Creative Implementation of leadership project

1. Creative Implementation of leadership project By: Ashley Coleman

2. megangoneil.blogspot.com

3. ISFJ • Introverted- 44% • Sensing- 1% • Feeling- 38% • Judging- 44% Me? • Warm hearted • Quiet, only speak up when necessary • Always believe the best of people and I truly care about what they say • Need to be needed • Great memory • Hold my feelings in, but encourage other to express there feelings • Learn by doing • Responsible/loyal/trustworthy/ dependable • Often take on more than I can handle, but I get it done (follow through with everything) • Need Feedback- positive or negative www.deviantart.com (Jung, 2013)

4. Leadership Characteristics • Hardworking • I try my hardest to be the example I want to see in others: I am dependable, reliable, truthful and I know when to ask for help. • I care what everyone says, typically people would say I have a democratic leadership style. • When something is wrong, I activate the proper chain of command immediately. Follow policies and procedures to the best of my ability. • Responsible, organized and motivated to help others • Finish all tasks • Peace keeper-when possible, promote teamwork. Flexible. • Don’t like to be in “charge”, I would prefer to be a member of the team, but I will step up when necessary. zoebrookes.com -

5. Servant Leadership- “The premise that leadership originates from the desire to serve; a leader emerges when others needs take priority” (Sullivan, 2012). towardthegoal.net -

7. www.fmh.org “ . . .a place to care for the sick, comfort the injured, and provide peace of mind for the citizens we serve.” Emma Smith, Founder in 1898 Frederick Memorial Hospital

8. www.fmh.org Frederick Memorial Hospital- Services- Behavioral health Cancer care Cardiology Center for sleep studies Emergency services (Adult, Pediatric, Psych.) Hospice/home care Hyperbaric medicine Imagine (CT, MRI, X-ray, echo, ultrasound) Orthopedic/ joint works program Medical/Surgical Neonatal ICU (level 3A) / Adult ICU Women’s and children, Women’s health. Wound Care center • Community Hospital-General medical surgical Hospital. • Non-profit organization • Opened in 1898 by Emma Smith • Over 10 sister location (immediate cares, hospice care, cancer care, infusion center, imaging centers, and wellness centers.) to help the community. • Total inpatient beds: 308 • Total Adult emergency room beds: 51 beds/treatment rooms • Total Pediatric Emergency room beds: 12

9. Frederick Memorial Hospital Core Values • Quality • Respect and dignity • Responsibility • Stewardship • Honest and Integrity • Collaboration and Teamwork www.istockphoto.com

10. Staffing • I work in the pediatric ER/Inpatient split unit. • We have 4:1 Patient to nurse ratio, unless we communicate with the charge nurse a higher acuity patient (Code, severe respiratory kid) then we may be 1:1 and stay in the room. If this is the case, the charge nurse would then take the rest of your assignment until you could attend to them. • The Hospital wide policy for the medical/surgical floors are 6:1 patient to nurse ratio. • There is at least one charge nurse on every floor. The floors that have over 30 patients have 2 charge nurses. • Typically we have 3 emergency room nurses, an inpatient nurse and a charge nurse, with someone on call. This allows us to have the 4:1 ratio. • Teamwork is key when running an ER. We are out own code team, so our communication amongst each other and teamwork is necessary to save lives. • We wear trackers that have “staff emergency buttons” that allows us to call to other nurses when we need help. This is a time saver and allows us to stay with our patients in the time of need. • We run as a patient/family centered care unit. We advocate for family to help with care. • We do not discriminate staff, we have a very diverse cultural staff. We also see a large diverse patient population • Self schedule online. nursinglink.monster.com

