NURSINGS LEADERSHIP ROLES IN POPULATION BASED ISSUES

Nursings Leadership Roles in Population Based Issues

Amanda Hubbard, RN
Ferris State University

NURSINGS LEADERSHIP ROLES IN POPULATION BASED ISSUES

Abstract
Domestic violence is prevalent all across the country. Changes are needed to help reduce the
domestic violence numbers. A forensic nurse that could be on the front lines of domestic violence
calls with police officers would help accomplish that. This change would require a forensic nurse
to work on a local level using their role to elicit change. It would require a chief nursing
executive to use her role to help elicit change on a state or national level. Both nurses have the
same traits to make changes in their respective communities.
Keywords: direct care nurse, chief executive nurse, leadership traits.

NURSINGS LEADERSHIP ROLES IN POPULATION BASED ISSUES

Nursings Leadership Roles in Population Based Issues

Domestic violence is a growing trend not only in Michigan but all across the country.
Domestic violence happens to women and men, young and old, and can take many forms from
rape and child abuse, to elder abuse and many things in between. Nurses whether at the bedside
or in leadership roles play a major part in helping to break the cycle of violence. Nurses are some
of the first people that can spot the potential victims of abuse; therefore nurses need to be
proactive whether they are at the bedside or helping to write state or federal policies on domestic
violence.
Role of Direct Contact Nurse
Forensically trained nurses are a specialty group of nurses specifically trained in abuse
cases. According to the International Association of Forensic Nurses (2006), forensic nurses
roles include screening for and assessment of abuse, forensic examination and collection of
evidence, having and developing safety plans, education and providing healthcare workers,
community programs and policy makers with outreach programs and information. Emergency
rooms are where these nurses are currently being utilized but other areas that they would work
well in would be outreach programs, nursing homes, and community health agencies that deal
with abused individuals. These nurses are specially trained in the psychological affects that abuse
brings with it.
In Kent county Michigan, forensic nurses take on the role of Sexual Assault Nurse
Examiners (S.A.N.E.). Most of these positions are in the emergency rooms of hospitals where
abuse victims are brought when they are found to have been raped or beaten. This is an already
established program. The community change that needs to be brought about is having a forensic

NURSINGS LEADERSHIP ROLES IN POPULATION BASED ISSUES

nurse that rides along with police when a domestic violence call is made. These nurses would be
available to spot abuse situations and help the victims leave a potentially deadly situation, along
with educating staff on the signs of abuse. Because these nurses have the psychological training
on abuse, they would make great first responders to domestic abuse calls. They could use their
training to help the victim see that they can be safe and not a victim. According to the National
Intimate Partner and Sexual Violence Survey (2010), 1 in 4 women and 1 in 7 men have
experienced severe physical violence by a romantic partner. These numbers could be reduced
with the use a forensic nurse being available as soon as help arrives.
Traits of a Leader
Leaders in any field must have many traits in order to insight people to help them provide
the means to make changes. Forensic nurses in the field of public health are no exception to the
rule. According to the Northwest Center for Public Health Practice, Roles of Leadership in
Public Health: Tutorial, Leadership competencies include being able to motivate and inspire
people, strategically plan, establish a vision, achieve results of a plan, develop a team and
partners, lead change, problem solve and make decisions.
With Kent County being so large one nurse would not be enough to deal with this large
amount of work. The forensic nurse leader would need to develop a team of nurses to cover all
areas of the county. They would need to partner up with local law enforcement agencies in order
to reach the victims of domestic disturbances. Communication with the victims, law enforcement
and one another would need to play a major role in developing the team and partners with which
they are associated with.

NURSINGS LEADERSHIP ROLES IN POPULATION BASED ISSUES

The biggest trait for the nurse would need to be able to show results and by showing the
results the nurse would also show that he/she led a change. The results would come from how
many people they were able to motivate to leave an abusive relationship. By being on the front
lines with the police, the nurse would be able to reach those victims and inspire them to leave
and seek justice against their attacker. This would increase the number of violent offenders being
put behind bars. This would lead to a decline in the number of return visits to the victims home,
showing that the program is making changes in peoples lives.
ANA Scope and Standards of Practice
All types of nursing have their own set of scopes and standards that nurses must abide by.
Harkness and DeMarco (2012), state that the Public Health Nursing: Scope and Standards of
Practice is a document that establishes the characteristics of competent public health nursing
practice and is the legal standard of practice, (pg. 9). The forensic nurse in this community
change project would have two sets to live by. They would have the set of forensic standards but
would also have to use the public health version because they are taking on the role of a public
health nurse with a specialty in forensics.
Public health nursing lives by 8 domains of practice which coincide with many of the
traits of being a leader mentioned previously. Public health nurses must have, Communication
skills and Leadership and systems thinking skills, (Harkness and DeMarco 2012, pg. 9). The
forensic nurse in the public health role would have both of these characteristics in order to
promote a change in the community.
Role of Change Nurse Leader

