compendium of leadership topics · web viewintroduction innovations, change management, and systems...

Running head: COMPENDIUM OF LEADERSHIP TOPICS 1

Compendium of Leadership Topics

Compiled by

Jane M. Schmaltz

In fulfillment of

academic requirements for the

degree of

Masters Science of Nursing

Nursing Administration Program

University of Mary

December 18, 2016

COMPENDIUM OF LEADERSHIP TOPICS 2

Table of Contents

Introduction

Innovations, change management, and systems thinking

Literature synthesis………………………………………………………………………..4

Application……………………………………………………………………………...…5

Communication and emotional intelligence

Literature synthesis……………………………………………………………………......6

Application…………………………………………………………………….…………..8

Conflict resolution

Literature synthesis………………………………………………………………………..9

Application…………………………………………………………………...…………..10

Policy and advocacy

Literature synthesis……………………………………………………...……………….11

Application………………………………………………………………………….……12

Decision making

Literature synthesis………………………………………………………………………13

Application…………………………………………………………………………….…15

Organizational Climate and Culture

Literature synthesis…………………………………………………………………..…..16

Application…………………………………………………………………………….…17

Influence versus Power and Leadership and Management

Literature synthesis………………………………………………………………….…...18

Application……………………………………………………………………………….20

Fiscal Responsibility and Sources of Funding



Application…………………………………………………………………….…………22

Retention and Succession Planning


Application……………………………………………………………………………….24

Quality


Application……………………………………………………………………….………26

Professional Membership and Professional Development


Application……………………………………………………………………………….28

Compendium Summary


Compendium of Leadership Topics

The world of nursing continues to change every day, which is why leadership must

change right along with the rest of healthcare. Growth in leadership excels with focus,

dedication, and increased participation from those involved. Leadership is not a set list of job

duties assigned in a job description; leadership continues to grow, develop, evolve, and improve

throughout one’s career. This paper will discuss a variety of different leadership topics that offer

opportunity for leaders to improve upon their knowledge, skills, focus, and practice to help guide

others into the future of healthcare. Also included in this paper are examples of experiences that

will substantiate the theoretical findings described through each topics literature synthesis

section. Deciding to take one’s leadership style to the next level only enhances the leader they

will become.

Innovations, Change Management, and Systems Thinking

Literature Synthesis

The old business model of continuing to do business as usual because it proves profitable,

is a historic way of thinking. In order to transform an organization with new innovative ideas,

one must think beyond status quo. Changing in a way that the entire company alters the way they

think and approach innovation is necessary in order to explore new business models, new

markets, and new ways of working (Gobble, 2013, p. 62). Changing an approach to innovation

can help the organization thrive in success and in positivity; sometimes the type of approach is

all it takes to ensure support for innovative ideas and change.

Leadership today involves every individual within an organization to bring change,

innovation, and updated thinking to the forefront of advancement and growth. Organizational

growth goes beyond a board of directors coming up with ideas to improve the success of a


facility; involving all employees on every level opens up the opportunity to think outside the

box. Allowing the acceptance of innovative ideas from those who carry out new change

processes (i.e. employees), increases the chances of breaking down barriers to change and

increase the participation or motivation of those individuals to assist in making the change

successful.

By allowing this combination of resources to identify different types of innovation and

strategic approaches to change as a substitute for the historic simple cause and effect

relationships, we allow others to look at minor details that are often overlooked as irrelevant and

broaden the possibilities for growth. The acceptance of broad brainstorming can help “change the

way a subject is viewed, by trying to avoid unintentionally narrowing people’s conception of the

subject; thus opening them up to more ideas for the subject’s use” (McCaffrey & Pearson, 2015,

p. 84). Through these opportunities for broadening innovative driven ideas, success and growth

of the organization becomes inevitable.

Leadership’s ability to change the way the organization thinks as a whole will aid in its

ability to adapt to new ways of thinking and preparing for the future. Actively listening to the

existing employees and concentrating on sustaining innovations as a result, will aid in the

participation and buy-in from staff necessary to ensure the changes are successful (Christensen,

Raynor, & McDonald, 2015, p. 53). Change, although outside the parameters of mainstream

thinking, can take time to accomplish; however, continuing to strengthen relationships with core

employees is the innovative way to ensure the growth of an organization in the future.

Application

Throughout my leadership experience, there have been many situations where change

was being initiated without the involvement of those directly affected by the change. This often


caused hard feelings among staff, and a difficult transition or acceptance of a new innovative

changes or idea. However, in my current clinical setting there has been an initiative to include

staff on large discussions regarding future changes throughout the facility. The most recent

committee, involved discussion of nursing shortages throughout the facility. This involved

administration, human resources staff, quality management, department directors, along with two

to three staff members from every department. Prior to implementation of any innovative idea or

process changes, there has been a great deal of meetings that administration has requested the

help of this committee. This direct collaboration has allowed the employees to be involved in the

decisions, add sustenance to the discussion that represent a different perspective of the business-

focused aspect, as well as represent the ideas and thoughts of their co-workers; thus, enhancing

ownership and participation to ideas, changes, and implementations that involved a well-rounded

organizational thought process. The encouragement of administration to include the staff in this

process has opened the possibilities for nursing involvement, ownership, and a shared

responsibility.

