Clinical Nurse Specialist/Nurse Practitioner as a Leader - Coursework Example

Clinical Nurse Specialist/Nurse Practitioner as leader Faculty Table of Contents I. Introduction II. Clinical Nurse Specialist III. Professional Leadership IV. Professional Leaders in Education and Research V. Role of Evidence in Decision Making VI. Barriers in Decision Making VII. Conclusion VIII. Reference I. Introduction Role of Clinical Nurse Specialist/Nurse Practitioner as leader has been one of the topic of discussion from some period. Clinical Nurse Specialist or Practitioner transform themselves from specialist to generalist to take care of multiple roles like clinical practice, educator, researcher, information providers, managers, team leader and risk analysts (Benner, 1984). The term “Leader” indicates the qualities of leaders, which these practitioners may pose. Leaders can change their personalities and behaviour according to the need of hour and requirement. Their personality may vary from being democratic to authoritative. This is required so that people under specific leadership may achieve desired goals and results. The changes may occur in particular way of dealing with people or doing some task. Leaders understand the behaviour and expectation of crowd and work accordingly. Leaders try to work from all the ways to have impact on the followers from persuasive behaviour to authoritative behaviour. Some people are ready to take risk, responsibilities and accountability of the work assign to them. For such kind of followers, leaders adopt empowering personalities where in the case vice versa their personality would be authoritative. II. Clinical Nurse Specialist Clinical Nurse Specialist/Nurse Practitioner are involve at various kinds of activities and domains related to clinical practice like clinical practice, education, research, professional development and leadership (Lukosius and DiCenso 2004). Their roles are autonomous and they are expected to focus on the heath needs of patients by using their knowledge and skills of the particular area (Ackroyd, 1996). Lukosius and DiCenso (2004) Health care restructuring has led to increased demand for advanced practice nursing (APN) roles (Dillon & George 1997, Pinelli 1997, Offredy 2000, Chang & Wong 2001). For instance in the case of Colorectal/Stoma Care, clinical nurse specialist handles range of responsibilities namely clinical practice, education, professional, research and audit, managerial, ensuring clinical governance and quality apart from other responsibilities. The clinical nurse specialist provides direction, leadership and support to other nursing staff of the related field and advice to the seniors. She helps in developing, implementing and evaluating new and existing policies, practices and changes related to colorectal and stoma care nursing. Hence, she works as a change and intermediary agent. One of the responsibilities includes liaison with multidisciplinary teams and other nursing services like community stoma care nurses, doctors and patient support groups. The following statement of Baxtar and Salter (2000) can help to understand the importance of Clinical Nurse Specialist in the Stoma Care, “Approximately 13,500 people undergo stoma formation each year. Cancer and inflammatory bowel disease are the most common. Colorectal cancer is the third most common cancer in the UK, with more than 31,000 new cases in 1995 (CRC 1999). It is thought that there are some 120,000 people with inflammatory bowel disease at any one time. Although not all these people will require stoma formation, all will need appropriate information, advice and support to enable then to make decisions about treatment options and to cope with the effects of chronic illness.” (Baxter & Salter, 2000) The advance practice in health care service will include all the stakeholders. It will focus on the long-term goals without compromising the short-term goals. Below is the patient focused advance nursing role development plan. It focuses on education, proper resource allocation and support to implement and evaluate the plan. It keeps APN in a central role of developing policies and protocols. This is because they are already in contact with the patient and have practical knowledge of challenges existing in the work area (Casteldine, 1991, Lukosius & DiCenso, 2004). Figure: Advance Practice Nursing PEPPA Framework (Developed by Spite, 1978, Dunn & Nickln, 1995 and Mitchell-DiCenso et al. as cited in Lukosius and DiCenso 2004) III. Professional Leadership Professional leadership has become an important aspect of this profession. However, accountability of the professionals for their actions and responsibilities is the primary thing. Accountability on one hand limits them to go beyond