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As Registered Nurses
advance their education from the Baccalaureate to the Master’s level it is
essential that they also enhance their leadership competencies. Nursing is not
only the largest sector of health professionals in the United States, 3 million
registered nurses, (IOM, 2010) but it has also been voted the most honest and
ethical profession for the past 15 years (Gallup, 2016) . Expanding
technologies, increasing diversity amongst patients and the increased number of
insured due to the Affordable Care Act are a few of the reasons necessitating
the need for expanded nursing knowledge. As an Advanced Practice Registered
Nursing student it is important for me to identify and enhance my personal
leadership skills.

     My vision for leading in the current
health care environment is to improve quality patient and population outcomes
by leading change in organizational and systems leadership and by communicating
and collaborating with other health professionals to manage and coordinate
optimal patient care. I plan to pursue a role in direct patient care as a
Family Nurse Practitioner and upon graduation plan to seek employment at the
Lubbock Veteran’s Outpatient Clinic. To be effective I will need to use the skills
of communication, collaboration, negotiation, delegation and coordination.

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     I feel I have strong communication skills
with patients and family members now but when I become an APRN I will have more
responsibilities and a need to communicate more with administration and other specialty
physicians. Collaboration with leaders from other health professions to ensure
comprehensive, cost-effective, safe, patient-centered health care will be  important so care is continuous and reliable
(ONS 2008).  My leadership vision also
includes negotiating by participating in the discussions of health policy
development and partnering with others (Grossman, 2007). My skills in
delegation were most utilized when I was the head nurse of a surgery clinic
with LVN’s, CAN’s and unit secretaries and as an officer and a non-commissioned
officer in the Army Reserves. I did not ask co-workers or subordinates to do
something that I myself wasn’t willing to do or had not done before. I believe
you lead best by example.

     Based on the fact that I have only been in
my current job for six months, defining my current leadership style was very
difficult. I am a night shift Registered Nurse in a Level 2 Emergency
Department with many other strong, competent nurse leaders. I definitely do not
believe in the Great Man Theory (Grossman, 2017) in which leaders are born, not
made. Because someone comes from money or a well-known lineage does not ensure
they possess the inherited traits of a leader. I tend to agree more that my
leadership style is a mix of the Situational Theory of “happening to be at the
right place at the right time” (Grossman, 2017) and Transformational
Leadership.

     I believe nursing is the second best job
in the world; number one is getting to be a mother. After high school
graduation I chose nursing school and with the shortage of nurses over the past
30 years it has shown to be I was in the right profession at the right time. Also,
due to lack of financial assistance for college I joined the Army Reserves at
age 19 and this has provided me with additional leadership training and opportunities
such as the Officer Basic and Officer Advanced Courses and the additional
duties of Family Support Liaison and the Anti-terrorism Officer.

  Prior to working in the Emergency Department
I was a high school Health Science teacher with anywhere between 80 and 220
students, depending on the number and type of courses I was instructing. In
this capacity I had a more transformational style of leadership which included
the idealized influence of assisting
the students with confidence, trust and respect.  Introducing high school students to careers
in Health Science meant they were going to have to step out of their current
circles of friends and talk to others who may someday be their co-workers or
patients. They needed to be confident in speaking to people who were older and
younger than themselves and respect the differences in others. Inspirational motivation was taught by
encouraging the students to develop short and long term goals  as well as being responsible for the choices
they made whether they were positive or negative and accepting the consequences
of their actions. We had a chapter about Maslow’s hierarchy of needs and
discussed self-actualization, that until the basic needs are met and a person
has developed self-esteem then it is difficult for a person to meet or
understand their full potential. This individualized
consideration was reinforced by encouraging the students to continue to
work hard and when they failed and to not give up. In intellectual stimulation I lead students to be creative in role
playing and by discovering more than one or two ways to solve a problem.
(Grossman, 2017).  I really enjoyed
teaching but as you know all too well it takes a great deal of your time
outside the 8-4 classroom. Upon acceptance into the APRN program I made the decision
not to be a student and a teacher at the same time but to return to nursing
full time. To this day I am delighted to see some of my previous students in
the hospital and on the ambulances and I hope that in some way I helped introduce
them to the wonderful world of medicine.

     The strengths that I possess as a leader
are reliability, self-confidence, trustworthiness, respect and stewardship. At
my current and previous place of employment I feel it is important to arrive to
work early, come prepared and be willing to stay until the work is finished.
Co-workers know they can rely on me to be ready to take their patient reports
on-time so they can leave their shift on-time, thus preventing overtime pay for
the hospital. The same with teaching, the students who needed extra assistance
could rely on me to meet them before or after school to complete make-up work.

