Creative Implementation of Leadership

Creative Implementation of Leadership
Naomi Everett, RN Naomi Everett, RN, SCRN

Personality Type and Leadership Values
Jung Typology Test = Introverted iNtuitive Thinking Judging (Humanmetrics, n.d.) INTJ = “Natural leader” (BSM Consulting, 2014, para. 5) Insightful (Typology Test, n.d.) “The big picture” (BSM Consulting, 2014, para. 12) According to the HumanMetrics Jung Typology Test I am an Introverted iNtuitive Thinking Judging (INTJ) personality type (Humanmetrics, n.d.). INTJ’s are “natural leaders” (BSM Consulting, 2014, para. 5). They are insightful and can easily apply what they observe (Typology Test, n.d.). INTJ’s have the ability to do great things because “they see the big picture” (BSM Consulting, 2014, para. 12).

Personality Type A breakdown of my testing reveals that I scored Introvert (56%), Intuitive (38%), Thinking (1%), and Judging (89%); my score for Thinking over Feeling was marginal (1%) so characteristics of Introverted Intuitive Feeling Judging (INFJ) may also fit (Humanmetrics, n.d.). A score of 56% for Introverted is interpreted as meaning my general attitude is approximately half way between introversion and not having a preference between introversion and extroversion (Humanmetrics, n.d.). At 38% my preference for intuition over sensing is not quite as strong but still significant. This means that rather than relying on hard facts I rely upon my perceptions of a situation (Humanmetrics, n.d.). My Thinking score is 1% which indicates that I have no real preference for thinking over feeling; I use both logical reasoning and emotions equally in my decision making (Humanmetrics, n.d.). An 89% Judging score indicates a very strong preference for judging over perceiving which can be interpreted as being structured over being flexible (Humanmetrics, n.d.)

Personality Type Contingency plan Take control Efficient Practical
Facts (Keirsey.com, n.d.) According to Keirsey.com (n.d.) INTJ’s are often referred to as the Mastermind. Masters of the contingency plan, INTJ’s plan every step of a project and anticipate every contingency, always having a plan B in place (Keirsey.com, n.d.). Masterminds will only take control of a situation if there is no other competent leader in place; in fact they frequently find themselves in positions of responsibility (Keirsey.com, n.d.). Once in control they make very efficient and practical leaders (Keirsey.com, n.d.). Masterminds also do not act without having all the pertinent information and will not trust any statement that is not backed up with facts (Keirsey.com, n.d.). PHOTO CREDIT: (Mastermind, n.d.) (Mastermind, n.d.)

Personality Type and Leadership Values
Planner Perfectionist Equity and fairness Trust is slow to develop Transactional leadership (Sullivan, 2013) In general the INTJ personality type describes me fairly accurately. I am a planner, I definitely swoop in and take change if I feel that no one is leading, and I am a perfectionist. I feel that the primary attribute of INTJ that contributes to my leadership style is fairness; I treat everyone with equity. The leader-follower relationship is partially built on trust; I need expend more effort that others do to foster that trust. When considering the various leadership styles, transactional leadership most closely aligns with the INTJ personality type. According to Sullivan (2013) this leadership style is based upon transactions between two parties, the nature of which is determined by the needs of the parties involved.

Facility Frederick Memorial Hospital Acute care hospital 298 beds
(Frederick Memorial Hospital [FMH], n.d.) Frederick Memorial Hospital is a 298-bed acute care hospital located in Frederick, Maryland, approximately 50 miles west of Baltimore and 45 miles northwest of Washington D. C. (Frederick Memorial Hospital [FMH], n.d.). The Hospital opened in 1902 and is currently the only acute care hospital in Frederick County and the only acute care hospital within a 25-mile radius of the city of Frederick (FMH, n.d.). PHOTO CREDIT: (FMH photo, n.d.) (FMH photo, n.d.)

Facility :: Neuroscience Unit
Primary Stroke Center Stroke Center Gold Performance Award Joint Commission Stroke Core Measures The Neuroscience unit that I manage is open 24/7 and has received and maintained Gold Performance status from the American Heart Association (Frederick Memorial Hospital [FMH], n.d.). My unit consistently rates very high for compliance with Joint Commission Core Measures for Stroke patients. PHOTO CREDIT: (Gold Award, n.d.) (Frederick Memorial Hospital [FMH], n.d.). (Gold Award, n.d.)

