Leadership and Ethics

Features

Leadership and Ethics

California Nursing Leaders Speak Out

By Working Nurse
Login
to Save


The theme for National Nurses Week 2015 is “Ethical Practice, Quality Care.”What are the biggest ethical challenges facing nurses today?
 

Lauren Spilsbury, RN, MSN

Vice President Patient Care Services
Redlands Community Hospital

It is very difficult for staff to be on the front line with end-of-life issues. Because today’s patients are older and sicker, there may be conflicts between patients’ wishes and family members’ desires. It is challenging to be the facilitator in these conversations, especially when patients are unwilling or unable to express their own needs. Nurses are perfectly positioned to ensure that the patient’s wishes are honored.

Mary Lynne Knighten, RN, DNP, PN, NEA-BC

Chief Nursing Officer/ Vice President, Patient Care Services
St. Francis Medical Center

One big challenge is how to assimilate technology into practice without being consumed by it. For example, how does a nurse decide whether to answer her smartphone, which has a call light from the nurse call system, when she is with another patient?

Another ethical challenge nurse­­s must face is how to impact the delivery of futile care when the physician is uncomfortable having end-of-life discussions and the family can’t hear what is being said. Nurses can help bring a quality-of-life perspective to the conversation.

Melanie Patterson, RN, DNP, MHA

Vice President Patient Care Services and Chief Nursing Officer
Children’s Hospital Orange County

How to establish a good rapport with patients and families without crossing professional boundaries. In pediatrics, that is often difficult, especially with the chronic patients we see frequently. When the patient and family consider the nursing team part of their family, it’s easy to turn a professional relationship to a personal one.

Another common dilemma is balancing the family’s desire to protect their child with the nurse’s responsibility to be honest and truthful. Nurses must help families understand that it is our job to build a respectful and understanding relationship by listening, providing insights and giving truthful information — even if that means answering a very direct question from a young patient.

Judy Pugach, RN, MPH, CPHQ, CPHRM

Interim Chief Nursing Officer
PIH Health Hospital - Downey

Today’s technology has fueled expectations for prolonged life. Nurses frequently find themselves caught between a family in crisis that wants everything possible to be done and a patient whose wishes are not being honored. Nurses must balance patient wishes with family expectations.

Patricia S. Matos, RN, DNP, NEA-BC

Chief Nursing Officer
UCLA Resnick Neuropsychiatric Hospital

The biggest challenge for nurses today is finding the time and support to explore evidence-based practice, research and ethics. In the current climate, most beds are full or filled as soon as they are cleaned. Emergency departments are overflowing, with patients receiving treatment in hallways. However, if nurses spend 100 percent of their time on patient care, they will not have the time to examine that care, to call the ethics committee about a complex issue or to engage in professional inquiry.

A number of years ago, I found an old nursing text from the 1950s that detailed procedures for caring for premature infants. One step was to place the infant in the incubator on an asbestos pad! I often wonder how many procedures we follow unquestioningly today will later be shown to be harmful. So, as leaders, the question we must face is this: Do we foster and encourage nurses to think critically about their work and the processes they follow or do we leave the asbestos pad in the incubator and hope for the best?

Linda Johnson, RN, MSN, NEA-BC

Vice President, Patient Care and CNO
Mission Hospital

The biggest ethical challenges facing nurses today often involve advocating to relieve patient suffering and improve quality of life. Nurses play a key role in trying to balance the needs of the patient with complex clinical, social and behavioral dilemmas and sometimes challenging family and team dynamics.

What advice would you give to a nurse who wants to go into management?

Lauren Spilsbury, RN, MSN

Vice President Patient Care Services
Redlands Community Hospital

Nursing schools do not necessarily teach practical management skills. I would suggest taking a management foundation class. I send my new managers to the Association of California Nurse Leaders’ Foundation for Leadership Excellence program to provide a strong groundwork for growth. To enrich your leadership and management skills, don’t ever say no to new opportunities to learn and grow. Your career becomes richer and more robust when you step up, stretch, branch out, aim high and taste the fruit of success.

Mary Lynne Knighten, RN, DNP, PN, NEA-BC

Chief Nursing Officer/Vice President, Patient Care Services
St. Francis Medical Center

First, ask yourself why you want to become a manager. If it’s to change others or because you think it looks easy, it’s not a good reason. On the other hand, if you want to achieve outcomes by leading, developing and influencing others, you probably have the “management gene.”

