Lesson 13: The Future of Nursing Leadership

Discuss where you see nursing leadership moving toward in the next five and ten years.

I see nursing leadership heading in a more education-centered direction in general. In the past, many nurse managers in hospitals were promoted to their positions based on their ability to perform patient care instead of on any leadership skills that they may have possessed. Many nurse managers' education may have previously ended at an Associate Degree level. I think that more nurse managers and nurse leaders will have much more formal education, and that nurse leaders will continue to encourage other nurses to continue their formal education as well in order to improve patient outcomes.

Lesson 12: Performance Appraisals and Dealing with Problem Employees

Imagine you are a nurse manager and record ways of terminating an employee.

Terminating an employee is often a progressive process. The first step is an informal reprimand or a verbal admonishment. The second step is a formal reprimand or written admonishment. If the undesirable behavior is still not corrected, the third step is suspension from work with or without pay for a brief time. The last step is involuntary termination or dismissal. The steps do not have to be followed chronologically. For example, for gross mistreatment of a patient, dismissal may be the only acceptable option. Use of intoxicants while on duty would be another cause for immediate dismissal.

If I had to terminate an employee, I would probably take that employee into my office privately. I would explain to the employee the reasoning behind my decision. If I thought that the employee may react violently, I would have another supervisor and/or a member of security present for the meeting. I would try to follow the progressive process as much as possible, but I would follow the policies of my institution and protect the safety of the patients above all else.

Lesson 11: The Nurse Manager's Role in Quality Control

What do you consider elements of quality care when receiving health care services? What do you consider elements of quality care as a professional nurse? Are the two similar or different?

Elements of quality care when receiving health care services include receiving caring, compassionate treatment utilizing the most current proven knowledge while taking in to account the cost of those services. A practitioner providing quality care would provide me with the knowledge to let me make my own decision while helping me to weigh the pros and cons of the decision to be made. A practitioner providing quality care would take financial cost into consideration because offering certain treatments that I can not afford to pay for and can not get someone else to pay for would be out of my reach and, therefore, useless. I would still want to know about them regardless.

Elements of quality care as a professional nurse include providing caring and compassionate service utilizing the most current proven knowledge. As nurses, many of us try to take some financial concerns into account, but we could do better when it comes to trying to save the patient money and still provide quality care. Educating the patient so that the patient can make their own decision is also important in quality care.

There are differences and similarities with my own perception regarding receiving and providing health care services. Differences include the emphasis on financial cost. I want the best services offered to me at the lowest prices possible that do not compromise quality. As a nurse, I want to offer the highest quality services at a reasonably low cost, but I know that there are times in the past when I could have improved upon that. For example, my choice in some dressing change supplies may have been altered somewhat if I had known the cost of some of those supplies. There are basic supplies that are not terribly expensive, such as a standard 4X4 gauze, and there are other supplies that were fancier but not necessary. The end result of wound healing would have been the same had I used the more expensive dressing or the 4X4. The physician could have been contacted to change the dressing order to save the patient some money. Also, when I worked on a Med-Surg unit, I would often send patients home with a weeks worth or more of dressing change supplies. This costs the hospital money, which over time raises the price of services for everyone. Similarities include the intent behind the attempt at quality, caring and compassionate treatment, utilization of the most current knowledge, and trying to save money.

Lesson 10: Conflict Resolution Collective Bargaining, Unionization and Employment Law

Record an example of conflict you experienced in your reflective journal and describe how you would handle the situation as a nurse manager.

