Nurse Management & Leaders Case Study Essay

Nurse Management and Leadership Case Study
Introduction
Good leadership is necessary in every business organization. When it comes to nursing, every health center must have a good leadership that supports the nurses so that they can maximize their performance. However, for leadership to be of good quality there needs to be a good working environment in all aspects (Pinelli et al., 2004). The following is a case study illustrating an ideal working environment that supports good nurse leadership in health institutions.Nurse Management & Leaders Case Study Essay

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Type of Organization The organization that I would like to work in is a medium sized health care center. The facility is equipped with all the necessary gear
As a graduate nurse leader, the responsibility will mainly be focused on mobilizing the other nurses to make sure they have delivered good quality services so as to promote patient outcomes. Communication on all levels will be important and therefore there must be frequent meetings to discuss issues that affect the nurses and the facility in general. Every nurse, regardless of their level of work, will be given an opportunity to air their views during these meetings and their opinions will be used in the decision making process. The communication process is also facilitated through in-organization research where the satisfaction level of all employees is measured. Nurses may sometimes be asked to answer some questionnaires that will be used to assess their attitudes towards the facility and what can be altered to make the workplace more comfortable for them. Research will also be taken seriously in practice to make sure everything is done accurately for the benefit of all the stakeholders of the facility. The Ohio Board of Nursing- Nurse Practice Act Performance as a graduate nurse must be in accordance with the rules and regulations of the Ohio board of nursing (Pinelli et al., 2004). The nurses must all be assesses and licensed by this board to make sure that they are qualified for the roles they play in the facility. The board is in full support of the facility and its method of governance because it promotes professionalism among the nurses. Nurse Management & Leaders Case Study Essay

Leadership is an important aspect of almost any industry. Most people would often think that leadership is only important in industries that are related to business or making profit. It is only logical to think that leadership is important in all aspects of managing an organization because an organization without an effective leader would not be able to survive the harsh business environment that is prevalent in a highly interconnected world economy. There are sources that suggest that leadership is part of a learning process. The objective of this paper is to discuss the importance of leadership and management in the field of nursing, particularly to support the idea that suggests that not all leadership is about changing or challenging people’s vision of the future. The author of this paper will draw on previously published literature on the topic of clinical leadership and management in the field of nursing to support the assumptions and inferences that will be made in this paper.Nurse Management & Leaders Case Study Essay

A leader, regardless of the type of organization or the processes and operations that it is involved in, is often described as someone who can easily inspire others to do orders and work together in order to achieve the goals of the company or organization. In this case, we are talking about an organization that is involved in the nursing industry. Examples of goals that a good leader in the nursing leadership can do are the enhancement of the quality of patient and healthcare, accessibility, and affordability, among others. This would of course vary from one organization to another, depending on the focus of the leader, and the current issues and problems that the nursing organization faces. Regardless, an effective clinical management and nursing leader should be able to know how to manage the available funds and financial resources, among others that can be used to fuel a project or any organization-related campaign, in order to achieve the organizational goals and objectives. This is where the effectiveness and skills of a leader in the nursing industry would be tested. Naturally, a leader who shows greater promise in meeting the organization’s clients and senior leaders’ expectations, or ideally, in outperforming them, would be considered as more effective compared to one that shows less promising results.Nurse Management & Leaders Case Study Essay

A common assumption in organizational management is the one that suggests that leadership is all about changing or challenging a group of people’s vision of the future. This assumption may pertain to the various changes that any leader of an organization would have to spearhead in order for the organization to reach its goals and objectives. This, at some point, may be considered to be true because after all, a company would not be able to grow without introducing significant changes to the way how things are organized from the chain of command down to the way how each small processes and operations are carried out (Stanley, Congruent Leadership: Values in Action, 2008). Often, the greater the changes that have been introduced, the better it would be for the organization in the long run, provided that everything from the planning process down to the part where the planned processes have to be implemented were properly executed. This is not to say, however, that all management-induced organizational changes lead to better results for the organization because there are surely other organizational change management plans that go awry. This is why there are indicators that can be used to access the effectiveness of a leader, regardless of the industry and one of such indicators is his ability to overcome the hindrances to meeting the organizational goals and objectives.Nurse Management & Leaders Case Study Essay

