Online RN to MSN
Clinical Systems Leadership

Future of Nursing-Leadership Revisited

In this informative webinar, our panelists will discuss the Future of Nursing Leadership and the following topics:

  • Emerging trends and leadership opportunities in population health
  • Emerging trends and leadership opportunities in complex systems
  • Emerging trends and leadership opportunities in delivery of care
  • Leadership competencies needed in today’s health care climate



Julia: Hi everyone, and welcome to the University of Arizona online Master of Science and Nursing and Clinical Systems Leadership. Thank you for taking the time to join us today, we know that you are excited to hear from our panelist. My name is Julia; I will be your moderator for today’s presentation. So let’s introduce you to our panelist today, first we have Cheryl or Cheryl Lecasse.

Cheryl is a clinical professor at the University Of Arizona College Of Nursing, core facility and the director for the online RN-MS program.

She has clinical expertise as an advanced practice nurse in geriatric and oncology care management. She also has a variety of leadership experiences in clinical practice, education and professional organization. Next we have Sherry Daniels; Sherry is a clinical instructor at the College Of Nursing and is a core faculty member in the online RN-MS program. Her clinical expertise is in the areas of pediatrics and population health. She has held a variety of leadership positions in nursing and public health and most recently was the director of the Pima County Health Department in Southern Arizona.

And our third panelist is Mary Walters. Mary is a clinical instructor at the College Of Nursing and is a core faculty member in the online RN-MS. Her clinical expertise is in the areas of geriatrics and nursing administration. She has held a variety of senior nursing leadership positions and most recently was the Chief Nursing Officer for the VA medical center in Southern Arizona. So here’s a look at what our panelist will be speaking to you about today. They’ll discuss the emerging trends and leadership opportunities in population health, conflict systems and the delivery of care. They’ll also define the leadership competencies and characteristics that are needed in today’s healthcare climate.

So Cheryl Lecasse, I am going to pass it over to you.

Cheryl Lecasse: Okay, thank you so much Julia. One of the things that we’re going to do is we’re going to set the stage today on looking at the different leadership opportunities that you may have and some of the ways that you might be able to lead in health care today and in the future. So the first thing that we’re going to do is look at some of the major influencers in health care today. And one that’s been in the news quite a bit is our shifting population demographics, not only looking at the population that’s aging and what that’s going to looking like for care, but also really helping shape our thinking about how we look at care.

We’re really entering an age where we’re looking at a lot of folks who have multiple chronic conditions and really being able to focus on all of those together as opposed to one at a time and that’s going to be very very important in the coming years. We also know that our older population accounts for about two thirds of the nation’s health care budgets and that has major ramifications for health care models and health care economics. We also are experiencing a shift in diversity of our clients and I wondered if Mary could expand on this as well?

In preparing for this I was doing some reading and really was kind of surprised at the numbers when I came across it, but in 2013 thirteen percent of our population was foreign born and when you add their children to the – looking at the total numbers of the demographics in the population – it brings it to twenty-six percent, and in 2015 seventeen percent of our work force was also foreign born. So when we start to look at providing health care this is a significant group of people that we really need to give some thought to as we plan to lead in health care and provide that care.
We also have seen some very innovative health care delivery models being formed and really shifting our focus to more of a community based focused and I wonder if Sherry could talk a little bit about those influencers in health care today.

Sherry Daniels: Thank you Cheryl, this is the other Sherry in attendance, there’s two of us in the room. Yes, you know, if we think about demographics and we start to think about the costs and we think about the ways in which our society is changing, one of those – several of the things that are happening in the United States at this point is looking at ways to deliver care that is quality, low cost, effective and there has been an increasing focus and shift to looking at ways in which we can promote health through disease prevention, ways in which we can reduce risk to our populations and overall ways in which we can utilize community systems, such as utilizing partnerships, community based organizations and sometimes those are not the traditional organizations we think of, sometimes those are faith based or educational systems that partner with health care institutions and organizations to do wrap around services for our population so that people with mental illness we can – and behavioral issues – we can wrap services around them, not only within the walls of health care organizations but also in the community settings to intervene early, hopefully to do some prevention activities and the third step of that is to provide comprehensive tertiary services with that kind of needs.