certain limits and on the other hand, it allows them to take actions within the limits of their profiles (Alavi & Cattoni, 1995). Professional leaders of clinical practices are working for the wide range of issues from maternal child health nursing, Psychiatric-mental health nursing, community mental health and others. They take care of the health of community in range of health related issues and problems (Lego, 1999; Alder & Alder, 1987). In the cases like substance abuse among teenagers and young people, the role of professionals becomes important to understand the reasons and causes of substance abuse. In the cases of mental disorders and stress, each case is different from other (Alder & Alder, 1987). However, professionals work directly with the patients and their community. This help them developing better understanding of the practical issues related to the problem. This can be utilised effectively in developing practice for different domains. (Gadow, 1985, Henneman, 1995; Spray, 1999) IV. Professional Leaders in Education and Research One of the responsibilities of Clinical Nurse Specialist in Stoma Care is to participate in clinical supervisions and critically evaluate the research findings. They participate in various collaborative research programme and projects related to Stoma care. In the case of patients going through colorectal surgery, these specialists provide them information and educate them about the problem and procedures. They act as Professional leaders. They can be effective teachers and instructors for teaching clinical skills to other nursing staff and educating patients and community. These people are influential. They can motivate learners to learn and develop certain skills. They can provide practical solutions, approach, and encourage them for their involvement in the learning and implementation of the clinical knowledge in best of their abilities. They can act as change agents. They can empower others by imparting them their knowledge and skills (Zeithamal and Bitner, 2002, Drenkard, 2004, Mills, 2005; Hughes et al, 2006). Practitioner can be a good researcher as she is in touch with the patients. Practitioner can implement strategies like observation, specific data collection and results of particular clinical practice with some extra effort along with the routine task. This information can help in understanding which kind of practices are effective or require more attention for the development. This will also helpful in finding the impact of socio-cultural factors influencing patient and treatment process. Practitioner can be given an opportunity to develop his research related skills and knowledge (Coluccio & Maguire, 1983; Cohem, 1995). V. Role of Evidence in Decision Making Evidence plays a crucial role in decision making for the patient. Evidences provide history of patient, his background information related to health and society and many others (Bauchner, 1999). Dave Sackett, one of the earliest advocates, defined evidence based medicine (EBM) as "the conscientious, explicit, and judicious use of best evidence in making decisions about the care of individual patients (Carney, 2005) Evidence based practice can help in maintain the high quality care for the patients. Through this health care providers can ensure patient preferences and value, develop better understanding of patient problems and relationship with them(Gerrish, 1997). This will help in developing and implementing better health care plan. VI. Barriers in Decision Making As mentioned by Haynes & Haines (1998) size and complexity of research, difficulty in developing policy based on evidence based practice, implementation issues like poor access to guidelines and evidences, organisational barriers, low patient adherence to the program are the barriers to the implement evidence based decision-makings. Professionals can identify these barriers and remove it with appropriate measures and strategies (Grimes and Garcia, 1997). Proper allocation of resources, proper and timely communication and supportive organisation culture can help in dealing with organisational barriers. Involvement of people related to the matters can also help in dealing with the barriers. VII. Conclusion Clinical Nurse Specialist/Nurse Practitioner as leader can bring changes in the community health care services. They are people with specialisation. Specialist practitioner may specialise in the child health nursing, psychiatric and mental health, maternal child health nursing or many others. The challenge their specialisation offers is in a particular domain of nursing. As a leader, they develop their skills and abilities to take care of issues related to general matters. They act as managers, information providers, facilitators, researchers, educators