Communication and Emotional Intelligence


In leadership there can be extreme emotionally charged situations that arise from time to

time. Being able to identify the emotions present in conversations or situations becomes a vital

part of productive communication. Entering into a discussion where emotions are high with the

ability to remain calm while communicating prevents escalation of a non-productive encounter.

“Successful leaders have learned how to cope with their emotions, making them emotionally

mature and intelligent” (Knyszewski, 2015, para. 6). There are times when your personal views


conflict with others, however offering up the ability to put one’s emotions aside to work through

issues is a phenomenal trait for a leader to possess.

Communication and emotional intelligence need to be congruent in order for leaders to

be successful with their communication approach. A leader’s ability to assess the emotional state

of the individuals involved in a conversation, debate, or conflict can make a difference in the

outcome and accomplishments of the situation. For a leader to have the awareness of the

appropriate timing and emotional state of those involved in an interaction, demonstrates the

leader’s ability to have complete emotional intelligence and appropriate communication skills.

“Having emotional intelligence separates truly successful leaders from those who have less faith

in their personal capabilities” (Knyszewski, 2015, para. 8). A leader with these demonstrated

skills helps others to learn the appropriate manner in which to communicate with each other,

recognizing times when emotions are high, and the wisdom to take a different communication

approach to defuse the emotionally charges situation.

Creating a positive work environment, through inclusion of emotional intelligence in

nursing training, can help with nursing retention, recruitment, and job satisfaction. “Emotional

intelligence skills are regarded as essential for establishing an empowering work environments in

nursing” (Heckemann, Schols, & Halfens, 2015, p. 744). An emotionally intelligent work

environment allows others to communicate effectively and perform their job to the best of their

ability.

In an emotionally intelligent leader, self-awareness of the way they emotional respond to

others, the way they communicate with others, and the way they manage their relationships are

key to their success. “Nursing leaders with high emotional intelligence leadership styles develop

staff nurses with significantly less emotional exhaustion, improved emotional health, greater


work group cooperation, and greater job satisfaction (Lucus, Spence Laschinger, & Wong, 2008,

p. 966). Emotional Intelligence, when executed properly, increases the success of

communication with productive outcomes.

Application

Sometimes it is very difficult to quickly assess the temperature of a discussion and think

with emotional intelligence prior to eliciting a response. There was a situation recently in our

pre-operative surgery care unit, where a surgeon was refusing to sign a required twenty-four-

hour history and physical update. This is a document that is required prior to surgery stating that

the doctor feels there has been no changes to the patient’s history and physical in the last twenty-

four-hours. In this discussion, the doctor stated that he saw the patient yesterday and he was not

going to updated the H&P again. The staff contacted me, as the Operating Room Manager, to

discuss this subject with the surgeon. I spoke on the phone with the surgeon briefly where I

explained to him that it was hospital policy to complete the twenty-four-hour update upon

admission and prior to surgery. At this point he claimed I was making this statement up in order

to delay his day. I could immediately tell the surgeon was escalating in his frustration and anger,

so I decided to come talk to him face-to-face with the documentation supporting my statement.

Upon entering the PSCU, he had become completely irate, talking to me inappropriately,

and personally attacking my leadership skills. At that moment, I took a deep breath (recognizing

the anger he was provoking in me) and did not respond to his verbal attack. Instead, I decided to

calmly hand over the highlighted document directly from the physician medical staffing rules

and regulations. The document stated exactly what I had explained to him earlier, proving that he

was indeed required to complete the update even though he had just seen the patient. He

immediately walked over to the computer and completed the required documentation. I thanked


him for completing the document and told him I was sorry for the confusion or any

inconvenience this might have caused.

The staff in PSCU all stood completely still until he had left the unit. Once he was out of

earshot they started asking questions about “how I did not yell back at him”, or “how I just took

all his insults without saying anything.” I tried to explain to them that by me not responding to

his outburst, I was able to de-escalate the conversation to be able to focus on the task at hand. I

explained that in a high stress or high emotional situation, it is best to put your personal feelings

and emotions aside in order to remain professional and accomplish your goal. Did I think he was

completely inappropriate in talking to me in such a matter? Absolutely, however, confronting

him in that situation would have only furthered his aggravation and increased the tension of the

situation. By recognizing the magnitude of his anger, I was able to act and react appropriately. I

hope that by the staff in the PSCU area witnessing the interaction between the angry surgeon and

myself, they might have learned how to be emotionally intelligent in a highly charged

conversation.