     I am
self-confident in my skills as a nurse, whether it is in medication
administration, starting an IV or completing a physical assessment.  My confidence helps assure the patient and
their family that I am able to provide them with very good nursing care. With
the self-confidence I also know that if I am unsure or uncomfortable with the
task at hand it is best to stop and ask for assistance or clarification before
making an error or causing harm to the patient.

     Trustworthiness is demonstrated in my
honesty to my employer by way of not stealing, lying or speaking negatively
about the organization. According to the article, Growing Nurse Leaders: Their Perspectives on Nursing Leadership and
Today’s Practice Environment,  the
Generation Y nurse leaders of tomorrow expects todays leader to “know each
staff member personally” and to “be available when needed” seemingly at a
moment’s notice (Dyess, 2016). Trust is an important concept in which the staff
feels you support them or ‘have their back’.

     I feel that respect is earned and that respect
for yourself is first noticed in a person’s appearance. From being in the Army
Reserves for 22 years I think the uniform or outward appearance of someone
speaks volumes in how they are perceived. When nursing I wear the uniformed
assigned- clean, navy scrub top and scrub bottom, hair pulled back and natural
trim nails. As a teacher I always “dressed up” in slacks and a blouse or
sweater, not in jeans or a t-shirt, so I could promote the image of a medical
professional even in the high school. The military speaks for itself in regards
to the uniform expectations, wearing of the hat and hair. Many nights in basic
training in Fort Dix, New Jersey we sat outside and polished our boots so they
glistened for the drill sergeant the next morning in formation.

     Lastly, stewardship is one of my greatest
strengths, effectively using financial, human and other resources (ONS, 2012). Taking
into a patient’s room what you anticipate needing, sharing supplies and resources
with fellow teachers and my students always knew I never through away a piece
of paper until it had been used on both sides. With the current cost of
healthcare appropriate use of supplies and resources is going to be paramount
to a facility staying accessible versus closing.

     With the establishment of the Affordable
Care Act and additional coverage of 32 million additional Americans (IOM, 2011)
in collaboration with returning for my Master’s degree I will have a greater opportunity
for further leadership growth and development. For this assignment I reviewed
what my own employer had available for nursing leadership and was surprised to
learn that through its Health Stream/Clinical Development program was a nurse
residency program and certification prep programs for TNCC and the CEN exams.
They also have tuition assistance but not for the Family Nurse Practitioner
tract.

     Currently I am an Emergency Department nurse
on the night shift and a Major in the Army Reserves. I am a mentor to my
co-workers in the ED but not in a true leadership position. I feel I
effectively lead by example with my willingness to assist them, my professional
appearance and professionalism with my patients and their family members.  In my military position I am an effective
leader to subordinate officers and enlisted personnel. My character and
competence are demonstrated on a daily basis as noted by how closely my
actions, decisions, and relationships adhere to Army ethics and values. I
proudly wore the Army uniform for 22 years then retired in 2008. Last year
after learning that the Army had a shortage for nurses and that tuition
assistance was available for the Family Nurse Practitioner I rejoined the Army
Reserve with hopes of staying in for another 15 years.

     Individual leadership competencies are
skills a professional nurse needs to be an effective leader. To develop these
leadership competencies I will: 1. Lead by demonstrating ethics and
integrity, exhibited by serving on an ethics committee at my place of
employment. 2. Increase my capacity to learn- this I can accomplish not
only by coursework for my Master’s in nursing but also via the Trauma Nurse
Care Course certification and successful passing of the Certified Emergency
Nurse exam. 3. Manage my self-care by establishing a work-life balance
for personal health maintenance and boundaries to maintain priorities. My
physical fitness requirements for the Army Reserve help on the physical side of
this goal whereas planning time for myself and my family is more challenging. 4.
Improve my oral communication- clear, convincing oral presentations and
effective listening is another leadership skill that I could place into an
action plan by becoming involved in the Toastmaster’s meetings that meet on a
monthly basis at TTUHSC (SHRM, 2008).

     When initially I looked at the breadth of
this assignment I thought, “Whew! That’s a lot!” and it has been a large
assignment.  The tasks at hand forced me
to look at what my current leadership style and competencies were. For the most
part I’ve been what some have termed “a refrigerator nurse”, nurses who went to
work to make money for a specific item or vacation and then stopped working
until the need for extra money arose again (Beauman, 2015). Though financially
I’ve never been able not to work, I have realized from this assignment that for
the most part I’ve had jobs and not careers where I really stepped up to
leadership positions to improve the overall department, facility or community.
Due to the current needs in health care and especially in them advancing
methods of educating nurses I can see as I go forward with my Master’s program
I am definitely going to have to improve my leadership competencies.

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