Search Our Essay Database

Essay Instructions: Please write a 2 page discussion paper and include the References page


Organizational Foundations
As you strive to grow in your leadership skills and abilities, you will likely find that your motivation and areas of focus are influenced by the context in which you work. In a similar vein, your commitment to developing professionally can contribute toward organizational effectiveness.
To that end, it is critical to recognize the importance of organizational culture and climate. In particular, through this week’s Learning Resources, you may consider several questions: How do an organization’s mission, vision, and values relate to its culture? What is the difference between culture and climate? And, how are these manifested within the organization?
For this Discussion, you explore the culture and climate of your current organization or one with which you are familiar. You also consider how the organization’s mission, vision, and values are conveyed through decisions and day-to-day practices.
To prepare:
• Review the information related to planning and decision making in health care organizations presented in the textbook, Leadership Roles and Management Functions in Nursing. Consider how planning and decision making relate to an organization’s mission, vision, and values, as well as its culture and its climate.
• Familiarize yourself with the mission, vision, and values of your organization or one with which you are familiar. Consider how these are supported, or demonstrated, through the statements and actions of leaders and others within the organization. In addition, note any apparent discrepancies between word and deed. Think about how this translates into expectations for direct service providers. Note any data or artifacts that seem to indicate whether behaviors within the organization are congruent with its mission, vision, and values.
• Begin to examine and reflect on the culture and climate of the organization. How do culture and climate differ?
• Why is it important for you, as a master’s-prepared nurse leader, to be cognizant of these matters?
Post on or before Day 3 a description of your selected organization’s mission, vision, and values. Describe how these are evidenced??"or perhaps appear to be contradicted??"in the words and actions of leaders and others in the organization, noting relevant data or artifacts. In addition, discuss the organization’s culture and its climate, differentiating between the two. Explain why examining these matters is significant to your role as a nurse leader.

“Foundations of an Organizational and Organizational Assessment: Program A” Program Transcript
[MUSIC PLAYING]
JOAN M. MARREN: I've worked for Visiting Nurse Service of New York for over 30 years. I've worked there through transit strikes, through blackouts, through blizzards, and through 9/11. There has never been a crisis in which our staff have not made themselves available to deliver care, regardless of the emergency circumstance.
I think in home health and community nursing, the family unit is the target, so to speak, of our intervention. It's not just the individual patient, and I think that's really important. We have to provide a certain kind of service to the individual around their diagnosed health care problem, let's say, but that individual exists within the context of the family.
And that family influences the choices that that individual may or may not make about their health care problem, and, to some extent, even the larger community does. So if, for example, in the area of diet. If we are trying to encourage a diabetic, or a patient with heart failure, to incorporate certain dietary choices into their daily meal plan, but in the larger-- either in the family there isn't adequate support for that, or in the larger community it's very difficult for them to get access to fresh fruits and vegetables. That will impact, ultimately, our success in accomplishing this kind of change, or the way in which that individual is able to manage the health problem on an ongoing basis.
Behavioral change, I think, is, to a large extent, dependent upon a relationship. And so one of the basic tenets, if one is to begin to have a prayer, so to speak, of attempting to influence behavior, it has to be through the development of a trusting relationship. So a trusting relationship is also dependent upon an element of time.
It's difficult to develop trust if your opportunity for interaction with an individual or family is so severely limited that you can't get to know each other. So there has to be a certain time that you have to build trust. I think secondly, for behavior to change, the kind of interaction that takes place has to be consistent with the values and beliefs of the individual whose behavior you're attempting to modify in some way.
So that really understanding those values and beliefs is important, and understanding how they might affect an individual's choices about health care, about diet, about end of life care, for example, are really important variables in successful behavioral change. And that has to do with, I believe, recruiting staff members who share the culture and the beliefs and have greater likelihood of
© 2012 Laureate Education, Inc. 1
being acceptable in the home or in the community to this population group. I think it means connecting with influences in the community, such as religious groups, political groups that might be representative, or individuals that might be representative of that group. And leveraging their influence in such a way that the health care needs are addressed more consistently with the beliefs of the population.