11. Frederick Memorial Hospital Legal considerations Ethical considerations When making any decision in nursing, you always have to think about: Respecting the patient and their beliefs (even if not the same as yours) Beneficence (To do good) Nonmaleficence (Avoid harm) Justice (To be fair) Veracity (To tell the truth) Fidelity (To be faithful) As a nurse, you have your own biases about things, but you have to put those aside and do what the patient wants and is best for them. FMH has an ethics committee If you cant solve your ethical dilemmas. Always advocate for your patient! Ethics is knowing what is right and wrong. Example: You see your mentor who Is a great friend, not waste a med, but takes it (ingest or injects it)...what do you do? Do you tell, do you confront her, do you stay quiet? Remember she is who taught you everything and she is one of your closest friends- Obviously, we all know what the right thing to do it…but, not all of us do it. As a leader, what do you do with this information if someone does tell you? End of life care also offers many ethical dilemmas • Can only act in your scope of practice/ what you’re licensed to do • Act as a reasonable, responsible, professional nurse to avoid negligence. • You do what you document, if it is not documented it was not done. Documentation is one of the only things that can save you in court. • Legally you have follow policies and ensure patient safety. • Uphold HIPPA • Can not restrain a patient unless correct protocol was used and they met the criteria for needing it. • At FMH we have legal attorney who talks with us once a year about documentation and legal aspects of nursing, so all staff know how to protect themselves. • Example: We can’t push ketamine in conscious sedations, only doctors can-but we can draw it up. Many of them ask us to push it and they will sign off on it. This Is out of our scope of practice, what do you do? As a leader/charge nurse, You can remind the doctor that we are not allowed to push the medication/pull the policy to show them.

12. ww.facebook.com

13. My coaching skills Communication, through emails, staff meetings and daily huddles. Communication is key!!! Actively listen to everyone, help encourage critical thinking through situations (we do case studies frequently on my floor), and I make decisions on a daily basis. I help make decisions about patient care and staffing. I encourage teamwork Everyone needs feedback, so when someone does something right, follows a policy, or overcame a hurdle, I offer them positive feedback. When someone needs help, I lend them a hand. If they do something not by policy, or wrong I offer them feedback on how they could improve it next time. I try to do this is positive way, and not like I am attacking them. I help develop staff members through educating about policies and procedures in daily huddles and I send out emails when I see people are struggling with certain things (for example, accessing/deaccessing a port policy) Great motivator. I worked my way up from the bottom, so I know what it is like, I try to be a great motivator and encourage people to try new things. If someone is having trouble starting IV’s I’ll go with them and work with them through the problem and keep encouraging them until they’re comfortable with the skill or policy. Intervene at the first sight of a problem. Try to work through the problem and if I don’t have the solution, I will find someone who does. “Coaching, the day-to-day process of helping employees improve their performance, is an important tool for effective nurse managers” (Sullivan, 2012). www.ideasandtraining.com

14. www.ideasandtraining.com

15. Shared Leadership • “The application of shared leadership assumes that a well educated, highly professional, dedicated workforce is comprised of many leaders” (Sullivan, 2012). • “ Appropriate leadership emerges in relation to the current challenges of the work unit or the organization” (Sullivan, 2012). • No one person can run everything, it takes everyone to make the hospital work. • “Hospital leadership isn’t a one person job” (FMH, 2013) • We have a CEO of the hospital, CEO of nursing, mangers, educators, staff nurses, support staff, environmental health services, kitchen staff and volunteers that ALL help the hospital run. The CEO couldn’t run the hospital himself and neither can the staff nurses. We share responsibility and rely on each other to ensure the hospital is ran smoothly. • Different leaderships are needed in different situations. Each employee knows this and during certain situations a democratic leader may turn autocratic. • Our hospital is full of well educated, professional, dedicated staff members that work as a team to help it run. Each employee has their own responsibilities that they need to follow. Leaders are everywhere, behind a desk signing checks, running around helping everyone, starting and Iv, cleaning a room, or helping someone to the bathroom-they’re everywhere.