Conflict Resolution


Conflict among staff can cause a number of problems on a unit, which could be

interfering with the care of the patients. Improving conflict resolution skills are necessary to

function as a team to be able to place their primary focus on the care of the patients. “Developing

appropriate conflict resolution skills among all team members is imperative if the goal of

improved quality and increased productivity in a team environment are to be realized” (Baker,

1995, p. 296). The first step a leader takes to be able to resolve conflict, is to provide education

to the staff about different conflict resolution strategy techniques that are available. Once


education has occurred, the leader must be able to demonstrate openly to the staff their ability to

address and resolve conflict in order for their team to follow their example.

Conflict resolution becomes successful when the individuals involved are willing to find

solutions, show respect, and practice a little humility in order to dissolve the conflict peacefully.

Leaders can act as mediators during staff conflict in a way that allows others to communicate

openly in a safe environment. Being able to communicate openly about the issues they have with

each other, opens up the possibilities and willingness to find a solution to their issues.

Conflict is often left unaddressed for fear of confrontation with the other individual.

When left unaddressed conflict tends to grow in strength and emotion. Unresolved conflict can

lead to nonproductive and negative relationships, evokes negative images and words of those

involved (Victor, 2013, p. 79). Barriers to conflict resolution can include “lack of time, increased

workload, people in less powerful positions, lack of motivation to address conflict, and avoiding

confrontation for fear of causing other team member emotional discomfort (Brown, Lewis, Ellis,

Stewart, Freeman, & Kasperski, 2011, p. 8). The key to breaking down the barriers of addressing

conflict is to understand that facing conflict in order to resolve it can lead to positive changes and

outcomes for those involved. Conflict resolution and positive outcomes are essential for the

continuity of care provided to our patients and satisfaction of the staff. The leader’s ability to

facilitate conflict resolution can create a positive work environment which in turn promotes

satisfied patients, staff, and provides excellent customer service.

Application

Conflict in a high stress environment, such as the operating room, is inevitable; being

able to resolve it is the key. During my clinical experience, we had a situation come up with the

neurosurgical team; which consists of two registered nurses and four surgical scrub technicians.


The team had had a series of conflicts and negative interactions over the period of a month.

Unfortunately, none of the conflicts had been resolved and tensions between team members was

at an all-time high. They had gotten to a place where they were not communicating with each

other in the surgical suite, which was developing potential issues that could affect patients or

their care.

My preceptor (who is my director) and I decided to pull a meeting together with the

whole team to lay all the problem, issues, and hard feelings out on the table in order to resolve

this ongoing conflict. Each team member was willing to sit down and explain why they were

mad and why they were not communicating very well with their co-workers. It was a very

emotional meeting, however, very productive. We figured out there was a great deal of

misunderstanding and miscommunication that was driving their inability to resolve this situation

on their own. They had worked things out among themselves, all vowing to increase

communication and addressing issues immediately instead of allowing them to grow into a giant

unnecessary mess. It actually ended with hugs, smiles, and laughter. In the weeks following the

meeting, the team has really come together with communication, helping each other out, and

going the extra mile. Conflict resolution, when performed appropriately, can have fantastic

outcomes for everyone involved.

Policy and Advocacy


With the constant changes in healthcare, nurses need to up their stakes in the game. One

of the primary roles of a nurse, including nursing leaders, is to be an advocate for the patients.

Getting involved in decisions that are made on behalf of the patients and on behalf of the

profession continue to be an essential commitment that needs to be fulfilled. Involvement with


the primary stakeholders in policy making, legislation, and updated regulations needs to be a

high priority of the nursing profession. The future requires greater involvement from nurses as

individuals and leaders to motivate and lead nurses towards developing higher quality of care in

a healthy professional work environment. Focusing on the Institute of Medicine’s core

competencies of providing patient-centered care, working in interprofessional teams, employing

evidence-based practices, applying quality improvement to care, and utilizing informatics will

aid in positive future healthcare outcomes (Greiner & Knebel, 2003, para. 3). Empowering

nurses to make decisions that are respected, trusted, and supported is an essential role that

leadership must exhibit.

Through leadership’s empowerment of nurses, the confidence to become more assertive,

responsible, and competent will come easier for them. With this confidence comes a more

powerful advocacy for the patients and their needs. “Each nursing department brings an expertise

and skill necessary for advancing social, economic, and health-related policies that will better the

lives of the people we serve” (Smith, 2015, p. 69). A leader’s encouragement of nurse’s input,

experience, and involvement are the successes of the future of the nursing profession.

Nursing leaders also need to encourage and teach nurses to play the role of the advocate

in the policy making process. Nurses possess the knowledge, clinical experience, professional

ethics, and patient advocacy to supply policy makers with the background information needed to

create new policies. Nurses have the ability to influence the issues that need changed at a

governmental level, and to change the direction of healthcare to best fit the ever-changing needs

of the society they serve.


