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Response One
Hi Joshua,
I do concur that it is the responsibility of the nurses to provide quality and safe care, which presents the image of the institution. The way the patients are treated determine their perspective towards health care staff and the various health settings. Nurses have the mandate to care for the wellbeing of the public, considering it is the primary call of their profession You raise key points about effectiveness, satisfaction, and better patient care regarding good nursing leadership. An effective leader has distinctive personal qualities such as the ability to think critically, foster collaboration, and inspire others towards achieving personal: Professional, and institutional goals (Scully, 2015). With a transformational leader in the institution you work at, it is easier for nurses to capitalize on the opportunity to shape and grow the institution’s success towards quality-based care with motivation and inspiration from the leader. Transformational leadership provides employees with the autonomy to make decisions in their destined practice; hence nurses can implement interventions that they believe are of the essence to the patients. The use of the evidence-based method of a Clinical Opiate Withdrawal Scale (COWS) tool is important towards quality-based care as it can be adopted in inpatient and outpatient settings to assess the vital signs and symptoms of opiate withdrawal, determine a patient’s level of dependency, and provide the right intervention (Barbosa-Leiker et al., 2015). The use of an evidence-based tool is remarkable towards quality and safe care.
Response Two

Hi Erica,
I like the way you discuss how nurses have the capacity to take responsibility to ensure quality care and patient safety despite their leadership or subordinate positions. Nurses are unique because they have key medical skills and knowledge, are creative and visionary, and can participate in decision-making at the patient level. Understanding the form of leadership in your institution is vital in determining the organizational culture, and with an affiliative leader, as in your case, it is crucial towards quality improvement. Your leader seems to emphasize aligning the staff with the organization’s goals and appreciative of the work done by the nurses, which are a win-win situation for the patients, staff, and the institution. The supportive nature of your unit manager and supervisors is impressive as they provide a conducive environment for nurses to implement and try new practices that develop their skills and competency (Cope & Murray, 2017). The use of retrospective reviews supports quality improvement in your unit as it acknowledges the need to provide services that are certain and evidence-based. The tool reduces the cost of healthcare, wastage of resources, readmission cases, patient harm, save the image of the institution, and the career of the involved nurses or lawsuits by causing no harm (Algaze et al., 2016). Such a tool supports advancement towards quality improvement in a clinical setting.
Response Three
Hi Lorrie,
I agree with the approach that your discussion takes. It seems to acknowledge the first-hand presence and experience of nurses with the situation at the patient level and working of the health systems. It is true that with quality and safe interventions, the patient is assured of recovery and gains trust of the institution; this is likely important for minority groups that mistrust the health system due to historical injustices. Having a strategic leader as the CEO of your facility is substantial towards quality improvement since they work towards the vision of the organization and motivate colleagues towards that vision (Bergh et al., 2016). Strategic leaders have the capacity to execute organizational changes by using the nurses to achieve the goals of the facility in the context of their job by encouraging their propositions and ideas.
Costs of health care are a critical issue even to the government and patients hence the need for quality improvement measures that are less wasteful and achieves quality outcomes. The facility needs to be ready to spend on improvement factors such as technology, which minimize human error that may lead to medication errors and cause harm to the patient (Ducey & Coovert, 2016). I agree implementing change is not easy since there is the need for resources, and it may be met with resistance. Changing the functional and cultural change process is a broad concept. I think it would be important to clarify the means of curbing the problem of medication errors in your facility for quality improvement.

References
Algaze, C. A., Wood, M., Pageler, N. M., Sharek, P. J., Longhurst, C. A., & Shin, A. Y. (2016). Use of a checklist and clinical decision support tool reduces laboratory use and improves cost. Pediatrics, 137(1), e20143019.
Barbosa-Leiker, C., McPherson, S., Mamey, M. R., Burns, G. L., Layton, M. E., Roll, J., & Ling, W. (2015). Examining the factor structure of the clinical opiate withdrawal scale: a secondary data analysis from the National Drug Abuse Treatment Clinical Trials Network (CTN) 0003. Drug and alcohol dependence, 152, 218-223.
Bergh, D. D., Aguinis, H., Heavey, C., Ketchen, D. J., Boyd, B. K., Su, P., … & Joo, H. (2016). Using meta‐analytic structural equation modeling to advance strategic management research: Guidelines and an empirical illustration via the strategic leadership‐performance relationship. Strategic Management Journal, 37(3), 477-497.
Cope, V., & Murray, M. (2017). Leadership styles in nursing. Nursing Standard, 31(43).
Ducey, A. J., & Coovert, M. D. (2016). Predicting tablet computer use: An extended Technology Acceptance Model for physicians. Health Policy and Technology, 5(3), 268-284.
Scully, N. J. (2015). Leadership in nursing: The importance of recognising inherent values and
Question
Joshua Tuckett
RE: Discussion – Week 6
COLLAPSE

The staff nurse has be responsibility to be the direct representative of the level of care that is provided at an institution. If the patients feel that their nurse and physician are in tune with their needs they will have positive feelings about the institution as a whole. The staff nurse must be ready to provide competent care while making the patient feel cared for. Good nursing leadership is associated with better effectiveness, better satisfaction and better patient care (Manning, 2016). The development of skills and following well developed and effective policy and procedure can make the difference in providing quality care. The staff nurse is directly responsible for patient safety and can be the difference between safe and unsafe care (Aebersold, 2016).
The CEO of the company that I work for is a transformational leader. She is a forward thinker that encourages staff member to grow and improve upon their area of influence. I have had the great opportunity to move from a very autocratic corporation into my current role and it has made all the difference for me professionally. Patient care is placed first in priority and while finances will always play part of the decision making process, it is viewed that if we provide the best care, the money will follow and not the other way around.
As we implement the Clinical Opiate Withdrawal Scale (COWS) will align us with state, national, and international guidelines (Canamo & Tronco, 2019). Patient care and safety will improve. Patients will be provided the appropriate assessments and interventions. The patients, staff, and company will all benefit as COWS becomes fully implemented. Staff will start to feel the benefits as they feel the quality of care rise and sense the satisfaction of providing good care. The patients will also feel the increase in care quality, and the facility as a whole will benefit.