[SPEAKING FOREIGN LANGUAGE]
We actually have a kind of a satellite, what we call the Chinatown Community Center, where people can walk in and request services of our organization, but where we also conduct blood pressure screenings, health education classes, during the season flu immunization, and so on. And are sort of very much a part of that community and visible in the community, networked with health care providers and community-based organizations, so that we are seen as a resource there. And then when people need home health care, for example, they would access it through us and would be willing to bring an organization like ours into their lives in a whole variety of ways.
So what we have done, as an organization, again, both at the individual nurse level and at a programmatic level, is to really understand what are those beliefs? What are those barriers? And what do we need to do, as individual practitioners and as a health care provider, more broadly, to make those services more accessible?
© 2012 Laureate Education, Inc. 2
“Foundations of an Organizational and Organizational Assessment: Program B” Program Transcript
KEVIN F. SMITH: Our vision, I think, is over time to be able to look at that community, look at that public, and say to them, if you come here we'll keep you safe. We'll keep you from being harmed when you're under our care. That's really our vision. And if we do that, and we do it well, we believe that all of the other elements of what one might call a business plan, a strategy, will largely fall from that, take care of themselves.
Our mission is to promote the health of the people. There are about 500,000 people who live in our service area. And when their health is threatened or it fails them, to help them address that and take care of it. That's our mission over time, to promote that health and to take care of it when it goes away in some fashion.
NURSE: Gonna strap them down. And then I'm even gonna put lead on it.
KEVIN F. SMITH: I believe what contributes to that is a shared and deep commitment on the part of everybody who works here, all 2,600 people, to that vision and that mission. The belief that they are doing good work on behalf of the community, and those community members are their family members. They are their neighbors.
I think what the staff here does day in and day out, in interaction after interaction, is make it personal. They treat one another, and more importantly, they treat patients and families like they would want to be treated, like someone who they care about would want to be treated.
Our decision making structure here tends to be very decentralized. We believe across our management team quite strongly in the power of enabling everybody in the organization. We have a saying that we use around here frequently that we don't practice administration here, we practice medicine.
And those of us who work in support and management and leadership type positions, I think we take the opportunity to constantly remind ourselves that our job is to remove barriers and enable the folks who work at the bedside delivering patient care, and those who support that effort, to allow them to do their job, give them the resources. So I think an awful lot of that is about empowering people to do their best at doing their job.
RUTH: Good morning, greeter desk. Ruth speaking. Yes. OK, I'll connect you. Thank you.
KEVIN F. SMITH: For all of the bricks and mortar and all the technology that characterizes this hospital and all of today's hospitals, this is still at its core a
© 2012 Laureate Education, Inc. 1
people business. And we try to adopt that approach and use it. Not just in our interactions with patients, but as we relate to problems that need to be solved, issues that need to be addressed, as we work as a team within the organization, employee to employee.
© 2012 Laureate Education, Inc. 2
“Foundations of an Organizational and Organizational Assessment: Program B” Program Transcript
KEVIN F. SMITH: Our vision, I think, is over time to be able to look at that community, look at that public, and say to them, if you come here we'll keep you safe. We'll keep you from being harmed when you're under our care. That's really our vision. And if we do that, and we do it well, we believe that all of the other elements of what one might call a business plan, a strategy, will largely fall from that, take care of themselves.
Our mission is to promote the health of the people. There are about 500,000 people who live in our service area. And when their health is threatened or it fails them, to help them address that and take care of it. That's our mission over time, to promote that health and to take care of it when it goes away in some fashion.
NURSE: Gonna strap them down. And then I'm even gonna put lead on it.
KEVIN F. SMITH: I believe what contributes to that is a shared and deep commitment on the part of everybody who works here, all 2,600 people, to that vision and that mission. The belief that they are doing good work on behalf of the community, and those community members are their family members. They are their neighbors.
I think what the staff here does day in and day out, in interaction after interaction, is make it personal. They treat one another, and more importantly, they treat patients and families like they would want to be treated, like someone who they care about would want to be treated.