The idea of continuous innovation is not only used in the field of technology. It may also be considered important in other fields such as in the field of nursing in this case. Any nursing organization which has failed to continuously innovate either the delivery of its product and services or the quality of its products and services themselves would surely suffer from the negative consequences of being left out by its competitors who have managed to do the opposite — to continuously introduce innovations despite the often high price that organizations have to pay for it. Introducing innovation is not a one-night thing. It is rather a continuous process and most of the time, the leader of the organization plays a major role on whether an organization would be highly innovative or otherwise (Stanley, 2011). Also, the process of introducing innovation is often coupled with the process of introducing changes. Innovation is something that would not be made possible without introducing changes. This actually brings us back to the main question about the validity of the idea that suggests that leadership is all about introducing changes and challenging people’s vision of the future. An effective leader would surely be able to find a workaround on how to introduce innovations without having to make dramatic changes or even go to as far as challenge the people’s vision of the future (Howieson & Thiagarajah, 2011), unless the aspect of the organization that the leader would like to change is the vision of the organization itself.Nurse Management & Leaders Case Study Essay

In a nursing organization, the role of the leader is often geared at improving the quality of healthcare delivered by the entire nursing team or department or if its quality is already at par with the organizational performance, maintaining it (Marquis & Huston, 2014). Other goals that the nursing leader may participate may have something to do with increasing the affordability and the accessibility of health and patient care. An effective leader often exhibits a set of personal qualities that would help him surpass the hurdles involved in achieving the goals and objective of the organization, some of which include but may not be limited to persistence, initiative, integrity, courage, and his ability to handle stress. The leader’s ability to think critically, set goals and execute the necessary actions to meet those goals, communicate skillfully with other members of the team, be it a subordinate or someone who has a higher position, and collaborate with other people when it comes to nursing-related works and responsibilities are often the ones that would determine whether the organization’s vision and mission would be realized or not (Davidson, Becoming a nurse leader, 2010).Nurse Management & Leaders Case Study Essay

Nurses are often forced to be creative and innovative in their work. This is because they are the ones who usually have the first-hand experience in interacting with patients. They are often the ones who become compelled to make last minute decisions with regards to patient and healthcare (Marquis & Huston, Classical Views of Leadership and Management, 2012; Davidson, Elliott, & Daly, 2006). Nurses function as the front liners when it comes to patient care. At times, they often become required to do administrative works such as documenting the patients’ progressions and regressions. The same is, in fact, true for nurse leaders, except for the fact that they have the added responsibility of managing and leading people. Also, their co-nurses look up to their nurse leaders and often, an ineffective and highly inefficient nurse leader creates an equally ineffective and highly inefficient set of new nurse leaders as well. In the end, the purpose of the nursing leader would always have something to do with the ultimate goal of meeting the expectations of the entire department in meeting department and organizational goals and objectives.Nurse Management & Leaders Case Study Essay

In conclusion, the role of the nursing leader in a clinical leadership and management in the nursing industry is more concerned with the fundamental goal of effectively and efficiently executing the conceptualized plan of actions in order to reach the set organizational goals and objectives than changing and or challenging the people’s vision of the future. At some point this is true but there is more to being a leader than just introducing changes to the organization and stimulating changes among one’s subordinates. The idea is to see the bigger picture of being a leader and just by doing so, one would be able to determine that being a nursing leader is not just about changing or challenging the people’s vision of the future. In this case, being a nursing leader is more concerned with being a role model to the people, exhibiting the signs of being a leader such as having integrity and excellent communication skills, among other traits of being an effective nursing leader Nurse Management & Leaders Case Study Essay

