Running head: NURSINGS LEADERSHIP ROLE

Nursings Leadership Role in Population Based Issues Tamara Putney Ferris State University

NURSINGS LEADERSHIP ROLE Abstract Population and community based health issues often present many challenges and may utilize many nursing roles. Two nursing roles critical in the population health problem of unplanned

teen pregnancy in Kent County, Michigan are the direct educator role and the non-direct political change agent or nurse leader role. A venue for the direct contact nursing educator role is in the schools, as a school nurse. While the venue for the non-direct political change agent/nurse leader is as a member of the National Association for School Nurses Director for Michigan. Both roles are extremely important and although they complement each other there are many similarities and differences. Both nursing roles require specific educational requirements, unique leadership skills and demand strict adherence to the standards of professional nursing practice as set forth by the American Nurses Association. Analysis and reflection of both roles reveal author challenges and competencies. Keywords: nursing, leadership, roles, population issues, teen pregnancy, community nursing

NURSINGS LEADERSHIP ROLE Nursings Leadership Role in Population Based Issues Since 1990 the rate of pregnancy in teens 15-19 years old has decreased dramatically, down 42% nationwide (The National Campaign, 2012a). But, in Kent County, Michigan rates

are still high and even beat the State of Michigan average (Community Health Needs Assessment for Kent County, 2012). Realizing a population health problem exists and change is needed, the focus of the Ferris State University Community Health Nursing class (group four) community change project will focus on prevention of teen pregnancy for ages 15-19 years in Kent County, Michigan. Nurses play critical roles when it comes to population and community based health issues. While there are many factors and disparities surrounding the occurrence of teen pregnancy in this age group, there are also many proven interventions and strategies to promote prevention. One of the major strategies for prevention of teen pregnancy is to provide education to teens on various topics related to sex education and contraception. One of the best venues to carry out this education is the public school (The National Campaign, 2012b). There are two main ways to reduce the rates of teen pregnancy. First, produce changes in adolescent sexual behavior and second, produce changes in contraception use (Will, 2008, p. 159). There are many direct and non-direct nursing roles that can assist in the delivery of this education to help address this population based issue. One of the greatest means to provide sex education to females and males is by utilization of the role of school nurse (The National Campaign, 2012b). Producing great outcomes with education of teens in schools takes the direct role of the school nurse or educator, but that direct care role needs the complement of a leadership nursing role. A very pivotal leadership-nursing role that can advocate for the needs of the school nurse is that of the National Association of School Nurses Director for Michigan, acting as a political change agent. This nursing leadership role is critical to the success of school

NURSINGS LEADERSHIP ROLE education programs because resource allocation, budgets, and by laws are produced which provide the tools needed in communities for successful outcomes. Role of Direct Contact Nurse-School Nurse/Educator According to the National Association of School Nurses (NASN) this nursing role is

critical to successful education of teen pregnancy prevention. The school nurse not only presents the education, they help develop the material and evaluate the effectiveness. These nurses are also able to provide nonjudgmental counseling and referral services to extend or adapt education programs to both the school and the surrounding community (Will, 2008). There are four levels of school nurses: emergent, competent, proficient and expert (Department of Education, 2009, p.3). The educational and certification requirements of each are well defined by the NASN and are dictated by both community and school needs, as well as budgets (2009). The minimum educational requirement is a registered nursing license in good standing. These nurses assess, diagnose, identify outcomes, make plans for implementing interventions, perform health teaching and health promotion, consult, evaluate, assure quality practice, manage health services and must know how to identify and utilize resources (2009, p.5-19). Concerning this community change project, in order to successfully promote the prevention of teen pregnancy, they must keep current with evidence based sex education material, as well as be aware of the latest teaching and learning techniques (National Association of School Nurses [NASN], 2012a). Leadership Traits The school nurse, or direct role of educator, is focused on public and community health and must exhibit many strong leadership traits (Harkness & DeMarco, 2012). This nurse must be empowered and possess a strong ability to empower others. Nurses in schools must understand the needs of the population they serve, and be inspiring. These nurses must be