Cheryl Lecasse: So Sherry, you started talking about that word ‘partnership’ and we are looking at partnerships in ways that we have never looked at partnerships before. We are now partnering with our patients and families as well as health organizations and community organizations to be able to support care of family groups and of individuals within families. So one of the focuses that we have in those partnerships is to help people manage their own health and to sort of bring them to that stage of well-being, whether they have complex chronic illnesses or acute issues or they’re just looking at being healthier individuals. So one of the ways that we do that is to really re-examine what interventions we are providing as health care communities and providers. So what do we help people with, so to speak, and partner with them? One of those issues is looking at a person in totality in that ‘whole person’ approach. So what does their relationships have to do with their physical health, that has to do with their environment, that has to do with their faith, for example, and trying to get an integrative piece of care that will support that individual where they are in their health care trajectory. The other thing that I wondered if Mary can just touch on is using that systems approach to health care?

Mary Walters: So it’s not about nursing anymore, we have come out of our silo and really really work in a system and are beginning to understand that any place that you touch the system is going to have an effect – or a ripple effect – other places within the system. So really learning to be a systems thinker as you approach the individual care of the patients and also as you approach functioning as a professional within the organization where you work.

Cheryl Lecasse: So one of the things that we’ve laid the ground work for is to really think about what is that essential knowledge that people need who are in health care for optimal patient care outcomes and our slide that we have up just has a very general list and we’re actually going to be discussing these in a bit more detail as we go through but for those of you who are listening and perhaps not seeing the slides, we’re really looking at things like, “What is patient centered care versus community centered care and how do we do that for the best possible outcome of the individual and the individual within a support system and then within the bigger community?” We’re also looking at how we collaborate with our professional colleagues to have the best approach to those patient outcomes.

We’re looking at local and regional health care needs and then expanding them out to more of the national scene for health care and then around the globe and what does that look like and how do we bring that to our own community. Other essential knowledge that we need to have is, “What’s going on with health care policy and how do we advocate for the groups of patients that we care for?” And then also looking at having an essential knowledge of the business of health care and what that means in the whole scheme of health care delivery. So we’ll be talking a little bit more about that throughout our session today. So one of the things that comes up quite a bit in nursing certainly is taking a look at nurses being leaders in health care.

And there was a – institute of medicine put out a report in 2011 called ‘the future of nursing’ and that had several different components that we’re going to touch on today and that really lays out the essence of how are nurses educated and then how are they practicing and is there a mismatch in being able to fully practice the way that we’ve been educated as nurses. And then that really leading into improving not only the education system, but really moving people through a process where they can practice to the highest level of their education and helping people move through that educational trajectory.

Another aspect of that report is having nurses be full partners with all health care professionals to be able to provide a newer style of care and redesigning how we deliver health care and then looking at the planning and policy making that goes around the infrastructure for health care. So that was the basis and we’re going to also talk a little bit now about where we are now, a few years later after that report. I think Mary, do you want to talk a little bit about the first two?

Mary Walters: Sure. The first recommendation or – that came out the IOM report was that nurses should practice to the full extent of their education and training and something that really is front page news these days is the bill that’s before congress, that the VA has put forth, asking that all the advanced practice nurses who work in the VA would be authorized to function to the full extent of their education and training and in most states that is independent practice and that really is what the recommendation is and the reason for this of course is it’s the right thing to do.

But the other good reason to do this is the fact that it really increases access to primary care for veterans and I know that you probably been reading in the paper about the incredible demands that the VA system is under to try and provide timely care to veterans and so I think it’s a wonderful opportunity to make that argument right in line with the IOM report and certainly the American Nurses Association has been front and center in supporting this change. So if you would like to comment on this idea you can go to a website – – and you’re going to talk about AP44 saying whether you think this is a good idea, you’re in support of it and it gets to, not only the VA, but also to a congress people and that time to comment closes on July the twenty-fifth and kind of what we’re hearing a little bit on that is that it’s even stronger if you happen to be a veteran and could also be writing in support of that.

So hopefully when we talk about this next year this will be a done deal and we will have nurses moving forward as advances practice nurses, particularly in the VA. The next recommendation from the IOM report was that nurses should achieve a higher level of education and training and that in 2014 we were up to fifty-one percent of nurses had a baccalaureate degree, so we’ve definitely made some advances with that and Oregon has a model where it really is a pretty seamless transition for a nurse in Oregon to go from an associate degree to a bachelor’s degree and I would certainly say that – I’m being very biased of course – but I think one of the tremendous advantages and beauty of the program that we’re going to be hearing about, and that hopefully you’re very interested in at the University of Arizona, is your ability to go as an experienced nurse with an associate degree, is to go into an educational program and graduate with a master’s degree which I think really really enhances the level, not only of professionalism, but the skill of the nurses who’re taking care of the patients in the United States today.

