NURS 4020 – Leadership Competencies in Nursing and Healthcare Research Paper

NURS 4020 – Leadership Competencies in Nursing and Healthcare Research Paper

NURS 4020 – Leadership Competencies in Nursing and Healthcare Research Paper

Nurse Leader Competencies

AONE is committed to developing and disseminating core competencies for nurse leaders in a variety of care settings and levels of responsibilities. These competencies have been developed by experts in the nursing leadership field and approved by the AONE Board of Directors. NURS 4020 – Leadership Competencies in Nursing and Healthcare Research Paper

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Nurse Executive Competencies
Executives can use these competencies as a self-assessment tool, useful in the identification of possible areas for growth. Aspiring nurse leaders can use them in planning personal preparation for their careers. Health care organizations may utilize them as a guideline for job descriptions, expectations and evaluations of nurse leaders. Nurse educators can utilize them as a curriculum guideline for the educational preparation of nurses seeking expertise and knowledge in executive practice. NURS 4020 – Leadership Competencies in Nursing and Healthcare Research Paper

System CNE Competencies
The role of the system chief nurse executive (CNE) is a sub specialty of nursing leadership and requires its own set of competencies. Guided by the AONE Nurse Executive Competencies’ domains: communication and relationship building, knowledge of the healthcare environment, leadership, and professionalism, business skills the following competencies describe the skills, knowledge, and attributes of nurse leaders in the role of the system chief nurse executive. They are presented as information for both system nurse leaders and those who employ or work with them. They can be used as a guideline for job description development role expectations, evaluation criteria, and a self-assessment tool in the identification of possible areas for growth and career planning. NURS 4020 – Leadership Competencies in Nursing and Healthcare Research Paper

Post-Acute Care Competencies
Post-acute care nursing leadership is as much a specialty as any clinical specialty and requires proficiency and competent practice specific to the executive role. Health care systems will consolidate and become a predominant model of integrated care delivery. As such, enterprise-focused executive nursing leadership is vital to the success of community systems. Nursing practice should be aligned to the future state of nursing and a consolidated model for care delivery where the hospital will not be centric to delivery model and the health care continuum will be the focus.

Nurse Manager Competencies
The Nurse Manager Competencies are based on the Nurse Manager Learning Domain Framework and capture the skills, knowledge and abilities that guide the practice of these nurse leaders. The successful nurse leader must gain expertise in all three domains: the science of managing the business; the art of leading the people; the leader within.

Healthcare Leadership Alliance Competency Directory
The Healthcare Leadership Alliance (HLA) Competency Directory is a searchable reference tool that highlights the expertise needed for effective management across a broad spectrum of health care administration roles, including, hospital administration, medical practice administration, nursing administration, health care financial management, and health care information and management systems. NURS 4020 – Leadership Competencies in Nursing and Healthcare Research Paper

Leadership and Management Competence in Nursing Practice

 

Written specifically for the experienced nurse enrolled in an RN-to-BSN program, this text guides nurses through an interactive critical thinking process to become effective and confident nurse leaders. All nurses involved with direct patient care already rely on similar strategies to oversee patient safety, make care decisions, and integrate plan of care in collaboration with patients and families. This text expands upon that knowledge and provides a firm base to reach the next steps in academia and practice, enabling the BSN-prepared nurse to tackle serious issues in care delivery with a high level of self-awareness and skill.

Leadership and Management Competence in Nursing Practice relies on a keen understanding of what experienced nurses already bring to the classroom. This text provides a core framework and useful skills and strategies to successfully lead nursing and healthcare forward. Clear, concise chapters cover leadership skills and personal attributes of leaders with minimal repetition of material covered in associate’s degree programs. Content builds on the framework of AACN Essentials of Baccalaureate Education, IOM Competencies, and QSEN KSAs. Each chapter presents case scenarios to promote critical thinking and decision-making. Self-assessment tools featured throughout the text enable nurses to evaluate their current strengths, areas for growth, and learning needs. NURS 4020 – Leadership Competencies in Nursing and Healthcare Research Paper

Key Features:

