LESSON FOUR The Profession of Nursing in Canada Introduction Registered Nurses in Canada are held in high regard by the public; known as knowledgeable, ethical and professionals who provide quality, safe and effective nursing care to individuals, families and communities. We are a self-regulating profession with standards of practice, ethical guidelines and a clear scope of practice. Our professional role in the Canadian health care system is a privilege, and with it comes many responsibilities including those of an advocate, leader, life-long learner and accountable practitioner. Lesson Outcomes 1. Understands the role and responsibilities of the Registered Nurse, including those of advocate and leader. 2. Describe the concept of self-regulation. 3. Describe what scope of practice means in terms of the profession, personal and employment. 4. Explores the standards of practice of the Registered Nurse. 5. Understands the importance of professional presence. 6. Discuss the concepts of continuing competence, fitness to practice and reflective practice. 7. Understands what it means to be accountable for nursing practice. 8. Discuss the roles of regulatory bodies, professional organization and unions. August 2015 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 1
Required Readings See required reading list Websites Association of Registered Nurses of Prince Edward Island: http://www.arnpei.ca/ Canadian Association of Schools of Nursing: http://www.casn.ca/ Canadian Nurses Association: https://www.cna-aiic.ca/en College of Registered Nurses of Nova Scotia: http://www.crnns.ca/ Nurses Association of New Brunswick: http://www.nanb.nb.ca/ NurseONE: http://www.nurseone.ca/ Canadian Federation of Nurses Unions: http://www.nursesunions.ca/ August 2015 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 2
Responsibilities of the Registered Nurse The Registered Nurse in Canada is defined as follows: Registered nurses are self-regulated health-care professionals who work autonomously and in collaboration with others. RNs enable individuals, families, groups, communities and populations to achieve their optimal level of health. RNs coordinate health care, deliver direct services and support clients in their self-care decisions and actions in situations of health, illness, injury and disability in all stages of life. RNs contribute to the health-care system through their work in direct practice, education, administration, research and policy in a wide array of settings. (CNA, 2007) Let s review this definition in more detail, starting with the first statement, Registered nurses are self-regulated What is Self-Regulation? Self-regulation means that Canadians have given RNs the privilege of regulating themselves, the government delegates this role to the regulatory bodies. This means that RNs are expected to act in the best interest of the public at all times. Provincial law known as the RN Act makes each provincial regulatory body responsible to protect the public by ensuring that RNs practice safely, competently and effectively. Some RN Acts also describe what an RN is legally permitted to do, such as administer medication. Self-regulation also involves striving to continuously improve the practice of nursing. In Nova Scotia the regulatory body is known as the College of Registered Nurses of Nova Scotia (CRNNS). In Prince Edward Island the regulatory body is known as the Association of Registered Nurses of Prince Edward Island (ARNPEI), and in New Brunswick there is the Nurses Association of New Brunswick (NANB). Some of the regulatory activities include providing nurses with standards of practice, a code of ethics; ensuring RN educational programs meet certain criteria; setting licensure requirements and offering a process for conduct and competence review. For example, the mandate of CRNNS is as follows: To serve and protect the public interest; preserve the integrity of the nursing profession; and maintain public confidence in the ability of the nursing profession to regulate itself. (CRNNS, 2009) August 2015 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 3
Unregulated professionals have no one governing their actions, although they may use a title and standard educational curriculum. Licensed Practical Nurses are selfregulated, while Continuing Care Assistants or Personal Care Workers are not. RNs in the Maritimes must join a regulatory body in order to practice nursing in each of the provinces. One must be registered and licensed in a province to use the title Registered Nurse and to practice nursing in that province. Registration is the term used to describe the listing of a member in good standing on the membership roster, while licensure is the right of the member to practice the profession, as granted by the regulatory body. It is illegal to practice nursing without some form of active-practicing licence. The regulatory bodies provide the following services to nurses: Professional practice and policy development Practice consultation Continuing competence Professional conduct Educational opportunities Promote evidence-informed practice Unions Those working in a unionized agency are also represented by unions, who negotiate job-related issues with employers. The union is concerned with issues such as economic welfare, benefits, working conditions and responsibilities. In Nova Scotia, the Nova Scotia Nurses Union (NSNU) or the Nova Scotia Government Employees Union (NSGEU) represent nurses, in New Brunswick it is the New Brunswick