National League for Nursing.

Title: LEADERSHIP: ESTABLISHING RELATIONSHIPS AND INFLUENCING CHANGE Instructions: LEADERSHIP: ESTABLISHING RELATIONSHIPS AND INFLUENCING CHANGE This week’s focus is on developing foundational interpersonal skills that will prepare you for professional practice as a leader and change agent. As a leader, how will you influence change in your professional specialty area? Identify two strengths you have that will promote strong leadership. Identify two areas of improvement to your skill in leading and influencing change. What are two priority strategies you will implement as professional development tools for leadership? Focus: WEEK 4: LESSON Leadership: Establishing Relationships and Influencing Change Introduction Effective nurse leaders produce good outcomes in clinical, political, administrative, and academic settings (Scully, 2015). Consistent with the Institute of Medicine Report on the Future of Nursing (2010), nurses are in unique positions to use influence to improve patient care, work environments, and patient health outcomes, as well as to elevate the profession of nursing. As a master’s- prepared advanced practice nurse, you will have opportunities for intraprofessional and transprofessional leadership and collaboration. Leadership may be an informal or formal role, but regardless of the role, nurse leaders must have the skills to successfully lead and implement change in complex health care environments. Possessing strong self-knowledge based on principled values and beliefs is foundational to any leadership role. Before leading effective change, one must be competent in the ability to lead self, which includes the development of essential leadership skills. This week, students are introduced to foundational interpersonal skills and will build upon these skills to establish and cultivate effective relationships and lead change. Becoming a Leader Developing nurse leaders in today’s evolving and complex healthcare environment is a challenge faced by the nursing profession (Scully, 2015). Shifts in the health care delivery model have led to an expanded role for nurses in professional practice. As a master’s- prepared advanced practice nurse, there will be many opportunities to demonstrate informal and formal leadership daily in varied healthcare settings. You do not need a title such as manager, coordinator, director, or dean to lead. As a master’s-prepared advanced practice nurse, you are a leader. The National League for Nursing (NLN) states that master’s-prepared nurses function as leaders and change agents and demonstrate leadership that promotes positive change in people, specialty areas of practice, systems, and the profession of nursing (2010). Similarly, the American Association of Colleges of Nurses (AACN) state that master’s- prepared nurses are leaders of healthcare teams and engage in leadership in a variety of settings (2011). Wong, Cummings, and Ducharme (2013) linked nursing leadership with improved nursing practice outcomes, including reduced turnover, increased retention, enhanced group work, and improved patient outcomes. Leadership, with an emphasis on building and maintaining effective relationships, is used to promote high quality and safe patient care (AACN, 2011). Canadian College of Health Leaders (2010) outlined key concepts and ideas for leadership growth, including developing communication and emotional intelligence skills and creating and fostering relationships. Another foundational skill essential in the development of leaders is understanding, appreciating, and using power and influence to affect positive change. Consistent with the Person-Centred Nursing Framework and the Chamberlain College of Nursing Conceptual Framework, development and enhancement of individual attributes and competencies must be focused on first to function effectively in a leadership role. Essential leadership skills include strong interpersonal skills. There are several definitions of interpersonal skills with a common focus on effective interactions with people. This lesson will focus on emotional intelligence, advanced communication, and power and influence as essential interpersonal skills that support effective leadership. Also introduced are the concepts of connective and change leadership. Interpersonal Skills As we continue to explore the PCN Framework and as discussed last week, the outermost ring of the conceptual model focuses on the attributes of the nurse (McCormack & McCance, 2017). This week, we will explore interpersonal skills in the context of the PCN Framework and how this attribute enhances the nurse’s professional competence and ability to care for others. Person-Centred Model According to McCormack and McCance (2017), interpersonal skills include a mix of emotional intelligence and advanced communication skills used to engage in courageous conversations and to respond effectively to others. These skills contribute to the establishment and maintenance of relationships. Effective leaders use relational skills to build partnerships and affect positive change. Emotional Intelligence Emotional intelligence (EI) is a skill nurse leaders can use to establish successful relationships and support effective interdisciplinary communication. Emotional intelligence is the awareness, examination, and management of personal emotions and understanding how these can affect relationships. EI also involves the perception and management of others’ feelings and emotions to facilitate positive collective action. Emotional Intelligence According to Porter-O’Grady and Malloch, emotional intelligence is composed of five elements: (a) self-awareness, (b) self-regulation, (c) motivation, (d) empathy, and (e) social skills (2015). What is motivation? View Answer Motivation used within the context of emotional intelligence refers to the personal desire to succeed and achieve one’s goals beyond the monetary gain or prestige. Motivation drives one to persevere despite obstacles and frustrations (Porter-O’Grady & Malloch, 2015). What is empathy? View Answer This skill is imperative when communicating with an interdisciplinary team. Empathy requires one to understand the emotional response of others. Empathy permits one to develop a rapport with a diverse group of people and consider their emotional