Application

A large part of retention in the operating room has to do with the way the staff is treated

by the surgeons. This has been an ongoing struggle that often times leads to staff not wanting to

work with a surgeon who treats them so poorly. In the operating room there is a policy that

discusses the optimal behavior that is to be exhibited by the physicians; what is considered

acceptable behavior and what is not. Unfortunately, there is not a description of consequences to

the physician if their behavior goes outside the policy description. Thus, leaving the

unacceptable behaviors untouched and unchanged.

Just recently, there has been a committee formed to change the policy to include a series

of consequences if the physician’s behavior is deemed inappropriate. The committee was formed

by nurses working in the operating room, with the inclusion of administration, the OR director,

the chairman of the OR committee, risk management, human resources, and three physician

champions. The members included at the table are key stakeholders in the operational function of

the operating room, which allows for a well-rounded discussion and a thought provoking

solution.

The policy change has not been approved yet; however, the OR chairman is presenting it

to the legal department, as well as the Medical Executive Committee. The efforts of the nurses,

and the committee they brought together, might help retain some of our prize employees; if they

know there is something being done to rectify this inappropriate behavior from the physicians.

This committee has also shown other nurses that their participation in policy changes and

advocacy can result in positive outcomes.

Decision Making



Decision making processes often involve upper management with minimal input from

lower level employees. Often times this leads to lack of participation and involvement from

those employees once decisions are implemented. In an industry that is constantly changing,

healthcare organizations would be wise involving the employees in the decision making process.

This will help them take ownership in the implementation phase by showing increased

participation due to their involvement in the decision making process. Leaders can make this

happen by actively encouraging involvement in decisions that would directly impact the

employees work environment.

Leadership can enhance involvement by providing evidence based practice changes that

will increase the knowledge of the nursing staff to make informed decisions for their patients.

Evidence based practice “involves using the best evidence in making patient care decisions and

best evidence typically comes from research conducted by nurses and other health care

professionals” (Polit & Beck, 2017, p. 676). Research in the healthcare field will continue to

grow and evolve in many different ways, which nurses can utilize to develop and provide

evidence based quality care decisions.

Nurses must become involved in the decisions to help improve the future of nursing and

the number of nurses coming into the profession itself. Leaders helping nurses feel that their

ideas will make a difference in turn makes them want to participate and take ownership in the

unit, as well as influence others and influence decisions with a greater knowledge base. Nursing

expertise comes with time to include experience, education, understanding of nursing principles

and theories, along with their devoted passion for the profession. A thorough education and

understanding of nursing theory and principles enable nurses to know the right questions to ask

to zero in on patient problems in order to provide safe care and make good clinical decisions.


Clinically expert nurses are distinguished from their colleagues by their often intuitive ability to

efficiently make critical clinical decisions while grasping the whole nature of a situation

(McHugh & Lake, 2010). Expert nurses can recognize unexpected issues that may arise, while

having the intuitive to grasp the whole situation in order to accurately respond and make

decisions in the best interest of their patients. “The greatest importance that nurses need to

understand is learning to use decision making strategies to guarantee patient care security and

patient care quality” (Hedberg & Larsson, 2004, p. 316). After all, nurses recognize the needs of

their patients and have so much to offer when making decisions that will affect those needs.

Application

Recently in the operating room we lost our night shift nurse to a different department.

Being able to fill that position is very difficult due to the experience and qualifications that are

required of a night shift OR nurse. In order to fill this position, typically we pull staff from the

day shift to fill in a week at a time. This typically brings forth staff dissatisfaction due to the fact

that they already take an enormous number of call hours in addition to their regularly scheduled

shifts. We decided to go to the staff and instead of dictating how the shift was going to be

covered, we asked for their help with making the difficult decision. We asked for their thoughts

and alternative solutions to this issue in order to fulfill the shift obligation and make the

satisfaction of the staff a priority.

The response and participation of the staff was such a wonderful sight to see. They

worked very hard together as a team to come up with an “out of the box” alternative to covering

the shift. You could see the great deal of thought process involved in their solution and how very

proud they were of such an amazing alternative to this issue. Involving the staff in this situation

was the best decision we could have made for the department. There was a sense of ownership


and satisfaction due to them being a part of the decision, and not dictated what they would be

doing to solve the shortage on that shift. Sometimes involving those who are directly affected by

the decision, can turn up ideas that might have never come to light.

Organizational Climate and Culture


Organizational culture utilizes values brought forth to mold the organizations attitudes,

behaviors, and environmental effects of the individuals who are part of that organization. This is

very important to the patients who want a welcoming, positive, soothing environment in which to

get better and heal in. The culture that is represented by the hospital personnel, is similar to the

way you want your children to act when you have guests over. You want them to feel welcome,

taken care of, respected, and important. The culture of the organization can make a patient’s

experience one of healing and comfort. Organizational culture serves as a cognitive map for

members so they can understand what is valued in their organization, and how to direct their

behaviors accordingly (Crane & Wooten, 2003, para. 5). Having this “map” will help guide the

organization into focusing on a welcoming environment which enhances the overall culture and

attitude of those involved.

