The Current and Future Role and Responsibilities of the Professional Nurse Leader within an Urgent Care Organization
Wenyang Cai
NUR3110-HD02
Professor Paradiso
May 16, 2016
Introduction—Our Management Style
Being a nurse leader today is very challenging. Besides having knowledgeable and skilled in nursing practices, nurse leaders have to have competent in all aspects of management, be an excellent communicator, effective team builder, and proactive in preparing for emerging new threats. City Urgent Care is a fast pace care center that provides many first-aid urgent cares. Being a nurse leader here requires not only the possess of above leader qualities, but also the ability to apply these skills smoothly and quickly into this work environment. By given this, our management style would be requiring managers to be transformational leaders, which is to identify the needed change, creating a vision to guide the change through inspiration, and serves to enhance the motivation, morale, and job performance of followers through a variety of mechanisms (Marquis & Huston, 2012).
Mission Statement, Goals and Objectives to be Learned by Staff
City Urgent Care Center is a freestanding facility that serve the diverse community of New York City’s lower Manhattan. City Urgent Care’s purpose is to provide care when individuals are sick, hurt, or in pain when their primary physician is not available, and to provide fast service to clients and help them get back to optimal health. We believe that every patient should be admitted and treated regardless of sex, age, ethnicity, language culture or lack of insurance coverage.
City Urgent Care Center conveniently located in Lower Manhattan and thus can be easily access by MTA trains and buses services. This easily accessible location helps people in need get access to care more rapidly. Our center provides fast service for walk-in patients. Individuals will be seen by a doctor in less than 15 minutes, therefore emergency diseases can be handled in a timely manner, lives can be saved. In addition, our center opens 24 hours and 7 days a week in order to help those individuals who encountered spontaneous accidents and illnesses. We provide clients who seeking cares during their primary physicians’ off work hours, and we provide clients who encounter emergency accidents with more fast-acting care than hospitals’ ER.
A mission statement is a powerful tool that can drive practice growth, productivity and success when thoughtfully developed and properly utilized. Sometimes practices leaders determine the goals of their practice but fall short of communicating the purpose, goals and performance standards in a way that inspires both patients and staff. “An actionable mission statement is an excellent tool to begin to accomplish all of this” (Bisera, 2015). Therefore, we will orient our staff the mission statement of our care center the first day of their orientation. In order to communicate the mission successfully, we will learn the way that Bisera mentioned in her study, that is keep it real, and to narrow our focus and not try to be all things to all people, but use polarizing, interesting words that not every other practice in the specialty could use. (Bisera, 2015).
Overcome Resistance to Changes
Many nurse leaders today will readily admit that one of the most significant challenges is to deal with rapid changes occurring in the health care environment. “For most of the staff, they would feel changes are unwelcome and they usually resist to changes, because in most situations where they were asked to change, they are substituting new and unfamiliar behaviors or practices for old comfortable ones” (Sherman, 2011). Therefore, staff’ resistance to changes is a really a common situation and it is challenging for nurse leader to perform the changes.
“Many change attempts fail because the individual undertaking the change uses an unstructured approach to implementation. In contrast to accidental change or change by drift, the planed change is the deliberate application of knowledge and skills by a leader to bring about a change. Successful leaders must be well founded in change theories and be able to apply such theories appropriately” (Marquis & Huston, 2012). Leaders must act as role models to subordinates during the change process. First, leaders must be actively engaged in change in their own work and model this behavior to staff. Second, leaders must be able to assist staff members in making the needed change requirements (Marquis & Huston, 2012). Therefore, in order to perform changes successfully, as nurse leaders we must plan changes and then engage in assisting staff members to deal with changes. In addition, as mentioned by Sherman (2011), we can follow John P. Kotter, a Harvard business professor’s 8-step-plan model that helped with change. Firstly, we will create a sense of urgency about the need for change. We can inspire staff to see the need and the good for change, to make change real and relevant. Secondly, we will build a team to help guide the change. We will get the right people in places, make them as pioneer leaders, to make change happen. Thirdly, we will develop and communicate the change vision, to create a simple, clear strategy of what the change is and how it is going to occur. Fourthly, we inform as many staff as possible, keep them informed and respond to their needs, never let them feel change occurs suddenly. Fifthly, we listen to the staff members, address their concerns and provide feedback, remove obstacles and reward their progress. Sixthly, we will create short-term wins, to establish some easy to reach goals in order to manage the change slowly step-by-step. Seventhly, we will build and encourage determination and persistence, report these on the progress. Eighthly, we will weave the change into the culture and practice in tangible ways. We believe that as we make planned change as a collaborative process, involve the staff that affected by a change would be included in planning it, and leaders actively engage in change in their own work and model this behavior to staff and actively assist staff members in making the needed change requirement, resistance can be overcome and changes will be performed successfully.
