Management Concepts for Advanced Practice, Interview Example

Outline

1. Introduction

• Description of purpose and goals

2. Assessment of Roles

• Description of Nurse in relation to organizational Practice
• Role Evolution in Advanced practice
• Predominant Model Theory
• Leadership behavior and attitude
• Politics of Leadership power
• Intra-Organizational involvement
• Extra-organizational involvement

3. Role Analysis
4. Comparative analysis of expectations
5. Conclusion

• Summary of interview

Abstract

Interpreting management concepts for advanced practice by way of an interview is a unique opportunity for students of the discipline. The foregoing account in this document relates an interview interaction with a nurse who is dispensing an advanced practice role in her organization. During this discussion attempts were made to gather data that will be pertinent in improving functioning of nurses involved in similar roles.

Introduction

Description of purpose and goals

The purpose of this assignment is to offer opportunities for students to apply concepts learnt in a classroom setting to the real world situation. Therefore, by interviewing an advance nurse practitioner primary data would be collected regarding how these principles are translated within an organizational structure. Precisely, the goals are to gather primary data and relate these findings to concepts formulated by theorists in the science to influence evidence based practice. This is expected to be a learning experience for the advanced student nurse to inculcate positive leadership/ management techniques after he/she graduates and functions in an administrative capacity.

Assessment of Roles

Advanced practice nurse according to Eileen O’ Grady (2004) is a term used to classify certified nurse-midwives; certified nurse anesthetist; clinical nurse specialists and nurse practitioners. Their role embody application of nursing interventions that provide positive health outcomes when direct care of individuals is executed, populations managed; healthcare organizational functions are supervised and health policies developed and implemented (O’Grady, 2004). An interview was conducted with Mrs.WG who is an impressive Nursing Manager at a very prestigious healthcare facility in my city. This interview took place at her office on the facility’s premises during the hours of 9: 50—11:00 AM. It lasted approximately 55-60 minutes. Fifteen minutes were used as a break period.

My understanding of an advanced practice nurse is that his/her role exemplifies the highest position a nurse can attain in contemporary practice. Nurse practitioners particularly distinct from other categories are capable of performing duties similar to a Medical Practitioner. The only difference is that they are not licensed to practice as MDs. This limits the scope of Nurse practitioners’ intervention due to their limited power. Therefore, in describing their role it can be considered to substitute doctors’ functions but not replace them.

Description of Nurse in relation to Organizational Practice

This Advanced Nurse Practitioner is the nursing service administrator of a 150 bed obstetric facility and team leader for 10 resident obstetricians; 10 registered obstetric nurses; 10 Licensed Practical Nurses and 20 auxiliary staff members. The auxiliary staff functions in the kitchen; cleansing and records sections of the organization.WG is capable of functioning as nurse and midwife in two  nursing disciplines. In her capacity as nursing service administrator she is not required to perform deliveries, but supervises primary health care offered to women within the facility ensuring that shifts are adequately staffed and the facility is managed according health care regulations.

Another major managerial responsibility entailed recruitment of the most efficient staff. As such, she functions as a human resource manager as well. Therefore, in executing this role she ensures that all staff is appropriately remunerated for their very high quality of work through incentive schemes. She pointed out that people like to know that they have job security and sustenance after they cannot work any longer. Consequently, she researches opportunities and makes them available to all categories of workers under her supervision.

Role Evolution

This professionally attired woman who appears to be in her mid-forties holds a Bachelor’s Degree in Nursing; Masters in Health Service Management and a Doctorate in Contemporary Health Care Philosophy. This twenty five year illustrious nursing career started with a humble beginning as a Licensed Practical Nurse serving in various health care facilities. Later she qualified as a Registered Nurse with advanced studies in obstetric nursing. Now she is manager/ administrator of a private hospital functioning in that capacity for 15 years.

Mrs. WG emphasized that the evolution to this level in nursing practice was not a very easy road. Moving up the ladder from a young Licensed Practical Nurse entailed being instructed by registered nurses, following doctors’ orders and interacting with some challenging patients. Fondly, she remarked that her patients were not pregnant women all the time.  However, mentoring by senior nurses helped her through those difficulty days. It was due to their encouragement that she has achieved professional success.

Predominant Model Theory

Elaine Marshall (2010) speaking about transformational leadership in nursing practice quoted Boyce (2010) to say that in the twenty first century illiteracy would not be defined as inability to read and write, but instead the difficulty of being unable to learn, unlearn and relearn ( Marshall, 2010). Hence, the theory behind transformational leadership in advanced practice nursing is that there is the perpetual need to learn. In the same way as science and technology takes precedence and new evidence emerges it may become necessary to unlearn concepts and principles which have become obsolete. Ultimately, new concepts and techniques will have be redefined and relearnt

This advance practice nurse indicated that she hated autocratic leadership as a young nurse. She never liked supervisors who did not trust her ability to function independently. For her it meant a violation of her professional intelligence. In response she allows subordinate staff to function with integrity and further give them the space to do it efficiently according to how they were certified. By same token benevolent management styles were not advocated. They were interpreted as simply ridiculous lacking transparency. Definitely, it is not tolerated in that organization. There is no scope for, ‘do as I say and not as I do in this maternity facility,’ she remarked.The theoretical model guiding her leadership while being transformational was clearly democratic. Importantly, in explaining Mrs. WG’s leadership style, she considered herself to be managing with democratic prudence.

Leadership behavior and attitude

Mrs.WG exemplary leadership qualities include empathy for patients experiencing labor and delivery as well as support for their loved ones. She has been recognized as an astute on –the- job educationists for interns and new staff. Her unique ability to understand and resolve conflicts without any judgmental attitude has won the hearts of many patients and staff alike. Apart from these virtues she has demonstrated her conviction for high standards which she conveys to the entire staff.  Importantly, patent care comes first on her agenda because she considered that if women were not admitted into the hospital there would be no jobs for her and staff. Subsequently, they could not operate as a business. Her greatest strengths can be described as openness, understanding, organizing; facilitating; learning; affirming; collaborating; supporting and team player/ actor.

