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Ethics for Charge Nurses in Frontline Leadership

This is an excerpt from Charge Nurse Leader Program Builder.

Like your practice, your frontline leadership requires that you adhere to ethical principles (ANA, 2015). There is value added when you practice within your professional code of ethics and abide by policies, facility ethics guidelines, and legal standards, such as employee confidentiality. You often serve as advocate, negotiator, protector, preceptor, and counselor to team members, patients, and families. Additionally, you help new staff members settle into their new roles and positions and may preceptor or mentor students completing clinical assignments on your unit.

A code of ethics is a set of principles of conduct within an organization that guides decision-making and behavior (Makaroff, Storch, Pauly, & Newton, 2014). Applying ethical, legal, and policy rules is essential to the safe, effective nursing practice and leadership. Most ethics codes specify that members conduct themselves honestly, fairly, competently, and justly.

Ethics exercise: This exercise will help you consider some of these potential ethical questions and principles you may encounter as a frontline leader and ways to anticipate them with proactive problem solving (Gantt, 2014):

  • Read your specialty practice or profession’s code of ethics: What issues are discussed? What was the outcome? What might be done differently?
  • Draw on personal, practical, lived experiences: What about a situation or question was troubling? Review the Choice and Awareness Model and consider how it might apply to the ethics of the discussion or situation. This model offers one approach for ethical decision-making and working through ethical dilemmas. What other models have you used?
  • Look through books and journals on ethics that include situations testing personal or professional values, beliefs, or morals in how to perform work or interact with co-workers, colleagues, or customers/clients/patients. How do these examples fit situations you encountered during a preceptorship or mentorship? How will your decisions be affected by the ethical choices made by those in the books or journals?

Leadership in an Age-Diverse Nursing Workplace

Book excerpt from Managing the Intergenerational Nursing Team.

Your challenge is to keep all generations engaged, motivated, and satisfied in their jobs in order to increase productivity, morale, and job satisfaction. It is expensive to replace a nurse employee, so you must also find ways to decrease attrition and turnover. You are going to need to build more personal relationships with your staff nurses to increase team morale and make them feel needed and wanted.

Great leaders have a vision of the future that they can sell to others to get their buy-in. Your managerial style will benefit from having a vision of the future that your staff will support. Then you can persuade them to join as a team to bring that vision into reality. Your job is sales—selling your vision. Your job is production—giving them the tools to do the job right. And your job is cheerleader—motivating and supporting them in their efforts.

Successful and fair management of an age-diverse group begins with an open discussion of the differences between the generational cohorts while you maintain a positive attitude. Generational stereotyping can be a risky practice, so look at the needs of your diverse team in the context of their generation with caution. It would be a mistake to assume that everyone in that generation thinks the same or wants the same things. You will need to tailor your leader­ship techniques accordingly, including communication styles, conflict resolution, coaching, and motivating. Some of your staff will eagerly follow your leadership. Some of them will question and even dismiss your efforts. Knowing the preferences for each generation can provide insight to help motivate and affirm yourself during the rough times.

Generational considerations can also show you the path to solidify your work team and bring out the potential in every individual. When the team wins, you win; so set them and yourself up with every advantage to be a productive and effective work team by attending to their genera­tional needs. It will be time and energy well spent.

Nurses push to prevent assault in healthcare

Healthcare professionals are four times as likely to be assaulted on the job compared to other professions, and lawmakers in Massachusetts are looking to strengthen protections for nurses and healthcare workers.

Last week, the Massachusetts Nurses Association (MNA) endorsed bill S.765/H.795, which would strengthen penalties against assaults on healthcare workers. The MNA has called the bill Elise’s Law, in honor of Elise Wilson, a nurse that was stabbed multiple times on the job last month. The bill would increase the penalty for assaulting emergency medical technicians, ambulance operators and attendees, or healthcare providers from a misdemeanor to a felony. The bill would also streamline how victims of healthcare violence can use the justice system, making it easier to seek legal recourse for their injuries.

The bill is part of a larger effort to improve prevention and response to workplace violence in healthcare. “Health care professionals are being assaulted at a rate four times greater than those working in other industries,” said Donna Kelly-Williams, RN, president of the MNA, in a press release. “Fear of violence and actual violence is rampant in Massachusetts health care facilities. An assault on a nurse is a serious action and should be taken seriously by our judicial system.”