The healthcare environment is constantly changing becoming increasingly more complex (Marshall, 2010). Nurse leaders can play a significant role in healthcare. The role of nurse leaders in healthcare is advocated for by the Institute of Medicine (IOM) in its report titled “The future of nursing: Leading change, advancing health” and other organizations such as the American Nurses Association (Smith, 2011). Nurse leaders play diverse roles in organizations such as charge nurses and specialists. Previously, my vision of a nurse leader was limited to tasks performed by nurses in managerial positions. This perspective has, however, changed to include nurses in other roles such as staff nurses educating patients and students.
My vision of a nurse leader is a person who is resilient, an effective communicator, and who utilizes a transformational style of leadership. The healthcare environment is dynamic due to changes in regulatory requirements such as organizational, local, and national policies. It is also plagued by multiple and complex challenges due to changing patient demographics, patterns of chronic and endemic diseases, increased focus on patient safety, and emergence of new infectious diseases (Marshall, 2010). It is, therefore, imperative for nurse leaders to demonstrate resilience in the way they respond to changes. They should also be able to support other staffs in embracing change positively. They should help staffs see that changes are imperative and achievable (Frankel, 2011).Nurse Management & Leaders Case Study Essay
Good communication skills are essential for fostering trust amongst staffs and rallying them towards a common goal. Nurse leaders are constantly communicating with managers, physicians, staffs, patients, families, and non-employees. They should be able to communicate in a supportive, concise, and non-threatening manner using appropriate non-verbal expressions and a well-modulated tone. They should also have effective listening skills as a considerable proportion of time is spent listening. Lastly, they should be able to foster a safe and positive working environment that permits open and trustful communication (Smith, 2011).
Regarding transformational leadership style, for nurse leaders to be effective, they must be visionary, goal-oriented, and strategic (Smith, 2011). They should be dynamic, passionate, solution-focused, and have a motivational impact on other people. A good nurse leader seeks to develop nursing staffs under her charge through leadership (Sherman & Pross, 2010). Research findings suggest that mentoring fosters learning opportunities that help in the supervision and assessment of staffs in practice settings. Further, they suggest that supportive leadership styles that include coaching, mentoring, and supervision reduce emotional exhaustion, stress, burnout, increase self-esteem, and buffer the effects of a negative work environment (Frankel, 2011). This is because strong nurse leadership helps to create positive working environments. Overall, transformational leadership when employed shapes and changes the values and goals of staffs in achieving a collective purpose (Frankel, 2011).Nurse Management & Leaders Case Study Essay
In summary, the ever-increasing complexity of the healthcare environment has made it necessary for nurses to assume leadership roles. Previously, my vision of a nurse leader was limited to tasks performed by nurses in managerial positions. My vision of a nurse leader currently is a person who is resilient, an excellent communicator, and who uses a transformational style of leadership.

