Specialties Endocrine Article

Nursing Leadership

Discussion of leadership styles and goal creation for the next decade.

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Nursing Leadership

Leadership Styles

As a Doctor of Nursing Practice (DNP) student, I have been challenged by one of my professors to think more about my current leadership style. As nurses, this is not something we often think about. My current leadership style is more democratic in nature. I seek agreement and input from nursing and leadership in an effort to get them to buy into new processes. To me, it seems important that not only administration and providers support changes but also nurses as in most cases they are carrying out the practice change.

As a program requirement, we must work on a DNP Scholarly Project throughout our studies. While the parameters are wide for what you can focus on, the goal is to see healthcare system changes. Developing educational interventions, new protocols, or new tools are some examples. In my DNP project, I will be required to lead an educational intervention with nurses. I oftentimes feel like I need to develop more of an authoritarian leadership style. With this style, my focus would be on mobilizing nurses to follow along with new processes and in a new, better direction (Goleman, 2000). These ideas around leadership and my personal leadership style led me to think about what changes I would like to lead over the next 10 years. I am lucky to say I thoroughly enjoy my current role and can see myself there long-term. But despite my love for my job, I do not want to see stagnancy in my nursing career. I want to help create and sustain long term positive changes in my profession.

As I reflect on my current practice and healthcare organization, three goals come to mind.

Over the Next Decade, I Would Like to See ...

Goal Number One

The creation of an outpatient diabetes center started at my current hospital. Many of our patients lack insurance, are underinsured, or have state programs not accepted at local endocrinology offices. Unfortunately, this often leads to poor follow up, re-hospitalization, and poor diabetic control. Seeking grant funding and establishing this center would help close a major gap in accessible care in the area.

Goal Number Two

Better discharge coordination for inpatient diabetic patients. As a consulting service, endocrinology is often last to know or not notified of patient discharge. This can lead to a delay in patients receiving needed supplies or sometimes the primary service sending incorrect insulin orders. Often patients’ inpatient and outpatient insulin needs are vastly different and require adjustments to avoid both hypo and hyperglycemia.

Goal Number Three

Increased endocrinology consultations for poorly controlled or new diabetics. Consultation of endocrinology is not mandatory for new or poorly controlled diabetics. The service has previously sought out this idea to improve glycemic control both inpatient and outpatient. In addition, there are resources available to the diabetic team such as free insulin vouchers and specialty knowledge that are not available to the primary service but prove valuable especially for new diabetics.

Moving Forward

In order to change current practice and institute these practice changes, I need to adapt a change theory. Cambell discussed Kotter’s change management model which is comprised of increasing urgency, building a guiding team, getting the vision right, communicating for buy-in, enabling action, creating short-term wins, not letting up, and making it stick (Campbell, 2008). While having a vision of change is great, I need to first start by creating urgency within my organization and gathering a team to help with these goals. As nurses, we should be challenged to reflect and determine what our leadership style is.

How can we use this to create goals and system change over the next decade?

References

Campbell, R. J. (2008). Change management in health care. The health care manager, 27(1), 23-39.

Goleman, D. (2000). Leadership that gets results. Harvard business review, 78(2), 4-17.
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endoNP

About endoNP, BSN, MSN, RN, APRN, NP

endoNP has 7 years experience as a BSN, MSN, RN, APRN, NP and specializes in Endocrinology.

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TriciaJ

TriciaJ, RN

4,297 Posts

Specializes in Psych, Corrections, Med-Surg, Ambulatory. Has 42 years experience.

I love the idea of better discharge coordination for inpatient diabetic patients. What I don't love is the typical scenario of putting one more thing on the backs of inpatient floor nurses.

Whatever change you try to implement hinges heavily on just who is supposed to do it and what else are they supposed to do.

The outpatient diabetes clinic is a perfect idea, for all the reasons you mention and more. A referral to them and an initial contact before discharge would go a long way to bridging the gap.

Good luck with your project.

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