reactions (Porter-O’Grady & Malloch, 2015). What are social skills? View Answer In the context of emotional intelligence, social skills are defined as the ability to manage relationships while networking with others. People who have social skills are capable of finding commonalities and using them to create a working rapport (Porter-O’Grady & Malloch, 2015). Advanced Communication Skills Mensik (2014) suggests that communication is one of the most important keys to leadership success. In today’s fast -paced, fluid, and complex health care environment, interpersonal communication skills are critical to productivity, collaboration, and safe and quality practices. Communication is essential in influencing others and producing change. The master’s-prepared advanced practice nurse must be adept at communication with patients, nurses, and other members of the interprofessional team. Enhanced communication skills are used to develop interprofessional relationships and patient and community partnerships, as well as to disseminate scholarly information (Cotterill-Walker, 2012). Nurse leaders must understand aspects of advanced communication and how effective communication contributes to positive outcomes. Advanced communication skills include elements of critical listening, critical question, and critical thinking (Porter- O’Grady & Malloch, 2015). Advanced communication skills include creating a safe environment that cultivates open and honest dialogue. Nurse leaders can create safe environments by building trust through displays of authenticity, integrity, and vulnerability. Critical listening skills require a commitment to listening. Oftentimes, we are busy thinking about our busy day or how to respond when it is our turn to talk. A commitment to listening involves having an open and clear mind, being nonjudgmental, and being an active listener without interrupting. Another component of advanced communication is critical questioning. Porter- O’Grady and Malloch state the purpose of asking critical questions is to check perceptions of issues or situations, seek clarification, and render greater understanding (2015). Likewise, Mensik (2014) acknowledged it is important to clarify any information that was unclear and to confirm understanding. Examples of critical questions: What is your understanding of this situation? Why is this important to you? To others? Which issue do you think the situation is related to: systems, technical, people? What do you need to know to make a decision on the issue? What assumptions do you tin others have made about this situation? Who else cares about this issues as much as you do? This sounds very rationale. What do people believe about it? This sounds very emotional. What do people believe about it? What are the choices in the situation? What would you find helpful in this situation? (Porter- O’Grady & Malloch, 2015, p. 332) Critical thinking is an advanced communication skill that takes place after listening and asking questions. Critical thinking in the context of communication requires an assimilation of information, validating perceptions, and reaching logical conclusions (Porter- O’Grady & Malloch, 2015). In addition to analyzing what was stated, it is important to also analyze nonverbal messages. Nonverbal communication is expressed through body language and expressions. As nurses, we are astute at forming a quick assessment, evaluating the data, and making a decision in a very short time frame. This is no different from when we first meet someone and form an opinion in a matter of seconds. Our perception of the person is influenced by the professional appearance (or lack thereof) coupled with the person’s verbal and nonverbal communication skills. Mensik (2014) provided the following tips for portraying positive body language: keep movements relaxed, use open arm gestures, show the palms of your hands (signals credibility and candor), smile, provide a firm handshake, respect personal space, maintain eye contact, and nod when people talk (when in agreement and understanding). There is also some negative body language you should avoid, such as pointing with your finger, crossing your arms, rolling your eyes, and sighing (Mensik, 2014). Technology and Communication In today’s society, social media is a primary means for information sharing. The healthcare environment is not immune from this influence (Gagnon & Sabus, 2015). Social media allows for innumerable professional communication opportunities. Innovations in technology have led to a shift toward a casual communication style commonly used in text messaging, e-mailing, and communicating on a social network. It is not uncommon with this mode of communication to see a unique set of abbreviated language with no expectation of proper grammar. The problem is that this casual communication style can work its way into professional writing, scholarly dialogue, and/or the workplace. As a leader and professional nurse, you must abide by the principles of responsible use of social media and maintain professional and legal boundaries. Reflection Take a moment to reflect on the social media sites you access and subscribe to. What personal information are you communicating that could have implications on your professional image. Power and Influence Master’s-prepared advanced practice nurses must understand how power and influence are used to make choices that affect positive change. Derived from education, social status, scope of practice, and personal relational skills, power influences accountability, responsibility, and relationships (Hamlin, 2015). Power is used to influence others, mobilize resources, and accomplish goals (Porter- O’Grady & Malloch, 2015). Likewise, Sullivan (2013) states “power describes the capacity to be influential and influence…in the use of that power” (p. 33). Nurses are in a unique position to use power and influence to improve patient care, work environments, patient health outcomes, and to elevate the profession of nursing. There are risks associated with influence and power most often seen when these skills are misused or motives for use are misaligned. As a leader in the healthcare environment, you should understand power and influence and demonstrate the ethical use of these skills to establish relationships and promote