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In the U.S. and globally, the current shortage of nurses could have crippling effects on
health care systems, yet within healthcare nurses are the most underserved by developmental
opportunities, especially in terms of organizational leadership and business-related education
(Bazarko, 2011; Benner, Sutphen, Leonard, & Day, 2009). To address this gap, we developed a
program focused on the cultivation of executive mindset and enterprise-level organizational
knowledge and skills in nurse leaders, under the auspices of the executive education division in a
business school. Since inception, we have delivered the program three times, during 2011, 2012,
and 2013. Feedback from participating nurse leaders and their organizations indicates that the
program is successful as evidenced by post-program evaluation, demand for future program
offerings, and discussions about creating additional versions of the program.
At least one company that sent nurses to the program also created an extensive in-house
“wrap-around” to augment the on-campus program. This program extension was created to
ensure that nurse leaders received ongoing support, mentoring, and career sponsorship, as well as
the additional enrichment necessary to ensure a strong return on investment for the individual,
her or his team, and the organization. Early evaluation indicates that nurse participants have
made significant impacts in this organization and have accelerated their career progression at a
rate greater than other high-potential nurses in the organization.
We believe these results are due to program curricula that addresses developmental needs
common to anyone transitioning from technical and manager roles into executive roles, as well
as developmental leadership needs unique to this population. The unique needs result in large
part from gender and identity dynamics in medicine and health-related business organizations,
Nurse Leader Development Program–4
which profoundly impact nursing as a profession, healthcare as an industry, and nurses entering
organizational leadership in particular (Cummings, 1995).
Below, we explore some of the issues that confront nurses moving into leadership in
healthcare, summarize program curricula and delivery, and present evidence that the program
results in participants becoming more effective in leading strategic initiatives and organizational
change projects at system, organization, and team levels. We offer our experiences in the hope
that they inspire similar offerings for nurse leaders, not only because this group is greatly
underserved, but also because we strongly believe that nursing represents a vital voice in the
search for solutions to the global healthcare crisis, yet this group receives the least attention to
gaps that may prevent them from more powerfully and effectively participating in this process.Nurse Management & Leaders Case Study Essay
The Nurse Leader Challenge
The shortage of nurses in the U.S. and globally could be crippling for healthcare systems,
particularly at a time when resource demand is on the rise (Bazarko, 2011; Buerhouse, Auerbach,
& Staiger, 2009). In order to meet the demands of the Affordable Care Act, it is critical that
nurses are prepared to serve in a variety of leadership roles to effectively contribute to delivery
of safe, high quality, and affordable patient care; develop new models of care; and be drivers of
the organizational changes that lead to healthier and safer work environments and make
healthcare as an industry work better for everyone.
Despite the urgency of these challenges and opportunities, nursing is the most
underserved group within healthcare in terms of education generally and business-related
education specifically (Benner et al., 2009). Few organizations are investing in the development
of nurse leaders who possess the skills necessary to lead change at a time when the healthcare
landscape is evolving radically. This underinvestment likely reflects broader societal devaluing
Nurse Leader Development Program–5
of care work and those who perform it, as well as cultural beliefs that nurturing and relational
styles and values are mutually exclusive with the strategic and agentic values identified with
Western leadership (Eagly & Chin, 2010; Eagly & Karau, 2002). A recent report released by the
prestigious Institute of Medicine (2010) put forth an urgent call to action to address these gaps in
developing nursing executives and leaders.
Gender dynamics impact many organizations in many industries, however we believe
there are also particulars by industry that are important to consider. The institutionalization of
divergent norms and values in different professions within an industry is a factor that recent
literature reviews suggest are under-emphasized in business leadership research (Gardner, Lowe,
Moss, Mahoney, & Cogliser, 2010; Jackson & Parry, 2011). We believed addressing these
issues explicitly would be vital with this population, and one benefit we hope for is increased
interest in addressing industry-specific gender dynamics with research, especially in healthcare.
As we assessed this situation, we discussed together and with other stakeholders in the
program two sets of questions, among many others:
1. To what extent should we directly address gender issues generally and gender issues Nurse Management & Leaders Case Study Essay
manifested in healthcare and nursing? Time is always at a premium in executive
education programs. How could we make sure participants were acquiring the
knowledge, skills, abilities, qualities, and perspectives any aspiring organization
executive needs, while also addressing barriers and opportunities unique to this
population, given their identity as nurse executives?
2. How could we maximize the “value add” of the program both for participants and
their organizations? For nurse leaders, given cultural patterns of the devaluing of care
workers, it was especially important to assure outcomes of real and immediate value
Nurse Leader Development Program–6
to organizations’ strategic imperatives in order to facilitate maximal positive impact
on participants’ careers.
Gender Dynamics in Healthcare
With many clinical and technical professionals, moving into team and organizational
leadership is a challenge in part because their education generally lacks leadership content and
experience. In nursing these issues are even more complex due to professional values clashes