Our decision making structure here tends to be very decentralized. We believe across our management team quite strongly in the power of enabling everybody in the organization. We have a saying that we use around here frequently that we don't practice administration here, we practice medicine.
And those of us who work in support and management and leadership type positions, I think we take the opportunity to constantly remind ourselves that our job is to remove barriers and enable the folks who work at the bedside delivering patient care, and those who support that effort, to allow them to do their job, give them the resources. So I think an awful lot of that is about empowering people to do their best at doing their job.
RUTH: Good morning, greeter desk. Ruth speaking. Yes. OK, I'll connect you. Thank you.
KEVIN F. SMITH: For all of the bricks and mortar and all the technology that characterizes this hospital and all of today's hospitals, this is still at its core a
© 2012 Laureate Education, Inc. 1
people business. And we try to adopt that approach and use it. Not just in our interactions with patients, but as we relate to problems that need to be solved, issues that need to be addressed, as we work as a team within the organization, employee to employee.
© 2012 Laureate Education, Inc. 2
Nurses practicing in today's healthcare environment are confronted with increasingly complex moral and ethical dilemmas. Nurses encounter these dilemmas in situations where their ability to do the right thing is frequently hindered by conflicting values and beliefs of other healthcare providers. In these circumstances, upholding their commitment to patients requires significant moral courage. Nurses who possess moral courage and advocate in the best interest of the patient may at times find themselves experiencing adverse outcomes. These issues underscore the need for all nurses in all roles across all settings to commit to working toward creating work environments that support moral courage. In this manuscript the authors describe moral courage in nursing; and explore personal characteristics that promote moral courage, including moral reasoning, the ethic of care, and nursing competence. They also discuss organizational structures that support moral courage, specifically the organization's mission, vision, and values; models of care; structural empowerment; shared governance; communication; a just culture; and leadership that promotes moral courage.
Key words: ethical work environment; shared governance in nursing; professional practice models; leadership; evidence-based leadership; moral development; moral courage; organizational empowerment; support for moral courage; the ethic of care
"Our lives begin to end the day we become silent about things that matter." (Martin Luther King, Jr.; Barden, 2008, p. 16).
Morally responsible nursing consists of being able to recognize and respond to unethical practices or failure to provide quality patient care. Moral distress has been defined as physical and/or emotional suffering that is experienced when internal or external constraints prevent a person from taking the action that one believes is right (Pendry, 2007). Ethical dilemmas in practice arise when one feels drawn both to do and not to do the same thing. They can cause clinicians to experience significant moral distress in dealing with patients, families, other members of the interdisciplinary team, and organizational leaders. Nurses experience moral distress, for example, when financial constraints or inadequate staffing compromise their ability to provide quality patient care. These situations challenge nurses to act with moral courage and result in nurses feeling morally distressed when they cannot do what they believe is appropriate (Cohen & Erickson, 2006). Nurses who consistently practice with moral courage base their decisions to act upon the ethical principle of beneficence (doing good for others) along with internal motivation predicated on virtues, values, and standards that they believe uphold what is right, regardless of personal risk.
Ethical values and practices are the foundation upon which moral actions in professional practice are based. Morally responsible nursing consists of being able to recognize and respond to unethical practices or failure to provide quality patient care. The foundation of quality nursing care includes nurse practice acts, specialty practice guidelines, and professional codes of ethics. Familiarity with these documents is necessary to enable nurses to question practices or actions they do not believe are right. Although a code of ethics and ethical principles can guide actions, in themselves they are not sufficient for providing morally courageous care. Moral ideals are needed to transcend individual obligations and rights. The moral commitment that nurses make to patients and to their coworkers includes upholding virtues such as sympathy, compassion, faithfulness, truth telling, and love. Nurses who act with moral courage do so because their commitment to the patient outweighs concerns they may have regarding risks to themselves.