  • Provides information needed for the associate’s degree nurse to advance to the level of professionally prepared baccalaureate degree nurse
  • Chapters contain critical thinking exercises, vignettes, and case scenarios targeted to the RN-to-BSN audience
  • Self-assessment tools included in most chapters to help the reader determine where they are now on the topic and to what point they need to advance to obtain competence and confidence in the professional nursing role
  • Provides information and skills needed by nurses in a variety of healthcare settings
  • Includes an instructor’s manual and PowerPoint slides

 

Nurse leader competencies

Faced with healthcare reform, national healthcare imperatives, and nursing shortages, today’s healthcare landscape is complex.1 To respond to the changing healthcare climate, organizations should conduct a thorough analysis of business practices, processes, department structures, and job responsibilities of both front line staff and leadership positions. Nursing must strategically position itself to prepare for this uncertain environment within the organization.2

The nursing leadership model at Texas Children’s Hospital hadn’t changed for several years. A new vision for the nursing department was developed—to be recognized as the nation’s leader in both pediatric and obstetrical nursing. A new strategic plan was also developed that focused on exemplary practice, technology, patient and family contentedness, workforce planning, and quality outcomes. To execute the new vision and strategic plan, the nursing leadership structure needed to be reviewed and adapted to support rapid change and produce high-quality outcomes.

Key tenants were developed to provide a framework for the redesign of nursing leadership positions:

  • Nursing scope of practice statements must guide nursing decisions and hands-on care. Nursing practice should be guided by the latest research and evidence-based practice. Nurses should be leading changes in guidelines, policies, and patient education based on the new knowledge in the literature.
  • Structure and process will result in improved patient and family outcomes. There should be a defined structure and streamlined processes to produce positive outcomes. Nursing leadership should be examining both structure and processes within their organizations to ensure the best possible patient outcomes. NURS 4020 – Leadership Competencies in Nursing and Healthcare Research Paper
  • Nursing leaders must be supported clinically and administratively. Nurses should be focused on providing key nursing functions. Other administrative tasks should be performed by support departments or roles. The nurse leader’s focus on nursing practice, improvements in care, and nursing quality will ultimately improve overall care for patients and their families.3 The most significant investment a nurse executive can make in an organization and the delivery of quality patient care is the development of current and future nurse leaders.

Determining competencies

The Magnet® program challenges nurse leaders to utilize leadership principles to enact transformation within their own practice setting to meet the demands of healthcare in the future. Utilizing a solid vision, influence, clinical knowledge, and expertise in nursing practice will help nurse leaders with this transformation.5

Nursing executives partnered with the human resources department to envision and shape the new leadership roles and conduct a dynamic job analysis. Using a future focus, new job responsibilities were identified that encompassed both clinical and leadership tasks. Based on the new tasks identified, job descriptions were created. Human resources guided nursing leadership through a process to develop business-driven success profiles that aligned with Texas Children’s strategic priorities. The activity yielded a set of competencies, personal attributes, knowledge, and experience areas for each role. These competencies served as the foundation of the talent strategy.

The ACD’s competencies included:

  • influence
  • emotional intelligence
  • driving for results
  • facilitating change
  • high-impact communication
  • business acumen.

The PCM’s competencies included:

  • promoting patient and family relationships
  • aligning performance for success
  • building a successful team
  • leading through vision and values
  • building trust and facilitating change
  • making healthcare operations decisions/problem solving.

The ACD competencies build from the core competencies of the PCM role. For example, whereas the PCM is expected to align performance for success of individual clinical nurses, the ACD is responsible for providing influence for a variety of stakeholders who may or may not be in his or her direct reporting structure. NURS 4020 – Leadership Competencies in Nursing and Healthcare Research Paper

After new competencies were identified, a gap analysis was completed to identify the difference in key responsibilities and competencies that were required in the current state versus what was required in the future role. The gap analysis served as a communication and implementation tool, and helped incumbents differentiate future job expectations from the present. Further, it clearly defined the new roles for the organization and was used to share the vision of leadership impact in detail. The results of the gap analysis showed that the future nurse leader would become more of a clinical expert with a focus on patient outcomes. He or she would also focus on staff support/encouragement and model peer accountability at the bedside.

