GOVERNANCE IN HEALTH CARE PRACTICE

Prepared by: Anna Liza R. Alfonso RN,R , AN

LEARNING O!"ECTIVE#:
At the end of the group discussion, the doctoral students will be able to: 1. Determine transition period of Nursing Leadership. 2. Describe the effects of using unlicensed personnel in Nursing Services 3. Synthesized effects of nursing Leaders in non- nursing position . !pply "no#ledge on the different collaborative practice model use in health care practice

LEA$ER#HIP IN TRAN#ITION
LEA$ER
$nfluential person has the ability to lead a group or department #ithout having a formal appointment. %erson #ho influences and guides direction& opinion and course of action. Arie%, A. defines a leader as 'a person capable of inspiring and associate others #ith a dream.' $t is therefore important that organizations have a mission high transcendent& since it is a po#erful #ay to strengthen the leadership of its directors. L ( L)!D& L*+)& L)!,N ) ( )N-./S$!S-$0& )N),1)-$0 ! ( !SS),-$+)& !0.$)+), D ( D)D$0!-)D& D)S$,*/S ) ( )22$0$)N- !ND )22)0-$+) , ( ,)S%*NS$3L)& ,)S%)0-2/L

T&PE O' LEA$ER#:

a) NAT(RAL LEA$ER4 -he person becomes the leader inspite of himself. .e does not see" the goal& it is trusted upon him by the group and by the tide of events. (Eg. Abraham Lincon,Mahatma Gandhi) b) CHARI# ATIC LEA$ER: -he person is an authentic hero in the eyes of his follo#ersfor he can do no #rong. .e5she inspires people to ma"e any sacrifice even their lives for the cause. (Eg. Asoka, Akbar, andit !awaharlal "ehru etc.) c) RATIONAL LEA$ER4 consistent and persistent. 6Eg. #arl Mar$, Lenin, Mao etc.)

d) CON#EN#(# LEA$ER4 -he leader is perceived as acceptable to all. .e5she rises in the absence of the above three and this leader is in a tenous position of #al"ing a tight rope for e7istence. (Eg. resident of %ndia, &peakers, Members of the arliament etc.) e) LEA$ER !& 'ORCE4 -he leader8s po#er spea"s through the nozzle of gun. .e5she dominates others through fear. .e is ruthless in suppressing opposition. .e does not reign as long as this type of leadership contains #ith in itself the seeds of its o#n destruction. 6)g. Napolean& .itler& Stalin etc.9

ROLE# O' A LEA$ER

Service provider -eam builder ,ecourse manager Decision ma"er and problem solver 0hange agent 0linical consultant :entor

LEA$ER#HIP
*rigin of the #ord is from the #ord ;lead< meaning ;to go< Leader ship is the process of influencing people to accomplish goals= that is& it is the ability to influence the behavior of others& to#ards the achievement of a mutually established goal. Leadership is the art of getting others to #ant to do something you are convinced should be done. Leadership is management s"ills that focus on the development and employment of vision& mission and strategy as #ell as the creation of a motivated #or" force. Leadership is a style or a process #hereby a person called a nurse leader #ill influence a group of people "no#n as the follo#ers for the purpose of attaining a single goal or ob>ective

Heal)* Transi)ion
Demographic and epidemiologic changes that have occurred in the last five decades in many developing countries and that are characterized by ma>or gro#th in the number and proportion of

middle-aged and elderly persons and in the fre?uency of the diseases that occur in these age groups. -he health transition is the result of efforts to improve maternal and child health via primary care and outreach services and such efforts have been responsible for a decrease in the birth rate= reduced maternal mortality= improved preventive services= reduced infant mortality& and the increased life e7pectancy that defines the transition.

Transfor+a)ional leaders*ip
! transformational leader is defined as a leader #ho motivates follo#ers to perform to their full

potential over time by influencing a change in persons and by providing a sense of direction.
-ransformational leaders use charisma& individualized consideration and intellectual stimulation to

provide greater effort& effectiveness& and satisfaction in follo#ers.