Create a motivating climate
In planning and organizing, leaders attempt to establish an environment that is conductive to getting work done. Motivation is the force within the individual that influences or directs behavior. The leader can create an environment that maximizes the development of human potential (Marquis & Huston, 2012). Many other studies have supported this view. One author named Bisera, has described the importance of how developing a motivating organizational climate has motivation effects on changing the morale, motivation, and innovation of the hospital staff. This author pulled out a study on a 50-bed custodial back ward of chronic schizophrenics, and indicate the result that motivation factors promoted more effective team functioning, improved discharge rates, and conveyed a sense of the ward as no longer backward. “In order to enhance team functioning and to prevent the development of backwards, an institution must have a climate that motivates both staff and patients” (Gaston, 2016). Knowing the importance of motivation could lead, we can use some effective ways to create a motivating working environment. For example, we can create awarding systems like setting up employee of the month. Each position would have one employee to be voted as employee of the month, and we will hold an awarding meeting to gather all staff involved, to celebrate the employees of the month and ask them to make a short speech about what they believe that they did well during the month, and thus encouraging other staff to do well and try to get improved as well. In addition, we can ask patients to do evaluation questions right after discharge, including ask them if there’s anyone in particular they want to mention and thankful with. In this way we can praise those staff who were mentioned by the patients in the meeting. As leaders, we will also walk around at work, try to see if there’s any staff need help with so we can give them a hand, try to address mistakes they made right away but in a manner and proper way, and try to point out the good things they do and acknowledge their success. I believe these can help creating a motivating climate and staff will be motivated to become enthusiastic workers.
Staff Orientation
New staff that joins City Urgent Care Center will need to attend a full 6-week orientation section in order to have competence to provide good care to our patients. The 6-week orientation contains a 2-weeks in class lecture time and a 6-weeeks of clinical practice guided by unit nurse preceptor. At the beginning of the in-class section, staff will receive a welcome message from our center CEO and unit managers, as making the staff feel warm and welcome is very important to create a harmony atmosphere and thus make the staff start to love the place that they are going to work at. Next, staff will learn the mission statement of our center, as it is the goal of our facility and understanding it will help staff effectively work towards the standard. The following section will be the employee expectations and policies. For example, staff will be follow the dress code, which requires staff to wear uniforms and dress professionally. In addition, staff will require to follow the personal conduct policy, rules for providing patient safety policy and chain of command policy. After all these sections have been introduced, staff will time to ask questions freely, and managers will provide them the answers.
Follow the orientation meeting will start the 2-weeks in class section, in which knowledge of proper equipment use, diseases protocol, IV infusion techniques, medication administration, and proper use of computer network will be covered. Staff will need to complete a post-class examination after this 2-weeks learning. If staff does not pass the exam, repeated the course will be required. Our goal is to ensure staff’s competence and thus safe cares will be given. In the 4-weeks clinical practices section, nurse preceptors will guide the new staff and demonstrate the skills learned in the first 2-weeks in class section. New staff will be able demonstrate all these skills. If there are any steps of any procedures they don’t feel comfortable with, the preceptors will help them and make them practice more often until they perform the procedure successfully.