Leadership Competencies: Knowledge, Skills, and Aptitudes Nurses Need to Lead Organizations Effectively

The healthcare workplace is comparable to what a person sees when looking through a kaleidoscope: as the moments pass, an endless variety of patterns emerges. Undesirable patterns that have materialized include the widely publicized shortage of nurses in the workforce and the high rates of turnover among nurses. Healthcare organizations increasingly depend on recruitment and retention of nurse-managers to reverse these trends. NURS 4020 – Leadership Competencies in Nursing and Healthcare Research Paper

Critical care nurses become leaders through a variety of routes, many of which do not include formal managerial training or education. To produce positive results, critical care leaders need effective strategies to manage departmental operations and inspire staff. One strategy used by chief nursing officers, professional nursing associations, and employers is to design and implement formalized critical care leadership and managerial training programs that are evidence based and results oriented. In “Leadership Research in Business and Health Care,” Vance and Larson1 report an under use of evidence-based research in the development of healthcare leaders. The evidence-based research that is available is largely descriptive and is poorly translated into healthcare.

In this article, I provide a compilation of practical managerial skills for critical care nurses in formalized managerial roles, as well as leadership skills that are useful for all nurses. These skills are based on my managerial and leadership experience, the findings of numerous experts, and healthcare and business resources.

The highly divergent and dynamic leadership skills described herein mirror the responsibilities of critical care managers. The skills also illustrate the need for open-minded leaders who collaborate with colleagues and peers to prepare for and respond to the multifaceted challenges that arise every day. For purposes of clarity, the leadership skills are grouped into 4 main categories: NURS 4020 – Leadership Competencies in Nursing and Healthcare Research Paper

  1. organizational management

  2. communication

  3. analysis/strategy, and

  4. creation/vision.

Included in each of these categories are key skills and abilities that make leaders effective. Although the categories are an artificial separation of skills that intertwine and overlap, the skills are discussed separately for the purpose of explaining each skill and demonstrating its applicability. Despite the expansive nature of this topic, the examples are brief; the references cited provide additional information and resources.

Healthcare businesses can benefit from examples of other successful organizations. The book Built to Last,2 a study of successful corporate habits, indicates that continuity of leaders and ongoing leadership development contribute significantly to the success of an organization. Organizations and their shareholders benefit if employees are taught to manage time, information, human resources, change, revenue and expenses, information technology, and equipment. In a follow-up research book, Good to Great, Collins3 describes a level 5 leader as one who builds enduring greatness through the use of personal humility and professional will to mentor others to do the right thing, one who takes responsibility for failures while giving credit to others for their success, and one who relies on inspired standards to motivate others. He states that level 5 leadership is one of the key determinants of organizational greatness. The essence of “great” leadership is effective management of oneself and others in response to a variety of situations. Therefore it is essential that leaders learn to manage their emotional response to a variety of situations and others’ actions. NURS 4020 – Leadership Competencies in Nursing and Healthcare Research Paper

How staff members perceive nurse-managers is critical to recruitment and retention efforts. Wieck et al4 suggest areas for the betterment of current and future leaders. They indicate that the entrenched and emerging workforce wants leaders who demonstrate honesty, integrity, and optimism. Workers want good communicators who are receptive to others and who are motivational, fair, approachable, and empowering.4 Results of “Reversing the Flight of Talent,” a survey of 1600 staff nurses conducted by the Advisory Board’s Nurse Executive Center, indicate that nurses want to work for effective nurse-leaders.5 Of the nurses surveyed, 84% had considered leaving their jobs because of dissatisfaction with their direct managers; however, only 43% of nurses surveyed who were very satisfied with their managers had still considered leaving nursing.5 Incorporating research findings on healthcare and business leadership into educational programs for nurse-leaders will expand and enhance their leadership skills. NURS 4020 – Leadership Competencies in Nursing and Healthcare Research Paper

Managing Human Resources

An enormous part of the nurse-leader’s role is the management of human resources, specifically nursing resources. Considerable attention is paid to the complexities of understanding people, because just as with a disease, it is easier to implement interventions if the diagnosis is known. Geddes et al13 conclude that a need exists for fiscal accountability, quality-enhancing management strategies, and personnel management. How to involve and engage critical care nurses should be included in the training of nurse-leaders. Kouzes and Posner14 concluded that genuine caring for people (critical care nurses) is at the heart of effective leadership. How critical care nurses interact with patients and with colleagues directly affects not only satisfaction among customers and employees but also the safety of patients. Therefore, teaching critical care leaders how to manage human resources is vital to an organization’s success.

