Creative Implementation of Leadership

1. Creative Implementation of Leadership Jennifer Brewer Frostburg University, NU 406

2. Introduction • I am a Registered Nurse supervisor at Saint Joseph’s Ministries (SJM), a skilled nursing facility. • If I were to play a higher leadership role at SJM, I would carry out the plan as shown in this presentation. • This presentation is based on a real facility, and most information is based on factual data.

3. Saint Joseph’s Ministries • Non-profit, long-term care, skilled nursing facility • Offers rehabilitations services • Physical therapy • Occupational therapy • Speech therapy • Aqua therapy • SJM is a member of Ascension Health • SJM is partially funded by the Daughters of Charity • St. Catherine’s is a “neighborhood” within SJM • 82 beds total among three floors • 26 private rooms • 56 semi-private rooms

4. Mission Statement Rooted in the loving ministry of Jesus as healer, we commit ourselves to serving all persons with special attention to those who are poor and vulnerable. Our Catholic health ministry is dedicated to spiritually centered, holistic care, which sustains and improves the health of individuals and communities. We are advocates for a compassionate and just society through our actions and our words. (SJM, 2011)

5. Staffing at St. Catherine’s • Currently, each floor is staffed accordingly: • Mountain View, 2nd floor (“Rehab unit”, higher acuity patients) • 2 Nurses • 2 or 3 geriatric nursing assistants (GNAs)—depending on census • 22 = max patient census • Garden View, 1st floor (“Dementia unit”) • 1 Nurse • 1 Certified Medicine Aide (CMA) • 3 GNAs • 30 = max resident census • Terrace, ground floor (long-term care residents) • 2 Nurses or • 1 Nurse and 1 CMA • 3 or 4 GNAs—depending on census • 30 = max resident census

6. Staffing (cont.) • I would continue a similar staffing strategy to the one currently in place • I would adjust staffing as needed, keeping in mind situations such as.. • Low Census – reduce staffing expense • Example: substituting a nurse for a CMA instead of 2 nurses • Example: staffing with 3 GNAs instead of 4 • New nurses should work with experienced nurses and not CMAs • Try to keep staff on same floors for consistency in patient care

7. Cultural Development • All employees at SJM will live by the “core values” • Core Values: • Service of the Poor • Dedication • Reverence • Creativity • Integrity • Wisdom

8. Cultural Development (cont.) “Organizations with high-performance cultures reinforce their concern for individual employees in many different ways..” (Lussier & Achua, 2010) • All employees will treat each other with dignity and respect • Employees will have enough autonomy to excel and contribute • Increased responsibility will be given to the best employees • Employee achievements will be celebrated • Reasonable and clear performance standards will be set for all employees

9. Legal Considerations • Policies and procedures will be clearly written and enforced • Employees will learn and follow policies and procedures • Standard level of care will be followed and incorporated into policies and procedures • Excellent training program for new hires including continued support • Adequate staff training for new equipment or new software • Proper documentation—timely, accurate, complete • Monthly staff meetings to discuss what areas need improvement

10. Ethical Considerations • Reinforcing the “core values” by role modeling and reminding at meetings • Rewarding those who demonstrate the “core values” • Creating and maintaining an ethics committee open to anyone • Educating staff on resources (e.g. colleagues, Director of Nursing, MD Board of Nursing)

11. Coaching • “The day-to-day process of helping employees improve their performance” (Sullivan, 2012) • Coaching sessions should “last no more than 5 to 10 minutes” (Sullivan, 2012) • Will also be used to reinforce positive behaviors • Will be results-oriented • Will help the participant “become more self-aware, ensure accountability, and attain professional goals (Sullivan, 2012)

12. Leadership Theory I would lead SJM using a combination of Shared Leadership and Transformational Leadership Shared Leadership, according to Sullivan (2010): • Self-directed work teams • To some degree, nurses will manage their own planning, organizing, and day-to-day work activities • Shared governance • Nurses come together to make key decisions • Decision making is conducted by representatives of the nursing staff who have been authorized by administration and their colleagues to make decisions on important manners • Co-leadership • Nurses, including RNs and LPNs, will work together to lead the floor’s team of GNAs and CMAs.