Nurses Union (NBNU). Prince Edward Island s nursing union is known as the Prince Edward Island Nurses Union (PEINU). Unions can help nurses resolve work life issues such as: Overtime Mandatory call back Staff mix Vacation benefits Professional Organizations Each of the Maritime regulatory bodies is a member of the Canadian Nursing Association (CNA), our national association that advocates for healthy public policy on behalf of nurses. The CNA represents nurses in Canada at a national and international level, voicing concerns about such issues as poverty, health care, health concerns and others. By lobbying the government and involving the public this organization helps to bring about policy change. CNA also strives to enhance health care, standards of nursing and professional development of nurses. Other professional organizations that RNs can belong to include specialty nursing groups, alumni associations or associated groups (e.g., Operating Room Nurses Association of Canada, Victoria General Hospital School of Nursing Alumni, Sigma Theta Tau International Honor Society of Nursing). August 2015 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 4
Now let s go back to our definition of the Registered Nurse: Registered nurses are self-regulated health-care professionals who work autonomously and in collaboration with others. What does being a professional mean? There are six characteristics that define whether a group can use the title professional and they are as follows: 1. Professionals have a specialized body of knowledge Nursing research provides us with a unique and specialized body of knowledge that helps to guide our approach to meeting the health needs of the public. Our knowledge is different but complementary to other health care providers such as physicians or social workers. The RN Act of 2006 defines the practice of the RN in Nova Scotia as: in order to the application of specialized and evidence based knowledge of nursing theory, health and human sciences, inclusive of principles of primary health care, in the provision of professional services to a broad array of clients ranging from stable or predictable to unstable or unpredictable, and includes (i) assessing the client to establish their state of health and wellness; (ii) identifying the nursing diagnosis based on the client assessment and analysis of all relevant data / information; (iii) developing and implementing the nursing component of the client s plan of care; (iv) coordinating client care in collaboration with other health care disciplines; (v) monitoring and adjusting the plan of care based on client responses; (vi) evaluating the client s outcomes; (vii) such other roles, functions, and accountabilities within the scope of practice of the profession which support client safety and quality care; (A) promote, maintain or restore health; (B) prevent illness and disease; (C) manage acute illness; (D) manage chronic disease; (E) provide palliative care; (F) provide rehabilitative care; (G) provide guidance and counseling; and (H) make referrals to other health care providers and community resources; and also includes research, education, consultation, management, administration, regulation, policy or system development relevant to the above (CRNNS, 2009) August 2015 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 5
2. Professionals can apply this knowledge competently Anyone receiving care from a RN expects that they will be competent and safe practitioners. A professional has the ability to recognize and act on learning needs. RNs have the responsibility to maintain competence and be committed to life long learning. If you are unfamiliar with something or have never performed a certain skill, you are required to obtain the necessary education to do so. Professional selfregulation means that you are trusted to seek guidance and assistance when you require additional knowledge or help. 3. Professionals provide service to the public Registered Nurses have a role as an advocate for the rights of individuals and communities. It also involves working with other health care professionals and sectors to serve the public better. 4. Professionals adhere to a code of ethics A code of ethics is a statement of the values and acceptable professional conduct. The Canadian Nurses Association Code of Ethics provides us with a practical guide for everyday ethical decision-making. This will be discussed in more detail later in Lesson 10. 5. Professionals engage in self-regulation The reason professionals engage in self-regulation is because we have a specialized body of knowledge. How could we expect someone else to govern our practice when they know nothing about it? We know ourselves and our work best, and therefore are entrusted to be the most capable in determining who can practice when and how. There are public representatives who are members of the councils of the regulatory bodies who ensure that the profession is meeting its obligation to protect the public and serve in their best-interest. 6. Professionals uphold individual accountability This is a very important aspect of professionalism, each individual nurse is responsible for the decisions they make and the care they provide. RNs need to be willing and able to assume responsibility for their actions and must accept the consequences of their behaviour. They must be able to explain the reasons for the actions they take (or do not take!). These reasons must reflect the professional responsibilities that they are given. Please Read: Lesson Four: Required Reading 1 (note this reading applies to all Maritime learners) August 2015 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 6
