Running head: LEADERSHIP STRATEGY ANALYSIS

Leadership Strategy Analysis
Cheryl Hamilton, Jaya Lingam, Samantha Poma, & Sydonie Stock
Ferris State University

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LEADERSHIP STRATEGY ANALYSIS

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Abstract

Quality improvement is an ongoing concern in the healthcare setting. One aspect of care that is
under constant scrutiny is the quality of report given from one nurse to another during change-ofshift. Utilizing a checklist while at the patient’s bedside will assist the nurses in communicating
pertinent patient information and ensure quality patient care. The checklist will be evaluated by
the nurse manager in order to identify areas of the report that needs improvement. The use of
checklists and the results from data collected will be evaluated throughout the course of the study
in order to demonstrate their effectiveness in streamlining report and improving quality of care.

LEADERSHIP STRATEGY ANALYSIS

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Leadership Strategy Analysis
Shift transition and patient handoff from one nurse to the next is a vital component of
quality care for patients. With quality of patient care influencing all areas of healthcare, it is the
nurse’s duty, to evaluate the components of nursing handoff to enhance the quality of care. Over
the years, nurses have been exploring best practices to ensure quality of care during end of shift
report. One way of producing quality care is to conduct handoff at the bedside (Costedio,
Powers, & Stuart, 2013). According to Reinbeck and Fitzsimons (2013), utilizing bedside report
empowers staff, permits a safe handoff of care between nurses, and improves patient
participation of their own care.
One uses strategies in order to implement effective change (Yoder-Wise, 2013). In order
to implement changes in bedside report, participation, communication, education, information,
and support are necessary (Yoder-Wise, 2013, p. 337). A transformational leadership style can
be assumed in order to inspire staff to be emotionally engaged and connected with the changes
taking place (Yoder-Wise, 2013). Transformational leaders are inspiring and use communication
techniques to promote change (Yoder-Wise, 2013). By being a transformational leader, one can
use these strategies to effectively implement the change of patient handoff between nurses
(Yoder-Wise, 2013).
Support for Change
End-of-shift report has been evolving over the years. Some have entailed use of
gathering around a tape recorder in one room to listen to what the previous shift had to say. In
this instance there is no way to ask questions to the previous nurse nor is the patient there to give
their feedback.

LEADERSHIP STRATEGY ANALYSIS
Cairns, Dubjak, Hoffmann, and Lorenz (2013), discovered that bedside report can
increase quality and decreases risk and liability factors. Their study concluded that utilizing
bedside report produces positive outcomes such as decrease in call light usage, increase in
patient satisfaction, and decreases shift overtime (Cairns et al., 2013). The use of a checklist
during end-of-shift report also increases quality of care. Following a checklist decreases
unanswered questions and increases nurse preparedness (Welsh, Flanagan, & Ebright, 2010).
Applying bedside report as a set standard in the clinical practice provides safe,
collaborative care that involves the patient (Costedio, Powers, & Stuart, 2013). This method of
handoff enhances communication and quality of care for the patient if consistent and accurate
information is exchanged during this time (Reinbeck & Fitzimons, 2013). It is important to
incorporate a bedside report that is presented in a systematical, consistent matter in order to
increases quality of care (Costedio, Powers, & Stuart, 2013).
Collaborative Team
Teamwork and collaboration are important aspects in health care. The interdisciplinary
team consists of nurses, nursing technicians, nursing students and charge nurse. It is essential
to have good communication between the health care team in order to provide the best care
for patients. Safety is the highest priority when it comes to patient care. Patient safety is an
integral part of teamwork and collaboration. Having clear communication between the health
care team about care plans, goals for treatment, or changes in care is very important. If team
members communicate effectively, they are able to collaborate and work together as a unit to
provide the best care possible for the patient (Yoder-Wise, 2013).
The interdisciplinary team that will be utilized to implement the change to bedside
report will include the incoming and outgoing nurses, nurse technician or aid, patient and