Organizational climate influences attitudes and expectations that have a direct effect on

employee behaviors (Roch, Dubois, & Clarke, 2014, p. 229). Transforming a culture to a place

where they are mentally fit, able to handle stressful situations, communicate effectively, and are

resilient when faced with challenges is the ultimate climate for sustainability. By setting this

structured climate and environment that is supported by management and leadership, it promotes

nurses’ performance of essential caring practices and will also help to ensure safe, patient

centered services (Roch et al., 2014, p. 238). Leadership must promote adequate staffing,


appropriate education, a culture that fosters professionalism and curbs disruptions, encourage

nurse leadership at all levels, educate the staff to work as collaborative teams and to

communicate better across all health professions to enhance the strength of the unit and promote

a healthy work environment (Wood, 2014, para. 4). This enhanced culture and climate breeds

positivity; which ultimately breeds positive work environments and positive patient care

outcomes.

Positive climate and culture occurs ideally everywhere in the organization once a positive

innovative way of thinking begins. This is ultimately a way of thinking that takes the safe

reliable care provided, and instead takes it to the next level by envisioning better ways to

accomplish it. The ultimate expectation is that everyone in the organization becomes a part of an

innovative culture by advancing their work, the quality of their work and the impact from their

work so that it becomes a way of life to think and work innovatively. The understanding that

every discipline in the organization has an impact on the innovative successes and without their

participation in an innovative culture it would be difficult to move forward. There must be full

support and encouragement from leadership and administration to change the culture and foster a

positive change to the organizations climate.

Application

Nearly a year ago my director and I initiated a department wide culture change

discussion. There was a third party brought in to assist us through a discussion with the staff

about the need for changing the culture in the operating room. The attitudes and negativity

throughout the operating room had gotten completely out of hand, to the point that people hated

coming into work. There needed to be a change in the climate and in the culture in order to move

past this stage of negativity.


We met every week for 6 weeks, where we discussed issues, problems, possible

solutions, possible causes, and the need or want to make things better for everyone. The

participation was mandatory with great results. We began “training” ourselves to think before we

speak, to try hard to see the positive side to situations, and to begin to mend fences among our

co-workers. This process was amazing; although it might have taken a while for everyone to

come on board with the ideas the outcome has been simply amazing.

During the last couple of months, there have been many positive interactions from those

who have been mending their relationships. There also has been new staff members who have

come into the environment just recently, who were enthusiastically taught what it looks like to

have open communication and positive interactions with their co-workers to promote a positive

work environment. This education of the new team member by the current staff was so

fascinating to watch. The explanations of our unit history and how hard they worked to get to the

fully functioning positive environment was an intricate part of their explanations. The positive

vibe that is going throughout the unit is completely contagious. There are still a few people that

have a long way to go; however, the overall climate and culture has changed and evolved into

wonderful working relationships that promote positivity and hard work.

Influence Verses Power, Leadership, and Management


Power and empowerment are often seen in nursing as non-existent. Powerlessness is

unfortunately the word that most nurses feel is present. Nurses have insightful ideas, practice

changes, patient focused ideas, however they feel powerless in getting those ideas out there to

make a difference. Leaders need to encourage and empower nurses to come forth with ideas to

help make a difference in the lives of their patients. By leadership giving a nurse the


encouragement to stand up and do something about their ideas, thoughts, and perceptions they

can give the profession the power it needs to become strong as a whole.

Leadership has the opportunity to lead their staff through the use of positive influence,

instead of pushing their power around to make things happen. Leaders can influence others

through exhibiting “characteristics that show a sense of optimism; a passion for their profession;

ability to form personal connections; provide excellent role modelling and mentorship; and the

ability to manage crisis” (Anonson, Walker, Arries, Maposa, Teleford, & Berry, 2014, p. 127).

Influential leadership allows for an environment that empowers employees to feel that their ideas

will make a difference, which makes them want to participate and take ownership in their unit.

This promotes positive attitudes, positive outcomes, and promotes staff retention. All parts of

making the image of nursing a positive one. Utilizing influence instead of power aids in staff

confidence to become more assertive and responsible, along with their willingness to work

harder for their leader and organization.

Having influence as a leader exhibited by patience, respect, forgiveness, commitment,

honesty, humility, and kindness towards individuals in all different arenas of experience are the

keys to positive leadership principles (Hunter, 2012). A leader chooses to exhibit these

principals not only to be a better person, but to become a fabulous leader. They lead by example

throughout every area of their life, which shows their staff and their peers the strengths needed to

succeed at whatever they are doing.