Next, go back to school and advance your degree. Being a lifelong learner is an essential attribute for someone in management. Finally, always say yes to taking on something new. This helps you grow in management scope and experience.

Melanie Patterson, RN, DNP, MHA

Vice President Patient Care Services and Chief Nursing Officer
Children’s Hospital Orange County

Take every opportunity to lead groups and projects. Talk to your supervisor/manager about your goals and find a mentor.

Judy Pugach, RN, MPH, CPHQ, CPHRM

Interim Chief Nursing Officer
PIH Health Hospital - Downey

You must first build your skillset as a strong clinical nurse. Take advantage of opportunities to participate in projects, not only at the department level, but organization-wide. This will help you develop a broader perspective as well as exposing you to different leadership styles.

Patricia S. Matos, RN, DNP, NEA-BC

Chief Nursing Officer
UCLA Resnick Neuropsychiatric Hospital

Push yourself. Take on increasingly responsible roles. Start perhaps as a charge nurse or filling in for the manager. Then, ask yourself if you like being a leader. Next, assess your skills and experiences. Are you able to manage difficult situations? Do the staff like when you are in charge? Can you inspire rather than direct — at least some of the time? To me, the most important question is whether you can really listen. Your decisions will be based on the information you receive, so if you don’t listen to all the facts, your decisions will likely be faulty.

Finally, avail yourself of all the leadership-related educational opportunities you can find. If you don’t have your BSN, get it; managers in Magnet hospitals must have it. If you don’t have your MSN, get that as well. Not only will you learn a tremendous amount, Magnet hospitals may someday require a master’s degree for managers. You might as well be ahead of the curve.

Heidi Crooks, RN, M.A.

Chief Nurse Executive
UCLA Health System

Prepare yourself academically and get the skills necessary for a leader. Read Kouzes and Posner’s book The Leadership Challenge. Engage a team to work with you; when you work with others, you’ll accomplish more and build a support network. Take on leadership roles in your unit, on unit practice councils and in the community. If you take on increasingly difficult assignments and responsibilities, within a few years, you will be recognized as a nurse leader on the move. 

Make a five-year plan. Be clear about what you would like to accomplish, whether it’s changing a nursing practice to improve patient care or developing a program to provide care for an underserved population. Reevaluate and adjust your plan at least yearly. Apply for positions that are of interest to you. As long as the experience would fit your plan, go for it, even if the position is outside your community or is international.

Linda Johnson, RN, MSN, NEA-BC

Vice President, Patient Care and CNO
Mission Hospital

The advice I would give is to develop a solid plan to build your experience and expertise, find your passion, and listen to what your heart is telling you. Nurse leaders who feel a special calling to their role are needed, whether at the bedside or in an executive suite. Your role as a leader will be to inspire, advocate for, grow and develop your team to be future leaders.

What are the most important traits for an effective nursing manager?

Lauren Spilsbury, RN, MSN

Vice President Patient Care Services
Redlands Community Hospital

Boldness. Actively lead change, don’t just float along. Other important traits are excellent listening skills; the ability to analyze data, both financial and quality; and the strength to set expectations and hold people accountable.

Mary Lynne Knighten, RN, DNP, PN, NEA-BC

Chief Nursing Officer/Vice President, Patient Care Services
St. Francis Medical Center

The title of my master’s thesis was “Skills and Characteristics of Front-Line Nurse Managers,” so this one is easy. Listening, fairness, integrity, transparency, advocacy and presence.

Melanie Patterson, RN, DNP, MHA

Vice President Patient Care Services and Chief Nursing Officer
Children’s Hospital Orange County

Flexibility, persistence, openness and an ability to go broad with ideas.

Judy Pugach, RN, MPH, CPHQ, CPHRM

Interim Chief Nursing Officer
PIH Health Hospital - Downey

You must have passion for the work and that passion must be visible to your team. The ability to treat each day as a new opportunity to pursue excellence is another good characteristic to have. Being thoughtful and a good listener is also important.

Which of your accomplishments makes you the most proud?