Deciding whether to act with moral courage may be influenced by the degree of conflict between personal standards and organizational directives; by fear of retaliation, such as job termination; or lack of peer and/or leadership support. In this manuscript the authors begin by describing the concept of moral courage. Next they explore personal characteristics that promote moral courage, including moral reasoning, an ethic of care, and nursing competence. Organizational structures that support moral courage, specifically organizational mission, vision, and values; models of care; structural empowerment; shared governance; communication; a just culture; and leadership are addressed.
Moral Courage in Nursing
Nurses who act with moral courage do so because their commitment to the patient outweighs concerns they may have regarding risks to themselves. Packard and Ferrara (1988) proposed that nursing is comprised of four components. These components include: (a) taking the right actions to effect health promotion and quality of life; (b) possessing the knowledge and skills necessary to discern when and when not to respond; (c) knowing what the appropriate action(s) should be; and (d) demonstrating a willingness to act, thus supporting the ethical principle of beneficence. Nurses who are morally courageous are able to confidently overcome their personal fears and respond to what a given situation requires; they act in the best interests of their patients (Day, 2007). Nurses who exhibit moral reasoning and act with moral courage demonstrate a willingness to speak out and do that which is right in the face of forces that would lead a person to act in some other way (Lachman, 2007).
Sekerka and Bagozzi (2007) have asked "What induces people to act in morally courageous ways as they face an ethical challenge in the workplace?" (p.132). They noted that nurses practice with moral courage when they confront situations that pose a direct threat to care. For example, the nurse who questions discharging home a hospitalized frail elder who lacks the appropriate level of home care services and resources, thus jeopardizing the patient's safety and wellbeing, is acting with moral courage. This nursing response is based upon a commitment to serve and advocate for patients and the profession.
Kidder (2005) has argued that an individual who acts with moral courage is committed to moral principles, cognizant of the actual or potential risk that upholding those principles may require, and willing to endure the risk. Nurses can help their colleagues develop moral courage by reaffirming their colleagues' strengths and resolve, taking risks in helping to confront obstacles, possessing vision, remaining focused and disciplined toward the intended outcome(s), and taking actions that may go against the status quo but are necessary to do what is virtuous and principled (Walston, 2003).
Purtilo (2000) identified moral courage as a necessary virtue for healthcare professionals, one that enables them to not only survive but to thrive in changing times. Purtilo noted that morally courageous individuals respond to situations that incite fear and anxiety without knowing the end result of their response because they believe in doing what is morally right. The nurse on a general medical unit, for example, who confronts the physician who is reluctant to transfer an acutely ill patient in need of intensive care to the ICU, is acting with moral courage so as to provide safe care for the patient. Purtilo stated that "a rich understanding of care includes creativity, faithfulness to one's moral foundation, and a focus on the full significance of a situation" (p. 5). Practicing with moral courage responds to the call to act with moral conviction, even when the human tendency would be to act in ways that are incongruent with one's convictions when one perceives that personal security is endangered (Purtilo).
Personal Characteristics that Promote Moral Courage in Nursing
Nurses can enhance their ability to demonstrate moral courage in nursing by advancing their moral reasoning skills, nurturing their personal ethic of care, and enhancing their professional and cultural competence. Each of these behaviors will be discussed below.
Moral Reasoning
Kohlberg's theory of moral development provides a useful framework for understanding how one's personal ability to make moral judgments is influenced over time by personal development, knowledge acquisition, experience, and the environment (Cohen & Erickson, 2006; Ketefian & Ormond, 1988). Individuals at the highest level of moral development use their conscience to determine the right course of action by independently examining and delineating moral values and principles rather than by relying on group norms (Ketefian & Ormond, 1988). Ethical environments are characterized by shared decision making, taking responsibility for the consequences of one's actions, and utilizing opportunities for collective participation that empower individuals to develop higher levels of moral judgment (Ketefian & Ormond, 1988; Murray, 2007). Nurses who work in ethical environments are "aware of an ethical culture" (Murray, 2007, p. 48). They understand their role responsibilities and how an ethical environment supports their identification of ethical issues and concerns. They engage in meaningful ethical discussions (Murray, 2007).