and many others. As a leader, they try to fulfil the gaps of the health care delivery system in the community. Clinical Nurse Specialist/Nurse Practitioner as a leader can contribute to the society in various ways. Their specialisation will offer them ability to take best decisions within their professional limits. They can contribute as a researcher to collect and provide primary data. Their observation abilities can help in finding out qualitative reasons and evidences for particular health related problem or treatment procedure. The goal of continuous improvement of the quality of services can be achieved with their active contributions. VIII. Reference 1. Ackroyd, S. (1996) Traditional and new management in the NHS hospital service and their effects on nursing. In Themes and Perspectives in Nursing, 2nd edn. Soothill, K., Henry, C. and Hendrick, K. eds. Chapman and Hall, London. 2. Alavi, C. and Cattoni, J. (1995) Good nurse, bad nurse. Journal of Advanced Nursing, 21: 231-260. 3. Alder, P. A. and Alder, P. (1987) Observation techniques. In Handbook of Qualitative Research. Denzin, N. K. and Lincoln, Y. S., eds. Sage Publications, Thousand Oaks 4. Baxter A & Salter M (2000) Stoma Care Nursing, Nursing Standard, January 26, l14:19, 59 available at http://www.nursing-standard.co.uk/archives/ns/vol14-19/pdfs/career1.pdf [cited 12 November 2007] 5. Benner, P. (1984) From Novice to Expert: Excellence and Power in Clinical Nursing Practice. Addison Wesley Publishing Company, Menlo Park, CA. 6. Bauchner, H. (1999). Evidence-based Medicine: A New Science or an Epidemiologic Fad?. Pediatrics 103: 1029-1031 7. Casteldine, G. (1991) The advanced nurse practitioner, Part 1. Nursing Standard, 5, 43: 34-36 8. Carney, S. (2005) Competences for the foundation programme—part 3: Evidence based medicine, BMJ Publishing Group Ltd, available at http://careerfocus.bmj.com/cgi/content/full/331/7527/231[cited 31 October 2007] 9. Coombs Maureen A.; (2004) Power & Conflict between Doctors and Nurses: Breaking through the Inner Circle in Clinical Care,. Routledge:New York 10. Cohen, A. (1995) The market and professional frameworks. In Interprofessional Issues in Community and Primary Health Care. Owens, P., Carner, J., Foucher, J., eds. Macmillan: London. 11. Coluccio, M. and Maguire, P. (1983) Collaborative practice: becoming a reality through primary nursing. Nursing Administration Quarterly, 7: 59-63 12. College of Nursing offers Clinical Nurse Leader Track Online available at http://www.usouthal.edu/nursing/CNL.html [cited 31 October 2007] 13. CNA (2000) Advanced Nursing Practice: A National Framework, Canadian Nurses Association: Ottawa 14. Clinical Nurse / Midwife Specialist Role Resource Pack available at http://www.sehb.ie/search/publications/cns_cms_resource_pack/cns_cms_resource.pdf[cited 31 October 2007] 15. Drenkard, K.N. (2004) The clinical nurse leader: A response from practice. Journal of Professional Nursing, 20(2), 89-96 16. Gadow, S. (1985) Nurse and patient: the caring relationship. In Caring, Curing, Coping. Bishop, A. H. and Scudder, J. R. eds. University of Alabama Press, Tuscaloosa 17. Gerrish, K. (1997) Being a marginal native: dilemmas of the participant observer. Nurse Researcher, 5, 1: 26-34. 18. Grimes D.E. & Garcia M.K. (1997) Advanced practice nursing and work site primary care: challenges for outcomes evaluation. Advanced Practice Nurse Quarterly 3, 19–28. 19. Haynes B & Haines A (1998) Getting research findings into practice, Barriers and bridges to evidence based clinical practice available at http://www.bmj.com/cgi/content/full/317/7153/273 [cited 31 October 2007] 20. Henneman, E. (1995) Collaboration: a concept analysis. Journal of Advanced Nursing, 21: 103-109. 21. Hughes R.L., Ginnett, R.C. & Curphy, C.J. (2006). Leadership: Enhancing the Lessons of Experience (5th ed.). Boston: McGraw-Hill/Irwin 22. Lukosius D. B. & DiCenso (2004) A framework for the introduction and evaluation of advanced practice nursing roles Blackwell Publishing Ltd, Journal of Advanced Nursing, 48(5), 530–540 available at http://lmi.ides.state.il.us/healthcareers/PDF/ClinicalNurseSpecialist.pdf [cited 31 October 2007] 23. Lego S. (1999) The One-to-One Nurse-Patient Relationship, Perspectives in Psychiatric Care, Vol. 35, 1999 24. Mills. Q.(2005) Asian and American Leadership Styles: How Are They Unique?retreived on 6th February 2007 from http://hbswk.hbs.edu/item/4869.html 25. Spray, S.L. (1999) The Evolution of the Psychiatric Clinical Nurse Specialist: An Interview with Hildegard E. Peplau Perspectives in Psychiatric Care, Vol. 35, 1999. 26. Zeithaml Valarie A. and Mary Jo Bitner, 2002 ‘Services Marketing-Integrating Customer Focus Aross the Firm’. 2nd Ed., New York: Tata McGraw-Hill Read More