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family, and the nurse manager. The incoming and outgoing nurses will perform the bedside
report with the checklist on each patient during change-of-shift. These team members are vital
to the compliance and effectiveness of policy changes regarding utilizing a checklist during
bedside report. The nurses will use the checklist to help guide change-of-shift report in order
to ensure all pertinent information is being communicated. It is important that the technician
or aid is included in the bedside report because bedside “reporting can promote teamwork and
staff accountability, helps prioritize patient care” and allows patients to communicate with the
technician or aid about their care (Radtke, 2013, p. 22). The nurse manager will receive each
checklist after report is given and will review them to identify areas of concern that need to be
addressed.
Study
Data Collection
In order to make effective changes, leaders must analyze and reanalyze the data. This is
done in many different ways determined by the type of data being studied (Yoder-Wise, 2014).
For the change-of-shift report, it is necessary to determine first if a change needs to be made.
Appendix A is a survey designed to collect patient perceptions of the efficacy of nurse’s changeof-shift reports. Although nurses may not be compliant with change initially, if the patients’
perceptions of the report are negative it will negatively affect the unit and the hospital. As SandJecklin and Sherman (2013) found, being included in the report process improves patient
satisfaction with care. Appendix B shows a survey designed to record the nurses’ opinions of
their report experiences. If the nurses believe there could be improvement in the reporting
process, changing the change-of-shift reports will happen more smoothly. Appendix C is the
data collection form utilized during report. This provides an ordered list of every topic that

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needs to be covered for the next nurse. The nurse receiving report will mark the appropriate
column correlating to the topics listed. These lists will then be analyzed, using a Pareto chart to
identify the areas of report that need the most attention (Yoder-Wise, 2013).
Goal
Just as nurses and patients make goals to improve the patient’s health and quality of life,
goals must be formed to improve care processes as well. The goal formed for shift report is:
improved satisfaction with bedside report by nurses and patients by six months. It will take time
for the nurses to get used to the new checklist and to appreciate what it does for the report
process, even if all the nurses involved agree the change is needed.
Strategies
Before implementing any changes to the shift report, the surveys found in Appendices A
and B must be distributed to the patients and nurses in order to determine current satisfaction of
change-of-shift report. Responses from these surveys will be included in the experimental
changes and will be added to the report checklist found in Appendix C. As White (2014)
discussed, it is vital to have the team members’ input in the policy change to make that change
successful. Introduction of the checklist will occur during staff meetings the week before
implementation. During report, the nurses will utilize the checklist, marking whether or not the
outgoing nurse met each line item or if the oncoming nurse had to ask about the line item. After
report both nurses will sign the checklist and will then turn it in to the nurse manager. In order to
encourage the use of the checklist, lunch will be provided for each month that every person
submits a completed checklist for the first six months. After the initial six month period, the
reward schedule will be re-evaluated.

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Evaluate
Evaluation is a constant part of change. The responses on the checklists will be
monitored weekly by the nurse manager to evaluate if there is an improvement in report content.
Each month, the results from the checklists will be compiled into appropriate charts and graphs
to better portray the data collected. The information gained from these data displays will show
where education or further assistance is needed. At the end of the first six months using the
checklist, satisfaction surveys will be re-administered to evaluate if patient and nurse satisfaction
has changed and to gather information that will assist in the continuous improvement of the
change-of-shift report process.
Support and Analysis
Bedside report is an effective method that “can result in improved patient and nursing
satisfaction and patient safety outcomes” (Sand-Jecklin & Sherman, 2013). It is important for
nurses to perform their change-of-shift report at the bedside because it allows the patients to be
better informed, increases patient understanding, and leads to increased patient involvement in
their care. If nurses are at the bedside, the patient is able to listen to report and learn how they are
improving, what care has been provided, and any future care plans. At this time, patients are
also able to ask questions and help participate in report by discussing changes that the nurse may
not have known. If report is done away from the bedside, it “does not provide an opportunity for
the patient to be included in developing or revising plan of care and goals” (Cairns, Dudjak,
Hoffman, & Lorenz, 2013, p. 160).
The use of checklists will enable the nurses to communicate more effectively about
pertinent information pertaining to the patient. “A core component of nursing practice is to
ensure the communication of information facilitating the transition of care from one provider to