NURSINGS LEADERSHIP ROLE excellent at producing change in needed areas, not just pertaining to teaching pregnancy

prevention, but producing the change to make a positive impact on the entire student and faculty population, which will emanate into the community. These nurses oversee health education in schools and even take part in policy making, therefore communication and collaboration skills are critical (NASN, 2012a). Many times these nurses are required to collaborate with other schools, school board representatives, or other state level legislative representatives in order to show evidence that change is needed in some certain area of student needs (Healthy Schools Campaign, 2011). Consequently, they will need to be fair, honest and extremely competent. Direct contact school nurses must strive to be lifelong learners and adhere to the standards set forth by their governing body, as well as the American Nurses Association. School nurses must emit confidence and be very organized. Many times school nurses will need to coordinate activities or be able to direct others to accomplish goals required to meet the educational requirements, according to school or state policy, therefore they will need good judgment skills and need to be dependable. American Nurses Association Standards of Professional Practice All nurses must be compared to professional standards in order to evaluate their effectiveness. The school nurse is no exception. The American Nurses Association (ANA) has set forth standards that every nurse must strive to meet to ensure that care in any form is appropriate and professional (American Nurses Association [ANA], 2010). The community change project to promote the prevention of pregnancy by utilizing the school nurse role is directly linked to nearly every ANA Standard of Professional Practice. However, the most critical standards are those concerning: ethics, education, evidence-based research, quality of practice, communication, leadership, collaboration, and professional practice evaluation (2010).

NURSINGS LEADERSHIP ROLE Role of Nurse Leader-National Association of School Nurses Director for Michigan The role of nurse leader is imperative to any change project. For this prevention of teen pregnancy community change project the National Association of School Nurses (NASN) Director for Michigan role is very important to act as a leader and political change agent. This nursing leader is a member of the Michigan Association of School Nurses (MASN), but holds a seat on the NASN Board of Directors (NASN, 2012b). This nurse leader is an elected official designated to represent Michigan at the NASN meetings. This director is also a member of the NASN Executive Committee (Michigan Association of School Nurses [MASN], 2008). This position is extremely important to this prevention of teen pregnancy community change project, because this nursing leader is an advocate for all school nurses. This leader is also a spokesperson to vie for policy changes needed for enhancement of education and allocation of

resources, based on evidence provided to them by the school nurse (the direct care nursing role). This nursing leader also has the power to influence school health budgets and works with all other members of the MASN to evaluate effectiveness of state curriculum, in order to ensure it meets the needs of schools and the community. Leadership Traits Many of the leadership traits of this non-direct nursing role are similar to that of the direct contact nurse. However, this nursing role requires more skillful use of management techniques, collaboration, resource utilization, and patience, due to the political nature of this role. This nurse will have progressed through the educational attainment process and possess at least a masters degree in nursing, many times a masters degree in business, and have at least one specialty certification (NASN, 2012c). The nurse in this leadership role must understand politics, policy development and structure, by-laws and understand how to develop, propose and

NURSINGS LEADERSHIP ROLE present budgets (MASN, 2008). This nurse must be very, organized, confident, competent, fair, honest, and commit to lifelong learning. American Nurses Association Standards of Professional Practice Just as the direct contact role must adhere to multiple standards of professional practice, as set forth by the ANA, so does this leadership nursing role. Being a strong and high-powered nurse executive/change agent such as the NASN Director for Michigan, the ANA standard of leadership (Standard 12) is crucial (ANA, 2010). This nurse must also be very ethically sound, continually evaluate their practice, and be masters of communication, resource utilization and collaboration. Analysis When analyzing the roles of the direct educator role of school nurse and the leadershipnursing role of political change agent, the NASN Director for Michigan, many similarities and differences are apparent. Obviously, the initial degree, Registered Nurse, is a basic similarity as

is the requirement to follow the same code of ethics and nursing standards set forth by the ANA. These roles share a common goal of promoting population-based health and they also share a common target population, in this case teenagers 15-19 years. These roles are also similar in that they both require superior leadership, collaboration, communication and critical thinking skills. The individuals in both nursing roles need to be skilled at research, be culturally competent and understand the needs of those they serve. Since both roles share a common goal, that is, reduction in teen pregnancy, the success of one role will impact the performance or successful outcomes produced by the other. Although many similarities exist, there are also differences that make these roles very unique. The practice venue and power of each of these roles is different. Both have ties to the

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community, but they are on extremely different levels. The direct contact or educator role works directly with the community, the teens and the families. Whereas the leadership, or change agent role, takes information delivered from the direct contact nursing role and uses that information to influence and produce changes, or develop policies to influence change for the population or society as a whole. Differences also exist in the amount of education and certifications required, as well as the political contacts needed to produce change. Concerning the political arena both these roles reflect complexities that deal with the educational system, government and healthcare expenditures related to teen pregnancy and similar issues. Politics and implications to nursing and the healthcare system are directly tied to these roles in that they both have massive amounts of influence on policy. Both by impacting and producing change, which directly impacts the cost of healthcare and all systems related to the care of the teenage mother and the impending child. Both roles influence political change on all levels, local, regional, state and national. Reflection This author obviously lacks the skills needed for the leadership or change agent role for now, based on experience, political expertise and education level. Both roles are intriguing, but this authors interests lie more in the direct community influence role. Working directly with community members to produce change would be more suitable. This author does possess above average leadership skills, as evidenced by a current practice management role, great communication, collaborative, critical thinking skills and strongly adheres to a strict code of morals and ethics. The role of the NASN Director for Michigan nurse leader role would be challenging due to the political atmosphere and long waiting periods required for change. To partake in any