I was working as a licensed practical nurse at a hospital in a different state. There was tension between myself and one of the nurse techs. I needed some information from the nurse tech regarding one of my patients, so I went to her to get the information. She was with a patient, so I asked her to speak to me when she was done. She came to the door of that patient's room, very loudly and in a vulgar manner told me that she was tired of my behavior, and that she was not going to take it any more. She also verbally threatened me physically. I considered her behavior to be highly unprofessional and unacceptable, so I went to the assistant nurse manager on the floor in order to have her mediate between the two of us. Upon meeting in the office, the nurse tech proceeded to profusely compliment the assistant manager, which obviously pleased her. I mentioned that the nurse tech yelled at me and threatened me in front of a patient. The nurse tech fully admitted to her actions. She was not disciplined or even told not to behave in that manner. That was the day I started looking for employment elsewhere.
If I had been the nurse manager, I would have addressed the problem immediately. There is no reason to physically threaten another person in the work environment, and yelling to another staff member in front of a patient is unacceptable. At the very least, a written warning would have been warranted, as well as anger management training for the nurse tech. Also, mediating between the two employees may have also been helpful.

Lesson 9: Creating a Motivating Climate Organizational, Interpersonal and Group Communication

Record your thoughts concerning motivation. Include an example of when you felt motivated/not motivated as a result of a manager’s actions. Thoughtfully record a personal career development plan.

My current thoughts regarding motivation revolve around the fact that I have so little of it at the moment when it comes to getting all of the worthless papers that are required for this semester done. I think that it is important to be motivated. I must have some motivation left. After all, I am still submitting these blogs, and I am still getting my work done. Anyway, positive motivation in the workplace is important. For many people, workplace motivation is financial. For others, it involves recognition. Motivation is often a combination of many different factors that are unique to the individual.

I have felt both motivated and not motivated simultaneously as a result of a manager's actions. I recall a time when I worked on a busy Med-Surg unit as an LPN. I had a problem and went to the manager in hopes of reaching a resolution. This particular manager was terrible at her job in general, and did nothing to help me with my situation. I was motivated to remember her terrible management style, to never emulate it, and to find another job. I was not motivated to stay there and continue to work on that unit. In fact, at that point I was not motivated to want to be a nurse any more! Luckily, future experiences taught me that the entire profession of nursing cannot be judged based upon one negative working environment.

I am no longer sure of my personal career plan. I thought that I was six months ago. I know that I want to eventually continue my education. I know that I would like to continue to work in public health. I do not know if I want to become a family nurse practitioner or not. I have considered pursuing an administrative degree or perhaps a master's degree in public health. I definitely want to make sure that whatever degree I choose, I have many career options open. I know of one nurse who got a master's degree in alternative medicine. I do not think that such a degree would be very versatile. Higher education is very expensive, and I have a tendency toward frugality. I want to make sure that I get the most bang for my buck, especially if I will have to go in to debt to finance it. Ultimately, I want to do what is best for my family. I am just not sure what that is anymore!

