GOVERNANCE IN HEALTH CARE PRACTICEPrepared by: Anna Liza R. Alfonso RN,RM,MAN

LEARNING OBJECTIVES:At the end of the group discussion, the doctoral students will be able to:

1. Determine transition period of Nursing Leadership.2. Describe the effects of using unlicensed personnel in Nursing Services3. Synthesized effects of nursing Leaders in non- nursing position4. Apply knowledge on the different collaborative practice model use in health care practice

LEADERSHIP IN TRANSITION

LEADER

Influential person has the ability to lead a group or department without having a formal appointment. Person who influences and guides direction, opinion and course of action. Arieu, A. defines a leader as "a person capable of inspiring and associate others with a dream." It is therefore important that organizations have a mission high transcendent, since it is a powerful way to strengthen the leadership of its directors.

L – LEAD, LOVE, LEARN E – ENTHUSIASTIC, ENERGETIC A – ASSERTIVE, ACHIEVER D – DEDICATED, DESIROUS E – EFFICIENT AND EFFECTIVE R – RESPONSIBLE, RESPECTFUL

TYPE OF LEADERS:

a) NATURAL LEADER: The person becomes the leader inspite of himself. He does not seek the goal, it is trusted upon him by the group and by the tide of events. (Eg. Abraham Lincon,Mahatma Gandhi)

b) CHARISMATIC LEADER: The person is an authentic hero in the eyes of his followersfor he can do no wrong. He/she inspires people to make any sacrifice even their lives for the cause. (Eg. Asoka, Akbar, Pandit Jawaharlal Nehru etc.)

c) RATIONAL LEADER: consistent and persistent. (Eg. Karl Marx, Lenin, Mao etc.)d) CONSENSUS LEADER: The leader is perceived as acceptable to all. He/she rises in the absence of the

above three and this leader is in a tenous position of walking a tight rope for existence. (Eg. President of India, Speakers, Members of the Parliament etc.)

e) LEADER BY FORCE: The leader’s power speaks through the nozzle of gun. He/she dominates others through fear. He is ruthless in suppressing opposition. He does not reign as long as this type of leadership contains with in itself the seeds of its own destruction. (Eg. Napolean, Hitler, Stalin etc.)

ROLES OF A LEADER

Service provider Team builder Recourse manager Decision maker and problem solver Change agent Clinical consultant Mentor

LEADERSHIP

Origin of the word is from the word “lead” meaning “to go” Leader ship is the process of influencing people to accomplish goals;

that is, it is the ability to influence the behavior of others, towards the achievement of a mutually established goal.

Leadership is the art of getting others to want to do something you are convinced should be done.

Leadership is management skills that focus on the development and employment of vision, mission and strategy as well as the creation of a motivated work force.

Leadership is a style or a process whereby a person called a nurse leader will influence a group of people known as the followers for the purpose of attaining a single goal or objective

Health Transition

Demographic and epidemiologic changes that have occurred in the last five decades in many developing countries and that are characterized by major growth in the number and proportion of middle-aged and elderly persons and in the frequency of the diseases that occur in these age groups.

The health transition is the result of efforts to improve maternal and child health via primary care and outreach services and such efforts have been responsible for a decrease in the birth rate; reduced maternal mortality; improved preventive services; reduced infant mortality, and the increased life expectancy that defines the transition.

Transformational leadership

A transformational leader is defined as a leader who motivates followers to perform to their full potential over time by influencing a change in persons and by providing a sense of direction.

Transformational leaders use charisma, individualized consideration and intellectual stimulation to provide greater effort, effectiveness, and satisfaction in followers.

The primary focus of the transformational leadership style is to make change happen in:

Our Self, Others, Groups, and Organizations

The transformational style requires a number of different skills and is closely associated with two other leadership styles: charismatic and visionary leadership.

Transformational leadership encompasses the intuitive and emotional nature of people and inspire followers to high levels of commitment and effort to achieve group goals which emphasizing interpersonal relationship.

Transformational leaders gain the respect and trust of their followers; instill in them a sense of pride and, mission, communicate high expectations promote intelligent, rational problem solving; and give followers individualized consideration it is leadership that creates purposes for institutions.

FEMINISM AND NURSING

NURSING

• “Nutrix” – Latin to Nourish• Assisting sick individuals to BECOME HEALTHY, and healthy individuals ACHIEVE OPTIMAL HEALTH

• ART (ideal of service and principle) & SCIENCE (systematic/scientific body of knowledge)

• CARING profession

• VOCATION

• A GROUP OF PROFESSIONALS that has common goal...TO PROMOTE AND ENSURE OPTIMUM LEVEL OF FUNCTIONING

• A SERVICE ORIENTED profession

• “NURSING IS DOING THE WILL OF GOD”- Florence Nightingale

FEMINISM

Defined as: “a concern with action, political or personal, the struggle for equality; valuing the individual, respect for the individual; and [having] an awareness or consciousness of oppression which may be experienced by women directly or men vicariously through women’s experiences” (Allan, 1993).

According to the Stanford Encyclopedia of Philosophy, the true goal of feminism is not for women to have more power than men, but to eliminate sexism and for society to express equality for everyone (Haslanger & Tuana, 2004).

Historically, feminism and nursing have not been interrelated, however, the integration of the ideals of feminism into nursing could change the negative image of nursing to the public.