And we also have that trajectory where we’re supporting our baccalaureate students for achieving that higher level of knowledge and ability and for leadership as well. And I think that’s it’s so important for people to think about, “Well how can I make a difference and what’s that next step in the educational process?” So I’m going to ask Sherry Daniels to talk a little bit about the [unintelligible 00:15:56] points and where we are in achieving those from the IOM report.

Sherry Daniels: Well the third concept or key point from the IOM Future of Nursing report talks about nurses being full partners with other health professionals in redesigning health care. Nurses should be onboard, currently there’s a campaign for action, looking at trying to place ten thousand nurses on boards across the United States. And of course we only think of hospital boards as our first for – you know – first and foremost when we think about boards that effect health. But as we look at ways in which nurses can effect policy, that nurses can help to guide news ways of doing business, different ways of delivering health care, you can think about other places that nurses can be effective on boards and if you were to do some research and looking at the patient protection and affordable care act, you will see that there were multiple nurse leaders involved in helping to write that act on twenty-ten.

There are nurses currently serving on boards across the United States that look at how we use technology, how we design admissions programs, how we look at quality programs. Nurses can serve on a variety of places; even in our policy course we talk about it sometimes what those spots are, perhaps on school boards where you may be affecting policy that encourages movement and good foods in our elementary schools and safe playgrounds. You may be on a board that – you can see my public health sense – but on a board that deals with preventing domestic abuse or deals with gun violence.

So nurses, when they partner with not just health professionals and sort of those traditional walls within organizations, but they look beyond that, where health exists in communities. The opportunities are endless for affecting health and the way in which we deliver health care to our populations. If you think about effective work force planning, and here it talks about work force planning and policy making related to better data collection and approved information infrastructure, I would say that definitely – if you look at the way in which we try to – many of you have probably been challenged by new EHR’s and new EMR’s and the way in which we collect data to tell us not only about the care that we’re delivering to individuals, but it helps to guide leaders from the bedside to the boardroom to understand the types of care we’re giving, the types patients that present the way in which we may be able effect health and better outcomes at earlier stages.

We certainly we have – in a variety of settings, I’m sure the Mary and Cherry both could speak to how they have been involved in looking at what should be collected for data. How do we understand what we do and using that data to evaluate and go back and redesign how we deliver care. So I would say that effective workforce planning and policy is beyond technology here. That it really does go beyond the walls of our organization and we start to gather and base our next generation of health care on what we see today and making some hopefully educated guesses using evidence as well as some assumptions about where we are going next for delivery of health care.

Julia: So next we’re going to shift into meeting in population health and Sherry will be talking to us about that.

Sherry Daniels: Hey, you get to hear my voice again for a couple of more slides. Well if we go back a couple slides – we’re not going to go back a couple slides – but if we talked about the way that – those four key points. That we talked to you about, “Nurses should practice to their full extent and that they should achieve higher levels of education, that we should be full partners and we should be able to collect better data,” and you then look at additional goals that have been outlined for health care and nurses and public health.

We can marry up a variety of those goals if you take those four that we’ve just talked about in the future of nursing and you look at the way in which – the Triple Aim – and we’ll talk a little bit later about the Quadruple Aim – but at this point we’ll talk about the Triple Aim, that the three mains goal of those are to improve the health of the population, that we’re looking to enhance the patient care experience through satisfaction and quality and safety, and we’re also looking to reduce per capita cost. You look at the patient protection and affordable care act, which is the PPACA, and that also has its goals, it’s many of those same things.

In fact many of the goals outlined in the PPACA were based on the Triple Aim and they also look at the provision of quality and affordable health care for all Americans, extending the role and scope of public programs to assure health, to improve the quality and efficiency of health care, you see it’s almost exactly verbatim from the Triple Aim, and then the added, “Here’s the prevention of chronic disease and improving overall public health.” And being a public health professional I also put in the additional three core functions of public health which guide everything that public health and/or population is based – is the framework upon which they construct programs, delivery services and evaluate what is happening within our community. And that is to assess the health of communities, developing policies that can affect better health and well being and then ensuring that our populations and communities has access to safe and effective and quality care.

So looking at the next slide, you know, if you think about ways in which nurses can lead in population health, and for those of you who may be practicing in an acute care setting or within the walls of a clinical program, the practice to population health is that bigger piece that happens out there. But I always have my students in my population health class to think about – that the individuals that we care for reside within the context of family and when it’s in the context of environment and community and that as your patients move in and out through their care transitions, into care, out of care and through different stages of care, that they’re going in and out of those context.