Reflective Journal, Clinical Day #5, THE LAST ONE

I completed twelve hours at Timpanogos Hospital following the house supervisor today. It was my last clinical shift. My sixty hours are now done! My goals for today included learning about budgeting, conflict resolution, managing staffing, the leadership role of the house supervisor, and how to positively interact with employees.
It was much less busy today than it was yesterday. The tube system went down in the Emergency Department. My mentor was able to go to the engineering department and fix the problem with the computer, which saved the hospital money by him not having to call in staff from the engineering department for the repair. That is about as close to anything related to budgeting that we did all day today. Although there is no formal budget that the house supervisor follows, he is always financially conscientious. This example can help me in my practice as a nurse because reasonable frugality can save not only my employer money, but my patients' money as well.
The only situation related to conflict resolution came in the form of a fully oriented irate patient who needed a peripheral IV placed. Many years ago he had received severe burns on both arms which are now both covered in scars. His nurse was unsuccessful in placing an IV due to all of the scar tissue. My mentor was calm and focused while placing the IV, even though the patient pulled his arm away several times during the process and repeatedly complained about how painful it was. I got the distinct impression that the patient would have become more irate if my mentor had attempted any other approach. I will try to incorporate the same calm and focused attitude when dealing with patients who are irate, as I believe that this will help me to better accomplish my tasks in my own practice.
Staffing always seems to be a shift-long concern, and today was no different. We rounded on all of the units at least twice in order to collect the patient census. Two nurses were sent home on call, and one CNA called in sick. Additionally, Mountain View Hospital in Payson called and asked if Timpanogos had a pediatric nurse that could be sent to their facility. They didn't. I don't understand why they don't have a prn pool like IHC does, or why they think that nurses would appreciate being volunteered out to that facility. That is a long drive with little to no incentive for the trip. Anyway, I learned that it is important to stay informed and to know what is happening regarding census and staffing so that you can be better prepared to meet staffing needs. I will try to incorporate this in to my own practice if I ever become a manager by being observant and diligent regarding census and staffing.
The house supervisor continued to show leadership and a willingness to help. Outside of the women's center, there were ants on the carpet that were congregating in one spot. Engineering was contacted, but they already knew about the ant problem. In fact, the nursery had been previously moved to another floor, and the ants were partially to blame. My mentor found some ant spray and sprayed the insects down. Then he had housekeeping vacuum their remains. We checked the spot later in the day, and no new ants were noticed. I never would have guessed that pest control fell on the shoulders of the house supervisor, but he rose to the occasion once again. I will try to incorporate his example in to my own practice by trying to be helpful and take the initiative when the occasion calls for it.
He continued to positively interact with all of the employees. Every time we would round, he took the time to have pleasant conversations with the staff. Somehow we got on the silly subject of hospice for cats when talking to the staff on one unit (it does not really exist). The levity put the nurses at ease, and I think that it made my mentor more approachable. It is important to seem approachable, especially in times of potential crisis. Employees are likely to divulge more information to a leader who seems amicable. I will try to follow his example in my own practice by being pleasant and approachable to everyone I work with. This can contribute to positive morale in the work environment.

Overall, I think that my entire clinical experience was far too lengthy. I think that management-type learning could have been accomplished in eight to sixteen hours. There were several hours today when I was struggling to stay awake in the office as we awaited a call from anyone who needed anything. However, I did get to attend a cardiac stint placement yesterday. Although that has nothing to do with leadership, it was a valuable experience for me. I feel grateful to my mentor for agreeing to have me follow him, and I told him so. The worst part of this clinical for me was not being able to participate in patient care. That just seems unnatural to me at this point. While I do understand why it is that way, it still felt weird. I hope that this completes my clinical reflective journal!

Reflective Journal, Clinical Day #4

I completed twelve hours of clinical time following the house supervisor at Timpanogos Hospital today. My goals for today include learning about budgeting, conflict resolution, managing staffing, the leadership role of the house supervisor, and how to positively interact with employees.
The tube system went down (again), and we went to see if it could be fixed without calling engineering. The engineering department is on-call on the weekends. If they are called in, they are automatically paid for at least two hours, even if the repair takes fifteen minutes to complete. The house supervisor could not complete the repair, and engineering was called. However, the attempt to save the hospital money was notable. This was about as close to a budgeting lesson as I could get due to the fact that the house supervisor is not actually in charge of a specific budget.
There was a situation regarding conflict resolution. A 95 year-old patient with a decreased mental status was supposed to have a diagnostic test yesterday but the machine broke down in the middle of the test. The patient was dying, and the daughter wanted to have another test done (the machine had since been fixed), a lumbar puncture, an autopsy ordered for after the patient's death, and she wanted the hospital to pay for the autopsy because there was no diagnosed cause for the patient's impending demise. She also wanted the last day of the patient's hospitalization free of charge. The house supervisor and the physician spoke to the daughter regarding the testing options. After talking to the daughter about the rigors of the tests and the potential inconclusiveness of the autopsy, she decided against all testing and opted instead for comfort measures. The chief nursing officer was notified about the situation, and she gave permission for the last day of the hospitalization to be free of charge. Talking to the daughter and attempting to understand the cause of her demands helped to diffuse a potential future lawsuit for the hospital. Paying for the final day of hospitalization is also much less expensive than paying for a lawsuit. The daughter may still choose to file a lawsuit, but now she is much less likely to do so. Remembering this situation and the way it was handled may help me in the future to please my patients and their families, and to possibly avoid litigation.
Managing staffing was a shift-long process. There were some procedures and surgeries that required on-call staff to be called in. Some staff called in sick, and there were six anticipated admissions near the end of the shift. I think that was the most admissions in a shift I have witnessed since my clinical experience at this hospital. My mentor spent a lot of time of the phone arranging staffing for various units. I have a lot of respect for the effort that it takes to keep each unit properly staffed, and I will try to incorporate the knowledge that I gained by watching my mentor in the future if I am ever in charge of staffing.
My mentor serves well in his leadership role. He sets a good example, and helps out when the occasion arises. He arranged to have me watch a cardiac catheterization, which I found fascinating. He also arranged to have me watch most of a CT-assisted abscess drainage procedure. When we arrived and he asked the physician for permission to observe, it was discovered that one team member was missing in order for the procedure to be performed. He volunteered himself to fulfill the role, which pleased the previously-cranky physician. He also assisted a code in the Emergency Department, among other duties. He performed all of his tasks effectively and he made a point to be as helpful as possible to all staff members and patients. I hope that I can gain the skills and confidence to be as effective as my mentor is in a leadership position.
My mentor always interacts with employees in a positive manner. We made rounds to each floor, and greeted each employee. He calls everyone by name, and makes an effort to have a pleasant conversation with everyone. This makes him approachable and more informed. During down time, staff will often come to see him to chat or to voice concerns. I hope that I can learn from his example and be a kind and approachable leader in the future by positively interacting with all staff members.

