2121stst Century Nursing Leadership: Century Nursing Leadership:

New Rules and New RolesNew Rules and New RolesDr. Mary Ferguson-ParDr. Mary Ferguson-Paréé

Trent Fleming Leadership ClassTrent Fleming Leadership ClassMarch 31, 2004March 31, 2004

Today Is About Our FutureToday Is About Our Future

• A new day is emerging in healthcare

• New rules for engagement with patients and families

• This new day is our day

• New roles are required for Nursing and all health professionals

Nursing Has Come Full CircleNursing Has Come Full Circle

• Healing community practice

• Military/medical/institutional enterprise

• Reintegration of nurses in primary care

• Shift to holistic, multi-modality services and self care

THE UNIQUE PRACTICE OF NURSINGTHE UNIQUE PRACTICE OF NURSING

• Knowing

• Being with

• Doing

THE UNIQUE PRACTICE OF NURSINGTHE UNIQUE PRACTICE OF NURSING

• Nursing Science• Human science• Quality of Life from the person’s perspective• Non-judgmental• Non-punitive• Holistic - mind

- body- spirit

• Facilitating individual’s journey of wellness• Uniquely positioned for the needs of the future

consumer and system

Our Time Has ComeOur Time Has Come

Consilience – The Sciences are Converging

“towards new kinds of synthesis/holism to understand complex systems”

“The human condition is the most important frontier of the natural sciences. Conversely, the material world exposed by the natural sciences is the most important frontier of the social sciences and humanity. The consilience argument can be distilled as follows: The two frontiers are the same.”

Edward O. Wilson

Consilience: The Unity of Knowledge

2003 First Ministers’ Accord on Health 2003 First Ministers’ Accord on Health Care RenewalCare Renewal

• Health care services are patient-centered and safe

• Access to a health care provider 24 hours a day, 7 days a week

• Applied research and knowledge transfer are essential to improving access and the quality of care

• Academic health centers vital in developing new approaches for the collection of information and evidence needed to improve care

• Balance between individual responsibility for personal health and our collective responsibility for the health system

Nurses of the Future Nurses of the Future Scholar PractitionersScholar Practitioners

• Nursing is knowledge work carried out in a healing relationship

• Serving citizens of the world

• Developing future scholar/practitioners

• Generating new knowledge

Nursing Knowledge SupportsNursing Knowledge Supports

• Theory Development

• Patient Partnered Practice

• Health Literacy

• Patient Safety

• Systems Innovation

The Future Healthcare OrganizationThe Future Healthcare Organization

• Supports knowledge workers

• Requires innovation

• Engages generations of workers

• Connects patients and families as partners in health

Do We Have The Ingenuity To Get There?Do We Have The Ingenuity To Get There?

• Technical ingenuity helps us solve problems in our physical world

• Social ingenuity helps us meet the challenges we face in our social world

• Our supply of ingenuity involves both the generation of good ideas and their implementation within society

• Obstacles occur when people try to implement new ideas

Thomas Homer-Dixon

The Ingenuity Gap

Our Frame of ReferenceOur Frame of Reference

We didn’t invent the car through an exhaustive study of the horse.

How will the system look?How will the system look?

Brief intercurrent specialized interdisciplinary services

Advanced Practice Nurses leading tertiary/quaternary care

Primary/Secondary interdisciplinary services

Nurses/Health Continuum

X Intersection/Partnership

Nurses/Patients/Family/Interdisciplinary team

X

Increasing Medical Specialization Increasing Medical Specialization

• High tech interventions• Robotics • Nanotechnology• Genetics interventions• Biotechnology• Stem cells• Retooling the physical body

Evolving Concerns of Nursing Evolving Concerns of Nursing

• Decision support and choice management with patients regarding health meaning, humanity and quality of life and death

• Key relationships and environmental context to support health planning with patients and their families

• Engagement of learners and learning technology

• Translational research

A National PerspectiveA National Perspective

Academy of Canadian Executive Nurses

Nursing Executive Leadership Paper

“Towering Genius Disdains a Beaten Path”Abraham Lincoln

Nursing LeadershipNursing Leadership

• Grounded in nursing

• Structure and consideration behaviour

• Shared Leadership

• Advocate for client-centred care

• Moral agents

• Resides in the reality and humanity of nursing practice

Organizational StructureOrganizational Structure

• Flexible

• Organic

• Permeable

• Horizontal networks

• Vertical integration

Goals of the ACEN Position on Nursing LeadershipGoals of the ACEN Position on Nursing Leadership

• Stimulate dialogue• Dislodge us from a long and traditional path• Be courageous for the students we support, the

practitioners we lead and the renewal of the profession

• Source of innovation• Leap forward to engage a new vision of

professional practice for nursing• Reconfigure work design and work environment

for nurses

Criteria for Knowledge WorkersCriteria for Knowledge Workers

• Empowerment to use knowledge

• Drawing knowledge from workers

• Participative, laterally structured management models

• Pay for performance

• Self managed work teams

• Blurring of manager/staff roles

2121stst Century Leadership for our New Century Leadership for our New Rules and New RolesRules and New Roles

The new rule is everybody shares in leadership for our new roles in the future system

Interactive Session ThemesInteractive Session ThemesDartmouth, Nova Scotia, April 2003Dartmouth, Nova Scotia, April 2003

• Nurses’ perspectives on how to provide leadership for these new rules and new roles.

