Upload
nguyenphuc
View
223
Download
2
Embed Size (px)
Citation preview
Leadership in Nursing:
A ChoiceDenver Metro Oncology Nursing Society
Annual Fall Conference
September 23, 2016
Kathy Boyle, PhD, RN, NEA-BC
Chief Nursing Officer
Denver Health
Objectives
1. Review Nursing Leadership Examples and Stories
2. Discuss the process of choosing to lead.
3. Analyze the evidence and structures for leading
4. Identify methods of self care for nursing leadership
2
• Nursing in Colorado and the United States
• Denver Health
• Kathy Boyle and Cindy Anderson---MDONS 2007 on PFCC
• Who is here today?
3
Our Connections:“
“Underlying the national debate about health
care insurance reform is the much less visible but
very significant issue of the
health care workforce.”Colorado Center for Nursing Excellence
Nurses 2015:•In the US - about 3.1 million
•In Colorado – (56,854) Active RN Licenses* Apr 2016
•At Denver Health – 1,616 All RN’s – April 2016 - HR
1,364 – Female or 84%
252 – Male** or 16%•Ages at Denver Health
Age Range: Under 30: 12.9%
Age Range: 30 to 50: 63.4%
Age Range: 50 & over: 23.8%
*www.kff.org/other/state-indicator/total-registered-nurses/
** Health Resources and Services Administration: Workforce
Trends. National Male Nurse Average 9.6% - https://census.gov/../Men_in_Nursing 2011
Nursing Overview
Nurses as leaders in health care
“2015 Gallup Poll:
Nursing is the Most Trustworthy Profession
with 85% of Americans ranking their honesty
and ethical standards as “high” or “very high”Gallup.com
Most Trusted!
Least Trusted?8% Members of Congress
8% Telemarketers
7% Lobbyists
Denver Health---established in 1860
• Public, quasi-governmental authority (divested from city in 1997)
• 525-bed Integrated Safety Net Health Facility
• Serve the people of Denver: 1 in 4 or 150,000
• 58% are ethnic minorities
• Uncompensated care: $188 million in 2015 ($5.9 billion since 1991)
• 6,700 employees
Review
Nursing Leadership
Examples and Stories
8
Family:
My parents’ character:
Ron and Harriet---ethics, kindness, knowledgeable, questioning, curious about people, non-judgmental, advocacy for success for my brother and I
Nuclear and extended family as team model
Nursing:
Skilled nursing facility in Morrison, CO
Adult Psych at Fort Logan
High Risk Labor and Delivery and Flight Nursing
9
My Nursing Leadership Story
Shared Governance and Leadership
(Porter-O’Grady, 1988)
The Visionary Manager (Kaiser, 1988)
10
Shared Leadership
Closet Architect and Feng Shui Master
Facility planning and clinical leadership
Expert to novice leader in various roles
11
Leadership with Collaboration
• Observing others---”I wouldn’t do the CNO role” or “I can see the possibility of that role”---observing Dr. Colleen Goode, PhD, RN, FAAN
• Collaboration and my doctoral thesis: “Nurse-Physician Collaborative Communication and
Safety Climate”---fit with leadership
12
13
Discuss the Process of Choosing to Lead
The Choice to Lead
• The circumstances• “You’d be good at this!”• “I want to do this”• “I’d follow her/him anywhere”• Succession Planning (organizational commitment)• Financial gain? (Factor your volunteer hours!)• Power• Ambition• What is missing?
14
Kathy Black, BSN
15
L&D staff nurse “It’s not going well”
Learning the relief charge role at 1 year!
Should I apply to be a flight nurse too?
You’d be good at the Assistant Head Nurse
role!
Got that job, didn’t get the next job as
manager.
Wouldn’t she be a good CNO?
Leadership Conversations and Choices
Brenda Nevidjon, RN, MSN, FAAN
CEO of Oncology Nursing Society
Her choices in leading.
16
Oncology Nursing Society CEO
Florence Nightingale (1810-1920)
17
“No man, not even a doctor, ever gives any other definition of what a nurse should be than this—’devoted and obedient.’ This definition would do just as well for a porter. It might even do for a horse. It would not do for a policeman.”
(Nightingale, 1859)
Leaders we admire and why? What is your path to leadership story?
• How are you leading in nursing?
• Formal or informal?
• Any mentors?
• Someone you watch and admire?
• What do you enjoy most about your RN leadership role?
18
19
Analyze evidence and
structures for leading.