and gendered dynamics that have been institutionalized over a century. In healthcare, leadership
frequently consists of three professional groups, each with strong professional identities: nurses,
physicians, and organizational or business professionals (for short, if not literally, RNs, MDs,
and MBAs). Each identity encompasses deeply institutionalized and strongly held sets of values
and norms, and these three sets of values and norms are often in conflict with each other. Each
of the three also encompasses linguistically different ways of describing patient care. Identities
such as these are critical to how leaders develop (Day, Harrison, & Halpin, 2009).
Relational and caring values are pivotal in feminine identity formation across cultures,
and care forms a central value tenet in nurse identity formation. In contrast, physician education
and much business education imparts strongly held independence and agentic values
(Cummings, 1995; Eagly & Karau, 2002). Given a man and a woman with the same resume,
research has shown that men are more likely to be seen as potential leaders, in part because
leadership is associated with these values in Western cultures (DeRue & Ashforth, 2010; Koenig,
Eagly, Mitchell, & Ristikari, 2011) Nurse Management & Leaders Case Study Essay
As a profession, physicians pride themselves on being scientists and are focused
generally on treatments and outcome measures. Similarly, business and management specialists
are trained to focus on financial and economic efficiencies. Although things are now changing,
Nurse Leader Development Program–7
nursing education, in contrast, taught nurses to focus on each patient’s experience of care, at
times without clear regard for resource consumption or outcomes. In addition, there are other
gendered traditions in healthcare, such as nurses being seen as assistants or handmaidens to
doctors (Cummings, 1995).
Thus, as nurses move into leadership and work more closely with physicians and nonclinical business leaders, they may face both internal and external threats to their identity,
including being affiliated with “self-important” doctors and “uncaring” business people by those
they used to work with, and being seen as “overreaching” or as “advocating for a cost center” by
those they seek to influence, as represented in Figure 1.
———————————
Insert Figure 1 about here
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The research we undertook to prepare for the program suggested unique challenges that
come together in nurse leader identity formation and competency development, as represented in
Figure 2: gender and power in health care, clashes of identity values between clinical nursing
and business leadership, and dilemmas posed in transforming from nurturing, caring roles into
those involving business acumen. We designed the program curriculum to address these three
elements in interrelated ways and in sessions specifically designed to address each individually.
———————————
Insert Figure 2 about here
———————————
Although evidence from research literatures on gender in business, management,
leadership, and nursing all strongly suggested that the dynamics represented in Figures 1 and 2
would have impacted participants in the program, we also confirmed this using participants’
perspectives. During a session of the program, we asked participants to respond to a brief open-
Nurse Leader Development Program–8
ended survey, which included the question, “Do you think gender issues impact your leadership
in healthcare?” We informally content-analyzed the responses and present them in Table 1. In
addition, we held an interactive session on the existing nurse leader brand identity versus
participants’ desired brand identities.Nurse Management & Leaders Case Study Essay
———————————
Insert Table 1 about here
———————————
Examination of Table 1 reveals three primary challenges that almost every participant
mentioned (and it should be noted that approximately 15% of respondents were male), as well as
one opportunity. The challenges include struggles with participants’ feminine style effectiveness
in masculine-dominated environments; struggling with stereotypes and biases about women as
leaders; and effectively articulating the value of their leadership, the contributions of nursing,
and their own teams’ impacts. The participants also pointed out that nursing currently had some
strong female leadership, which is an opportunity for nursing to leverage. We believed that
participants would be better equipped to deal with the identified challenges by a program that
addressed them directly through modules on business communication, leadership styles and
development, and executive presence, and in addition by facilitating an explicit examination of
beliefs participants may hold about their own identities as nurses and executives.
Similar issues were also uncovered in the interactive session on nurse leader brand.
Specifically, participants identified that one element holding them back from embracing the
healthcare leader identity is the clashes with their “old” notions about nurse identity, as well as
the subtle and not-so-subtle ways other members of the three professional groups identified in
Figure 1 react and respond to them as leaders.
The Program Curriculum: General and Organization-Specific Extension
Nurse Leader Development Program–9
Given budgets for nurse leader development, we were limited to two four-day modules.
The curriculum is summarized in Table 2. Examination of Table 2 reveals specific sessions
addressing identity directly, such as sessions on nurse leader brand and leadership development,
including one explicitly tying these to gender, as well as sessions on business acumen. Each
session was designed to both deliver content knowledge and perspectives, and to contribute to
one or more of the integrative elements of leader development, business acumen, and the
strategic project. These three elements provided an opportunity to synthesize material from each
session in a holistic way. Each of the three is summarized below. A fourth integrating element
was us as the lead faculty team—one of us is an MBA professor with extensive experience in
leader development and one is a nurse executive with extensive experience in healthcare; the
latter also allowed us to leverage the opportunity identified in Table 1.
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Insert Table 2 about here