Employee Evaluation
According to Simth, Gunzenhauser &Fielding (2016), “the ability of a local health department to assess and improve employee performance through an effective evaluation process is critical to overall organizational success. A constructive performance evaluation process not only provides meaningful feedback on work performance but also provides opportunities to reinforce work behaviors that support the organization’s mission, to recognize exceptional work, and to guide future growth and learning” (Simth, Gunzenhauser &Fielding ,2016). Therefore, it will be very helpful and it is very essential to have effective employee evaluation ways. City Urgent Care center will perform employee evaluation through their individual performance, teamwork adequacy, and effective communication skills. For individual performance’s evaluation, we will look at the criteria of being at work on time, follow our center’s policies, and performance at work. These will be evaluated by asking peers to do a questionnaire to evaluates colleague’s performance on these aspects as well as by the manager’s observation. For teamwork adequacy’s evaluation, the tasks performance that completed by a team as well as their unity at work, will be evaluated by their manager by observation. For effective communication skills’ evaluation, staff will be asked to complete a questionnaire regarding how they feel they understand of other colleagues’ communication as well as a questionnaire of self-assessment. In combination of these evaluation methods, feedback from multiple aspects and divers team members can be provided, which yields more objective and accurate prospects of employees’ performance, and thus meaningful feedback on work performance, opportunities to reinforce work behaviors that support the organization’s mission, as well as guides for future growth and learning can be provided.
Conflict Management
Traditionally, nurse managers used to avoid or suppress conflict, but now can no longer afford to respond to conflict by this way, because this is nonproductive. Based on Conflict Theory, too little conflict results in organizational stasis while too much conflict reduces the organization’s effectiveness and eventually immobilizes its employees (Marquis & Huston, 2012). To handle conflict properly, the first step is to identify the cause of the conflict. Next, I will ask the involved staff to gather together privately, to talk about the problem face to face. I will listen carefully to their conversation and try to get all the information possible to differentiate between facts and opinions, also remaining an unprejudiced manner. When addressing the conflict, I’ll be careful about that the focus should be on the causes of the disagreement and not on personalities, and concentrate on understanding but not on agreement. I will also provide feedback, try to provide solutions acceptable to everyone concerned. If necessary, I will refer them to third-party consultation, or try an open-minded and constructive negotiation. After the conflict solved, I will restate the final decision, and end the conversation on a friendly note, to make sure both side ended peacefully.
Communication
“Organizational communication is a high-level management function. Communication impacts all management activities and cuts across all phases of the management process” (Marquis & Huston, 2012). The ability to communicate effectively often determines success as a leader-manager. Leaders must communicate with large and small groups as well as with individual employees. It is essential that the manager has an understanding of group dynamics, including the sequence that each group must go through before work can accomplished (Marquis & Huston, 2012). In City Urgent Care Center, they are many different kinds of stuffs needed to be communicated often with staff in order to run the best organization. Staff meetings will be an effective tool that use for communication among staff. Before the meeting starts, the leader should set a goal to have a clear objective about what the purpose is for the meeting, together providing a formal meeting agenda to staff in order to give staff the review of contents would be in the meeting. Also, leader has to consider who would get involved, and to attend the meeting. Therefore, notifications will be sent to them through email and their unit managers. Staff meetings will be held in a conference room. Electronic devices, such as PowerPoint presentation, will be used to help demonstration. During the meeting, we should set a positive emotional context, establish ground rules, and stick to the agenda (Gaddis, 2010).
An ad hoc meeting is used on a temporary basis to overcome inflexibility in the structure (Marquis & Huston, 2015). It is usually used to dealing with unpredictable situations such as natural disasters and emergency patient care. During ad hoc meetings in our center, unexpected of life-threatening ER patients’ cases will be discussed by physicians and nurses.
