Ethical Dilemma Faced by a Health Care Professional by Applying Ethical Principles

Ethical Dilemma Faced by a Health Care Professional by Applying Ethical Principles

Develop a solution to a specific ethical dilemma faced by a health care professional by applying ethical principles. Describe the issues and a possible solution in a 3-5 page paper.

Introduction

Whether you are a nurse, a public health professional, a health care administrator, or in another role in the health care field, you must base your decisions on a set of ethical principles and values. Your decisions must be fair, equitable, and defensible. Each discipline has established a professional code of ethics to guide ethical behavior. In this assessment, you will practice working through an ethical dilemma as described in a case study. Your practice will help you develop a method for formulating ethical decisions.

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Instructions

Note: The requirements outlined below correspond to the grading criteria in the scoring guide. At a minimum, be sure to address each point. In addition, you are encouraged to review the performance-level descriptions for each criterion to see how your work will be assessed.

For this assessment, develop a solution to a specific ethical dilemma faced by a health care professional. In your assessment:

  1. Access the Ethical Case Studiesmedia piece to review the case studies you will be using for this assessment.
    • Select the case most closely related to your area of interest and use it to complete the assessment.
    • CASE STUDY SELECTION: TO VACCINATE OR NOT?:

Jenna and Chris Smith are the proud parents of Ana, a 5–day–old baby girl born without complications at Community Hospital. Since delivery, the parents have bonded well with Ana and express their desire to raise her as naturally as possible. For the Smiths, this means breastfeeding exclusively for the first six months, making their own baby food using pureed organic foods, and not allowing Ana to be vaccinated. Ethical Dilemma Faced by a Health Care Professional by Applying Ethical Principles

The Smiths are college educated and explain they have researched vaccines and decided the potential harms caused by them far outweigh any benefits. They point to the rise in autism rates as proof of the unforeseen risk of vaccines. Their new pediatrician, Dr. Angela Kerr, listens intently to the Smiths’ description of their research, including online mommy–blogs that detail how vaccines may have caused autism in many children. The Smiths conclude by resolutely stating they’ve decided not to vaccinate Ana, despite the recommendations of the medical community.

Dr. Kerr begins by stating that while vaccines have certainly sparked controversy in recent years, she strongly recommends that Ana become fully vaccinated. Dr. Kerr explains that vaccines have saved the lives of millions of children worldwide and have been largely responsible for decreases in child mortality over the past century. For example, the decreased incidence of infection with the potentially fatal Haemophilus influenzae type b, has resulted from routine immunization against that bacterium. Similarly, epidemics such as the recent outbreak of measles are usually associated with individuals who have not been vaccinated against that pathogen.

Dr. Kerr goes on to endorse the general safety of vaccines by informing Ana’s parents that safety profiles of vaccines are updated regularly through data sources such as the federal government’s Vaccine Adverse Event Reporting System (VAERS). The VAERS, a nationwide vaccine safety surveillance program sponsored by the Food and Drug Administration and the Centers for Disease Control and Prevention, is accessible to the public at https://vaers.hhs.gov/index. This system allows transparency for vaccine safety by encouraging the public and healthcare providers to report adverse reactions to vaccines and enables the federal government to monitor their safety. No vaccine has been proven casual for autism spectrum disorder (ASD), or any developmental disorder. On the contrary, many studies have shown that vaccines containing thimerasol, an ingredient once thought to cause autism, do not increase the risk of ASD.

Finally, Dr. Kerr reminds the Smiths that some children in the general population have weakened immune systems because of genetic diseases or cancer treatment, for example. It may not be medically feasible to vaccinate such children. Other children are too young to receive certain immunizations. Instead, these children are protected because almost all other children (and adults) have been vaccinated and this decreases their exposure to vaccine–preventable illnesses (VPIs). This epidemiological concept is known as “herd immunity.” As more parents refuse immunization for their healthy children, however, the rate of VPIs will increase. This puts vulnerable children at significant risk of morbidity and mortality. Routine childhood immunization contributes significantly to the health of the general public, both by providing a direct benefit to those who are vaccinated and by protecting others via herd immunity. Dr. Kerr concludes by stating that after considering the risks versus the benefits of immunization, most states require vaccinations before children can attend school. Parents may decide not to vaccinate under specific circumstances, however, which vary by state. Ethical Dilemma Faced by a Health Care Professional by Applying Ethical Principles

Jenna and Chris Smith confirm their understanding of what Dr. Kerr has explained, but restate that they do not want Ana vaccinated at this time. Dr. Kerr is perplexed as to what to do.

 

  • Note: The case study may not supply all of the information you need. In such cases, you should consider a variety of possibilities and infer potential conclusions. However, please be sure to identify any assumptions or speculations you make.
  • Include the selected case study in your reference list, using proper APA style and format. Refer to the Evidence and APAsection of the Writing Center for guidance.
  1. Summarize the facts in a case study and use the three components of an ethical decision-making model to analyze an ethical problem or issue and the factors that contributed to it.
    • Identify which case study you selected and briefly summarize the facts surrounding it. Identify the problem or issue that presents an ethical dilemma or challenge and describe that dilemma or challenge.
    • Identify who is involved or affected by the ethical problem or issue.
    • Access the Ethical Decision-Making Modelmedia piece and use the three components of the ethical decision-making model (moral awareness, moral judgment, and ethical behavior) to analyze the ethical issues.
      • Apply the three components outlined in the Ethical Decision-Making Model media.
    • Analyze the factors that contributed to the ethical problem or issue identified in the case study.
      • Describe the factors that contributed to the problem or issue and explain how they contributed.
  1. Apply academic peer-reviewed journal articles relevant to an ethical problem or issue as evidence to support an analysis of the case.
    • In addition to the readings provided, use the library to locate at least one academic peer-reviewed journal article relevant to the problem or issue that you can use to support your analysis of the situation. The NHS-FPX4000: Developing a Health Care Perspective Library Guidewill help you locate appropriate references.
      • Cite and apply key principles from the journal article as evidence to support your critical thinking and analysis of the ethical problem or issue.
      • Review the Think Critically About Source Quality
        • Assess the credibility of the information source.
        • Assess the relevance of the information source.
  1. Discuss the effectiveness of the communication approaches present in a case study.
    • Describe how the health care professional in the case study communicated with others.
    • Assess instances where the professional communicated effectively or ineffectively.
    • Explain which communication approaches should be used and which ones should be avoided.
    • Describe the consequences of using effective and non-effective communication approaches.
  2. Discuss the effectiveness of the approach used by a professional to deal with problems or issues involving ethical practice in a case study. Ethical Dilemma Faced by a Health Care Professional by Applying Ethical Principles
    • Describe the actions taken in response to the ethical dilemma or issue presented in the case study.
    • Summarize how well the professional managed professional responsibilities and priorities to resolve the problem or issue in the case.
    • Discuss the key lessons this case provides for health care professionals.
  3. Apply ethical principles to a possible solution to an ethical problem or issue described in a case study.
    • Describe the proposed solution.
    • Discuss how the approach makes this professional more effective or less effective in building relationships across disciplines within his or her organization.
    • Discuss how likely it is the proposed solution will foster professional collaboration.
  4. Write clearly and logically, with correct use of spelling, grammar, punctuation, and mechanics.
    • Apply the principles of effective composition.
    • Determine the proper application of the rules of grammar and mechanics.
  5. Write using APA style for in-text citations, quotes, and references.
    • Determine the proper application of APA formatting requirements and scholarly writing standards.
    • Integrate information from outside sources into academic writing by appropriately quoting, paraphrasing, and summarizing, following APA style.

Example Assessment: You may use the following to give you an idea of what a Proficient or higher rating on the scoring guide would look like:

  • Assessment 3 Example [PDF].

Additional Requirements

Your assessment should also meet the following requirements:

  • Length: 3–5 typed, double-spaced pages, not including the title page and reference page.
  • Font and font size: Times New Roman, 12 point.
  • Written communication: Use correct spelling, grammar, and punctuation.
  • References: Integrate information from outside sources to include at least two references (the case study and an academic peer-reviewed journal article) and three in-text citations within the paper.
  • APA format: Follow current APA guidelines for in-text citation of outside sources in the body of your paper and also on the reference page. Ethical Dilemma Faced by a Health Care Professional by Applying Ethical Principles

 

Current Problem or Issue in Health Care Assignment

Current Problem or Issue in Health Care Assignment

Write a 4-6 page analysis of a current problem or issue in health care, including a proposed solution and possible ethical implications.

Introduction

In your health care career, you will be confronted with many problems that demand a solution. By using research skills, you can learn what others are doing and saying about similar problems. Then, you can analyze the problem and the people and systems it affects. You can also examine potential solutions and their ramifications. This assessment allows you to practice this approach with a real-world problem.

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Instructions

Note: The requirements outlined below correspond to the grading criteria in the scoring guide. At a minimum, be sure to address each point. In addition, you are encouraged to review the performance-level descriptions for each criterion to see how your work will be assessed. Current Problem or Issue in Health Care Assignment

  1. Describe the health care problem or issue you selected for use in Assessment 2 (from the Assessment Topic Areasmedia piece) and provide details about it. TOPIC: LIMITED ACESS TO HEALTHCARE
    • Explore your chosen topic. For this, you should use the first four steps of the Socratic Problem-Solving Approachto aid your critical thinking. This approach was introduced in Assessment 2.
    • Identify possible causes for the problem or issue.
  2. Use scholarly information to describe and explain the health care problem or issue and identify possible causes for it.
    • Identify at least three scholarly or academic peer-reviewed journal articles about the topic.
      • You may find the How Do I Find Peer-Reviewed Articles?library guide helpful in locating appropriate references.
      • You may use articles you found while working on Assessment 2 or you may search the library for other articles.
      • You may find the applicable Undergraduate Library Research Guide helpful in your search.
    • Review the Think Critically About Source Qualityto help you complete the following:
      • Assess the credibility of the information sources.
      • Assess the relevance of the information sources.
  1. Analyze the health care problem or issue.
    • Describe the setting or context for the problem or issue.
    • Describe why the problem or issue is important to you.
    • Identify groups of people affected by the problem or issue.
    • Provide examples that support your analysis of the problem or issue.
  2. Discuss potential solutions for the health care problem or issue.
    • Describe what would be required to implement a solution.
    • Describe potential consequences of ignoring the problem or issue.
    • Provide the pros and cons for one of the solutions you are proposing.
  3. Explain the ethical principles (Beneficence, Nonmaleficence, Autonomy, and Justice) if potential solution was implemented. Current Problem or Issue in Health Care Assignment
    • Describe what would be necessary to implement the proposed solution.
    • Explain the ethical principles that need to be considered (Beneficence, Nonmaleficence, Autonomy, and Justice) if the potential solution was implemented.
    • Provide examples from the literature to support the points you are making.

Example Assessment: You may use the following to give you an idea of what a Proficient or higher rating on the scoring guide would look like:

  • Assessment 4 Example [PDF].

Additional Requirements

Your assessment should also meet the following requirements:

  • Length: 4–6 typed, double-spaced pages, not including the title page and reference page.
  • Font and font size: Times New Roman, 12 point.
  • APA tutorial: Use the APA Style Paper Tutorial [DOCX] for guidance.
  • Written communication: Write clearly and logically, with correct use of spelling, grammar, punctuation, and mechanics.
  • Using outside sources: Integrate information from outside sources into academic writing by appropriately quoting, paraphrasing, and summarizing, following APA style.
  • References: Integrate information from outside sources to include at least three scholarly or academic peer-reviewed journal articles and three in-text citations within the paper.
  • APA format: Follow current APA guidelines for in-text citations of outside sources in the body of your paper and also on the reference page. Current Problem or Issue in Health Care Assignment

Organize your paper using the following structure and headings:

  • Title page. A separate page.
  • Introduction. A brief one-paragraph statement about the purpose of the paper.
  • Elements of the problem/issue. Identify the elements of the problem or issue or question.
  • Analysis. Analyze, define, and frame the problem or issue.
  • Considering options. Consider solutions, responses, or answers.
  • Solution. Choose a solution, response, or answer.
  • Ethical implications. Ethical implications of implementing the solution.
  • Implementation. Implementation of the potential solution.
  • Conclusion. One paragraph. Current Problem or Issue in Health Care Assignment

 

Nursing homework help

Assignment Requirements 

  1. Locate a lay press article from a national newspaper, for example, from The New York Times, The Washington Post, or other national publication. The article should be no more than three (3) years old.

Locate an article on one of the following topics:

  • Sex trafficking
  1. Environmental global health issue: For example, but not limited to: Safe water, sanitation, disasters, or oral health.
  2. Read over your chosen article and respond to the following:
  • Provide a summary of your article. Include the name of the newspaper and author, as well as date of publication.
  • Include data that supports the significance of the topic. For example, related deaths, health care costs, demographic information.
  • During NR503, we have discussed the determinants of health, at-risk groups, social justice theory, outcomes, inter-professional collaboration, advocacy, and other concepts related to epidemiology and population health. How do the concepts addressed in NR503 relate to your article’s topic? Provide definitions and examples in your writing. Nursing homework help
  • Integrate information from the World Health Organization and the SDG’s.

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  1. Your initial postshould be a minimum of two (2) paragraphs with 4-5 sentences per paragraph.
  2. Your initial postshould speak about your chosen article and use supporting scholarly evidence that supports your analysis. You may use your textbook to support your writing.
  3. Reply postsshould include a minimum of one scholarly reference and be a minimum of one (1) paragraph, 4-5 sentences. The reply post should build upon the post to which you are responding.
  4. A scholarly tone should be maintained throughout all posts. For reply posts, this includes the name of the person to whom you are responding as well as closure with your name.
  5. A link to the article should be included as well as a reference list using current APA.

Resources: (If links do not work, please search using related terms/names below).

U.S. Office on Trafficking in Persons: https://www.acf.hhs.gov/otipLinks to an external site.

Partners for Vulnerable Youth: Founded by National Association of Pediatric Nurse Practitioners: https://www.napnappartners.org/content/provider-educationLinks to an external site.

WHO and SDG: https://www.who.int/health-topics/sustainable-development-goals#tab=tab_1Links to an external site.

Kaiser Global Health Policy: https://www.kff.org/global-health-policy/Links to an external site.

CDC and Global Health: https://www.cdc.gov/globalhealth/index.htmlLinks to an external site.

List of Newspapers in the US: https://www.infoplease.com/culture-entertainment/journalism-literature/top-100-newspapers-united-states. Nursing homework help

 

Agenda Comparison Grid Assignment

Agenda Comparison Grid Assignment

To Prepare:

  • Review the agenda priorities of the current/sitting U.S. president and at least one previous presidential administration.
  • Select an issue related to healthcare that was addressed by two U.S. presidential administrations (current and previous).
  • Consider how you would communicate the importance of a healthcare issue to a legislator/policymaker or a member of their staff for inclusion on an agenda.
  • Use your Week 1 Discussion post to help with this assignment.

