Leadership Skills Mentoring and Coaching

When I was a  manager of a team of nurses and social workers, collaboration existed in my direct report team, and as a team, we functioned using critical thinking, interdisciplinary team approach and collaboration on cases together.  But in the big picture of corporate America under the manager that I reported to, this was not acceptable, it was more along the lines of a multidisciplinary team.  In this type of team, you only have individual thinking in the group, meaning their way and no other opinions.  The focus would be on tasks and check off systems regardless if it was feasible to do (Rubenfeld & Scheffer, 2014).

Nurses do have the ability to be leaders, educators and changers of a system, if assertive enough to make that change, but in order to do so, a good team of interprofessional people is needed (Denisco & Barker, 2012). Because at the end of the day, the patient is who counts and why changes are necessary. If more companies were focused on having a management style that was transformational vs transactional, this would alleviate the unnecessary resignation of employees, corrective action plans and disgruntled employees.

In my team, for instance, a good way that we incorporated learning was to have one person do a case study every week.  They would team up with another person on the team to present the case study on a difficult patient.  During this time the team had the ability to comment on the case, make suggestions and also refer to our medical director for review.  This allowed me to mentor the nurses and social workers during our weekly meetings so that we could continue to go over any other cases that may have been difficult or of concern to them.

 

References

Denisco, S. M., & Barker, A. M. (2012). 25. Advanced practice nursing: Evolving rules for the transformation of the profession (2nd ed., pp. 547-567). [Vital Source Bookshelf] Retrieved from https://campus.capella.edu/web/library/home

Rubenfeld, M. G., & Scheffer, B. (2014). Critical thinking and patient-centered care. Critical thinking tactics for nurses: achieving the IOM competencies (3rd ed., pp. 155-180). [Vital Source Bookshelf]. Retrieved from https://campus.capella.edu/web/library/home

 

 


Source: Rosie’s Nurse Corner

Leadership Theories and Attributes

I had the opportunity to interview Mary Alice Cullen, a Director of Patient Care Services.  She oversees the Neonatal Intensive Care Unit (NICU), labor and delivery, pediatrics, maternity ward, and the women’s clinic.   Mary graduated in May, 2016 with her Doctorate of Nurse Practice. Mary has always wanted to get her MSN.  As she started to study to get her MSN, it opened her eyes to endless possibilities of what she could do with her degree.  When she graduated with her MSN, the position that she was in opened up for her and she took on the job.  As she went through her role she wanted to make more of an impact on the role and the clients and staff she was supporting.  Mary decided to continue school for her Doctorate in Nurse Practice (DNP) with a concentration on Executive Doctorate in Nurse Practice, and this degree is also approved by the American Nurses Credentialing Center (ANCC). Her attributes are that of a caring leader, one that will work with her staff to encourage and teach them and empower them to be the best that they can be, even when they do not see that they can.

Mary does not often do hands-on care she is in an executive role.  However, she does round daily.  She provides support to her managers that manage the staff, in order to provide better care for the patients. Her leadership model is Kouzes and Posner, but if she is scrubbed in for surgery in labor and delivery, her transactional model side comes out.  Meaning this is a time as a transactional manager, where following directions the same way every day is crucial.  Mary most recently participated in a study that involved strategic planning of having single-family NICU rooms for the parents.  These were her visionary plans and the hospital agreed after the research was completed, that having individualized patient rooms in the NICU, would benefit the staff and the parents of the babies.

My leadership style is very similar to Mary’s in that I lead by example and I am not afraid to do the work that my staff does.  This makes a strong leader because the people who follow you will know that although you are in a position of higher authority, you will still be humble enough to do the job your staff does and be able to explain it from their side and understand the position that they are in.  Knowing your staff’s job by example, allows the manager to know the timeliness of things that need to be accomplished and the ability of each worker’s caseload and what they can manage. There are seven attributes to being a good leader and Mary possesses those in her character, her track record to be given assignments and projects that have been successful and in the skills that she shows handling her staff (Baer, 2012).