-he primary focus of the transformational leadership style is to ma"e change happen in4

*ur Self& *thers& 1roups& and *rganizations -he transformational style re?uires a number of different s"ills and is closely associated #ith t#o other leadership styles4 charismatic and visionary leadership.
-ransformational leadership encompasses the intuitive and emotional nature of people and inspire

follo#ers to high levels of commitment and effort to achieve group goals #hich emphasizing interpersonal relationship.
-ransformational leaders gain the respect and trust of their follo#ers= instill in them a sense of

pride and& mission& communicate high e7pectations promote intelligent& rational problem solving= and give follo#ers individualized consideration it is leadership that creates purposes for institutions.

'E INI#
N(R#ING

AN$ N(R#ING

;Nutri7< ( Latin to Nourish !ssisting sic" individuals to 3)0*:) .)!L-.@& and healthy individuals !0.$)+) *%-$:!L .)!L-. !,- 6ideal of service and principle9 A S0$)N0) 6systematic5scientific body of "no#ledge9 0!,$N1 profession +*0!-$*N

! 1,*/% *2 %,*2)SS$*N!LS that has common goal...-* %,*:*-) !ND )NS/,) *%-$:/: L)+)L *2 2/N0-$*N$N1 ! S),+$0) *,$)N-)D profession ;N/,S$N1 $S D*$N1 -.) B$LL *2 1*D<- 2lorence Nightingale

'E INI#
Defined as4 ;a concern #ith action& political or personal& the struggle for e?uality= valuing the individual& respect for the individual= and ChavingD an a#areness or consciousness of oppression #hich may be e7perienced by #omen directly or men vicariously through #omen8s e7periences< 6!llan& 1EE39. !ccording to the Stanford )ncyclopedia of %hilosophy& the true goal of feminism is not for #omen to have more po#er than men& but to eliminate se7ism and for society to e7press e?uality for everyone 6.aslanger A -uana& 2FF 9. .istorically& feminism and nursing have not been interrelated& ho#ever& the integration of the ideals of feminism into nursing could change the negative image of nursing to the public.

HI#TORICAL !AC,GRO(N$
-he first nurses #ere men& but this gender dominance gradually shifted. 3ecause of this shift& nursing #as not vie#ed as a profession because it #as& and oftentimes still is& vie#ed as ;#omen8s #or"< 6Sullivan& 2FF29. 3ecause of lac" of funding for nursing education and apathy directed to#ard the oppression of nurses by male doctors& by the 1E3Fs& nurses had been reduced to acting as aides to men 61roups A ,oberts& 2FF19. Due to the sub>ugation of their position by men and the fear of being stereotyped as uncaring feminists& many nurses chose not to participate in the feminist movements of the 1EGFs 6.unt& 1EEH9.

Nurse #ith baby and male doctor 6Bagner& 1E2I9

-hese negative connotations& ho#ever& lead not only to the disrepute of female nurses& but of men #ho are in the profession as #ell 6Sullivan& 2FF29. :ale nurses are presented as overly feminine& homose7ual& or as underachievers& and are discriminated against in the #or"place.

-he health care system could benefit from using a feminist approach& to promote the e?uality of genders. Nursing #ould be able encourage more men to >oin the profession if these gender stereotypes #ere absent. -hus& #e #ould have t#ice as many students applying to nursing schools& #hile gaining more respect from society as a #hole 60hristman. 2FF19.
Nurses of different specialties at #or" 6Staff Nurse $nterest 1roup& 2FFI9

!t present& 2eminism at its core& benefits both genders in society #ell as in nursing. -he e7pansion of the feminist perspective& #hich is slo#ly gaining relevance in the field of nursing& #ould help reform the pervasive image in popular culture of incompetence #ithin nursing by sho#ing that #hether or not it is a profession that female-dominated& nursing is a legitimate and important >ob. .

as to is

and Bomen #or"ing together #ill benefit INCREA#ING (#E O' (NLICEN#E$ A##I#TIVE :en the future of nursing. 6Direct Diagnostic Services& 2FFH9 PER#ONNEL: THE ERO#ION OR EVAL(ATION O' N(R#ING-