Reflective Journal, clinical day #3

I spent yet another twelve hours following the house supervisor at Timpanogos Hospital yesterday, and it was not nearly as busy as it was Saturday. My goals for the day included learning more about how to manage a schedule, how to positively interact with employees, how to manage conflict in order to be a more effective manager and/or leader, and learning more about the roles of house supervisor, and learning more about the role of nurse practictioner (which is what my mentor is studying to become).
My mentor carried a paper copy of the schedule with him throughout the shift, and he had to call many employees off and put many on call. He regularly went in to the computer system to make staffing updates, and we rounded on the units many times to interact with employees and to get current census information. He stated that he could collect the information over the phone, but talking to them in person adds a personal touch and creates rapport. The staff seemed genuinely happy to see him whenever we rounded. We answered some calls to obtain supplies from the central distribution area because only he had keys to the room. He did state that whenever staff calls him for supplies, he is careful to ask if they have checked other places before he must run around the hospital seeking them out. Otherwise, he would be playing fetch all day because the staff at one time had gotten in to the habit for calling him for supplies that would often be available on an adjoining unit that they had not bothered to check.
There was one incident of conflict. An RN in the nursery complained that lab staff was rude to her. The order for blood typing had, according to her, been entered in to the computer system. A lab staff member claimed that it was not in the system, and the nurse stated that the staff member was rude and unhelpful on the phone. The blood typing had been completed prior to our arrival, but the nurse stated that it took a while to get it done and the difficult situation was a waste of time and resources. The nurse was advised by my mentor to fill out an incident report regarding the situation. We then went to speak to the lab staff. The one staff member who had been reportedly rude was not there, but another lab staff member stated that the order had been entered very late in the shift, and the blood typing had been done when the order was received by them. She stated that the staff member had followed procedure. It appeared to be a problem with the computer systems not properly communicating with each other. When we finished talking to the staff member in the lab, my mentor stated that it is important in conflict situations to remain calm and neutral, and to listen to both sides. He stated that he didn't doubt that the lab staff member had been rude because she has a history of behaving in that manner. Nurses have a tendency to not fill out incidence reports, but the reports provide documentation of problems to administration. The documentation may help to reinforce future complaints from nurses of rude behavior from that particular staff member.
It appears to me that the role of house supervisor is all-inclusive. We rounded the units for census data and to see if they needed assistance. We collected supplies for units. My mentor temporarily fixed a door that would not seal with a wad of paper and some tape until engineering could get to it when they were able to come in. He told me that part of his responsibility was to make sure the place didn't fall apart over the weekend. In the emergency department, some of the nurses were discussing nipples on the fountain drink machine. I asked my mentor what was meant my this, and he took me to the machine. He told me that the apparatuses should be cleaned daily, but often they are done weekly if they are lucky. He took the nipple off one of the dispensers and showed me why. The dispenser nipple was coated in black gunk. It was disgusting. He said it didn't tend to get as bad with the Sprite dispenser, but he had seen it worse that that on the Sprite dispenser before. I don't think I will be drinking fountain soda drinks again! We then proceded to clean that portion of the machine, soak them for disinfection, and replace the nipples with previously disinfected ones.
Later in his office, we had a considerable amount of down time. He is attending school to become a nurse practictioner, and I asked him questions about the roles of a nurse practitioner. He stated that the most difficult part of becoming a nurse practitioner is learning to rely on yourself and get out of the habit of calling the physician for every problem. This is because you become the prescribing provider. He stated that the adjustment from registered nurse to nurse practitioner is a hard one to make. According to the nurse practitioners he has spoken to, that adjustment can take at least a year. A nurse practitioner can choose to work under a physician or open a private practice, but he stated that it is usually wise to work under a physician until that adjustment is made. He also stated that family nurse practitioners are reimbursed by medicare at 85% of what a physician gets. So these nurses get to do the exact same work as a physician and get less money for it. Go figure.
While I considered the day to be boring for the most part, I was still grateful for the opportunity to get some more clinical hours completed. I expressed gratitude to my mentor for allowing me the experience of following him, as I do at the end of every shift. My next shifts are scheduled for February 26 and 27. Only two more shifts to go!

