An RN journey to leadership

EJForand, BSN, MSN, RN

My journey to becoming a nurse leader

Ebony J. Forand, RN, BSN

I began my career in 1996 after graduating from a BSN program in nursing. I can remember thinking I was going to save the world as a brand new nurse. Life as I see it today has really changed. I know I cannot change the world but I know the world has changed me in how I look at it.

I began my nursing career as a medical/surgical nurse just as they had suggested in school. I practiced as a med/surg nurse for 2 years in a small community hospital and then I moved on to a level 1 trauma center where I worked for an additional year on a med/surg floor.

At year three of my career I changed my specialty and practiced as an obstetrics and gynecology nurse in an emergency treatment unit for nine years. During that time I also maintained jobs at an outpatient clinic, and an agency nurse caring for geriatric patients.

Life became interesting when, while pregnant with my second child, I had just bought a new home with my husband and eight year old child and was awarded with having to make an abrupt change in career again. At that time I began working as a clinical instructor for an LPN program, after giving birth, I realized that was not my forever home and began working in the emergency department of a small community hospital while working part time in my alma-mater's health center as a college health nurse. These were times of extreme learning on my part.

I worked as an emergency nurse at night and on my days off worked as a college health nurse during the day. I had my son, and as if working two jobs with a new baby weren't enough, I began pursuing my goal of a Master's of Science degree in nursing health care leadership. While pursuing my degree on a part time basis, I was awarded the emergency nurse of the year award at the hospital. Soon after being awarded the emergency nurse of the year award, I became a nursing house supervisor. Shortly after becoming a supervisor, I was asked by senior leadership to take opportunities as a leader. I then lobbied on Congress for the hospital, and starred in a commercial for hospital jobs.

Following those interesting times, I left my college health job, and was a nurse manager for a year. I kept my house supervisor nursing job per diem became a nursing supervisor once again to complete my final year of graduate school. This position I currently work in has been the toughest job by far as it is a three part job that is innovative with the use of a Care Logistics system.

The system was first initiated two and a half years before I began the job. The system works on a hub and spoke model of communication. I designed my nursing capstone project around the communication of this project as a nursing competency. The system was first initiated to help decrease the wait times of patients in the emergency department, monitor patient's length of stay, and decrease missed opportunities for patients to move through the health care continuum to continue their healing or recovery at the next level of care following hospitalization.

The hospital is comprised of an 182 bed acute care hospital, 126 bed behavioral hospital, hospital-based rehabilitation center, outpatient services for counseling and family support programs, outpatient substance abuse treatment centers, and a continuing care network that includes skilled nursing facilities, residential care facilities, and an adult day health program. An organizational assessment was completed by the RN author through face to face meetings, telephone calls, e-mail exchanges, anonymous and random surveys that gathered data to improve quality measures. A Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis was completed, and cited many balanced opportunities. The author decided to focus on communication of current technology as staff nurses were still voicing uncertainty about the Clinical Care Coordinator (C3) position.

A management competency was designed to explain the C3 position to new employees, current employees and engage the supervisors to gain buy-in from the interdisciplinary team to increase communication through their individual input of patient care to ensure patients were receiving the best patient-centered care possible. The C3 position is made up of three parts, the nursing supervisor, the care coordinator, and the documentation integrity specialist. The position is one of constant interruptions, problem solving, challenges, and constant communication. The position is 12 hours of running, and problem solving.

As a supervisor, the C3 position is a nursing resource to know the hospital policies, find answers, communicate changes in levels of care, ensure nurses feel supported, and ensure the managers feel supported. The position also entails communicating directly with other C3's and the hub C3 to ensure proper bed placement of incoming patients to the unit. As a Care Coordinator the position entails caring for patients post-acute care placements, speaking with families to set up social service consults or requesting physicians address any unanswered questions by patients or staff nurses.

As a Clinical documentation integrity specialist, the position entails reviewing patient charts daily to ensure patients Diagnostic Related Group (DRG) levels of care are supported by documentation of nurses and physicians, Lengths of Stay (LOS) days are being monitored, and whether or not the documentation supports insurance interqual levels of care for patient stay.

Those three job functions are directly related to patient safety, quality, and patient and staff satisfaction. The leadership competency focuses on gaining staff and leader buy-in for supporting the established hub and spoke model of communication to ensure that the right level of care is given to each patient and care is done the right way every time.

Communicating the need for updates from doctors, nurses, patients and their families, social workers as well as other interdisciplinary teams must happen or mistakes can become actualized.

The competency focuses on describing the C3 functions, tying financial data of improvements made to decreasing patient wait times, decreasing patients leaving without being seen in the emergency department, decreasing LOS to be aligned with DRG and right level of care, as well as patient satisfaction. The aim is to ensure that peer C3's are each teaching their staff on the units and departments what information needs to be communicated to give each patient the best possible care and thus empowering nurses and interdisciplinary team members to become key stakeholders in improving their individual areas of communication for patients.

A pilot project was completed on peer C3's, nurse managers, leaders and the nursing practice council. The end result was better understanding on how to increase knowledge of the C3 position, raw data to exhibit staff made improvements in care, and increased resources of nursing staff. The saying, "knowledge is power," is what gives influence to encourage nurses to look at improvements in care over the past two years since implementation of the innovative technology and build on continued improvements from their own achievements in improving patient-centered care.

I have now nearly completed my graduate degree work and am looking to share my journey with others on how a career voyage can lead to becoming a nurse leader. In the age of texts, emails, tweets, Instagram, Facebook, etc., there can be no better satisfaction than the published word.

The journey to becoming a nurse leader was a struggle, but well worth enduring tough times of financing a graduate education and juggling time between, home, work and school. In the end, the peace of mind to be proud of the journey traveled and the successes gained along the way was all worth it.

An RN journey to leadership

About EJForand, BSN, MSN, RN

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