Ethical and Legal Responsibilities

Getting ready for class I have learned a lot about ethics committees. One of the websites that we had to read through for class talked about ethics committees. I didn't realize that there was such a thing, I guess I never really thought about it, because as soon as I thought about ethics committees it made complete sense to me to have such things in hospitals, etc. Ethics committees can be very helpful in different situations.

The underlying goals of ethics committees are:

• to promote the rights of patients;
• to promote shared decision making between patients (or their surrogates if decisionally incapacitated) and their clinicians;
• to promote fair policies and procedures that maximize the likelihood of achieving good, patient-centered outcomes; and
• to enhance the ethical tenor of health care professionals and health care institutions. (http://depts.washington.edu/bioethx/topics/ethics.html)

In the discussion for "My Sister's Keeper" I talked about the importance of being a patient advocate. That seems to be what the ethics committee is. The are leaders that advocate for the patients best interest.

After Class:

I liked what we discussed in class. We talked about how ethical issues are different to different people because everybody has a different point of view on things. Ethics have to due with your personal values, and sometimes your personal values can put you into a sticky position.

One of the questions that was brought up in class was: How do we take our personal values and bring them into the job?

It made me think that there would be some things that I would not wish to participate in, such as abortions. (Hopefully I wouldn't get a job that I ever have to deal with that.) And there are some things that I will have to leave up for the patient and act as the patient advocate whether I agree with them or not. Sometimes, I will have to make sure that the patient has the knowledge that they need to make an educated decision and that will be all that I can do.Other times I may need to get involved with an ethics committee and see what happens with that.

Leadership is about...

1. Leadership requires personal mastery: Nurses demonstrate leadership when they show competence ad mastery in tasks they perform. Nurses are deemed competent by means of license to practice nursing (NLN 2010).

2. Leadership is about values: "Leaders know what they value. They also recognize the importance of ethical behavior. The best leaders exhibit both their values and their ethics in their leadership style and actions" (About.com, Leadership Values and Ethics). "Nurse leaders use the hospital vision and values as guiding principles on which to act" (http://www.oumedicine.com).

3. Leadership is about service:

"The true leader serves. Serves people. Serves their best interests, and in doing so will not always be popular, may not always impress. But because true leaders are motivated by loving concern than a desire for personal glory, they are willing to pay the price."

— Eugene B. Habecker
in The Other Side of Leadership

"Good leaders must first become good servants."

— Robert Greenleaf

4. Leadership is about people and relationships: "The deeper your relationship, the stronger your leadership."

"For example, 24 studies reported that leadership styles focused on people and relationships (transformational, resonant, supportive, and consideration) were associated with higher nurse job satisfaction" (Leadership styles and outcome patterns for the nursing workforce and work environment: a systematic review).

5. Leadership is contextual: "Because the current workforce is made up of individuals from a wide variety of backgrounds, ages, education, ethnicity, experience, and culture; and because leadership is often faced with a rapidly changing business environment, a single leadership style cannot be expected to be effective with every person, or in every situation. The best leadership style is "the style that works". The leadership style that works is a result of taking into account all the components or forces in the situation or "the context"' (http://www.jsri.com/jsri-contextual-leadership.html).

"Contextual leadership implies both a capability to discern trends in the face of complexity and uncertainty as well as adaptability while still trying to shape events. It allows leaders to adjust their style to the situation and to their followers’ needs" (http://www.business-leadership-qualities.com/contextual-leadership.html).

6. Leadership is about the management of meaning: "Leadership is about the 'management of meaning,' and that leaders emerge because of their role in framing experience in a way that provides the basis for action; that is, by mobilizing meaning, articulating and defining what has previously remained implicit or unsaid, by inventing images and meanings that provide a focus for new attention and by consolidating, confronting or changing prevailing wisdom" (Robert Birnbaum, How Colleges Work, 1998).

I also found good information in the book “Management and Leadership for Nurse Administrators” that talked about management of meaning being the second competency of leadership. It states that, “Nursing leaders transform the social architecture or culture of health care organizations by using group discussion, agreement, and consensus building, and they support individual creativity and innovation.”

7. Leadership is about balance: In the book “Nursing Leadership” it states that, “leadership requires balance within and between the nexus of industrial and professional concerns to manage and drive in order to facilitate practice and better health outcomes for communities and individuals.”

8. Leadership is about continuous learning and improvement: “Continuous learning is essential at all levels of nursing” (Leadership Competencies: Knowledge, Skills, and Aptitudes Nurses Need to Lead Organizations Effectively). I think that as healthcare continues to improve and new things are discovered that it is very important that nurse leaders keep up to date with what they can and continuously learn and improve their skills.

