Nursing Portfolio
Leadership:
NURS480w: Nursing Leadership & Management
Course Work:
The focus of this course was to prepare undergraduate nursing students in areas of leadership, management and change theories to prepare us for professional practice. This class puts emphasis on leadership issues and responsibilities specific to nursing. The key concepts that were emphasized in this course were leadership styles, empowerment, mentoring, and managing change. I expect all of these will prove to be key skills as I work to further my education in the field of nursing.
A true leader has the confidence to stand alone, the courage to make tough decisions, and the compassion to listen to the needs of others. He does not set out to be a leader, but becomes one by the equality of his actions and the integrity of his intent. —Douglas MacArthur
Throughout this class we explored issues related to leadership and strategies for conflict management, delegation, communication and motivation. Our major assignment for this course was a group paper on safe patient care supplemented by discussion boards throughout the course.
Below I highlight some important skills that this course has prepared me with.
Hover over each skill to find out more!
Working In A Team Setting
This course improved my teamwork and collaboration skills through the assignments, which were all completed in a small group. In situations such as this I tend to take a leadership role which I really enjoy. I took the initiative to reach out to my team members and create a shared document to determine who would complete each part. I was able to ensure everyone's part was completed on time, compile the document, edit and submit it before the deadline.
Communicate Verbally
Through this course I was able to develop my verbal communication skills through practice activities in class.
We discussed and practiced different communication strategies depending on the situation, such as peer coaching, discipline as well as less formal communication such as communicating with patients and family members.
We also discussed barriers to communication such as speaking to loudly or accusingly, or getting off track and not having a quiet space.
Located above is a paper I wrote for this class on improving safe patient care. We built off an example I witnessed as a student nurse where beds were not being plugged back in by transport staff causing patients to have unnecessary falls. During this experience, I was able to see how leadership responded and made appropriate changes to prevent this from happening in the future.. Throughout our paper we explored the oversight that allowed this unfortunate accident and the role nurse leadership played in its resolution. As a future nurse leader it is critical to observe how situations are handled by nurses already in leadership position and then reflect on what went well and what could be improved upon to learn from and incorporate into your leadership in the future.
Discussion Boards
There are challenges always facing nursing leadership. Today’s health care environment has put even greater pressure on those in leadership roles. Your readings in Chapter 1 of the Sullivan text broadly touches on some of these issues. You also may have witnessed some issues affecting nursing leaders during clinical rotations and if you work in healthcare. Reflect on one (1) of these challenges such as: culture, technology, evidence-based practice, health care costs. You are free to address another challenge not listed or in your textbook that may be unique to the health care environment you have visited as a student or are employed.
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How do these challenges impact the leadership role?
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How do you think this will affect your choice to move into nursing leadership in the future?
In my opinion, the biggest concern facing nursing leadership currently is the nursing shortage. All the other challenges become irrelevant when you have no staff to be concerned about it. While there are many causes to which this shortage could be attributed, I think the most important from a nurse leadership role is the high rate of turnover and nurse burnout. According to Haddad, Annamarju and Toney-Butler (2020), the national turnover rate varies from 8.8% to a whopping 37% depending on specialty and location. Such severe shortages can lead to larger patient loads and increase the chance for error, however to deal with these shortages, many hospitals seem to take the “a severely burnt out nurse is better than no nurse” approach and continue to increase patient-nurse ratio. Another interesting point made by Haddad, Annamarju and Toney-Butler is that technology may be partially to blame as seasoned nurses struggle and leave the profession at an earlier rate.
This is a unique challenge in the healthcare field in general and I think as leaders in nursing that is where the responsibility falls. Stepping up as a leader means taking responsibility for the people below you and making effective decisions in the best interest of the people underneath you. I would be interested in a leadership role in nursing and I do not think this would dissuade me, rather I see it as something that I would like to be part of the solution to!
References:
Haddad LM, Annamaraju P, Toney-Butler TJ. Nursing Shortage. 2020, Dec 14. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493175/
Sullivan, E. J. (2018). Effective leadership and management in nursing (9th ed.), p. 5-6. New York, NY: Pearson.
The second discussion board, located to the right, discusses a patient safety concern. For this I highlight that despite nurses documenting every 2 or 4 hour patient turning as prescribed, it is not always being completed. This was also something I noticed in clinical and requires immediate intervention from the units leadership. For this issue, I was able to make suggestions, such as TURN and TEAM, which were both implemented in a pilot study and enhanced nursing compliance with hourly turning. This intervention is incredibly important & something I will carry with me into my future nursing practice.