The human resources department and hospital policies guide nurse-leaders in decision making. The current nursing shortage and high turnover rates indicate a need for collaboration and close working relationships with human resources professionals. Those professionals can track the reasons for high turnover, vacancies, and/or excellent retention of critical care nurses. Mark and Critten15 suggest that the future focus of human resources departments should be organizational central intelligence and the facilitation of organizational learning and creativity. NURS 4020 – Leadership Competencies in Nursing and Healthcare Research Paper

Siddiqui and Kleiner16 reviewed human resources operational management and concluded that health-care organizations should adapt the latest methods used by human resources professionals. These methods include encouraging diversity in the workplace, promoting from within the company, and cross-training personnel whenever possible.16 Ridenour17 reports that leadership competencies influence patients’ outcomes, continuous learning, relationships with customers, use of resources, strategic planning, and compliance. How employees are treated and mentored is critical to retention efforts; therefore, management training should include interpersonal skills and strategies for responding to different personalities.

Leaders learn strategies to create a culture of understanding through the use of personality-profiling tools. Effective profiling tools are non-judgmental, accurate, applicable, and easy to understand. One of the best-known tools is the Myers Briggs Type Indicator.18 This tool is an instrument for measuring a person’s preferences by using 4 basic scales:

  1. extraversion/introversion,

  2. sensate/intuitive,

  3. thinking/feeling, and

  4. judging/perceiving.

Combinations of the different preferences can result in 16 personality types. An understanding of the personality type is crucial to a leader’s ability to empathize with another person and what that person may be experiencing. NURS 4020 – Leadership Competencies in Nursing and Healthcare Research Paper

The Keirsey Temperament Sorter19 is a profiling tool based on the theory that every personality has 2 sides. Temperament is partially inherent at birth, whereas character is a set of learned habits or skills. With this tool, temperaments are sorted into 4 basic categories with multiple combinations. Persons with artisan temperaments are predisposed or born to impulsive action; those with guardian temperaments, to responsible service; those with idealist temperaments, to personal development; and those with rational temperaments, to objective analysis. The survey consists of 70 questions and results in a person’s profile of combinations. The temperament analysis is a method for understanding a person’s character through the identification of the person’s learned habits and skills.

A newer profile that is nonjudgmental, accurate, applicable, and easy to understand is Time Typing.20 The titles “Past,” “Present,” and “Future” are metaphors for physical time and are used to explain that opportunity, knowledge, and control are reference points from which persons interpret situations and make decisions. This model also helps persons understand what motivates them, how they gain self-esteem, how they communicate, and what types of reward systems they prefer.

Persons of the Past type are attuned to information and risk aversion. Past-oriented people are very comfortable with gathering and analyzing data and they seek the “truth.” Persons of the Present type are attuned to control. They create organization out of chaos and excel at creating and following a plan. They have patience and strive to create stable harmonious environments, often by maintaining the status quo. Persons of the Future type are attuned to opportunity. They thrive on chaos and change. They don’t want to miss an opportunity so they don’t turn anything down but will quickly abandon things that won’t work. Theorists think that people have some characteristics of all 3 types, but everyone has a primary or dominate perspective or “way of looking at the world.” NURS 4020 – Leadership Competencies in Nursing and Healthcare Research Paper

Time Typing does not have complex combinations of “types” that require the learner to focus more on understanding the personality profile than understanding a person’s decision-making style. It is an ipsative tool that compares the person to himself or herself. Most of the other profiling tools are normative, ranking the person against others and creating a judgmental environment that contributes to selection bias. Time Typing also includes tools to help evaluate team dynamics and a decision wheel that helps leaders facilitate decision making. Its simplicity makes it a powerful corporate training tool. Table 3⇓ is a comparative representation of the 3 types of tools: Myers Briggs Type Indicator, Keirsey Temperament Sorter, and Time Typing.

