphasis on getting NIH funding scholarship of discovery Inter-professional emphasis Nursing service and education collaborate Research shaped by clinical need/funding Emphasis on diversified funding for scholarship scholarship of teaching, utilization, and discovery

9 The Demand for Nurse Leadership IOM s Keeping Patients Safe. Transforming the Work Environment of Nurses (2004) urged nurses to exert transformative leadership, take responsibility for the design of work and workspace to prevent and mitigate error, and serve as prime movers in developing organizational cultures of safety.

10 IOM s The Future of Nursing (2010) emphasized nurses practicing to the full extent of their education, more educated nurses, nurses as full partners with physicians and other health professionals in redesigning and leading healthcare change (including serving on boards), improved data collection to guide decision making, and lifelong learning.

11 In 2010, the RWJF commissioned Gallup to survey opinion leaders (n=1500) about the roles nurses are playing. About half said nurses already have a great deal of influence in preventing medical errors and providing quality care, but 80% said that they would like nurses to have even more influence than they now do in preventing errors, ensuring quality, promoting wellness, increasing efficiency, coordinating patients, and addressing the needs of an aging population.

12 IOM s Best Care at Lower Cost (2014) summarized the characteristics of a continuously learning health care system: real-time access to knowledge; digital capture of the care experience; empowered patients; incentives that promote continuous improvement; full transparency; a leadership committed to a culture of teamwork; and supportive system competencies.

13 Leadership is a process whereby the individual inspires and catalyzes others to achieve institutional mission and organizational goals in an environment where the context (e.g., economic situation) and meanings (e.g., of health and aging) are continuously evolving, thus the continual need to design new ways of realizing shared, longheld values.

14 Leadership is not synonymous with administrative title Ranges from individual performance and productive teamwork to inspiring higher performance in others and creating enduring excellence Leadership is not only what you do, but what you get done

15 Leadership=Full Career Stages Preparation Independent Contributions Development of Home Setting Development of Health Care and Profession Gadfly (Wise Person) Period Needed Mentoring Individual short- and long-term relationships Development of mentoring structures Nominations to national programs

16 Central Activity: Learning PREPARATION Primary Relationship: Student, Teaching and/or Research Assistant Major Theme: Assimilating values, knowledge base, and clinical/inquiry skills important to a practice profession and health care Mentoring Needed: Help set short-term and career goals; guide to experiences that build skills and expand vision without overwhelming; welcome to profession and identity as a leader

17 Independent Contributions Central Activity: Demonstrating ability to work independently and interdependently, while developing competence Primary Relationship: Colleague, Preceptor Major Theme: Dealing with gap between ideals learned and the realities of work setting Mentoring Needed: Help understand institutional mores; involve in governance; provide feedback so abilities improve; keep focus on meeting professional and institutional benchmarks

18 DEVELOPMENT OF HOME SETTING Central Activity: Facilitating home institution while growing personal expertise Primary Relationship: Mentor, Committee Chair, Manager, Supervisor, Administrator Major Theme: Assuming responsibility for development of others and of setting Mentoring Needed: Help ask right questions; provide feedback regarding how to effect change; discuss how to make best use of others; offer tips on strategic planning

19 DEVELOPMENT OF HEALTH CARE AND PROFESSION Central Activity: Shaping future of health care and profession/specialty Primary Relationship: Consultant, Board Member, Officer, Administrator Major Theme: Exercising power of authority in creating a vision for the future Mentoring Needed: Provide tips on effective board behavior; recommend for opportunities; help strategize; sponsor for honors

20 GADFLY (Wise Person) PERIOD Central Activity: Continue to shape health care and profession though Medicare card in hand Primary Relationship: Coach, Consultant, Board Member Major Theme: Exercising power of authority when no longer constrained by institutional obligations Mentoring Needed: Assist in envisioning postretirement opportunities; encourage boldness

21 Asked to come today to speak on leadership, the best thing that I can do is to end by focusing on what each one of us can do to achieve the goals of the Indiana Center for Nursing s Strategic Plan

22 ICN becomes one voice for Indiana nursing Do we all understand the power of a neutral organization representing a range of schools, clinical facilities and other organizations devoted to assuring the state s nursing workforce? Do we all understand the power of coming to ask for something holding hands? What can each stakeholder do to strengthen the voice, so our separate actions can be aggregated to advantage?