Leadership involves many different aspect and abilities, most of which can become very

influential and motivating for those around them. Skilled leadership is required to create and

sustain an organizational culture of excellence that helps others to continues to develop and

improve upon their work environment (Pintar, Capuano, & Rosser, 2007, p. 115). A leader’s


ability to focus on mentoring, encouragement, emotional intelligence, respectful interactions,

positive attitudes, making informed decisions, and facilitating growth and improvement will gain

the respect and hard work from those under their direct leadership. Putting others before

yourself, encouraging their successes, and guiding them through work and life is what being a

good leader is all about.

Application

Throughout my clinical experience, I observed many situations where the staff was

appreciative of the leadership my preceptor exhibited. There were many situations where he

would jump right in and help the staff or cover assignments for staff. This immediately exudes

an enormous respect for a director who is willing to physically do what he is asking of his

employees. The employees were more likely to help him out knowing that he understands what

they go through on a daily basis. Having a leader who is not dominant with power, but influential

in his leadership has made a huge impact on the ability of the staff to go the extra mile.

I also observed a team lead RN utilize her “power” over other staff members. She is the

person who makes out the staff schedule every 6 weeks. So when she asks them to stay over their

shift, some of the staff are afraid to disagree or stand up to her because they were afraid that she

would make their next schedule unpleasant. The staff came to us explaining her behavior, and

how they felt bullied into staying late for fear of receiving a horrible schedule. In this situation,

we decided on counseling the team lead in order to help her recognize the difference between

influence and power. You want your staff to work for you, not out of fear of the consequences,

but because they want to work for you. Manipulating others into doing things with the use of

“power”, only makes a situation turn and stay negative. One must respectfully work with their

employees in a fair manner; if they are to offer up their time to help you out.


Fiscal Responsibility and Sources of Funding


Leadership has a large responsibility to closely monitor the financial aspect of care in

order to ensure funding stays sufficient for the organization. There are many avenues a leader

must frequent in order to make sure their unit is remaining within benchmark figures. For

nursing, one of the top priorities are the constant assessment of productivity of the unit and staff.

“Monitoring, measuring, and improving productivity is the largest driver for attaining financial

targets” (Goetz, Janney, & Ramsey, 2011, p. 175). Optimizing staff time with productive work,

while eliminating non-productive wasted time is a way to reduce salary costs and improve

productivity at the same time. Leadership is responsible for reviewing their productivity

routinely to determine if there are ways to ensure the unit is being fiscally responsible.

Another aspect of leadership’s involvement in financial responsibilities is by improving

the quality of patient care in order to improve patient outcomes, which in turn can improve the

financial successes of the facility. Enhancing the quality of care provided to the patients will

reduce hospital stays, reduce hospital costs, reduce supplies utilization, reduce nursing staff

requirements, and improve patient outcomes which in turn provides the organization with return

customers and increased funding. Providing quality care in a cost-effective manner will help

meet the goal of the changing health care system (Bantz, Wieseke, & Horowitz, 1999, p. 90).

Leaders knowledge to link funding and expenditure to the quality of the care provided helps to

teach those around them the responsibility of being fiscally aware; at the same time aides in

improving financial gains along with patient satisfaction.

Leaders have the task of analyzing their units for ways to reduce costs, ways to efficiently

allocate resources, increase staff motivation, eliminate wasteful operations, identify opportunities


to save money, and to increase the communication with their staff in order to facilitate financial

gain. Enabling staff to participate in cost saving measures, as well as brainstorming to come up

with ways to reduce the unit’s cost, induces ownership and participation from the staff in the

unit’s financial status. Leadership must be financially aware and fiscally responsible in all

decisions made in order to become successful.

Application

Productivity has been a hot topic throughout my clinical experience. In an effort to

reduce the waste and costs of staffing, the organization I work for brought in a company to look

at the staff productivity throughout the hospital. They have been observing and identifying areas

of improvement, areas that are staffed too heavily, areas that are understaffed, and areas that are

costing the facility large amounts of money to staff. They have given the hospital

recommendations as how to allocate the staffing differently in order to utilize productivity of the

staff without reducing the workforce. This will affect every department throughout the hospital,

moving staff to areas of need and away from areas lacking productivity. The utilization of staff,

as well as moving staff to different departments, is a very emotionally charged subject; one that

is a sound business proposal, however not anticipated to be a satisfier among staff.

Another area I have experienced with fiscal responsibility is the collaboration between

the purchasing department, the central supply department, and the operating room to reduce the

costs of supplies utilized in the operating room. With the assistance of our organizations national

supply chain, we were able to change our supplier for most of our disposable supplies with a

drastic cost savings. We have tediously researched high quality products that come from

different companies at lower costs. We have charged our staff to continue to work on reducing

wasted supplies, and encourage them to find less expensive alternatives to some of our higher


priced items. This will enable the staff to take ownership in the cost reduction process and help

the department to become fiscally responsible.

