Running head: ANALYSIS OF A NURSE LEADER

Analysis of a Nurse Leader Tamara Putney Ferris State University

ANALYSIS OF A NURSE LEADER Analysis of a Nurse Leader As Yoder-Wise (2011) explains, leadership takes many forms and requires a variety of skills and characteristics. This paper will examine the nursing leadership role held by Jennifer Standfest, MSN, RN-BC at Munson Medical Center. Information was gathered during a personal interview on September 19, 2012. Job duties, collaboration, legal and ethical issues, use of power and influence, decision making and problem solving, as well as management and conflict resolution will be discussed and analyzed.

Jennifer Standfest is the director of nursing practice and professional development; a role she has held since 2010. Standfest graduated with honors from Calvin College in 2001 with a bachelors degree in nursing and immediately enrolled in Grand Valley State University for her masters in nursing education; awarded in 2006. Prior to leading nurses at the director level, Standfest served as a cardiac telemetry nurse for three years in Grand Rapids, Michigan before moving to the Traverse City area and taking a cardiothoracic staff nurse position at Munson Medical Center. After only 2 years as a staff nurse she secured a resource clinician position, which she held for 5 years before being named the hospitals director of nursing practice and professional development. Standfest holds many certifications including non-violent crisis intervention, advance care planning facilitator, and she is board certified in her cardiovascular specialty. Job Duties The overall job duty of the director of nursing practice and professional development, as described by Jennifer Standfest, is to assist with setting and accomplishing a direction and vision for nursing services (personal communication, September 19, 2012). Standfest stated, the role also ensures nursing practice meets standards of care and determines how to bridge gaps

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if and where they exist (personal communication, September 19, 2012). A very important part of this leadership role is working with nursing departments to connect with the hospitals overall mission, vision, and strategic plan. Standfest explains that this role is integral to encouraging research and evidence based policy and protocol development with regard to nursing practice (personal communication, September 19, 2012). When asked about challenges, Standfest commented that the most challenging aspect of the role is determining the right balance of the demands within the nursing profession with regard to the tug of technology and regulations, while still ensuring a caring relationship with patients (personal communication, September 19, 2012). The job description as described by Standfest, matches the organizations published job description. On the Munson Medical Center organizational chart, Jennifer Standfest reports directly to the hospitals chief nursing officer. Standfest has no direct reports under her supervision but has a great deal of authoritative and decision making power within the organization (personal communication, September 19, 2012). Collaboration The ability to collaborate with multidisciplinary teams to produce effective outcomes that meet organization strategic goals, and support the mission and vision, is an essential skill of a nurse director level individual (Kirk, 2009). Jennifer Standfest collaborates very closely with all department directors, clinical nurse specialists, unit managers, and resource clinicians for provision of seamless delivery of services (personal communication, September 19, 2012). Standfest also collaborates with human resources to promote nurse retention (personal communication, September 19, 2012). When asked about goals, Standfest identified her main goal of collaboration is to unify nursing departments, promote the sharing of resources,

ANALYSIS OF A NURSE LEADER encourage research, and as a top nursing leader, promote growth of the staff (personal

communication, September 19, 2012). Some of the ways Standfest supports nursing are through attendance of shared governance activities, personally greeting all new nurses, and weekly rounds in every unit (personal communication, September 19, 2012). Analysis of the leadership quality of collaboration reveals that Standfest thrives in the area of collaboration. Standfest understands the importance of quality outcomes and the role of the staff related to the patients and the organization as a whole. Legal and Ethical Issues As a leader, it is imperative to understand how legal and ethical issues can affect patients, staff and the organization (Yoder-Wise, 2011). When asked about a legal or ethical issue currently being managed, Standfest referred to a current violent inpatient that cannot be discharged, although medically stable (personal communication, September 19, 2012). Due to the nature of this patients diagnosis he cannot be discharged to himself, and placement in another facility has been a challenge (J. Standfest, personal communication, September 19, 2012). Staff is subjected to an unsafe environment and the organization is footing the bill because the insurances limits are met (J. Standfest, personal communication, September 19, 2012). Standfest describes this type of ethical and legal dilemma as extremely difficult to resolve (personal communication, September 19, 2012). According to Standfest, he is utilizing scarce resources that other patients need (personal communication, September 19, 2012). Organizational implications are financial, both from a reimbursement and a resourcing aspect. Standfest believes that handling legal and ethical issues quickly at the nursing director level is a critical skill that has the capability to make or break a career (personal communication, September 19, 2012). Standfest explains that when approaching ethical or legal issues it is

