Writing

Case Study 1-1

Transforming Leaders

Cameryn is the vice president for professional development at a large metropolitan hospital in the Midwest. She has been in her role for 6 years and has accepted new responsibilities over the years, widening her scope of work to include direction of all the clinical nurse specialists (CNSs), the new graduate residency program, and the research- and evidence-based practice initiatives. She also oversees the Magnet program, which strives for continual readiness for redesignation.

Cameryn and some of the other leaders in the organization have become concerned about the competence level of some nurse managers and their assistant managers, clinical leads, and shift supervisors. The managers and others “get the job done”, but they do not seem to be focused on inspiring the workforce to achieve excellence in their work or preparing potential leaders for succession. In fact, some managers seem to be threatened by informal leaders who excel in the clinical setting; they fail to encourage them to develop their skills and competencies to assume direct leadership roles in the future.

For all in manager and supervisory roles, the hospital provides a quarterly leadership educational event with motivational speakers. The feedback regarding the leadership event is positive, and managers are expected to share with their staff the new knowledge gained from the motivational speakers and presentations. How this new knowledge is shared and disseminated is not assessed. Cameryn wonders whether it is shared at all and questions how well the leadership messages are integrated into the daily behaviors and activities of the managers.

Cameryn has been reading about transformational leadership and how one of the characteristics of a transformational leader is to inspire others to achieve what they previously thought was impossible. Cameryn reflects on those in her own career who inspired her to return to school for further education and ultimately to seek roles where she could influence nursing practice and patient care. In her heart, she wants to provide the same experience for all developing nurse leaders in the clinical setting and also in beginning-level management positions. She believes that management is far more than “getting the job done and completing tasks” and needs to include behaviors that transform individuals into those who have a thirst for new knowledge and quest to constantly change the status quo to achieve excellences in their work.

Cameryn is inspired to do something about the development of nurse managers. She realizes that the first step would be to inspire her colleagues to embrace the same vision for nursing leadership at all levels within the organization, especially with their focus on managing budgets and meetings organizational priorities. Cameryn is convinced that with better prepared frontline managers, many of the organizational priorities could be achieved more expediently. She wants the group to examine the current roles expected of clinical leads, shift supervisiors, nurse managers, and their assistants and the personal and experience requirements for the roles. She also wants to impress upon her colleagues that their own behaviors strongly influence those who are watching their interactions with others and daily behaviors in their roles. She realized that this is a sensitive subject, and she decides to develop a strategy to informally lead her colleagues on a journey for their own improvement and to influence them to improve the experience of their direct reports. She realizes that the interconnection between her colleagues and their direct reports is critical for the changes that she envisions to transform every nurse manager and supervisor into true inspirational leaders.

Cameryn decides to move beyond the occasional inspirational speaker and elects to empower the management team at all levels with as much information as possible about transformational leadership, workplace empowerment, healthy work environment, and nursing excellence. She works with the Collaborative Governance Council for Professional Development to initiate a leadership journal club for clinical leaders and all levels of management. The journal club is led by the memebers of the Professional Development Council who choose the journal articles to read and review. The council also establishes group meeting norms, leads the discussion about the articles, and creates a short summary of the articles for all of the nursing staff to read in the Magnet Nursing Newsletter.

Cameryn also decides that it is important to determine the actual learning needs of those in management positions, so she develops a self-assessment tool using the leadership domains outlined by the American Organization of Nurse Executives and the Benner levels of competency as the response set. The new assessment tool provides information as to how each manager, assistant manager, clinical lead, and shift supervisor perceives his or her level of competence in each of the leadership domains. From that information, Cameryn plans to develop educational content and experiences that are targeted to areas where managers perceive themselves to be least competent. She also meets with those who are more expert in the leadership domains and discusses their mentoring those who are less experienced and competent and presenting some of the formal content needed for development of the frontline leadership team.

Recognizing that professional development is very complex and multileveled task, Cameryn also plans to develop educational content and experiences for the more expert group to teach them how to mentor others and how to prepare and present educational content using teaching methods that are innovative, engaging, and inspiring to learners. Cameryn realizes how interconnected each level of the plan is and how necessary it is to create a fluid and adaptable project management plan to guide the various stages of development to transform nurse managers into true leaders.

She soon realizes that in her work with the collaborative governance councils to develop an educational intervention for the frontline managers she has forgotten to engage the Human Resources department, which is also responsible for leadership development. There are many indications of their discontent with her new leadership development program. When Cameryn recognizes their concern, she meets with them to discuss ways that Human Resources could be instrumental in the assessment and development of frontline managers.

Needless to say, not all of her colleagues embrace her vision to transform the leaders in the organization. Many barriers emerge that would dissuade most from continuing to achieve their vision, and Cameryn is disappointed at times and must continually refocus her energies to remain on course despite the barriers. When she recognizes that one of her colleagues or one of the nurse managers is not “on board,” she spends personal time talking with that person and helping to translate the vision so that it could become his or her reality as well. She is continually engaged in dialogue with others to support the change effort, and she formally recognizes the actions and efforts of those who are involved in mentoring less experienced leaders and those who are involved in the educational activities.

The transformational process has taken several years, but reflecting on the progress, Cameryn and her colleagues believe that significant changes have occurred in the organization and that nurse leaders at every level have benefited from the efforts to enhance the competencies and skills of the frontline managers. The benefits of the program are validated with significant improvements in employee opinion surveys and in surveys to assess healthy work environment.

Questions:

1. How do you think that complexity science and quantum leadership systems thinking provide a framework for an initiative to advance the competencies and skills of frontline managers and to change the management culture to a leadership culture in an organization? What leadership theory is in use?