Politics of Leadership

Mrs.WG mentioned that that there is a difference between power and authority. As the head of this 150 bed maternity facility Mrs. WG’s leadership authority lay in modeling the expectations of her organization. It meant exemplifying daily before subordinate staff how to manage a 150 bed maternity facility efficiently. She had the authority to execute the concept through her office. However, she had no power in making employees comply if this was enforced in a way to let them feel uncomfortable on the job.

Precisely, the political authority also embodied engaging staff to ensure a top up approach instead of a bottom up influence. As such, the authority to discipline staff members was invested upon her through the designation of Facilities Nursing Service Manager, because resource management fell within her portfolio.  Her concept of authority and use of power is to demonstrate through modeling what ought to be accomplished. If this does not work then, a one on one discussion either at a staff meeting forum or structured interview could be reinforced. Ultimately, her goal is to be the best leader there is on earth.

Intra-Organizational involvement

Mrs. WG has used her initiative to organize on- the- job continuing education and training when the need to re-learn procedures and principles for evidence based practice intervention becomes imminent. She is also very instrumental in organizing training for supervisors in various departments within the facility’s management and functions as chairperson for the Leadership Improvement Strategies Committee in her organization.

Extra-organizational involvement

This Advanced Practice Nurse has contributed to leadership Nursing Journals; organized hospital leadership seminars and is involved in re-educating her community on the importance of proper obstetrical care during pregnancy.

Role Analysis

Terese Bondas (2006) writing on ‘Paths to Nursing Leadership’ emphasized the need of educational requirements as the advance practice adopt leadership roles in nursing management positions. She reiterated that it is important in determining the competency at which nursing managers’ function. (Bondas, 2006).Therefore, in summarizing Mrs. WG’s leadership and management styles one evident advantage is the application of her academic qualification acquired through years of training. Her credentials included a Masters in Health Service Management and Doctorial studies in Contemporary Health Care Philosophy.

Management staffing techniques seem to be another strength Mrs.WG possessed.  Marie Carney (2006) writing on “Understanding Organizational Culture: the key to successful middle manager strategic involvement in health care delivery” (Carney, 2006) confirmed that strong organizational cultures were responsible for magnificent strategic involvement (Carney, 2006). Mrs. WG exhibits a strong command of her organization in maintaining a calm industrial climate. Clearly, the organizational culture adapted by Mrs. WG lends itself to support and affirmation as being the catalyst for cohesiveness and high quality performance highlighted by Lucile Joel (2009) in class readings

Mrs. WG was rather vocal concerning her profound philosophy regarding leadership styles. Clearly, she emulated the styles she loved best  and her values can be closely linked to Stina Sellgren’s (2006) philosophical assumptions on leadership styles while writing about,    “Leadership Styles in Nursing Management: Preferred and Perceived.’ Sellgren (2006) contends that ‘Subordinates prefer managers with more clearly expressed leadership behavior than managers themselves prefer and demonstrate.” (Sellgren, 2006).

My Interviewee Mrs. WG, vehemently, expressed this leadership style when she emphasized integrity to mean transparency in leadership whereby there was no ‘do as I say’ actors in the organization, but more importantly, ‘do as I do.’ These leadership qualities accompanying the roles to be performed are pertinent for development in 21st century nursing care industry being confirmed by Diane Huber (2009) in ‘Leadership Nursing Care Management’ (Huber, 2009).

Comparative analysis of expectations

The leadership qualities demonstrated by this advanced practice obstetric nurse is above my expectation. Interacting with many advanced practice nurses in the profession it was a relationship inducing fear of losing one’s job in the way authority and power were articulated. Mrs. WG is very humble and practices her convictions of being fair, firm and friendly allowing staff to function confidently and if mistakes are made the appropriate reformative action is taken. One of the characteristics of advanced practice nurse leadership as outlined by Lucille Joel (2009) is to demonstrate leadership through the imitation of change (Joel,2009).This has been the strategy model adopted by Mrs.WG in her organizational management. Very often with increasing shortage of health care professionals to fill vacancies the model is ‘a do as I say’ intervention because there is not time to model what is appropriate.

Conclusion

Summary of interview

This was a very powerful learning experience because it provided data on how to lead and how not to lead. However, actual practice in nursing leadership role articulation is still evolving. Organizations adapt various management styles consistent with their ideology of leadership. As such, it can be deducted that there is no correct or incorrect leadership style, but rather the appropriateness is determined by the organizations’ goals. It is hoped that leaders such as Mrs. WG share their culture of transparent management practices across advanced practice nursing professions in making the discipline more functional.

References

Bondas, Terese. (2006). Paths to nursing leadership. Journal of Nursing Management, 14(5), 332-339.

Carney, Marie. (2006). Understanding organizational culture: the key to successful middle managerial strategic involvement in health care delivery? Journal of Nursing Management. , 14(1), 23-33.

Huber, D. (2009). Leadership and Nursing Care Management. New York. Elsevier Health Sciences

Marshall, E. (2010).Transformational Leadership in Nursing. Springer Publishing Company

O’Grady,E. (2004). Chapter 43. Advanced Practice Registered Nurses: The Impact on Patient Safety and Quality. An Evidence- Based Handbook for Nurses.

Sellgren, Stina. (2006). Leadership styles in nursing management: preferred and perceived. Journal of Nursing Management, 14(5), 348-355

Joel, L. ( 2009) Advanced Practice Nursing: Essentials of Role Development. New York. P.A Davis Company