The Ethic of Care in Nursing
The ethic of care is characterized by attentiveness, responsibility, competence, and responsiveness. The 'ethic of care' is not a set of rules and principles. Rather, it is a way of practicing that requires specific moral qualities that facilitate taking the right action (Tronto, 1994). The ethic of care is characterized by attentiveness, responsibility, competence, and responsiveness. Resulting actions include caring for, emotionally committing to, and being willing to act on behalf of a person with whom one has a significant relationship (Beauchamp & Childress, 1994). Nursing practice that includes the ethic of care promotes moral courage. Moral courage is enhanced in situations in which the ethic of care is present as evidenced by building consensus, promoting interdisciplinary collaboration, and positively influencing outcomes that support rather than oppose moral decision making (LaSala, 2009). Consider, for example, a nurse caring for a patient with invasive ductal breast carcinoma and spinal metastases who desires to die at home surrounded by family and assisted by a hospice team, but whose husband is hesitant about taking his wife home, fearful that he will be unable to manage her care. The nurse acts with moral courage by advocating for the patient's wishes, despite the palliative care physician's recommendation that the patient remain hospitalized given the probability of imminent death. Through effective communication and collaboration with the physician, the nurse is successful in facilitating the patient's discharge home with patient-controlled analgesia and hospice care, thus responding to the patient's wishes (LaSala, 2009). The moral qualities associated with the ethic of care enable nurses to care for patients and families during times of sickness and uncertainty, provide the inner motivation to do what is right and good, and demonstrate moral courage both within the context of patient care and from the perspective of the nurses' collegial, collaborative relationships with other healthcare professionals.
Nursing Competence
Professional competence is a prerequisite for providing morally responsible care. The elements of a profession, such as formal education based on theoretical knowledge, a code of ethics, professional organizations that guide practice, and the provision of necessary service to society (Miller, Adams, & Beck, 1993), all serve to develop professional competence. Standards for ethical conduct are also necessary in order to provide morally responsible care (Maraldo, 1992).
Leininger (1991) defined transcultural nursing as a humanistic and scientific area of formal study and practice focused upon similarities and differences among cultures with respect to human care, health, and illness that are related to cultural values, beliefs, and practices (norms). These norms include the way rights and protections are exercised, and even what is considered to be a health problem (United States [U.S.] Department of Health and Human Services, 2001). Nurses need to understand and appreciate inherent similarities and differences not only locally, but regionally, nationally, and worldwide as well. In order to provide morally competent care that respects individual values and needs, it is imperative that nurses examine their own health-related values and beliefs, as well as those of the healthcare organization in which they work; it is only then that they can support the principle of respect for persons and provide the ideal of transcultural care (Bjarnason, Mick, Thompson, & Cloyd, 2009).
Organizational Structures that Support Moral Courage
McClure, Poulin, Sovie, and Wandelt (1983) observed that certain healthcare organizations seemed better able to withstand pressure on their professional environments, experiencing less upheaval and producing higher quality patient outcomes with lower morbidity and mortality rates than 'average' healthcare organizations. These same institutions showed remarkable resilience in limiting turnover and maintaining patient and staff satisfaction. These observations resulted in nursing's recognition of Magnet hospitals, a designation that recognizes organizations in which nurses want to work and patients find healing environments (Aiken & Salmon, 1994; Aiken, Smith, & Lake, 1994; American Nurses Association (ANA,) 1998). It was noted that these organizations have in place a number of structures that enhance the quality of the care provided as well as the working environment. Structures that are described below help create the context for actualizing moral courage in nursing.
Mission, Vision, and Values
Creating the foundation for an environment that fosters moral courage among nurses requires that all stakeholders have a clear understanding of the organizational mission, vision, and values, as well the philosophy of the nursing department (Lachman, 2009). Clearly stating and supporting the mission, vision, and values sets the tone for the work of nursing in the organization, pictures a state that implies a commitment to organizational improvement, and suggests the types of activities that will ensure that the organization reaches those goals. Developing a nursing philosophy allows the organization to define itself not only to its internal community, but to its external community as well.