Facility :: My Team Neurologists Case Managers Nurses
Clinical Nurse Specialist Neuroscience Certification Patient Care Technicians PT/OT/ST As manager of the neuroscience unit my team is comprised of Neurologists, Case Managers, Nurses, and Patient Care Technicians. In addition, our neuroscience team works closely with Physical, Occupational and Speech Therapists. Choosing the right Clinical Nurse Specialists was crucial to the success of this team. Our CNS is responsible for providing education to our nurses. We support and encourage all of nurses to achieve neuroscience certification.

Facility Legal considerations Ethical considerations
Cultural development Excellence, every patient, every time The legal and ethical considerations that I must contend with include reporting suspected abuse, reporting suspected substance abuse of both patients and employees, assuring that patient documentation is accurate, and serving as a patient advocate for both clinical issues and for any family or social issues that need to be addressed. The culture that I endeavor to create within my unit mirrors the culture of the hospital. Excellence… every patient, every time. I tell my staff to always do your job as if you are being observed; as if you are teaching the right way to do it. I actively encourage a culture of accountably on the unit. This takes a great deal of reinforcement but I am trying to foster an environment when nurses and patient care technicians feel more comfortable calling each other out on a variety of issues. If someone feels that something should have been addressed before end of shift everyone should feel comfortable speaking up.

Facility :: Coaching Skills
Communication Communication is the single most important skill that a manager must have. Communication on a 24 hour 7 day a week unit is challenging. I send weekly updates to the staff. We use daily huddles with the charge nurses, my clinical nurse supervisor, and the case managers to keep up to date on our patients and clinical issues. I arrive before the shift change at least 3 days each week so that I can have face-time with the night-shift staff. It is of great important to develop relationships with all members for the team. I endeavor to project a positive attitude and vibe on my unit. My philosophy is to reinforce the positive rather than focus on the negative. We post a Last Day since… fall and pressure ulcer signs. I emphasize how many days we went without incident rather than focusing on the fact that we had a fall of pressure ulcer. Every member of my staff has completed TeamSTEPPS training and is encouraged to use this tool to communicate concerns within the unit. We’re all in this together! PHOTO CREDIT: (TeamStepps, n.d.) (TeamStepps, n.d.)

Leadership Theories Situational (Lussier and Achua, 2010)
Contingency (Changing Minds, n.d.) Hersey and Blanchard (Changing Minds, n.d.) Shared I tend to utilize both situational and shared leadership styles. According to Lussier and Achua (2010) Situation, or contingency, leadership attempts to explain how different situational variables interact with a leader’s personality and behavior. Hersey and Blanchard’s situational leadership theory states that a leader must first assess the follower’s task readiness (which is their ability and willingness to complete a task) and then adapt the leadership style to the follower’s maturity level (Changing Minds, n.d.). The follower’s maturity is task specific and refers to the follower’s ability to perform the task and their willingness to take it on (Changing Minds, n.d.). In Hersey and Blanchard’s theory it is the maturity level of the follower that dictates the style of the leader (Changing Minds, n.d.). The leader adapts the leadership style to the task competency of the follower (Changing Minds, n.d.). Shared leadership or shared governance is pivotal to the success of my unit. My unit is comprised of educated and motivated professionals. We utilize a unit practice council to make collaborative decision regarding both clinical and management issues on the unit. All team members are encouraged to attend and have their voice heard. Everyone gets a say. This is the place to voice both clinical practice concerns and team-work concerns. PHOTO CREDIT: (Leadership, n.d.) (Leadership, n.d.)

