Empowering Nurses to Lead Every Nurse in Every Setting

1. Empowering Nurses to LeadEvery Nurse in Every Setting North Dakota Action CoalitionLeadership Program

2. The North Dakota Action Coalition is a member of the Campaign for Action that was established in response to Institute of Medicine Future of Nursing Recommendations. Website: www.campaignforaction.org

3. Institute of Medicine Report High-quality, patient-centered health care for all will require a transformation of the health care delivery system 3

4. Campaign for Action Areas of Focus Education Practice & Care Leadership Interprofessional Collaboration Diversity 4

5. The North Dakota Action Coalition is focused on the leadership development area of focus from the National Campaign. We have been working in groups over the last two years to develop leadership training customized to the needs of North Dakota nurses. www.ndcenterfornursing.org/nd-action-coalition/

6. Every Nurse in Every Setting

7. Nationally, it has been shown that when nurses are positioned to influence system practice and policies it leads to improvements in quality of care, wellness, and reduced medical errors. • Nurse-led initiatives have: • Reduced falls with harm • Reduced “code blue” calls • Reduced 30-day re-admissions • Improved care transitions. 7

8. What Can You Do as a Nurse Leader? • Volunteer • Speak up at workplace • Pursue lifelong learning • Serve on boards and enter policy debates • Mentor • Seek out committees • Share the Institute of Medicine report • Support academic progression • Teach the next generation • Join the North Dakota Action Coalition 8

9. The North Dakota Action Coalition is co-lead by:the ND Action Coalition North Dakota Center for Nursing University of Mary Harold Schaefer Emerging Leaders Academy Cheryl Kalberer, MED, Coordinator, Emerging Leaders Academy Coordinator at the University of Mary Established in 1998 Experiential leadership development program for select students Mission: To identify and develop servant leaders of moral courage Guided by an external advisory board of representatives from across the health care profession http://www.umary.edu/academics/emergingleadersacademy/ela_tab1.php • Patricia Moulton, PhD Executive Director • Established in 2011 • 501c3 non-profit organization • Vision: A unified voice for nursing excellence • Mission: Guide the ongoing development of a well-prepared and diverse nursing workforce to meet the needs of the citizens of North Dakota through research, education, recruitment and retention, advocacy and public policy. www.ndcenterfornursing.org

10. Leadership Is……. Is not……. A title A right A job In your genetic makeup A means for power • Everybody’s business • Relational • Learned • Self-development • An ongoing process

11. Leaders and Managers : Change Agents LEADER: • Innovates • Develops • Investigates reality • Focuses on people • Challenges status quo • Asks what and why • Does the right thing MANAGER: • Administers • Maintains • Accepts reality • Focuses on system and structure • Accepts status quo • Asks how and when • Does things right

12. The North Dakota Action Coalition Leadership Program is divided into 4 modules. Communication is foundational for learning and understanding about systems. Knowledge of how systems function is necessary to institute change. The ability to accept and engage in change is necessary to be an advocate for health policy.

13. North Dakota Action Coalition Leadership Module Authorship Module Chair(s): Module Consultant: Module Committee Members:

14. The learning module begins with the next slide.

15. ECHOEssential CommunicationHearing Ourselves Presented by the North Dakota Action Coalition Communication Group

16. The purpose for this learning activity is to introduce the 5 factor model for becoming a skilled communicator and to provide reflective practice tools that grow your communication skills. Objectives • Define communication. • Review the 5 factor model for becoming a skilled communicator. • Review the use of self-reflection. • Review frameworks/ standards/ codes that inform the practice of self-reflection in nursing. • Use self-reflection to develop expertise for becoming a skilled communicator. • Develop your personal action plan to become a skilled communicator

17. To successfully complete this learning activity and be awarded contact hours: • The learner must • Complete the module and the additional reading assignments. • Complete the learning activities. • You will need to write in a journal during this learning activity, you may do so either on paper or by using your computer. Save your work so you can access it and re-read your thoughts. • Complete course and self evaluations. • To earn a certificate of Achievement in Leadership Development you will need to complete the additional project as described at the end of this learning activity.

18. Opportunities for further learning are presented through-out this learning activity. You are urged to take time to engage in these extra learning activities.

19. Communication is far more than speaking …. It is about HEARING not only what others say to us but HEARING what we say to others. To become a skilled communicator we must learn to hear ourselves.

20. Becoming a skilled communicator requires 5 factors: • Becoming aware of self-deception • Becoming reflective • Becoming authentic • Becoming mindful • Becoming candid The foundation for this learning activity is based on the Five Factor Model of Becoming a Skilled Communicator (Kupperschmidt, Kientz, Ward, and Reinholz, 2010). http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol152010/No1Jan2010/A-Healthy-Work-Environment-and-You.html

21. Becoming reflective exposes self-deception, which leads to discovering your authentic self. • The act of reflection leads to heightened awareness / alertness to verbal and nonverbal communication (emotional intelligence) which is being mindful. • These states of becoming prepare one to speak purposefully, to express and listen truthfully also known as being candid.

22. When we speak we count on others to listen and hear our meaning… When we listen others count on us to hear their meaning… Communication is about meaning making.

23. Meaning making requires we reflect on the way we process and store the stories of our experiences…depending on one’s world view and adult development level shared experiences may end up being a different story to another person.

24. As we process the bits of data we constantly receive during the act of communicating. We translate those bits into streams of information. It is in reflecting/ thinking that we turn all those bits into knowledge and eventually wisdom.