A nursing philosophy describes professional behaviors that hold nurses responsible and accountable for exercising moral courage when acting to achieve the organization's mission and vision. According to Shirey (2005) "clarity in an organization's mission, vision, and values is key to effective management in today's increasingly complex healthcare environment. To clearly articulate mission, vision, and values, employees must experience consistency between what is espoused and what is lived" (p. 59).
Models of Care
Professional practice models include reward and recognition systems acknowledging performance improvement…along with empowerment and engagement in the workplace. Another aspect of professional nursing that promotes moral courage in the workplace includes a professional model of care that exemplifies nursing's goal of enhancing the lives of patients and colleagues. The American Nurses Credentialing Center (AACN) (2008) has defined a professional practice model as the driving force of nursing care; a schematic description of a theory, phenomenon, or system that depicts how nurses practice, collaborate, communicate, and develop professionally to provide the highest quality of care for those served by the organization (e.g. patients, families, and community). Professional practice models illustrate the alignment and integration of nursing practice with the mission, vision, and values that nursing has adapted. Fasoli (2010) has noted that autonomy, accountability, professional development, emphasis on high quality care, and delivery models that are patient centered, adaptable, and flexible provide a framework for professional practice models in nursing. Professional practice models include reward and recognition systems acknowledging performance improvement, and nurses' commitment to uphold high standards of practice predicated on a strong value system, moral courage, and quality professional relationships, along with empowerment and engagement in the workplace.
Structural Empowerment
In her theory of structural power in organizations Kanter described four structural factors within organizations that lead to empowerment (Kanter, 1983; Matthews, Laschinger, & Johnstone, 2006). She explained that employees who (a) have access to information; (b) receive support from organizational leadership, subordinates, and peers; (c) are given adequate resources to do the work; and (d) have opportunities for personal and professional development are empowered to contribute to achieving organizational goals (Matthews et. al., 2006; Ning, Zhong, Libo, & Qiujie, 2009). Empowerment may come from within, collectively as in work groups, or from the work environment (Manonlovich, 2007). Nurses who are empowered take control of their practice and participate in decision making at the point of care, thus strengthening a professional practice model and promoting positive patient care outcomes.
An example of this empowerment would be that of Nurse M, who heard other nurses on the unit discussing how patients assigned to Nurse J had recently complained of not receiving pain medication when requested. The nursing staff had recently observed notable changes in Nurse J's behavior as evidenced by being unwilling to help out, less engaged, and easily angered. One evening after receiving report from Nurse J, one of Nurse M's patients stated to her that he was in acute pain and had not received any pain medication from the nurse on the previous shift. Upon reviewing the patient's medication record, Nurse M found that Nurse J had documented that the patient received narcotic analgesia every four hours that shift. This information was also recorded in the unit's automated medication system. The following day, Nurse M discussed her findings with her nurse manager, who has a reputation for supporting, developing, and empowering her staff. Nurse M did this not only out of concern for that patient's safety and wellbeing but also because of her compassion for Nurse J whom she had known in the past as a trusted colleague and competent nurse. The nurse manager recognized Nurse M's moral courage in coming forward, and spoke with Nurse J who became emotionally distraught, admitting to drug diversion and problems with substance abuse. Although Nurse J resigned her position, the nurse manager continued to offer her support and resources to assist in her rehabilitation. Organizational factors, such as those described in this example, including open and supportive leadership, adequate resources, and professional development empower nurses to act and promote moral courage in the workplace.
Shared Governance
Shared governance promotes collaborative decision making and shared responsibility; it empowers nurses to act with moral courage by taking ownership of their practice at the point of care. Shared governance has been described as "a managerial innovation that legitimizes nurses' control over practice, extending their influence into administrative areas previously controlled only by managers" (Hess, 2004, p. 2). Research has demonstrated several positive outcomes of shared governance, including increased nurse satisfaction and retention and a more motivated, engaged nursing staff (Bretschneider, Glenn-West, Green-Smolenski, & Richardson, 2010). Work environments in which shared governance is firmly embedded facilitate active involvement of frontline staff in the creation of a professional practice model that promotes quality patient care outcomes.