Aebersold, M. (2016). The staff nurse clinical leader at the bedside: Swedish registered nurses’ perceptions. Nursing Research and Practice, 2016. doi: 10.1155/2016/1797014
Canamo, L. J., & Tronco, N. B. (2019). Clinical Opioid Withdrawal Scale (COWS). Critical Care Nursing Quarterly, 42(3), 222-226. doi:10.1097/cnq.0000000000000262
Manning, J. (2016). The influence of nurse manager leadership style on staff nurse work engagement. JONA: The Journal of Nursing Administration, 46(9), 438-443. doi:10.1097/nna.0000000000000372

2 days ago
Erica Lawson
RE: Discussion – Week 6
COLLAPSE
Week 6 Discussion

The staff nurse must sometimes take on the role of a leader as it pertains to ensuring quality and patient care. They may not have a formal title and will likely work behind the scenes to influence change (Yoder-Wise 2019). The staff nurse may need to feel comfortable speaking up if they see actions or practices that result in inefficiency or could potentially put the patient in an unsafe situation. For example, if the staff nurse notices that a fellow nurse never participates in bedside shift reports or does not do regular, intentional rounds he or she may need to address it (either with the nurse or with the nursing leadership). I believe that as nurses, we all have the responsibility to our patients to ensure that the organization we are working for does their best to put the interests and safety of the patients first.
I would describe our CEO’s leadership style as affiliative (Murray). We have town halls a few times a year. Our CEO always leads these mandatory, hospital-wide staff meetings. He takes the time to review what our future plans and goals are. However, he also always takes time to discuss all the things we have accomplished and talks about how important we all our to continually achieving our mission. He makes sure to relay to us how we are all appreciated for the hard work that we do.
The leadership on my unit, specifically my unit manager and the nursing supervisors always support doing what is in the best interest of the patients. Recently, we have noticed a significant influx in the number of patients who require a sitter for their safety. Unless the patient is admitted under a Baker Act order, the unit funds safety sitters. Even though the sitters likely pose a significant cost for our unit, our manager always supports us when we say that a patient needs this safety intervention.
I believe that my organization is already a high-performing organization as we recently achieved Magnet status within the past year or so. However, in order to maintain a high-level of performance, I would recommend that units continue to utilize retrospective reviews in cases where we are unsure if a practice or service is efficient. Not only could this continue to reduce unnecessary services, but it would likely make room for continuous quality improvement.

References
Murray, A. (n.d.). “Leadership Styles.” Retrieved from https://guides.wsj.com/management/developing-a-leadership-style/how-to-develop-a-leadership-style/
Yoder-Wise, P. S. (2019). Leading and managing in nursing (7th ed.). St. Louis, MO: Mosby.
Response

Lorrie Nein
RE: Discussion – Week 6
COLLAPSE
There are many different roles that the staff nurse implements in order to promote quality in a high performing health care organization. Nurses tend to develop substantial knowledge of the strengths and weaknesses of hospital systems and how they fail, and their ability to create workarounds to broken or dysfunctional systems is legendary in health care (Needleman et. al, 2009). If I were in a hospital and I felt the true effort from a nurse, I am more likely to feel positive and reassured about the situation I am in, which is exactly why we as nurses need to spread the feeling of affirmation.
I feel as though the CEO of my facility can be identified as being a strategic leader. He combines flexibility, steadfastness, big picture thinking and an ability to see the small details, and him being a strategic leader, he has his pulse on the market and can spot signs of change before happening (Norwich University Online, 2019). I can definitely tell that both the CEO and CNO have a vision for the organization, which is exactly why they are trying to motivate and persuade others to see the vision as well. In order to expand and increase the company someone has to have a vision that can either lead to success or sadly even failure.
My senior leadership definitely supports changes. Yes, budgeting is an important part of the organization, but in order to expand and promote my facility, I feel as though we need to spend some money on improvement factors. My practice problem talks about medication errors, which can be costly to the health care system, which is why organizations must budget for instances like that. I have come to understand that it is important to communicate with those around you and those above you in order to stay “on the same page”.
I recently read an article that talked about the work environments and how those can lead to high-performing organizations. By creating better work environments for nurses, there may be more of an increase in accurate productivity. According to Kyle (2020), effective teams can be significant drivers of innovations that enable broader quality improvements and efficiency gains across organizations. Research suggests that transitioning to effective teams depends on mutually reinforcing functional and cultural change processes. It is not secret that making changes are difficult in any organization (Kyle, 2020).
Reference:
Kyle, M., Aveling, E., and Singer, S. (2020, February 25). Establishing High-Performing Teams: Lessons From Health Care. Retrieved from https://sloanreview.mit.edu/article/establishing-high-performing-teams-lessons-from-health-care/
Needleman, J., Hassmiller, S., L.T., K., Buerhaus, G.S., W., L.H., A., . . . Spear S.J. (2009, January 01). The Role Of Nurses In Improving Hospital Quality And Efficiency: Real-World Results. Retrieved from https://www.healthaffairs.org/doi/full/10.1377/hlthaff.28.4.w625
Understanding CEO Leadership Styles. (2019). Retrieved from https://online.norwich.edu/academic-programs/resources/understanding-ceo-leadership-styles
https://sloanreview.mit.edu/article/establishing-high-performing-teams-lessons-from-health-care/

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