Retention and Succession Planning

Literature synthesis

With the shortage of nurses continuing to rise, we must take action to aid in nursing

retention through the reduction of burnout and workplace stressors. Leaders must protect the

assets we have from leaving our organizations due to preventable issues. Leaders and

organizations must be a part of the solution to retaining these valuable nurses through

eliminating potential obstacles.

Leaders can educate their staff on the success of working in interprofessional teams, and

the importance of developing team communication and collaboration to improve patient care and

aiding to the feeling that every team member matters no matter if you are a doctor or a nurse.

Nurses want to work in an environment where they feel appreciated and that their opinion

matters when it comes to the care of their patients. Team building can lead to better

communication and greater awareness of the contributions of each member of the team, all of

which are likely to improve interprofessional relationships, nurses’ work environment, and even

retention of the RN workforce. (Buerhaus, Donelan, Ulrich, Norman, DesRoches, & Dittus,

2007). This communication, collaboration, and comradery will facilitate nurses to stay where

they are working and to recruit other nurses to be a part of this teamwork environment.

When nursing shortages are present, corners are cut in the care provided, the quality of

the care provided to the patients decreases, and evidence-based practices are thrown to the

wayside in order to accomplish tasks in a timely manner. The utilization of quality improvements

can make nursing more enjoyable knowing that they are providing the best care possible for their


patients, and that care is constantly being improved to facilitate positive patient outcomes.

Quality improvement is another area where nurses feel empowered to make the appropriate

changes for the greater good of their patients; empowerment is a high factor in nurse retention.

Succession planning in leadership should be well thought out and initiated well before

leadership changes are made. There are many advantages to planning a succession in advance

that include improving employee morale by choosing a strong leader; motivates good

performance of the leadership change; offering new ideas and experience to the leadership team;

as well as providing continuity of leadership presence (Tepanier & Crenshaw, 2013, p. 982).

When you have leadership succession program that is constantly seeking to help younger leaders

advance their personal and professional goals by advancing their learning, you know you have an

exceptional leadership model to learn from. Leaders who coach and mentor those around them to

succeed are leaders who are building the future of their organization. Building a leadership team

of young managers all the way up to executive level management ensures growth, stability, and

sustainability for the future in leadership.

Application

Throughout my clinical experience, I have gone to a couple of meetings regarding

retention and nursing shortage. Our facility has planning sessions scheduled that include staff

representation from each unit as I discussed earlier in the paper. These planning sessions will

continue until a solid solution to retention is encompassed. The temporary solution for our

facility is to alleviate the stressors placed on our current staff due to the shortage by bring in

international nurses from the Philippines, as well as utilize travel nurses to fill in the gaps. This

temporary solution comes with an enormous expense to the hospital, however being able to

retain some of our current staff and provide the quality of care we believe in, this is a necessity.


Succession planning was one area I found difficult to observe. There is a director that is

retiring at the end of the year after working in our facility for over forty years. I was able to talk

to her about her retirement and if she had done any succession planning. She let me know that

she had been planning for over a year and working with administration on the best way to divide

up her responsibilities. She had hand-picked individuals that she recommended to administration

and with approval she began training them into her position. Her position was actually broken

down into two different positions once administration realized the complexity of the work she

had taken on over the years. She was able to completely train both of the individuals, delegate

tasks to clinical coordinators, and ease the discomfort levels of her staff with having someone

new replacing her. The transition will be completed at the end of this month, and she feels that

the transition will be with only minor obstacles due to her yearlong succession planning.

Quality


The importance of quality management and quality improvement is an essential part of

the healthcare industry. Providing quality care to patients remains a top priority of nursing and

leadership. Leaders can develop strategies that support nurses better in identifying and delivering

quality nursing care that reflects responsibility, caring, empathy, respect, and advocacy (Burhans

& Alligood, 2010, p. 1689). Leaders should want to build relationships that help people focus on

the future that is surrounded with new innovative ideas to improve the quality of care and move

the organization in the right direction.

There are many internal activities that a facility can utilize to improve the quality of the

care they provide. Many institutions have quality improvement teams, that meet to discuss ways

to improve the quality of the institution. These teams look at evidence-based practices to


implement the best practices with sound foundation that nurses can use to provide the highest

quality patient care possible. Evidence based practices “involve using the best evidence in

making patient care decisions and best evidence typically comes from research conducted by

nurses and other health care professionals” (Polit & Beck, 2017). The decision to utilize evidence

based practices will only produce higher quality care with higher patient outcomes.

The intended effect of evidence based practice is to standardize healthcare practices to

science and best evidence and to reduce illogical variation in care, which is known to produce

unpredictable health outcomes. Development of evidence-based practice is fueled by the

increasing public and professional demand for accountability in safety and quality improvement

in healthcare. (Institute of Medicine, 2011). It is up to us as nurses to take that knowledge and

research, and to implement the changes that are necessary based on the evidence to improve the

quality of care we provide. Research and evidence-based practices provide quality care that are

the future of healthcare; it is our responsibility to move forward with its implementation.