And so if we think about the biggest broadest context, and that is the piece of population health which is community, or big and broad, and I would say you would need to think about this not only as a local issue, but national and global issues. You want to think about just overall – and Mary addressed it earlier, and Cherry as well – is just the increasing, preventable chronic diseases. We now know that thirty-five percent of adults in the U.S. are obese, seventeen percent of the children in our communities are obese and that diabetes mellitus has increased – has doubled over the last twenty years and now represents – and now twenty-nine million adults in the United States have that.

So if you’re able to work with individuals who reside in families who are parts of populations and communities and are helping to be on the upstream piece of that, that you’re helping to lead initiatives and look at ways in which you might be able to affect your environment. To help the people mitigate, or prevent first of all, chronic disease or to mitigate those results, those chronic issues that they have with chronic disease because at this point chronic disease represents forty-six percent of the world disease burden.

Mary talked a little bit, so did Cheryl, about our changing demographics and even though our population is aging, it’s interesting as I was looking at trending for populations, I was surprised to find that even though our population is rapidly aging, our millennials and genX’s are starting to catch up and by the year 2028 they will be – represent an equal number of people in our population, so even though we focused and we will continue to focus on our aging population, we also need to keep in mind as leaders, the ways in which we need to affect health now for those millennials and those genX’s who will then become older adults, and how do we keep – how do you devise and implement programs that address a thirty year old.

A very hard population to – actually have them even come in for care, unless they’ve been injured or there’s already a chronic disease occurring. I mean if you think about not only age, but you – and Mary talked about just the sheer numbers of people immigrating to our country and the racial shift, the racial balance, the ethnic balance and those challenges that that has for our health care system. I’m sure you’ve all have practised in environments where you’ve taken care of patients who speak no English or they may speak English but they do not understand in terms of the health literacy, of the instructions you’re given, so as nurse leaders we really need to understand as our society and communities shift and change, how do we best position our resources, how do we best position our ability to focus on that changing landscape.

Poverty and health disparities play a huge role in care, just before I came to this I was looking at some information about – in the South, in certain communities in the South that a diagnosis of cancer is automatically a diagnosis of, you know, prognosis of death. And that has to do with the ability of people to access – remember I’m going back to the slide where I talked about assurance and policy – whether or not people have access to care, whether or not – I’m sure that you probably intuitively know people that live in poverty have poorer health. Violence and social disintegration, a fear of terrorism, gun violence and those types of things affect not only communities but it affects individuals and so how – you know – mental health I would roll into this piece as well.

How do we address those things early in, how do we do primary prevention, and if we can’t do that then what way can we identify early in, how do we do primary prevention and if we can’t do that, in what ways can we identify early. How can we prevent – address it in a way that we get an end result that is better for our communities and our populations. And then I would challenge you to think about environmental change, and I don’t just mean climate change, although that is a huge piece. But when you think about global warming and you think about the movement of infectious diseases across populations, across continents.

So diseases that used to reside in South America, in Central America, are now on the doorstep of Arizona, which is where we are. If you think about environmental changes in terms of pollution, if you think about environmental change in terms of food scarcity, that is climate – environments changed. People have less access – may have less access to clean water, healthy food and environments that are free of contaminants. These are all areas that have – that are rich with opportunities for nurses to lead. So I would say that I would – that in looking at what nurses bring to the table and leading in each of these areas that I’ve just discussed, I would say that first and foremost, we are very experienced at looking at complex systems.

And if you start to look at, if you haven’t already sort of internalized that piece, that communities and populations are complex systems that which we as individuals and families live, we certainly understand the complexity of working in a hospital, the complex systems that is a human body, the ways in which we need to work together to affect positive outcomes. But start to think about ways in which all the pieces around your patients are inter-related and the complexity of that, and nurses understand that piece and I think that skill, that knowledge, that inherent ability to look at complex system positions us perfectly to translate that into looking at communities and those target populations within.

We certainly understand the inter-relatedness of populations – environments and populations – I mean you can as sort of [unintelligible 00:30:25] individual, but if you look at health and environment in individuals and/or populations together, you understand those concepts, you understand how they’re related and you can, as a nurse, you understand how one effects the other and how to add resources to eventually improve care. We certainly are skilled at assessing and diagnosing our patients and that is easily translated to looking at – assessing and diagnosing population health.

