Transformational Nursing Leaders

reading:

A Nurse Executive Competencies

Communication and Relationship-Building
Effective Communication

Make oral presentations to diverse audiences on nursing, health care, and organizational issues

Produce cogent and persuasive written materials to address nursing, health care, and organizational issues appropriate to the audience

Resolve and manage conflict

Relationship Management

Build trusting, collaborative relationships with

-Staff

-Peers

– Other disciplines and ancillary services

-Physicians

-Vendors

-Community leaders

– Legislators

-Nursing and other educational programs

Deliver “bad news” in such a way as to maintain credibility

Follow through on promises and concerns

Provide service recovery to dissatisfied customers

Care about people as individuals and demonstrate empathy and concern while ensuring that organizational goals and objectives are met

Accomplish objectives through persuasion, celebrate successes and accomplishments, and communicate a shared vision

Assert views in non-threatening, non-judgmental ways

Influencing Behaviors

Create and communicate a shared vision

Reward appropriate behaviors and confront and manage inappropriate behaviors

Develop, communicate and monitor behavior expectations

Diversity

Create an environment which recognizes and values differences in staff, physicians, patients, and communities

Assess current environment and establish indicators of progress toward cultural competency

Define diversity in terms of gender, race, religion, ethnicity, sexual orientation, age, etc.

Analyze population data to identify cultural clusters

Define cultural competency and permeate principles throughout the organization

Confront inappropriate behaviors and attitudes toward diverse group

Develop processes to incorporate cultural beliefs into care

Shared Decision Making

Engage staff and others in decision making

Promote decisions that are patient-centered

Provide an environment conducive to opinion sharing

Community Involvement

Represent the organization to non–health care constituents within the community

Provide consultation to community and business leaders regarding nursing and health care

Be an effective board member for community and/or professional organizations

Medical Staff Relationships

Build credibility with physicians as a champion for patient care, quality, and nursing professionalism

Confront and address inappropriate behavior towards patients and staff

Represent nursing at medical executive committee and other medical staff committees

Collaborate with medical staff leaders in determining needed patient care services

Collaborate with physicians to develop patient care protocols, policies, and procedures

Collaborate with physicians to determine patient care equipment and facility needs

Utilize medical staff mechanisms to address physician clinical performance issues

Facilitate disputes involving physicians and nurses or other disciplines

Academic Relationships

Determine current and future supply and demand for nursing care Identify educational needs of existing and potential nursing staff

Collaborate with nursing programs to provide required resources

Collaborate with nursing programs in evaluating quality of graduating clinicians and develop mechanisms to enhance this quality

Serve on academic advisory councils

Collaborate with nursing faculty in nursing research and incorporate nursing research into practice

Knowledge of the Health Care Environment
Clinical Practice Knowledge

Maintain knowledge of current nursing practice and the roles and functions of patient care team members

Articulate patient care standards as published by JCAHO [Joint Commission], CMS, and professional nursing literature

Understand, articulate, and ensure compliance with the State Nurse Practice Act, State Board of Nursing regulations, regulatory agency standards, and policies of the organization

Ensure that written organization clinical policies and procedures are reviewed and updated in accordance with evidence-based practice

Role model lifelong learning, including clinical subjects such as disease processes, pharmaceuticals, and clinical technology

Delivery Models/Work Design

Maintain current knowledge of patient care delivery systems and innovations

Articulate various delivery systems and patient care models and the advantages/disadvantages of each

Serve as change agent when patient care work/workflow is redesigned

Determine when new delivery models are appropriate, and then envision and develop them

Health Care Economics

Articulate federal and state payment systems and regulations, as well as private insurance issues, which affect organization’s finances

Understand and articulate individual organization’s payer mix, CMI, and benchmark database

Health Care Policy

Articulate federal and state laws and regulations that affect the provision of patient care, e.g., tort reform, malpractice/negligence, reimbursement

Participate in the legislative process concerning health care through membership in professional organization and personal contact with public officials