2. One of the roles of the quantum leader is to read the signposts that give direction and feedback regarding change process. What were some of the signposts that Cameryn encountered during the development of the frontline manager group, interactions with her colleagues, and the encounter with the Human Resources department?

3. In your opinion, what effect will advancing the frontline managers, her own colleagues’ competence, and transformational leadership culture have on organizational climate, nursing satisfaction, and even patient outcomes?

Discussion 1

The unlawful restraint of a patient can be a legal pitfall for the PMHNP.  K.W. was found eating hamburgers out of a Mcdonald’s dumpster and drinking water from an old water hose.  She had not taken a bath in weeks. She refused to live in an apartment because she wants to “live off the fat of the land.”  

1. Cite the Baker Act law to defend your position.  
2. Find one newspaper article written in the last 5 years that supports your position.  Summarize the details of the case and the laws cited 

Submission Instructions:

• Your initial post should be at least 500 words, formatted, and cited in current APA style 

Healthcare

Chapter 12 explores the important issues of cost, access and quality, including that having access to affordable quality health services is both (1) a key determinant of health care and (2) a significant benchmark in assessing the effectiveness of the health care delivery system. 

In chapters previously discussed in this class, we have studied that vulnerable populations experience great challenges in:

• Accessing health services, 
• Paying for health services (which contribute to the access problem), and 
• Receiving quality health services (as opposed to the quality typically available to non-vulnerable populations).   

Vulnerable population groups include racial/ethnic minorities, the uninsured, children, women, persons living in rural areas, migrant workers, homeless persons, persons with mental illness, the chronically ill, and persons with a disability.  While members of the population groups listed above often have incomes at or below the federal poverty level, I think that poverty could perhaps be added as a distinct vulnerable population group.  With the exception of the population groups for women and children, any of these vulnerable population groups include adult men.  Therefore, the vulnerable population groups include people from every population group.  

Those living in rural areas are especially hard-hit with finding access to medically necessary health services.  Challenges that they face include, at the most basic level, poverty and the chronic health conditions associated with poverty.   Other challenges of living in a rural area include a shortage of health care providers, a lesser quality of care, a lack of health insurance, and increasingly, the loss of a community hospital that includes in its mission an obligation to serve the health needs of special populations.

Assume that you are the CEO of a rural hospital in an agricultural community characterized by high poverty, high unemployment, and poor health status due to chronic health conditions.  You are fortunate that your hospital was just purchased by a larger health system and you now have access to financial resources that will enable your hospital to invest in its future for the first time in 25 years.  You are excited about bringing new programs to improve access for the community’s long neglected vulnerable populations.  

However, you have a newly constituted board of directors that has as its focus achieving financial stability followed by growth.  The board views the community’s high percentage of residents who fall into the vulnerable population as a reason for the hospital’s financial struggles, and has directed you to improve the payer mix by replacing the uninsured and Medicaid patients with commercially insured and private pay patients.  The board has also directed you to:

• Recruit young doctors trained in state-of-the-art medicine and technologies;  
• Implement  cash cow programs such as orthopedic surgery, cosmetic surgery, pain management, oncology, post-acute rehabilitation, etc.; 
• Reduce the hospital’s charity and bad debt accounts; 
• Invest in an electronic medical record platform; and 
• Make needed facility improvements and medical equipment purchases.    

How will you, as hospital CEO, utilize the recent infusion of capital from the new health system owner to achieve the board’s financial objectives while also improving access to necessary health services by the vulnerable populations served by your hospital (mostly uninsured and Medicaid)?  Is your goal of improving access to the community’s vulnerable populations fundamentally inconsistent with the board’s goal of increasing revenues and modernizing the hospital; or can the two goals be reconciled and mutually achievable?  If your goal is inconsistent, how is it inconsistent?

American History 1

in which you discuss the reasons for United States involvement in Vietnam. Outline the ways that the crisis in Vietnam affected the presidencies of Johnson and Nixon. Be sure to set your response within the larger context of the Cold War and specific events within Southeast Asia. In what ways did president Carter try to restore American confidence following the Vietnam War?

In 1997, Professor Pauline Kim of the Washington University School of Law published “Bargaining with Imperfect Information:

A Study of Worker Perceptions of Legal Protection in an At-Will World” in the Cornell Law Review. In it, she reported the results of a survey of Missouri employees and their perceptions of protections the law provides them from losing their jobs under various circumstances. The survey revealed that the vast majority of employees were unaware of the at will rule and erroneously believed the law protected their employment from being terminated for a variety of reasons that are clearly legally permissible under the employment-at-will default rule. For example, nearly 89 percent of respondents believed that it is unlawful for an employer to fire an employee because of the employer’s personal dislike of the employee. Similarly, 87 percent of respondents believed an employer would be breaking the law if it fired an employee for erroneously concluding that the employee had stolen from the employer, even when the employee had provided proof that she had not.

Defenders of the employment-at-will rule justify it in a number of different ways. One of those is that employees who value greater job security can negotiate with employers for protection from unjustified termination of their employment (usually at the cost of a lower salary or other benefit concessions). Similarly, at least in theory, employers pay a wage premium for the

labor flexibility that the at-will rule provides. However if Professor Kim’s survey is broad representative of workers

knowledge about the at-will rule, then such employees are unlikely to value job security accurately and or to demand an appropriate wage premium. Employers presumably have no such misunderstanding. As a result. they benefit from theil

employees misapprehension of the at-will rule and some may encourage such misunderstanding in order to cultivate feelings of loyalty and security among their employees

What, if any, ethical obligation do employers, who are at an information advantage, owe to prospective employees toensure that they understand employment at will prior to negotiating the details of their employment?

3 paragraph response