Reflective Journal, clinical day #2

Today I spent twelve hours following the house supervisor at Timpanogos Hospital. It was a busy day. My objectives for today included learning more about how to manage a schedule, how to positively interact with employees, and how to manage conflict in order to be an effective manager and/or leader. Some employees had to be called off on certain units due to low census. Later in the shift, a few employees had to be called back in due to admissions. I was given the task of calling one employee and telling her that she was being called off of the upcoming night shift. I completed the task without difficulty or hesitation. My mentor told me that sometimes employees try to argue him into not calling them off, but if census is low and staffing is excessive for patient acuity levels, staff is called off regardless of their argument.
My mentor interacted with all employees in a respectful and positive manner. He took the time to talk to each of the nurses not only about the patients, but also about their personal lives. He called them by name, and shared humorous stories on more than one occasion. He appeared to put the staff at ease, and let them know that he was there to help. We were called to get supplies on more than one occasion, and the staff verbalized their gratitude.
There was one nurse who had gone above and beyond her job description. She made necessary calls and arranged to have the next shift as well as her own appropriately staffed for her unit. My mentor presented her with a gift card for her extra efforts to express appreciation. The hospital has several gift cards to different businesses set aside for that purpose, and the boost to this nurse's morale was obvious upon her receipt of the card.
The NICU currently is equipped with six beds. There were eleven babies total in the NICU, so they had to open one of the adult ICU units that had been closed specifically for those other babies. Each of the babies in the makeshift NICU had its own large room, and the nurses loved the setup. A new NICU is being built to accommodate the anticipated increase in patients due to a new neonatologist the hospital has recruited who is in high demand.
Last night, there was a mixup regarding the physicians and a patient. One physician attempted to admit a patient, but was unable to because someone mistakenly thought he did not have admitting priviledges. A hospitalist was involved, and yet another physician was angry about the situation because he was called at two o'clock in the morning regarding the patient's necessity for admission and the patient was not his. I think, and my mentor agreed, that the situation could have been easily resolved without unnecessarily upsetting a physician. My mentor and I had the pleasure of listening to the uninvolved physician rant about the other physician in the emergency department. Apparently the original physician was to blame for the entire fiasco. My mentor encouraged him to file a formal complaint in order to better resolve the situation. Neither my mentor nor myself understood why three physicians instead of one became involved in the attempted admission of the patient last night. The botched admission process caused major delays in that patient's care, and could have been avoided.
The operating room staff were placed on standby for a possible surgery that never happened. They were already present from a previous emergency procedure, and my mentor was reluctant to let them go until we knew whether the other possible surgery would happen that afternoon because they were technically not on call at that time. We took a few trips between the ER and the OR in an attempt to expedite the process. The second surgery did not happen.
In the midst of all of this, a fountain soda machine in one floor's nourishment room began gushing fluid spontaneously from the top of the machine and under the sink where tubing was located. It was a huge, wet, sticky mess. I watched my mentor and another male staff member shut the machine down. I am glad they knew what to do, because I was never taught how to handle that in nursing school!
Today I met my goals. I observed my mentor frequently consulting the schedule and making changes according to the units' needs. I watched him calmly and positively interact with hospital staff, and calmly handle the conflict regarding the physicians. I am happy to have one more clinical shift complete, and I am pleased that I have only three more shifts left. My mentor works every other weekend. I will follow him tomorrow, and again in two weeks on Saturday February 26 and Sunday February 27.