Leadership Theories
• Autocratic leadership
• Transactional
• Transformational
• Shared leadership
• Situational leadership
• Resonant leadership
20
• Chaos Theory and Nursing Leadership
• Leading with Kindness (Baker & O’Malley, 2008)
21
LeadershipModel of Exemplary Leadership
(Kouzes & Posner, 1987))))
Five Leadership Characteristics
1. Challenge the process
2. Inspire a shared vision
3. Enable others to act
4. Model the way
5. Encourage the heart
22
My leadership perspective:
evidence and influences
• The Visionary Manager (Kaiser, 1988)
• Followership (Kelly, 1988)
• The HCAHPS Handbook: Tactics To Improve Quality and the Patient Experience (Ketelsen, Cook, Kennedy, & Studer, 2014)
• The Toyota Way to Lean Leadership (Liker & Convis, 2011)
• The Future of Nursing: Leading Change, Advancing Health (IOM, 2010)
Nurses on Boards Coalition (NOBC) 10,000 nurses by 2020
23
The Future of Nursing
Leading Change, Advancing Health (IOM, 2011)
24
• A great opportunity to unify nursing
• Robert Wood Johnson Initiative at Institute of Medicine (IOM)
• Eclectic group, inter-professional team worked on this
• Eight recommendations
Recommendation 2 Expand opportunities for nurses to lead and diffuse collaborative improvement efforts.
Recommendation 7 Prepare and enable nurses to lead change to advance health.
Structures to Support Leadership
• Standards and Goals from Joint Commission
• Magnet® Model Components/Sources of Evidence
• Baldrige National Quality award
• Professional organizations
• Research and EBP
• Organizational values (note DH’s in separate slide)
• Strategic Planning
• Hospital policies and guidelines
25
More Leadership Structures
• Performance appraisals---evaluations
• Progressive discipline—at Denver Health Accountability Based Performance (ABP)
• Professional development funds
• Succession Planning
• Lean Systems Thinking: Respect for people and continuous improvement
26
Magnet® and Transformational Leadership
• Role of CNO---transformational, strong vision, involve nursing at all levels
• CNO influence---committees, office location, change
• Use of data for decision making
• Advocacy for nursing practice and for leadership
• Visibility and Accessibility
• Leadership development
27
Effective Visions?
11-22 words
Denver Health:
To be the healthiest community in the United States
Oncology Nursing Society:
To lead the transformation of cancer care
American Nurses Credentialing Center (ANCC)
for Magnet®:
ANCC will be a transformational force for global quality health care through excellence in credentialing.
Disneyland:
To be one of the world’s leading producers and providers of entertainment and information.
28
Nursing Leadership Structures
Our Values
30
Patients First at Denver Health
Leadership Practices that I value
• Vulnerability
• Visibility
• Communication
• Lean and leadership principles---my interpretation for shared leadership and Lean
• Advocacy for talent…”I know who you are!”
31
Nurse Executive Shadow Project
“I’m not here to spy on you or because anything is wrong.” “I’m here to learn and be better able to advocate for you!”
Wear blueberry RN scrub topWork along side an employee for 2-4 hoursFollow up communication with what I learnedAdvocacy issues brought forward
Inspiring with mutual benefits!
32
CNO Leadership at
Care Provider Orientation
• Attend first hour
• Purpose: Connection, review mission, vision, organizational strategic pillars, nursing theory and Magnet® journey.
• 5 questions
• Weave in stories regarding Denver Health
33
ELITE
• Magnet® conference inspiration
• Rapid Planning Event (RPE)
• 2014 started with 5 nurses and their coaches
• One year program to graduation
• Successful advancement in leadership
• Evolved into focus beyond nurses
34
Excellerate!
Unleashing Leadership Potential
• For current managers and leaders (not just in nursing)
• Leadership skill assessment
• 7 month program
• 50 hours group learning
• 80 hours unstructured learning
• Leadership coaching
• Individual and cohort project
35
Succession Planning
• My own experience with
Colleen Goode, PhD, RN, FAAN
• Denver Health Succession plans
• Vizient Academic Medical Centers National CNO Network Chair---focus including wisdom worker.
How succession planning ultimately works?
36
37
Identify Methods
of Self Care for
Nursing Leadership
Self Care Methods
• Resiliency Training
• Spiritual time-out at Denver Health
• Taking breaks and being off the unit
• Wellness departments
• ZEN rooms
• Schwartz Rounds™ The Schwartz Center for Compassionate Care
• Personal self care methods outside of work?
38
Schwartz Rounds™
39
• “Schwartz Rounds are a place where people who don’t usually talk about the heart of the work are
willing to share their vulnerability, to question
themselves. The program provides an opportunity for dialogue that doesn’t happen
anywhere else in the hospital.” – Participant
Jean Watson, PhD, RN, AHN-BC, FAANFounder / Director: Watson Caring Science Institute
Caritas Processes and Self Care
1.Sustaining humanistic-altruistic values by practice of loving-kindness, compassion and
equanimity with self/others.
3. Being sensitive to self and others by cultivating own spiritual practices;
beyond ego-self to transpersonal presence.