Application

During my clinical experience there was an implementation of a “huddle board”. The

purpose of this board is to discuss any quality, safety, or risk situations or topics to prevent any

reoccurrences. For the operating room specifically, we discuss patient safety concerns or

adverse events from the previous day and what changes we have made to prevent them; any

practice change alerts to improve the care we provide; any customer complaints or comments

and how to ensure those situations were handled properly; what we did to provide excellent

customer service, safety and quality focuses of the week, and customer service focuses of the

week. This has helped ensure transparency in the operating room and to make sure everyone is

well informed to situations that occurred on the unit and how to prevent or enhance them. The


implementation of the “huddle board” has been a wonderful quality improvement for the care we

provide and for staff involvements throughout the operating room.

Professional Membership and Professional Development


Professionalism is not just characterized in those with a specific professional degree; all

disciplines in an organization are designed to act professional together. Every discipline is

connected in a way that all actions and activities have some kind of impact on the entire

organization in one way or another. The changes that are made throughout a nursing facility

affect the future of the entire organization, that is why professionalism efforts are portrayed

throughout every discipline.

Professional development in the nursing industry involves a lifelong commitment to

education and to the profession. Professional development includes continuing education, skill

level improvement, promotion of quality care as a leader, becoming a living example of

upholding standards, commitment to excellence in the healthcare industry, and ownership in the

profession as a whole. Leadership much change and develop right along with new technology,

new products, and new techniques brought forth through evidence based practices.

Becoming involved in professional organizations is not only a necessity to be able to

professionally advance along with the industry; it is an obligation that needs to be continued to

promote the success of the nursing field. A professional organization is a group that has specific

goals, objectives, and functions that relate to the mission of a specific profession (Finkelman, A.

and Kenner. C. 2016). In the nursing profession, the professional organizations are designed by

nurses for the advocacy of nurses. Professional organization offer “advocacy motivated by moral

and ethical principles, seek to influence policies by pleading or arguing within political,


economic, and social systems and also institutions, for an idea or cause that can lead to decisions

in resource allocation that promote nurses, nursing, and all of healthcare” (Mathews, 2012).

Nursing leaders must continue to develop professionally, including holding professional

memberships, to be able to coach, inspire, and motivate others to advance their own personal and

professional development and to advance the profession of nursing.

Application

Recently in the operating room there have been many discussions about professional

membership and professional development. There are a few professional memberships that

directly relate to the operating room which naturally draw the attention of OR nurses due to the

continuing education this organization provides about the operating room. The nursing staff had

decided to go with the Association of periOperative Registered Nurses (AORN), also due to the

fact that operating room practices are directly influenced by the AORN recommended standards.

They began an AORN chapter at our hospital for anyone to join; the outcome of

participants was overwhelming and exciting. The first goal is to investigate ways to help improve

our professional development as operating room staff, and how to incorporate that development

into our everyday practices. This professional membership has sparked interest from our staff,

and from the staff of a local surgery center, to belong to a professional organization and to build

on our professional development. The importance of professional development and membership

in professional organizations help open doors to the possibilities of your leadership development.

Compendium Summary

Successful leadership can only be achieved through an individual leader’s choice to

constantly improve their own leadership skills. Knowledge that leadership involves innovative

ideas that affect the future of an organization; transparent communication with the involvement


of emotional intelligence; professional conflict resolution that can eventually be a part of daily

practices; involvement in policy making, policy changes, and advocacy for the patients, staff,

and healthcare in general; being involved in decision making, as well as involving the staff who

are affected by those decisions; promotion of a positive organizational climate and culture will

improve the work environment and care provided to the patients; acknowledging that a leader

who influences or inspires others over the use of power will gain respect and the participation

needed from staff; having a fiscally responsible attitude in all aspects of care; knowledge of the

need for retention and succession planning in order to facilitate a seamless workflow; welcoming

the focus of quality improvement in order to provide the best care possible; and to continue to

develop oneself through professional membership and professional development, are primary

examples of how a leader can focus on their personal growth, as well as a perfect example of

what being a leader is all about. A leader who continues to work hard at improving their

leadership skills, practice, and knowledge, while allowing their focus to include the many

different leadership topics discussed throughout this paper, can become inspirational to those in

which they lead. Remembering that as a leader you must lead by example; acting, behaving,

speaking, and thinking in the way that will inspire others to participate, act professionally,

collaborate, promote positivity, and most of all, want to work hard for an inspirational leader.

Leadership continues to grow, evolve, and strengthen through hard work, persistence, and

dedication. This dedication will enhance the future of leadership and ensure the success of an

organization.


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