HISTORICAL BACKGROUND

The first nurses were men, but this gender dominance gradually shifted. Because of this shift, nursing was not viewed as a profession because it was, and oftentimes still is, viewed as “women’s work” (Sullivan, 2002).

Because of lack of funding for nursing education and apathy directed toward the oppression of nurses by male doctors, by the 1930s, nurses had been reduced to acting as aides to men (Groups & Roberts, 2001).

Due to the subjugation of their position by men and the fear of being stereotyped as uncaring feminists, many nurses chose not to participate in the feminist movements of the 1960s (Hunt, 1998).

These negative connotations, however, lead not only to the disrepute of female nurses, but of men who are in the profession as well (Sullivan, 2002). Male nurses are presented as overly feminine, homosexual, or as underachievers, and are discriminated against in the workplace.

The health care system could benefit from using a feminist approach, to promote the equality of genders. Nursing would be able encourage more men to join the profession if these gender stereotypes were absent. Thus, we would have twice as many students applying to nursing schools, while gaining more respect from society as a whole (Christman. 2001).

At present, Feminism at its core, benefits both genders in society as well as in nursing. The expansion of the feminist perspective, which is slowly gaining relevance in the field of nursing, would help to reform the

Nurse with baby and male doctor (Wagner, 1927)

Nurses of different specialties at work (Staff Nurse Interest Group, 2007)

pervasive image in popular culture of incompetence within nursing by showing that whether or not it is a profession that is female-dominated, nursing is a legitimate and important job. .

INCREASING USE OF UNLICENSED ASSISTIVE PERSONNEL: THE EROSION OR EVALUATION OF NURSING?

UNLICENSED ASSISTIVE PERSONNEL (UAP)

American Nurses Association defines the Unlicensed assistive personnel (UAP) as individuals who are trained to function as assistants to registered and professional nurses in providing of patient care activities.

Their duties are delegated and supervised by the registered nurses. In practice unlicensed assistive personnel includes the following individuals: certified nurses aide, orderlies or attendants, clinical assistant, home health aide, nursing assistant and personal care assistants (Fitzpatric, & Green, 1995).

The use of unlicensed assistive personnel fills the void created by the current shortage of nurses and decreases the costs of providing patient care.

Although nurses are frequently asked to delegate and supervise patient care-related activities, they often do not feel qualified to do this effectively.

Continuing education is an effective way for nurses to learn the supervision and delegation skills required, and should be supported by academic and clinical educators.

THE EROSION OR EVALUATION OF NURSING?

The main problem faced by the nursing personnel especially the registered nurses is the negative effects that arise as a result of delegation and these include their increased risks of being exposed to professional liabilities resulting from supervising the unlicensed assistive personnel and the concern of reduced quality in care given to the patients as a result of involvement of unlicensed personnel in the provision of the health care services.

Men and Women working together will benefit the future of nursing. (Direct Diagnostic Services,

2008)

SOLUTION:

The values and ethics

The nursing profession involves working under strict code of ethics which the unlicensed assistive personnel might not be familiar with. The ethics of nursing include respect for humanity and the order not to participate in activities that conflict with caring and healing principles. The delegation of unlicensed assistive personnel might compromise with the observation of such ethic especially considering the fact that they are not held accountable by the management they may be tempted to ignore the seriousness of the ethically acceptable standards of nursing profession.

NURSES IN NON –NURSING LEADERSHIP POSITIONS

While a fall in the number of nursing leaders may be attributed to the current nursing shortage, studies have noted that there is also a significant deficiency in the number of nursing leaders. In 2002, nurses are in a distinct position to influence healthcare policy and legislation. We need nursing leadership to exert that influence and by nurturing both leadership as well as clinical skills.

The nursing profession trains new nurses on operating the latest technology and complex medical equipment. In contrast, once at the bedside they rarely get the opportunity to apply even basic leadership principles. Nursing as a profession does a disservice to new nurses by not developing their leadership capabilities.

BEST PRACTICE

1. Know who your leaders are, what they do as a leaders, and how their leadership influences the organization.

2. Know your organization’s mission and vision and how they influence leadership processes.3. Be knowledgeable about the organization’s strategic directives and goals.4. Nursing leadership success requires regular interaction with the medical staff for communication,

relationship building, goal achievement, goal development and policy and practice changes.5. Always allow for ongoing feedback on ways to improve processes in area of assignment as well as the

organization as a whole. Use this feedback as a way to close the loop with staff.6. Recognize the opportunities for leadership growth for yourself and others7. Remember that all leadership styles functions may take many forms, but all leadership should be aligned

around common goals.

“The ability to deal with ambiguity while developingphysician relationships and partnerships [is] integral to the

work of the nurse leaders. It is also important that leadersdemonstrate work-life balance so that our young talented

nurses will desire to move into leadership positions.”—Patricia Crome, RN, MN, CNA, FACMPE

Principal, Rona Consulting Group; past member,AONE Board of Directors, Seattle,Washington.

REFERENCES

Sullivan, E.J. & Decker, P.J. (2001). Effective Leadership and Management in Nursing(5th ed.). Upper Saddle River, NJ: Prentice Hall.

Kurzman, E. T., & Buerhaus, P. I. (2008). New Medicare payment rules: Danger or opportunity for nursing? American Journal of Nursing,108, 30–35.