The Assignment: (1- to 2-page Comparison Grid, 1-Page Analysis, and 1-page narrative) with a title page. This is an APA paper. Use 2-3 course resources and at least 2 outside resources.

Part 1: Agenda Comparison Grid

Use the Agenda Comparison Grid Template found in the Learning Resources and complete the Part 1: Agenda Comparison Grid based on the current/sitting U.S. president and the previous president, and their agendas related to the population health concern you selected. Be sure to address the following:

  • Identify and provide a brief description of the population health concern you selected.
  • Explain how each of the presidential administrations approached the issue.
  • Identify the allocation of resources that the presidents dedicated to this issue. Agenda Comparison Grid Assignment

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Part 2: Agenda Comparison Grid Analysis

Using the information you recorded in Part 1: Agenda Comparison Grid on the template, complete the Part 2: Agenda Comparison Grid Analysis portion of the template, by addressing the following:

  • Which administrative agency (like HHS, CDC, FDA, OHSA) would most likely be responsible for helping you address the healthcare issue you selected and why is this agency the most helpful for the issue?
  • How do you think your selected healthcare issue might get on the presidential agenda? How does it stay there?
  • An entrepreneur/champion/sponsor helps to move the issue forward. Who would you choose to be the entrepreneur/champion/sponsor (this can be a celebrity, a legislator, an agency director, or others) of the healthcare issue you selected and why would this person be a good entrepreneur/ champion/sponsor? An example is Michael J. Fox is champion for Parkinson’s disease.

Part 3: Fact Sheet

Using the information recorded on the template in Parts 1 and 2, develop a 1-page fact sheet that you could use to communicate with a policymaker/legislator or a member of their staff for this healthcare issue. Be sure to address the following:

  • Summarize why this healthcare issue is important and should be included in the agenda for legislation.
  • Justify the role of the nurse in agenda setting for healthcare issues. Agenda Comparison Grid Assignment

 

The Connection Between Academic And Professional Integrity

The Connection Between Academic And Professional Integrity

Part 2, Section 1: Writing Sample: The Connection Between Academic and Professional Integrity

Using the Academic and Professional Success Development Template you began in Module 1, write a 2- to 3-paragraph analysis that includes the following:

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  • Explanation for the relationship between academic integrity and writing
  • Explanation for the relationship between professional practices and scholarly ethics
  • Cite at least two resources that support your arguments, being sure to use proper APA formatting.
  • Use Grammarly and Turnitin to improve the product.
  • Explain how Grammarly, Turnitin, and paraphrasing contributes to academic integrity.

 

Nursing homework help

Create a PowerPoint presentation that addresses each of the following points/questions. Be sure to completely answer all the questions for each bullet point. Use clear headings that allow your professor to know which bullet you are addressing on the slides in your presentation. Support your content with at least two (2) sources and the textbook using APA citations throughout your presentation. Make sure to cite the sources using the APA writing style for the presentation. Include a slide for your references at the end. Follow best practices for PowerPoint presentations related to text size, color, images, effects, wordiness, and multimedia enhancements. Review the Signature Assignment rubric criteria for this assignment.

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This week, you will develop a PowerPoint presentation reviewing the theories from each module. Please select one theory from each module (1-8) and answer the following questions. You should have 2 slides per theory with a total of 8 theories discussed.

  • Describe the theory
  • Provide 3 examples of how the theory applies to current practice
  • Provide 3 positive patient outcomes resulting from utilizing the theory
  • Explain 3 benefits to nursing satisfaction when utilizing the theory
  • Describe two barriers to using the theory in practice and at least one method for overcoming each barrier (support methods with sources)
  • Support from literature clearly noted throughout

Theories

Nightingale Theory

Dorothea Orem Theory

Dorothy Johnson Behavior Systems Model

Imogene King Theory of Goal Attainment

Callista Roy Adaptation Model

Jean Watson’s Theory of Human Caring

Rosemarie Parse’s theory on Human Becoming School of Thought

Choose 1 more current nursing theory for a total of 8 theories in the presentation. Nursing homework help

Health Assessment Wk 2 Discussion Post

Health Assessment Wk 2 Discussion Post

APA format with intext citation

3 scholarly references with in the last 5 years I have attached the chapter and reference from this book for you to utilized. Please use other scholar sources as well.

Plagiarism free with Turnitin report (I will be turning it in through Turnitin on.

300 minimum word count

Countless assessments can be conducted on patients, but they may not be useful. In order to ensure that health assessments result in the necessary care, health assessments should take into account the impact of factors such as cultures and developmental circumstances.

  • Analyze diversity considerations in health assessments
  • Apply concepts, theories, and principles related to examination techniques, functional assessments, and cultural and diversity awareness in health assessment  

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To prepare:

  • Reflect on your experiences as a nurse and on the information provided in this week’s Learning Resources on diversity issues in health assessments.
  • Reflect on the specific socioeconomic, spiritual, lifestyle, and other cultural factors related to the health of the patient assigned to you.
  • Consider how you would build a health history for the patient. What questions would you ask, and how would you frame them to be sensitive to the patient’s background, lifestyle, and culture? Develop five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.
  • Think about the challenges associated with communicating with patients from a variety of specific populations. What strategies can you as a nurse employ to be sensitive to different cultural factors while gathering the pertinent information?

 

CASE STUDY

Mono Nu, a 44 year-old Filipino patient comes to the clinic today to have his “blood thinner” labs drawn since he started them two weeks ago. Upon assessing the labs the nurse practitioner notes that he is still out of range. When assessing the patients compliance both stated that he had been taking them just as prescribed. He has been doing well and eating a diet rich in fish and tofu. He doesn’t understand why his medications are not working.

Post an example of the specific  socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you are assigned. explain the issues that you would need to be sensitive to when interacting with the patient and why, Provide at least five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks. Health Assessment Wk 2 Discussion Post

Module 10 Discussion – Influence Of Multidimensional Care Elements On Disorders

Module 10 Discussion – Influence Of Multidimensional Care Elements On Disorders

Directions:

Disorders of the endocrine system affect many individuals. Providing multidimensional patient care can be challenging for patients experiencing these disorders. Ensuring the plan of care meets the patient and family needs is important in order to increase adherence to proper medical treatment following discharge.

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What does it mean to provide a multidimensional approach? Provide at least three examples of how the care team can meet the patient and the family’s needs? List at least three care team members and how are they involved in providing multidimensional care?

Please make your initial post by midweek, and respond to at least one other student’s post by the end of the week. Please check the Course Calendar for specific due dates.

Roles and Responsibilities In Leadership And Management Assignment

Roles and Responsibilities In Leadership And Management Assignment

Topic 2: Roles and Responsibilities In Leadership And Management

Objectives:

  1. Explain the role of a nursing leader in quality patient care.
  2. Explain the role of a nurse manager in quality patient care.
  3. Discuss the importance of emotional intelligence in working with groups.
  4. Examine leadership styles conducive to addressing nursing issues.

 

Assignment 1

One of the five elements of emotional intelligence is self-awareness. Explain why emotional intelligence is crucial for effective leadership. Discuss what behaviors someone with a high degree of self-awareness would demonstrate within the context of leading and managing groups. Provide an example.

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Assignment 2

Discuss the purpose of strategic planning in a health care environment. Explain what factors affect future planning in an organization and what tools can be used for future planning. Roles and Responsibilities In Leadership And Management Assignment

Assignment 3

Select a topic for your Topic 3 Executive Summary assignment. Post your idea and basic thoughts about the topic using the assignment details from Topic 3.

  1. The purpose of the quality improvement initiative.
  1. The target population or audience.
  2. The benefits of the quality improvement initiative.
  3. The interprofessional collaboration that would be required to implement the quality improvement initiative.
  4. The cost or budget justification.
  5. The basis upon which the quality improvement initiative will be evaluated.

You should provide thoughts to your peers about their topics and ideas that may assist them in completing their projects.

 

 

 

Assignment 4

Benchmark – Effective Approaches in Leadership and Management

Assessment Description

In this assignment, you will be writing a 1,000-1,250 word paper describing the differing approaches of nursing leaders and managers to issues in practice. To complete this assignment, do the following:

  1. Select an issue from the following list: bullying, unit closures and restructuring, floating, nurse turnover, nurse staffing ratios, use of contract employees (i.e., registry and travel nurses), or magnet designation.
  2. Describe the selected issue. Discuss how it impacts quality of care and patient safety in the setting in which it occurs.
  3. Discuss how professional standards of practice should be demonstrated in this situation to help rectify the issue or maintain professional conduct.
  4. Explain the differing roles of nursing leaders and nursing managers in this instance and discuss the different approaches they take to address the selected issue and promote patient safety and quality care. Support your rationale by using the theories, principles, skills, and roles of the leader versus manager described in your readings.
  5. Discuss what additional aspects managers and leaders would need to initiate in order to ensure professionalism throughout diverse health care settings while addressing the selected issue.
  6. Describe a leadership style that would best address the chosen issue. Explain why this style could be successful in this setting.

Use at least three peer-reviewed journal articles other than those presented in your text or provided in the course.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.  Roles and Responsibilities In Leadership And Management Assignment

This benchmark assignment assesses the following programmatic competencies:

RN to BSN

1.1:       Exemplify professionalism in diverse health care settings.

1.3:       Exercise professional nursing leadership and management roles in the promotion of patient safety and quality care.

3.4:       Demonstrate professional standards of practice.

Rubric Criteria

Collapse All Rubric

Selected Issue, Setting, and Impact on Patient Safety

22.5 points

Criteria Description

Selected Issue, Setting, and Impact on Patient Safety

  1. Excellent

22.5 points

A clear description of the issue is presented. How the issue impacts quality of care and patient safety is detailed and accurate.

 

Professional Standards of Practice to Rectify Issue or Maintain Professional Conduct (B)

22.5 points

Criteria Description

Professional Standards of Practice to Rectify Issue or Maintain Professional Conduct (D3.4)

  1. Excellent

22.5 points

A through discussion of how professional standards of practice should be demonstrated in this situation to help rectify the issue or maintain professional conduct is presented. An understanding of the importance of professional standards of practice in resolving issues and maintaining professional conduct is demonstrated. Strong rationale supports discussion.

 

Differing Roles and Approaches of Nursing Leaders and Nursing Managers (B)

22.5 points

Criteria Description

Differing Roles and Approaches of Nursing Leaders and Nursing Managers (C1.3)

  1. Excellent

22.5 points

A detailed explanation of the differing roles and approaches for nursing leaders and nursing managers is presented. A well-developed explanation of how the roles and approaches relate to the selected issue, and how they would promote patient safety and quality care, is provided. Rationale using theories, principles, skills, and nursing manager or nursing leader roles is used. The explanation demonstrates insight into exercising the roles of professional nursing leadership and management in the promotion of patient safety and quality care. Roles and Responsibilities In Leadership And Management Assignment

 

 

 

Ensuring Professionalism Through Diverse Health Care Settings (B)

30 points

Criteria Description

Ensuring Professionalism Through Diverse Health Care Settings (C1.1)

  1. Excellent

30 points

A detailed discussion on what additional aspects managers and leaders would need to initiate to ensure professionalism throughout diverse health care settings while addressing the selected issue is presented. The aspects presented clearly continue to address the selected issue and relate to a diverse health care setting. The items proposed in the discussion support the exemplification of professionalism in diverse health care settings.

 

Leadership Style to Address Issue

22.5 points

Criteria Description

Leadership Style to Address Issue

  1. Excellent

22.5 points

The characteristics of the identified leadership style are clearly described. A detailed explanation of why this style could be successful in this setting is presented. Strong rationale is provided for support.

 

Thesis Development and Purpose

7.5 points

Criteria Description

Thesis Development and Purpose

  1. Excellent

7.5 points

Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.

 

Argument Logic and Construction

7.5 points

Criteria Description

Argument Logic and Construction

  1. Excellent

7.5 points

Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.

 

Mechanics of Writing (includes spelling, punctuation, grammar, language use)

7.5 points

Criteria Description

Mechanics of Writing (includes spelling, punctuation, grammar, language use)

  1. Excellent

7.5 points

Writer is clearly in command of standard, written, academic English.

 

Paper Format (use of appropriate style for the major and assignment)

3 points

Criteria Description

Paper Format (use of appropriate style for the major and assignment)

  1. Excellent

3 points

All format elements are correct.

 

Documentation of Sources

4.5 points

Criteria Description

Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)

  1. Excellent

4.5 points

Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.

Roles and Responsibilities in Leadership and ManagementBy Stacey Whitney

Essential Questions

  • What impact do effective decision-making skills have on the nurse leader?
  • How does self-awareness affect how nurses lead and manage effectively?
  • How do leaders and managers approach issues differently? How are they alike?
  • How does role stress negatively affect the nurse leader?
  • What are the necessary components of delegation?

Introduction

Nurses are considered leaders in the health care industry. Professional nurses naturally acquire leadership and management skills as they practice by providing safe, quality nursing care for their patients. Because nurses provide patient advocacy, follow evidence-based practices, and create necessary change in health care environments that affect quality care, nurse leadership is vital, especially as health care reform becomes increasingly focused on patient/client/consumer satisfaction. Roles and Responsibilities In Leadership And Management Assignment

The work that professional nurses provide by leading and managing in nursing has the potential to impact not only the nurses under their command, but ultimately every single patient who is cared for by their team of nurses. Theoretically speaking, every element has the potential to impact every other element. This fact should influence one’s willingness to lead and manage in a purposeful way. Consistent challenges exist for nurses who choose to lead or manage. In an effort to meet those challenges, the goal of this chapter is to provide a solid foundation of understanding of the role of nurse managers, professional leadership, emotional intelligence, inter/intraprofessional relationships and collaboration, and the process of working in teams.

While reviewing this chapter, consider the following:

  • How does the organizational structure of a hospital or agency affect the role of a nurse manager?
  • Are mentoring relationships really important?
  • What does shared governance mean?
  • How do nurse managers motivate nursing teams?

Nurse Managers: Organizational Role and Function

To understand their function within the current health care environment, nurse managers must first be aware of their role within an organizational structure. Health care organizations can be categorized by the types of services offered and by the length of time those services are provided. These varying health care organizations may function through institutional providers, such as acute care hospitals, long-term care facilities, and rehabilitation facilities. Facilities may provide different ranges of care for specific patient care populations or treat only certain diseases or conditions. Further, ownership of such health care organizations can be categorized as publicprivate nonprofit/not-for-profit, or for-profit.

Certain characteristics exist that define health care organizations and institutional providers. These characteristics include:

  1. Ownership – Public, private nonprofit or not-for-profit, and for-profit
  2. Accreditation Status – Joint Commission, Magnet
  3. Types of Services Offered – General or specialized care
  4. Length of Direct Care Services – Primary care, secondary care, or tertiary care.
    1. Primary care providers provide entry into the system through health maintenance, chronic care, and long-term care.
    2. Secondary care providers focus on prevention of disease complications and function as home health care, ambulatory care centers, and nursing centers.
    3. Tertiary care providers offer rehabilitation or long-term care in the form of home health care, long-term care facilities, rehabilitation centers, skilled nursing facilities, assisted living programs, or retirement centers.
  5. Teaching Status – Teaching hospitals typically provide exceptional care because of access to state-of-the-art equipment and researchers (Yoder-Wise, 2015).

