Leadership and Dynamic Adaptation

       In a recent School Wide Nursing Forum a speaker brought to our attention the fact that in Great Britain, Nurses frequently have complete control over patient diet and activity levels. This made me curious as to why Nurses aren't able to take control of certain aspects of care when it is warranted. The fundamental change would likely have to come at first in the curriculum and research into the practice of nurse run nutrition programs etc. But what prevents this change in healthcare or really any change in healthcare that may be for the better.

In the British Journal of Healthcare Management, Joanna DaCosta writes, "The traditional hierarchal model of postgraduate medical training is not conducive to developing practical leadership skills among
doctors and does not support change and innovation. Medical professionals should actively
promote the development of leadership skills amongst their more junior colleagues with a
particular emphasis on collaborative working across professional boundaries" (Dacosta, pg 575, 2012)

Now this may seem like an attack on traditional medicine, provider models of care or doctors in general but in reality it is none of the above. The author goes on to emphasize the need for Dynamic Adaptation and how to foster a Dynamic Environment. (Dacosta, 2012).  If there is one thing I have learned about leadership this quarter it is that the preconceived notions I had about leadership were false. In my mind a leader gave orders and in turn had responsibility for the overall success of any undertaking. A leaders job is actually to do everything in their power to ensure that all have a responsibility for the outcome and a desire to see that outcome to be a positive one. In patient care the outcome is often a life that hangs in the balance right? Ultimately a more effective model of care saves more lives doesn't it? I may be misunderstanding things or thinking too black and white but ultimately leadership contributes to this balance somewhat of that I am sure.

The author goes on to outline transactional and transformational leadership, one focused on negotiation and the other focused on promoting "followers [that] are both emotionally and rationally inclined to contribute more to a task than originally planned" (DaCosta, pg 576, 2012).

For innovation and growth to occur "an environment of 'psychological safety' that fosters risk taking and opportunism, and supports others to learn and adapt" (Dacosta, pg 579). If we want to solve the system wide issues in healthcare we must create this environment. We need to draw on the experience and ideas of all. As nurses we can lead the way in fostering leadership within our profession that is Progressive, Dynamic and Adaptive.

I would like to thank Marie Manthey the amazing nurse and amazing woman who came and spoke to our school at the forum. I was lucky enough to attend a Nursing Salon Marie held and it is people like her who continue to contribute and care in an immeasurable and immense fashion that are able to truly make a difference.










DaCosta, J. (2012). Leadership models for healthcare improvement. British Journal Of Healthcare Management, 18(11), 575-580.

Diarrhea and Domesticating Germs

   I really enjoyed this video. It really shows how big out of the box thinking can start to solve problems that seem unsolvable. For me that is what it means to be a leader. Thinking Big.

      In this video Evolutionary Biologist Paul                   Ewald talks about how limiting transmission    actually causes pathogens to evolve into less   harmful or "Domesticated" versions of   themselves.

           This could revolutionize how we view disease treatment and put and end to the progression of medication resistant drugs.


I know that sometimes we all have a tendency to just accept the problems of the world as endemic or overwhelming. It is true leaders like this gentlemen that make me want to believe in the solution.
                   

Case Management and Patient Centered Care

One of the prominent topics covered in this week’s reading was patient case management. The nurse's role as a case manager or coordinator of care has expanded significantly over the last quarter of a century (Huber, 2010). With the decline of general practitioner MDs and provider-to-patient ratios increasing, the case management role is one that we, as nurses, must continue to develop. Assessing patient needs and information will become more critical than ever as the Affordable Care Act comes to fruition in the coming years.

One important aspect of the Affordable care act that will be going into effect is a bundled payment per beneficiary policy.  This is officially referred to as Efficiency of Care, one of the Care Measures to be instituted. More important is the bundling payment time period that will stretch 3 days before a hospitalization or clinic visit to 30 days following discharge (Cesta, 2012).

This is important to case management because there is now a financial benefit and imperative to efficiency. Let’s say a man goes to the clinic with a fever and they run a CBC. Later that night the man goes to the ER and another CBC is performed. This second test lends no new diagnostic information, yet under the current system these providers are rewarded for their redundancy. The clinic and hospital bill separately for their services, even if they are both under the same umbrella health system.  Thus, they profit twice from duplicate testing. The patient has double the number of invasive procedures, higher potential for site infection and has to spend that much more time around potential nosocomial infections. Under the new system these redundancies will be decreased and patient care will improve. Medicare will still likely pay for services rendered within reason but they will now be able to pay attention to Efficiency of Care and assess how institutions measure against one another (Cesta, 2012).

Increased case management and communication will be required to institute this new level of efficiency. My hope is that the end result of increased case management is a higher level of patient centered care. After everything is running smoothly that the extra time saved by not repeating tests gives a provider the time and resources to order that screening that saves a life. I would like to work in a system that offers more that just treatment for the most severe conditions. I believe we can get there as a nation if we focus on attempting solutions as opposed to profiting off of the loop holes.


Cesta, T. (2012). The Role of Case Management in an Era of Healthcare Reform -- Part 3. Hospital Case Management, 20(9), 135-138.