I’ve been to the population course, perhaps worth looking at, the overall health and well-being of a target population and looking at what might be a community health diagnosis. So what is there about the population, or the environment, or the community in which our patients reside, in the hospital, outside the hospital? What is there about that that we can look at in a bigger, broader context and apply our assessment skills and then develop diagnosis that we can then apply solutions to solve or address? We understand that our community is our partner, we all know that if you’re working in a hospital and you have a patient who is discharged you need to be able to connect those folks with partnering agencies, accountable care organizations, community health systems, mental health systems, home health, primary care.

We understand and we certainly use our evidence based information to come up with solutions and interventions and we understand that we can advocate for our patient and we should be advocating for our patients not only at the bedside, but in the boardrooms and in our communities and so the idea of advocating through policy, meaning for example a student in their previous class has been looking at policy that she could analyze and advocate for, is a nurse in labor and delivery, and she looked at the internal policy of her hospital of allowing formula distribution to new-born’s and their mothers and she certainly was well verses in the importance of not introducing formula early, the health benefits of breast feeding.

Then she analyzed that policy, took it to her hospital board for changes in the hospital policy and subsequently actually testified at her state legislature for over-arching state rules and guidance in relationship to this. So she took what she saw at the bedside level, at the individual level, and moved that all the way up and in working to protect the population in new-born’s as a whole. So I think that if you think about the ways in which you do your everyday job, you do all of these things and I think as you add to your skillsets, those additional pieces of leadership, you will start to see the ways in which you can make changes and move them forward.

Cheryl Lecasse: Thank you Sherry for laying some really some foundational ground work of, “How do we shift our thought into more of a population perspective.” And now Mary’s going to talk a little bit about how we’re going to take a look at leadership in complex systems.

Mary Walters: So going back to that IOM report and looking at the recommendation that nurses should serve on boards, I talk a little bit more about that, I mean what are the things I should start thinking about, that sounds like way beyond my scope or something that I might be able to do, so when this ‘Nurses on Boards’ coalition was established twenty nursing organizations came together and the American Nurses Association took the lead. And as Sherry mentioned, the goal was to have ten thousand nurses on board by the year 2020. And as of 2016 we’ve got two-thousand nurses on board so far, so that’s a start, but still a long way to go. And just to get you to thinking about this a little bit in perspective is that woman and nurses are very under-represented on boards.

Only fifteen percent of Fortune500 board members are woman. And when you start looking at hospital boards only nine percent of hospital boards are woman. In faith based hospital boards it goes up to twelve percent, but really the voice of nurses and the voice of woman are underrepresented on boards. Laurie Benson is the director of ‘Nurses on boards’ coalition and I found a quote from her just about a week ago and she suggests you find an organization you’re passionate about, know your strengths, express your interest and don’t let your calendar talk you out of getting involved, and I think the bottom line is volunteer, volunteer on alumni organizations, volunteer on nursing organizations, I think these are opportunities to kind of get you noticed, where people will say, “Oh, she’s a nurse and this is what a nurse looks like,” and if someone asks you to join a board or to participate say yes.

And I really recommend that you never turn down an opportunity to speak in front of an audience. I know there’s nothing more terrifying than speaking in front of an audience, but practise does make you a little more comfortable and really really does bring the image of nursing and the voice of nursing in front of people so that they can begin to understand a little bit more about what we’re capable of, how we can lead, and really and truly what it is we do. Nurses truly are vital to the health of Americans in the future, you know the stories, you know what is needed and you would have an opportunity to put that forward. My own experience as far as boards are concerned, I do serve on the executive leadership and strategic planning board for our VA here Tucson and I also chair the Veteran and Family Advisory Council for the VA here in Tucson.

So there are all kinds of opportunities and I know frequently we think we don’t have time, but it’s amazing where those opportunities would lead you to other things and other opportunities. Other ideas as far as leading and complex systems and what we’re going to be needing in the future, just the quick review, we’ve talked about the Triple Aim, improve the population health and the patient experience of care while reducing per capita cost and I’m sure that all of you have heard those things and are living those expectations in your job every single day. But as we’ve gotten a little farther with that, we’ve really seen that even though this is all a very good thing, it has resulted in some unintended consequences.

And when we look at some of those unintended consequences, we’re being asked to improve health, improve the patience experience, reduce cost, in an environment that we’re looking at where obesity and diabetic – wasn’t diabetes or epidemic – or there’s income disparities, and really, where the patients are being taught to define satisfaction as, “Getting what I want when I want it,” and it has really put the nurses in a very very difficult situation and we’re beginning to see articles in the last year or so thinking, “ We really need to revisit this Triple Aim and maybe it should be a Quadruple Aim,” and the point of the fourth point is improving the experience of providing care, where we’re focusing more on the care provider.