Table 2.1

Examples of Direct Care Services

Primary Care Providers

(Entry into health care system)

Secondary Care Providers

(Prevention of disease complications)

Tertiary Care Providers

(Rehabilitation or long-term care)

Ambulatory Care Centers Home Health Care Home Health Care
Independent Providers Ambulatory Care Centers Skilled Nursing Facilities
Physician Offices Nursing Centers Assisted Living Centers
School Health Clinics Long-Term Care Facilities
Nursing Centers Retirement Centers

Nurses practicing in managerial positions should understand their organization’s functional organization structure. The structure can be presented in a diagram or chart that identifies the functions and main managerial positions within an organization. Nurse managers do not function solely at upper levels in health care organizations. Depending on the size and structure of the organization, management positions can be present at lower, middle, and upper levels. The flow of authority depends upon the organizational structure. Typically, lower level managers have lower levels of authority than middle or upper level managers. Middle level managers, for example, typically serve in the role of directors, heads of departments, or supervisors of units. Middle level managers are responsible for completion of day-to-day operations of units and departments and often coordinate the flow of information from upper to lower levels. Organizational charts can serve as visual aids that are helpful in understanding the flow of authority. Depending on the size of the organization, the charts can be complex and include varying levels of administration. Figure 2.1 is an example of an organizational chart that specifically outlines the nursing structure of a hospital. Roles and Responsibilities In Leadership And Management Assignment

Figure 2.1

Hospital Nursing Organizational Structure

Administrative and Managerial Responsibilities

Responsibilities of nurse managers may seem to solely revolve around managing staff shortages, increasing patient acuity, and increasing costs of care, but daily operations should not overshadow the need for influential leadership. Administrative and managerial responsibilities of the nurse manager of a department or unit can be complex and ever changing. The term management can be defined as the process, including social and technical functions and tasks, that occurs within an organization for the purpose of accomplishing predetermined goals (Longest, Rakich, & Darr, 2000). Managerial functions are generally the same regardless of organization size and structure, but the amount of time spent on each is related to the manager’s perceived importance of each task (Purnell, 1999). The main tasks of the nurse manager can be categorized into the following functions:

  1. Planning – This includes the task of prioritizing and knowing what needs to be accomplished within the organization. Setting goals to reach performance targets is an example of planning.
  2. Organizing – This function relates to the organizational structure as assignments are made by prioritizing tasks and analyzing activities, such as distribution of authority and assigning teams.
  3. Staffing – This function includes the hiring and retaining of quality staff, which is vital for ensuring positive patient outcomes.
  4. Directing – This function involves motivating and empowering the nursing team through effective leadership and can be accomplished by giving and receiving feedback to other team members, establishing and communicating goals and objectives, and developing people.
  5. Controlling – This is the task of supervising and monitoring staff members, including analyzing, appraising, and interpreting performance. Corrective action is sometimes necessary by enforcing accountability for individual actions.
  6. Decision Making – Effective decision making is based on organizational policies and procedures. Managers often provide recommendations to improve systems and processes. (Longest et al., 2000)

Effective communication between the nurse manager and team members is a key component of all these functions. Nurse retention, motivation, satisfaction, and engagement are positively affected by nurse managers who communicate in an effective and professional way (Saleh et al., 2018). Furthermore, the leadership style of nurse mangers has a direct correlation to nurse job satisfaction and retention (Asamani, Naab, & Ansah Ofei, 2016). There are many characteristics that comprise successful leaders (See Table 2.2). A study in 2011 included the act of humility on the list, finding that practicing humble leadership, by empowering others, was a strong predictor of organizational success (Grande, 2017). This can be done by sharing authority and responsibility, which makes others feel valued, thus more productive.

Leadership can be defined as the process of influencing people so that they willingly and enthusiastically strive to achieve the goals of the group (Weihrich & Koontz, 2005). Nurses at all levels, from bedside nurses to nurse managers and chief nursing officers, are leaders. In fact, the publication of the Institute of Medicine’s (IOM) report, The Future of Nursing: Leading Change, Advancing Health, produced a significant directive for nurse leaders: “Clinical nursing leadership, at the point of service now, is recognized as a central professional competency to ensure quality patient care and patient safety” (Grindel, 2016). As nurse managers recognize the need for clinical leadership at the bedside, or point of service, they should model effective leadership skills by intertwining them into day-to-day management practices. By demonstrating successful leadership, nurse managers can positively influence future nurse leaders (Arzouman, 2015).

Table 2.2

Effective Characteristics of Nurse Leaders and Managers

Trustworthy Able to identify needs of others
Uses critical-thinking skills Trusts personal intuition
Empathetic to others, sincere Self-motivating
Accepts responsibility willingly Timely follow-up of actions
Considers multiple options in decision making Sets boundaries
Good communicator Willing to counsel others
Motivates others Able to control own emotions
Skilled in dealing with difficult people Acknowledge others ideas and opinions
Good steward of resources Professional
Values people Invests in building up others

Strategic Planning

The health care environment is in constant change, faced with significant challenges, and in need of continuous process improvement. Nurses play a key role in developing and planning organizational goals for the future. Strategic planning is the process in which organizational leaders purposefully look ahead into the future, outline goals for the organization, and develop a process to reach those goals. Many are the plans in a person’s heart, but it is the Lord’s purpose that prevails. —Proverbs 19:21 (New International Version)Traditionally planning is based on an organization’s mission and vision, and change should be accomplished in an organized way. Strategic planning for health care has changed over time. Goals for the 1960–1980s included infrastructure and expanding facilities. The 1980s through 2010 mainly involved building physician staff. Due to managed care and the Patient Protection and Affordable Care Act of 2010, expanding services to larger populations was a priority, as organizations desired competitive costs. Currently the strategic planning trend is consumer-based, meaning that it is driven by the level of satisfaction of services provided (Healthcare Financial Management Association, 2017).

Strategic planning is what nurses do as they plan daily, weekly, monthly, annually—5 years, 10 years, 20 years in the future—and what strategies they need to use to achieve established goals. In other words, planning is always happening, and it is a good practice for a nurse manager to be organized, thoughtful, and purposeful. Applying strategic planning skills is the cornerstone of a leadership or management position and can be described as the conceptual framework of looking into the future and strategically planning the approach for what the future will look like in the short term and in the long term. It is important to understand the mission, vision, and trajectory of the organization involved and incorporate strategic planning in creating the goals that accompany that trajectory. Irrespective of the current organizational situation, strategizing how to achieve outcomes for identified goals and planning for the future should be considered priorities.

Many factors affect future planning of organizations, including budgeting, level of staff expertise, levels of care provided, and time. A SWOT analysis is an effective planning tool that can identify strengths, weaknesses, opportunities, and threats (SWOT) related to a project, institution, or organization (see Figure 2.2). Organizational strengths and weaknesses can be graphed against opportunities and threats. This subjective tool can prove useful in decision making, planning, and understanding the direction of an organization.

Figure 2.2

SWOT Analysis

Delegation

Delegation is the use of personnel to accomplish a desired task by allocation of responsibility and authority (Joseph, 2014). Increasing complexities of care and demands for health care services that exceed the capabilities of available licensed nurses creates the need for delegating nursing tasks to unlicensed assistive personnel (UAP) who act for the nurse and provide competent care. Delegation can occur within teams of colleagues at the same level or in situations in which there are subordinates or individuals in an assistive capacity. UAPs require delegation and supervision, but anyone can receive delegation. Delegation occurs when tasks are assigned to individuals, in general, irrespective of title or position. The most important aspect of delegation is determining whether delegating a task is appropriate and if the knowledge, skill, and ability of the individual aligns with the task to be delegated.

The registered nursing license is an agreement between the nurse and the governing bodies of the state of practice. The registered nurse agrees to practice competently within the guidelines of the Nurse Practice Act (NPA). Competency can be defined as an ongoing process that integrates knowledge, skills, and judgment to safely and ethically practice in a defined role (Currie, 2008, p. 86). Common concerns of delegation to UAPs by registered nurses include:

  • Is delegation legal in all states?
  • Do the organizational policies permit delegation?
  • What are the nurses’ responsibilities in delegation?
  • Is it appropriate to delegate nursing tasks to UAPs?
  • Is the nurse liable for the actions of UAPs when delegating?
  • What patient safety risks are associated with delegation?

Each question can be answered by examining the NPA that governs the nurse’s practice in the state of employment and the organizational policies. Health care organizations should develop delegation policies that are consistent with the state board guidelines. The definition of delegation in the NPA can vary from state to state. Key concepts that remain the same in most NPAs include:

  • The practice of nursing cannot be delegated, only nursing tasks that are within the scope of nursing practice.
  • Appropriate delegation is an individual decision that depends on the situation, patient status, and capability of the UAP. Tasks should not be routinely delegated.
  • Almost all NPAs include a section of what not to delegate, including any activity that requires professional nursing judgement and skill.
  • The nurse is ultimately responsible for the nursing care provided by the UAP (Johnson, 1996).

Laws in each state define the use of UAPs in performing nursing care. The American Nurses Association (ANA) and the National Council of State Boards of Nursing (NCSBN) have issued a joint statement asserting that “mastering the skill and art of delegation is a critical step on the pathway to nursing excellence” (ANA/NCSBN, n.d., p. 4), which also included a decision tree for delegation, accounting for assessment and planning, communication, surveillance and supervision, and evaluation and feedback.

Professional Relationships

Roles are behavior expectations of a person in a certain position. Nurses often wear many “hats” and function in society not only as health care professionals, but also in other roles such as spouses, parents, children, and friends. Multiple roles often lead to interrole conflict due to multiple demands. Maintaining professional boundaries when professional and societal roles intersect is an important aspect to consider. It is no surprise that nurses, as trusted health care professionals, often share close relationships with patients. Special care must be taken so that the nurse does not damage the therapeutic nurse-patient relationship. The nurse must adhere to professional boundaries (National Council of State Boards of Nursing [NCSBN], 2014).

Professional boundaries are defined by the NCSBN (2014) as “the spaces between the nurse’s power and the client’s vulnerability” (p. 4). Crossing these boundaries can occur when the needs of the nurse are mixed with the needs of the patient. The boundary lines can sometimes be blurred when either the patient or the nurse introduces inappropriate conversation or physical contact (Hanna & Suplee, 2012). The following should be considered as warning signs of inappropriate professional behavior:

  • Personal discussions regarding intimate issues with a patient,
  • Acknowledging a particular patient as a favorite,
  • Meeting with a patient in settings other than those used for direct patient care,
  • Behavior that could be considered flirting,
  • Speaking negatively about other staff members with patients or their families,
  • Keeping secrets for or with a patient,
  • Spending more time that usual with a patient, becoming overly involved,
  • Thinking that one is the only nurse who can care for the patient, and
  • Believing one is the only nurse who understands the patient.

Patients may also seek out personal information about a nurse or demonstrate inappropriate behavior. The nurse should consult a respected colleague or request assistance from a supervisor in this case (NCSBN, 2014).

The nurse-patient relationship is one of unequal power. The nurse demonstrates power in the relationship because of the nurse’s position in the health care system. The needs of the patient, including patient safety, must be a priority. The nurse must never use the nurse-patient relationship to meet personal needs. Civil actions, penalties, and criminal charges can be brought against the nurse who commits unthinkable acts with a patient, such as sexual misconduct, sexual harassment, or battery, to name a few. Charges could apply at the level of a felony or misdemeanor and could include jail time (Hanna & Suplee, 2012).

Technology is ever changing and so are the ways used to communicate with others. Social media has become one of the most common forms of communication in today’s society. Some social networks such as Facebook, Instagram, and LinkedIn can provide necessary ways for health care professionals to develop and maintain relationships with patients, but caution must be taken, as these platforms can easily be used to cross professional boundaries. Roles and Responsibilities In Leadership And Management Assignment

Consensus Building

Consensus building includes gathering opinions, listening, discussing ideas and differences, and coming to a mutual agreement. It does not include a majority or minority rule, a unanimous vote, or bargaining (“United States Office of Personnel Management,” n.d.). Conflict should be expected in the workplace and can be used as a tool for positive change. It is important to note that consensus building is a voluntary process in which participants seek a mutually accepted resolution of their differences (Bingham, 2011). Various methods, such as brainstorming, negotiation, and mediation, can be used to resolve conflict successfully.

Behavior in the workplace that is positive or negative should be considered as one component of a performance appraisal or evaluation. Professional performance appraisals are a common responsibility of nurse managers. Areas of growth, including areas in need of improvement or discipline should be included in appraisals. It is important that performance appraisals accurately depict individual work performance, as income and promotions are typically linked to them.

Collaboration and Shared Governance

Cooperatively working together toward a common goal can be termed the process of collaboration. Collaboration is needed in situations such as significant issues involving patient care, organizational decision-making processes, and times when professional relationships are in need of repair. When differing viewpoints cannot be merged together into one solution, it is important that individuals involved in the collaboration process put personal satisfaction and personal goals aside to determine the best possible solution. Collaboration can by key in negotiating differences, by providing health care professionals the opportunity to learn and grow through cooperative problem solving (Blair & Wood, 2014). The Canadian Nurses Organization recently acknowledged key points related to professional collaboration at its annual meeting. These key points include:

  1. Enhanced intraprofessional collaboration leads to safer patient care and supports nurses in focusing on patents rather than professional boundaries.
  2. Addressing professional boundaries, hierarchies, and silos will support nurses in providing patient-centered care.
  3. Entry-to-practice educational reform, ongoing education for nurses in practice, and strong leadership are needed to develop and support the attitudes and skills for successful intraprofessional collaboration.
  4. Effective intraprofessional relationships can strengthen the professional voice and image of nursing. (Lankshear & Limoges, 2018, p. 20)

Collaboration and shared governance should be used to determine the best ways to practice and produce positive patient outcomes. Shared governance has been proven to improve patient outcomes, patient satisfaction, nurse retention, and job satisfaction. It has been connected to nurse autonomy, empowerment, and improved decision making. In addition, the Magnet Recognition Program includes shared governance as a key component of its evidence-based management practices (Joseph & Bogue, 2016).

Shared governance is an “organizational innovation that legitimizes health care professionals’ decision-making control over their practice, while extending their influence to administrative areas previously controlled by managers” (Hess, 2011, p. 235). Shared governance, as a partnership between bedside nurses and nursing managers and leaders, empowers nurses by giving them a voice. Through shared governance coordinated councils, periodic meetings of staff and management provide a platform for open communication and transparency regarding decisions that need to be made in the organization.

Consider the following example of the shared governance process in a postoperative cardiac unit within a large urban hospital. Monthly meetings are voluntary for all staff members. The council consists of 10 representatives, including two nurse managers, four registered charge nurses, two unit nurse practitioners, and two clinical nurse educators. In order for the council to foster shared governance, an equal number of staff members are assigned to each representative. The representatives are expected to communicate with those staff members and seek feedback regarding agenda items and discussion topics, allowing each staff member to have the opportunity to voice an opinion to the council (Bieber & Joachim, 2016).