Understanding cultural norms and diversity is just as important as understanding individuals. Dreher and Macnaughton21 contend that cultural competence is really nursing competence. As communities become more diverse, it is important that leaders adopt strategies to teach, provide feedback, and motivate persons from different cultural backgrounds and different skill mixes. For example, asking patients to participate in focus groups and report their feelings and perceptions of their treatment allows managers and staff to see the world from the patients’ eyes, including the patients’ cultural views and norms.

Leadership mentoring bridges the regulatory and subjective aspects of human resources management through the pairing of experienced leaders with novice leaders. To illustrate a type of mentoring, Montgomery22 presents a descriptive method whereby an experienced professor mentors a doctoral student in the needed leadership and administrative experiences. The mentoring of new critical care managers by the chief nursing officer should occur over time and is enhanced through the resolution of increasingly complex situations. NURS 4020 – Leadership Competencies in Nursing and Healthcare Research Paper

Key Nursing Leadership Competencies

Health care environments today challenge the skills of even the best nursing leaders.  Whether it is issues of retaining staff, concern about patient safety, meeting the budget or complying with regulatory rules, more demands are being made of professionals in nursing leadership positions.  In 2002, I was part of a research team that conducted research that involved interviews with 120 nursing managers in South Florida to determine their perspective on the leadership skills needed by nursing leaders today.  The results of this research were reported in the Journal of Nursing Administration in 2007.  These results are still timely today nearly one decade later.  Nurse leaders identified personal mastery, interpersonal effectiveness, financial management, human resource management, caring and systems thinking as critical leadership competencies for today’s nursing managers.  Here are some of the insights that they shared with us.

1.  Personal Mastery

Leadership skills begin with understanding one’s self.  Personal Mastery is a critical component for leadership success.  Outstanding leaders demonstrate self-confidence and are able to trust and empower others.  They know how their communication and actions impact others and are sensitive to watching the cues in an environment when things are not going well.  Nurse managers told us that to be a great leader, your staff needs to have confidence that you are trustworthy and treat everyone fairly.  Leaders make mistakes but having personal mastery is being able to look at your mistakes, acknowledge them and learn from them.  There is nothing that staff appreciates more than a leader who is able to say “I was wrong”.

2.  Interpersonal Effectiveness

Interpersonal Effectiveness was felt by the managers in our study to be a second key for success.  This skill includes not only the ability to communicate, listen and facilitate conflict but also “having a visible presence”.   Nursing staff today wants face-to-face contact with their leaders.  E-mail is simply not enough.  Staff wants to know that they can talk with their managers and feel that they are really being heard and known as individuals.  This is a challenge as the average number of staff supervised by an experienced manager in our study was 65 FTE. NURS 4020 – Leadership Competencies in Nursing and Healthcare Research Paper

3.  Financial Management

Nursing leaders will not survive in their roles if they are not savvy about Financial Management, our third key for success.  Most nursing leaders in our study cited this as their weakest area.  There is constant pressure to justify the nursing staffing budget, which is a critical part of any hospital’s operating budget.  There is now good research to support that higher RN staffing ratios results in better patient outcomes.  Proposals that clearly outline the financial benefits of RN staffing models will need to be constructed to make the arguments clear to Chief Financial Officers.  The costs of turnover and unfilled beds because of staffing issues need to be quantified and nursing leaders need to have confidence in presenting financial information.