Again, let s go back to our definition of a Registered Nurse in Canada: Registered nurses are self-regulated health-care professionals who work autonomously What does working autonomously mean? To work autonomously means we must be able to account for everything we do when we act independently. We do not require direct supervision all of the time. We must be accountable in order to act autonomously. For example, when an RN conducts a health assessment (including physical examination) he or she is responsible for the quality and comprehensiveness of the assessment. The RN is expected to take action on the findings that arise from the assessment, acting independently on the things that fall within his or her scope of practice, and to collaborate with other health care professionals caring for the client. As an RN in Canada many actions are your own responsibility, you do not need to call on a physician or supervisor to check your actions or direct you in making decisions. However, sometimes you will need to collaborate with a physician or another health care professional- it is your obligation to consult others when needed. RNs can independently administer medications that have been prescribed by a physician, however if a client has an adverse reaction to that medication the RN must report it to the physician. As well, it is the RN s duty to carry out the orders of physicians intelligently, which means they RN must have the knowledge to determine if the order is safe and ethical. If the RN feels that the physicians order is not safe or ethical, then they must question the order and discuss it with the physician or supervisor. An RN is obliged to protect the public and should refuse to participate in unethical procedures or conduct. August 2015 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 7
Activity 1 Lesson Review 1. Reflect on the characteristics of a professional. How do these characteristics relate to you and your practice as a Registered Nurse? Are they familiar to you or new? 2. Do you think that the concept of autonomy is one that is valued throughout the world? 3. Take some time and explore the website for your regulatory body. What position statements most interest you? What publications seem relevant to your current learning needs? What educational opportunities do they offer? August 2015 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 8
4. Using the lesson, fill in the blanks in the following paragraphs. RNs in Canada have the of being, and are always expected to act in the of the public. All RNs are required to practice,, and. Being self-regulated means continuously to nursing practice. RNs are known as, which means that our group has specific characteristics. The first is that RNs have a body of knowledge that guides. The practice of RNs involves clients, client data obtained from assessments, and implementing the component of the care plan. The RN seeks to, or health; prevent and ; manage and illness; and provided and care. RNs may also be involved in research,, consultation,, administration or policy development. RNs must be able to and act on needs. RN follow a that helps to outline our and professional conduct. RNs are, which means that they are for each decision they make. Autonomous practice means that RNs are able to do some things within their of practice, but must with other health care professionals when appropriate. August 2015 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 9
So back to the definition of the Registered Nurse: Registered nurses are self-regulated health-care professionals who work autonomously and in collaboration with others. RNs enable individuals, families, groups, communities and populations to achieve their optimal level of health. So how do we ensure that the care that we provide helps people to achieve their optimal level of health? Well, one way is to ensure that we provide good practice. There are several ways that regulatory bodies help to ensure that nurses provide good practice. One is through the helping nurses to maintain their continuing competence. Continuing Competence When a RN graduates from university they may feel relieved to be free of study and books however this won t last very long! Throughout our careers RNs continue to develop professionally, constantly gaining experience and knowledge as they strive to keep up with the constant changes in the health care world. Every year, RNs are expected to review the following practice guides and reflect on their practice, the Standards of Nursing Practice, the Entry-Level Competencies and the CNA Code of Ethics. After this reflection and review they determine their own learning needs and develop a plan to meet these needs over the upcoming year. Nurses need to continually update their knowledge and skills in order to practice competently in health care today. This can be achieved through self-directed study, continuing education, inservice programs and other learning opportunities. Reflective Practice So what is the point of all this reflection? Reflection helps us to learn from our experiences and how to connect theory with practice. By critically examining our own practice it will help us to challenge some of the things that we do- as the goal is ultimately to improve nursing care and client outcomes. In this complex and