Bieber and Joachim (2016) offered a case study example regarding a situation in which a shared governance council addressed dissatisfaction of a unit’s self-scheduling guidelines. A group of RNs, including a leadership representative, formed a council to address the scheduling issues. The concerns were discussed and the current self-scheduling procedure was reviewed. A revised set of self-scheduling guidelines was then presented at the council meeting and sent to all RNs on the unit. For the final set of guidelines to be successful, the council held that it was essential that all RNs felt they had an equal role in the discussion of changes to the guidelines. Certain changes were controversial and needed further discussion. These changes were addressed one at a time at the council meetings. Through negotiation, a new set of guidelines were agreed upon and became the new self-scheduling guidelines. The study claimed that changing the scheduling process gave the RNs a voice and resulted in improved RN satisfaction (Beiber & Joachim, 2016, pp. 64-65). Roles and Responsibilities In Leadership And Management Assignment

Studies have shown that a connection between perceptions of shared governance and overall work engagement exists. It is the essence of nursing leadership and the key to empowering professional nurses to be an active part of the change process (Joseph & Bogue, 2016).

Change, Innovation, and Conflict Management

Continuous change in the health care field has become a constant for nurses and a constant for life in general. Change can be defined as the process of making something different. Most aspects of health care have experienced changes in some form, such as changes in patient acuity, computer software systems, skill mixes of medical providers, or changes in protocols, but the fundamental basics of providing nursing care have not changed.

At the national level, health care reform has fueled enormous change in the health care industry. The IOM has encouraged nurses to take a leading role in health care change by being active in the process rather than resisting it. The IOM report, The Future of Nursing: Leading Change, Advancing Health, details how nurses’ roles, responsibilities, and education should change to meet the needs of a complex and ever-changing health care system that provides care for an aging and increasingly diverse population (Institute of Medicine [IOM], 2010).

All registered nurses should be recognized as important change agents and innovators whose voices should be heard regarding topics such as improving health care services or health care cost containment. Nurses on the front lines of health care have valuable information regarding professional trends, such as predicting and preventing hospital readmissions or improving continuity of care and care coordination, and can act as agents of change within the process (Garon, 2016).

Change is rarely easy and is often complex and difficult. Barriers to change continue to exist. Nurse managers should have an understanding of nursing theory as they attempt to guide their teams through the process and navigate through the barriers. As one of the most commonly used theories related to nursing education and patient learning, the governing principle of change theory is the use of certain motivating factors that can provide empowerment and the desire to change. By setting goals and offering incentives, learning and change occur.

Differences in opinion regarding change can often cause conflict or disruption, which is common in work environments. Grohar-Murray and Langan (2011) identified the seven types of conflict that can occur in the workplace (see Table 2.3).

Table 2.3

Types of Conflict in Health Care Environments

Type of Conflict Characteristics/Examples of Conflict
Professional-Bureaucratic Conflict A nursing supervisor in middle management defending staff and patient care needs to organizational administrators who are decreasing nursing resources and funding.
Nurse-Nurse Conflict Two nurses disagree.
Nurse-Physician Conflict One side attempts to force values on another. An example of a nurse-physician conflict might be a disagreement regarding a patient’s plan of care.
Personal Competency-Gap Conflict A nurse that is unable to be objective and unbiased in situations that involve personal conflicts of interest.
Competing Role Conflict A nurse feels that his or her roles are in opposition. An example might be performing tasks that might be against the nurse’s religious beliefs.
Expressive-Instrumental Conflict The need to release emotional tension conflicts with the need to complete tasks.
Patient-Nurse Conflict A patient disagrees with restrictions placed on him or her, such as dietary or visiting hour restrictions.

Note. Adapted from Leadership and Management in Nursing (4th ed.), by M. E. Grohar-Murray & J. C. Langan, Boston, MA: Pearson, 2011, pp. 91-92.

Conflict that is managed poorly or avoided can create negative working environments that can have negative effects on patient quality of care and patient safety, create patient dissatisfaction, and increase health care costs (Kantek & Kavla, 2007). The good news is that positive work relationships and positive change can result from successful conflict management. In fact, when conflict is managed in a constructive way, the quality of patient care and patient safety are improved (Labrague & McEnroe-Petitte, 2017). Strategies for managing conflict include the five approaches of dominating, obliging, avoiding, compromising, and integrating, which are explained in the Table 2.4. Nursing leadership requires effective communication skills and productive conflict management. Professional opinions often vary and misunderstanding often occurs. Conflict cannot be avoided, but it can be resolved with effective leadership and management.

Table 2.4

Strategies for Managing Conflict

Strategy Characteristics/Examples
Dominating Used when quick action is needed, sometimes seen as aggressive use of power, or forcing a solution to the conflict.
Obliging Person or group gives up own needs for the needs of others, in an attempt to smooth the conflict or situation. This may reduce the emotional component of conflict.
Avoiding Postponing dealing with conflict due to emotional upset. Both sides are aware of a conflict but choose not to acknowledge it.
Compromising Preferred strategy in which both parties accept middle ground. Neither side gets what it wants, and the rewards are divided between both parties.
Integrating Integrating ideas or problem solving when goals of both sides have importance.

Note. Adapted from Managing Conflict in Organization, by M. A. Rahim, New Brunswick, NJ: Transaction Publishers, 2011.

Quality Improvement and Creating High-Performance Teams

Professional nurses aim to deliver high-quality patient care in a safe, effective way. They carry this responsibility first and foremost for the patient, but also for themselves and their respective organizations. Quality improvement (QI) is a process that involves continuous improvement of health care delivery. Every organizational department should be involved in the QI process, and ideally all departments should work together to identify appropriate aims for QI projects. As quality initiatives are decided upon, the next steps are to collect data, analyze the results, and implement change. The QI process is very similar to the nursing process, which includes assessment, diagnosis, planning, implementation, and evaluation (Barnhorst, Martinez, & Gershengorn, 2015).

Improvement in quality health care was fueled by the 2000 IOM report, To Err Is Human. This report encouraged evidence-based care by suggesting that medical errors were a leading cause of death in the United States. Based on this premise of 20 years ago, evidence-based care and QI have become popular terms in all health care settings (Kohn, Corrigan, & Donaldson, 2000). A few examples of QI projects lead by nurses that are known to improve patient outcomes include central-line associated bloodstream infections (CLABSIs) prevention protocols, ventilator-associated pneumonia prevention protocols, improving early mobility, decreasing average length of stay, and prevention of catheter-associated urinary tract infections (Barnhorst et al., 2015).

The opportunity to build and create effective teams exists in many areas of nursing. Creating high-performance teams in health care is a leadership challenge that can be difficult, but it is of the utmost importance, as ineffective teamwork can negatively affect patient care. Rarely do high-performance teams naturally occur; they must be created and managed by nurse leaders (Eggenberger, Sherman, & Keller, 2014). The IOM discussion paper, “Core Principles & Values of Effective Team-Based Health Care” (Mitchell et al., 2012), outlined five personal values that usually characterize members of effective teams: honesty, humility, curiosity, creativity, and discipline. The following characteristics exist in effective teams:

  • Cooperation amongst members,
  • Conflicts effectively managed,
  • Decisions made cooperatively,
  • Shared goals,
  • Members engaged in teamwork,
  • Clear communication,
  • Clear roles,
  • Mutual trust,
  • Cultural differences accepted, and
  • Measurable outcomes and processes (Eggenberger et al., 2014).

The nurse manager should recognize common obstacles that typically occur when working with teams, such as mistrust, communication breakdowns, and confrontation. Assessing the effectiveness of teams should be an ongoing process (Eggenberger et al., 2014).

Personal Leadership

While there are some people who are natural leaders, leadership skills can also be learned and put into action. Consider this description of leadership provided by John P. Kotter, PhD, the Konosuke Matsushita Professor Emeritus of Leadership at Harvard Business School:

Leadership in a modest sense—i.e., leadership with a lower-case (little) “l”—is far more prevalent and far more important than most people realize. . . . Not flashy or dramatic, it rarely attracts much attention, and often goes unnoticed. But it can be found in all leadership stories. A person steps into the situation, figures out which direction things need to move, communicates that successfully to a few other people whose help is needed, and then energizes him/herself and the others to make something happen under difficult conditions. (as cited in Escott-Stump, 2011, p. 1109)

Acts of leadership are not always recognized as notable acts by those in authoritative positions. All nurses have potential to make a difference in patients’ lives on a daily basis through various types of leadership opportunities that present themselves in everyday practice.

Successful leadership is important because it has been associated with staff nurse job satisfaction and retention, and independent, proactive leadership is desired by staff nurses. The values and behaviors of an organization begin with its leadership (Azaare & Grosse, 2011). Successful leaders can be relied upon for professional responsibility and accountability. A responsibility is an obligation to complete a duty, task, or assignment. Accountability is being morally responsible for nursing actions and professional conduct and accepting ownership of those actions. Successful leadership is closely related to self-awareness, or understanding one’s self by recognizing strengths and weaknesses, moral values, thought processes, character, emotions, motivations, desires, and goals. Having a good awareness of self allows leaders to have more control over interactions with others. It allows for greater control over time management as well, which is a key component of balancing work and personal/family life (Marquis & Huston, 2017). In fact, balancing stress, or stress management, along with time management, are two important strategies for self-management.

Keep in mind that leadership is not always tied to positions of authority. Good leaders produce quality care in many settings. Clinical nurse leaders, for example, are critical to the success of patient care. Professional leadership can simply be viewed as a relationship with others that requires a defined skill set. Kouzes and Posner (2017) have developed five practices and 10 commitments of exemplary leaders in any setting that, when applied, can enable the leader to motivate others, inspire change, and share in common organizational goals (see Table 2.5).

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Table 2.5

Five Practices of Exemplary Leaders

Five Practices Ten Commitments
Model the Way 1.      Clarify values by finding your voice and affirming shared ideals.

2.      Set the example by aligning actions with shared values.

Inspire a Shared Vision 3.      Envision the future by imagining exiting and ennobling possibilities.

4.      Enlist others in a common vision by appealing to shared aspirations.

Challenge the Process 5.      Search for opportunities by seizing the initiative and by looking outward for innovative ways to improve.

6.      Experiment and take risks by constantly generating small wins and learning from experiences.

Enable Others to Act 7.      Foster collaboration by building trust and facilitating relationships.

8.      Strengthen others by increasing self-determination and developing competence.

Encourage the Heart 9.      Recognize contributions by showing appreciation for individual excellence.

10.  Celebrate the values and victories by creating a spirit of community.

Note. Adapted from The Leadership Challenge (6th ed.), by J. M. Kouzes & B. Z. Posner, Hoboken, NJ: John Wiley & Sons, Inc. 2017.

Nursing role models, preceptors, or mentors assist nurses with transition into professional practice. Role models can be defined as competent experienced nurses who are effective in inspiring others. Their relationship with the nurse is passive in that the nurse does not actively seek out their information, but rather, models their behavior over time. Preceptors are experienced nurses who provide not only knowledge of the role, but also a short-term, one-on-one relationship with the nurse that typically offers emotional support. As they clarify role-expectations and promote organizational values, preceptors may receive incentive pay from the organization for participating in this role. Mentors use education in the form of teaching and modeling as a means to clarify the nurses’ professional role. Mentorship is an intentional, long-term relationship between the nurse, considered an expert in the field, and a novice nurse desiring expert status. The two professionals intentionally decide upon a mentoring relationship. The mentor may offer activities that facilitate growth for the novice nurse, including role modeling, listening, empathizing, and challenging activities outside of their comfort zone, which can provide opportunities for professional growth, set professional standards, and establish expectations for interpersonal communication. Mentors lead others by example and typically possess strong moral and ethical values (Jakubik, Eliades, Weese, & Huth, 2016; Marquis & Huston, 2017).

Madison (2014) reviewed mentoring relationships as a three-phase process:

  1. Finding and connecting with a more experienced person in the workplace.
  2. Teaching, modeling, and offering insider knowledge, which fosters a sense of competence and confidence.
  3. Sensing change and growth as the mentoring relationship moves to a conclusion (Madison, 2014, pp. 121-135).

Emotional Intelligence

To be successful in the workplace, the nurse leader or manager must be able to handle interpersonal conflicts in a therapeutic way. Emotional intelligence (EI) signifies the nurse’s ability to correctly acknowledge people’s emotions from their expressions, including body language, facial expressions, and spoken word. EI is the ability of self-perceptions of the person’s empathy, impulsivity, and assertiveness, as well as social and personal intelligence applied to respond to another person or situation in a therapeutic manner (Kemerer & Cwiekala-Lewis, 2016; Petrides & Furnham, 2001).

EI has been credited as being extremely important in developing leadership skills, communication skills, and other skills expected from nurses that are noncognitive. It is a trait that is linked to safer working practices (Parnell & Onge, 2015). Despite many organizational changes made by health care facilities to improve patient safety, errors still occur. The Joint Commission named the most frequent cause of such events as ineffective leadership and communications (“Sentinel Event Data,” 2013).

Goleman (1995) identified five characteristics of EI proven to be helpful for leaders, which include self-awareness, self-regulation, motivation, empathy, and social skills. Self-awareness, or emotional awareness, includes the ability to understand personal emotions and how they can affect others. Self-regulation is emotional control. It is the ability to think before acting and then redirect impulsive actions. Motivation is the desire to achieve goals. It is the ability to face obstacles with persistence. Empathy is an innate ability to sense and understand the emotions of others. It is the ability to anticipate and consider the needs of others in the decision-making process. Finally, social skills are the ability to manage relationships. Social skills allow individuals to listen and respond appropriately to others in an inspiring way (Goleman, 1995; Parnell & St. Onge, 2015, p. 89).

The effects of EI in the individual nurse leader or manager can be seen in the health care team as a whole. Collaboration, communication, and respect in the health care team are some of the positive effects of individual team member EI on the health care team as a whole (Holbery, 2015).

Interprofessional/Intraprofessional Relationships and Collaboration

The term interprofessional communication refers to communication between or amongst groups. Intraprofessional communication occurs on the inside or within an organization. For example, while many organizations have intranet communications that function privately for authorized users only, Internet communication can occur between any groups that are connected on the World Wide Web. Collaboration, by utilizing the skills of professionals, improves coordination of care, patient safety, and quality of care. Why is there a lack of collaboration in health care if it reaps so many benefits? Collaboration seems to be effective only if it begins early in the educational process.