(NLICEN#E$ A##I#TIVE PER#ONNEL .(AP/ !merican Nurses !ssociation defines the /nlicensed assistive personnel 6/!%9 as individuals #ho are trained to function as assistants to registered and professional nurses in providing of patient care activities. -heir duties are delegated and supervised by the registered nurses. $n practice unlicensed assistive personnel includes the follo#ing individuals4 certified nurses aide& orderlies or attendants& clinical assistant& home health aide& nursing assistant and personal care assistants 62itzpatric& A 1reen& 1EEJ9. -he use of unlicensed assistive personnel fills the void created by the current shortage of nurses and decreases the costs of providing patient care. !lthough nurses are fre?uently as"ed to delegate and supervise patient care-related activities& they often do not feel ?ualified to do this effectively.

 0ontinuing education is an effective #ay for nurses to learn the supervision and delegation s"ills re?uired& and should be supported by academic and clinical educators.

THE ERO#ION OR EVAL(ATION O' N(R#ING -he main problem faced by the nursing personnel especially the registered nurses is the negative effects that arise as a result of delegation and these include their increased ris"s of being e7posed to professional liabilities resulting from supervising the unlicensed assistive personnel and the concern of reduced ?uality in care given to the patients as a result of involvement of unlicensed personnel in the provision of the health care services.

#OL(TION:
'he (alues and ethics -he nursing profession involves #or"ing under strict code of ethics #hich the unlicensed assistive personnel might not be familiar #ith. -he ethics of nursing include respect for humanity and the order not to participate in activities that conflict #ith caring and healing principles. -he delegation of unlicensed assistive personnel might compromise #ith the observation of such ethic especially considering the fact that they are not held accountable by the management they may be tempted to ignore the seriousness of the ethically acceptable standards of nursing profession.

N(R#E# IN NON 0N(R#ING LEA$ER#HIP PO#ITION#

Bhile a fall in the number of nursing leaders may be attributed to the current nursing shortage& studies have noted that there is also a significant deficiency in the number of nursing leaders. $n 2FF2& nurses are in a distinct position to influence healthcare policy and legislation. Be need nursing leadership to e7ert that influence and by nurturing both leadership as #ell as clinical s"ills. -he nursing profession trains ne# nurses on operating the latest technology and comple7 medical e?uipment. $n contrast& once at the bedside they rarely get the opportunity to apply even basic leadership principles. Nursing as a profession does a disservice to ne# nurses by not developing their leadership capabilities.

!E#T PRACTICE
1. Kno# #ho your leaders are& #hat they do as a leaders& and ho# their leadership influences the organization. 2. Kno# your organization8s mission and vision and ho# they influence leadership processes. 3. 3e "no#ledgeable about the organization8s strategic directives and goals.

. Nursing leadership success re?uires regular interaction #ith the medical staff for communication& relationship building& goal achievement& goal development and policy and practice changes. J. !l#ays allo# for ongoing feedbac" on #ays to improve processes in area of assignment as #ell as the organization as a #hole. /se this feedbac" as a #ay to close the loop #ith staff. G. ,ecognize the opportunities for leadership gro#th for yourself and others I. ,emember that all leadership styles functions may ta"e many forms& but all leadership should be aligned around common goals. )'he abilit* to deal with ambiguit* while de(eloping ph*sician relationships and partnerships +is, integral to the work of the nurse leaders. %t is also important that leaders demonstrate work-life balance so that our *oung talented nurses will desire to mo(e into leadership positions.. / atricia 0rome, 1", M", 0"A, 2A0M E rincipal, 1ona 0onsulting Group3 past member, A4"E 5oard of 6irectors, &eattle,7ashington. RE'ERENCE# Sullivan& ).L. A Dec"er& %.L. 62FF19. Effecti(e Leadership and Management in "ursing 6Jth ed.9. /pper Saddle ,iver& NL4 %rentice .all. Kurzman& ). -.& A 3uerhaus& %. $. 62FFH9. Ne# :edicare payment rules4 Danger or opportunity for nursingM !merican Lournal of Nursing&1FH& 3F(3J.