This first discussion board located to the left discusses a challenge that is facing nursing leadership. For this, I chose the shortage of nurses which causes the nurse to patient ratio to be higher, in turn causing high turnover of staff and worse patient outcomes. This is something that I witnessed in clinical frequently and I hope to one day have an opportunity to address.
As a nurse leader, you are charged with improving quality and safety in health care systems. Describe a nursing or patient care concern from your current clinical practice (or identified during clinical rotations) that needs improvement. Analyze the significance of the concern for nursing practice. Using information gained from readings, discuss the concern.
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Why is it important to explore this concern or issue?
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What would be the best or preferred practice for this concern?
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As a nurse manager or leader, how will you improve practices in you rwork environment related to this concern?
Despite the best efforts by nursing staff, pressure ulcers have been a long-standing concern in nursing facilities all around the country. It is important that patients spend time up and out of bed if possible and if not, are frequently repositioned. On my unit many of our patients are high fall risks and very ill with COVID-19, meaning they are often bed bound. Additionally, they are elderly, incontinent and a nutritionally deficit making them high risk for skin breakdown. These circumstances have led to many patients being put on q2h repositioning. My concern, however, is how often that repositioning is actually taking place due to the high patient load, lack of care partners, and COVID-19 precautions.
So why does this matter? Not only does skin breakdown decrease the quality of life while hospitalized, it can also be incredibly painful and could cost the U.S. healthcare system upwards of $27 billion dollars (Padula W.V., Delarmenta B.A. 2019). I understand that nursing units can get busy and what seems to be such a small task can be easily overlooked. Plus, it is easy to document quickly, with our without actually doing the repositioning. Rates of missed q2h turns in long term care facilities has been reported as high as 50% (Berlowitz, D.R., Frantz, R.A. 2007). An interesting study done on this topic used cue-selection in evidenced based practice to mitigate this and would be something worth looking into implementing on any unit as a nurse leader. Cuing is used to help nurses remember repositioning required by protocol and “Reinforces timely recall and performance of this task, even in the presence of distracting intrusive events”. (Yap, T. L., Kennerly, S. M., Bergstrom, N., Hudak, S. L., & Horn, S. D. 2016). For this, they implemented 3 interventions, On Time Quality Improvement for Long Term Care, Turning for Ulcer ReductioN (TURN) and Turn Everyone And Move (TEAM). These, combined with EMR technologies were used to reinforce teamwork and enhance delivery of this nursing intervention.
I understand that nurses are often understaffed and gowning up to enter COVID+ patient rooms can be a burden and therefor may be a barrier to implementing this change. With COVID+ patients, clustering of care has become more and more important to avoid having to go in and out of a patients room more than necessary. This means that a patient may receive his morning meds between 8am and 9am and then if stable and calm the nurse may not enter the room until after 2pm for afternoon meds, completely missing at least 2 opportunities for the patient to be turned. Even with q4h vitals, there is still a missed opportunity for repositioning. Between these concerns, and general resistance to change and additional tasks for already understaffed, overworked nurses, implementing something such as this this may be easier said than done.
References:
Berlowitz D.R., Frantz R.A. (2007). Implementing best practices in pressure ulcer care: the role of continuous quality improvement. J Am Med Dir Assoc. 2007;8(3 Suppl):S37–41
Padula W.V., Delarmente B.A. (2019 Jan 28). The national cost of hospital-acquired pressure injuries in the United States. Int Wound J. 2019 Jun;16(3):634-640. doi: 10.1111/iwj.13071. PMID: 30693644.
Yap, T. L., Kennerly, S. M., Bergstrom, N., Hudak, S. L., & Horn, S. D. (2016). An Evidence-Based Cue-Selection Guide and Logic Model to Improve Pressure Ulcer Prevention in Long-term Care. Journal of nursing care quality, 31(1), 75–83. https://doi.org/10.1097/NCQ.0000000000000128
Future Goal Development
This course has many implications and benefits in my future as a registered nurse. I strive to continue climbing in any professional position and leadership skills are a must. My current goal in my position with Sentara Leigh as a floor nurse is to become a charge nurse. To do so, it is important that I am able to lead and manage people. Good communication skills are also necessary and a skill I have had the opportunity to hone throughout this course. I have no doubt that this will be one of the most beneficial courses to my future I have had an opportunity to take at Old Dominion University.