Huber, D. (2010). Leadership and Nursing Care Management. (4th ed). Saunders an Imprint of Elselvier Inc. Maryland Heights, MO

Mentoring and Networking: Two win wins

       Mentoring and Networking are two key tools of leadership that I think are under valued by my generation. Growing up around such readily available technology and information to me there seems to be a shift among young people towards self-reliance and independent thought. As we start to move into the job market some of these skills that may have come more naturally to generations before need to be developed. In nursing especially, with a large percent of nurses set to retire in the coming years, the wisdom of these nurses must be retained.
     How do we find a mentor or where do we start? The answer is to find someone with the a high level of expertise in your area of interest. It shouldn't be approached like a friendship or anything other than what it is, a critical need for the knowledge and expertise the mentor has. According to Huber "the closer the link between the employee's needs and the mentor's competencies, the more likely it is that the mentorship will be productive" (Huber, p.724, 2010). We can use this to think about how to initiate a mentorship upon entering the field. What are we struggling the most with and who is the best at it. Well we might have a hard time working with patient families. In this case we could seek out a family therapy specialist or a family oriented home care nurse. We could seek out someone on the unit we work on that deals with families in the exact same capacity only does it extremely well. As long as we line up our honest need with their expertise there is a good chance it will work out. We can remember that there is a good chance they didn't get to where they are by magic. Likely any potential mentor has those who helped them along the way and most are happy to give something back. It speaks to the value of their knowledge and expertise when people specifically seek it out and the relationship that develops can be a continued source of validation and reassurance for both.

     Networking is something that, until recently, I didn't understand how mutually beneficial it was. Just through articulating your passion and drive to work with a specific company or in a specific capacity before the position is created you set yourself apart form those just looking for a job. Employers know the value of having employees who aren't just seeking a paycheck and what a difference it makes to have passionate team members. As nursing students we have this passion and if we make it known through networking the likelihood that we will get where we want to go when it is available to us increases dramatically.
     One thing I recently learned in another class related to networking is to think big. With this in mind I just sought out Diane Huber, the author of our textbook on Linked In. I saw in the about the author section that she went to the University of Iowa. There is the connection and I have found how she could aid my passion. I have grown up a huge Iowa Hawkeyes fan and my father went there for Law School. I would love to pursue my DNP or Nurse Practitioner's degree there someday and I know what an outstanding nursing university it is. Imagine the commitment and passion she would know I have for that institution if I reached out to her probably at least a full 5 or 10 years before I am planning on attending. I also really value her work and know what a great assest she would be to me as a mentor if I am ever awarded a leadership position. Of course I couldn't find her on there, it doesn't always work out like you would wish.

     The same holds true in networking as it does in mentorship nobody got where they are alone. We all need referrals and there is a desire for assisting those that are as sincere to follow in your footsteps or join your institution. I want the best future students attending MSB and would assist anyone I felt deserving in entering our program. 

       Considering what we are bringing to the table in either mentoring or networking we can proceed with confidence and knowledge of the true win-win scenario that is Mentoring or Networking.



Huber, D. (2010). Leadership and Nursing Care Management. (4th ed). Saunders an Imprint of Elselvier Inc. Maryland Heights, MO

Controlling the brain with Light...and RN leadership?

Dr. Karl Deisseroth of Stanford University Speaks on his amazing research.

       Just a heads up this video is a little bit long and kind of dry especially if you aren't as interested in science, science fiction, and psychology as I am. I included it in this my RN Leadership blog because the speaker, Dr. Karl Deisseroth of Stanford University, does a few key things in the last few minutes of the video that I found to be excellent examples of leadership.

       He describes throughout the video his groundbreaking research utilizing rare bacterium, archaea and fiber optics to make ground breaking strides in the treatment of brain disorders. Ok yada yada yada big deal right. Amazing man, amazing work, but why is it in a nursing blog?


Leadership Connection

       If you watch the last three minutes he does two things. First he gives credit to those who came before him and made his research possible while at the same time making a case for the importance of scientific research in general. He also uses his research as a case for preserving the environment  because these light responsive bacterium are rare and require a specific eco system. In both cases he is discussing micro-organisms, society at large, and how he relates and depends on them. He is aware of his relation with and dependence on to the smallest and the largest systems which he operates in. This is essential to leadership because so often leaders fail to see the value of all the components in their system. How do I fit into the big picture and relate to these overwhelming societal issues? How does each piece benefit me? What does each person bring to the table? It is about awareness. Great leaders have great awareness.

       The second thing he does is present some potential ethical, and even philosophical concerns that could result from his work. So often in nursing we are called on to navigate complex ethical issues and I think more than anything we are called to do what he does here. To raise awareness. I don't need to know how I feel about long term ventilation patients, or withholding medical nutrition necessarily as much as I need to be aware that it is a complex ethical issue and everyone has a right to their own opinion. I can then help others to find their own path and their own opinion by raising awareness of all the contributing factors and things to consider. What does brain death really mean? Does tube feeding necessarily increase quality or even length of life? In leadership I can raise awareness of contributing factors surrounding controversial decisions, so that while all may not agree, understanding and compromise can be reached.

In short leadership to me today is having great awareness and raising awareness in others.

(I am probably using this for my presentation topic so nobody steal it.)