Nurse Administrator Practicum

NURSE ADMINISTRATOR PRACTICUM1

Nurse Administrator Practicum

Lori A. Majeske

Ferris State

NURSE ADMINISTRATOR PRACTICUM1

Abstract

The role of nurse administrator is complex. Learning to employ many techniques to engage and encourage team members is essential. Using the ANA Nursing Scope and Standards of Practice for Nurse Administrators and AORN Standards and Recommended Practices for Inpatient and Ambulatory Settings, along with theory and evidence-based research; an exploration of the concept of nurse administrator as a leader, mentor, coach and communicator is discussed. A project exploring a surgical fire with evacuation will be described. Strategies to address issues and concerns are developed. Analysis of the information is included to determine goals and objectives criteria.

Keywords: transformational leader, engagement, emergency preparedness and communication

NURSE ADMINISTRATOR PRACTICUM1

Nurse Administrator Practicum

The nurse administrator may work in a variety of settings. The role of an administrator uses leadership skills and multiple resources to guide personnel. The use of the American Nurses Association (ANA) Scope and Standards of Practice for Nursing Administration provides statements to guide this role (American Nurses Association [ANA], 2010). Nurse administrators must use creativity and innovation to engage personnel. Combining these skills with business acumen and an understanding of regulatory guidelines will assist the nurse administrator to provide leadership in any setting.The nurse administrator faces many challenges in this role. The continuing development of evidence-based practice, changing regulations as well as the current economic situations faced, need to be monitored and analyzed for appropriate actions.

This paper will explore the issues, challenges and concerns faced in one setting while analyzing the strategies used to address these concerns. Theory, research and an application of knowledge will demonstrate the ability to adapt to the changing environment of a nurse administrator. A clinical project describes the need for continuing education and communication with multiple resources within the hospital and the community. The practicum is evaluated by both the preceptor and student according the goals and objectives proposed.

Practicum

The role of nurse administrator may be developed in a variety of settings and encompasses many levels of leadership. These may range from leading a small team within a small hospital setting to senior leadership roles including Chief Nursing Officer. In order to understand the scope of this role, the nurse administrator can use the Nursing Administration Scope and Standards of Practice to provide structure to the role. This will assist in the advocacy for nursing while creating an atmosphere of understanding to provide quality services using evidence to guide practice(American Nurses Association, 2010). Using transformational leadership to implement an organizational structure will be required to sustain healthy outcomes in a pay for performance (PFP) environment (Everett & Sitterding, 2011). This environment may include multi-disciplinary teams caring for patients with much higher levels of acuity in a shorter period of time. In order to sustain healthy outcomes, leaders must provide a vision using innovation and communication. This is not a new idea, but should be considered when developing long-term plans. Accountability of members will be critical to support change initiatives (Aroh, Occhiuzzo, & Douglas, 2011). As I explored my role as a nurse administrator student, I found communication to be one of the greatest challenges. Determining the most effective method of communication was the most critical element. The dynamic structure of the environment produces challenges to ensure members understand what changes are taking place and must provide an opportunity to ask questions, seeking clarification of information. Using this as a base for proposed goals, I developed a plan to use communication throughout my experiences to enhance my skill level and provide leadership. I developed a plan to research and provide an educational experience for personnel using critical thinking and communication to provide care to patients in an emergency situation. I furthered developed a plan to use the Scope and Standards of Practice for Nurse Administrators to enhance my role as a leader within my departments and within the hospital setting. The use of open communication techniques to explore my strengths and weaknesses as a nurse administrator student will be an element throughout this experience. The use of appreciative inquiry and mentoring to promote change, while employing emotional intelligence and transformational leadership to guide this work is demonstrated.

Appreciative inquiry

The American Nurses Association (ANA) scope and standards of practice describe a philosophy and methodology to promote positive work environments (American Nurses Association, 2010). To foster open communication and conflict resolution, I need to consistently look for opportunities that allow teams to explore methods to express ideas. Engaging them in conflict resolution with each other can be time consuming at the forefront, but can lead to creating a culture where they will hold each other accountable for their actions. According to Cooperrider and Srivasta, the developers of theory of appreciative inquiry, the moment of change begins at inquiry(The Center for Appreciative Inquiry website, n.d.). They further explain that people are receptive to sharing positive things of them.

Throughout my practicum, the use of appreciative inquiry was employed. As I explored the many reasons for frustration and perceived lack of commitment, noted in an employee engagement survey, I used this as a framework to conduct meetings. The open dialogue with staff in small focus groups, allowed me to ask questions and encourage staff to clarify any uncertain comments or suggestions. I find this an effective method of teaching and communication as it allows me to gain a better understanding of where any areas of discrepancy may have stemmed from. This can be used as I continue my daily routine as I can look for trends in lack of communication or processes that cause errors or potential errors.