Leadership Responsibilities
Forecasting (Businessdictionary.com, n.d.; Vanguard Software Corporation, 2014) As defined by BusinessDictionary.com (n.d.) forecasting is a planning tool that helps managers use data from the past to cope with the uncertainty of the future. I tend to use judgment forecasting rather than quantitative forecasting. According to Vanguard Software Corporation (2014), judgment forecasting uses intuition and experience to predict the future. This jives with my Jung Personality Style of INTJ as 38% my preference for intuition indicated that rather than relying on hard facts I rely upon my perceptions of a situation. On my unit I must forecast for a host of unpredictable phenomenon. Over the Summer I had several nurses out of work on medical leave. I could not hire new staff because they were all on FMLA and I had to keep their positions open. I was forced to utilize both over time and float pool nurses to cover shifts during a Summer of unprecedented high census. Needless to say the entire nursing staff got burnt out. Now I am contending with vacancies as many of those nurses that worked so hard over the Summer have decided to transfer to new departments. Once these vacancies are filled I can re-new my focus on helping as many nurses as possible with obtaining neuroscience certification. PHOTO CREDIT: (Forecasting, n.d.) (Forcasting, n.d.)

Regulatory Agencies Joint Commission (The Joint Commission [TJC], n.d.) 2013 Top Performer (T. Kleinhanzl, & R. Yalamanchili, personal communication, November 13, 2014) America’s Hospitals: Improving Quality and Safety (T. Kleinhanzl, & R. Yalamanchili, personal communication, November 13, 2014) National Database of Nursing Quality Indicators (Press Ganey Associates, 2014) Agency for Healthcare Research and Quality (Agency for Healthcare Research and Quality [AHRQ], 2014) Maryland Board of Nursing (Maryland Board of Nursing [MBON], 2011) The most important thing to remember about any regulatory agency is that it is their goal to improve the quality of patient care, not to shut you down. Joint Commission is an independent, not-for-profit organization that accredits and certifies health care organizations and programs in the United States (The Joint Commission [TJC], n.d.). Accreditation from the Joint Commission is seen as a symbol of high quality healthcare delivery. Joint Commission’s mission is to “continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value” (The Joint Commission [TJC], n.d., para. 2). Our hospital just experienced a Joint Commission survey and we did very well. Our hospital was one of only 1,224 hospitals in the country that achieved Top Performer status in 2013 (T. Kleinhanzl, & R. Yalamanchili, personal communication, November 13, 2014). In addition, the hospital will be named in the Joint Commission’s 2014 annual report “America’s Hospitals: Improving Quality and Safety,” for attaining and sustaining excellence in accountability measure performance for four clinical areas – Heart Attack, Heart Failure, Pneumonia and Surgical Care (T. Kleinhanzl, & R. Yalamanchili, personal communication, November 13, 2014). National Database of Nursing Quality Indicators or NDNQI tracks nursing sensitive indicators such as: pressure ulcers, falls, hospital associated infections, and RN job satisfaction. Data is collected periodically by the facility itself and reported to NDNQI (Press Ganey Associates, 2014). For the past 15 years, Agency for Healthcare Research and Quality or AHRQ, an agency of the Department of Health and Human Services or HHS, has been tasked with generating evidence to make health care safer, higher quality, more accessible, equitable, and affordable (Agency for Healthcare Research and Quality [AHRQ], 2014). AHRQ’s primary areas of focus are: improving healthcare quality by promoting the implementation of Patient Centered Outcomes Research, improving healthcare safety, improving healthcare accessibility, and finally improving healthcare affordability, efficiency, and cost transparency… all through publishing clinical guidelines based upon evidenced based practice (AHRQ, 2014). The Maryland Board of Nursing is responsible for licensing nurses in the State of Maryland. I utilize their database to ensure that each licensed professional’s license is in effect. I have not had to do so during my short career but if I needed to I would be required to report an unsafe nurse to the Mary Board of Nursing (Maryland Board of Nursing [MBON], 2011).

Accreditation Maryland Institute for Emergency Medical Services System Primary Stroke Center (Maryland Institute for Emergency Medical Services [MIEMS], n.d.) American Heart Association Get With The Guidelines: Stroke (American Heart Association [AHA], 2014) Gold-Plus Quality Achievement Award Frederick Memorial Hospital has been deemed is a Maryland Institute for Emergency Medical Services System Primary Stroke Center (Maryland Institute for Emergency Medical Services [MIEMS], n.d.). Get With The Guidelines®-Stroke is an in-hospital program for improving stroke care by promoting consistent adherence to the latest scientific treatment guidelines (American Heart Association [AHA], 2014). The goal is to provide faster and more efficient care to patients presenting with stroke (AHA, 2014). Our facility and unit has been awarded the Gold Plus Achievement Award and has been recertified three times. Our Gold-Plus status is prominently displayed on the hospital’s website. The facility also promotes our status with the American Heart Association at our Stroke support group meetings and on Stroke Awareness Day.