13. Leadership Theory (cont.) Transformational Leadership: • Goal: “to generate employees’ commitment to the vision or ideal rather than to themselves” (Sullivan, 2010) • Will foster employees’ inborn desires to “pursue higher values, humanitarian ideals, moral missions, and causes” (Sullivan, 2010) • Inspire others that they can do exceptional things

14. Forecasting Staffing • Decided based on patient census • Patient census will be reported daily, staffing adjusted accordingly • Social workers will report dates when admissions are incoming and when patients will be discharging Operating Budgeting • Will use last year’s figures as a starting point • Readjustments will be made during the actual budget period • Monthly reports will be reviewed by managers • Identify items that are over or under budgeted • Find out why variance has occurred • Examine payroll and use of overtime

15. Regulatory Agencies Maryland Department of Health and Mental Hygiene, Office of Health Care Quality “ensures that State licensure and Medicare/Medicaid standards are maintained for nursing homes through unannounced on-site surveys, follow-up visits, and complaint investigations” (DHMH, 2013)

16. Accreditation Agencies Currently SJM is not accredited by any agency, according to the Director of Nursing If I was leading, I would make sure SJM is following the Joint Commission’s National Patient Safety Goals for Long Term Care • The purpose of the National Patient Safety Goals is to improve safety • The goals focus on problems in health care safety and how to solve them • (See next slide for examples) Joint Commission, 2013

18. Marketing Plan Target audience • Adults needing long-term care, skilled nursing services, or short-term rehabilitation services Advertising • Detailed, user-friendly, Internet website • Newspaper and magazine ads • Sponsoring good causes • Involving staff in community events to represent SJM • Participating in volunteering opportunities to represent SJM • Position filled for a liaison between SJM and various local hospitals to provide brochures and talk to prospective patients about SJM

19. Staff Retention • Open door policy for all administration and managers • Staff can come to administrators and/or managers at anytime to discuss any concerns • Excellent training program for new hires • Opportunity to extend training for new hires as needed • Supportive preceptors and mentors • Opportunities for continuing education • Reimbursement program for degree-seeking employees • Reimbursement for renewing licenses • Reimbursement for obtaining relevant certifications or specialties

20. Staff Retention (cont.) • Annual performance evaluations • Monthly meetings to discuss strengths and weaknesses • Employee of the month • Monthly newsletters • Showcasing core values in action • Dates of next month’s important events (e.g. meetings, in-services, outside company events) • Employee of the month • Daily email newsletter • Important events • Education tip (e.g. computer/software trick, nursing standard of care, policy & procedure reminder)

21. Relationship with Human Resources • I would recognize potential HR needs/issues and encourage a meeting between the two parties • I would educate staff on how HR is resourceful • I would want to be involved in the hiring selection process • If I were leading SJM, I would stay in constant contact with HR on areas such as patient or staff complaints about employees

22. Organizational Flow Chart • Currently at SJM, the Director of Nursing answers to the Administrator of Nursing • The Administrator of Nursing answers to the Board and the President of Ascension Health

23. Disaster Planning Emergency code system • RED – fire alarm • WHITE – uncooperative person • SILVER – person with a weapon • ORANGE – hazmat, mechanical • YELLOW – weather-related • BLUE – medical • PURPLE – missing resident • BLACK – epidemic • BROWN – external emergency • GREEN – bomb threat • “For Real” – personal distress • Announced by authorized personnel over intercom speakers

24. Disaster Planning (cont.) • “RACE” Fire Plan • RESCUE those in immediate danger • ALARM – pull alarm, alert others • CONFINE – close doors • EXTINGUISH – if fire is small • Have regular fire drills

25. Succession Planning • According to Sullivan (2010), succession planning is essential to ensure a smooth transition after managers leave or retire • Succession is the natural outgrowth of leadership development • Strategic succession planning involves: • Identifying core competencies required at each level of management • Recognizing potential recruits • Providing opportunities for development and growth

26. Networking • I will network on a professional and personal level • I will keep on-going relationships with current and past colleagues • I will keep in touch through technological mediums such as LinkedIn or Facebook • I will ask friends and colleagues to connect me with others • I will be active in professional organizations, participate at events and meetings, and keep in contact with people I meet

27. Critical Issues • I will keep up to today on critical issues through memberships to relevant professional organizations • I will read professional journals relevant to my field • I will discuss critical issues with colleagues • I will choose to be emailed critical issue alerts from reputable organizations

28. References • DHMH. (2013.). Long Term Care. Maryland Department of Health and Mental Hygiene. Retrieved June 26, 2013, from http://dhmh.maryland.gov/ohcq/LTC/default.aspx • Joint Commission. (2013). Long Term Care National Patient Safety Goals. Retrieved June 12, 2013, from http://www.jointcommission.org/assets/1/6/2013_LTC_NPSG_final_10-23.pdf • Lussier, R.N.& Achua, C.F.(2010). Leadership: Theory, Application, & Skill Development. (4th ed.). Mason, OH; Southwest. • SJM. (2011). Associate Handbook. 3-4, 42. • Sullivan, E.J. (2012). Effective leadership and management in nursing (8th ed.). Upper Saddle River, NJ: Pearson.