Practicing in a shared governance environment enables the nurse to act with moral courage when aggressive treatment of a patient based on the family's wishes continues, despite the patient's expressed wishes that it be withdrawn. In such a situation, out of duty to the patient and to self, the morally courageous nurse will advocate for the patient by initiating conversations with other care providers, consulting with the hospital ethics committee, and utilizing other appropriate resources to engage the family and patient in meaningful discussion that can result in consensus around the goals of care. Nurses practicing in shared governance settings have access to the information and resources they need to make effective decisions, create change, and influence outcomes (Hess, 2004).
Communication
Nurses act with moral courage when they use the chain of command to share and discuss issues that have escalated beyond the problem-solving ability and/or scope of those immediately involved. The Joint Commission (TJC) requires that organizations respect the patient's right to, and need for effective communication; it directs organizations to take action to address communication needs (TJC, 2009). The strength of this directive is based upon overwhelming evidence from TJC's sentinel event database indicating that communication is cited as a root cause in nearly 70 percent of reported sentinel events, surpassing other commonly identified issues, such as staff orientation and training, patient assessment, and staffing (Joint Commission Resources, n.d.).
Every day nurses and their healthcare colleagues are confronted with challenging situations where effective communication is essential, while at the same time fraught with difficulty. Assertive communication is the act of stating a position with assurance. It is an honest, direct, and appropriate means of communicating that focuses on solving a problem (Lachman, 2009). The use of assertive communication is imperative not only to patient safety and to quality patient care, but also to invoking the chain of command. Nurses act with moral courage when they use the chain of command to share and discuss issues that have escalated beyond the problem-solving ability and/or scope of those immediately involved. Engaging the chain of command both ensures that the appropriate leaders know what is occurring and allows for initiating communication at the level closest to the event, moving the discussion upward as the situation warrants.
Just Culture
The concepts of effective communication and chain of command are inherent in a position statement recently published by the ANA. The 'just culture' model seeks to create environments that incentivize rather than punish error reporting. In a just culture, individuals are not held accountable for system problems over which they have no control. A just culture recognizes that patient care safety and quality is based on teamwork, communication, and a collaborative work environment (ANA, 2010). Just culture environments enhance moral courage in the workplace.
Leadership
Nurse leaders demonstrate moral courage when they oppose work environments that put patient safety at risk. For example, chief nurses act with moral courage when they firmly oppose cost-containment measures, such as nursing layoffs or reductions in healthcare services, that would jeopardize the delivery of safe, competent patient care. Nurse leaders can create environments that support moral courage by clearly providing guidelines for nurses to use when they observe unethical practices and by providing resources, such as ethics committees, shared governance structures, and mentoring opportunities that enable nurses to confront ethical dilemmas in practice (Murray, 2007).
All nurses can demonstrate leadership by role modeling ethical behaviors based on established nursing practice standards. They can also recognize colleagues and peers when they uphold ethical principles and demonstrate moral courage, and work to develop and implement policies and procedures that facilitate effective responses to moral distress at the point of care (Murray, 2007).
Conclusion
Nurses who possess moral courage embrace the challenge of transforming the profession and the workplace. They are the nurses who question the premature discharge of an elderly patient with no social support and limited resources, refuse to administer a medication whose efficacy or dosage they question, challenge those who treat others unjustly, or speak up when others remain silent.
Nurses who act with moral courage take risks knowing that they may encounter lateral violence, including bullying, harassment, or sabotage, as well as risk of termination. Nurses practicing with moral courage know that addressing these issues is leadership in action, the type of leadership that began with Florence Nightingale -- who role modeled moral courage on the battlefield, in the classroom, at the bedside, and among legislators in advocating for the rights of patients, colleagues, and humanity. In her writings on leadership, perhaps Nightingale said it best:
What is our needful thing? To have high principles at the bottom of all. Without this, without having laid our foundation, there is small use in building up our details. This is as if you were to try to nurse without eyes or hand…If your foundation is laid in shifting sand, you may build your house, but it will tumble down (Ulrich, 1992, p.40).