10.Opening to spiritual, mystery, unknowns-
allowing for miracles.40
Theory Of Human Caring
Reduce nurse stress and burnout
The Wellbeing of the Nursing Workforce
Burnout associated with early retirement, ETOH use, Suicidal ideation
Increased likelihood to eat poorly and smoke cigarettes
80% of staff experiencing compassion fatigue
Need to focus on health and wellbeing of nurses
(Kreitzer and Koithan, 2016)
Managing/Leading Change
Burnout prevention as a tactic
Limit the volume of organization-wide communication
Highlight critical information
Resequence changes: examples from Denver Health and your facility
(Koppel, et al, 2015)41
Thriving through Supportive Environments(Pabico, 2015)
Health care is “VUCA”---Volatile, Uncertain, Complex, Ambiguous
Opportunities for the environment:
•Align with bigger purpose
•Transparency and trust (quote below)
•Partner
•Empowerment and resilience
“The certainty of misery is better than the misery of uncertainty”. (Zimmerman, 2007)
42
Your perspective on self care methods
43
Leadership stories
The choice to lead
Evidence/ structures
Self care
44
Summary
What makes a great leader?
Characteristics of thriving leaders
3 Questions from Roselinde Torres’---October 2013
45
Quotes
“Kind leaders endorse reality” Baker & O’Malley, 2008
“Remember not getting what you want is sometimes a
wonderful stroke of luck.” Dalai Lama
“Chase your dream, believe in yourself, go big or go
home, and don’t lose sight of what you are.” Walt Disney
46
Thank You
for leading in nursing!
Contact Information
Phone 303-602-4957
References
ANCC, & ANA. (2008). Magnet model components and sources of evidence: Magnetic recognition program. Dallas, TX, United States: American Nurses
Credentialing Center.
Baker, K. (2015). Review: The influence of resonant leadership on the structural empowerment and job satisfaction of registered nurses. Journal of
Research in Nursing, 20(7), 623–624. doi:10.1177/1744987115603887
Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine., Robert Wood Johnson Foundation., &
Institute of Medicine (U.S.). (2011). The future of nursing: Leading change, advancing health. Washington, D.C: National Academies Press.
Doyle, R. M. (2004). Applying New Science Leadership Theory in Planning an International Nursing Student Practice Experience in Nepal. Journal of
Nursing Education, 43(9), 426–429. doi:10.3928/01484834-20040901-10
Getha-Taylor, H., Fowles, J., Silvia, C., & Merritt, C. C. (2015). Considering the effects of time on leadership development: A local government training
evaluation. Public Personnel Management, 44(3), 295–316. doi:10.1177/0091026015586265
Giltinane, C. L. (2013). Leadership styles and theories. Nursing Standard, 27(41), 35–39. doi:10.7748/ns2013.06.27.41.35.e7565
Hutchinson, M., & Jackson, D. (2012). Transformational leadership in nursing: Towards a more critical interpretation. Nursing Inquiry, 20(1), 11–22.
doi:10.1111/nin.12006
James, K. (2015). Leadership Special Interest Group: What is leadership?. Canadian Oncology Nursing Journal / Revue Canadienne De Soins Infirmiers
En Oncologie, 25(1), 114-115. Retrieved from http://www.canadianoncologynursingjournal.com/index.php/conj/article/view/40
Johansson, B., Fogelberg-Dahm, M., & Wadensten, B. (2010). Evidence-based practice: The importance of education and leadership. Journal of Nursing
Management, 18(1), 70–77. doi:10.1111/j.1365-2834.2009.01060.x
Kaiser, L.R. (1988) The Visionary Manager. Emerging Issues in Health Care 1988. Tom C. Wilson P.P.A., Editor, Estes Park Institute, 99-104.
Kelley, R. E. (1988). In Praise of Followers. Harvard Business Review, 66, 142-148.
Ketelsen, L., Cook, K., Kennedy, B., & Studer, Q. (2014). The HCAHPS handbook 2: Tactics to improve quality and the patient experience. Gulf Breeze,
FL: Fire Starter Publishing.
References Continued
Koppel, J., Virkstis, K., Strumwasser, AB., Katz, M., and Boston-Fleischhauer, JD., (2015). Journal of Nursing Administration, Regulating the Flow of
Change to Reduce Fontline Nurse Stress and Burnout, Vol. 45, Issue 11, 534-536.
Leadership research (2015). The Journal of School Nursing, 31(4), 240–240. doi:10.1177/1059840515591817
Lee, C. (1970). Followership: The Essence of Leadership. Training, 27-35.
Liker, J. K., & Convis, G. L. (2011). The Toyota way to lean leadership: Achieving and sustaining excellence through leadership development. New York:
McGraw-Hill.
McChesney, C., Covey, S., & Huling, J. (2012). The 4 disciplines of execution: Achieving your wildly important goals. New York, NY: Free Press.
Omery, A. (1983). Phenomenology: A method for nursing research. Advances in Nursing Science, Vol. 5, Issue 2, 49-64.
Pabico, C. (2015). Journal of Nursing Administration, Creating Supportive Environments and Thriving in a Volatile Uncertain, Complex, and Ambiguous
World, Vol. 45, Issue 10, 471-473.
Williams, R. L., II, McDowell, J. B., and Kautz, D. D. (2011). A caring leadership model for nursing’s future. International Journal for Human Caring, 15(1),
31-35.