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

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• Nursing in Colorado and the United States

• Denver Health

• Kathy Boyle and Cindy Anderson---MDONS 2007 on PFCC

• Who is here today?

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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

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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

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My Nursing Leadership Story

Shared Governance and Leadership

(Porter-O’Grady, 1988)

The Visionary Manager (Kaiser, 1988)

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Shared Leadership

Closet Architect and Feng Shui Master

Facility planning and clinical leadership

Expert to novice leader in various roles

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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

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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?

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Kathy Black, BSN

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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.

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Oncology Nursing Society CEO

Florence Nightingale (1810-1920)

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“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?

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19

Analyze evidence and

structures for leading.

Leadership Theories

• Autocratic leadership

• Transactional

• Transformational

• Shared leadership

• Situational leadership

• Resonant leadership

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• Chaos Theory and Nursing Leadership

• Leading with Kindness (Baker & O’Malley, 2008)

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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

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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

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The Future of Nursing

Leading Change, Advancing Health (IOM, 2011)

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• 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

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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

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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

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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.

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Nursing Leadership Structures

Our Values

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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!”

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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!

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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

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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

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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

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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?

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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?

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Schwartz Rounds™

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• “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)

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Your perspective on self care methods

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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

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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

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Thank You

for leading in nursing!

Contact Information

kathy.boyle@dhha.org

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

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Getha-Taylor, H., Fowles, J., Silvia, C., & Merritt, C. C. (2015). Considering the effects of time on leadership development: A local government training

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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.