16. Shared Governance Leadership • FMH has shared governance councils. • “Shared governance erupted in nursing to allow clinical nurses to participate in the decision making processes that directly or indirectly affect their practice” (FMH, 2013). • This allows everyone to be included in the decision making process. • Each unit has practice councils (Pediatrics and OB-Family center are together) • “Clinical Leadership Team meetings, staff huddles, one-on-one supervisory meetings, and nursing symposiums are just some examples of what makes leadership and governance effective at FMH” (FMH, 2013). www.questforlifecoaching.com

17. tomdesantohealthcare.blogspot.com

18. Forecasting- Thinking about the future • Productivity. Our unit has had a decreased census, less than what was estimated for us at this time, so we have to flex nurses (send them home). This is something nurse managers have to do, as they’re in charge of staffing. There was also an email that was sent out stating why we were flexing more and when to call staffing to offer our staff u for floating to other units. We are also asked if we flex/float support staff (tech, secretary, assistants) then we pick up their work also, to make us more productive. • We look at what our census was for the last couple years and apply that to our next years budget, to budget enough money for our patient population. If we can’t meet it, we have to cut the budget where we can, staffing. • Our budgets run in fiscal years July 1 – July 1st. We have budget meetings throughout the year to look at numbers and data to make a budget for the next year. • Our hospital is shutting down an entire floor in December 2013 because of decreased census. • We also just implemented meditech 6.1, which will help with productivity and accuracy which is the most up to date nursing information system. Facebook.com

19. jeffpatterson.me

20. Regulatory agencies at FMH Facility regulatory agencies Agencies which I follow The joint commission Magnet status- I am obtaining my BSN I ensure patient safety (fall precautions/ prevent med errors). Maintain good infection control ANA- I practice within my scope of practice. This provides the most up to date information. MBON- I have to renew my license and practice within my scope. ANCC- I am obtaining my BSN, which is a requirement for being apart of a Magnet status hospital. QI- Based on their studies, we follow new procedures/protocols/advice for safer, more efficient and more adequate care. • The Joint Commission ( JCAHO) • The American Nurses Association (ANA) Protects nurses- • Maryland Board of Nursing (MBOM)- Regulates nursing practice • American Nurses Credentialing Center (ANCC)- Magnet Status • Quality Improvement (QI) • Maryland Health Care Commission- Quality and ability to access care

21. www.medstarhealth.org

22. “Magnet Journey” • The American Nurses Credentialing center accredits the Magnet program. • FMH is trying to reach Magnet status, this will ensure us to have more resources and we that we are most up to date with nursing research to ensure adequate care. • When I started as a nurse at FMH in March 2013, I had to sign a contract stating I would start a BSN program within a year of employment and finish it within five years of employment. • FMH has partnered with Hood College in their RN-BSN program. If you enroll and are an employee you will get a discount. • Every year I will have to fill out a clinical ladder, which goes by points. Although, I have been a nurse less than a year, I was still to fill it out so I can measure my growth and move up on the clinical ladder. To move up the ladder you have to have so many points, and participate in so many continuing education credits (CEU’s). • I’m apart of the residency program, which is a program budgeted through this. It is for new nurses that are hired and is a 12 month program that helps with support and policies, also if you have any problems/struggles they help you overcome them. We meet once a month for 4 hours.