References

Baer, J. (2012). Theories of leadership. In Leadership in health care (2nd ed., pp. 45-69). [Vital Source Bookshelf]. Retrieved from https://campus.capella.edu/web/library/home

 

 

 


Source: Rosie’s Nurse Corner

Are Healthcare Workers Forgetting Good Patient Care

I remember most recently having a bad reaction to zinc when I took it on an empty stomach (yes learned that lesson) and passing out with blood pressure and blood sugar bottoming out.  I felt better on the ambulance ride to the hospital after some IV fluids.  The paramedics stayed with me until they had a room to take me to for an exam.  But the nurse then said since I was feeling better, I can get up off the stretcher and wait in the regular waiting room.  They sent an orderly to walk me to the waiting room.  I had my purse, winter coat, boots in one hand and my work bag in the other hand.  The orderly did not offer to get a wheelchair to help me considering I had just passed out an hour ago.  I thought to myself at that moment boy he is rude as he walked 20 feet ahead never looking back to see if I was okay and two, never offered to help carry anything.  My husband arrived minutes later and was appalled at the treatment of a patient this way.

Now at this moment, I still have not been seen for any lab work or by a doctor.  When I finally got into a room two hours later, the doctor did not come in for another hour and a half.  When he came in, he was there a whole 2 minutes and said we are going to send you for some chest x-rays, lab work, EKG and put you on a heart monitor and watch you for 23 hours.  I said wait, I had a bad reaction to a medication how do you derive at all this in a 2 minutes checkup? The best part is where they make you wait for 23 hours is an open room with many other patients looking at you from across the hall.   This triage area does not have curtains, it is a holding area.  I grabbed my things and said I will see my regular doctor thank you very much.

I cannot understand legally or ethically how patients can be treated this way.  Is there not a policy in hospitals that they must follow to give better patient-centered care? As in the Colorado model, it states there should be a management leader looking out for the rest of the team to be sure that patients are being informed of things and being involved in their care as opposed to left alone for hours at a time and not a single explanation of care and why it is being ordered (Goode, Fink, Krugman, Oman, & Traditi, 2010).

References

Goode, C. J., Fink, R. M., Krugman, M., Oman, K. S., & Traditi, L. K. (2010, August 10). The Colorado patient-centered interprofessional evidence-based practice model: A framework for transformation. Worldviews on Evidence-Based Nursing, 96-105.


Source: Rosie’s Nurse Corner

Passive Descent vs Pushing in Second Stage of Labor

Most recently I was asked to comment on whether during the second stage of labor ( which is the onset of full cervical dilation) should be passive descent vs. pushing.  In my opinion, it all depends on what policy the treating practitioner uses.  I worked at a high level labor and delivery unit up North where women were flown in if it was an emergency or bad delivery anticipated or trauma.  But we also were a Catholic Hospital and took care of the indigent. We had a teen obstetrics clinic in the area (not related to the hospital) but it was across the street.  They handled all the teenage pregnancies that came through their doors.  It was managed by two very caring midwives.  At this clinic, the girls not only received prenatal care but they also received information on how to take care of their babies.  The girls were referred to pediatricians to get healthcare for the babies and to school counselors to help them get their GED’s.  But the best part was that these midwives taught natural childbirth at their clinic.  When a girl came into labor, they went into the birthing room and they did perineal massage to do natural descent.  They worked with the contractions.  These girls rarely had any perineal tears.