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The first integrative element is leader development, including learning about the leader Nurse Management & Leaders Case Study Essay
self-development process (Orvis & Ratwani, 2010; Rothausen, 2011). This portion of the
program included specific sessions on leadership and executive presence and applied leadership
development categories that were tightly tied to the business acumen and project elements as
well. Six categories of leader development activities recommended in the research literature on
leader development were explicitly covered and also woven into the program, including
developing goals and plans; education and continuous learning; processing of past leadership
experiences as well as leadership experiences that occurred between modules 1 and 2; a 360-
degree leadership assessment from the participants’ current team and leaders and discussion of
other assessments; intentional development of relationship such as mentors, sponsors, and peer
Nurse Leader Development Program–10
coaches both in the program and outside it; and reflection (see Day, 2012; Rothausen, 2011; Yost
& Plunkett, 2009).
Although the elements of the leader development portion of the program are too
numerous to fully describe here, one feature in the relationship category is peer coaching. For
this element of the program, participants were matched in pairs by program staff and reviewed
by us. Pairs were matched for similar levels of responsibility and ease of relationship
sustainability, with other factors also considered. Before meeting their peer coaches,
participants’ experiences with peer coaching were discussed, and a model for strong peer
coaching presented (based on Parker, Hall, & Kram, 2008). Pairs then engaged in structured
sessions with each other in order to get feedback on their development plans and other elements
such as the 360-degree assessment feedback report.
The business acumen portion of the program was based on foundational competencies of
the MBA with a focus on management and leadership elements as well as ethics, which is a
foundational element of the business school hosting the program. As part of program
development, we reviewed critical areas of study in current MBA programs, with special
attention to gender issues (e.g., Datar, Garvin, & Cullen, 2010; Kelan & Jones, 2010). Many
nurse leaders have learned these subjects on-the-job or through company training without a
theoretical, strategic foundation. Business acumen elements were woven into both the leader
development and applied project as well. After each business acumen session, participants had
an opportunity to reflect on their need for further development in that particular aspect of
business acumen and brainstorm resources available to them to meet any ongoing development
gaps in these areas. In addition, each element was brought in to the development and execution
of the applied strategic projects. Nurse Management & Leaders Case Study Essay
Nurse Leader Development Program–11
The applied strategic change project involved each participant developing a project
proposal for strategic change and getting feedback from their manager and a program sponsor
before the program started. A minimal project summary was submitted prior to acceptance into
the program. Many evening sessions of the program (not listed in Table 2) involved using
specific planning tools to develop the project further. In addition, actions taken between module
1 and 2, as well as explicit consideration of leadership learning from these project execution
steps, was woven into sessions toward the end of module 2.
In addition to this program, one forward-thinking organization that sent participants also
developed an impressive program extension, which leveraged the learning from the program to
drive home all three primary integrative elements by building further on the foundation the
program established. This organization determined that it was important for their nurse leaders
and their organization to augment the existing program in order to cultivate long-term
sustainability and garner greater return on nurse leader and organization investment. Leaders in
this organization saw that the education and peer networking afforded through the standard
program provided strong foundational learning and cross-organization peer benchmarking,
feedback, and support. However, without structures in place internally to assess ongoing
learning needs; provide strong mentorship, coaching, and sponsorship; and facilitate long-term
ownership and accountability for driving organizational changes and improvements through the
projects, it was less likely that short-term changes would translate into long-term benefits for the
participant and the organization.
This one year program “wrap-around” was managed exclusively by the organization, and
added additional elements to the program foundation, as well as putting robust longitudinal
Nurse Leader Development Program–12
outcome measurement in place. The additional elements added are listed below, and evidence of
their effectiveness is reviewed in the next section.
 Post-program 360-degree assessment with measurement of changes from the
initial program 360. Changes in manager, peer, and subordinate feedback were
assessed.
 Ongoing peer coaching delivered through a peer participant in the program. This
organization worked with program staff from the university to ensure that peer
coaches for its nurse leaders were from other units of the same organization.
 Assignment of a career sponsor. In order to increase structure and accountability,
career sponsors ensured that each nurse leader had a senior executive in the
company looking out for her or his ongoing career advancement. This involved a
commitment to creating visibility for the nurse leader through networking
opportunities and high profile assignments, and ensuring that the nurse leader was
considered, when appropriate, for future assignments and positions in the
organization.
 Formal checkpoints for the project after the completion of module 2 that provided
ongoing structure and support in order to increase the sustainability of the
learning that had occurred during the program foundation. This involved a
midpoint and final project review with an audience of company executives that
included participants’ managers and career sponsors. Nurse Management & Leaders Case Study Essay