NURSINGS LEADERSHIP ROLES IN POPULATION BASED ISSUES

According to the Association of State and Territorial Directors of Nursing (ASTDN)

2008, Only twenty-nine states (58%) have a Public Health Nursing Director/ Chief Nurse
position within the state agency. Michigan is one of the states that are lucky enough to have a
chief nursing executive (CNE). This is the nurse that would be able to bring about the change of
having a forensic nurse on the front line with police officers. These senior level leaders have the
ability to influence policy development and collaborate with officials and partners to address
issues in public health (ASTDN, 2008).
Traits of a Leader
Communication is one of the biggest traits that the CNE would need to be successful. The
CNE would need to communicate to law makers and state representatives the need to have a
forensic nurse on the front lines. The CNE would have to show how the program would work
and how it would lower the domestic violence numbers. They would need to know every aspect
of the plan and help develop partnerships with law enforcement agencies. This nurse would
basically get the plan of the direct care nurse implemented on a state level.
A strong will would have to be had by the CNE. This nurse would be battling for more
money from an already drained budget. She would need to be confident that she could get the
policy made but also confident in the fact that the forensic nurse could help bring about the
changes. The CNE would need to be savvy in order to deal with the policy makers and media.
ANA Scope and Standards of Practice
The Eight Domains of Public Health Nursing Practice would also be used by the CNE.
Policy development and program planning skills would need to be utilized in order to bring
legislative policy changes to the state legislature. Financial planning and management skills

NURSINGS LEADERSHIP ROLES IN POPULATION BASED ISSUES

would need to be had in order to present the forensic nurse program and receive state money to
implement the plan. The CNE is still a public health nurse and would have to live by these
standards, which are legal standards that all nurses are held to.
Analysis
Both nurses are governed by the same scope and standards. There is no wonder that they
share a lot of the same similarities in the roles that they hold. Both require great communication
skills in order to achieve their goals within the planned change. They both require that they form
connections with agencies and partners in order to get the project completed from their
respective positions. Both also need to be strong and confident in one another and in the belief
that they can achieve the desired change.
The main difference in the two is that the forensic nurse would be working directly with
the nurses, police officers and victims in Kent County in order to bring about the plan. The CNE
would be fighting to make the changes in policy to be able to make the program a successful
state wide program. The connections that the two would make would also be a difference. The
forensic nurse would work with local leaders in Kent County and the CNE would work with state
wide leaders. Both nurses have the leadership skills to impact the political arena the difference is
on the political level to which they work. The forensic nurse would work with county community
leaders and the CNE would work with state and federal leaders, both causing the change to
happen at their respective levels.
Reflection
The direct care of the patients would be better suited to my skill level. I can communicate
with patients and co-workers in order to implement changes at the patient care level. My strong

NURSINGS LEADERSHIP ROLES IN POPULATION BASED ISSUES

will would help implement the change program, no matter how long it took to achieve success. I
work better on a smaller scale where I can see differences being made.
My biggest fault would lie with the political arena. I hate politics and despise the fact that
nothing ever seems to get accomplished. As a CNE, I would end up getting frustrated and
quitting the position due to the fact that it would take years to see the results of all of the hard
work. Simple gratification could not be had on a state or federal level. I would much rather work
at the bedside where I can see instant differences.
To be competent in both roles would require more education on my part. As a direct care
nurse in the change program I would need to receive education in forensic nursing. This would
require a critical care position in order to complete the forensic training. As far as the CNE
position goes, I would need to definitely get my masters degree if not a doctorate of nursing to
feel competent to make changes on a state or national level. I would also need to have a wide
variety of nursing experiences in order to be a competent nurse leader on a state or national level
as well. Being a direct care nurse on a med/surg unit would not fulfill competencies for a
position as a CNE or even a forensic nurse. It would limit a lot of things in both positions.
Therefore education is a must for me to succeed at any level.

NURSINGS LEADERSHIP ROLES IN POPULATION BASED ISSUES

References
Association of State and Territorial Directors of Nursing (2008).
http://www.astdn.org/downloadablefiles/ASTDNPolicyandProcedureManual62006FINAL.pdf
Harkness, , G.A., & DeMarco, R.F. (2012). Community and public health nursing practice:
Evidence for practice. Philedelphia: Wolters Kluwer/Lippincott, Williams & Wilkins.
International Association of Forensic Nursing.
http://iafn.org/associations/8556/files/IAFN%20Position%20StatementViolence%20is%20a%Health%20Issue%20Approved.pdf
National Intimate Partner and Sexual Violence Survey.
http://www.cdc.gov/violenceprevention/pdf/cdc_nisvs_overview_insert_final-a.pdf.
Tjaden, Patricia & Thoennes, Nancy, (2000). Prevalence, incidence & consequences of violence
against women. National Institute of Justice https://www.ncjrs.gov/pdffiles1/nij/183781.pdf.