challenging world it is imperative that we take the time to formally reflect on occurrences and try to make sense of situations. You may have been reflecting since you finished nursing school. As a new graduate you may have been overwhelmed by a new environment, new challenges and situations. If you found yourself in a critical situation for the first time you may not have known what to do. As you watched senior staff deal with the situation you may have not understood the reasons behind some of their actions, and you may have felt unprepared. Afterwards you may have done some reflection on everything that happened and asked yourself, Why did the doctor order that? or How did she know that would happen? You may realize that you did have the knowledge and theory, but that you lacked the confidence to act. You may realize that you did not have enough knowledge about that disease or treatment and so need some information on it. Through reflective practice you can identify areas that need improvement and also areas of strength that can help you in situations. August 2015 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 10
Self awareness is a fundamental element of reflective practice. It is important for us to be cognizant that our personal needs, wishes, feelings, fears, strengths, and weaknesses can interfere with our ability to understand the client and hence our ability to provide nursing care which is truly centered on the client. Knowing yourself allows you to differentiate between your own values and beliefs, and those of the client. The distinction is important in gaining an understanding of the client as a unique individual with unique perspectives and unique choices. By knowing yourself you can avoid superimposing your beliefs and preferred solutions upon the client. (RNAO, 2002; RNANO, 2006). As you progress though this course it is important to reflect on what you are learning and how it will affect your nursing practice. In your clinical practice it is expected that you will reflect on experiences, some RNs do this through personal journaling. This involves describing the event, examining it in detail, and understanding how it made you feel. The next step is to compare the experience to other experiences that may have happened to you in the past. It is your goal to identify what you knew and what you did not know as well. Focus on developing a plan to improve your practice and be confident in your ability to creatively maneuver around the barriers that you will face. The next time that you are faced with a similar situation remember the strategies that you identified and do your best. The process of reflective practice is continual and is essential as we strive to improve nursing and the services that we provide to our clients. August 2015 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 11
The following is an overview of five stages involved in reflection, along with examples of questions which relate to each of the five stages. Stage 1. Describe what happened during the experience Questions to Ask Yourself What happened? What did you do/say? 2. Examine feelings How did you feel? What were you thinking? 3. Evaluate the experience What went well? What did not go well? What was the outcome? 4. Analysis of the situation What did you need to know? What should you have known? 5. Conclusion What did you learn from this situation? What would you do if it happened again? The process of reflective practice can produce the following outcomes: Learning, knowledge, and understanding A type of action A review process Professional development Problem solving Decision making Unexpected outcomes Recognition there is a need for further reflection Reflective practice is an essential part of ensuring that you adhere to our standard of practice of continuing competence. It is imperative that we as registered nurses maintain the knowledge, skills and judgment that our practice requires in order to provide safe, competent nursing care. It is our duty to ensure that we keep our knowledge current and congruent with advances in medical science and technology. Continuing competence entails the commitment to life-long learning as you uphold the standards of professionalism that are required to be a registered nurse. August 2015 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 12
Fitness to Practice It is important to remember that RNs must accept their responsibility to maintain fitness to practice. That is they strive to maintain their physical, mental and emotional well-being. If you are struggling in one of these areas, your ability to think, make decisions, clinical judgements and handle stress may be negatively affected. This can impact client/patient care, perhaps jeopardizing the safety of those that you are caring for. It is crucial that nurses take time to nurture and take care of themselves! This means ensuring that you get enough sleep, healthy food, exercise and stress relief. Professional Conduct Review Unfortunately a small number of RNs have extreme difficulties in their nursing practice, and may not be able to provide safe, effective, competent care. This may be due to a fitness to practice concern, for example, a nurse who practices while under the influence of alcohol. Or it may be a competence issue, for example when a nurse does not have the appropriate knowledge, does not seek assistance, and provides unsafe care. When a RNs nursing practice does not meet these standards a colleague, employer, manager, or member of