ROLES OF A ROLES OF A PROFESSIONAL PROFESSIONAL

NURSENURSE

The Nurse roles are ways of describing the nurse’s activities in practice. However, the roles are not in actuality exclusive of one another. In practice, several roles often coincide.

The American Association of Critical-Care Nurses believes that patient advocacy is an integral component of critical care nursing practice. Therefore, definitions of advocacy are essential.

WHEREAS, nurses safeguard the patient and the public when health care and safety are affected by the incompetent, unethical, or illegal practice of any person and

WHEREAS, critical care nurses are confronted with situations that require them to act immediately on the patient’s behalf, and

WHEREAS, personal and professional risks are associated with being a patient, and

WHEREAS, state nurse practice acts may require the nurse to be a patient advocate, and

WHEREAS, the process of informed consent mandates that the patient or the patient’s surrogate be informed fully and give consent freely, and

WHEREAS, the continuum of advocacy is not limited to the individual but may extend to societal concerns,

PROFESSIONAL NURSE’S ROLES:

1) As CAREGIVER

2) As PATIENT ADVOCATE

3) As COUNSELOR

4) As LEADER

5) As MANAGER

6) As TEACHER

7) As COORDINATOR

As CAREGIVERAs CAREGIVER

As a As a caregiver caregiver is the role of human relations. is the role of human relations. The chief goal of a nurse in this role is to The chief goal of a nurse in this role is to convey understanding about what is convey understanding about what is important and to provide support. The important and to provide support. The nurse supports the client by attitudes and nurse supports the client by attitudes and actions that show concern for client welfare actions that show concern for client welfare and acceptance of the client as a person, and acceptance of the client as a person, not merely a mechanical being. Caring is not merely a mechanical being. Caring is central to most nursing interventions and central to most nursing interventions and an essential attribute of the expert nurse.an essential attribute of the expert nurse.

As PATIENT ADVOCATEAs PATIENT ADVOCATE

A A patient advocatepatient advocate is an advocate of is an advocate of client’s rights. According to Disparti client’s rights. According to Disparti (1988), advocacy involves promoting what (1988), advocacy involves promoting what is best for the client, ensuring that the is best for the client, ensuring that the client’s needs are met, and protecting the client’s needs are met, and protecting the client’s rights. client’s rights. Social advocacySocial advocacy entails entails advocating on behalf of a population or a advocating on behalf of a population or a community to effect positive change. community to effect positive change. Nurses engaged in this form of advocacy Nurses engaged in this form of advocacy can create healthy environments through can create healthy environments through political action, community education, and political action, community education, and involvement in professional organizations.involvement in professional organizations.

According to Kohnke (1982), the actions of an advocate are to inform and support. An advocate informs the client about the rights in a situation, and provides them with the information they need to make an informed decision. The first step in informing is to make sure the client agrees to receiving the information. In addition, an advocate must (a) either have the necessary information or know how to get it, (b) want the client to have the information, (c) present information in a way that is meaningful to the client, and (d) deal with that fact that there may be those who do not wish the client to be informed.

Private duty nurse

As a COUNCILORAs a COUNCILOR

Nurse as a Nurse as a councilorcouncilor focuses on helping the focuses on helping the person develop new attitudes, feelings, and person develop new attitudes, feelings, and behaviors rather than on promoting behaviors rather than on promoting intellectual growth. The nurse encourages the intellectual growth. The nurse encourages the client to look at alternative behaviors, client to look at alternative behaviors, recognizes the choices, and develop a sense recognizes the choices, and develop a sense of control. Counseling can be provided on a of control. Counseling can be provided on a one-to-one basis or in groups. Often nurses one-to-one basis or in groups. Often nurses lead group counseling sessions. The nurse lead group counseling sessions. The nurse may be a leader, member, or resource person may be a leader, member, or resource person in any self-help group in which the nurse may in any self-help group in which the nurse may assume the role of structuring activities and assume the role of structuring activities and fostering a climate conductive to group fostering a climate conductive to group interaction and productive work.interaction and productive work.