Educate patient care team members on the legislative and regulatory processes and methods for influencing both

Interpret impact of state and federal legislation on nursing and health care organizations

Governance

Articulate the role of the governing body of the organization in the following areas:

Fiduciary responsibilities

Credentialing

Performance management

Represent patient care issues to the governing body

Participate in strategic planning and quality initiatives with the governing body

Interact with and educate the organization’s board members regarding health care and the value of nursing care

Represent nursing at the organization’s board meetings

Evidence-Based Practice/Outcome Measurement

Interpret information from research

Utilize research findings for the establishment of standards, practices, and patient care models in the organization

Disseminate research findings to patient care team members

Participate in studies that provide outcome measurements

Allocate nursing resources based on measurement of patient acuity/care needed

Patient Safety

Support the development and implementation of an organization-wide patient safety program

Design safe clinical systems, processes, policies, and procedures

Monitor clinical activities to identify both expected and unexpected risks

Support a non-punitive reporting environment and a reward system for reporting unsafe practices

Support safety surveys, responding and acting on safety recommendations

Ensure staff is clinically competent and trained on their role in patient safety

Articulate and take action to support the JCAHO National Patient Safety Goals

Utilization/Case Management

Articulate organization for the criteria model adopted by the organization

Communicate key points of the model to a variety of audiences (nursing, financial, medical staff)

Involve physicians in on-going utilization management practices

Design continuum of care options for managing patient throughput (long term care units, urgent care centers, admission/discharge units, etc.)

Quality Improvement/Metrics

Articulate the organization’s QI program and goals

Determine patient care quality improvement goals and objectives

Define metrics as related to process improvement

Explain and utilize metrics as a unit of measure for any process

Articulate the link between metrics and goals

Articulate the link between organization metrics and national quality initiatives/metrics

Target outcomes that are evidence-based (comparison data benchmarking)

Define quality metrics by

Identifying the problem/process

Measuring success at improving specific areas of patient care

Analyzing the root causes or variation from quality standards

Improving the process with the evidence

Controlling solutions and sustaining success

Risk Management

Identify areas of risk/liability

Ensure staff is educated on risk management and compliance issues

Develop systems which encourage/require prompt reporting of potential liability by staff at all levels

Envision and take action to correct identified areas of potential liability

III. Leadership

Foundational Thinking Skills

Address ideas, beliefs, or viewpoints that should be given serious consideration

Recognize one’s own method of decision making and the role of beliefs, values, and inferences

Critically analyze organizational issues after a review of the evidence

Maintain curiosity and an eagerness to explore new knowledge and ideas

Promote nursing leadership as both a science and an art

Demonstrate reflective leadership and an understanding that all leadership begins from within

Provide visionary thinking on issues that impact the health care organization

Personal Journey Disciplines

Value and act on feedback that is provided about one’s own strengths and weaknesses

Demonstrate the value of lifelong learning through one’s own example

Learn from setbacks and failures as well as successes

Assess one’s personal, professional, and career goals and undertake career planning

Seek mentorship from respected colleagues

Systems Thinking

Promote systems thinking as a value in the nursing organization

Consider the impact of nursing decisions on the health care organization as a whole

Provide leadership in building loyalty and commitment throughout the organization

Synthesize and integrate divergent viewpoints for the good of the organization

Succession Planning

Promote nursing management as a desirable specialty

Conduct periodic organizational assessments to identify succession planning issues and establish action plans

Serve as a professional role model and mentor to future nursing leaders

Establish mechanisms that provide for early identification and mentoring of staff with leadership potential

Develop a succession plan for one’s own position

Change Management

Utilize change theory to plan for the implementation of organizational changes

Serve as a change agent, assisting others in understanding the importance, necessity, impact, and process of change

Support staff during times of difficult transitions

Recognize one’s own reaction to change and strive to remain open to new ideas and approaches