LEADERSHIP STRATEGY ANALYSIS

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another” and the checklist will help guide the nurses through proper report procedure (Cairns,
Dudjak, Hoffman, & Lorenz, 2013, p. 160). In a study conducted by Cairns, Dudjak, Hoffman,
and Lorenz (2013), it was discovered that the use of “a standardized patient safety checklist and
face-to-face report at the bedside improved effectiveness of communication of nurses at change
of shift”.
Peplau’s interpersonal theory can be utilized to support the need for report to occur at the
bedside. Radtke (2013) states that “Peplau’s interpersonal relations theory defines the
relationship between the nurse and patient as one that is therapeutic and based on trust and
mutual understanding, as well as open communication” (p. 20). It is important to understand that
performing change of shift report at the bedside and utilizing checklists allows the nurse to have
effective and open communication with the patient as well as the other nurse. Performing report
at bedside as well as using checklists will lead to increased quality of care and patient
satisfaction.
Conclusion
Quality can be measured in a number of ways using graphs and charts to aid in the
interpretation of data. The measurement methods utilized for change-of-shift report are surveys,
checklists, and graphs that will display the quality and effectiveness of report. Effective
communication is important during change-of-shift reports to increase quality of patient care.
The use of a checklist during bedside report will ensure all pertinent information is being passed
from one nurse to the next. Preforming this report at the patient’s bedside will enable the patient
to be an active partner in his or her care and will improve the quality of care received.

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References

Cairns, L., Dudjak, L., Hoffman, R., & Lorenz, H. (2013). Utilizing bedside shift report to
improve the effectiveness of shift handoff. The Journal of Nursing Administration, 43(3),
160-165. doi: 10.1097/NNA.0b013e318283dc02.
Costedio, E., Powers, J., & Stuart, T. (2013). Change-of-shift report: From hallways to the
bedside. Nursing, 43(8), 18-19.
Radtke, K. (2013). Improving patient satisfaction with nursing communication using bedside
shift report. Clinical Nurse Specialist, 27(1), 19-25. doi:
10.1097/NUR.0b013e3182777011
Reinbeck, D. & Fitzimons, V. (2013). Improving the patient experience through bedside shift
report. Nursing Management, 44(2), 16-17.
Sand-Jecklin, K. & Sherman, J. (2013). Incorporating bedside report into nursing handoff:
evaluation of change in practice. Journal of Nursing Care Quality, 28(2), 186–194.
Welsh, Flanagan, & Ebright. (2010). Barriers and facilitators to nursing handoff:
Recommendations for redesign. Nursing Outlook, 58(3), 54-148.
White, A. (2014). Implementing change in the perioperative setting. AORN Journal, 99(2), C7-8
Yoder-Wise, P. (2014). Leading and managing in nursing (5th ed.). St. Louis, MO: Elsevier
Mosby.

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Appendix A

Patient Report Satisfaction
Spectrum Health encourages you to be partners in your healthcare. One way to include you in
your care is to give “Bedside Report” – the Nurse leaving tells the oncoming Nurse your history
and your care plan while in the room with you.
In an attempt to better serve our patients, we are conducting a survey research that will evaluate
how the Nurses perform “Bedside Report”.
During your current admission, how many days have you been on this unit? _______________
Please respond to the following statements:
1. The oncoming Nurse, or the Nurse taking over your care, was knowledgeable about your
health history and your current health problems.
1
Very Satisfied

2

3

4

5
Not Satisfied

2. The Nurse Aid or Nurse Tech working with you was knowledgeable about your health history
and your current health problems.
1
Very Satisfied

2

3

4

5
Not Satisfied

3. The “Bedside Report” was performed in your room and you were able to participate if you
wanted.
1
Very Satisfied

2

3

4

5
Not Satisfied

Please provide any suggestions you may have to make your “Bedside Report” experience better:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

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Appendix B

Nurse Report Satisfaction
In an attempt to make change-of-shift report go more smoothly, we are conducting a survey
research on current satisfaction levels of change-of-shift report.
How many years have you worked on this unit? ________________
Please answer the following questions:
1. This hospital operates on Patient Satisfaction. How satisfied do you think the patients are
with your Bedside Report?
1
Very Satisfied

