NurseLeader Interview Paper
Course605, section 3
Leadershipremains a critical part in the development of an organization. I gotto interview an advanced nurse practitioner who has shown thetransformation that great leadership can have on an institution thatseems to be heading down the drains. Through Rose, my interviewee, Iwas able to learn about her job as an APN nurse manager, style ofleadership, leadership attributes, evolution of her role as a nursein the institution and role in the intra-organizational andextra-organizational arena. The purpose and goal of this paper areto outline how a unit with no leadership for many years was turnedaround by a dynamic Adult Nurse Practitioner (APN) and how shechanged the culture in preadmission testing by motivation, dedicationand instilling the vision for patient-centered care at the VAHospital in Boston.
Assessmentof the Role of the Advanced Practice Nurse (APN)
Iwork at the Veteran’s Administration, a branch of the Federalgovernment dedicated to serving the heroes at all levels. Some of theservices offered at the hospital are exclusively designed to care forthe patient population.
Igot an opportunity to interview Rose, APN Nurse Manager ofPre-Admission Testing at the Boston VA Hospital in Jamaica Plain. She ranks third on the organizational chart as she reports to DrFirehole, Associate Chief of Surgical Services and Dr Itani the Chiefof Surgery. Her administrative responsibility is to coordinate withstaff and providers from Urology, Orthopedics, Ophthalmology,Cardiology and Vascular services to ensure that blood work, EKG andanesthesia visits are completed before patients’ surgery. Her scopeof responsibility involves managing seven employees under herdepartment. These employees are three mid-level providers, twolicensed practical nurses and two health technicians. It also coverspatients completing preadmission testing before surgery (Heale…etal, 2014). Rose is part of the VA Consortium and is a preceptor tostudent nurse practitioners and new nurse practitioners.
Rose’sexperience speaks so much about a person who values her career. Hertenacity, encouragement, professionalism and positive attitudepropelled me into choosing Rose as the person to interview eventhough there was a long list to choose from. Rose first worked as anNP in the Infirmary of the Rhode Island prison system for five years.Her job was to perform History and Physicals upon admission to thejail, treat psychiatric and ill patients. She then got into primarycare for five years with her panel of patients before working forthree years homeless shelters and detox units. She subsequentlyexpanded her role as an assistant professor at the University ofRhode Island Instructor of BSN students in medical –surgicalrotations in a rehab center and a Community Hospital. Over the leastthree years, she has been the manager of the preadmission testingunit at Boston VA Hospital.
Whenshe was first employed as an APN manager at Boston VA, she met adisfranchised system as a result of a merger of three hospitals.There were lots of problems between the managers and other staff. Themerger led to the demotion of many managers to staff nurse positionsensuing in anger, hostility and bullying. The former manager incharge of specialty units exhibited poor leadership skills as sheturned a deaf ear to the staff that made numerous requests to solvethe issues in the department (Buerhaus, 2010).
Oneof the things Rose did upon employment as the person in charge of thedreaded preadmission testing was to have a meeting with the staff.The meeting resulted in a detailed plan on how to bring change, whichwas met with so much resistance. The management concurred with it,taking up the model of Brigham Hospital that saw an all NP unit inpretesting instead of an RN based unit. Through her kindness,discipline, civility, respect and communication she inspired changeinto the staff to follow the mission of the Veterans Hospital andaccept the new changes to patient care that were being implementednationally. Her managerial skills and commitment to bring change madepreadmission testing one of the best units at the Boston VA.
Rosewas raised in a family of five children by an alcoholic father. Sheattended a Catholic High School then enrolled in an engineeringprogram at Massachusetts Maritime Academy. After a year, she decidedto pursue a nursing career where she graduated from the CommunityCollege of Rhode Island having an associate degree in nursing. Rosewent back to school for a BSN program and graduated from theUniversity of Rhode Island. In 2001, Rose graduated from theUniversity of Rhode Island NP program as an Adult Nurse Practitioner.It would allow her to manage an underserved patient population.
Rosemet her first mentor, Ron, at on a psychiatric unit at the BedfordVeterans Hospital. Her mentor encouraged her to go back to school bygiving her a broader picture of patient care, and politics in the VAsystem. Diane, Rose’s second mentor, was the PA for ophthalmologyand a seasoned physicians’ assistant for fifteen years and adedicated VA employee for thirty years. Diane guided Rose to readEKG’s and politics in the system to improve the quality of patientcare while serving as her mentor for three years. Both of them workedendlessly to improve patient care model in pretesting even thoughthey worked in different departments.
Rose’spredominate style of leadership is democratic. She fully supports thestaff and is accountable for what goes on in her unit. She is anexcellent listener and problem solver who is willing to help each ofthe team members achieve their goals. Rose uses the leadership modelof Patricia Brenner to make certain the employees use their strengthto contribute to various team activities. Under the leadership, thestaff can develop their skills as they have a mentor who leads themin the right direction. According to her, the input of each personmatters the most hence the reason she takes into considerations thedecisions made by each member. Her free style gives all staff achance to make decisions that Rose assumes responsibility for henceexemplifying the democratic style of leadership (Lorna & Kai,2016).
