Nurses As Leaders Helen N Turner, DNP, RN-BC, PCNS-BC, FAAN
Clinical Nurse Specialist, Pediatric Pain Management President,
American Society for Pain Management Nursing [email protected]
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Leaders Fidel Castro Che Guevara Alexander, The Great Asoka
Winston Churchill Julius Caesar Franklin D Roosevelt Napoleon
Bonaparte George Washington Adolf Hitler Mao Zedong Abraham Lincoln
Martin Luther King Nelson Mandela Mahatma Gandhi Others??
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What is Leadership? Action of leading a group of people or
organization State or position of being a leader Process of social
influence Maximizes efforts of others Towards achievement of a
goal
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Leadership is NOT Single style Static Management The style of
leadership is dependent upon the prevailing circumstance Leaders
exercise a range of management styles and deploy them as
appropriate. (Robert Tannenbaum, R. & Schmidt, W.H., 1958,
1973)
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What is Management? Characteristic ways of making decisions and
relating to subordinates. Styles Autocratic Permissive
Paternalistic Democratic
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Management is NOT Single style Static Leadership
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Management Vs Leadership Manager's job is to plan, organize and
coordinate; leader's job is to inspire and motivate Manager
administers; leader innovates Manager is a copy; leader is an
original Manager maintains; leader develops Manager focuses on
systems and structure; leader focuses on people Manager relies on
control; leader inspires trust (Warren Bennis, 1989)
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Management Vs Leadership Manager has a short-range view; leader
has a long-range perspective Manager asks how and when; leader asks
what and why Manager has his or her eye always on bottom line;
leaders eye is on horizon Manager imitates; leader originates
Manager accepts status quo; leader challenges it Manager is the
classic good soldier; leader is his or her own person Manager does
things right; leader does the right thing (Warren Bennis,
1989)
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What is Ethics? Systematic way to form value judgments on human
actions Is organized and reflective Is NOT intuitive or based on
gut feeling Principles of right conduct within a social system
Critical concept: We make judgments all the time What results from
these judgments?
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Ethics is NOT Morals Principles/habits related to right or
wrong conduct Personal, subjective, more abstract Values Beliefs in
which there is emotional investment Rules by which we decide
between right/wrong, good/bad, should/shouldnt
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Healthcare Ethics Bioethics Clinical ethics In clinical care
settings Ethics of the encounter between clinician and patient
Research ethics Organizational ethics
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Guiding Constructs of Ethics Beneficence Nonmaleficence
Autonomy Justice Fidelity Veracity View from 30,000 feet
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Beneficence Act for the patients benefit Relieve pain and
suffering Keep society safe
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Nonmaleficence Do no harm Stopping a medication shown to be
harmful Refusing to provide a treatment that has not been shown to
be effective Increased opioid prescriptions = increased opioids on
the street An decision is required To act or not Doing nothing may
cause harm
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Autonomy Individual right to decide Pain may impair autonomy
Assumption of incompetence maybe a violation Accepting or rejecting
care or components of care Opioids only We do not always agree with
patients decision Ritualistic mutilation
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Justice Equitable Access to care Resource utilization
Discrimination Societal impact (abuse, misuse, death)
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Fidelity Faithfulness to obligations, duties, observances
Loyalty to patients interests Fidelity by Briton Riviere
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Veracity Truth telling Trusting Truth by Bernini
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What is Conflict? Opposition Inherent incompatibility Internal
or external
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Patient-centric Conflict Poorly controlled pain Conflict with
patient/family Concerns about addiction/misuse Questioning patients
experience/knowledge Determining competence Competence Vs
capacity
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Clinician-centric Conflict Balancing beneficence and
nonmaleficence Benefits of action Vs risks of action (or inaction!)
Interprofessional conflict To prescribe or not Systems
barriers
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Areas of Potential Conflict Pain management agreements Do
patient rights supersede societal rights Multidisciplinary
treatment Vs Interventional Managing pain Vs measuring disability
Conflicting guidelines Direct to patient marketing
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Ethical Conflict Leads to Moral Distress HOWEVER,
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Moral Distress Unethical
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What Is Moral Distress? Feelings of frustration, anger, and
anxiety when facing institutional obstacles and interpersonal
conflicts about ones values Unruh, 2010
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Impact on Patient Care Safety Quality
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Living with moral distress does harm!!
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Recognizing Moral Distress Responses to moral distress Physical
Emotional Behavioral Spiritual
Spiritual Cues Loss of meaning Loss of control Crisis of
faith
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Moral distress leads to professional burnout!
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Recognize Moral Distress American Association of Critical Care
Nurses: The 4As to Rise Above Moral Distress.
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ASK Am I feeling distressed or showing signs of suffering?
GOAL: Become aware of moral distress
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AFFIRM Your distress, your commitment to take care of yourself,
and your professional responsibility to act GOAL: Make commitment
to deal with your distress
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ASSESS Identify source of your distress, determine the severity
of the situation, and contemplate your readiness to act GOAL: Ready
to make an action plan
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ACT Prepare to act or not, take action, and maintain desired
change or accept the outcome GOAL: Preservation of integrity and
authenticity
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From Distress to Courage
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Intervene Reflect Support Communicate Self care
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What Is Moral Courage? The willingness to stand up for and act
according to ones ethical beliefs Lachman et al, 2012 It is a
virtue Morally courageous professionals persevere to stand up for
what is right even if it means they do so alone.
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Developing Moral Courage Personal Professional Organizational
Links of Courage by Larry Poncho
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Personal Attributes Awareness of own beliefs and values Take
time for reflectionChoice Vs Judgment Support Strong skills in
effective communication and advocacy Advance your moral reasoning
Nurture your personal ethic of care
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Professional Attributes Debriefingpeer support Developing
supportive environment Building consensus Promoting
interprofessional collaboration Enhancing professional and cultural
competence
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Professional Attributes Follow a professional model of nursing
care that exemplifies nursings goal of enhancing lives of patients
& colleagues Positively influence outcomes that support rather
than oppose moral decision making Safety Quality
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Organizational Attributes Administrative support of moral
courage Open communication at all levels Policies and procedures
supporting ethical practice Staff empowerment and protection
Healthy work environment Interdisciplinary engagementJust Culture
Review Education Monitoring
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Applying Ethics In Management and Leadership
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Managing During Conflict Accept the inevitability of conflictit
is part of life Dont be a conflict-avoiderit wont disappear, it
will only get worse Stay calm Even when provoked, keep a close hold
on your emotions Maintain the ethical high ground Dont think in
terms of winning, so much as constructively resolving and moving
forward It isnt easy A consistent, rational approach to managing
conflict will make things less stressful Victor Lipman
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Leading During Conflict Find the opportunity in conflict Be a
"Mediator" who works for the good of all using: Integral vision
(the ability to see every point of view) Systems thinking (how
parts of a conflict relate to each other) Presence and inquiry to
gather necessary facts Conscious conversation (foundation for
dialogue) how we speak to each other and how we listen Bridging
(building alliances to enable innovative solutions) Innovations
(bursts of creativity leading to new ways of negotiating) Mark
Gerzon