the public must intervene and report them to the CRNNS. It is the duty of each individual nurse to report a colleague who is engaged in professional misconduct, is incompetent, is engaged in conduct unbecoming the profession, is incapacitated or is placing his or her clients at risk in any way. The following further describes some of the activities noted above that are unacceptable for an RN and should be reported: Failure to uphold the Standards for Nursing Practice or Code of Ethics Abusing a person physically or sexually (i.e, engaging in sexual relations, touching sexually or making sexual comments to a client) Stealing Inappropriately influencing someone to make or change a will or power of attorney Abandoning a client Failing to provide care to a client Disclosing confidential information about a patient inappropriately Falsifying documents Borrowing money from a client August 2015 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 13
Committing fraud Possessing or trafficking in drugs Not possessing the knowledge, skill or judgement necessary to provide care (incompetence) Providing care while incapacitated, such as by drugs, alcohol or illness Please Read: Lesson Three: Required Readings 2 and 3 (Read only the Standards of Practice and Entry Level Competencies for the province you will be licensing in as a Registered Nurse) August 2015 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 14
Activity 2 Lesson Review 1. For each of the following practice issues identify the Standard of Nursing Practice that guide this action as a Registered Nurse. a) You make a medication error and report it to the charge nurse on duty. b) One of your clients IV line is occluded, another is ringing for pain medication and a third is complaining of chest pain. You ask one of your colleagues for assistance. c) You attend a continuing education workshop on wound care. d) Following a client s episode of acute shortness of breath you immediately document your assessment, interventions and plan. e) You encourage a client to voice his concerns over the medical treatment that he is getting, and voice your concerns as well. f) You help to coordinate the nursing care of the clients in your long term care facility. g) After witnessing severe incompetence by another health care professional you speak to them and report them to your supervisor. August 2015 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 15
2. Find the continuing competence program for the regulatory body to which you are pursing your licensure on their website. Review the program. Take note of any questions that you have for discussion in class. Scope of Practice According to the CRNNS (2009) scope of practice is defined as: The roles, functions and accountabilities which members of a profession are educated and authorized to perform (p. 9). As mentioned in previous lessons, our health care system is trying to become more community-centered with a team -based model of service delivery. It will be extremely important for our profession to ensure that our members understand their scope of practice, but also to allow our scope of practice to be flexible enough to allow change. Our goal is to provide nursing care that best meets the health needs of the community. The following will briefly discuss the three levels of scope of practice and how they will guide you in your everyday practice. The Scope of Practice of the Profession The broad scope of practice of Registered Nurses is defined by the respective regulatory body, and is often guided by legislation in the RN Act. It identifies all of the activities that can be performed by registered nurses, as lay people lack the necessary skills and knowledge to perform them. It forms the basis of the practice of registered nurses and defines this practice for the public and other health disciplines. Some of the scope of practice of the RN is similar to other health care professionals. The Scope of Practice as defined by Organization This involves the registered nurses scope of employment. Every organization has procedures and policies in place for many activities of staff. In one hospital it may be the responsibility of the Intravenous Access team to initiate all IV s and a nurse may not be permitted to perform that skill as it is not within his or her job description to do so. Or a certain procedure may be performed on one type of unit, but not on another (e.g., permitted in an Emergency Department but not on a Medical-Surgical Unit). Even if you are competent to perform a certain skill, if it is not policy for an RN to do that task in that area of the organization, you cannot do it. This is important to understand as you need to practice within the rules of the organization that you are working for, or your practice will not be supported and you could face a complaint from the regulatory body. August 2015 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 16
The Scope of Practice of the individual Registered Nurse This is defined by each registered nurse s education, experience and knowledge that render one competent to perform the activities as described by our professional scope of practice. For example, a nurse has to ask for help when one of her clients requires an intravenous (IV) line to be inserted, as she has not completed the required education and supervision in learning this skill. Even though it is within her professional scope of practice (i.e., registered nurses are allowed to insert IV s) it is beyond her personal scope of practice. It is essentially up to you as the professional registered nurse to be accountable to provide safe, ethical, competent care and recognize the limits of your practice - whether they be internal (e.g., lack of experience) or external (e.g., hospital policy, professional limitations). Scope of Practice of Individual RN Scope of Practice of Organizati on Scope of Practice of RN Profession August 2015 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 17