What are we asking care providers to do and is there a way to change the environment we’re asking care provider, nurses in particular, to work. So it’s a tall order for a nursing leader and it really takes a skilled nursing leader to begin to look at that environment and to try to bring back the joy in nursing.

I know we’ve all had that experience at different times and now’s the time to really revisit that. Lastly, in looking at leading in conflict system, when we look at that Institute of Medicine report from 2011, it’s now – we call the Institute of Medicine members – or board members – back together to take a look in 2015 to say, “Where are we, have we made any progress?” And I think the first answer is, “Absolutely, yes. We have made some progress,” this report has galvanized nurses and really given us a playbook or a strategic plan, “What are we working on?” –”These are the four things that are recommended,” and we’ve really put a lot of time energy and effort into it and have made some improvements. But what’s left? What else do we need to do in terms of that, and the first assessment was again, back to scope of practice.

And as we’ve seen the push back from various segments saying that, “They don’t think that the advanced practice nurse should function independently,” we haven’t done a good enough job of building common ground so that Americans understand what it is nurses do or an advanced practice nurse does. Our next thing in education, we’ve made some advancements. We still have a ways to go as far as the educational levels for nurses and something that we’re seeing is that many health care organizations want a baccalaureate prepared nurse, and so then where does that leave the associate degree prepared nurse.

Diversity, we’ve talked a little bit about that to, and diversity really needs to be a priority in nursing and not only in our educational programs, in our faculties – in our leaders. And the more diverse our organization – or our profession is the, the better the ideas, the better the innovation and on the issue of collaboration, we still have a ways to go as far as increasing inter-professional’s collaboration, but more and more we’re hearing that the way we deliver health care is with the team and team has become a verb and not a noun and we’re really surrounding our patients with a team to improve that collaboration and leadership and make it better for the health of our country.

And lastly, with workforce data, the only way you really know the impact of nurses is with being able to access data and we’re hearing more and more about health care analytics where we can tell what’s happening with our patient population, but in order to determine what is the impact of the advanced practice nurse they must be able to bill under their own national provider identifier, and now frequently advanced practice nurses are billing under a physician provider, not the identifier, and thus we’re not necessarily being able to see what the impact is of advanced practice nurses. So we’ve made some progress, here’s the interim report, we still have a ways to go in those areas.

Cheryl Lacasse: So now that you’ve heard a little bit about population health and you’ve heard about systems, maybe that’s not exactly where you are right now, how do you lead from where you are in clinical care? And most nurses are in some type of clinical care and you know, where are we going with that? Well, we’ve seen some kind of a shift in our culture, and it’s really a shift from illness care to the care of health and wellbeing, and how do we do that? Well, one of the first things that we do is we are shifting our thinking to patient centred care across settings and really being that true partner with the patient. To make sure that they get what they need when they need it to be able to put them in a kind of space where healing can happen.

We look at a whole person approach which nurses have traditionally always done, but there’s a lot more emphasis on doing a more integrative assessment. The picture that you see on the slide is the model of wellbeing from the University of Minnesota and it’s a wonderful depiction of the different dimensions. We do very well as nurses looking at individuals and there health, we may look a little bit at their relationships, but how often do we access their environment in which they are actually living in and healing in. How many times do we actually look at those community perspectives that Sherry talked about, and what that looks like. How many times do we actually ask them, “What is your purpose in life?” which is their inner core of, “Why do I even need to heal?” you know, what’s that purpose all about and then what are some of their security needs.

And I think Sherry talked about that in the context of population health. But wherever we are, as care givers, we need to be doing that holistic assessment and then based on that holistic or, as we’re using the term, an integrative assessment, we are now looking at person centred interventions. Traditional interventions that we know are appropriate for the patient, but then what are some of the integrative things that maybe we don’t – we haven’t really thought about, you know. Very simple things, like doing deep breathing at an acute care bedside as that’s appropriate to be able to lay anxiety as opposed to giving a larger dose of an antialitic, and how do we really blend the two to be able to put the patient in the best position for healing.

The other thing that we come to look quite a bit now and we are really tasked with that as nurses, is looking at our models of care. The model that I have up on the slide is the chronic care model and that really looks at the health systems in the context of community and how we actually deliver health care, but we’re also looking at things like relationship based care, how do we do guided care as opposed to prescriptive care, and that implies the partnership, and how do we do that in the context of what is academically termed Caring Science, but we really emphasize care as nurses.