In its 2011 report, the IOM recommended that nurses should be educated with doctors and other health professionals both as students and later. The concept of interprofessional collaboration is advanced further by the Patient Protection and Affordable Care Act (2010), which promotes better health care outcomes through coordinated care. Examples of coordinated care include patient-centered medical homes and accountable care organizations (IOM, 2011). Interprofessional collaboration occurs when health professionals work together to identify patient needs, solve problems, make decisions regarding patient care, and evaluate collectively. Patients and professionals benefit from this collaborative approach. Increasing costs of health care, including an aging population, and increasing demand for health care workers contribute to the need for quality services provided to patients. It is important to remember that the patient, as well as family members, should be involved in the decision-making process about the patient’s health. Interprofessional collaboration should be

a practice orientation, a way of health-care professionals working together with their patients. It involves the continuous interaction of two or more professionals . . . organized into a common effort, to solve or explore common issues with the best possible participation of the patient. (Herbert, 2005, as cited in McDonald & McCallin, 2010, p. 2.)

The term shared vision suggests that all members of a group have the same future goals for an organization. As nurse leaders and managers, it is imperative that the organizational purpose, or mission statement, is recognized and integrated into professional practice. The mission statement should serve as a decision-making tool or a template of purpose for the organizational leadership and guide all activities of the organization. It is the highest priority in meeting organizational goals and objectives. Mission statements are useful only if the organization uses them honorably for guidance (Marquis & Huston, 2017).

Figure 2.3

Sample Mission Statement

Core values can accompany mission statements to provide the fundamental beliefs of an organization. Core values are also the personal beliefs, priorities, and motivating forces that provide the framework for leadership and daily decision making. They are the basic elements of how nurses practice the profession, and are used every day in all actions and activities.

Just as core values of individuals and organizations can differ, so can the diversity of the workforce. The main area of diversity is language, which can include accents, alternative meanings of words, and dialects (Marquis & Huston, 2017). Cultural differences, such as religion, age, gender, ethnicity, and sexual orientation, create a diverse workforce. The nurse manager should be aware that problems may occur when cultural awareness and sensitivity are not practiced. Responses or actions that could be seen as discriminatory should be recognized and avoided. Managers have a legal responsibility as well. Discrimination is prohibited by Title VII of the Civil Rights Act of 1964.

Diversity in Nursing

“Each individual is unique and recognizes individual differences – race, ethnicity, gender, sexual orientation and gender identity, socio-economic status, age, physical abilities, religious beliefs, political beliefs, or other attributes. It encourages self-awareness and respect for all persons, embracing and celebrating the richness of each individual. It also encompasses organizational, institutional, and system-wide behaviors in nursing, nursing education, and health care.” (National League for Nursing, 2016, p. 2)

Nursing leaders should be comfortable working with a diverse workforce, without an attitude of only tolerance. Organizational employees should reflect the diversity of the community they serve by incorporating various genders, ages, and spoken languages. The importance of this cannot be overstated. Educating and hiring nurses who mirror the diversity already present in the American population is key for positive patient outcomes. (Elfman, 2018; Marquis & Huston, 2017).

When managing a diverse staff, considerations regarding group dynamics should be taken into account when assigning tasks. Group dynamics are the attitudes and behaviors that occur within a group. Nurse managers should be obligated to communicate with not only individual employees, but small and large groups as well. It is important for nurse managers to understand how groups typically perform to aid in communication among members of the group.

Merriam-Webster’s dictionary defines professionalism (2018) in practice as “the conduct, aims, or qualities that characterize or mark a profession or person.” A professional nurse should pay particular attention to promoting a professional image. Further, professional nurses should be aware of virtual first impressions, such as e-mail correspondence, social media remarks, and discussion forums. Correct formatting, grammar, spelling, and tone should always be practiced to ensure that the nurse projects a professional image (Bergren, 2005). Roles and Responsibilities In Leadership And Management Assignment

Professionalism should certainly be evidenced in the workplace. Demands placed on nurses and other professionals can cause very high stress levels, which in turn can increase incidents of incivility, or the lack of formal politeness and courtesy in speech or behavior. Civility, or politeness and courtesy, can be seen as general respect of the rights and feelings of others (Pinckney, 2015). According to Clark (2015), characteristics of a healthy workplace include “civil conversations at all organizational levels, shared organizational vision and values, leadership, both formal and informal, and civil conversations at all levels of the organization” (p. 19). The Code of Ethics for Nurses With Interpretative Statements, produced by the ANA, states that all nurses have an obligation to their clients and themselves to promote an ethical, safe, and civil environment (American Nurses Association, 2015).

Working in Teams

One task of the nurse manager or leader is the organization and structure of teams to accomplish patient care and organizational goals. The nurse manager is responsible for selecting, planning, and monitoring groups of nurses to deliver coordinated patient care. The teams are structured in various ways according to the organization, such as:

  • Team nursing includes a nurse leader who coordinates team members to care for groups of patients.
  • Primary care nursing involves one registered nurse responsible for 24-hour planning and coordination of care.
  • Modular nursing, or mini-teams, includes a registered nurse and unlicensed assistive personnel who provide care to a small group of patients.
  • Interprofessional teams working together to deliver coordinated patient care (Marquis & Huston, 2017).

Motivated employees typically have the desire to achieve goals despite obstacles that may occur. Motivating factors may vary, depending on personal preference, and can be short-term approaches to inspire and engage staff. These motivators should be consistent with the organization’s vision and mission. Nurse leaders and managers should strive for staff who are not only motivated, but are actively engaged in their health care roles. According to Clark (2018), employees desire work that matters to them, personally, organizationally, and societally. Nurse leaders and managers should use the following steps to increase engagement for a more committed and involved staff:

  1. Lead the team with optimism,
  2. Create a positive and healthy work environment,
  3. Be visible and available to the staff,
  4. Foster interpersonal and organizational trust,
  5. Cultivate relationships with others,
  6. Set clear goals and provide feedback,
  7. Provide meaningful work,
  8. Encourage autonomy and individual growth,
  9. Communicate and be transparent, and
  10. Use simple yet powerful strategies to keep employees engaged (Clark, 2018).

Effective communication is one of the fundamental elements of good nursing practice and should be prioritized as such when working with teams. Communication is the heart of holistic patient care that is absolutely essential in health care today. Communication is an ongoing process in which participants share information. Nurse managers should understand the difference between individual and group communication and recognize the process a group often goes through prior to meeting set goals or tasks. Communication in written and verbal forms is important at all stages of group work. The stages of newly formed groups, as identified by psychologist Bruce Tuckman (1965), include:

  1. Forming – Boundaries are being tested to determine acceptable behavior.
  2. Storming – Members break off into subgroups and resist requested demands.
  3. Norming – Conflict is resolved, consensus is met.
  4. Performing – Focus and energy are on task completion and performance.

Nonverbal communication (e.g., silence, appearance, eye contact, facial expression, and posture) is estimated to include approximately 70% of all communication (Cherry, 2016). This can be a significant barrier if the intended verbal message does not match the nonverbal communication received. Consideration and positive modeling of nonverbal communication should be an important consideration for the nurse leader and manager.

Planning, a critical part of teamwork, is an attempt to reduce the risk and uncertainty that may affect outcomes. Planning is necessary to answer questions of what, when, where, why, how, and by whom, and is important on both organizational and personal levels (Sullivan, 2012, p. 50). It includes unity of goals that are set for the organization and/or team, and can be used to direct team members toward set objectives (Marquis & Huston, 2017).

A team’s productivity relates to how well the team worked together by using available resources. When a team’s work has come to completion, the team may provide recommendations for the nurse leader or manager regarding the assigned task. These recommendations are reflective of the teams’ productivity.

Reflective Summary

Nurses provide quality patient care for patients that has a far-reaching impact. Effective nursing leadership and management skills are critical in keeping up with health care reform and changes in health care environments. Effective communication, decision making, self-awareness, and proper delegation of nursing tasks are a few required skills exceptional nursing leaders require. The baccalaureate-prepared nurse will provide the important leadership and management skills that today’s rapidly changing health care environment demands.

Key Terms

Accountability: Being morally responsible for actions and professional conduct and accepting ownership of those actions.

Change Theory: A theory that promotes change by using certain motivating factors that allow patients to feel empowered and have the desire to modify unhealthy habits. Roles and Responsibilities In Leadership And Management Assignment

Civility: Politeness and courtesy that shows a general respect of the rights and feelings of others.

Collaboration: Two or more people working together toward a common goal; in a health care setting, this work is meant to provide safe, quality care to patients in a nonthreatening environment.

Communication: Interpersonal sharing of information and/or feelings are exchanged in verbal and nonverbal methods.

Competency: An expected level of performance that integrates knowledge, skills, and abilities.

Consensus Building: Includes gathering opinions, listening, discussing ideas and differences, and coming to a mutual agreement. It does not include majority or minority rule, a unanimous vote, or bargaining.

Core Values: Fundamental beliefs.

Delegation: The use of personnel to accomplish a desired task by allocation of responsibility and authority under the guidelines set forth by regulating health care boards at the state and national level.

Emotional Intelligence (EI): The nurse’s ability to identify people’s emotions from their expressions, including body language, facial expressions, and spoken word.

Empathy: An innate ability to sense and understand the emotions of others.

For-Profit: Type of institutions that are proprietary or investor-owned. For-profit institutions provide services to generate income from patients who can afford to pay for services.

Functional Organization Structure: System represented in a diagram or chart that identifies the functions and main managerial positions of the identified organization, and those who are responsible for the defined functions.

Group Dynamics: The attitudes and behaviors that occur within a group.

Incivility: The lack of formal politeness and courtesy in speech or behavior.

Interprofessional Collaboration: Professionals working together to identify patient needs, solve problems, make decisions regarding patient care, and evaluate collectively.

Interprofessional Communication: Takes place when one person is communicating with another person in the same profession.

Intraprofessional Communication: Takes place when one profession is providing information to another profession.

Mentorship: An intentional, long-term relationship between a nurse, who is considered an expert in the field, and a novice nurse desiring expert status.

Mission Statement: Stated organizational purpose that is recognized and integrated into professional practice.

Motivation: The desire to achieve goals.

Organizational Structure: The manner in which organizations delegate decision-making power and management to help run the business on a day-to-day basis.

Preceptors: Experienced nurses who provide not only knowledge of the role, but also a short-term, one-on-one relationship with a nurse who typically offers emotional support.

Private Nonprofit/Not-for-Profit: Institutions controlled by voluntary boards or trustees who provide care to a mixture of patients whose ability to pay may include charity.

Professional Boundaries: Defined by the National Council of State Boards of Nursing (NCSBN) as “the spaces between the nurse’s power and the client’s vulnerability” (NCSBN, 2014, p. 4).

Professionalism: The competence, skills, and exhibited behavior of a set of trained workers (e.g., nurses, doctors, engineers).

Public: Type of institution that provides care under the direction and support of local, state, or federal government.

Quality Improvement: A systematic and formal approach to collecting, analyzing, and disseminating data in order to improve services or products that a business renders.

Responsibility: An obligation to complete a duty, task, or assignment.

Role Models: Competent, experienced nurses who are effective in inspiring others.

Self-Awareness: Understanding one’s self by recognizing strengths and weaknesses, moral values, thought processes, character, emotions, motivations, desires, and goals.

Self-Management: Balancing stress, or stress management, along with time management, are two important strategies.

Self-Regulation: Emotional control or the ability to think before acting and redirect actions.

Shared Governance: A partnership between bedside nurses and nursing managers and leaders that involves decision making and empowers nurses by giving them a voice.

Shared Vision: Suggests that all members of a group have the same future goals.

Social Skills: The ability to manage relationships and listen and respond appropriately to others in an inspiring way (Goleman, 1995).

Strategic Planning: The process in which organizational leaders purposefully look ahead into the future, outline goals for the organization, and develop a process to reach those goals.

References

American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Retrieved from https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses

American Nurses Association/National Council of State Boards of Nursing. (n.d.). Joint statement on delegation. Retrieved from https://www.ncsbn.org/Delegation_joint_statement_NCSBN-ANA.pdf

Arzouman, J. (2015). Leadership. Medsurg Nursing24(1), 5.

Asamani, J. A., Naab, F., & Ansah Ofei, A. M. (2016). Leadership styles in nursing management: Implications for staff outcomes. Journal of Health Sciences6(1), 23-36. doi:org/10.17532/jhsci.2016.266

Azaare, J., & Grosse, J. (2011). The nature of leadership style in nursing management. British Journal of Nursing. doi.org/10.12968/bjon.2011.20.11.672

Barnhorst, A. B., Martinez, M., & Gershengorn, H. B. (2015). Quality improvement strategies for critical care nursing. American Journal of Critical Care24(1), 87-92.

Bergren, M. D. (2005). Virtual first impressions. Journal of School Nursing21(2), 122-124.

Bieber, P., & Joachim, H. (2016). Shared governance: A success story. Nurse Leader14(1), 62-66.

Bingham, G. (2011, February). What is consensus-building and why is it important for resource management? Retrieved from www.resolv.org

Blair, W., & Wood, S. (2014). Reflecting on the process of developing a nursing framework through collaboration. International Practice Development Journal4. Retrieved from http://www.fons.org/library/journal.aspx

Cherry, K. (2016). Understanding body language and facial expressions. Retrieved from https://www.verywell.com/understanding-body-language-2795399#step7

Civil Rights Act of 1964, Pub. L. No. 88-352, 78 Stat. 241 (1964).

Clark, C. (2018). 10 tips to boost employee engagement. American Nurse Today13(1), 12-14.

Clark, C. M. (2015). Conversations to inspire and promote a more civil workplace: Let’s end the silence that surrounds incivility. American Nurse Today, 10(11), 18-22.

Currie, P. (2008). Delegation considerations for nursing practice. Critical Care Nurse28(5), 86-87.

Eggenberger, T., Sherman, R. O., & Keller, K. (2014). Creating high-performance interprofessional teams. American Nurse Today9(11). Retrieved from https://www.americannursetoday.com/creating-high-performance-interprofessional-teams/

Elfman, L. (2018, February 22). Meeting nursing demand through diversity. Diverse, 10-11. Retrieved from www.diverseeducation.com

Escott-Stump, S. A. (2011). Leadership with a little “L.” Journal of the American Dietetic Association, 111(8), 1109. doi.org/10.1016/j.jada.2011.06.020

Garon, M. (2016). Change and innovation. Retrieved from https://nursekey.com/change-and-innovation

Goleman, D. (1995). Emotional intelligence: Why it can matter more than IQ. New York, NY: Bantam Books.

Grande, D. (2017). The imperative of humble leadership. American Nurse Today13(3), 12.

Grindel, C. (2016). Clinical leadership: A call to action. MedSurg Nursing, 25(1), 9.

Grohar-Murray, M. E., & Langan, J. C. (2011). Leadership and management in nursing (4th ed.). Boston, MA: Pearson.

Hanna, A. F., & Suplee, P. D. (2012). Don’t cross the line. Respecting professional boundaries. Nursing 201242(9) 40-47. doi.org/10.1097/01.NURSE.0000418612.68723.54

Healthcare Financial Management Association. (2017). Retrieved from www.hfma.org/content.aspx

Herbert, C. (2005). Changing the culture: Interprofessional education for collaborative patient-centered practice in Canada. Journal of Interprofessional Care19(1), 1-4.

Hess, R. G. (2011). Slicing and dicing shared governance: In and around the numbers. Nursing Administrative Quarterly35(3), 235-241.