ANALYSIS OF A NURSE LEADER imperative that all sides of the story are known, and that all implications and options are

considered (personal communication, September 19, 2012). Emotions play a part in any legal or ethical issue, but a leader must remain unbiased, yet demonstrate empathy and compassion for all involved (J. Standfest, personal communication, September 19, 2012). Elchos (2010) presents the DECIDE model for approaching legal and ethical issues. This model has been utilized by very successful nursing leaders and involves many of the steps Standfest described. The word DECIDE is an acronym for the process: define problems, ethical review, consider options, investigate outcomes, decide on a plan and evaluate the results (Elchos, 2010, p. 20). Analyzing Standfests approach to dealing with legal and ethical issues reveals she is systematic in her approach, although she did not quote a certain model or theory for which she follows, her approach is patient centric, organized, and considers the implications to patients, families and the organization. Use of Power and Influence Yoder Wise (2011) defines power as the ability to influence others to achieve goals (p.176) and influence as the process of using power (p. 179). When asked how she views power and influence, admittedly, Jennifer Standfest does not like the word power; she believes it is fraught with misconception (personal communication, September 19, 2012). Standfest believes, that a collaborative approach to using her positional power to influence others is very effective (personal communication, September 19, 2012). Incorporating concepts from nursing theorist Martha Rogers, Dr. Elizabeth Barrett (2010) has developed the Barrett power as knowing participation in change theory. This theory is of particular interest because Jennifer Standfest believes that if power and influence are correctly utilized, others become the keeper and distributor of power and change will occur (personal

ANALYSIS OF A NURSE LEADER communication, September 19, 2012). Empowering others to understand change, and teaching them how to want to influence others they come in contact with, is an art a leader must possess (J. Standfest, personal communication, September 19, 2012). There are times when executive

type decisions need to be made, with little or no opportunity for collaboration. Standfest states it is the experience and maturity of the person making the decision that will determine success or failure (personal communication, September 19, 2012). Kirk (2009) identifies listening, collaboration, human management skills, the ability to make things happen, integrity, intellectual flexibility, holding others accountable, strategic influencing, and political astuteness (p. 963) as all critical to a leaders ability to effectively and successfully utilize power and influence to produce change and maintain staff cohesiveness. Jennifer Standfest is a dynamic leader and an expert at utilization of her positional power to influence others and produce lasting change. She understands that her skillful use of power and influence directly affects patient care and staff, as well as the bottom line of the organization. Use of Decision Making and Problem Solving Process Jennifer Standfest makes decision every day related to process, rules, regulations and budgets. Standfest is especially concerned about making the wrong decision and producing a negative effect on patients, staff or the organization (personal communication, September 19, 2012). As Yoder-Wise (2011) explains, decision making and problems solving skills of nurse leaders are absolutely essential and must continually be examined for opportunities aimed at improvement. Just as the American Nurses Association (ANA) Standards of Professional Practice (2012) dictates, collaborative relationships in decision-making are crucial. Nurse leaders must make decisions and approach the problem solving process based on the effects on outcomes of

ANALYSIS OF A NURSE LEADER care, patient safety, and the nursing practice environment, all while meeting regulatory guidelines and supporting the organizational mission and vision (American Nurses Association, 2012). When asked about her approach to decision-making and problem solving, Standfest described herself as a collaborator (personal communication, September 19, 2012). She rarely makes decisions to implement new processes, protocols, or to solve problems without full collaboration and evidence to back up the decision (J. Standfest, personal communication, September 19, 2012). When asked about the healthcare process taking a village, Standfest could

not agree more. She said there is no one person who ever makes decisions (J. Standfest, personal communication, September 19, 2012). As Standfest explains, a perfect example is deciding to implement a new hospital process for administration of emergency blood products (personal communication, September 19, 2012). The first step in this process is to humanize the problem, gather evidence, and understand that the final process will affect patients, as well as staff (J. Standfest, personal communication, September 19, 2012). Standfest states that if the process is too difficult and cannot be carried out safely each time, patients, staff and the organization will all feel the negative impacts (personal communication, September 19, 2012). Part of being a successful leader is to identify the resources needed to assist in the problem solving process; our patients depend on it (J. Standfest, personal communication, September 19, 2012). As Kirk (2009) states, effective, successful leaders must exhibit courage, be willing to make quick and contentious decisions, and be willing to engage in difficult debate (p. 963). Analysis of Jennifer Standfests decision making and problems solving abilities prove successful, but as she admits, it probably takes longer than it should at times (personal communication, September 19, 2012). Standfest identifies that the ability to make snap decisions are difficult for