Lauren Spilsbury, RN, MSN

Vice President Patient Care Services
Redlands Community Hospital

I am most proud of moments when I witness bedside nurses sitting at the table with physicians and other clinicians, having knowledgeable, fruitful discussions on how best to integrate evidence into everyday practice. I am awed by the excellence displayed by the nursing staff at our hospital. They are driven by evidence-based practice and yet provide individualized and compassionate care. They are truly amazing.

Mary Lynne Knighten, RN, DNP, PN, NEA-BC

Chief Nursing Officer/ Vice President, Patient Care Services
St. Francis Medical Center

Completing my doctor of nursing practice degree, which was a life goal. When the executive leadership DNP was created at University of San Francisco, it was the perfect program for me — I am all about evidence-based practice. I am very proud and honored to have led our hospital to achieve international recognition as a patient- and family-centered organization. The partnership between our nurses, medical staff, and our patients and families is making the hospital a better place for the community to receive healthcare.

Melanie Patterson, RN, DNP, MHA

Vice President Patient Care Services and Chief Nursing Officer
Children’s Hospital Orange County

When I have mentored or supported someone who accomplished their goals. I am also extremely proud of the way our RNs and staff care for our patients and families.

Judy Pugach, RN, MPH, CPHQ, CPHRM

Interim Chief Nursing Officer
PIH Health Hospital - Downey

I am so pleased and fortunate to be a nurse leader and at the same time to have been able to balance my career with family. I am part of a team of incredible nurse leaders in my organization who make a difference in our patients’ lives on a daily basis. We all bring different strengths to the table. Together, we are invincible! I am proud to be their colleague.
 

Patricia S. Matos, RN, DNP, NEA-BC

Chief Nursing Officer
UCLA Resnick Neuropsychiatric Hospital

Most of all, I remember the patients who improved under our team’s care. Many patients were admitted over the years who were completely dysfunctional due to mental illness, but who were subsequently discharged and able to return to family and previous life.

The other accomplishment is the part I played in helping my previous employer twice attain Magnet designation. While it is a tremendous amount of work, it raises the bar of nursing practice to levels most nurses never thought they could achieve. The emphasis on evidence-based practice and research gave many nurses a new platform for development. They expanded their practice into the community (both locally and globally) and became more confident and articulate about nursing practice.They replaced antiquated thinking and became more flexible and thoughtful. As the nurses learned to individualize care and become less rigidly dependent on written policies and procedures, the patients ultimately benefited.

The Magnet journey also pushed me to attain my DNP. I had never planned to return to school and the thought of all the work involved was daunting. Finishing was not only a personal accomplishment, but the culmination of a process of growth and enlightenment that surprised and amazed me.

Heidi Crooks, RN, M.A.

Chief Nurse Executive
UCLA Health System

I am most proud of having had the privilege to lead a phenomenal nursing staff that participated in the design of the new hospital.
We recognized that because we were moving into a gorgeous new facility, we also needed to update our look and behaviors. So, we implemented standard uniforms in all departments and trained all staff in what we call “CICARE,” a new way to connect and relate to all of our patients. Because of this, our patient satisfaction and staff engagement scores are now among the best in the nation.

Linda Johnson, RN, MSN, NEA-BC

Vice President, Patient Care and CNO
Mission Hospital

The journey to achieve Magnet recognition was a wonderful opportunity to support and advance the professional practice of nursing. Participating in the growth and development of our nursing staff and future nurse leaders is an incredibly rewarding experience.

------------

Photos above: Top row, from left: Heidi Crooks, RN, M.A.; Judy Pugach, RN, MPH, CPHQ, CPHRM; Patricia S. Matos, RN, DNP, NEA-BC; Second row: Mary Lynne Knighten, RN, DNP, PN, NEA-BC; Linda Johnson, RN, MSN, NEA-BC;  Lauren Spilsbury, RN, MSN; Bottom: Melanie Patterson, RN, DNP, MHA

­­­­­­  ­­­­ 

This article is from workingnurse.com.

You might also like

Men in Nursing 2016

Features

Men in Nursing 2016

Paths to Caring

Pictures of Her

Features

Pictures of Her

Family photos bring a human dimension to critical care

Six Savvy Ways to Beat Nurse Burnout

Features

Six Savvy Ways to Beat Nurse Burnout

It all comes down to self care

View all Features Articles