2

3

4

5
Not Satisfied

2. How satisfied are you with the organization and ease of receiving report?
1
Very Satisfied

2

3

4

5
Not Satisfied

3. How often do you feel report is rushed and/or chaotic?
1
Very Often

2

3

4

5
Not Often

4. How often do you stay overtime because of change-of-shift report?
1
Very Often

2

3

4

5
Not Often

5. How often do you perform change-of-shift report at the patient’s bedside?
1
Very Often

2

3

4

5
Not Often

Please provide any suggestions you may have to make change-of-shift reporting better:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

LEADERSHIP STRATEGY ANALYSIS

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Appendix C

Bedside Report Checklist
Oncoming Nurse: please complete this checklist based on the report you receive. Give
completed sheet to your manager.

YES

NO

I
HAD
TO
ASK

Are you in the patient’s room?
Is the Nurse Aid or Nurse Tech with you?
Patient’s name and age
Patient’s code status
Patient’s allergies
Patient’s diet
Patient’s admission diagnosis
Patient’s admission date
Is the patient in Isolation? Why?
Patient’s Physicians and Therapies
What event brought Patient to this unit?
Patient’s health history
Most recent labs AND previous labs to show a comparison
Most recent blood sugars AND previous blood sugars
Meds: when was the last PRN given, when is it due next?
Where has Patient’s pain been?
What tests are scheduled?
When is PT. OT. Speech supposed to come?
Did anything notable happen during the shift? During the previous
shift?
Where is the Patient’s IV? Hep-locked? Fluids?
When is the IV and tubing due to be changed?
Patient’s family and involvement level
Nurse giving report ___________________________________

Date ________________

Nurse receiving report _________________________________

Date ________________

LEADERSHIP STRATEGY ANALYSIS
I.

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Leadership Strategy Analysis – Quality Improvement Process

Purpose: Nursing leaders, managers and followers must be committed to a quality
improvement culture. To work effectively in a quality-focused environment nurses must
participate in Quality Improvement initiatives. This assignment will give you the opportunity to
analyze a clinical activity from a Quality Improvement perspective.
Assignment Guidelines:
1. Select a clinical activity to be reviewed. This could be a problem you have identified in
clinical or simply an area of nursing that has been considered a standard of care or a
care delivery practice for some time.
2. Identify and design a collaborative team to review the activity. This team should include
stakeholders or other disciplines that are affected by the clinical activity. Justify the
inclusion of each team member by identifying their purpose or function on the team.
3. As a team:
a. Design and perform a data collection method for reviewing the clinical activity.
(See Yoder-Wise p.396)
b. Establish a goal for improvement.
c. Identify strategies that will be used to implement change.
d. Establish a method for evaluating movement toward the desired goal.
4. Provide support and analysis, utilizing theory and current research, for each step of
quality improvement process.
5. Paper must be in APA format.
6. Paper should be 5-8 pages in length. 8 page maximum with the exclusion of the
coverpage, abstract and references.
7. See the grading rubric for further details.
Grading Rubric for
Leadership Strategy Analysis – Quality Improvement Process

Introduction: Background and
purpose for quality and safety
initiatives. Discusses the leadership
strategy to be performed.
Identify Clinical Need: Identifies a
clinical activity for review. Provides
an analysis of the problem using
current nursing literature.
Designs an Interdisciplinary Team:
Identifies and analyzes the inclusion
of team members involved with the
problem.
Data Collection Method: Chooses
and designs a method of data
collection. Provides support for
collection method as a leadership
strategy.
Establishes Outcomes: Identifies a

POINTS
POSSIBLE
5

10

10

10

5

POINTS
AWARDED

Comments

LEADERSHIP STRATEGY ANALYSIS
standard of care (goal for
improvement) that reflects evidencebased practice.
Implementation Strategies: Selects
and describes a process for
implementing change. Integrates
theory and EBP to support the
identified process.
Evaluation: Identifies and designs a
method for measuring improvement.
Integrates theory and EBP in
analyzing improvement.
Scholarship: Integrates evidence of
theory, current evidence-based
research and information
management resources to support
decisions.
Sentence structure, spelling,
grammar & punctuation; APA
Format
TOTAL POINTS

14

10

10

10

30

100