PROFESSIONALISM

• Leadership


  The ability to direct or motivate a person or group to achieve set goals
• Nurses as leaders

  • Assume leadership by virtue of position
  • Become effective leaders over time
• Leaders


  • Have power to influence a group
  • Explicit: power by virtue of position
  • Implied: power due to other factors, such as personality
• Leadership Qualities

  • Charismatic
  • Dynamic
  • Enthusiastic
  • Poised
  • Confident
  • Self-directed
  • Energizing
  • Critical thinkers
  • Knowledgeable
  • Culturally aware
  • Flexible
• Leadership present in all nurses: Education and practice will develop skills and behaviors
• Leadership Skills

  • Commitment to excellence
  • Problem-solving skills
  • Commitment to and passion for one's work
  • Trustworthiness and integrity
  • Respectfulness
  • Accessibility
  • Empathy and caring
  • Desire to be of service
  • Responsibility to enhance personal growth of all staff
  • Self-knowledge
• Leadership Styles

  • Autocratic
  • Democratic
  • Laissez-faire
  • Servant
  • Quantum
  • Transactional
  • Transformational
• Autocratic


  Assumes control over the decision and activities of the group
• Democratic

  Sense of equality among leader and participants
• Laissez-faire


  Leader relinquishes power to the group
• Servant

  Philosophy and practices related to serving others
• Quantum


  Leader views organization and members as interconnected and collaborative focusing on "information age"
• Transactional


  Reward good behavior; punish negative/detrimental behavior
• Transformational

  Able to inspire and motivate
• Conflict management

  • Process to work through conflicts
  • Minimizes negative effects
  • Promotes positive consequences
• Conflict engagement


  Teaches skills to help nurses perform well in the face of conflict rather than avoid it
• Conflict Resolution Strategies

  • Avoiding: aware of conflict but ignore/avoid/postpone resolution
  • Collaborating: joint effort to resolve; win-win
  • Competing: Win for one at the expense of another
  • Compromising: both parties relinquish something of value
  • Cooperating/accommodating: one party makes conscious decision to concede to other party
  • Smoothing: focus on agreement rather disagreement; original conflict rarely resolved
• Change

  • Process of transforming or modifying something
  • Planned
  • Unplanned
  • Developmental
  • Ever present
• Changing Health Care System

  • Increasing chronically ill/older people
  • Increasing role of government
  • Rising cost
  • Changing patterns
• Reasons for Resistance to Change

  • Threat to self: inadequacy; more work
  • Lack of understanding: Understand the WHY
  • Limited tolerance for change: Causes disruption in routine
  • Disagreements about the benefits of change: We've always done it this way
  • Fear of increased responsibility: more work
• Overcoming Resistance to Change

  • Explain proposed change to all affected
  • List the advantages of the change
  • Relate the change to the person's existing beliefs and values
  • Provide opportunities for open communication and feedback
  • Indicate how change will be evaluated
  • Introduce change gradually
  • Provide incentives for commitment to change
• Time Management

  • Nursing begins with individual patient but ultimately encompasses many patients
  • Establish goals and priorities for each day
  • Evaluate goals in terms of their ability to meet the needs of patients
  • Establish a timeline and allocate priorities to hours in the workday
  • Evaluate success or failure in managing time
  • Use the results of the evaluation to direct the next day's priorities and timeline
• Delegation

  • The transfer of responsibility for the performance of an activity to another person while retaining accountability for the outcome
  • The RN is responsible and accountable for nursing practice
  • UAP's can gather information, RNs interpret the information
  • Facilities are responsible for ensuring that UAP's are qualified and capable of performing tasks delegated to them
• Considerations When Delegating Nursing Care

  • Right task: Consider complexity of the activity and what is allowed by state law or facility policies
  • Right circumstance: Stability of the patient's condition, Potential for harm, Predictability of the outcome, Overall context of other patient needs
  • Right person: Qualifications and capability of the UAP
  • Right direction: Aware of patient status, when to seek assistance, what to report
  • Right supervision: RN remains accountable for delegated tasks and outcomes
• Becoming a Leader

  • Skills are developed with Observation, Gained knowledge, Experience
  • Developed slowly and carefully
  • Effective nursing leaders improve Health outcomes, Health care system
• Collaborative Care

  The Inter-Professional health care team
• Continuity of Care

  • Appropriate, uninterrupted care
  • Facilitating transition between settings or levels of care
  • Depends on excellent communication
  • Patient handoffs: transfer of responsibility
• Components of effective team structure

  • Interact interdependently and adaptively
  • Have complementary skills
  • Have effective leadership
  • Work toward a common goal
  • Have clear roles and responsibilities
  • Hold themselves mutually accountable for achieving the goal
• Interprofessional collaborative teams

  Improve patient and family experiences, improve outcomes, reduce cost, enhance workplace and satisfaction
• Care transition

  Continuous process
• Care coordination

  Central responsibility
• Four Rights

  • Right care
  • Right time
  • Right person
  • Right setting
• Care Coordinator


  • Responsible for identifying health goals and coordinating services/providers to meet those goals
  • Understand strengths/weaknesses of patient and family
  • Self-management
  • Patient advocacy
  • Navigate complex systems
  • Communicate
• Vulnerable Populations

  • People with disabilities or multiple chronic conditions
  • People with mental illnesses or substance use
  • Cultural, racial, and ethnic minorities
  • Undocumented immigrants
  • LGBTQ+
  • People experiencing poverty in rural and urban areas
  • Those who are homeless
• Impaired Nurses

  • Interfere with care coordination
  • Fatigue
  • More likely to express concern for wrong decision or intervention
  • Substance Use Disorder (SUD)
  • 10-15% of all nurses impaired or recovering
  • Increased stressors and availability of drugs
  • Inform management of concern
  • Peer Assistance Programs
  • Return to work after treatment
• Signs of SUD

  • Behavioral changes
  • Narcotic discrepancies
  • Increase in patients with uncontrolled pain
• Workplace Violence

  • Disruptive behaviors negatively effect outcomes and relationships
  • Lead to compromised patient safety
  • Decreased satisfaction with care
  • Decreased productivity
  • Increased errors
  • Poor patient and staff outcomes
• Examples of Workplace Violence

  • Professional Incivility
  • Bullying
  • Aggressive behaviors
  • Ineffective/abusive/ negative communication
• Professional incivility

  • Rude, disruptive, intimidating, undesirable verbal/non-verbal communication or behaviors
  • Failing to act when action is warranted
  • Considered a precursor to bullying by some
• Bullying


  • May be from coworker, supervisor, other healthcare provider
  • Persistent
  • Direct physical/verbal behaviors (Overt)
  • Indirect behaviors (Covert)