Holbery, N. (2015). Emotional intelligence—Essential for trauma nursing. International Emergency Nursing23(1), 13-16. doi.org/10.1016/j.ienj.2014.08.009

Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. Retrieved from http://books.nap.edu/openbook.php?record_id=12956

Jakubik, L. D., Eliades, A. B., Weese, M. M., & Huth, J. J. (2016). Mentoring practice and mentoring benefit 4: Supporting the transition and professional growth—An overview and application to practice using mentoring activities. Pediatric Nursing42(5), 252-253.

Johnson, S. H. (1996). Teaching nursing delegation: Analyzing nurse practice acts. Journal of Continuing Education in Nursing27(2), 52-58.

Joseph, H. B. (2014). Delegation in nursing management: common errors. Asian Journal Nursing Education and Research4(2), 242-244.

Joseph, M. L., & Bogue, R. J. (2016). A theory-based approach to nursing shared governance. Nursing Outlook64, 339-351. Retrieved from https://www.sciencedirect.com/science/article/pii/S0029655416000166

Kantek, F., & Kavla, I. (2007). Nurse-nurse manager conflict how do nurse managers manage it? Health Care Management26(2), 147-151. doi.org/10.1097/01.HCM.0000268618.33491.84

Kemerer, D., & Cwiekala-Lewis, K. (2016). Emotional intelligence for leaders in nursing. Polish Nursing, 4(62), 562-565. doi.org/10.20883/pielpol.2016.60

Kohn, L. T., Corrigan, J. M., & Donaldson, M. S. (2000). To err is human: Building a safer health system. Washington, DC: National Academies Press.

Kouzes, J. M., & Posner, B. Z. (2017). The leadership challenge (6th ed.). Hoboken, NJ: John Wiley & Sons, Inc.

Labrague, L. J., & McEnroe-Petitte, D. M. (2017). An integrative review on conflict management styles among nursing students: Implications for nurse education. Nurse Education Today59(59), 45-52.

Lankshear, S., & Limoges, J. (2018). Better together: A fresh look at collaboration within nursing. Canadian Nursing, 114(1), 18-20. Retrieved from www.canadian-nurse.com/en/articles/issues/2018/january-february-2018/better-together-a-fresh-look-at-collaboration-within-nursing

Longest, B. B., Rakich, J. S., & Darr, K. (2000). Managing health services organizations and systems. Baltimore, MD: Health Professions Press.

Madison, J. (2014). Professional issues in nursing: Challenges & opportunities (3rd ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing (9th ed.). Philadelphia, PA: Wolters Kluwer Health.

McDonald, C., & McCallin, A. (2010). Interprofessional collaboration in palliative nursing: What is the patient-family role? International Journal of Palliative Nursing16(6), 286-289.

Mitchell, P., Wynia, M., Golden, R., McNellis, B., Okun, S., Webb, C. E., … Von Kohorn, I. (2012). Core principles & values of effective team-based health care [Discussion paper]. Retrieved from http://nam.edu/perspectives-2012-core-principles-values-of-effective-team-based-health-care

National Council of State Boards of Nursing. (2014). A nurse’s guide to professional boundaries. Retrieved from https://www.ncsbn.org/ProfessionalBoundaries_Complete.pdf

National League of Nursing. (2016). Diversity in nursing: An NLN vision statement [News release]. Retrieved from http://www.nln.org/newsroom/news-releases/news-release/2016/02/16/diversity-in-nursing-an-nln-vision-statement.

Parnell, R. B., & St. Onge, J. L. (2015). Teaching safety in nursing practice: Is emotional intelligence a vital component? Teaching and Learning in Nursing10, 88-92. doi:org/10.1016/j.teln.2014.11.001

Patient Protection and Affordable Care Act, Pub. L. 111-148, 124 Stat. 119 (2010).

Petrides, K. V., & Furnham, A. (2001). Trait emotional intelligence: Psychometric investigation with reference to established trait taxonomies. European Journal of Personality15, 425-448.

Pinckney, M. Y. (2015). Increasing civility in the workplace [White paper]. Retrieved from http://hdl.handle.net/10755/560732

Professionalism. (2018.). In Merriam-Webster’s online dictionary. Retrieved from https:///www.merriam-webster.com/dictionary/professionalism

Purnell, L. D. (1999). Health care managers’ and administrators’ roles, functions, and responsibilities. Nursing Administration Quarterly23(3), 26-37.

Saleh, U., O’Connor, T., Al-Subhi, H., Alkattan, R., Al-Harbi, S., & Patton, D. (2018). The impact of nurse managers’ leadership styles on ward staff. British Journal of Nursing, 27(4), 197-203. doi:10.12968/bjon.2018.27.4.197

Sentinel event data root causes by event type 2004-2012. (2013). Retrieved from http://www.jointcommission.org/Sentinel_Event_Statistics/

Sullivan, E. (2012). Effective leadership and management in nursing (8th ed.). Upper Saddle River, NJ: Prentice Hall.

Tuckman, B. (1965). Forming storming norming performing model. Retrieved from http://www.businessballs.com/tuckmanformingstormingnormingperforming.htm#standard-copyright

United States Office of Personnel Management. (n.d.). Performance management: Teams. Retrieved from https://www.opm.gov/policy-data-oversight/performance-management/teams/effective-teams-strive-for-consensus/

Weihrich, H., & Koontz, H. (2005). Management: A global perspective (11 ed.). New York, NY: McGraw-Hill.

Yoder-Wise, P. (2015). Leading and managing in nursing (6th ed.). Retrieved from https://pageburstls.elsevier.com/#/books/9780323185776/

Class Resources

  1. The Impact of Nurse Manager’s Leadership Styles on Ward Staff

Read “The Impact of Nurse Manager’s Leadership Styles on Ward Staff,” by Saleh et al., from British Journal of Nursing (2018).

  1. Code of Ethics for Nurse With Interpretive Statements

Review “Code of Ethics for Nurse With Interpretive Statements,” by the American Nurses Association (ANA) (2015), located on the ANA website.

https://www.nursingworld.org/coe-view-only

 

  1. Nurse Manager Risk Information Management for Decision-Making: A Qualitative Analysis

Read “Nurse Manager Risk Information Management for Decision-Making: A Qualitative Analysis,” by Islam, Hutchinson, and Bucknall, from Collegian (2017).

 

  1. They Lived Experiences of Becoming First-Line Nurse Managers: A Phenomenological Study

Read “They Lived Experiences of Becoming First-Line Nurse Managers: A Phenomenological Study,” by Guanawan, Aungsuroch, Nazliansyah, and Sukarna, from Iranian Journal of Nursing and Midwifery Research (2018).

 

  1. Nurse Managers’ Insights Regarding Their Role Highlight the Need for Practice Changes

Read “Nurse Managers’ Insights Regarding Their Role Highlight the Need for Practice Changes,” by Moore, Sublett, and Leahy, from Applied Nursing Research (2016).

 

  1. Personality Characteristics of Nurse Managers: The Personal and Professional Factors that Affect Their Performance

Read “Personality Characteristics of Nurse Managers: The Personal and Professional Factors that Affect Their Performance,” by Handan and Uiku, from Journal of Psychiatric Nursing (2018).

 

  1. Understanding the Role of the Nurse Manager: The Full-Range Leadership Theory Perspective

Read “Understanding the Role of the Nurse Manager: The Full-Range Leadership Theory Perspective,” by Witges and Scanlan, from Nurse Leader (2014).

 

  1. Assessing the Nurse Manager’s Span of Control: A Partnership Between Executive Leadership, Nurse Scientists and Clinicians

Read “Assessing the Nurse Manager’s Span of Control: A Partnership Between Executive Leadership, Nurse Scientists and Clinicians,” by Cupit, Stout-Aguilar, Cannon and Norton, from Nurse Leader (2019).

 

  1. Growing Nurse Leaders: Their Perspectives on Nursing Leadership and Today’s Practice Environment

Read “Growing Nurse Leaders: Their Perspectives on Nursing Leadership and Today’s Practice Environment,” by Dyess, Sherman, Pratt, and Chiang-Hanisko, from Online Journal of Issues in Nursing (2016).

https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No1-Jan-2016/Articles-Previous-Topics/Growing-Nurse-Leaders.html. Roles and Responsibilities In Leadership And Management Assignment

Current Trends In Nursing Practice Assignment

Current Trends In Nursing Practice Assignment

Topic 2: Current Trends In Nursing Practice

 

Objectives:

  1. Describe the role of nursing in the reformation or restructuring of the health care delivery system.
  2. Predict how the nursing profession will grow or transform in response to emerging trends.

 

Assignment 1

Explain how interprofessional collaboration will help reduce errors, provide higher-quality care, and increase safety. Provide an example of a current or emerging trend that will require more, or change the nature of, interprofessional collaboration.

Assignment 2

Describe one innovative health care delivery model that incorporates an interdisciplinary care delivery team. Explain how this model is advantageous to patient outcomes. Current Trends In Nursing Practice Assignment

Assignment 3

 

Health Care Delivery Models and Nursing Practice

Examine changes introduced to reform or restructure the U.S. health care delivery system. In a 1,000-1,250 word paper, discuss action taken for reform and restructuring and the role of the nurse within this changing environment.

Include the following:

  1. Outline a current or emerging health care law or federal regulation introduced within the last 5 years to reform or restructure some aspect of the health care delivery system. Describe the effect of this on nursing practice and the nurse’s role and responsibility.
  2. Discuss how quality measures and pay for performance affect patient outcomes. Explain how these affect nursing practice and describe the expectations and responsibilities of the nursing role in these situations.
  3. Discuss professional nursing leadership and management roles that have arisen and how they are important in responding to emerging trends and in the promotion of patient safety and quality care in diverse health care settings.
  4. Research emerging trends. Predict two ways in which the practice of nursing and nursing roles will grow or transform within the next five years in response to upcoming trends or predicted issues in health care.

    ORDER NOW FOR CUSTOMIZED SOLUTION PAPERS

You are required to cite a minimum of three sources to complete this assignment. Sources must be published within the last 5 years, appropriate for the assignment criteria, and relevant to nursing practice.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

Rubric Criteria

Collapse All Rubric

Current or Emerging Health Care Law or Federal Regulation and Effect on Nursing Practice, Role and R

24.75 points

Criteria Description

An outline of emerging health care law or federal regulation and a description of the effect on nursing practice and the nurse role, and responsibility.

  1. Target

24.75 points

A clear and accurate outline of an emerging health care law or federal regulation and a clear and accurate description of the effect on nursing practice and the nurse role, and responsibility is present.

 

Quality Measures Pay for Performance, Patient Outcomes, and Effect on Nursing Practice

33 points

Criteria Description

A discussion on how quality measures and pay for performance affect patient outcomes, and how they affect nursing practice, expectations, and responsibilities of the nursing role.

  1. Target

33 points

A clear and accurate discussion on how quality measures and pay for performance affect patient outcomes, how they affect nursing practice, expectations, and responsibilities of the nursing role is presented. Current Trends In Nursing Practice Assignment

 

Professional Nursing Leadership and Management Roles

33 points

Criteria Description

A discussion of professional nursing leadership and management roles that have arisen and how they are important in responding to emerging trends and in the promotion of patient safety and quality care in diverse health care settings.

  1. Target

33 points

A clear and accurate discussion of professional nursing leadership and management roles that have arisen, how they are important in responding to emerging trends, and in the promotion of patient safety and quality care in diverse health care settings is present.

 

Predict Change in Nursing Roles and Nursing Practice

24.75 points

Criteria Description

Predictions for how the practice of nursing and nursing roles will grow or transform within the next 5 years in response to upcoming trends or predicted issues in health care.

  1. Target

24.75 points

Predictions for how the practice of nursing and nursing roles will grow or transform within the next 5 years in response to upcoming trends or predicted issues in health care are thoroughly and insightfully discussed.

 

Thesis, Position, or Purpose

11.55 points

Criteria Description

Communicates reason for writing and demonstrates awareness of audience.

  1. Target

11.55 points

The thesis, position, or purpose is clearly communicated throughout and clearly directed to a specific audience.

 

Development, Structure, and Conclusion

11.55 points

Criteria Description

Advances position or purpose throughout writing; conclusion aligns to and evolves from development.

  1. Target

11.55 points

The thesis, position, or purpose is logically advanced throughout. The progression of ideas is coherent and unified. A clear and logical conclusion aligns to the development of the purpose.

 

Evidence

9.9 points

Criteria Description

Selects and integrates evidence to support and advance position/purpose; considers other perspectives.

  1. Target

9.9 points

Specific and appropriate evidence is included. Relevant perspectives of others are clearly considered. Current Trends In Nursing Practice Assignment

 

Mechanics of Writing

9.9 points

Criteria Description

Includes spelling, capitalization, punctuation, grammar, language use, sentence structure, etc.

  1. Target

9.9 points

No mechanical errors are present. Appropriate language choice and sentence structure are used throughout.

 

Format/Documentation

6.6 points

Criteria Description

Uses appropriate style, such as APA, MLA, etc., for college, subject, and level; documents sources using citations, footnotes, references, bibliography, etc., appropriate to assignment and discipline.

  1. Target

6.6 points

No errors in formatting or documentation are present.

Current Trends in Nursing PracticeBy Pamela McNiff

Essential Questions

  • How do quality metrics in health care affect patient outcomes?
  • How do wellness initiatives and patient-centered care affect reimbursement rates?
  • How do federal regulations address the current opioid crisis and reimbursement rates?
  • How does federal funding through the Health Care and Education Reconciliation Act affect nursing education and trends related to employment?
  • Why are the American Nurses Association Political Action Committee initiatives important in nursing?

Introduction

In recent years, the cost of health care has become increasingly unsustainable. Cost and quality concerns, coupled with caring and paying for medical treatments, has created a need for change. This chapter will review the current health care laws and quality metrics that are driving this change. Additionally, health care professionals need to understand identified outcomes and values, as these metrics directly affect nursing and the trends related to employment and education. The Affordable Care Act (ACA) of 2010 addressed a push for quality and value that is now directly linked to providers’ and organizations’ pay and reimbursement. Federal regulations and the opioid crisis in the United States is also linked to pay for performance and current policies to address this issue. The Health Care and Reconciliation Act addresses the nursing shortage and ongoing education for all levels of nursing with the support of the American Nurses Association (ANA). Current nursing knowledge should include:

  • Pay for performance (P4P),
  • Quality metrics to improve processes of care,
  • Value and quality of outcomes directly,
  • Federal regulation for opioid use, and
  • Federal funding and support for nursing education.

This chapter will explore the need for nurses to understand current metrics, how they directly affect nursing, and the importance of higher education to produce optimal patient outcomes.

Health Care Laws

In order for health care in the United States to be sustainable and provide quality patient care, economic change must occur. Health care expenditures are rising—so much so that more resources per capita are devoted to health care in the United States than in any other nation (Salmond & Echevarria, 2017).