One day one of the midwives was on vacation and the other one was in the clinic and could not get there this one time and one of their girls came in almost completely dilated and effaced.  The resident on duty that evening was one of the most arrogant doctors I had ever seen, he had smart remarks before he even got in the room with her. He went inside to do her exam and he rammed into her and the girl nearly jumped three feet, I calmed her down as she was a scared 15-year-old girl.  She screamed and he said listen you had something much bigger in there than my finger, I quickly stated, doctor that is enough.  He said,  yes she is dilated,  get her in the delivery room, I said that the girls go to the birthing rooms and deliver there in a more holistic approach; his reply was, we don’t have time for that garbage, get her pushing and delivered.  This poor child gave birth and had tears from front to back, she was in such pain, as she could not have an epidural or pain meds since she was already effaced and 10 cm.  I did not have kids at that time, but could only imagine by the grips of my hand and the tears and screaming that she was suffering.  I was barely 21 years old.  The midwife came finally after she closed the clinic at 7pm to check on her patient and was so angry after the patient told her what happened. She brought up the incident to the hospital administrator who placed the doctor on probation.  He had a few incidents with me and some other nurses and eventually was fired from the residency at that hospital. Knowing the hospital’s practice for each unit and also what the practitioner believes is very important (Denisco & Barker, 2012).  Some doctors will approach labor and delivery with a more holistic approach.  This would be an approach that Jean Watson’s theory on caring would fit in to.

 

 

References

Denisco, S. M., & Barker, A. M. (2012). 25. In Advanced practice nursing: Evolving rules for the transformation of the profession (2nd ed., pp. 547-567). Retrieved from https://campus.capella.edu/web/library/home


Source: Rosie’s Nurse Corner

Evidence-Based Models and Practice Settings

One of the clinical problems that I see in the Neonatal Intensive Care Unit (NICU) is nurses and healthcare staff becoming complacent in their environments because it is a job and the passion is lost allowing the nurse to move through the motions.  We are all guilty in many professions, not just nursing, of treating people matter of fact and we forget it may be our hundredth experience, but it is their first experience, no matter what the experience is. When we approach any person, especially in our nursing experience, we have to approach them with kindness and passion. We as nurses cannot continue to eat our young (the new nurses coming to work) and continue to treat our patients as if we need to move on to our next task. Our body language, tone of voice and facial expressions give away our genuineness.  We are all busy, but we have to put that aside and go back to compassion and empathy, thinking about how we want to be treated in this situation if we were in it.  We have to utilize our critical thinking to see what level of care that parent needs to get through this situation at hand.

One problem that I see is infant readiness for oral feeding of the premature baby.  There are different opinions on the expertise of how it is done.  Being able to see the situation first hand as a mother and then being able to see it as a professional, made me aware of not only my actions but others around me.  My son was given breast milk initially via NG Tube until he was ready to try a bottle.  Initially, the bottle feeding was started once per day and increased and they would leave the bottle-feeding for when the parents were there to feed the baby to create that bonding experience.  One day I arrived at the NICU on a weekend ready to spend the entire day with my son and getting to feed him several times per day.  The shift nurse that I had never met said that I was feeding my son wrong.  She took over the feeding entirely and when the rest of the feedings occurred that day, she took over because she stated that I was making the baby aspirate due to my inexperience.  I was only allowed to hold him.  When the change of shift occurred, she said okay time to go, I stated that we were in a private room and the nurses close the door so that we do not have to leave during the change of shift.  We were in a private room because at one point the baby had developed a hospital-borne infection called Serratia and he had to remain there until discharge.   Staying in the room was an arrangement that I made with upper management due to the fact that I worked full time as did my husband and we did not have much visiting time with him during the week.  She proceeded about her business and ripped the baby right out of my arms.

I cried for days until Monday came and I made a complaint to my head nurse who assured me that this was documented in my chart right on the front. She showed me the chart and stated that she would speak to the nurse about her abruptness.  The weekend nurse assigned apologized to us a few days later, but by then my feelings were already crushed.   It was later discovered that the baby was aspirating even when he was fed via g-tube it had nothing to do with how I was holding or feeding him.  It was inevitable.  In the end, it was decided that the baby would have a Mickey G-tube inserted surgically for feedings to expedite his discharge home.

When discussing with peers, the Colorado model seemed appropriate because it has a patient-centered focus.  In the NICU, the focus is not only on the baby but the parents, they become your patients, too.  In this instance, the issue that I experienced was discussed and it came to be known, that yes, as nurses we can have the one-track mind of getting things done and checked off a list. There is a lot that happens in the NICU that is unexpected, so the less that can be focused on that is routine, the better.  Nurses can do things better, faster and with expertise, but is it really better?  Parents would say no because they are left out of the important equation in the Colorado model.  The Colorado model discusses that patients should have some control or personal choice in decision making, whether for personal preferences religious or cultural decisions (Goode, Fink, Krugman, Oman, & Traditi, 2010).