According to the U.S. Bureau of Labor Statistics, health care workers experience the most non-fatal workplace violence compared to other professionals, and account for 70% of all non-fatal workplace assaults. A survey conducted by the MNA found that 75% of nurses reported that violence was a problem in their workplace, and the Emergency Nurses Association reports that 80% of emergency department nurses have been a victim of workplace violence.

For information on how to prepare your facility for workplace violence, check out this excerpt from Preventing Workplace Violence: Handbook for Healthcare Workers.

Clinical Nurse Leaders, partners in quality improvement

Quality within any healthcare system depends on improving patient outcomes, which rely on continual nursing professional development and overall improvements in system performance. One of your most important resources for managing such improvements is the Clinical Nurse Leader (CNL). This clinician is a Master’s prepared Advanced Generalist nurse who builds quality measures in patient care outcomes and implements evidence-based practice principles at the clinical point of care and service. These outcomes align with the facility’s goals and strategic plan and can positively impact patient care processes.

 

For example, when working with a CNL, you can align the care team with strategic performance goals. CNLs and the Quality Systems team are important resources for strategic planning for quality and performance improvement (objectives, priorities, expectations, deliverables, and timelines). Working together, you can establish an infrastructure for engaging and motivating staff and other team members to work toward achieving improved patient care outcomes within the organization’s measures of performance. CPI only happens when everyone engages to improve management of operations and care delivery.

 

As the context of healthcare environments continually evolves and changes, your role becomes more complex and demanding. However, these growing challenges offer expanding opportunities for developing partnerships with your nurse manager, CNLs, and interprofessional team members to improve quality, practice, and competency in managing unit operations and coordinating patient care. By taking of advantage of these opportunities, you can help create a unit culture of safety, quality, and practice excellence.

Source: The Effective Charge Nurse Handbook

ANA continues to oppose Senate health care bill

The American Nurses Association (ANA) weighed in last week on the potential cuts to Medicaid and Essential Health Benefits in the proposed Senate bill.

In a press conference on June 22, ANA President Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN outlined the harmful effects of eliminating the Essential Health Benefits used by millions in the U.S. The draft health care proposal from Senate GOP would make drastic cuts to Medicaid and increase the number of uninsured Americans by 22 million, according to the most recent Congressional Budget Office (CBO) estimate.

“In addition to eliminating the (essential health) benefits, the Senate Republican draft health care bill’s changes to Medicaid would be disastrous for our nation’s most vulnerable,” Cipriano said. “Medicaid is the safety net for tens of millions of children, as well as the poor and disabled. We’re nurses, and we’re here because we are very worried about our patients. We won’t stop fighting for them. We can do better and Americans truly deserve a better plan.”

The ANA has consistently spoke out against cuts to health care and Medicaid, voicing strong opposition to the American Health Care Act passed by the House of Representatives in May. ANA members, area nurses, and nursing students also participated in an “Emergency White Coat Fly-in,” and hopes to meet with Republican senators from key states that would be hurt the most by this bill and persuade them to protect health care.

Find more information on the ANA’s official website.

FREE Webinar: Fostering Nurse Engagement

Join Adirondack Health’s Chief Nursing Officer, Linda McClarigan, MSHA, BSN, RN, NE-BC, as she explains how the shared governance model has greatly benefited their work environment, in addition to lessons learned, best practices, and innovative projects that can help foster nurse engagement.nurse image

Participants of this webcast will discover:

  • Best practices for assessing your current work environment
  • Methods to encourage C-suite participation in nursing engagement programs

Innovative projects focused on sustaining productivity and a positive work environment.

Save your seat now!

Newly promoted leaders need support too

Many companies have clear guidelines for onboarding a new hire; they often have formal training, manuals, and extra resources to help them adjust to their new responsibilities. However, many nurse leaders are promoted from within, and their training path is often less clear. As a new study suggests, the training process for internal promotions is often inadequate, and internal hires require just as much support as external ones.

Michael Watkins wrote in the Harvard Business Review about this issue, and coined the term “inboarding” to describe the process of training internal hires for their new position. About two thirds of the new hires in his study were internal; 70% of them said that their transition was as difficult as joining a new company, and 35% found the transition more difficult. This results in unnecessary failures and difficulties for the organization.