23 Achieve higher levels of education Seamless academic progression LPN-ASN, ASN-BSN, ASN-MSN, BSN-DNP, BSN-PhD Link what we are doing not only to 2010 IOM report but to 2014 IOM report emphasizing development of continuously learning health care systems Emphasize benefits of intra-professional teams

24 All nurses practice to the full extent of their education Ensure that all educational programs prepare their graduates to describe their generic abilities and special experiences Strengthen links between additional nursing education and preparation for leadership in growing areas, e.g., quality-improvement methods; managing transitions; facilitating patient self-management

25 Support inter-professional practice and education Prepare nurses at all levels to be part of expert teams Prepare nurses to lead inter-professional teams Team work linked to greater emphasis on wisdom of the whole

26 For better... Shared goals Shared knowledge Mutual respect Frequent communication Timely communication Problem-solving communication

27 Or worse Functional goals Specialized knowledge Lack of respect Infrequent communication Delayed communication Finger-pointing

28 Core Competencies for Interprofessional Collaborative Practice: International Center for Interprofessional Practice and Education:

29 Interprofessional Education and Teamwork (Josiah Macy Jr. Foundation): ofessional-education-and-teamwork Interprofessional Education for Collaboration (IOM): l-education-for-collaboration.aspx

30 Improve Indiana Nursing Workforce Data infrastructure What data are missing that would assist work of state legislature? What data are missing that would assist clinical facilities in their decision making?

31 Expand scholarship funding Can ICN become even more of a central repository for information regarding scholarship and leadership-development assistance? Could ICN play a larger role in orienting Indiana money managers and estateplanning lawyers to the need for scholarship assistance?

32 Education-practice partnerships Dedicated educational units Identification of research projects that address real-life problems and use institutional data Using shared simulation labs to teach students, test the competency of staff, and prepare family caregivers What other ways can service and academia work together for the enhancement of both?

33 Promoting a diversified nursing workforce diversity among health professionals is associated with improved access to care for racial and ethnic minority patients, greater patient choice and satisfaction, better patient provider communication, and better educational experiences for all students while in training (National Research Council, 2004)

34 21 st Century Nursing: The Wisdom of The Whole Diverse in Gender Race/ethnicity Language Religion Education Age Personality Politics Life experience SES background Avocational Interests Specialties Other???

35 Statements of mission that recognize the value of diversity Intensive student recruitment and retention efforts working with high school counselors; a balance of quantitative and qualitative admission criteria; pre-college boot camp; financial support to make schooling affordable; socialization opportunities for first in family to go to college; mentoring

36 Intensive faculty recruitment and retention efforts recognizing core value of a diverse faculty; helping new hires feel welcomed by and comfortable in community; leadershipdevelopment opportunities; coaching; recommending for awards Looking critically at our marketing materials and environments, including our art work, to ensure that our settings show how open we are to different people

37 Every Curriculum Committee should have a Diversity Subcommittee charged with reviewing each course to ensure that subject matter is mindful of 21 st -century diversity and what constitutes culturally-competent care Make good use of local and state data in planning curricula and services, e.g., Indianapolis has one of the highest concentrations of Burmese immigrants

38 All nurses need to learn how to facilitate groups with diversity of thought, so they are comfortable and effective in those situations We need to stop having only minorities speak about minority issues

39 Let me end by emphasizing the greatest value I see in the Indiana Center for Nursing. It is its convening authority, its ability to convene a range of stakeholders for the purpose of launching a course of action that goes beyond the purview of any one of the interested parties. Let s maximize that advantage.