Return on Investment Marketing Plan
Product Place Price Promotion While I do market my unit to patients that I want to choose Frederick Memorial Hospital at health fairs and the like I spend most of my marketing efforts toward attracting quality nurses. My return on investment plan consists primarily of investing in my staff. I want to hire the right nurse for the job from the get-go. Even if I do not have open positions I go to job fairs to market my neuroscience unit. My four P’s of marking consists of product, place, price & promotion (Sullivan, 2013). My product is my unit. I promote my unit as a supportive environment in which to work. I have little control over what the organization offers as a whole but I can control what my own unit has to offer. It is my belief that nurses want to work on a unit that provided high-quality care and frankly I don’t want to attract nurses that don’t. My place is our physical plant. Our hospital I located within a nice safe community and we offer free parking for all employees; not something that Baltimore or DC hospitals care boast. My price is the salary that I can offer. I have no real control over this aspect of my marketing plan. I can however promote that fact that I offer weekly lunch and learns and frequently I am able to offer free continuing education units for these programs. My promotion of the unit as a great place to work is for the most part word-of-mouth. It is however very important no represent my unit honestly. As anyone is sales will tell you… sale is all about building relationships. If my unit is not represented in an authentic manner then I will end up with an employee retention problem. PHOTO CREDIT: (Four P’s, n.d. ) (Sullivan, 2013) (Four P’s, n.d. )

Return on Investment Employee Retention Plan
Positive reinforcement (McLeod, 2007) Address negativity Staff development Opportunities for growth Education Human Resources While I do not subscribe to any one motivation theory I do utilize some of the B.F. Skinner’s behavior modification techniques (McLeod, 2007). I use positive reinforce or the reward of positive behavior (McLeod, 2007). This again speaks to my theory of acknowledging the successes rather than focusing on the failures. On the unit we address negativity immediately. I find that if you do not address negativity it will only fester and increase; no one wants to work in an environment beset with negatively. I find that if I spend money up front on providing education and support to my staff I will save the cost of continuously training new hires. I can offer growth opportunities nurses who are motivated to increase their skill set. While the unit is staffed with permanent charge I do train staff nurses as relief charge nurses. Staff nurses can precept new hires. Frederick Memorial Hospital uses Clinical Ladder system to recognize nurse experience and leadership. I offer as many Clinical Ladder opportunities as I can to my nurses. Nurses can participate in skills assessment days or be validators for new skills. While nurses are not paid extra to precept new hires, they do earn clinical ladder points. Participation in shared governance councils also earns Clinical ladder points. All of these activities increase job satisfaction. It is a win-win situation to invest in my staff. The staff is happy. My unit generally has good job retention. And, my patients receive better quality care related to the fact that there nurses have increased knowledge and job satisfaction. Maintaining a good working relationship with our Human Resources department is essential. I rely on Human Resources to screen potential employees. In order with HR to perform this task for me I must effectively communicate my needs. I also rely on HR to make sure that new hires comply with new employee screenings such a drug testing and physicals. In addition to new hires, HR gets involved with employee grievances. I work with HR to ensure that I am documenting and disciplinary issues appropriately on an on-going basis. It’s impossible to back-track on the documentation and next to impossible to discharge an employee without good cause. PHOTO CREDIT: (Motivation, n.d.) (Motivation, n.d.)

