1. 1 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 40 The Nurse Leader in the Community

2. 2 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Objectives 1. Explain why nurses need effective leadership, management, and consultation skills in today’s public health care environment. 2. Explore what is meant by partnership and interprofessional practice, and describe how these concepts are related to nursing leadership, management, and consultation. 3. Analyze what is meant by systems thinking in community-based and public health settings.

3. 3 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Objectives, Cont’d 4. Describe the major competencies required to be effective as a nurse leader, manager, and consultant in community-based and public health settings. 5. Examine nursing leadership strategies to enhance patient safety and reduce health care errors in community settings. 6. Explain how nurses provide leadership in care coordination in the community.

4. 4 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Major Trends and Issues  To Err Is Human (IOM, 2000)  Evidence-based practice  Seamless system of care  Vertical integration  Movement toward more community partnerships  Use of Internet  Collaboratives  Focus on implementing the core functions of public health.

5. 5 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Definitions  Consultation  Process in which the helper provides a set of activities that help the patient perceive, understand, and act on events occurring in the patient’s environment  Increasingly focuses on ways to better coordinate the care delivery process across sites of care

6. 6 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Leadership and Management Applied to Population-Focused Nursing Goals of Nursing Leadership Goals of Nursing Management Theories of Leadership and Management Nurse Leader and Manager Roles

7. 7 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Goals of Nursing Leadership  To work with others to ensure a healthy community  To serve as an advocate for vulnerable and high-risk populations and to work toward eliminating disparities in health care access, quality, and outcomes  To participate in establishing public and organizational policies and programs that promote a healthy living and working environment  To work with interprofessional teams to design ways to coordinate care across sites and over time, and to evaluate and continually improve health care outcomes

8. 8 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Goals of Nursing Management  To achieve agency and professional goals for patient services and clinical outcomes using a systems perspective  To help personnel perform their responsibilities effectively and efficiently  To mentor other staff members and foster lifelong learning  To develop new services that will enable the agency to respond to emerging community health needs  To monitor health outcomes for particular population groups and identify changes or variances suggesting new problems

9. 9 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Theories of Leadership and Management  Transformational leader  Systems theories and systems thinking  Distribution effects  Roy’s adaptation model  Complex adaptive systems  Microsystems

10. 10 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Nurse Leader and Management Roles  First-line nurse managers:  Team leaders  Program directors  Mid-level or executive-level nurse managers:  Division directors  Local or state commissioners of health  Directors of large home health agencies  Function as coaches, facilitators, role models, evaluators, advocates, visionaries, community health program planners, teachers, and supervisors

11. 11 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Consultation Goals Theories of Consultation Consultation Contract Components Nurse Consultant Role

12. 12 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Goals  To help others empower themselves to take more responsibility, feel more secure, deal with their feelings and with others in interactions, and use flexible and creative problem-solving skills  Internal consultant  External consultant

13. 13 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Theories of Consultation  Process model consultation  Focuses on the process of problem solving and collaboration between consultant and the patient  Major goal of the process model is to help the patient assess both the problem and the kind of help needed to solve it

14. 14 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Consultation Contract Components 1. Patient and consultant goals 2. The identified problem 3. The time commitment 4. Limitations of the contract 5. Cost 6. Conditions under which the contract may be broken or renegotiated 7. Intervention strategies suggested 8. Expected benefits for the patient 9. Methods of data collection to be used 10. Potential interventions 11. Evaluation methods to be used 12. Confidentiality

15. 15 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Nurse Consultant Role  Traditional consultant  Specialist consultant  Internal consultant  Resource person  Facilitator  External nurse consultant

16. 16 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Leadership Competencies  Empowerment  Delegation  Critical thinking  Decision making

17. 17 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Interpersonal Competencies  Communication  Creating a motivating workplace  Appraisal and coaching  Contracting  Supervision  Team building  Promoting diversity

18. 18 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Power Dynamics and Conflict Resolution  Effective conflict resolution requires negotiation skills, and skills in recognizing and managing power dynamics.  Principled negotiation emphasizes collaborative problem solving and development of mutually agreeable ways of achieving goals.  Win-win, win-lose, lose-lose outcomes

19. 19 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Organizational Competencies  Planning  Business plan  Organizing  Implementing and coordinating  Monitoring, evaluating, and improving

20. 20 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Fiscal Competencies  Forecasting costs  Develop and monitor budgets  Variance analysis  Conduct cost-effectiveness analysis

21. 21 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Analytical and Information Competencies  Monitor clinical outcomes  Identify systems issues that can result in health care errors  Plan to better meet the health needs of their populations