9. Leadership is about effective decision making: “Educating leaders and team members about different decision-making strategies cultivates critical-thinking skills. These tools encourage teams to remain focused as the teams evaluate possible solutions. Tools should be easy to use so that staff members do not spend more time learning the tool than evaluating the solutions” (Leadership Competencies: Knowledge, Skills, and Aptitudes Nurses Need to Lead Organizations Effectively).

10. Leadership is a political process: “Nurse leaders require skills and expertise in political competence and knowledge of the policymaking process” (Deschaine, J. E, & Schaffer, M. A. (2003)Strengthening the Role of Public Health Nurse Leaders in Policy Development, Policy Politics Nursing Practice, 4, 266-274. doi: 10.1177/1527154403258308)

11. Leadership is about modeling: I really liked this whole quote: “A clinical nursing leader is one who is involved in direct patient care and who continuously improves care by influencing others (Cook, 2001). Leadership is not merely a series of skills or tasks; rather, it is an attitude that informs behavior (Cook, 2001). Several important functions of a nurse leader are: acting as a role model, collaboration to provide optimum care, provision of information and support, providing care based on theory and research, and being an advocate for patients and the health care organization (Mahoney, 2001). In addition, nurse leaders should have knowledge of management, communication, and teamwork skills, as well as some background in health economics, finance, and evidence-based outcomes (Mahoney, 2001). Personal qualities desirable in a nurse leader include competence, confidence, courage, collaboration, and creativity. Nurse leaders should be aware of the changing environment and make changes proactively. Leaders who show concern for the needs and objectives of staff members and are cognizant of the conditions affecting the work environment will encourage productivity (Moiden, 2003). In doing this, it is important that a philosophy of productivity is established.” (http://www.ukessays.com/essays/nursing/leadership-in-nursing.php)

12. Leadership is about integrity: integrity is defined as the quality of being honest and having strong moral principles; moral uprightness. “In my interventions in troubled workplaces, the healing process depends on individuals of integrity who can model appropriate behaviours and help lead the group out of trouble. Through their actions, they demonstrate to others that integrity is a worthy virtue. They help others to understand that honesty in dealing with each other, knowing the difference between right and wrong, having courage to do what is right, and caring about relationships can improve outcomes for individuals and for the organisation.” (http://www.aim.com.au/publications/bkchapters/seven_ch3.html)

Leadership and Management

Think about how theories of leadership and management impact nursing leadership and management roles.

Through the articles that I read and the power points that I read for class I learned a lot. I learned that nursing management is control. Managers control their environment and manipulate things to get the outcomes that they desire. Leadership on the other hand is to release control. Leaders are guided by group process. They collect information, receive feedback, and empower others. In the article "A nursing theory for leadership" Laurent (2000) uses a theory developed by Ida J. Orlando for patient care and nursing leadership. Laurent (2000) states that leadership is releasing the control to the employees. Laurent (2000) shared an example of management versus leadership. Management would be taking a patient, gathering the needed information, formulating a hypothesis, and implementing that hypothesis. Leadership would be taking a patient, gathering the needed information, formulating multiple hypothesis, validation (from the patient to meet the patients concerns, from information gathered, and/or from other nurses), and then implementing the best hypothesis. "Leadership equals direction, management involves logistics, speed and tools to go in that direction. Managers do things right whereas leaders do the right thing" (Laurent, 2000, 86).

I liked Orlando's theory and feel that it is a great theory to live by as a nurse. Patients need to be involved in their care and validating information with your patients will help to keep care patient centered as well as focused on their immediate needs. Leaders don't just jump to conclusions but seek validation from other sources before implementing care. It involves verbal interactions.

This also applies to nurse/nurse interactions. If there were a problem with a nurse on the floor a leader would talk to them, discuss the problem, and discuss the different solutions to the problem. Validating each solution to find the right solution(s) to fix that problem. Leaders are much more helpful and better inclined to fix things the right way. They see a whole picture.

I really liked what Laurent (2000) closed the article with, "Through providing direction and vision, as employees are involved in validating hypothesis about their performances and actively involved in the plans and decisions that affect them, leadership occurs. More importantly, if RNs provide that direction and help cast that vision, they become nursing leaders" (87).

I want to strive to be a nurse leader and to use Orlando's theory in my life and work as a nurse to give direction and do the right things.

Reference

Laurent, C. L. (2000). A nursing theory for nursing leadership. Journal of Nursing Management, 8, 83-87. Retrieved from web.ebscohost.com.

After class on January 17 there were a few more things that I wanted to add to my post. In class we discussed that leadership is influence and motivation to achieve a goal. We talked about how every individual is just as important as the next, but sometimes they need motivation to get to where they need to be. (something like that. to the point that some people may need more motivation than others) I also liked when we talked about how leadership is consistent.

Management is coordinated actions and processes. There are three different styles of management:

Autocratic: "My way or the highway" (Corporate policy, codes, God, and military)

Democratic: People get together and work things out

Laissez-faire: Anything goes

A good manager is well rounded in all three styles.