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her because she relies heavily on the opinions of others (personal communication, September 19, 2012). According to Kirk (2009) just the fact that Standfest identifies this as a weakness shows her strength as a future exceptional leader. Management and Resolution of Conflict As Yoder-Wise (2011) explains, conflict in the nursing environment can result in negative patient outcomes and negatively charged working conditions. It is the duty of a nurse leader to understand how to manage and resolve conflict efficiently with the best interest of the patient, staff and the organization in mind (Yoder-Wise, 2011) When asked about management and conflict resolution, Standfest remarked that conflict is and always will be present, whether it is with staff, processes, families or patients (personal communication, September 19, 2012). The key to being a great leader is the ability to identify where the conflict is originating (J. Standfest, personal communication, September 19, 2012). Knowing what questions to ask, knowing how to ask them, delegating authority when appropriate, and helping others grow is critical to promoting organizational effectiveness and a cohesive staff (J. Standfest, personal communication, September 19, 2012). Standfest states, management and resolution of conflict has everything to do with people; how people think and how people act, and react, at any given moment (personal communication, September 19, 2012). Confronting conflict truthfully, head on, in the appropriate setting, presenting those involved in the conflict with evidence, and working out a solution together is usually very successful (J. Standfest, personal communication, September 19, 2012). Although Standfest has no direct reports, she remarks that her daily conflicts usually involves nursing staff. Milton (2009) explains that effective leaders must have direct and meaningful conversations with staff to get at core issues in the best interest of the organization, patient and other staff members. It is very important to understand that

ANALYSIS OF A NURSE LEADER management and conflict resolution can be done most effectively if the person involved is

recognized as having worth and not just as being a worker of an institution (Milton, 2009, p. 119). Jennifer Standfest demonstrates effective leadership in the area of management and conflict resolution. She exudes an understanding that conflict must be resolved swiftly and effectively to promote a cohesive work environment. Research correlates direct links of poor moral and working conditions of nurses, to a lower quality of patient outcomes in healthcare organizations (Aiken et. al, 2012). Standfest understands this and consistently aims to keep all goals directed at the best interest of the patient, staff and organization. Conclusion Analysis of the director of nursing practice and professional development role makes it clear that understanding how to be an effective leader is a journey. Becoming a strong nursing leader involves life long learning and utilization of evidence, formal education, listening, seeking out opportunity, and accepting feedback from others. Collaborating, problem solving, using power and influence, managing people, making decisions, and helping others grow is only a small piece of what leadership is all about. In nursing, the focus is the patient, the growth of the staff, and the well being of the organization as a whole.

ANALYSIS OF A NURSE LEADER References Aiken, L., Sermeus, W., Van den Heede, K., Sloane, D., Busse, R., McKee, M+,+ KutneyLee, A. (2012). Patient safety, satisfaction, and quality of hospital care: Cross sectional surveys of nurses and patients in 12 countries in Europe and the United States. BMJ, 344:e1717, doi: 10.1136/bmj.e1717 American Nurses Association. (2012). ANA principles. Retrieved September 21, 2012, from http://www.nursingworld.org/principles Barrett, E. (2010). Power as knowing participation in change: Whats new and whats next. Nursing Science Quarterly, 23, 47-54. Elchos, S. (2010). Is this ethical? You decide. Nursing Management, 41(2), 18-21. Kirk, H. (2009). Factors identified by nurse executive directors as important to their success. Journal of Nursing Management, 17, 956-964. Milton, C. (2010). Leadership and ethics in nurse-nurse relationships. Nursing Science Quarterly, 22(2), 116-119. Yoder-Wise, P. (2011). Leading and managing in nursing. (5th Ed.). St. Louis, MO: Elsevier

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