4.  Human Resource Management

The healthcare job market today is a very competitive one.  Nursing leaders feel that their ability to do a good job of managing the human resources that they are given has never been more critical.  Retention begins with a sound selection and orientation process.  The needs and desires of nursing staff in different age groups are often very different.   Identifying what motivates staff and keeps them is an important part of their job.  Nurse managers in our study told us that it was important for leaders to keep open minds about scheduling, how to best develop staff and what might work as a reward system. NURS 4020 – Leadership Competencies in Nursing and Healthcare Research Paper

5.  Caring for Staff, Patients and Self

Of all the skills discussed, the managers we interviewed were most passionate about the need to demonstrate that as a leader you care.  The ability to maintain a disconnectedness to staff was a major theme.  Whether it means bringing in food or celebrating successes, a great leader cares for his/her staff.   Even with 65 FTE, our managers felt they needed to learn about each of their staff and their families.  Most told us that they try their best to accommodate the needs of staff for time off or shift schedules.  Despite the demands of the nursing leadership role, it is important not to become disconnected from the patients that you care for.  Our nurse managers told us that it was important for their staff to see them making rounds on patients.  The care of others whether it is staff or patients begins with self-care. This seemed to be a problem area for all but the very seasoned nurse managers that we interviewed.   Most of the nursing leaders we interviewed work very long hours and feel very responsible in this era of staffing turbulence to be a resource for their staff at all times. NURS 4020 – Leadership Competencies in Nursing and Healthcare Research Paper

6.  Systems Thinking

A final skill needed by nursing leaders today is the ability to be a systems thinker.  No nursing unit, profession, hospital, healthcare agency or healthcare network is an island today.  The healthcare system is interconnected and the challenges confronting the system impact all of us.  The nurse managers in our study told us that the most effective nursing leaders are “big picture thinkers”.  They make it a point to try to develop a good understanding of how the area that they lead fits into the whole of the organization and respect the perspective of other disciplines.  They are proactive in looking at new initiatives such as changes in Medicare reimbursement and HIPAA and assess the impact on the areas that they lead.  They look at health policy initiatives and educate their staff, patients and colleagues about the implications of what is being proposed.

Key competencies for nursing

Building a culture of innovation

To innovate is to put new ideas into practice or existing ideas into practice in new ways. Innovation isn’t new, but its prominence and need in health care continues to increase. Addressing the complexities of healthcare delivery requires creative solutions and approaches that challenge the status quo. Building a culture of innovation necessitates developing skills that allow for ongoing innovation. For this reason, the American Nurses Association (ANA) is focused on nurse-led innovation for healthcare improvement as a part of its strategic goals. NURS 4020 – Leadership Competencies in Nursing and Healthcare Research Paper

Key competencies have been identified before, but nursing hasn’t adopted them as applicable to the innovation movement. The five competencies that all nurses should be proficient in include:

  • Creativity: Innovative solutions are the product of divergent thinking and creative problem solving. Nurses can demonstrate divergent thinking by identifying problems and developing a broad set of solutions. This is similar to brainstorming, and it’s a catalyst for creative ideas.
  • Spanning boundaries: Innovation happens when silos are broken down. Teams, departments, or organizations find creative solutions when they look outside of their own walls and across a broad scope of stakeholders. Cross-functional, interprofessional teams attain a better-balanced outcome that represents a variety of areas, making solutions more likely to “stick.” And inspiration may come from fields entirely outside of health care.
  • Change management: Nurses should be able to support and guide change within their organizations. The ability to embrace what’s new and different and help it develop “roots” is an important role for nurses, especially in such a dynamic environment. At the same time, organizations need to be agile and flexible to successfully adapt and even thrive when the unexpected happens. This is more likely to occur in a culture where creativity is recognized and rewarded. NURS 4020 – Leadership Competencies in Nursing and Healthcare Research Paper
  • Considered risk-taking: Creative problem-solving results in bold, often risky ideas. Yet risk-taking is often looked upon negatively in health care, and focus is placed on minimizing risks to prevent errors and reduce harm. Considered risk-taking is an intentional and thoughtful process where both benefits and potential problems are taken into account before an action is pursued.
  • Failure tolerance: Taking calculated risks means accepting that failure is a possibility and proceeding anyway. Innovative organizations embrace frequent failure as a learning opportunity. Leaders who role model failure as an opportunity for growth, build trust. The work of innovation continues, and success becomes more likely. NURS 4020 – Leadership Competencies in Nursing and Healthcare Research Paper

 

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