To address these costs, pay for performance (P4P) was developed, which rewards providers and organizations for delivering quality care with the goal of improving patient outcomes. This accountability process was established through the Centers for Medicare and Medicaid Services (CMS) as an incentive for improving patient care, lowering costs, and holding accountable those providers and organizations whose data does not show improvement. Quality metrics have been established in partnership with CMS and the Agency for Healthcare Research and Quality (AHRQ), a division of the U.S. Department of Health and Human Services (HHS), which publicly reports patient outcomes by way of the Hospital Consumer Assessment of Health Plan Survey (HCAHPS). Quality measures in acute care organizations include:

  • Client care experience (HCAHPS),
  • Delivery of care,
  • Efficiency of care, and
  • Client-specific outcomes (e.g. morbidity, mortality, rates of infection, falls).

According to Torgan (2013), P4P programs shift the focus from basic care delivery to high-quality care delivery. Examples of questions asked on HCAHPS include:

  1. Did the nurses communicate well?
  2. Were the nurses responsive?
  3. Did the nurses explain medications before dispensing them?
  4. Was the area around the room quiet at night?
  5. Did the doctors communicate well?
  6. Was pain controlled?
  7. Were the room and bathroom clean?
  8. Was information given about your recovery?

While HCAHPS are the focus for acute care organizations, quality metrics for the ambulatory care setting are determined by the Healthcare Effectiveness Data and Information Set (HEDIS). Created by the National Committee for Quality Assurance (NCQA), these metrics directly measure the clinical quality performance of health plans (Maurer, 2017). There are currently 94 measures across 7 domains of care (National Committee for Quality Assurance [NCQA], n.d.); therefore, it is essential that providers are familiar with how quality is being defined and measured in order to have full participation and achieve quality patient care.

Table 2.1 provides an example of 6 of the 94 current HEDIS measures from 2018, comparing the three main types of health plans: commercial or self-pay/employer insurance, Medicaid, and Medicare. Boxes marked with an “X” represent HEDIS measures that each health plan is required to follow. As depicted in the table, commercial health plans and Medicaid plans require every patient between the ages of 18–64 to be asked whether they have obtained a flu vaccination that year. Under the HEDIS Medicare guidelines listed, all but the flu vaccine must be included.

Table 2.1

Example of HEDIS 2018 Measures

HEDIS Measure 2018 Commercial Medicaid Medicare
Fall Risk Management X
Osteoporosis Testing in Older Women X
Physical Activity in Older Adults X
Medicare Outcomes Survey X
Flu Vaccination Ages 18-64 X X
Pneumococcal Vaccination Status for Older Adults X

The data obtained from these reports gives the consumer a comprehensive view of the performance of employers’ health plans and are designed as a report card for improving quality of care. In the ambulatory care setting, quality performance may be determined by any of the HEDIS measures; therefore, it is important that practitioners become familiar with how quality is being defined and measured.

As the federal government continues to change the way health care professionals are reimbursed, strategies to meet HEDIS measures have posed several challenges for providers. To improve patient outcomes, the model of population health, which analyzes data collected to improve both clinical and financial outcomes and manage patient care, must address behavioral determinates that are dependent upon the individual client, such as cigarette smoking, physical activity, and drug use. To achieve positive outcomes and improved health for individuals, collaboration is essential. According to Salmond & Echevarria (2017), with new reimbursement models, health care organizations will be incentivized to address health behaviors to improve patient outcomes and generate savings.

To support these models, many physician practices and hospital organizations are partnering and aligning operations to achieve these goals. While necessary to address rising health care costs, these payment models can become a financial hardship for some, making it crucial for health care professionals and organizations to collaborate.

The Affordable Care Act of 2010

The ACA, also known as Obamacare, was the product of two pieces of legislation: the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010. This legislation was developed, implemented, and signed into law by President Barack Obama on March 23, 2010 (Healthcare.gov, n.d.). The first section of the bill expanded Medicaid coverage and introduced comprehensive health plans with the expectation that the reforms would improve medical insurance coverage across populations. Insurance companies were then held accountable to provide services within the ACA Marketplace by offering more choices and options for obtainable, affordable medical insurance at lower costs. The second section of the bill was developed to fund the educational needs of health care.

The CMS also partnered with individual states to develop and identify priorities for eligibility within Medicaid and the Children Health Insurance Program (CHIP) to support low-income Americans with children. The intent of ACA and CMS was to fill the gaps left by private insurance plans and those uninsured or underinsured and in need of coverage because of low income. The ACA Marketplace is a means of coordination with insurance companies to provide low-cost insurance and determine eligibility for all types of insurance based on income. Tax credits are utilized to make insurance premiums through the ACA Marketplace affordable, and insurance companies are required to cover those individuals with preexisting conditions. Table 2.2 represents the major provisions of the ACA.

Table 2.2

Major Provisions of the Affordable Care Act

Provision Explanation
Preexisting Conditions This provision ensures that insurance cannot be denied based on preexisting conditions.
Young Adult Coverage Ensures that dependent children may remain on their parents’ health insurance plan until the age of 26.
Preventative Care Services Ensures that health care plans must fully cover preventative care such as screenings and immunizations.
Spending Limits Insurance companies cannot set a dollar amount on what they spend on benefits for the patient’s care during time of enrollment.
Menu Labeling Restaurants must list the calorie amount on their menus of each food item or meal.
Prevention and Public Health Funding will be allocated for public health and preventative care within communities.
Community Transformation Grants Funding will be awarded to a variety of state, local, and tribal agencies that contribute to building community and implementation of evidence-based health programs.

Note. Adapted from “The Affordable Care Act and Mental Health Services,” by C. A. Walker, 2014, Journal of Psychosocial Nursing and Mental Health Services, 52(9), 4.

While the ACA was designed to encourage better patient outcomes with lower associated costs and expanded access to care for more Americans, in some cases, the ACA has led to higher insurance premiums and fewer choices within the health care marketplace. In April of 2018, CMS issued a bulletin regarding benefit and payment parameters for 2019. According to CMS, “the final rule is intended to advance the Administration’s goals for increasing flexibility, improving affordability, strengthening program integrity, empowering consumers, promoting stability, and reducing unnecessary regulatory burdens associated with the Patient Protection and Affordable Care Act in the individual and small group health insurance markets” (Centers for Medicare and Medicaid [CMS], 2018b, para. 3). As key provisions have been modified to support affordability for the individual and family, individual states have been given more control over their insurance markets to promote and encourage participation within the ACA Marketplace.

Check for Understanding

  1. How does P4P improve patient outcomes?
  2. What is HEDIS, and what does it measure?
  3. What is HCAHPS, and what does it measure?
  4. Why has it been difficult to keep insurance companies involved with the ACA Marketplace?

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Federal Regulation of Opioid Use and the Opioid Crisis

Prior to the mid-1990s, pain control for individuals was often poorly managed. In response, advocates, such as the American Pain Society, proposed changes in pain-management practices. In 2001, The Joint Commission (formerly the Joint Commission on Accreditation of Healthcare Organizations), determined that pain is a subjective measure, and self-reporting of pain must be accepted by the medical establishment. Concurrently, pharmaceutical companies began to shape medical practice and public opinion by aggressively promoting and marketing opioids with unintended consequences.

According to the Centers for Disease Control and Prevention (CDC) (2016), since 2000, the rate of deaths from drug overdoses has increased by 137%, including a 200% increase in overdose deaths involving opioids. These increases included heroin, which is an illegally made opioid, and illicitly manufactured fentanyl, which is a synthetic opioid. In 2015 alone, 33,091 deaths in the United States were attributed to an overdose involving opioids (Laderman & Martin, 2017). Figure 2.1 provides estimates of overdose deaths involving opioids by type in the United States from 2000–2016. While different strategies are used to determine overdose deaths related to opioids, two interconnected trends have been identified: a 17-year increase in deaths from prescription opioid overdoses and a recent surge in illicit opioid overdoses driven by heroin and fentanyl (Centers for Disease Control and Prevention [CDC], 2017). Additionally, the CDC has noted that history of misuse of prescription opioids is the strongest risk factor for starting heroin use.

Figure 2.1

Overdose Deaths Involving Opioids

Note. Adapted from “Opioid Data Analysis and Resources,” by the Centers for Disease Control and Prevention, 2017.

The Comprehensive Addiction and Recovery Act (CARA) of 2016, became law on July 22, 2016. The legislation was established to give practitioners who dispense controlled substances the ability to dispense a narcotic drug in Schedule III, IV, or V for the purposes of maintenance and treatment or detoxification treatment (Department of Justice, 2018). Specific details regarding nurse practitioners (NPs) were also addressed in an expanded version of this bill as a means to support and treat those addicted to narcotics. Per the provisions within CARA, dispensation of narcotics for the use of detoxification cannot exceed 180 days to address the physical and psychological effects of withdrawal. The goal of these provisions is to gradually reduce the dosage of narcotics and ultimately have the individual achieve a drug-free state. Current Trends In Nursing Practice Assignment

In 2017, the HHS declared that the opioid crisis was a public health emergency and announced the following five-point strategy to combat the opioid crisis.

  1. Better addiction prevention, treatment, and recovery services through the support of grants and waivers to cover the cost of treatment for the individual to achieve long-term recovery
  2. Better data to improve and understand the crisis through public reporting with the focus on high-risk populations
  3. Better pain management from healthy, evidence-based methods of pain management
  4. Better targeting of overdose reversing drugs, which includes presidential budgetary support to achieve these goals
  5. Better research through a partnership with the HHS and the National Institute of Health (NIH) (Department of Health and Human Services [HHS], 2017)

The CDC has also provided recommendations for prescribing opioids for chronic pain that is not associated with palliative care, cancer, or end-of-life care. These guidelines have been put in place to help primary care providers navigate pain management options that are alternatives to opioids.

Reimbursement, Restrictions, and Monitoring Opioid Prescriptions

As federal and legislative regulations continue to address the opioid crisis, it is likely that providers and organizations that find alternative treatments and prescribe fewer opioids will receive higher reimbursement rates. Similar to HEDIS measures, insurance companies have and will be changing policies regarding what they will cover in terms of opioid medications and positive or negative patient outcomes. Prior authorizations, quantity limits, and drug utilization reviews are currently being used or implemented to determine the necessity of opioids and what alternative treatment methods have been used prior to prescribing opioids.

According to Wachino (2016), to optimize care while discouraging fraud, waste, and abuse of prescribed opioids, states are encouraged to consider implementing programs that provide ancillary care for beneficiaries diagnosed with chronic pain who have been found to be receiving unusually high doses of opioids, seeing multiple prescribers or pharmacies. The use and access of state prescription drug monitoring needs to be supported in order to identify inappropriate prescribing activity and those individuals who seek out opioid prescribers through various providers. Given the urgency of the opioid epidemic, CMS has finalized several new rules for 2019:

  • For opioid naïve patients, all initial opioid prescriptions will be limited to a 7-day supply.
  • CMS will continue to build and expand the Overutilization Monitoring System (OMS) to identify those beneficiaries considered to be at high risk for opioid addiction using real-time safety alerts at the time of dispensing and to address and support these individuals through case managers and prescribers (Centers for Medicare and Medicaid [CMS], 2018a).

With the CMS recognizing the need to address the opioid epidemic and implementing the necessary changes now, other health care insurance companies are likely to implement and adopt these strategies in order to address this issue.

Check for Understanding

  1. What was the catalyst for the opioid crisis?
  2. What is the underlying theme of the HHS five-point strategy for the opioid crisis?
  3. How do the opioid crisis and CMS rules affect those who prescribe opioids?

Nursing Shortage

The nursing shortage in America is cause for concern, especially given the increasing age of the baby boomer generation (Cox, Willis, & Coustasse, 2014). Statistics point to a 26% increase in the need for registered nurses (RNs) nationwide. As the current nursing workforce begins to reach retirement age, there is more cause for concern related to losing skilled leaders in the profession. A high rate of turnover associated with the nursing profession, attributed to factors such as job dissatisfaction and staffing concerns, is adding to the nursing shortage (Cox et al., 2014). In particular, novice nurses have reported particularly high levels of burnout and choose to leave the profession (Lin, Viscardi, & McHugh, 2014). Proposed solutions such as nurse residency programs and mandated safe staffing ratios are supported by the ANA. Nurse residency programs offer a designated amount of time in which a novice or new graduate nurse has additional education, mentor support, and additional resources to set them up for success when taking assignments on their own (Lin et al., 2014).

Additionally, the lack of sufficient nurse faculty to train new nurses has been cited as a factor contributing to the nursing shortage of nurses as well, with nearly 42,000 applicants to nursing schools being denied in 2006 (Cox et al., 2014). The HHS offers a nurse faculty loan program to address the dire need for nurses; however only a small number of nurses have been allocated these funds (Feldman, Greenberg, Jaffe-Ruiz, Kaufman, & Cignarale, 2015). Scholarship programs such as these, as well as mentoring programs to support nurse faculty, are necessary to increase recruitment and retention of full-time faculty to approve and properly train the host of students waiting to attend nursing school (Feldman et al., 2015).

Health Care and Education Reconciliation Act of 2010

As part of the ACA, provisions were enacted to ensure funding was available to those pursing health care degrees through federal funding, grants, loans, and employers obligation to support staff in continuing education through the Health Care and Education Reconciliation Act of 2010. With the current nursing shortage continuing to worsen as the baby boomer generation retires, it is imperative that nursing is supported across health care in order to enhance and support patients and programs. These provisions included:

  • Beginning July 1, 2010, all new federal student loans will originate through the Direct Loan program, instead of through the federally-guaranteed student loan program.
  • Includes $36 billion over ten years to increase the maximum Pell Grant to $5,550 in 2010 and to $5,975 by 2017.
  • Indexes the Pell Grant to the Consumer Price Index starting in 2013, to match the rising costs of college.
  • Addresses the FY 2011 shortfall in the Pell Grant program.
  • Expands the Income-Based Repayment program. Starting in 2014, the bill will cap new borrower’s loan payment at 10 percent of their net income, after adjustments for basic living costs, and would forgive any remaining debt after 20 years.
  • Invests $2.55 billion in Historically Black Colleges and Universities and Minority-Serving Institutions.
  • Includes $750 million for college access and completion support programs for students, including increased funding for the College Access Challenge Grant program, which funds programs at states and institutions aimed at increasing financial literacy and student retention. (Senate Democrats, n.d.)

Nursing Trends Related to Employment and Advanced Practice Nursing

Wellness and continuum of care models that have become the mainstay to keep individuals well will require more RNs with advanced nursing degrees to fill the gaps caused by the shortage of primary care physicians. To have affordable continuing educational opportunities, ongoing expansion of programs will be necessary to improve the nursing workforce. With funding support through the ACA, priorities and goals can be addressed through local and state organizations to increase the nursing workforce. In September 2010, the American Association of College of Nursing (AACN) announced the expansion of the nation’s centralized application service for RN programs, NursingCAS, to include graduate nursing programs to ensure that all vacant seats in nursing schools are filled to better meet the need for RNs, advanced practice nurses (APRNs), and nurse faculty (American Association of College of Nursing [AACN], 2017). In 2016, more than 38,800 vacant seats were identified in baccalaureate and graduate nursing programs. NursingCAS provides a way to fill these seats and maximize the educational capacity of nursing schools.