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political agenda takes an extreme amount of patience and influence, as well as connections in the community, be it local, regional, state, or national. To be competent in either role this author would require continuing education. Specialty certification in School Nursing or Public Health Nursing would be required, as would a masters level education and possibly a masters degree in business. Also, experience in both venues would be a must. This author only has experience in hospitals directly at or near the bedside of the patient. There are many roles that are critical to producing change concerning population based health problems. Direct care and leaderships roles come in all shapes and sizes, have differences and similarities and have the power to impact society and policy in their own way. Impacting the teen pregnancy rates in the form of pregnancy prevention requires teamwork and can only be accomplished if every role performs in a superior manner, as each role has a major influence on the performance of the other.

NURSINGS LEADERSHIP ROLE References American Nurses Association [ANA]. (2010). Nursing: Scope and standards of practice (2nd ed.). Silver Spring, MD: Author.

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Community Health Needs Assessment for Kent County. (2012). Kent County: 2011 community health needs assessment and health profile. Retrieved from http://www.kentcountychna.org/pdfs/KentCoCHNA_Final.pdf Department of Education. (2009). Competency in school nurse practice. Retrieved from http://www.michiganschoolnurses.org/documents/competencies.pdf Harkness, G., & DeMarco, R. (2012). Community and public health nursing: Evidence for practice. Philadelphia, PA: Lippincott Williams & Wilkins. Healthy Schools Campaign. (2011). School nurse leadership. Retrieved from http://www.healthyschoolscampaign.org/programs/schoolnurse/school_nurse.pdf Michigan Association of School Nurses [MASN]. (2008). Policies and procedures: Officers. Retrieved from http://www.michiganschoolnurses.org/documents/OperatingGuidelinesManual%201008%20PDF.pdf National Association of School Nurses [NASN]. (2012a). Role of the school nurse: Position statement. NASN School Nurse, 27(2). 103-104. National Association of School Nurses [NASN]. (2012b). NASN affiliates. Retrieved from http://www.nasn.org/AboutNASN/NASNAffiliatesChapters National Association of School Nurses [NASN]. (2012c). Education, licensure and certification of school nurses. Retrieved from http://www.nasn.org/PolicyAdvocacy/PositionPapersandReports/NASNPositionStatemen

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tsArticleView/tabid/462/ArticleId/26/Education-Licensure-and-Certification-of-SchoolNurses-Adopted-2002 The National Campaign to Prevent Teen and Unplanned Pregnancy. (2012a). Fast facts: Teen pregnancy in the United States. Retrieved from http://www.thenationalcampaign.org/federalfunding/prep.aspx The National Campaign to Prevent Teen and Unplanned Pregnancy. (2012b). Get organized: A guide to preventing teen pregnancy. Retrieved from http://www.thenationalcampaign.org/resources/getorganized/ch09.pdf Will, S. (2008). CDC reports increase in teen birth rate school nurses review pregnancy prevention programs and student/parent support activities. NASN School Nurse, 23(5). 158-160. doi: 10.1177/1942602X08322167

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Student Name: Tamara Putney
Nursings Leadership Role in Population Based Issues Paper Rubric Section Content Guidelines Clearly identifies two nursing roles needed to carry out your community project. Role of direct contact nurse Identifies possible agency for nursing role. Identifies a leadership role a nurse might take in part of the proposal. Clearly explains what leadership characteristics would be needed to be effective in carrying out this role. Links to ANA Standards of Professional Practice. 15%

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Possible Points
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Points Earned 10 15

Role of leader/manager nurse Identifies possible agency for nursing role. Identifies a leadership role a nurse might take in part of the proposal. Clearly explains what leadership characteristics would be needed to be effective in carrying out this role. Links to ANA Standards of Professional Practice.

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Analysis How are the roles similar? How are the roles different? How could the leadership roles for both nurses explained above impact the political arena related to your population based health concerns. What are the implications for the different skills needed? Reflection Which of your skills might be most suited to each role? What role requirements would be a challenge for you? What might you do to be competent in either role?

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Content Grade Writing Total:

100% FINAL GRADE less Deductions: DEDUCTION OF UP TO 30 points (-30%) will be made for APA/writing/grammatical/punctuation errors. 100%

100 -1 99

Comments: Excellent job with this paper. You covered all the required areas extremely well. I noted a few errors. See comments in paper. I did enjoy reading your paper and feel that you have a great understanding of the 2 roles. Keep up the great work. Jo