Mentoring

The American Nurses Association Scope and Standards of Practice for Nurse Administrators also use the framework of practice to include mentoring as an essential element of performance (ANA, 2010). A mentor is defined as a trusted counselor or guide by Merriam-Webster (2012). Mentoring is useful for both parties often creating winning situations for all. These can include sharpened skills, expanded networks and increased confidence (Heathfield, 2012). Using this theory to promote successful relationships within my peer group and teams, I can fully appreciate the need to both be a mentor and have a mentor. My new role as a manager allows me to assist in the development of direct reports. On the other hand, I am new to my role and need guidance and a person to bounce ideas off of as I promote growth and change. During this practicum, I used information provided during a course offered through McLaren Leadership Academy for managers whose departments received low scores on an employee engagement survey. This course “Change Anything” offered leaders methods to “become a scientist” to explore reasons change does not occur (Patterson, Grenny, Maxfield, MacMillan, & Switzler, 2011). This is a helpful tool to provide structure to determine why something is problematic. The problem can occur for a multitude of reasons and each person may have a different motivator to resolve the issue. This inquiry can be used to provide feedback when attempting to create change. Emotional intelligence can be integrated into the mentoring role to assist in controlling negative emotions while working with individuals, thus creating positive work environments.

Emotional intelligence

Emotional intelligence conveys a need for honesty and flexibility for nurse administrators. ANA suggests proactively responding to trends to promote change (2010). This basis allows a person to influence people and remain optimistic when adverse situations arise (Kiracofe, 2010). The article further suggests using this concept when hiring and training individuals to create a positive workforce. This can equate to a healthy financial outcome as employees are more productive and have higher rates of retention.

There are empirical studies by Quoibbach and Hansenne that show positive correlation between emotional intelligence and group cohesiveness (Suliman, 2010). There may be a relationship between emotional intelligence and coping mechanisms.

I need to consider these variables when making change. Groups will tend to be cohesive when the change is not viewed as a positive one. I feel this happens more often when staff does not understand why the change is necessary. I must also remember to include the “whys” of situations and not just use dictatorial methods to produce results. This is sometimes difficult for me to do, especially when I know the change will produce this mixed result. Necessity is important and sometimes just knowing why the decision is made is enough to soothe the emotional aspect associated with change. If change will take place or decisions need to be made, I attempt to promote a shared governance model allowing staff to make decisions regarding some aspects of change. This model of shared accountability can assist staff with a participative style of management which may be beneficial for both parties ("Shared Governance," n.d.).

Emotional intelligence can assist the nurse administrator student when attempting to make change. The need for honesty and open communication will promote transformation, sharing responsibilities between leaders and followers. This function of practice for nurse administrators will use communication and constructive criticism to create the desired change necessary to ensure healthy outcomes.

Transformational leadership

Transformational leadership proposes additional ways to use open communication techniques to create commitment by employing greater meaning and shared responsibility between leaders and workers (ANA, 2010). Research suggests two competencies for nurse leaders to employ to create a transformational leadership exemplar. These competencies, creating structures to ensure access to information, resources and support, and creating expectations for innovative, dynamic, empowering, and accountable behaviors of leaders and nurses can assist leaders in this journey (Everett & Sitterding, 2011, p. 401). Evidence-based practice will be an important tool as healthcare workers work toward value based purchasing[L1]. According to Tomlinson, transformational leadership works when teams have clear priorities and a clear vision of the organizational goals (2012). Additional studies suggest that participants will be more productive and provide satisfactory care to patients when working with leaders that employ transformational leadership styles (Brown, 2010).

One leadership theory uses transformational leadership behaviors. This theory, full-range leadership theory, is based on Burns ideas of leadership claiming a high degree of credibility with followers (Kanste, Kaarianen, & Kyngas, 2008). There were daily opportunities to enlist this theory throughout this nursing administration practicum. The project for this practicum provided another opportunity to work together to promote needed change using many of the above described concepts and theories.

Theory can assist new nurse administrators with clear elements to build a framework of practice. This is exemplified in the ANA framework for practice described above. This framework allowed me to demonstrate competency in the standards of planning, collaboration, and resource utilization for this practicum.

Planning

This practicum provided me with an opportunity to strengthen my ability to appropriately plan to achieve specific goals. The ANA Standards of Practice include measurement criteria for this standard (American Nurses Association, 2010). Identifying issues, problems or trends and utilizing the plan to provide direction to team members are two criteria demonstrated during this practicum. Examples of planning include preparing for meetings with the Surgical Services Department as well as the Surgery First Wednesday meetings with surgery staff. These meetings are used to provide information to attendees to communicate important information as it relates to trends in volume, needed improvements within the environment and any economic trends that may result from these deficiencies. Gathering data from various sources, verifying the accuracy and analyzing trends is one of the functions of the nurse manager role for surgery. Developing action plans to increase efficiencies from both a human resources perspective and a budgetary perspective is a challenge. Communicating this information is vital to the various department groups.

I also developed a plan to provide an educational opportunity as part of this practicum. This included a fire drill and involved several hospital departments as well as community services. The need to create change and transform the mindset of surgery team members was challenging for this project. We currently did not consider the need to assess the fire risk of each patient and have not planned or participated in any type of fire drill that would include an evacuation plan. This situation involved a multidisciplinary group to provide support and to educate those involved. Not only did the surgical staff need to develop a plan, the Bay City Fire Department had not had any recent walk through in the area. This could cause a delay in response time if the appropriate information was not relayed during an actual emergency. Using research, evidence-based literature, current guidelines and facility policies, the project was scheduled and will be discussed in detail.