Lesson 6: The Nurse Leader's Role in Managing Change

What is your attitude toward change?

My attitude toward change depends upon the situation. During an orientation meeting for my first job as an LPN, the word "change" was repeated frequently. Phrases such as, "change is good," "change is inevitable," and, "change is constant," were a large part of the meeting. I felt as though I were being primed for brain washing because it was repeated so much. Within the coming months, I discovered why the word "change" stressed so much during this meeting. I found that over time, my responsibilities were gradually being reduced, and I began to feel like a nurse assistant instead of an LPN. One RN even asked me why I was there due to the new limitations of my position. All of the LPN positions at this hospital were eliminated within two years. I was fortunate enough to have left that particular position for another one before I was a victim of that particular institutional change. Because of the negative experiences at that institution, I now have little desire to work there as registered nurse.
I realize that change is constant and inevitable. Sometimes an individual has control of the change, and sometimes not. When implementing a change that may affect others, I think it is important to involve them as much as possible in order to eliminate some of the confusion and anxiety that can result from change. Keeping them involved may possibly reduce some of the resistance that can come with change, depending upon the circumstances.

Lesson 5: Organizational Structure, Power and the Role of the Nurse Leader

I am scheduled to do two clinical day shifts at Timpanogos Hospital this Saturday and Sunday. My mentor was great to follow last time, and I look forward to having two less shifts to complete by next week.

For the purpose of the assignment, I will focus on my second job for the discussion of patient care models. I work for a home health agency, and the case management care model is utilized. The model works well because of increased work efficiency. The case manager coordinates the care of the patient and is directly involved in the care as well. A disadvantage of the model is the need for prior experience to effectively act in that role due to its extensive requirements.

Reward power is gained by the ability to grant rewards to others. Coercive power is based on fear and punishment. Legitimate power is the power inherent in one's position. Expert power is gained through knowledge or skill. Referent power is gained through association with others. Charismatic power results from a dynamic and powerful persona. Information power is gained when someone has information that another needs. Feminist or self-power is obtained through maturity, ego integration, confidence, and security in relationships. Strategies to increase my personal power base include being polite and kind to everyone I work with in order to build positive work relationships, learning all that I can to increase my knowledge base, and maintaining positive relationships in my personal life. Power can be used for good and less nobel purposes. Advocating for a patient to further facilitate their care is an example of a positive use of power. Attempting to dominate someone simply for the sake of dominance would certainly not be a noble or a long-term productive use of power. I agree with the text book on page 296 when it states that, "Power, therefore, is not good or evil; how it is used and for what purpose it is used determine if it is good or evil."