Organizational Chart John Verbus Senior Vice-President & Chief Operating Officer Patient Care Services Cheryl Cioffi, DNP, RN, NEA-BC Vice-President & Chief Nursing Officer Marybeth Mann Assistant Vice-President Women & Children ‘s Services Katherine Murray Director Cardiac & Vascular Services Nancy Bruce Medical-Surgical Services Michael McLane, RN 2C Oncology/Thoracic Surgery 2G Overflow Kathy Bunn Manager 3A Neuroscience Unit Naomi Everett, RN, SCRN 3B Medical-Surgical S. Kase 3G Medical-Surgical H. Dobecky-Bell Professional Development & Nursing Quality Jamie White Service Excellence Kathy Adams John Verbus is the Senior Vice-President of Frederick Memorial Hospital (Nursing Organizational Chart, 2014). I am directly accountable to and report to Michael McLane, the Director of Medical-Surgical Services. Michael McLane reports to Cheryl Cioffi, the Vice-President of Patient Care Services and Chief Nursing Officer. Cheryl Cioffi reports directly to John Verbus. I meet with Mike McLane on an almost daily basis to discuss patient census, staffing and other day-to-day issues. I also meet weekly with Mike McLane and the other Med-Surg unit managers. I meet monthly with Mike McLane and Cheryl Cioffi and the other Med-Surg unit manager to discuss budget and productively reports. (Nursing Organizational Chart, 2014)

Disaster Preparedness
Emergency Operations Plan Policy # ECPN 400 (Frederick Memorial Hospital [FMH], 2014, p. 1) Communication Resources and assets Safety and security Staff responsibilities Utilities management Patient clinical and support activities In order to be in compliance with Joint Commission regulations, Frederick Memorial Hospital Policy # ECPN 400 entitled Emergency Operations Plan (EOP) describes the established guidelines for an effective response to any event that may pose an immediate threat to the health and safety of the healthcare system’s patients, staff, and visitors. The policy is a framework for the management of both internal and external threats. Through this framework Frederick Memorial Hospital works cooperatively with local and regional emergency response agencies and ensure that our facility is in compliance with regulatory agency guidelines. (Disaster Plan, n.d.)

Bioterrorism Plan Isolation Handling specimens Notifications
Activate FMH disaster plan Small or large scale event Post-mortem care Post-exposure treatment for caregivers Given our facilities proximity to Fort Detrick the possibility of a biological attack or accident it feasible. In the event of one suspected or know exposure the patient would immediately by place in on airborne and contact isolation precautions in a negative pressure room (FMH, 2014). All staff caring for patient will use N95 or Power Air Purifying Respirators (FMH, 2014). All staff must also follow the guidelines contained in the Blue Book Medical Management of Biological Casualties when handling specimens (FMH, 2014). The following notifications must be made ASAP: ED physician, Infection Control chairperson, Nursing VP, Nursing Supervisor, FMH Administrator, Safety Officer, FMH Safety Officer, and Security. The Frederick County Health Department must also be informed (FMH, 2014). The ED physicians and managers will determine if the FMH internal or external disaster plan should be activated (FMH, 2014). In the event of a small scale event routine placement of patients and isolation procedures are followed. The Hospital Emergency Response Team will assist in triaging patients (FMH, 2014). In the event of a large scale event, cohorts of patients will similar symptoms will be clustered together (FMH, 2014). If more than 100 patients are affected, other facilities must be utilized (FMH, 2014). Funeral must be informed of special precautions that maybe required (FMH, 2014). Employees with exposure to the biological agent will need to receive prophylactic care based upon the current Center for Disease Control guidelines (FMH, 2014). PHOTO CREDIT: (WPClipart, n.d.) (WPClipart, n.d.) (FMH, 2014)

Networking and Critical Issues
American Association of Neuroscience Nurses Maryland Board of Nursing American Nurses Association Centers for Disease Control Agency for Healthcare Research and Quality MedScape I network both within my facility and within the various organizations of which I am a member. I utilize networking opportunities both the purpose of keeping in touch with nurses and to keep up to date with current events in nursing. I keep in touch with nurses who have assisted me in my career thus far and use the opportunity to introduce myself to those who may be of assistance to me in the future. Of course I’m always scouting for nursing talent for my unit. I am a member of the American Association of Neuroscience Nurses. I receive their monthly publication to keep abreast of clinical issues relating to neuroscience nursing. I am also an active member of the American Nurses Association. I follow not only the ANA, but also Centers for Disease Control, and Agency for Healthcare Research and Quality on social media. In addition, I subscribe to updates from MedScape, the CDC, and AHRQ. PHOTO CREDIT: (Networking, n.d.)

