The Demand for Nursing Leadership: From The Bedside to The Boardroom Angela Barron McBride Distinguished Professor-University Dean Emerita Indiana University School of Nursing Chair, Board Committee on Quality & Safety Indiana University Health
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 Angela s top ten list of opportunities ahead TedMed great challenges This is a time that demands transformational leadership
Dorothy M. Smith The distinguishing characteristic of professional nursing is clinical thinking... Clinical thinking involves data collection, problem setting, care planning, implementation and evaluation. Substantiated evidence of this care must appear on the chart, in a computer or on a yet to be invented device so that it can be retrieved for learning and research.
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, eg, Aiken s research Doesn t just support primary-care provider, but is primary-care provider Doesn t play same role for entire work life, but assumes different responsibilities over time, including inter-professional responsibilities Nurse=Leader Nurse Handmaiden
Some Dated Distinctions Leadership=administration There is one kind of real nurse Some roles in nursing only focus on providing clinical services, while others only focus on systems 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
Shifting Paradigms: Health Care 20 th -Century 21 st -Century Care episodic Fee for service Care shaped largely by educational background of providers Integrated delivery systems/managed transitions Capitated payment; bundled services Care shaped increasingly by evidence-based protocols and who has defining expertise
20 th -Century 21 st -Century Workarounds/variation the norm Process-oriented (what professional does) Care time and place bound Value teams of experts Emphasis on providerpatient relationship Wring out unnecessary variation Outcomes oriented (value of what is done) No time/place limitations Value expert teams Emphasis on improving context so provider-patient relationships can thrive
Shifting Paradigms: Academia 20 th -Century 21 st -Century Faculty: sage on stage Faculty: guide by side Faculty knowledgeable Faculty expert Ever-escalating costs Bend cost curve Process-oriented Outcomes oriented Time and place bound No time/place limitations Career counseling focuses Career counseling over on entry into nursing professional lifetime Research shaped by Research shaped by clinical personal preference need and funding Disciplinary silos Multidisciplinary learning and research
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.
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.
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.
Leadership is more than what person does; it is what person gets done 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 constantly evolving, thus the need to design new ways of realizing shared, long-held values
Leadership=Full Career Preparation Stages Independent Contributions Development of Home Setting Development of Health Care and Profession Gadfly (Wise Person) Stage Needed Mentoring Individual short- and longterm relationships over course of a career Development of mentoring structures orientation programs, journal clubs, writing groups, brown bag sharing
PREPARATION Central Activity: Learning 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
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
DEVELOPMENT OF HOME SETTING Central Activity: Facilitating home institution while growing personal expertise Primary Relationship: Formal Mentor, Committee Chair, Manager, Supervisor 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
DEVELOPMENT OF HEALTH CARE AND PROFESSION Central Activity: Shaping future of health care and profession/specialty Primary Relationship: Leader, Board Member, 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
GADFLY (Wise Person) PERIOD Central Activity: Continue to shape health care and profession though Medicare card in hand Primary Relationship: Coach, Leader, Board Member Major Theme: Exercising power of authority when no longer constrained by institutional obligations Mentoring Needed: Assist in envisioning postretirement opportunities; encourage boldness
Opportunities Ahead #1. An opportunity to take the lead in orchestrating system-level change Build cultures of safety Design work, workplace, and facilitative structures/processes Seek solutions for common population-based problems
Complex System Failure: Much More than The Behavior of the Individual Health Provider Institution Defenses Organization Information Technical Individual ACCIDENT
#2. An opportunity to participate in, build, lead, and study 21 st -century teams Intra-professional Inter-professional Team work linked to greater emphasis on wisdom of the whole
For better... Shared goals Shared knowledge Mutual respect Frequent communication Timely communication Problem-solving communication
Or worse Functional goals Specialized knowledge Lack of respect Infrequent communication Delayed communication Finger-pointing
Relational coordination: Connecting around patients, their families & communities Pharmacists CNAs,RNs, APNs Attending Physicians OTHERS Patient, Family & Community Physical Therapists Social Workers Technicians Referring Physicians Administrators
#3. An opportunity to take the lead in delivering outcomes that affect the bottom line Familiar with standardized measurement tools and focused on realizing the values proposition, eg, HCAHPS scores, core clinical measures, mortality index Nursing is no longer just a cost, but the means by which hospitals achieve maximum reimbursement
#4. An opportunity to take lead in comparative effectiveness research to test usefulness of Assistive devices and technologies Behavior change strategies Alterations in organizational structure Focus is increasingly on impact w hat is ready for widespread implementation across settings
Sarah Szanton during a CAPABLE home visit
#5. An opportunity to develop information systems that facilitate patients, professionals, and other stakeholders Clinical decision support Just-in-time learning Self-care materials Also an opportunity to design new products on interface between nursing and engineering
Computer game developed by Dean Anna McDaniel to prevent preteen girls from taking up smoking
#6. An opportunity to take lead in facilitating various transitions as clinical facilities strive to become accountable care organizations managing the care continuum Developmental Health-Illness Self-care
Dr. Mary Naylor speaking about her Transitional Care Model
#7. An opportunity to take the lead in coaching an aging population and facilitating meaningful end-of-life and palliative care Facilitating activities of daily living Managing chronic conditions Pain/symptom management Expediting crucial conversations Enabling family caregivers
Model developed by Dr. Marilyn Rantz to maintain frail elders in community; note importance of monitoring technology
#8. An opportunity to develop new connections and partnerships between schools of nursing, clinical agencies, and other partners Quality/safety initiatives, eg, The Knowledge- Based Nursing Initiative (Aurora, University of Wisconsin-Milwaukee, and Cerner) 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
Simulation Laboratory at Indiana University Health used by medical students, nursing students, and staff to upgrade their skills
#9. An opportunity to promote the notion that all healthcare policy boards, particularly of clinical agencies, should include at least one nurse RWJF initiative Quality and safety becoming as important as fiscal solvency
#10. An opportunity to promote the notion of the 21 st -Century Nurse Publicize work of nurses in meeting system changes demanded by IOM reports and American public Nurses involved in larger professional and community discussions
The 21 st -Century Nurse Marilyn Tavenner Mary Wakefield
TEDMED Great Challenges The role of patient Managing chronic illness Achieving medical innovation The obesity crisis Eliminating medical errors End-of-life care Whole-patient care Making prevention popular
Medical communication Preparing for dementia Foster adoption of best practices Addressing healthcare costs Impact of poverty on health Inventing wellness programs Causes of sleep deprivation Promoting active lifestyles
Impact of stress Future of personalized medicine http://www.tedmed.com/greatchallenges
The Times Demand Transformational Leadership Nurses who see opportunities and not just problems Nurses who believe that understanding and using quality-improvement techniques is at the core of being professional Nurses who daily help others to make sense of needed changes Nurses who not only know how to do things, but know how to get them done, document their effectiveness, and parlay these successes into the next round of achievement
Are we ready for the changes ahead?