Leadership & Management Brad Beck National University NSG 340A Christine Basiliere March 25, 2009Leadership & Management UL ‘The leader that I have followed is a charge nurse named Bea on 2 west of Kaiser Hospital. My first impression of Bea was that she seemed somewhat young on a floor of nurses ere ererees cy ereeoea he During the course of the first day that I was assigned, T ‘became more impressed with her as I found out how she handled her staff'and what she had accomplished during her time as a registered charge nurse. oe : Bea has worked at Kaiser for the eight yeas sinde graduating from nursing school. She received her ADN in nursing, but gives the impression that she might hold a higher degree the way she carries herself as a leader. When Bea started as a charge nurse on 2 west, the unit did not have a charge nurse for about 9 months. The floor was run by some of the more experienced nurses, but did not have a real leader. This made for a difficult situation to take over since many administrative tasks were not handled like a rotation schedule. At the time, Kaiser did not like to ~ put younger nurses in the role of charge nurse, but Bea proved that she was the right person to . de" vw take the job. The style of leadership that stood out to me the most was more of a democratic aN ivi and get help if they need it. She does not want to eZ micromanage her nurses. Democratic leadership is the type of leader who makes decisions by gathering information from the team before making a clear decision. (Whitehead, Weiss & Tappen, 2007) The role that Bea holds also needs to use a slight autocratic approach since she hhas to assign nurses patients. An autocratic leadership is a style when the leader gives orders and makes decisions for the whole group. (Whitehead, Weiss & Tappen, 2007) During my time a Pent with Bea, I noticed her ability to listen to nurses, CNAS, and doctors. She also was willing a yf to jump in and help other nurses who were too busy to handle all of their tasks. I witnessed her start a couple of IVs when the assigned nurse was busy handling other things. During the courseof the day I also noticed her upbeat personality. Her friendly attitude seemed to allow her nurses to not have a problem talking to her about any issues they hud. I was also able to witness how well Beu was when handling stress. Early on in the day a doctor was extremely mad when f certain labs were not drawn for his patient who was to be discharged that day. He proceeded to yell at Bea in on the floor in front of myself and other nurses. Bea calmly spoke to the doctor while fixing the situation of the labs. While assigned to Bea, | was able to speak to her about some of the decisions that she has had to make while working as a charge nurse. She told me about a time when there were six terminally ill patients on the floor and a non-terminal patient had to share a room with a terminally ill patient. The terminal patient was asking for morphine and wanting to “just dic” ) Bea noticed that the non-terminal patient’s mood was declining and started hanging up on his < wie who was also checked in tothe hospital for her own issues, Bea also noticed thatthe non- terminal patient has stopped eating, She made ita priority to move the terminal patient to a private room, and then noticed the mood of the non-terminal patient pick up. It is this kind of initiative that is important for effective leaders, They need to be aware of heir surroundings and act on their good ideas that will create a positive outcome. ‘Another leadership decision that I observed Bea make was for the training of traveling and floor nurses on the proper amount of oxygen that should be given to terminal patients. She felt that some ofthe float nurses and travelers were not giving terminal patients enough oxygen, A _ and decided to make it a priority to educate these nurses on end of life care. The ease that a Prompted this decision was a terminal patient with agonal breathing in which the nurse assigned 4id not tum up the oxygen to create a comfortable environment. This is an example of multiple behaviors of an effective leader. This is respecting the individual patient who might beuncomfortable at the end of their life. This is setting a specific goal to educate the nurses assigned to terminal patients, and this is also setting a vision for the future to create an environment for patients who might be experiencing an end of life situation to die in the most “comfortable” way possible, During her time as charge nurse, Bea has effected change by bringing order to a situation which did not have a charge for some time. 2 west is broken up into an oncology half, and a “dirty” half. ‘The dirty half is where any isolation patient is assigned, which tends to be harder nursing due to the precautions that are needed to be taken. While there no charge nurse to make sure that assignments were fair to all of the nurses staffed on the floor, the “older” nurses got to pick the clean oncology side and gave the “dirty” half to the newer nurses. When Bea started as ‘the charge, she created a rotation schedule for the nurses to make the staffing situation fairer to the newer nurses. Most of the nurses did resist the change of the rotation with the exception of one older nurse. Bea had to hold to the schedule and started proving that she would be an effective manager and not cave to the pressure of the