Succession Planning Mentor Internship
Succession planning within my organization is difficult. There is no formal, organized succession plan. There is no position for an assistant unit manager or to train a person to cover for me in my stead. If I am out of the office, I have to rely on another unit manger to cover for me. That being said, I use my networking contacts to stay in contact with likely candidates. I mentor nurses that are currently pursuing Masters Degrees in Nursing Administration. I offer graduate students internships in my department as frequently as I can. I use this as an opportunity to groom potential successors in a very informal manner. PHOTO CREDIT: (Succession Plan, n.d.) (Succession Plan, n.d.)

Why Am I a Nurse? Because there are not very many opportunities to make a real difference in a person’s life. As I nurse I get to do it every day… both for patients and other nurses. We reviewed many of the aspects of nursing from a leadership perspective. I believe in leading by example. I love what I do and I attempt to create an environment that allows caring and competent nurses to do what they love in a supportive space and the expand their knowledge base. That’s my leadership theory, marking strategy and succession planning all wrapped into one. PHOTO CREDIT: (Love Nursing, n.d.) (Love Nursing, n.d.)

References Agency for Healthcare Research and Quality. (2014). About. Retrieved from American Heart Association. (2014). Get with the guidelines-stroke overview. Retrieved from BSM Consulting. (2014). Portrait of an INTJ. Retrieved from Businessdictionary.com. (n.d.). forecasting. In forecasting definition. Retrieved from Changing Minds. (n.d.). Hersey and Blanchard’s approach. Retrieved from Disaster Plan [Clip art]. (n.d.). Retrieved from Forecasting [Photo]. (n.d.). Retrieved from Four P’s [Clip art]. (n.d. ). Retrieved from Frederick Memorial Hospital. (2014). Emergency operations plan (EOP) [Policy]. Retrieved from

References Frederick Memorial Hospital [Photo]. (n.d.). Retrieved from Frederick Memorial Hospital. (n.d.). Frederick memorial hospital’s2013 community health needs assessment for Frederick county, Maryland. Retrieved from Frederick Memorial Hospital. (n.d.). Stroke center. Retrieved from Gold Award [Clip art]. (n.d.). Retrieved from Humanmetrics Jung Typology Test [Measurement instrument]. (n.d.). Retrieved from Humanmetrics. (n.d.). INTJ: Introverted intuitive thinking judging. Retrieved from Humanmetrics. (n.d.). Jung typology test. Retrieved from Keirsey.com. (n.d.). Rational portrait of the mastermind (INTJ). Retrieved from Leadership [Clip art]. (n.d.). Retrieved from Love Nursing [Photo]. (n.d.). Retrieved from

References Lussier, R. N., & Achua, C. F. (2010). Leadership: Theory, application & skill development (4th ed.). Mason, OH: South-Western Cengage Learning. Maryland Board of Nursing. (2011). Instructions for completing and submitting the nurse practitioner (NP) attestation frorm & supporting documents . Retrieved from Maryland Institute for Emergency Medical Services. (n.d.). Specialty referral centers. Retrieved from Mastermind [Clipart]. (n.d.). Retrieved from McLeod, S. A. (2007). Skinner - operant conditioning. Retrieved from Motivation [Clip art]. (n.d.). Retrieved from Networking [Clip art]. (n.d.). Retrieved from Nursing Organizational Chart [Organizational Chart]. (2014). Retrieved from Press Ganey Associates. (2014). Frequently asked questions. Retrieved from

References Succession Plan [Photo]. (n.d.). Retrieved from Sullivan, E. J. (2013). Effective leadership and management in nursing (8th ed.). Upper Saddle River, NJ: Pearson Education. TEAMSTEPPS [Clip art]. (n.d.). Retrieved from The Joint Commission. (n.d.). About the joint commission. Retrieved from Vanguard Software Corporation. (2014). What is forecasting? Retrieved from WPClipart. (n.d.). Biological [Clip art]. Retrieved from

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