Obviously, counseling requires therapeutic communication skills. In addition, the nurse must be a skilled leader able to analyze a situation, synthesize information and experiences, and evaluate the progress and productivity of the individual or group. The nurse must also be willing to model and teach desired behaviors, to be sincere when caring in the welfare of the others.

As a LEADERAs a LEADER

At a client level, nursing leadership is defined At a client level, nursing leadership is defined as a mutual process of interpersonal as a mutual process of interpersonal influence through which the nurse helps a influence through which the nurse helps a client make decisions in establishing and client make decisions in establishing and achieving goals to improve the client’s well-achieving goals to improve the client’s well-being. The purposes of being. The purposes of leadershipleadership vary vary according to the level of application and according to the level of application and include (a) improving the health status and include (a) improving the health status and potential of individuals or families, (b) potential of individuals or families, (b) increasing the effectiveness and level of increasing the effectiveness and level of satisfaction among professional colleagues satisfaction among professional colleagues providing care, and (c) raising citizens’ and providing care, and (c) raising citizens’ and legislators’ attitudes toward and legislators’ attitudes toward and expectations of the nursing profession.expectations of the nursing profession.

Leadership style

- refers to the “individual’s pattern of relating to others or how the leader gets along with members of the work group”.

(1)Charismatic Leadership

- is characterized by an emotional relationship between the leader and the group members in which the leader “inspires others by obtaining an emotional commitment from followers and by arousing strong feelings of loyalty and enthusiasm”. A charismatic relationship exists when the leader can communicate a plan for change and the followers adhere to the plan because of their faith and belief in the abilities of the leader.

(2) Authoritarian or Directive Leadership

- The leader makes the decision for the group. The leader determines policies and gives orders and directions to the members. Authoritarian leadership generally has negative connotations and often makes group members dissatisfied. However, there are times that this kind of leadership is most effective. When decisions are necessary in an urgent situation, one person must assume the responsibility to make decisions without being challenged by other team members.

(3) Democratic or Participative or Consultative Leadership

- the leader participates as a facilitator, encouraging group discussion and decision making.

The leader focuses on the human aspects of the work relationship and tries to build effective work groups. Group members participate in decision making through collaboration and cooperation. This style increases group productivity and satisfaction. Democratic leadership is based on this principles (Tappen 1989):

Every group member should participate in decision making.

Freedom of belief and action is allowed within reasonable bounds that are set by society and by the group.

Each individual is responsible for himself or herself and for the welfare of the group.

There should be concern and consideration for each group member as a unique individual.

(4) Laissez faire or nondirective Leadership

- the leader participates minimally and often only on request of the members. This leadership style is also referred to as permissive or ultraliberalism. This style is described as a “hands-off” approach. This style is most effective for groups whose members have both personal and professional maturity, so that once the group has made a decision, the members become committed to it and have the required expertise to implement it. The leader acts as a resource person.

(5) Situational Leadership

- encourages managers to consider the environment or context in which management decisions are made. Douglass (1992) states that the situational leadership theorists share a basic assumption that successful leadership occurs when the leader’s style matches the situation. One factor influencing situational leadership is the personal and professional maturity of the group members. Also important in this style is the value given to the accomplishment of tasks and the concern given to the interpersonal relationships between leader and the group members and among group members.

(6) Transformational Leadership

- is a style in which the leader motivates others through values, vision, and empowerment. The leader envisions a clear, attractive, and attainable goal and enlists others to participate in attaining the goal. Through shared values, honesty, trust, and continuous learning, the leader empowers the group to share in goal attainment.

CHARACTERISTICS OF EFFECTIVE LEADERS

Use a leadership style that is natural to them.

Use a leadership style appropriate to the task and the members.

Assess the effects of their behavior on others and the effects of others’ behavior on themselves.