more experienced nurse. After some time, the nurses accepted this change, and it is still in effect today. Another change that Bea implemented was the job descriptions of the CNAs assigned to the floor. When Bea started as charge, there was no reall job description for the CNA. The patient load for a RN was 7 patients and multiple CNAs who would mainly stock the units and the patient's rooms. The CNA would usually not be involved in patient care. After taking over, she created a job description for the CNA to be involved in patient care, and also to stock the Units. This allowed the nurse to provide better patient care since they did not have to be delayed in a duty that a CNA js able to handle. There was little resistance to this change ftom the RNs, and some resistance from the CNAs. This is also still in effect on the unit.The unit has the charge nurse and utilizes a breaker nurse to provide breaks to nurses as they need them. Since the unitis so big, the breaker is the second in charge, and is also an experienced nurse. The breaker will fill in as charge nurse when they are not able to work on the assigned day. ‘The charge will also operate as a breaker on half of the unit due to its size. The nurses who would be considered “followers” have a god relationship with Bea. This is most likely due to her attitude and willingness to help out when needed. Kaiser Zion Hospital is part of the Kaiser Permanente Health Maintenance Organization. It is a not for profit organization with about 8 million members. ("Fast facts about kaiser permanente," 2008) Kaiser’s philosophy is “focusing on preventing illness as much as caring for ae . ("Fast facts about kaiser permanente," 2008) Kaiser's organization is a traditional the sich hierarchial structure. This is where there is a Vertical line of authority. (Whitehead, Weiss & ‘Tappen, 2007) There is a CEO department managers above the nursing department manager. The charge nurse answers to a department administrator (nursing manager). (Nursing department organizational plan, 1994) Once the organization reaches the nursing floor, the vertical structure is still present, but the decisions become a little more democratic within the unit. Kaisers nursing care delivery fethod utilizes a team nursing approach and total patient care. (Nursing department organizational plan, 1994) The nursing mission is to provide patients with nursing care, building relationships with providers and departments within the organization, achieving patient focused outcomes and is reflective of the high standards of performance of the nursing staff. (Nursing services mission) The time spent at Kaiser was educational. I was fortunate to be placed with Bea as the leader to follow around. She was a great example of what can be done as a young leader who is not afraid to jump in and work to make effective changes.References Kaiser Permanente. (2008). Fast facts about kaiser permanente. Retrieved March 24, 2009, from hitp://xnet.kp.org/newscenter/aboutkp/fastfacts.himl. Nursing department organizational plan (Kaiser nursing policy). (1994). Kaiser Foundation Hospital. Nursing services mission. Kaiser Foundation Hospital. Whitehead, D., Weiss, S., & Tappen, R. (2007). Essentials of nursing leadership and ‘management 4th edition, Philadelphia: F.A. Davis, A es we’GRADING SHEET FOR NURSING LEADERSHIP & MANAGEMENT PAPER Criteria Possible | Earned Points | Points Identify a “leader” within your clinical setting, 5 State why you selected this individual to study (cite individual’s ttle, cS position, etc. within the institution) Identify the characteristics/qualities of this individual that define him/her as | 5 a“leader”. Appropriately apply all leadership concepts/theories. al Cite and discuss at least two specific examples of the leader’s decision 5 ‘making style/process (management style), discussing/applying SPECIFIC cr concepts/theory pertinent to leadership in nursing, How does the leader effect change? Discuss the change process utilized. 7 ‘What strategies were utilized by the leader to effect change? What were the barriers to change? How were these barriers overcome? What suggestions w/, could you make as to implementation of change? Assure discussion of specific leadership/management in nursing concepts and theori Describe the “followers”. Describe and discuss specific behaviors exhibited | 5 during the change process, enhancing or detracting from the implementation of the specific changes. Utilize appropriate leadership/management we concepts, premises, and theories as applicable. Discuss the working environment/organizational structure in which the 10 leader functions, discussing IN FULL the type of organizational structure of the agency, citing and discussing principles, concepts and theories of the agency's organizational structure on the behaviors/values of the leader/manager and followers. Discuss and cite factors which enabled or q detracted from the leader's implementation of change, Were there any factors (policies/procedures; time; values; control, etc.) which influenced the change implementation? Describe and make suggestions as to how the Jeader managed or could have beiter managed these factors. Utilize appropriate leadership/management concepts, premises and theories as applicabl Correct use of APA style overall 3 References within last 5 years (primary sources) S Grammar/Spelling a [Total Points: AA / read 40