Lesson 4: Operational and Strategic Planning and the Nurse Leader's Role in Health Policy

Reflective Journal entry: I completed my first clinical shift Sunday. I attempted to fax the contact form in, but I don't think it worked, so I will hand deliver a signed copy. I am following a house supervisor on the weekends at Timpanogos Regional Hospital. Initially, I expected to learn how to manage staff, manage a budget regarding staff and patient census, and maybe learn a little more about how to successfully place a peripheral IV in a patient when the other nurses on the floor can not place it.
What I actually learned was that a house supervisor does so many things that are and are not nursing related. For example, we went to an engineering room twice to fix the tube system, which he told me he learned from talking to the engineers on the phone before when they did not want to come in to fix it themselves. I saw one peripheral IV placed, but I didn't consider it remarkable. I was impressed with his ability to handle the staff. We frequented different floors, checking on staff and asking if they needed help. There was a situation on one unit regarding a nurse who was upset with a physician who, according to her, did not want to come in because he had been in at four o'clock in the morning already. The patient needed help, and she had other complaints regarding this physician. The house supervisor instructed her to keep calling the physician repeatedly until he responded appropriately. He explained to me that it is important to listen to concerns objectively, because emotions often direct what you may be hearing from staff. For him to call the physician in that situation may serve to make the physician even more resistant to physically coming in and seeing that patient, and make him less cooperative in the future. I did not learn much about budgeting, because the house supervisor did not have that information. When the patient census is low, staff is called off. The house supervisor stated that he uses his judgment and considers patient acuity when he makes that decision. Labor and Delivery and Emergency Department nurses are never sent home due to lack of predictability.
I enjoy watching the house supervisor's interaction with staff. He is friendly and approachable, and treats each staff member with respect. He calls the people he knows by name, and he asks the name of anyone he is not familiar with. This will impact by nursing career because if I treat everyone with respect, my work environment will be much more pleasant.
He told me that in future shifts, we might go through some patient charts, depending upon how hectic each shift is.

Now to address the objectives:

The primary purpose of operational and strategic planning is to identify priorities that must be addressed to ensure a successful future. According to the textbook, strategic planning focuses on purpose, mission, philosophy, and goals related to the external organizational environment.

Values and beliefs affect an organization's strategic plan. If an organization's mission and staff values and beliefs are the same, there will likely be more success in the organization. If the values and beliefs of the organization and staff conflict, the organization will likely have a more difficult time achieving success.

An organizational mission statement identifies (usually in no more than three to four sentences) the reason that an organization exists. The philosophy comes from the purpose of the mission statement, is the basic foundation that directs all future planning toward the mission, and indicates the set of values and beliefs that guide all actions of the organization. Philosophies must become specific goals and objectives if they are to result in action. Policies are comprehensive statements that are derived from the organization's philosophy, goals, and objectives, and they explain how goals will be met while also guiding the general course and scope of organizational activities. Procedures identify the process or steps necessary to implement a policy. Rules are usually included as part of policy and procedure statements, and describe situations that allow one choice of action.

Regarding the nurse leader's role in strategic planning, there is a list on page 145 in the textbook that is numbered one through ten. I could restate the entire list in this blog, but I don't see the point in that when I can just go back and read it. Regarding a nurse leader formulating health policy, top-level management is more involved in setting organizational policies, and unit managers must decide how those policies will be implemented on their units. Input from subordinates allows the leader-manager to develop guidelines that all employees will support and follow. This is on page 159 in the textbook.

When an organization's values and philosophy differ from a nurse's personal value systems, internal conflict and burnout may occur.

Do I really have to address the objectives every week? The reflective journal combined with the objectives is lengthy!

Lesson 3: Ethical and Legal Responsibilities and the Role of the Nurse Leader as Advocate

I am ready to scream. I have tried to set up a clinical at Timpanogos Hospital in Orem. I called and spoke to more people than I can keep track of in an attempt to get the clinical time arranged. I got a call back from a potential preceptor a few nights ago, and she did not sound as though she wanted to be my preceptor. I read her the objectives from the syllabus, and told her I needed to complete ninety hours of clinical time. She told me that anything she had to teach me could be done in about two hours. I left the name and phone numbers of my professor per her request so that she can contact him. She then told me she would be back in town in early February. Is there any way to simplify this process? I am so frustrated!