In 2008, the Institute of Medicine (IOM) and the Robert Wood Johnson Foundation (RWJF) led a 2-year initiative to address four key issues for the future of nursing:

  • The need for nurses to be able to practice to the full level of their education and training,
  • Achieve higher levels of education through a seamless academic progression,
  • Partner with physicians and other health care team members to redesign health care, and
  • Require better data collection in order to achieve an appropriate nursing workforce.

Additionally, the link between nurse education and patient outcomes was confirmed in 2011, when Aiken (2011) found that a 10% increase in the proportion of BSN-prepared nurses reduced the risk of death by 5% (Robert Wood Johnson Foundation [RWJF], 2014).

One of the main recommendations was to ensure that 80% of all RNs will have obtained a BSN by the year 2020 (National Academies of Science, Engineering, and Medicine [NASEM], 2018). Many organizations, especially those seeking Magnet status through The Joint Commission, are now demanding that 80% of the RNs they employ obtain their BSN. This has led universities and community colleges to work together to create programs that help RNs with associate degrees to acquire their BSN in a seamless, affordable manner.

As the restructuring of the health care system continues and more APRNs, such as family NPs, are needed, the scope of practice, need for autonomy, and fair reimbursement through Medicare and Medicaid must continue to expand. Variations from state to state with regard to the scope of practice for NPs must also be addressed so that restrictions do not impede the progression for APRNs to support models of health care delivery.

Leadership in Nursing

While the ACA has provisions to educate, train, and support APRNs, visionary leaders in nursing are needed to develop practice and institute policy. In order to cultivate and bring the future of nursing forward, it is paramount that the profession of nursing support current and future leaders throughout all areas of nursing. To build this future, nurses who wish to pursue an executive, academic, or NP role will need to earn at least a master’s degree in nursing; however, doctoral degrees are becoming more of a standard in these roles (Pullen, 2016). “And we know that in all things God works for the good of those who love him, how have been called according to his purpose.” —Romans 8:28Nurse leaders promote and facilitate direction and collaboration at both the formal and informal levels within the nursing industry, demonstrating vital attributes that propel nursing leadership within the community. The voice of leadership in nursing is a voice for all nurses.

Advocating for the profession of nursing at the leadership level requires that nurses in advance practice have presentation skills and the ability to convey messages that support nurses at all levels and in all fields of nursing. It is imperative that nurses take an active role in establishing positions at high levels within organizations. More nurses with Doctor of Nursing Practice (DNP) and Doctor of Philosophy (PhD) degrees can be found at the levels of nursing administration, deans of nursing, chief nursing officer, and chief executive officer. Having APRNs in these positions gives nursing a voice and enhances the nursing profession.

As leadership in nursing gives a larger voice within organizations, advocacy for changes in health policy are crucial. The ANA provides critical information and influence on policies at both the state and federal level. Figure 2.2 represents the educational nursing continuum from diploma certificate to PhD or DNP and the assumed positions at each level of nursing.

Figure 2.2

Pathway of Educational Progression

Note. Adapted from “Best Types of Nursing Degrees,” by A. M. Wilson, 2011, Nurse Journal website.

As a nurse leader, involvement at the local, state, and national level benefits all nurses. The nurse leader is the active voice of a person with a global perspective who has decision-making skills in complex environments to achieve desired results within the context of nursing and the organization as a whole. Advocating for nurses is advocating for all. According to the ANA Code of Ethics (American Nurses Association [ANA], n.d.b), advocacy is the act or process of pleading for, supporting, or recommending a cause or course of action. Advocacy may be for persons, whether as an individual, group, population, or society, or for an issue, such as potable water or global health. Nursing leaders are true advocates for the profession and the health care population as a whole. These top thinkers have the ability to identify and address issues and collaborate with others in order to make change. The highest level of change takes place through legislation supported by the ANA.

American Nurses Association Political Action Committee (ANA-PAC) Initiatives

The ANA’s influence on local, state, and federal policy cannot be overestimated. The ANA Political Action Committee (ANA-PAC) exists and is supported through voluntary contributions in which ANA staff, the ANA-PAC Board of Trustees, and the constituent/state nurses’ associations work to identify candidates to support for federal office, regardless of party affiliation (ANA, n.d.a). These contributions are used, with complete transparency, only to support and give a voice to the thousands of nurses at all educational levels and practice settings.

The ANA-PAC Board of Trustees lobbies at the local, state, and national level to support individuals who understand the principles and policies and will endorse those initiatives that are targeted as key legislative policies that impact the profession of nursing. Showing strength by influencing policy gives nurses a public voice, which brings change and puts a spotlight on the nursing profession. Each year the ANA-PAC committee aims to support candidates who support specific initiatives relevant to the future of nursing. Three of those initiatives include health care reform, safe staffing, and nursing workforce development.

Health Care Reform

  • Ensuring universal health care for all that provides comprehensive physical and mental health care
  • Supporting preventative care services through primary care entities
  • Support a partnership between the government and private sector to assist individuals who do not have the means to cover the cost of health care
  • Funding to ensure a skilled workforce in nursing

Safe Staffing

  • Continuing to enact safe staffing legislation through The Safe Staffing for Nurse and Patient Safety Act (S. 2446, H.R. 5052)
    • This bill considers the nurses’ educational background, experience, availability of personnel, geography, technology, and acuity of patients

Nursing Workforce Development

  • Supporting Title VIII Nursing Workforce Reauthorization Act (H.R. 959), which is a bipartisan bill aimed as supporting the ongoing educational needs of nurses through federal funding
  • Securing funding for nursing grants to support advanced nursing education, workforce diversity, practice and retention, National Nurse Service Corp, Nurse Faculty Loan Program, and comprehensive nurse geriatric education

The economic value of the ANA cannot be overstated. Every nurse needs a voice, and the ANA is crucial in delivering that voice at the legislative level. This voice is needed to create change and make a stand on public issues that affect the nursing profession on a daily basis. Only through working together will nurses achieve the strength and support needed to develop, empower, and change the face of nursing and health care today. Current Trends In Nursing Practice Assignment

Check for Understanding

  1. How does the Health Care and Education Reconciliation Act support the nursing shortage?
  2. What expansion through the AACN was put in place to support nursing programs for nursing education?
  3. Why is nursing advocacy important?
  4. What is the ANA-PAC, and what are the initiatives currently being targeted?

Reflective Summary

Health care is an ever-changing and complex part of the economy. As legislation changes and costs increase, the underlying need for safe and proficient nursing care remains imperative. The ACA created changes that directly impact the patient’s ability to attain care and receive valuable preventative treatments. The nursing profession faces many challenges in order to continue providing the highest level of care to their complex and growing patient population. Concerns, such as safe staffing, burnout, and a lack of nurse faculty, require careful and thorough contemplation in order to devise sustainable solutions that benefit nurses and the patient population.

Key Terms

ACA Marketplace: State website for subsidized health insurance under the Affordable Care Act.

American Nurses Association Political Action Committee (ANA-PAC): Provides funding to federal candidates in order to make positive changes in nursing without regard to party affiliation.

Affordable Care Act (ACA): Health care reform legislation with multiple provisions signed into law by U.S. President Barack Obama and became known as Obamacare; among the provisions include health insurance coverage to uninsured, measures to lower costs and improve health care system efficiency, preventative care, extension of care to dependents under the age of 26, and prohibited insurance claim denial or higher premiums for preexisting conditions.

Children Health Insurance Program (CHIP): Health insurance coverage for children of parents whose income is too high to qualify for Medicaid but too low to pay for private health insurance coverage.

Comprehensive Addiction and Recovery Act (CARA) of 2016: A law set in place on July 22, 2016 to address the opioid crisis in the United States.

Healthcare Effectiveness Data and Information Set (HEDIS): Measures a broad range of health issues; this data is collected to determine whether improved patient outcomes are being achieved; set forth through the National Committee for Quality Assurance (NCQA).

Healthcare and Education Reconciliation Act of 2010: Provisions enacted through the Affordable Care Act to ensure funding to those pursing health care degrees through federal grants, loans, and employers.

Hospital Consumer Assessment of Health Plan Survey (HCAHPS): Metrics that publicly report patient outcomes for specific quality metrics in acute care organizations; put in place by the National Committee for Quality Assurance (NCQA).

Pay for Performance (P4P): A payment model developed and established through the Centers for Medicare and Medicaid (CMS) as an incentive for improving patient care and lowering health care costs.

Population Health: Defined as the health outcomes of a group of individuals, including the distribution of such outcomes within the group.

References

American Association of College of Nursing. (2017). Fact sheet: Nursing shortage. Retrieved from http://www.aacnnursing.org/Portals/42/News/Factsheets/Nursing-Shortage-Factsheet-2017.pdf

American Nurses Association. (n.d.a). American Nurses Association: Political action committee. Retrieved from https://ana.aristotle.com/SitePages/pac.aspx

American Nurses Association. (n.d.b). Year of advocacy. Retrieved from https://ana.aristotle.com/SitePages/YearOfAdvocacy.aspx

Centers for Disease Control and Prevention. (2016). Increases in drug and opioid overdose deaths — United States, 2004-2014. Retrieved from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6450a3.htm

Centers for Disease Control and Prevention. (2017). Opioid data analysis and resources. Retrieved from https://www.cdc.gov/drugoverdose/data/analysis.html

Centers for Medicare and Medicaid. (2018a). 2019 Medicare advantage and part d rate announcement and call letter. Retrieved from https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2018-Fact-sheets-items/2018-04-02-2.html

Centers for Medicare and Medicaid. (2018b). HHS notice of benefit and payment parameters for 2019. Retrieved from https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2018-Fact-sheets-items/2018-04-09.html

Cox, P., Willis, K., & Coustasse, A. (2014). The American epidemic: The U.S. nursing shortage and turnover problem. Retrieved from: https://mds.marshall.edu/cgi/viewcontent.cgi?referer=http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=2ahUKEwj2ysub_9vdAhU0HDQIHZz5CvQQFjAAegQICBAC&url=http%3A%2F%2Fmds.marshall.edu%2Fcgi%2Fviewcontent.cgi%3Farticle%3D1125%26context%3Dmgmt_faculty&usg=AOvVaw2XD9drwnos58RVyQkkrn9A&httpsredir=1&article=1125&context=mgmt_faculty

Department of Health and Human Services. (2017). 5-point strategy to combat the opioid crisis. Retrieved from https://www.hhs.gov/opioids/about-the-epidemic/hhs-response/index.html

Department of Justice. (2018). Rules – 2018. Retrieved from https://www.deadiversion.usdoj.gov/fed_regs/rules/2018/fr0123_2.htm

Feldman, H., Greenberg, M., Jaffe-Ruiz, M., Kaufman, R., & Cignarale, S. (2015). Hitting the nursing faculty shortage head on: Strategies to recruit, retain, and develop nursing faculty. Journal of Professional Nursing, 31(3), 170-178. doi: 10.1016/j.profnurs.2015.01.007

Healthcare.gov. (n.d.). Read the affordable care act. Retrieved from https://www.healthcare.gov/where-can-i-read-the-affordable-care-act/

Laderman, M., & Martin, L. (2017). Health care providers must act now to address the prescription opioid crisis. Retrieved from https://catalyst.nejm.org/act-now-prescription-opioid-crisis/

Lin, P. S., Viscardi, M. K., & McHugh, M. D. (2014). Factors influencing job satisfaction of new graduate nurses participating in nurse residency programs: A systematic review. Journal of Continuing Education in Nursing45(10), 439–452. doi: 10.3928/00220124-20140925-15

Maurer, J. (2017). What is HEDIS and what does it mean to you? Retrieved from http://magellanhealthinsights.com/2017/03/15/what-is-hedis-and-what-does-it-mean-to-you/

National Academies of Science, Engineering, and Medicine. (2018). Robert Wood Johnson Foundation and the AARP partner to establish the future of nursing: campaign for action. Retrieved from http://www.nationalacademies.org/hmd/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health/Action-Taken.aspx

National Committee for Quality Assurance. (n.d.). HEDIS and performance measurement. Retrieved from https://www.ncqa.org/hedis/

Pullen, R. (2016). Leadership in nursing practice. Nursing Made Incredibly Easy!, 14(3), 26-31. doi: 10.1097/01.NME.0000481442.05288.05

Robert Wood Johnson Foundation. (2014). Building the case for more highly educated nurses. Retrieved from https://www.rwjf.org/en/library/articles-and-news/2014/04/building-the-case-for-more-highly-educated-nurses.html

Salmond, S. W., & Echevarria, M. (2017). Healthcare transformation and changing roles for nursing. Orthopedic Nursing, 36(1), 12-25. doi: 10.1097/NOR.0000000000000308

Senate Democrats. (n.d.) The health care and education reconciliation act. Retrieved from https://www.dpc.senate.gov/healthreformbill/healthbill61.pdf

Torgan, C. (2013). Patient outcomes improved by pay for performance. Retrieved from https://www.nih.gov/news-events/nih-research-matters/patient-outcomes-improved-pay-performance

Wachino, V. (2016). CMCS informational bulletin: Best practices for addressing prescription opioid overdoses, misuse and addiction. Retrieved from https://www.medicaid.gov/federal-policy-guidance/downloads/CIB-02-02-16.pdf

Class Resources

  1. Overview and Summary: Healthcare Reform: Nurses Impact Policy

Read “Overview and Summary: Healthcare Reform: Nurses Impact Policy,” by Matthews, from The Online Journal of Issues in Nursing (2017).

https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-22-2017/No2-May-2017/OS-Healthcare-Reform.html

 

  1. Summary of the Affordable Care Act (ACA)

Read “Summary of the Affordable Care Act,” by the Henry J. Kaiser Family Foundation (2017), located at the HealthCare.gov website

https://files.kff.org/attachment/Summary-of-the-Affordable-Care-Act

 

  1. What Is Pay for Performance in Healthcare?

Read “What Is Pay for Performance in Healthcare?” located on the NEJM Catalyst website.

https://catalyst.nejm.org/doi/full/10.1056/CAT.18.0245

  1. Promoting Prevention Under the Affordable Care Act

Read “Promoting Prevention Under the Affordable Care Act,” by Chait and Glied, from Annual Review of Public Health (2018

https://www.annualreviews.org/doi/full/10.1146/annurev-publhealth-040617-013534

 

  1. Implementation of the Provision of the Comprehensive Addiction and Recovery Act of 2016 Relating to the Dispensing of Narcotic Drugs for Opioid Use Disorder

Read “Implementation of the Provision of the Comprehensive Addiction and Recovery Act of 2016 Relating to the Dispensing of Narcotic

… Read More

 

  1. What Is the U.S. Opioid Epidemic?

Read “What Is the U.S. Opioid Epidemic?” located on the U.S. Department of Health and Human Services website.

https://www.hhs.gov/opioids/about-the-epidemic/. Current Trends In Nursing Practice Assignment