Adapt leadership style to situational needs

Professionalism

Personal and Professional Accountability

Create an environment that facilitates the team to initiate actions that produce results

Hold self and others accountable for actions and outcomes

Create an environment in which others are setting expectations and holding each other accountable

Answer for the results of one’s own behaviors and actions

Career Planning

Develop own career plan and measure progress according to that plan

Coach others in developing their own career plans

Create an environment in which professional and personal growth is an expectation

Ethics

Articulate the application of ethical principles to operations

Integrate high ethical standards and core values into everyday work activities

Create an environment that has a reputation for high ethical standards

Evidence-Based Clinical and Management Practice

Advocate use of documented best practices

Teach and mentor others to routinely utilize evidence based data and research

Advocacy

Role model the perspective that patient care is the core of the organization’s work

Assure that the clinical perspective is included in organizational decisions

Ensure that nurses are actively involved in decisions that affect their practice

Active Membership in Professional Organizations

Participate in at least one professional organization

Support and encourage others to participate in a professional organization

Business Skills

Financial Management

Articulate business models for health care organizations and fundamental concepts of economics

Describe general accounting principles and define basic accounting terms

Analyze financial statements

Manage financial resources by developing business plans

Establish procedures to assure accurate charging mechanisms

Educate patient care team members on financial implications of patient care decisions

Human Resource Management

Participate in workforce planning and employment decisions

Champion a diverse workforce

Use corrective discipline to mitigate workplace behavior problems

Interpret and evaluate employee satisfaction/quality of work surveys

Create opportunities for employees to be involved in decision-making

Reward and recognize exemplary performance

Formulate programs to enhance work-life balance Interpret legal and regulatory guidelines

Manage collective bargaining environments or implement programs to avoid the need [sic]

Identify and eliminate sexual harassment, workplace violence, and verbal and physical abuse

Implement ergonomically sound work environments to prevent worker injury and fatigue

Develop and implement bioterrorism, biohazard, and disaster readiness plans Identify clinical and leadership skills necessary for performing job-related tasks

Select top talent, matching organizational needs with appropriate skill sets (assess job candidate skills sets)

Manage performance through rewards, recognition, counseling, and disciplinary action

Provide mentorship and career counseling to aspiring clinicians and leaders so they may develop required skill sets (succession planning)

Identify future skill sets needed to remain competitive

Analyze market data in relation to supply and demand and manage resources to ensure appropriate compensation

Develop and implement recruitment and retention strategies

Strategic Management

Analyze the situation and identify strategic direction

Conduct SWOT and gap analyses

Formulate objectives, goals, and specific strategies related to mission and vision

Understand what organizations should measure in order to “balance” the financial perspective

Measure and analyze performance from the learning and growth, business process, customer, and financial perspectives

Marketing Analyze marketing opportunities

Develop marketing strategies

Integrate marketing and communications strategies

Use public relations and media outlets to promote your organization

Information Management and Technology

Demonstrate basic competency in e-mail, common word processing, spreadsheet, and Internet programs

Recognize the relevance of nursing data for improving practice

Recognize limitations of computer applications

Use telecommunication devices

Utilize hospital database management, decision support, and expert system programs to access information and analyze data from disparate sources for use in planning for patient care processes and systems

Participate in system change processes and utility analysis

Participate in the evaluation of information systems in practice settings

Evaluate and revise patient care processes and systems

Use computerized management systems to record administrative data (billing data, quality assurance data, workload data, etc.)

Use applications for structured data entry (classification systems, acuity level, etc.)

Recognize the utility of nursing involvement in the planning, design, choice and implementation of information systems in the practice environment

Demonstrate awareness of societal and technological trends, issues and new developments as they apply to nursing

Demonstrate proficient awareness of legal and ethical issues related to client data, information, and confidentiality

Read and interpret benchmarking, financial, and occupancy data Source: The American Organization of Nurse Executives. (2005). AONE Nurse Executive Competencies. Address reprint permission requests to [email protected].

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