positive change. Developing influence includes self-presentation and skill development. Self-presentation is used to establish trust and credibility, which contribute to your ability to influence change. Self-presentation is both outward appearance and behaviors and attitudes. As discussed earlier in this lesson, body language can be used to convey openness and confidence. Skill development is also important to establishing influence. Through master’s nursing education, the advanced practice nurse is prepared to influence safe, quality care and affect positive change in a variety of settings and roles (AACN, 2011). Connective Leadership The shift in healthcare delivery models include a focus on person-centered care; developing partnerships with patients, families, and populations; and increased interprofessional collaboration. Two popular leadership styles promoted in nursing are transformational and transactional (Scully, 2015). Transformational leadership is the ideal style that combines holistic and individual approaches to meet collective goals (Dartey-Baah, 2015). Transformational leaders are usually charismatic and lead through vision and inspiration. Transactional leadership is based on contingency rewards (Dartey-Baah, 2015). Transactional leaders use a system of rewards and punishments to promote compliance and productivity. However, with a focus on current and future trends related to shifting healthcare delivery models and the expanding role of master’s- prepared advanced practice nurses, new leadership styles are emerging. Connective leadership styles, such as servant, distributive, and relational leadership, align with current and future trends related to the technological advances and increased diversity and globalization that are influencing healthcare delivery models and healthcare settings. Porter- O’Grady and Malloch (2015) acknowledge that a primary responsibility of the nurse leader is to build relationships. Connective leadership is practiced from a relational perspective centered on shared responsibility and collective achievement. Remember This Remember, relationships are developed through practiced inclusivity and valuing diversity. Our differences influence and enhance innovation and emerging changes. Change Leadership Health care is undergoing great transformation and this increases the complexity and chaos of practice settings. With the explosion of technological advances, there is an abundance of information, Internet interactions, virtual communications, and new knowledge, making it difficult for us to keep up with the changes that are occurring so quickly (Porter- O’Grady & Malloch, 2015). In this aspect, both planned and unplanned change are a continuous process. Due to the current healthcare environment, effective change leadership skills are necessary for successful identification, implementation, and evaluation of change and change outcomes. Nurse leaders must be able to engage others in the process of change. The nurse leader must be comfortable with change and can anticipate change (Porter- O’Grady & Malloch, 2015). The nurse leader understands that change is a normative, dynamic, and ongoing process that oftentimes allows for professional and organizational growth. Conclusion Although there are many different skills and styles associated with leadership, this lesson serves to provide you with a foundation of select essential leadership skills needed to cultivate effective relationships and lead change. Emphasis is placed on the master’s- prepared advanced practice nurse’s role as a relational leader and agent of change. Nurses in leadership positions will encounter numerous opportunities to lead and manage change. The nurse leader of today and the future must possess an expanded skill set based on foundational interpersonal skills. Interpersonal skills combined with other leadership skills promote relationships that are vital in producing safety and quality outcomes. A master’s- prepared advanced practice nurse is a leader of change. References American Association of Colleges of Nursing. (2011). The essentials of master’s education in nursing. Washington, DC: Author. Canadian College of Health Leaders (2010). Key points to leadership growth. A checklist for leaders. Retrieved from http://leadscanada.net/uploaded/web/Resources/key_points/KEYPOINTS_2016_EN.pdf Cotterill-Walker, S. M. (2012). Where is the evidence that master’s level nursing education makes a difference to patient care? A literature review. Nurse Education Today, 32(1), 57–64. doi:10.1016/j.nedt.2011.02.001 Dartey-Baah, K. (2015). Resilient leadership: A transformational-transactional leadership mix. Journal of Global Responsibility, 6(1), 99-112. Gagnon, K., & Sabus, C. (2015). Professionalism in a digital age: Opportunities and considerations for using social media in health care. Physical Therapy, 95(3), 406-414. doi:10.2522/ptj.20130227 Hamlin, L. (2015). Advanced practice nursing. Contexts of care. Burlington, MA: Jones & Bartlett Learning. Institute of Medicine. (2010). The future of nursing. Leading change, advancing health. Washington, DC: Author McCormack, B. & McCance, T. (2017). Person-centred practice in nursing and health care. Theory and practice (2nd ed.). Oxford: Wiley Blackwell. Mensik, J. (2014). Lead, drive, & thrive in the system. Silver Spring, MD: American Nurses Association. National League for Nursing. (2010). Outcomes and competencies for graduates of practical/vocational, diploma, associate degree, baccalaureate, master’s, practice doctorate, and research doctorate programs in nursing. New York, NY: National League for Nursing. Porter-O’Grady, T. & Malloch, K. (2015). Quantum leadership: Building better partnerships for sustainable health (4th ed.). Burlington, MA: Jones & Bartlett Publishing. Scully, N. J. (2015). Leadership in nursing: The importance of recognising inherent values and attributes to secure a positive future for the profession. Collegian, 22. doi:10.1016/j.colegn.2014.09.004 Sullivan, E. J. (2013). Becoming influential. A guide for nurses (2nd ed.). Upper Saddle River, New Jersey: Pearson Education. Wong, C. A., Cummings, G. G., & Ducharme, D. (2013). The relationship between nursing leadership and patient outcomes: A systematic update. Journal of Nursing Management, 21, 709-724.