25. We need to HEAR what we say to others….We need to HEAR what others say to us.

26. “Most people talk so they won’t hear”May Sarton, Belgian American writer

27. Communication is often filtered, we need to inspect, clean and sometimes replace our filters.

28. There are a number of strategies and tools to help you practice reflection

29. Becoming reflective is. . . • The process of pondering, carefully and persistently, the MEANING of an experience. • Creating meaning from past or current events that guide future behavior. • Self-questioning so situations become more clear and coherent. • Systematically examining the past and the present to inform the future. • Bulman, C., & Schutz, S. (2013). Reflective Practice in Nursing, 5th ed. Hoboken, NJ: Wiley-Black.

30. What is the benefit of reflective practice in nursing? • Helps you learn from experiences • Opens up your practice for others to examine - requires open-mindedness and courage. • Requires you to take on and act on criticism. • Is intermingled with feelings and emotions. • These feelings and emotions lead to deeper reflection. • Fuels motivation to improve one’s practice. Bulman, C., & Schutz, S. (2013). Reflective Practice in Nursing, 5th ed. Hoboken, NJ: Wiley-Black.

31. What specific skills are involved in reflection? • Self-awareness • Aware of character, beliefs, values, qualities, strengths, and limitations • Description • Ability to state characteristics or appearance WITHOUT expressing judgment

32. Skills involved in reflection (cont.) • Critical analysis • Separation of the whole into its component parts • Undertake a detailed examination of structure, elements, or parts. • Understand the nature of, how parts relate to, and influence other parts. • Include the manner ways of knowing (empirical, aesthetic, personal, ethical) • Challenge assumptions

33. Skills involved in reflection (cont.) • Synthesis (opposite of analysis) • The process of result of building up separate elements, ideas, into a connected and coherent whole • Evaluation • Make a judgment about the value of something • Use of predefined criteria or standards

34. Reflective thinking is a process that grows knowledge, skills, attitudes, and judgment

35. Reflection is meant to grow and challenge our thinking…..

36. Frameworks are maps to help guide us in reflection.

37. Frameworks ask a common set of questions that can guide our thinking. Gibbs Reflective Cycle

38. There are many frameworks to choose from or you can create your own.

39. One framework used in nursing is Tanner’s Clinical Judgment Model • Introduction • Background • Noticing • Interpreting • Responding • Reflection-in-action • Reflection-on-Action Nielsen, A., Stragnell, S., & Jester, P. (2007). Guide for reflecting using the clinical judgment model. Journal of Nursing Education, 4(11), 513-516. Consider how it compares to the Nursing Process • Assessment • Diagnosis • Outcomes identification • Planning • Implementation • Evaluation ANA’s Nursing Scope and Standards, 2nd Edition, 2010

40. The Nursing Process & Tanner’s Clinical Judgment Model Introduction (Assessment) Your view of the situation (Be aware of your viewpoint) Background (Assessment) Relationship, experiences, formal knowledge (Be aware of the factors that create your background) Noticing (Assessment) Initial and later (Be aware of your patterns for sensing situations)

41. The Nursing Process & Tanner’s Clinical Judgment Model Interpreting (Diagnosis) Cause, patterns, similarities, differences, observations, data (Be aware of your viewpoint, how does it impact your meaning making) Responding (Outcome planning, Implementation) Actions, stressors, feelings (Be aware of your patterns)

42. The Nursing Process & Tanner’s Clinical Judgment Model Reflection-in-Action (Evaluation) Think about practice while doing it (This takes practice) Reflection-on-Action (Evaluation) Thinking back on what we have done to discover how we may have contributed to the outcome or unexpected outcome. (Consider working with someone you trust to help clarify your point of view) http://simulation.laerdal.com/forum/forums/storage/14/4049/thinkinglikeanurse.pdf

43. You are strongly encouraged to utilize these frameworks for self care in becoming a skilled communicator.

44. For the reflective process to be effective, we must reflect on how we see ourselves in any situation. What self-deceptions do we hold? Have you examined your role and perceptions about miscommunications that have occurred?

45. Reflective exercise to become aware of self-deception Reflective Exercise • Do I fully appreciate the work of nursing and the environment in which that work takes place? • Do I base my practice on the Code of Ethics for Nurses? • Do I assume responsibility for attaining and maintaining my work environment? • What is my definition of my work environment? • Is my definition complete? • How would others describe the workplace? • Is that description how all members feel? • If there is collective unhappiness what is my responsibility in perpetuating the perceived shortcomings? • Am I open and trustworthy? • Do I acknowledge and change routines and behaviors that have hindered communication? • Commit at least 10 minutes to each question, write your reflections in your journal.

46. Authentic – Are you the real deal?

47. Over the next several slides Nursing’s Standards of Professional Performance are briefly reviewed. These standards describe a competent level of behavior in the professional role. • Standard 7. Ethics • Standard 8. Education • Standard 9. Evidence-Based Practice and Research • Standard 10. Quality of Practice • Standard 11. Communication • Standard 12. Leadership • Standard 13. Collaboration • Standard 14. Professional Practice Evaluation • Standard 15. Resource Utilization • Standard 16. Environmental Health

48. Standard 7. Ethics • Practices ethically Review the ANA Code of Ethics for Nurses http://nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/EthicsStandards/CodeofEthics.aspx Review the International Code of Ethics for Nurses http://www.icn.ch/about-icn/code-of-ethics-for-nurses/ • Standard 8. Education • Attains knowledge and competencies that reflect current nursing practice

49. Standard 9. Evidence-Based Practice and Research • Integrates evidence and research findings into practice • Standard 10. Quality of Practice • Contributes to quality nursing practice

50. Standard 11. Communication • Communicates effectively in all areas of practice • Standard 12. Leadership • Demonstrates leadership in the professional practice setting and the profession