23. Marketing Once an employee… You can move up the clinical ladder, offering you more resources, leadership and PAY! $350 sign on bonus if employed a year. A $1.50 guaranteed raise will be given each year after. 3 weeks paid vacation for all full time employees (can start after 90day probation period). If less than the allotted amount of call out’s/unscheduled sick time, a $100 check will be issued to you at the end of the fiscal year $200 allotted for outside conference/education use Free education conferences, seminars and education classes offered through the hospital. Monthly meetings for feedback, problems, issues that need worked out. Daily huddles on each shift to go over new evidenced based practice and new things on the unit. New nurses 12 month residency program. All nurses 12 weeks guaranteed orientation. After one year, allowed to cross train to NICU, family center and adult emergency room. • Product- Pediatric Emergency Room. We are open 24/7 • Place- Frederick Memorial Hospital, second floor. FREE parking to staff and patients. We offer self scheduling, 12 hours shifts and 12 hours of call a month. We are the only Pediatric ER in the Frederick region. If you love to work with kids, come join our team! • Price- We accept all insurance and turn NO one away! We offer full benefits, tuition reimbursement, retirement plans and a $350 sign on bonus (If you stay one year). $1.50 raise to every year after that you’re employed (maximum $20 in raises). • Promotion- Advertise online, the newspaper, and we set up at local job fairs. Apply now at www.fmh.org www.scholarships.net

24. Human Resources (HR) • Roxanne, the Pediatric HR representative. • Interview, hiring and firing (FTE approval) • Resource for problems/ peer mediator. Help council employees who are having issues, they can also find outside help for employees who may need it (counseling, rehab, etc.) • Hold records for benefits, and hold annual benefits fair for any changes that employees may want to make. • Prepare employee handbook, create/approve policies. I have to abide and educate on all correct policies. • Performance evaluation every 6 months (I submit the evaluation to HR) • HR holds all employees record (write ups, evaluations, call outs, etc.) • There is an open door policy with HR. I have my own representative or the unit. She is always reachable when at work by phone, or if outside the office by e-mail. She is a great resource for any questions. She also is the person who hires employees to pediatrics.

25. President of the hospital, CEO, Tom The staff nurses get information from either the charge nurse or nurse educator/nurse manager. The manager over sees the unit, then the department director oversees all of women’s and children and over sees our unit manger. If we do not get an acceptable outcome, we go to our director, Katherine. Martha, the educator helps educate staff about policies and new equipment. Shirley the VP of nurses and VP of the hospital then oversees everyone else, and then the person who makes the final say in all decisions and signs our paychecks is the President of the Hospital, Tom. Vice president of nursing, CNO, Shirley Vice president of the hospital, Department director, Katherine Nurse manager, Christie Nurse educator, Martha Charge nurse Who answers to who? Staff nurse

26. EMERGENCY!! www.nursetogether.com

27. Code: Yellow (Disaster) • “Code yellow announcement signifies that FMH has declared that the emergency preparedness plan (disaster plan) is in effect. Employees are expected to continue their work assignments, unless assigned by supervisory personnel to report to the manpower pool (located in the cafeteria).” (FMH, 2005) • Considered a code disaster if: 6 or more priority one patients are coming in or 15 or more serious casualties. • Policy located at each nursing station desk • If administrative personnel not present (nights/weekends), then hospital supervisor and ER doctors are in charge to coordinate and initiate disease protocol. President/CEO declares hospital Code yellow, when he is there. • How are we notified: Frederick county Emergency operations center’s (central alarm) radio, police department or casualties may appear without warning. • The Finance department starts the “call down roster” of people to call when code yellow is activated. • Low mass casualty: 25 or fewer victims • Mass casualty: 26-100’s of victims • Catastrophic mass casualty: 500 victims or greater. www.friendsdisasterservice.org -