Often the registered nurse shares certain skills with other professions such as medicine, or is only able to perform a skill after completing education above and beyond what was learned in basic education. The following discusses the categories of these skills and what they mean for you as a nurse. Advanced or Shared Competencies These are skills that are within the scope of nursing practice and may be performed by registered nurses, but are above what is required of the entry-level nurse. Generally you will require additional education and experience to perform these skills above what you learned in your basic education. Some of these skills may require standing orders or a physician s order. The terminology for these skills may vary among institutions, for example they may be referred to as specialized nursing competencies or post-entry level competencies (formally referred to as shared competencies). It is crucial that you check the policy of the institution before you perform any skill to ensure that you have the necessary experience and knowledge, and to ensure that you are adhering to the institution-specific guidelines for that procedure. Some skills may require informal training (e.g., learning to use a specific kind of IV pump) or a formal learning process (e.g., a learning package with a theoretical and practical component) and requires a demonstration. Remember, although you may have been proficient and skilled in these competencies in your previous practice, you usually must complete the required education specific to the institution in which you will be practising in order to be deemed competent and able to perform the skill independently. Example: Accessing a Port-a-Cath. Delegated Medical Functions A delegated medical function is a procedure/treatment/intervention that is normally within the scope of practice of medicine. In the interest of client care these skills have been approved by the regulatory bodies of nursing and medicine to be performed by registered nurses. Registered nurses can only perform the procedure if they have the required education and experience (i.e., certification). Example: Adjustment of insulin doses, removal of chest tubes. Medical Directive It is a written order for a medical procedure/treatment/intervention that may be performed by a registered nurse on a range of clients who all meet specific criteria. It must describe the assessment process to determine whether or not the client meets the criteria and specific monitoring parameters. These orders must always be written, are effective for an extended period of time only for a certain group of clients. Some medical directives may be within the scope of nursing practice (e.g., giving a medication) and others may require additional education or skill acquisition (e.g., August 2015 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 18
blood sampling). It is the responsibility of the registered nurse involved to recognize and judge the appropriateness of following the medical directive for each situation. Example: Written order for emergency room nurse to give antipyretic to clients with fever - ONLY when they meet the criteria, as evidenced by performing the assessment as outlined in the medical directive. If the client fits the criteria then the nurse can administer the antipyretic- even if a doctor has not yet examined them or is even aware of their case. It is imperative that you find and review the specific policy and procedure guidelines and complete any educational requirements defined by the institution that you are practicing in before performing any skill, regardless of your experience. August 2015 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 19
ACTIVITY 3 LESSON REVIEW 1. For this exercise match the description with the term or terms that best describe it! Description Term 1. A written order for an intervention that is performed by a nurse on a range of clients who all meet a certain criteria. 2. A registered nurse needs additional education and/or experience to perform these skills. 3. Include a description of the assessment process to determine whether the client fits the criteria of the group. 4. Skills or interventions that are normally the practice of medicine. A - Advanced Competency B - Delegated Medical Function C - Medical Directive 5. Skills or interventions that require you to check the policy and procedure guidelines of the institution that you are practicing in. Role as Health-care Professionals Let s finish reviewing the definition of the Registered Nurse: Registered nurses are self-regulated health-care professionals who work autonomously and in collaboration with others. RNs enable individuals, families, groups, communities and populations to achieve their optimal level of health. RNs coordinate health care, deliver direct services and support clients in their self-care decisions and actions in situations of health, illness, injury and disability in all stages of life. RNs contribute to the health-care system through their work in direct practice, education, administration, research and policy in a wide array of settings. August 2015 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 20