Collaboration

The collaborative effort of nurse leaders is an essential part of practice. Collaboration with all levels of nursing and other key stakeholders to enhance patient care and provide satisfactory outcomes is the intended goal. Goal achievement will not be obtained if all members do not agree with the stated objectives. This was evident in one of the various groups I had the opportunity to work with. The development of a hybrid OR room brought a multi-disciplinary team together to achieve of the goal of increased market share for vascular procedures. This new technology involves the surgical and cardiac and interventional radiology teams to provide care to patients through a minimally invasive approach.

In order to promote a healthy environment where the exchange of ideas and support of the goal was the main focus, each member had to be willing to listen to suggestions from other members. Carr describes five competencies necessary for collaborative leadership; delivering patient-centered care, working as part of an interdisciplinary team, practicing evidence-based medicine, focusing on quality improvement and using information technology (Carr, 2009, p. 178-179). I also had the opportunity to work with other individuals whose goals were not in line with the project. This created a longer working time and diminished the importance of those members’ contributions, in my opinion. A challenging first few meetings brought about the need to create agenda and guidelines. I had the opportunity to attend this meeting with my preceptor, Willa Rousseau, RN, MSN as well as my director Linda Szafranski, RN, MSN. Working with the two of them, and being able to share ideas and have a sense of being an essential part of the team, inspired me to use this as a model throughout this practicum. This collaborative effort also allowed me a better understanding of resource utilization.

Resource utilization

The use of resources in any environment, whether the resource is part of the workforce, or is considered in the outlay of the capital budget, is a prominent part of the nurse administrator role. Demonstrating competence in this standard was evident throughout this practicum. As previously mentioned, a collaborative effort between two procedural areas will provide care to a new population of patients. These patients will more than likely have higher co-morbidities and will need to be evaluated for high risk situations. The nurse administrator will need to develop evaluation methods to ensure safe, effective care is being delivered.

Organizational fiscal responsibilities were developed during this practicum. The need to consider a reduction in the workforce, either through attrition or through layoffs was requested. This challenge provided me the opportunity to examine all roles within the area of responsibility. Further examination allowed to me to use open dialogue with leadership members to determine final plans. This open dialogue was necessary to promote the change necessary to maintain a fiscally responsible outcome. To assist in the development of this plan, several meetings took place under the direction of Greg Purtell, Vice President of Human Resources. Mr. Purtell is also attempting to create change within the organization and held meetings to discuss new initiatives involving staff performance measures. These tools will assist administrators to more effectively evaluate employees and guide behaviors to increase promotion of the use of disciplinary action in the event dialogue and education are not enough to create change.

These competencies are an important element to the success of the practicum, but one cannot underestimate the need for constant, open communication in all aspects of performance. This is evident as I developed my project of fire risk assessment including a simulated fire drill and evacuation of a surgical suite. This project is necessary due to a recent incident in the department of surgery. The idea for this project came as a result of listening to a Keystone Surgery conference call where cohort members are encouraged to participate and share experiences to enhance the practices of other cohorts. With this in mind, I developed the project using literature, facility policies and evidence to provide an educational experience allowing members to explore scenarios and review appropriate materials to provide care for a patient in an emergency situation specific to our facility.

Project

As part of the practicum, a project was assigned. I chose to create a plan addressing the need for a fire risk assessment for each surgical procedure as well as developing a plan to evacuate the department in the event a fire cannot be controlled. Due to the many renovations within the department and additional rooms added, the evacuation routes were unclear. To further compound this issue, the regulations are different depending on the year when the area was constructed. We have had fire drills previously, but have not attempted to evacuate a room.

Research shows between 550-650 fires occur each year ("Preventing Surgical Fires," 2011). These fires can range from a small flash fire, to complete burning of drapes and linens. The most effective way to fight fires is prevention. There are three sources needed to create a fire, ignition sources, fuel sources and an oxidizer. The need to actively discuss each patient’s risk assessment is essential. The Anesthesia Patient Safety Foundation (APSF) has created an algorithmfor use in a procedural setting. A copy of this algorithm is provided, see Appendix A. Each member of the surgical team, surgeon, anesthesia provider and nursing staff including the scrub person and circulator need to clarify any potential source of fire in each procedure, A good understanding of the process is essential. There are other critical factors related to fire prevention. These include proper prep used for procedure, securing airways on patients having procedures above the level of T5, allowing the prep to dry without pooling of fluid specifically at the bedside, and tenting the drapes around facial procedures to decrease the incidence of vapors to build up. Ignition sources including bovies need to be controlled in a holster when not in use. Using the lowest possible concentration of oxygen is also important. Other useful tips are described in the AORN Perioperative Standards and Recommended Practices Safe Environment of Care, Recommendation IX (Association of PeriOperative Nurses, 2012).