 

 

References

Goode, C. J., Fink, R. M., Krugman, M., Oman, K. S., & Traditi, L. K. (2010, August 10). The Colorado patient-centered interprofessional evidence-based practice model: A framework for transformation. Worldviews on Evidence-Based Nursing, 96-105.


Source: Rosie’s Nurse Corner

A Gap in Practice in the NICU

Most recently I was asked to write as a contributor for a textbook called Comprehensive Neonatal Nursing 6th edition about what gaps there are in teh neonatal intensive care units.  The editors Carole Kenner, Leslie B. Altimier, and Marina V. Boykova, put together this textbook to support practice strategies and sound clinical decisions in teh neonatal intensive care unit.  My focus is on a NICU toolkit. https://www.amazon.com/Comprehensive-Neonatal-Nursing-Care-Sixth/dp/0826139094/ref=sr_1_1?keywords=9780826139146&linkCode=qs&qid=1570765494&s=books&sr=1-1

The specific gap in practice in the neonatal intensive care unit (NICU) is the challenge that parents face when they are discharged home.  The underlying assumptions of these issues include a lack of confidence to be able to take care of the baby, not enough information to understand the machines, a lack of practice time, and increased readmission rates to the hospital within 30 days of discharge from the NICU.  Regarding the population parents of premature babies, the argument that is most often heard from the nurses and the NICU team is that the parents have been in the NICU watching the nurses for the last five to seven months and they should be able to take care of their infant (Hutchinson, Spillett, & Cronin, 2012).

The parents of premature babies have a higher stress level when the babies are discharged due to not receiving specific education to ease the transition home (Busse, Stromgren, Thorngate, & Thomas, 2013).  In Miles’s (1994) study conducted via the Patient-Reported Outcomes Measurement Information System (PROMIS) following discharge from the NICU, it proved that there was a higher stress level for parents when they were discharged home.  Premature infant readmissions were analyzed and it was determined that there was a 31% readmission rate to the NICU.  The parents needed to be taught skills on how to avoid re-hospitalization (Hutchinson et al., 2012).

Premature babies were being born daily with multiple medical conditions that carried long term through the span of their lives.  When they were transitioned to their homes, they required management of their special needs in the home setting.  The transition program began 30 days before the baby was discharged to the home.  If the teaching was not done prior to the discharge home, then when they went home, the baby was susceptible to errors made at home with medications, infection control, or treatment in general.

When a baby is taken home from the regular nursery it is noted to be a scary time for parents due to the newness of being a parent.  For a parent of a premature baby, the anxiety increases especially if the baby had a long NICU stay.  The parents are accustomed to having the nurses there for support but when they go home, they feel alone.

The proposed solution for this gap in service is the implementation of a NICU navigator tool kit.  The toolkit is designed to help hospital nurses, doctors, therapists, social workers, and parents communicate more effectively towards reducing the parent’s anxiety surrounding their baby’s discharge to the home. The presentation of the NICU patient navigator toolkit contains evidence-based studies and real-life examples to demonstrate the toolkit’s necessity in the NICU.

 

 

References

Busse, M., Stromgren, K., Thorngate, L., & Thomas, K. (2013, August). Parent responses to stress: PROMIS in the NICU. Critical Care Nurse, 33(4), 1-13. http://dx.doi.org/10.4037/ccn2013715

Hutchinson, S. W., Spillett, M. A., & Cronin, M. (2012). Parents’ experiences during their infant’s transition from neonatal intensive care unit to home: A qualitative study. The Qualitative Report, 17(23), 1-20. Retrieved from http://www.nova.edu/ssss/QR/QR17/hutchinson.pdf


Source: Rosie’s Nurse Corner