Creating healthcare workplaces that support Creating healthcare workplaces that support nurses as knowledge workers.nurses as knowledge workers.

• Give nurses the power to act on the knowledge within their scope of practice

• See nurses as leaders in their practice areas• Develop a shared vision – define new values• Minimize standardized routines• Change policy to informational guidelines• Measure quantitative and qualitative indicators

and presence of governance structures

Integrating nursing services on the Integrating nursing services on the health continuum.health continuum.

• A continuum of partnership,support, communication, education and care in the journey through life and death

• System collaboration and joint accountability

• Build infrastructure partners

Acting as a moral agent in leadership for Acting as a moral agent in leadership for practice and the workplace.practice and the workplace.

• Nurses recognize ethical issues and use resources to act on them

• Encouraging patient-partnered practice• Role modeling – ethical principles dealing/interacting with

the people we work with• Facilitate self reflection• Safe environment for working through ethical/moral issues• Educate and empower patients and families and members

of the health team• Indicators – satisfaction – staff and patients

- turnover

Achieving innovation: Moving Nursing from traditional Achieving innovation: Moving Nursing from traditional practice and designing education to support it.practice and designing education to support it.

• It’s about clients health potential, perspective and choices

• Create opportunities to use knowledge of wellness

• Care by the community or family with nurses coordinating/facilitating and integrating

• Practice health outcomes based assisting the client to use the system appropriately maximizing their health

• Employers see learning as work

Achieving innovation: Moving Nursing from traditional Achieving innovation: Moving Nursing from traditional practice and designing education to support it. (Cont’d)practice and designing education to support it. (Cont’d)

Need for education/development re:• Entrepreneurial skills• Marketing skills• Project management• Leadership – in community• Public relations• Funding – how to apply for grants/applications• How to influence/change policy• Networking

Achieving innovation: Moving Nursing from traditional Achieving innovation: Moving Nursing from traditional practice and designing education to support it. (Cont’d)practice and designing education to support it. (Cont’d)

• Have the right person provide the right level of care

• Computer literacy

• Web based learning

• Self-directed learning

• Accountability for self learning

• Ongoing continuing education

• User friendly computer programs

Achieving innovation: Moving Nursing from traditional Achieving innovation: Moving Nursing from traditional practice and designing education to support it. (Cont’d)practice and designing education to support it. (Cont’d)

• Move on by letting go• Education of family (enable them)• Role clarity• Education and professional development via many

modalities• Professional practice environment of support and

learning• Create delivery models that facilitate walking the

talk

Achieving innovation: Moving Nursing from traditional Achieving innovation: Moving Nursing from traditional practice and designing education to support it. (Cont’d)practice and designing education to support it. (Cont’d)

Measure outcomes:• Satisfaction – client/nurse• Recruitment and retention audit• Consumers feel and know they are partners in

healthcare• Decreasing orientation time spent “in hospital”

Engaging the patient/family in the context of their Engaging the patient/family in the context of their community as a full partner in their health.community as a full partner in their health.

• Health care experience belongs to the client and their family

• Needs directed by the experience and needs of the client

• More web based/technological supports to patients and families

• More patients at home• Client is the expert about themselves• Client defines the risk levels they can accept• Dignity in risk, listening to the client

Engaging the patient/family in the context of their Engaging the patient/family in the context of their community as a full partner in their health (Cont’d)community as a full partner in their health (Cont’d)

Measure Outcomes:• Nursing available to educate, provide information

• Client satisfaction

• Information about all services available in each community

• Improved system responsiveness and sustainability

• Decreased length of hospital stay

• Readmission rate

• Demands on community supports

• Decreases in rates of illness

Connecting to and participating in Connecting to and participating in interdisciplinary primary care models.interdisciplinary primary care models.

• Multimodality healthcare provided 7 days a week/24 hours a day

• Collaborative practice is focused on the client needs

• Health promotion focus• Outcomes demonstrate improved health and

wellness

Change Is Our ChallengeChange Is Our ChallengeWhat Role Will you Play?What Role Will you Play?

“Mavens are data banks. They provide the message. Connectors are social glue: they spread it. Salesmen persuade us when we are convinced of what we are hearing.”

Malcolm Gladwell

The Tipping Point

Can We Get There?Can We Get There?

“We choose to go to the moon in this decade and do the other things, not because they are easy, but because they are hard, because that goal will serve to organize and measure the best of our energies and skills, because that challenge is one that we are willing to accept, one we are unwilling to postpone, and one which we intend to win”

John Fitzgerald Kennedy