Leadership The literature indicates a need for nurses to broaden their views on leadership, as it is no longer only associated with special authoritative roles but with daily interactions among clients, families and co-workers. Communication is vital to effective leadership as the process uses interpersonal relationships to promote action or change. Nurses must be able to use leadership skills to manage and coordinate teams of care as the amount of different disciplines in the workplace increases. Promoting leadership is nursing is importing to promote environments where nursing expertise is recognized and nurses are valued. Researchers have identified that nurses are better lead by transformational leaders than by other kinds of leaders. This style of leadership inspires others to examine themselves and work with the group to effect change. The relationships are based on shared morals, values and goals. It is the leader s first job to get others to explore these in relation to issues that they may be facing. This examination brings areas of dissatisfaction to the surface and can help to guide the group to areas that need change. The following are attributes of nursing leaders that help to transform ideas into reality: INTERPERSONAL EFFECTIVENESS: Build positive relationships that are based on trust and respect. This involves developing your relationships with all members of the healthcare team including other disciplines. CREATIVITY: Looks beyond the situation to develop new solutions to problems, is open to new ideas and approaches. Often nurses get into ruts and say we do it this way because we always have. It is important as we move to a nursing era that is based on evidence-based practice that we begin to challenge old ideas and welcome new ones. SELF-MASTERY: Assumes responsibility for personal development. An effective leader wholeheartedly accepts the commitment to life-long learning and seeks out educational opportunities, both formal and informal such as continuing education courses or researching a new treatment online. TECHNICAL SKILLS: Displays knowledge and skills to perform duties and keeps practice current. A leader makes the connection between knowledge and skills and demonstrates this through critical thinking and problem solving. They attempt to understand the why? of their actions so that every intervention is aimed at improving client outcomes. SYSTEMS THINKING: Understands how one s role relates to others in the organization and knows the complexities of the health care system. They realize that everyone in the health care system has a common goal- client care, but that the methods and perspectives will be different for different areas. The systems in place for one area may seem inefficient to others, and vice versa. August 2015 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 21
FLEXIBILTY: Seeks input from others and welcomes new ideas, is able to multi-task effectively and responds appropriately to new situations. ORGANIZATIONAL LEADERSHIP: Shows that they are committed to the team and contributes to the development of others. They are role models to students, coworkers and other disciplines. According to Donner & Wheeler (2004): Leaders are those individuals in formal or informal roles who are recognized by their peers and colleagues as experts in their practice, who consider patient care and nursing excellence as priorities, who can be trusted and with whom it s easy to have a conversation about one s dreams and visions for ones career (page 28). By accepting the challenge of this course you are demonstrating leadership attributes and will grow from the role of a student to that of a mentor! As mentioned before the structure of healthcare delivery is changing and more often the nurse is a member of a interprofessional team that shares ideas and attempts to guide care of the client in a manner that promotes positive outcomes. In order to be an effective member of this team you must be able to assume a leadership role, or the influence of the nursing perspective will be absent from the decisions regarding client care. As we move away from top-down authority to a network of multiple teams it is imperative that all nurses exercise their leadership skills and autonomy and not continually defer to a few colleagues in leadership positions. That is not to say that nurses should not seek input from other nurses when deciding on aspects of client care, but that they should learn to make their own decisions and not constantly defer to others. In summary it is important for the nurse to understand that nursing leadership is not only associated with management or the role of charge nurse. In order to provide safe, competent client care in an interprofessional team environment the nurse needs to be able to represent the uniqueness of the nursing perspective and advocate for the needs of each client. August 2015 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 22
ACTIVITY 4 LESSON REVIEW 1. Reflect on your own leadership attributes in relation to the characteristics presented in the lesson, and how you handle your leadership roles. What leadership attributes are your strengths? 2. Describe some strategies that you can use to improve one of your least strongest leadership attributes. August 2015 RN Professional Development Centre & Nova Scotia DOH, Halifax, NS 23