And how do we help our client see that caring and how does that caring enter into the partnership and how they see that, because that will drive that partnership forward in a much more productive way. Part of the what we are tasked to do from a health care reimbursement perspective is look at transition management and care coordination, both of those are integral into transitioning patients from care area to care area, whatever that might be, and then coordinating those complex patients into really being able to stay healthy in place where they are and very often people want to stay healthy at home, and how do we, as Sherry said, wrap them in services so they can be in place and they can have the quality of life, and they need help and they need our partnership as nurses and with the team approach, to be able to make that care coordination happen.

Mary talked about that Quadruple Aim and I’m going to talk a little bit more about how do we improve work life to help care [unintelligible 00:47:40] staff. Some of the things that you can do is to role model a caring attitude. And if you look around and think about sort of who you are as the care giver and what context you’re doing that care giving in within being a provider, do you have a caring attitude, do the people around you have a caring attitude, and being a champion for that in your own workplace. The other thing is to be a positive contributor to the community in your workplace.

How many times have you come to work and you look around in the huddle, early in the morning, and no one has a smile on their face, and they may setup a day that may not be the very best day in the world for that particular workplace environment. So it simple things that you can do right now that you don’t need a lot of extra education, you just need to be thoughtful about how you’re going about your day. Also contributing to the healing work environment, and what I mean by that is if you see that someone is having a really heavy work load that day, offer a helping hand, you know, it really goes a long way.

Ask them, even if they say, “I’m okay, I really don’t need help right now,” the fact that you’ve reached out to your colleague really lends to a nice caring work environment, so that’s something that you can do right now. So those are just a few of the things that you can do in clinical care. One of the things that I just wanted to just highlight very very quickly is for you to think about what characteristics do you have that might lend themselves to being a successful leader. For those who are taking a look at the slides, there’s a list of many characteristics that we see and there – as many as that are on the slide, there are many many more that you can think of.

So think about what you bring and then we’ll have a slide in just a couple of moments that we’ll talk about what you might need to think about developing as a leader. One of the things that we wanted to talk about just briefly, and we’ve really touched on a lot of these already, is looking at leadership competencies. And competencies that we tend to round back to is the competencies in leadership from the American Association of Nurse Executives, and there’s several different domains that they look at. We’ve talked a bit about business skills, and that’s everything from being very very carefully minded as to how utilize scarce resources all the way to understanding a unit budget or hospital budget and what does that mean in the grand scheme in delivery of health care.

We talked a little bit about the leadership skills and the professionalism, how you conduct yourself and what you bring to the table. That knowledge of the health care environment, what that really means is your clinical knowledge, your knowledge of populations that you’re working with and how you conduct business in your particular area of care. That could be unit, that could be a division, that could be a hospital or a large organization, or that could be a community or perhaps some of you are globally minded and travel to different parts of the world to take a look at that knowledge and use your knowledge to help others.

And we also talk about communication and relationship building and we’ve talked about that in each of our areas, that’s how we can partner with our colleagues and with our patients, families and communities. One thing that I wanted to touch on, and I know we’re running just a tad short on time, but there is many many essential leadership knowledge and skills and one of the things that all of us want to encourage you to do is to really look at what skills do you bring to your care environment and what skills do you need to develop and I’m going to challenge both Sherry and Mary to pick one skill off the list and to just talk a bit more about how you think individuals who are listening can develop that skill.

Mary Walters: I would actually say communication with patients, families and providers. I think it’s how we do our job, it’s how we are perceived and I think that the basic way is that you develop the skill, you speak up. And that takes a lot of guts, it takes a lot of nerve because lots of times you are in a situation where the power gradient is a little bit off and you’re not sure that what you have to say is important or anybody would want to hear, but you never know until you say it out loud and I think as nurses it’s just key to communicate, to speak up, to advocate for patients, to tell the story for patients and their families, those who aren’t doing it for themselves and how we communicate and how we present ourselves show the world the nurses that we are.

Cheryl Lacasse: Sherry, what would be the one that you would pick?

Sherry Daniels: Well I would have picked education and advocacy which balances off of what Mary just spoke to. I would talk about the advocacy piece, but in terms of education, I believe that understanding the rule that not only do we as nurses need to be as educated as we can possibly be about our profession, about the patients we serve and about the environment in which we live. We also need to impart information to our – as Mary said, with communication, it’s how do we educate individuals and families and populations of people.

