Running head: NURSE LEADERSHIP

Nurse Leadership: Individual and Community based Sherry A. Brabon Ferris State University

NURSE LEADERSHIP Abstract Nursing roles and characteristics for community and client focused nursing care are similar but can be distinct at the same time. Frameworks or models have been established for both nursing

roles. These frameworks offer guidance for assessment and encourage behavior changes in both the community and client focused nursing roles. Client focused nursing remains distinct from community nursing in that it is nursing care directly provided to the individual. On the other hand, community nursing focuses on groups of individuals with a common concern. However, roles of the nurse are comparable in both settings, such as use of the nursing process. In either setting, nurses should participate in their local governments or nursing associations. In my personal reflection, I identify my strengths in client-focused care using the nursing process. My weaknesses in community nursing include engaging stakeholders and securing funding sources. Nurses can be leaders both in the community and individual patient care settings.

NURSE LEADERSHIP Nurse Leadership: Individual and Community based Leadership roles may change based on the population being served. Client focused nursing care can differ from population based nursing care. Furthermore, these roles can differ from the setting in which the care is provided. Kent Countys lack of access to nutritious foods

will be used as an example throughout this document. This paper will review nursing leadership roles in relation to individual and population nursing care. Leadership characteristics will be identified for both roles. Correlation will be made between nursing roles and the Standards of Practice as outlined by the American Nurses Association (ANA). These nursing roles will be compared and contrasted. Finally, I will present my reflections based on my nursing abilities and how they compare to the nursing roles presented. Nursing Roles Client Focused Nursing Care Most commonly nurses provide services in a hospital, home or long term care facility. Nurses may also provide client or individual focused care while working in health departments. For the purpose of this paper, I will present nursing care from the health department viewpoint. Kent County residents have a lack of access to nutritious foods. Public health nurses can assess strengths, weakness, resources and needs. A nurse may utilize any of the behavior models when assessing clients perspectives regarding change: Transtheoretical model, learning model, health belief model, theory of reasoned action, social learning theory, theories of social support, relapse prevention model and the ecological model are models a nurse may use (Harkness and DeMarco, 2012). While utilizing motivational interviewing skills a nurse can determine client barriers to learning and

NURSE LEADERSHIP behavior change. Based on client interactions, a nurse can determine which model would provoke the best response by the client. Using Kent Countys lack of access to nutritious foods, a nurse can assess the clients ability to drive or other ways in which residents may obtain healthy food. Determining what

resources, strengths and weaknesses the clients have aides in assisting with access and obtaining nutritious foods. With client focused nursing care, the nurse works with the client to determine what they can do different to promote a positive behavior change; the nurse assists patients to their goals. The nurse is a guide, so to speak, for clients to direct themselves to a point of wellness. Nurses need to demonstrate confidence to patients. If a nurse believes a patient can accomplish a goal, the patient is more apt to believe the same. The nurse must demonstrate good communication skills. If the nurse does not understand where the client wants to be, the nurse cannot help the client reach their goals. Another characteristic of a client focused leadership role is having a positive attitude and a sense of humor (Forbes, 2013). Nurse leaders need to have empathy and understand that relapse may occur; a positive attitude may encourage a patient to pick him or herself up and try again. These are all characteristics of a good leader. The American Nurses Association (ANA, 2010) offers 16 standards of practice for nurses. When performing the above client focused care a nurse is using assessment skills, outcome identification, planning, implementation and communication. These standards are all part of the nursing process.

NURSE LEADERSHIP Community Focused Nursing Care Community based nursing care can be found at the local health department, Red Cross, state and federal based agencies. Again, for purposes of this report, the focus will remain at the local health department level of care. Nursing care at the community level focuses on groups of people. This may be a

disparity group, minority, disease epidemiology or any other group of individuals related in some way. Using the Kent County access to nutrition problem, the group identified is the residents of Kent County. Population nurses analyze data and trends to identify a common health care concern. Collaboration with stakeholders is key in community nursing. For example, when working with the Kent County access to nutrition problem, the nurse would analyze the data, the proof that access to nutritious foods is the real problem. Next, the nurse would develop a plan and include interested individuals and organizations. There are several frameworks for community assessment; these frameworks include epidemiologic approach, community as partner, functional health status approach, developmental models and approaches, community assessment assets-based approach and the collaborative model (Harkness and DeMarco, 2012). Though pieces of each framework may be used, the core framework used for Kent Countys assessment was the collaborative model. It was determined that many different agencies would be required to improve access to nutritious foods. By mobilizing many resources throughout the community, better outcomes can be achieved. Whitney, Dutcher and Keselman (2013) present a framework for outreach projects. They review projects, assessments, goals, evaluation methods and outcomes; this synopsis encompasses the role of the community health nurse.