And now to address the objectives:

One major ethical and legal challenge in the role of the nurse leader may be related to equal employment opportunity laws. There are some clinical settings, such as a labor and delivery unit, that may be so accustomed to its female workforce that the inclusion of a male may make the staff and patients uncomfortable. However, it is illegal to discriminate against a male applicant based on gender.

The most fundamental universal principle is respect for people. The other major ethical principles (autonomy, beneficence, paternalism, utility, justice, veracity, fidelity, and confidentiality) stem from this basic principle, according to the text book. I am not sure what is meant by the objective stating to discuss the application of principles of ethical reasoning.

Legal obligations require following the law and not doing anything illegal. Ethical obligations involve doing the "right thing" and adhering to one's own value system. Legal and ethical obligations may coexist within a given situation, or they may clash.

Resources available when addressing ethical and legal dilemmas include the American Nurses Association (ANA) Code of Ethics for Nurses, the ANA Standards of Practice for Nurse Administrators, the MORAL Decision-Making Model, the International Code of Ethics, the Nurse Practice Act, federal and state laws (such as HIPAA), and lawyers employed by the facility (if they are present).

managers responsibility to advocate for pts, subordinates, organization, profession, and self: Managers must advocate for patients regarding distribution of resources and technology use. Managers must help subordinates to resolve ethical issues and live with the solutions at the unit level, and create an environment conducive to professional and personal growth. Managers must create an environment of patient advocacy for their subordinates and patients. Nurse managers must broaden their knowledge, sociopolitical and otherwise, to assist the advancement of the nursing profession. I am not sure how to describe a manager's responsibility to advocate for himself or herself. Maybe it is supposed to be about sticking up for personal core values.

Lesson 2-Successful Leadership and Management

Think about how theories of leadership and management impact nursing leadership and management roles. Record your thoughts on your “Blog”

There are numerous theories regarding leadership and management, and I have seen some of those theories put in to practice as I have worked as a nurse. The most annoying type of leader that I have experienced is the authoritarian leader. The worst part of that particular experience was that the person practicing that form of leadership appeared to be more interested in exerting their own power and less interested in positive outcomes for the patients or the staff members. When the time came for me to move on, I was all too happy to leave that job. I have also experienced a laissez-faire leader, who did not last long in their appointed position. I am not sure if I have experienced a democratic leader. It is possible that I have, but the negative experiences that I have had with the other styles are more vivid. I think that a medley of the behavioral theories can be most effective, depending upon the situation. One person maintaining one behavioral style for every situation seems to be extreme and ineffective.
I think it does help to get the input of those who are being led. As an employee, I appreciate when my employer expresses an interest in my thoughts regarding situations within the organization. I feel like a valued member of the team instead of a grunt who is there to put in my time and collect my paycheck. I also think it is important for a leader or manager to effectively communicate with employees.
I recall a time during major organizational restructuring that was very poorly handled overall. The announcement that my entire department was being laid off was given during a television press conference, and we had no prior knowledge of this. After I had been relocated within the organization, additional changes were going to be made. If I remember correctly, administration began to communicate with the nursing staff only after some nurses started talking about joining a union. A representative came and asked us which benefit we would rather give up due to the necessity for more budget cuts. He appeared to be shocked when we gave him our answer, which happened to be the most cost-effective option for the organization at the time. I never understood why the administration did not communicate the situation with the employees prior to the press conference. If they had attempted to communicate, things may have turned out very differently.

Creation: A blog is born.

This is the first entry for this newly-created blog. I am not quite sure what the point of this blog is. I am not certain what I am supposed to post on here. I was speaking with some of my co-workers today, and one brought up a valid point. A new nurse may unwittingly post something on a blog that may violate HIPAA. Nurses have been penalized in the past for doing just that. I am reluctant to discuss anything related to a specific patient's care on here, and hope that I will not be docked points for that.
I have yet to set up a clinical site. I discussed this with my professor. I work Monday through Friday, which complicates things somewhat. I am anxious to get started, and even more anxious to have my clinical rotation completed. So far, the only things that I have accomplished for this class are setting up this blog and taking the syllabus quiz. I should have the first reading assignment done by tomorrow.