Are sensitive to forces acting for and against change.

Express an optimistic view about human nature.

Are energetic.

Are open and encourage openness, so that real issues are confronted.

Facilitate personal relationships.

CHARACTERICS OF EFFECTIVE LEADERS CON’T

Plan and organize activities of the group.

Are consistent in behavior toward group members.

Delegate tasks and responsibilities to develop members’ abilities, not merely to get tasks performed.

Involve members in all decisions.

Value and use group members’ contributions.

Encourage creativity.

Encourage feedback about their leadership style.

As a MANAGERAs a MANAGER

As a As a managermanager, nurse manages the nursing , nurse manages the nursing care of individuals, groups, families, and care of individuals, groups, families, and communities. The nurse-manager also communities. The nurse-manager also delegates nursing activities to ancillary delegates nursing activities to ancillary workers and other nurses and supervises workers and other nurses and supervises and evaluates their performance. In and evaluates their performance. In addition, the nurse uses principles of addition, the nurse uses principles of management and leadership was management and leadership was functioning as a case manager. Case functioning as a case manager. Case management involves coordination among management involves coordination among disciplines and with ancillary personnel to disciplines and with ancillary personnel to deliver care to the client in the most deliver care to the client in the most appropriate setting and in a cost-efficient appropriate setting and in a cost-efficient matter.matter.

Management is often confused with Management is often confused with leadership, because in much of the literature, leadership, because in much of the literature, leadership is associated with group leadership is associated with group interaction within an organizational setting. interaction within an organizational setting. Tappen (1989) defines management as Tappen (1989) defines management as “planning, giving direction, developing staff, “planning, giving direction, developing staff, monitoring operations, giving rewards fairly, monitoring operations, giving rewards fairly, and representing both staff members and and representing both staff members and administration as needed.” Management, administration as needed.” Management, therefore, occurs within an organizational therefore, occurs within an organizational environment. Leadership, by contrast, may or environment. Leadership, by contrast, may or may not require delegated authority within a may not require delegated authority within a formal organizationformal organization

Comparison of Leader and Comparison of Leader and Manager RolesManager Roles

Leaders_________________Leaders_________________May or may not have official May or may not have official

appointment to the position.appointment to the position.

Have power and authority to enforce Have power and authority to enforce decisions only so long as followers decisions only so long as followers are willing to be led.are willing to be led.

Influence others toward goal setting, Influence others toward goal setting, either formally or informally.either formally or informally.

Interested in risk taking and Interested in risk taking and exploring new ideas.exploring new ideas.

Relate to people personally in an Relate to people personally in an intuitive and emphatic manner.intuitive and emphatic manner.

Feed rewarded by personal Feed rewarded by personal achievements.achievements.

May or may not be successful as May or may not be successful as managers.managers.

ManagersManagers____________________________________Are appointed officially to the Are appointed officially to the

position.position.

Have power and authority to enforce Have power and authority to enforce decisions.decisions.

Carry out predetermined policies, Carry out predetermined policies, rules, and regulations.rules, and regulations.

Maintain an orderly, controlled, Maintain an orderly, controlled, rational, and equitable structure.rational, and equitable structure.

Relate to people according to their Relate to people according to their roles.roles.

Feel rewarded when fulfilling Feel rewarded when fulfilling organizational mission or goals.organizational mission or goals.

Are managers as long as the Are managers as long as the appointment holds.appointment holds.

As a COORDINATORAs a COORDINATOR

- Nurse as a - Nurse as a coordinatorcoordinator help shapes help shapes relationships between nurses and relationships between nurses and clients, nurses and support persons, clients, nurses and support persons, and nurses and colleagues. In this and nurses and colleagues. In this role, communication is important. role, communication is important. Communication facilitates all nursing Communication facilitates all nursing actions. The nurse communicates to actions. The nurse communicates to other health care personnel the other health care personnel the nursing interventions planned and nursing interventions planned and implemented for each client.implemented for each client.