How do we help them understand the context of health in their live, I mean just providing someone with a brochure about a disease process, medication information, is not enough, it’s providing you information, but how do we educate. I think that if we’re able to educate the people that we care for and those above, in terms of those folks who make the decisions about the people we care for. So if we are able to educate policy makers, educate organizational leaders, educate communities about the importance of health and prevention and providing resources, then that leads to advocacy. I think then when you have – when you’re educated, when the policy makers and the organizational leaders and your community is educated, then you can start to build that advocacy that provides the resources, that assures people have access to care, that they are living in safe environments. And so that would be the one I would pick for sure.

Cheryl Lecasse: I think that’s a nice place that we can wrap up because as you prepare for future roles in health care, you need to think about what your next step is and for some of you, you may be thinking about, “Well, maybe I need to go back to school and learn about some of things,” or perhaps revisit them in a different way. So I think with that we certainly will be here for a few more minutes to be able to take your questions. And I’m going to ask Julia to give us some questions if there are questions from the audience.

Julia: Sure, thank you ladies, that was very informative. So for all of you on the line, we do have a couple of minutes left for questions, so as I mentioned earlier, you can utilize that Q&A box that’s on the right hand side on your screen to enter any in. So one question that we do have is that you know, we talked a lot about the skills that leader’s need, so I’m definitely interested in leadership, where can I start?

Cheryl Lecasse: So there are many springboards to leadership, I think you know, the first step may be looking in your own institution and exploring what opportunities you have there. Many institutions have leadership training seminars; they might have different ways for you to step up in your unit if you’re in acute care or if you’re in the community. I think we’ve spoken a lot about volunteering. What I’ve personally found is be bold and step forward if it’s something that you think you might be interested in. If you don’t know a lot about it, if you’re willing to dive in, you will learn a lot and be open to what you will learn because you can be educated in a variety of informal and formal ways, and I through this out to both Mary and Sherry if you have anything to add?

Sherry Daniels: Well I would say one thing is to do an internal check, what is your passion, where does your passion lie and in what ways can you take that energy and translate that into change because without passion it is difficult. And I would also say that I know my new trajectory through a variety of positions, I was never afraid to try something new. And I think that if you’re offered an opportunity, and maybe that’s not your biggest passion, maybe it was some area that you probably didn’t think you were interested in, examine it for its ability to add a skill, strengthen something, give you a different perspective. I had an opportunity to try on a variety of roles, one of which was bio-terrorism preparedness management where I worked with law enforcement and EMS. I’ve never been in a room with so many – um, mostly men – but people with guns, I was a nurse! So – but I learned so many things from that experience, so I would say develop a passion, don’t be afraid to try something new and expand the ways in which you see the role of nursing, your role in all of that, that would be mine.

Mary Walters: I would just say lead from where you are, that nurses inherently are leaders in the work that they are called upon to do every single day. So doing your best, being your best self every day, leading from where you are, I’ll reiterate what others have said, volunteer, raise your hand, say yes, if somebody’s looking for someone to participate on a committee or do something special within the organization, say yes. The places it will take you… even though its kind scary, but you’ll be glad you did.

Cheryl Lecasse: So do we have any other questions Julia?

Julia: Yes, there is another question here; do you have any suggestions or advice on selecting a mentor for leadership development?

Cheryl Lecasse: I would recommend that you find someone that you admire, find someone you admire in your organization and make an appointment and say that you’re looking for a mentor and see what they say. Now sometimes people might say they don’t have time, but they might recommend someone else and you have definitely put forth your interest in leadership and lots of times I think when opportunities come along you remember the people who have expressed an interest, they may not be in the job right now, they might not be in leadership positions, but the sheer fact that you’ve looked for a mentor, that you’ve expressed an interest I think puts you in a very good position for a leadership opportunity.

Mary Walters: And I think going along with that, really assessing where you think you want to go in the next two to five years and find somebody who is already there who you think the world of and let them know that because they’re more likely – even though they’re a busy person, which very likely they will be – if you let them know that you’ve really been watching them and you would like to learn to do what they do, learn to be where they are now, you would like to get there, they’re more likely to mentor you, but you have to set the stage and you may have to talk to several people to figure out sort of where you need to be and who the right mentor will be for you?

Cheryl Lecasse: Any other questions Julia?

Julia: No, it does not appear that we have any other; we can give our attendees another minute or two to enter any questions into that Q&A box. Otherwise if you do think of something after the webinar is over, our number is listed there on the slide, you can reach our enrollment team 1 855 789 7046 and as I mentioned earlier, this will be – this session is being recorded so we will send out the link to everyone who has registered and attended here in the next few days and it will also be posted on the program web page. Doesn’t look like we have any more questions ladies so I think we can wrap up, I’d like to thank everybody for attending and we hope to hear from you soon.


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