Watkins identifies the lack of support given to inboarding as one of the main reasons for this disparity. So how can an organization make inboarding easier? To start, leaders should adopt a common methodology when approaching new hires. This includes using the same framework and tools for all leadership transitions. Watkins also suggests performing a risk assessment for transitions: identify the potential difficulties (such as relocation, new business divisions, or shifts in work culture) and provide additional support for those risks. This might sound simple, but changing an organization’s culture can be difficult and the first step is identifying that internal hires need the same support as external hires.

Did you receive formal training when you got your first leadership position? Did you feel prepared for your new responsibilities? Let us know in the comments, or take our Strategies for Nurse Managers Poll.

Perspectives on nurse leadership

The responsibilities of nurse leaders are changing rapidly and the role is more fluid than ever. We collected perspectives from several nurse leaders on how nurse leaders can stay effective in the ever-changing world of healthcare.

Jeanine Frumenti, RN, an expert in leadership consulting, posits that the most important aspect of nurse leadership is the ability to create a healthy work environment. “[Nurse Leaders are] always looking at what’s good for the organization, what’s good for their patients, their staff, their team — it’s not about them. And their focus stays on the goal… They’re transformational, giving those around them a voice, encouraging them to share in the decision-making, and owning their work and their practice.” This focus creates a healthy culture, that can allow their staff to flourish and take pride in their work.

Toby Cosgrove, CEO and President at Cleveland Clinic, writes that healthcare leaders need to embrace the quickly changing healthcare environment to remain effective. “Today’s leaders must have a clear vision of the future based on the most fundamental values of the organization. We need to communicate our strategies, achieve consensus, and move quickly to implement change. Innovation is essential, and so is the courage to fail. Most importantly, we must never give up.” Cosgrove agrees that leaders should rely on their staff and create an environment for them to grow: “A leader creates a learning environment that opens all caregivers to new skills and capabilities. Each of us needs to inspire and uplift our teams with a commitment to their professional growth and development.”

Claire Zangerlie, MSN, MBA, RN
, president and CNO for the Visiting Nurse Association in Cleveland, Ohio, argues that this impetus to teach should be applied to patients as well through population health management. As nurse leaders take on more and more responsibility, they will be able to educate “entire populations of patients through workshops and printed materials.” According to Zangerlie and her team, competencies that nurse leaders will need for population health management include: “Effective communication, including excellent negotiation skills; relationship management, including asserting views in nonjudgmental, nonthreatening ways; [and] diversity, including creating an environment that recognizes and values differences in staff, patients, families and providers.”

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Getting nurses from bedside to the boardroom

Last week, we discussed some of the benefits of having nurses in executive positions. It is crucial to bring a myriad of perspectives to these positions, and nurses are significantly underrepresented in hospital leadership. This week, Becker’s Hospital Review has offered up some tips about how nurses can prepare for hospital board seats.

The first thing an aspiring nurse should consider is the core competencies of the hospital board. This can be a little different for each hospital, so having a specific facility or type of facility in mind would be helpful; if you can find a facility that matches your nursing specialty, even better. Often, boards have lists of competencies, so not having the right core skills can sink an application right away.

Once you establish the required skills would need, you can begin working towards that goal. Many nurses don’t have opportunities to develop governance skills on the job, so it might be helpful to look outside the hospital for that. Volunteer board positions in their community or at a nonprofit organization can be a great way to get experience in governance and make nurses more appealing candidates for board positions.

Connections are key in this process as well. Nurses should meet with board members and the chair if possible, to better understand the board’s mission and how they might align with it. These relationships can be crucial to obtaining a board position, but also to keep it. Board members can become mentors that can teach nurses how to navigate their new responsibilities and help them through the gauntlet of new board membership.

Rock Your Health: How to deal with a dilemma

Recently I was faced with a decision to compromise my belief over yielding to conventional thinking that I now know is in question.  For example, we now know that cholesterol is no longer the cause of heart disease. Inflammation is.  But conventional thinkers may not have changed their thinking on this issue because new information takes time to catch up with everyone.

Because it is my job to educate on health issues and keep people informed with the latest scientific evidence, it is not always readily acceptable to the masses. So the challenge is – do you yield to the old paradigm or do you take the risk of telling the new truth and standing out on a limb?

I remember when I entered the field of wellness and when I tried to educate about it in the healthcare system one physician said to me “there is no such word as wellness.” But I of course forged ahead and now look where we are with wellness – front and center!

So how do you handle this? Please email me your comments to carol@carolebert.com.