28. Steps to take… • Once notified- page the hospitals assistant VP or hospital supervisor • Meaning, the charge nurse in the ER is gathering as much information about the event as possible (location, description, number of estimated number and type of casualties, estimated time of arrival, safety precautions that may be necessary due to type of event, and any special police or security that may be required? • After the information has been received it is determined or not to activate a code yellow, once activated… a code yellow is announced 3 times over the loud speaker and the hospital employees that are on the disaster team know how to respond. Each department activates their protocol and the command center is notified. • The command center is the security office and the security break room becomes the backup command center. Staffing allowed back there are: on-call administrator, VP of support services, VP for marketing and development, director of safety and security, communications supervisor, local fire/rescue services. • If extra help is needed (medical support, ancillary, administrative staff) then a disaster alert is sent out. • Emergency department physicians are performing care, ER charge nurse is coordinating care, staffing, resources/equipment and functions of the ER. The director of the ER becomes the triage officer • Command center communicates with ER charge nurse, the police, county disaster officials, update city officials, set up transport to other hospitals if needed, receive ongoing reports, this can all be done via central alarm. • If more deceased people than morgue can hold, they are to be placed at the hospitals loading deck on the back end, until space is found for them • People who are awaiting discharge are directed to the cafeteria to receiving discharge instructions • There are certain protocols for nurse/doctor: patient rations per injury and what part of triage you are located. • Ending the Code Yellow: When the disturbance is no longer a threat. The security, administrative officers consult with the command center, once delicate the disturbance has ended, security will notify all key personnel by phone and all in hospital emergency teams are sent home. • Security will check the hospital, bio med will replace supplies, and the debriefing process begins.

29. www.cmr-ltd.com Crisis management Victim/family Staff Chaplain and Frederick County center health department and Maryland institute for Emergency Medical Services Systems (MIEMSS) are in charge of debriefing They will help during and after the event. The teams will also come back per hospital request if necessary after the disaster is over to help with employees having a hard time dealing with it. • Crisis management, chaplains and volunteers art stationed throughout treatment areas are called upon as needed to provide support. • Purple zone is made into a designated “meditation room” for crisis intervention. • Security, crisis, and nurses escort patients to identify decreased victims. • Performance improvement/care coordinators are in the cafeteria-the designated discharge area. They’re there to support families, victims who are awaiting discharge.

30. FMH offers a 403b retirement plan. This is how I plan on retiring, through this plan. I currently put 3% of every paycheck into plan. FMH then matches this at the end of the year, up to a certain amount. www.ualocal501.org

31. Who is my succession? • Succession is occurs when someone takes over for another after they retire or leave. • When I know I am a year our from retiring, I will hold a meeting (after talking with HR) and let everyone know that I am leaving. I will then offer my position to all employees who are an RN III or RN IV. I will also offer a management and leadership class for everyone, but it will be mandatory for the people who will apply for my position. This class is paid for, it will offer free meals, staff will be paid to attend and you will receive continuing education credits (toward clinical ladder). • Once the class is over, interview’s will be held for anyone internally who wants my job. Requirements include at minimum: 5 years experience, RN III, BSN and management experience (Charge nurses count). I need to make sure that this person can handle my job, before I leave. • Once my position is filled, they will shadow me for 3 months. The last month, I will only be there to over look and help- basically a resource. • My job offers a lot of benefits: Higher pay, less physical requirements, free conferences, traveling to conferences, and the list goes on. www.betterment.com

32. Networking… • I plan to subscribe to certain medical journals, and read the newest up to date evidence based practice and implement that into my daily care. • I will become apart of the ENA, and PNA and have them send me via email the links to the newest up to date evidenced based practice. I will then forward these to my nurses, or print the articles and place them into our huddle book. • Our facility has something called “vital signs” which is a paper that comes out every week with hospital announcements, new policies, events, and resources, I plan to start putting a section in there for pediatrics. I would like to post links to journals and EBP information in this, so everyone can know. As we may be physically taking care of patients under 18, there are still patients hospital wide that may have smaller patients (frail elderly), mental disability, limiting development, and at times the adult ER can get a critically ill child. • Conferences, for pediatrics and emergency medicine.

33. www.ebay.com • Frederick Memorial Hospital. 2005. Emergency Preparedness management plan. Retrieved from: www.fmh.org • Frederick Memorial Hospital. 2013. Retrieved from: www.fmh.org • Sullivan, E. (2012). Effective Leadership and Management in Nursing. (8th Ed). Upper Saddle River, NJ. Prentice Hall. References-

34. The End!!! Being a nurse is so much more than a job. The hospital is like my second home. nursinglink.monster.com