Task force meeting focus on specific topics that needed to be handled by all different units. Topics such as emergent activation for cardiac arrest patients, emergent act for shock patients, immediate treatment for stroke patients, will be fall into task force meeting and leading physicians, head nurses and nurses that taking the task will need to attend.
Committee meetings will consist of staff members that vary in culture, religion and gender, on the purpose to create a harmony environment and members feel to speak on various issues.
Team Building Activities for Diverse Staff
“Team-building activities promote teamwork and collaboration and provide opportunities for team members to work as a cohesive unit to achieve a common goal. Managers often conduct team-building activities as a way to assimilate a team that is diverse in some way, such as culturally, socially, or logistically” (Bond, 2012). According to Bond (2012), there are several factors that can ensure the success of Team-Building Activities, which we can learn from and apply to our City Urgent Care Center. The first is to allow team members to change roles or levels of participation. By doing this, we can get interdisciplinary units’ members such as physicians, nurses, and PCTs to take part in the activities, and everyone is able to play a different role in the group. In addition, the activities should not dependent on specific knowledge, skills, or experiences. Creating solutions and responses that encourage team members to collaborate and exchange ideas is also essential. Therefore, the activity should be something interesting and irrelevant to work activities, such as holding a basketball match, a singing contest or a dinner party. The activities should also provide opportunities staff members to get to know each other, exchange ideas, and build harmonious relationships.
Responsibilities of Nurse-leader Manager
Marquis and Huston (2015) indicated that “Researcher has shown that the leader-manager must assume a variety of leadership styles depending on the needs of the worker, the task to be performed, and the situation or environment. This is known as situational or contingency leadership theory” (Marquis & Huston, 2015, p.48). Our City Urgent Care Center is a fast-paced medical center composed of only a few positions. Therefore, the nurse-leader manager is responsible for many different tasks, and must assume many different leadership roles. Considering the political aspect of their work nurse-leader managers themselves should stick to health care act as well as to ensure that other staff will comply with the act; considering the legal aspect of their work nurse-leader managers should make sure that our center keep up with the latest rules and regulations; considering the financial aspect of their work nurse-leader manager should stand for the interest of the center, uphold the rules of the center, and do their best for the center’s good. They also ensue that other employees will comply with the rules. As United States is a country of immigrant, employees as well as our clients will come from different countries of origin and have different religions; thus people will have different personal and cultural believes that conflicts will emerge between as well as between staff and patients-conflicts which raise ethical dilemmas. In so far as nurse-leader managers a facilitate creative problem solvers, they should understand and learn about other cultural differences. This will help them to solve ethical dilemma when they arise. As professional nurse-leader managers in the City Urgent Care Center, they should be transformational leaders and play different roles so as to dedicate themselves to the center. We believe that our nurse leader manager plays a critical role in our center. Having professional nurse-leader managers like this will make us the best center for patient care.
References
Bisera, C. (2015). What you’re missing without a mission statement. Dermatology Times, 36(11), 82-86 2p.
Bond, N. (2012). Key Success Factors for Effective Team-Building Activities. AMWA Journal: American Medical Writers Association Journal, 27(3), 129-131 3p
Gaddis, S. (2010). Effective meetings: how to take your next meeting from worn-out to wow!. Vermont Nurse Connection, 13(3), 5-5 1p.
Gaston E. Developing a motivating organizational climate for effective team functioning.
Hospital & Community Psychiatry [serial online]. June 1980;31:407-412 6p. Available from: CINAHL Complete, Ipswich, MA. Accessed May 10, 2016.
Marquis, L. B., & Huston, J. C. (2015). Leadership Roles and Management Functions in Nursing Theory and Application. (8th ed.). Philadelphia, PA: Williams & Wilken.
Rose Sherman blog emergingrnleader.com2011
Smith K, Gunzenhauser J, Fielding J. Reinvigorating Performance Evaluation: First Steps in a Local Health Department. Public Health Nursing [serial online]. September 2010;27(5):425-432 8p. Available from: CINAHL Complete, Ipswich, MA. Accessed May 13, 2016