Rose’sleadership behaviors and attributes make her deserving of a managerin the preadmission testing unit. She is supportive of her staff,visible in the unit and does her work diligently. She has developedvarious connections with other leaders in the system and collaborateswith the staff to coordinate other services as needed forpre-operations. She also holds meetings with the staff on a weeklybasis to help deal with any internal issues. Rose describes herstrengths as the ability to communicate well with the staff and herstrong leadership skills. Her weakness is EKG interpretation anddetermining when a patient is not optimized for surgery. Shedemonstrates her leadership qualities through the provision of aconstructive learning environment and using a team approach toimprove individual errors.
Withinher authority, Rose sets goals to manage changes in preoperativetesting and implements the strategic plans of the VA. Through thesestrategies, she hopes to empower other employees by helping themachieve their visions and missions. She also hopes that her careerand leadership skills motivate and inspires staff. There are certainchanges Rose has brought as a leader, one of them, virtual prep. Apatient, in this case, does not have to attend prep physically as itis done through a phone call (Hurlock & McCallum, 2016). Theother change is the collaboration with the anesthesia team to modifyguidelines in preoperative testing to ensure safe patient care. Theresult was a decrease in patient travel.
Inthe intra-organizational arena, Rose is involved in an Anestheticproject aimed at lowering the cost of extra testing for preoperativepatients. The project is beneficial as it helps the government saveover $3000 per month that could be used in repetitive blood testing. In collaboration with the anesthesia team, they came up with certainparameters. These are: EKG can be employed, or one year if reasonablehence no need to be repeated, Lab results are good for 90 days andMRSA swabs for day surgery are not a requirement. Additional testscan, however, be done as per a person’s request.
Inthe extra-organizational arena, Rose carries out research with theUrology team, Anesthesia of preoperative and postoperative nursingstaff aimed at minimizing postoperative urinary retention (POUR) andpotential complications. The goal is to flag patients at risk forPOUR in PATC, increase awareness of Anesthesia, surgical and nursingstaff of POUR. It aims to reduce risk factors in the preoperative,intra-operative and postoperative area and establish a process toallow patients time to avoid postoperatively beyond the postanesthesia unit closing hours. It also seeks to develop a process inPATC for catheter removal and to avoid trial on post operation dayone, promote ownership and centralize practice (David & Peggy,2015). This data was collected from May 2016 thru August 2016. As todate, Rose has not published research or any professional nursingarticles.She volunteers twice per month in a homeless shelter andis a member of the Massachusetts Nursing Association. Rose waspresented a prestigious award this year by the Chief of surgery forher high achievements in patient care, fostering and sustaining asuccessful preoperative program and commitment to outstanding patientcare.
Thereare certain behaviors and successes, which exemplify leadership inRose. The manner in which she managed to implement positive changesin a unit that remained dreaded for long is an achievement worthnoting. She is a leader that does not bow down to pressure ratherhopes to bring change by including the ideas of other members of thestaff in her plans. Her commitment to patient care, confidence andteam play are great attributes of a leader. She has a tremendoustenacity and is dedicated to giving veterans the best care possible. There is certain calmness when you enter the clinic, and you witnessstaff and patients treating each other professionally (Barton &Mashlan, 2011). The change at Boston VA is a great success that couldonly be achieved by a leader who would not be intimidated by othersenior officials. Rose has surpassed the expectations of many peopleregarding the change she has brought as a Nurse Manager inpretesting. She has revived the system that lacked managed andbrought great pride to it. The challenges of hostile workers andbullying co-workers are now a thing of the past.
Rosehas walked the talk so well that leaves out the staff mesmerizedregarding how she was able to bring such changes fast. My expectationof APN Nurse Manager of Pre-Admission Testing is to carry out theirroles in supervising the staff that work under them. Theseexpectations were however preceded by Rose who employed excellentleadership skills to transform a whole unit that needed some reform.As a manager, she manages to juggle her work with direction andbalances both well. She motivates the staff to attain their lifemission and vision, plays the role of a democratic leader andinvolves in extra-organizational and intra-organizational activitiesas well. She surpassed my expectations in pre-testing whileimplementing positive change.
and Evaluation of Learning Experience
Rosedisplays excellent leadership skills and attributes as an APN, NurseManager of Pre-Admission Testing. She took a plunge in one of themost troubled units and brought positive changes in a good manner.She restored the sanity of professionalism in pre-testing byemploying leadership skills. Her experiences in different nursingsectors, educational background and mentors all attest to her as aleader with a vision in mind. Her democratic leadership style coupledwith her leadership attributes empowers the rest of the staff. Roseis actively involved in the intra-organizational andextra-organizational arena through a myriad of activities. Herprogress is an embodiment of leadership and the positive changes itcan have.
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