NURSE LEADERSHIP One of the roles of the nurse leader in the community setting is influencing (Vaughan, 2012). Vaughan (2012) outlines nine steps to influence stakeholders and making an active change in community nursing. These nine steps are (a) identify your goal, (b) assess the current situation, (c) determine if goal is achievable, (d) gather evidence to support case, (e) identify stakeholders, (f) develop three key messages, (g) test messages, (h) manage the meeting, and (i)

review the results. These steps to influencing change at the community level are roles of a nurse leader. Characteristics of a good nurse leader includes having a positive attitude, being creative, following intuition, having the ability to inspire others, appropriate delegation, confidence, commitment and good communication skills (Forbes, 2013). These qualities will produce effective collaboration with key players to reach goals and positive outcomes. Though, a nurse may not require all of these characteristics to reach a desired goal, they would provide the most positive qualities ensuring future endeavors with community stakeholders. Assessment, diagnoses, outcome identification, planning, implementation, evaluation, education, evidence-based practice and research, communication, leadership, collaboration, professional practice evaluation and resource utilization are all Standards of Professional practice a community nurse would utilize (ANA, 2010). It is expected professional nurses follow these guidelines while providing care; this involves providing care at the community level as well. These standards are key for successful outcomes and to reach established goals in a quality and safe manner. Client Focused versus Community Focused Nursing Care In comparison, the client focused nurse and the community focus nurse continue to follow the nursing process. Assessment, diagnosis, planning, intervention and evaluation steps

NURSE LEADERSHIP are used for both types of nursing care. The standards of practice remain the same. Some may

be used more than others at the community level; however, all are used at some point in time for the client-focused level of care also. Both require a nurse leader for successful outcomes. On the other hand, client focused care is care provided to the patient or family whereas community focus care the nurse is looking at a group of people. The nurse is collaborating with community members to establish a plan based on assessment outcome, trends or epidemiology. These community members may be representatives of community businesses, politicians, hospitals, churches and other organizations that share the same goal or can assist in accomplishing the same goal. Whereas with client focused care the nurse collaborates with other health care officials; for example, doctors, dieticians, social workers, and physical therapists. The difference is the level of which the care is provided, patient versus community. Health care is political in nature. Government provides health care in the form of Medicaid and Medicare. These entities establish guidelines for private insurers. Health care providers need to understand the impact they may have on laws and regulation of insurance policies. The client-focused nurse may impact health care at the political level by offering preventive services or excellent secondary prevention that reduces the overall mortality and morbidity of the general population. Community nurses can monitor trends and establish interventions that prevent additional morbidity and mortality at the onset of disease trends. Community nurses can provide epidemiological evidence to politicians to promote policy change and enhance funding to public health endeavors. Furthermore, nurses at any level should participate in a nurses association. The main differences noted between client-based nursing care and community-nursing care is the volume of affected individuals, collaborating entities and impact of interventions. The

NURSE LEADERSHIP

community nurse is looking at a bigger picture of the overall statistics of disease epidemiology and providing the upstream approach to disease management. One role is not better than the other; both are needed to prevent morbidity and mortality. Both are needed to reach established goals. Personal Reflection Assessing, planning, diagnosing and evaluation are my strong points. I feel I provide guidance and maintain a positive influence for my clients. These roles would most reflect those of a client focused nursing approach. This type of nursing is what I have done for 14 years; it is what I know. Interventions, at times, are my weakest traits. To improve my skills, I identify where I am lacking and seek learning opportunities to enhance my knowledge base. Journaling is a great way to assess personal growth and enhance metacognitive thinking (Kuiper, Murdock & Grant, 2010). Journaling allows me to explore my thoughts and identify learning opportunities. I feel I am a good communicator and motivator as well; this is evident in my group projects. On the other hand, engaging stakeholders and finding sustainable funding would be my prevalent challenges. These roles are most utilized by community nurses and this role I have had very little experience even though I have been a public health nurse for eight years. My role at the local health department remains more client-focused than community focused. To become competent in these activities, I would need a mentor and practice. Public speaking was my weak area not too long ago and to overcome this inadequacy I sought opportunities to speak in front of groups. My skills have improved and I feel more comfortable and competent with public speaking. This is how I overcome any weaknesses or barriers.

NURSE LEADERSHIP Only experience in community nursing will expose additional challenges and areas in which I can improve my skills. In order to do this, I will seek opportunities to engage in

community planning events. By doing this, I will also begin to build relationships with potential stakeholders. Since my community is fairly small, being involved in community events will encourage stakeholders to build confidence in my abilities. This will be beneficial in future endeavors. In conclusion, there remains a distinction between community and individual nursing care. However, there are many similarities. Nurses are trained to provide services in both settings. Experience in each role enhances confidence and skills in both areas of nursing care.

NURSE LEADERSHIP Reference American Nurses Association. (2010). Nursing: Scope and standards of practice (2nd ed.). Silver Spring, MD: Nursesbooks.org. Forbes. (2013). Top 10 qualities that make a good leader. Retrieved from

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http://www.forbes.com/sites/tanyaprive/2012/12/19/top-10-qualities-that-make-a-greatleader/2/ Harkness, G. and DeMarco, R. (2012). Community and public health nursing. Philadelphia: Lippincott Williams and Wilkins. Kuiper, R., Murdock, N., Grant, N. (2010). Thinking strategies of Baccalaureate nursing students prompted by self-regulated learning strategies. Journal of Nursing Education, 49(8), 429-436. Whitney, W., Dutcher, G., & Keselman, A. (2013). Evaluation of health information outreach: Theory, practice and future direction. Journal of the Medical Library Association, 101(2), 138-146. Vaughan, P. (2012). Making it happen: A short guide to influencing skills. Practice Nurse, 42(8), 35-40.