…the accountability and responsibility for creating environments that promote moral courage…is an obligation shared by all nurses, in every role, in every specialty, in every setting. Nurses have obligations to patients, one another, and the global community to assure optimal health, personal wellbeing, and quality of life for all with whom they come in contact. In her seminal publication, Nursing Speaks for Itself, Margretta Styles (2006) described the transformation that needs to occur in nursing, writing, "There is a give and take to empowerment, so nursing must be prepared to reshape the health care environment and act as its full partner. Both the culture of the profession and the culture of the workplace must be transformed (p. 10)."
Challenges in the care environment are myriad. All professional nurses assume the responsibility for serving as patient advocates and role models. This duty exists whether nursing practice occurs at the bedside, in the classroom, in the board room, or in the research setting. Quite simply, the accountability and responsibility for creating environments that promote moral courage in practice and transform the workplace is an obligation shared by all nurses, in every role, in every specialty, in every setting.
References
Aiken L. & Salmon M. (1994). Health care workforce priorities: What nursing should do now. Inquiry 31, 318-329.
Aiken L., Smith H. & Lake E. (1994). Lower Medicare mortality among a set of hospitals known for good nursing care. Medical Care, 32(8), 771-787.
American Nurses Association (2010). Just culture. Retrieved March 31, 2010, fromwww.nursingworld.org/FunctionalMenuCategories/MediaResources/PressReleases/ 2010-PR/ANA-Statements-Affecting-Nursing-Practice.aspx
American Nurses Credentialing Center. A new model for ANCC's magnet recognition program. Retrieved March 17, 2010, from: www.nursecredentialing.org
Beauchamp, T. L. & Childress, J. F. (1994). Principles of biomedical ethics. (4th Ed.). New York: Oxford University Press.
Bjarnason, D., Mick, J., Thompson, J. A., & Cloyd, E. (2009). Perspectives on transcultural care. In D. Bjarnason and M. A. Carter (Eds.), Nursing Clinics of North America: Legal and Ethical Issues: To Know, To Reason, To Act (pp. 495-503). Philadelphia: W.B. Saunders.
Barden, C. (2008). Breaking down the wall of silence to create healthy work environments: An interview with author Rosemary Gibson. AACN Advanced Critical Care, 19(1), 16-18.
Bretschneider, J., Glenn-West, R., Green-Smolenski, J., & Richardson, C. (2010). Strengthening the voice of the clinical nurse: The design and implementation of a shared governance model. Nursing Administration Quarterly, 34(1), 41-48.
Cohen. J. S. & Erickson, J. M. (2006). Ethical dilemmas and moral distress in oncology nursing practice. Clinical Journal of Oncology Nursing, 10(6), 775-780.
Day, L. (2007). Courage as a virtue necessary to good nursing practice. American Journal of Critical Care, 16(6), 613-616.
Fasoli, D. R. (2010). The culture of nursing engagement: A historical perspective. Nursing Administration Quarterly, 34(1), 18-29.
Hess, R. G. (2004). From bedside to boardroom -- nursing shared governance. Online Journal of Issues in Nursing. Retrieved July 18, 2010, fromwww.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/ OJIN/TableofContents/Volume92004/No1Jan04/FromBedsidetoBoardroom.aspx
Joint Commission Resources (n.d.). Robert Wood Johnson Foundation. Retrieved March 31, 2010, from www.dev.icps.jcrinc.com/Products-and-Services/Conferences-and-Seminars/ Robert-Wood-Johnson-Foundation-Communication/
Kanter, R. M. (1993). Men and Women of the Corporation. New York, NY: Basic Books.
Ketefian, S. & Ormond, I. (1988). Moral reasoning and ethical practice in nursing: An integrative review. National League for Nursing, New York, Publication Number 15-2250.
Kidder, R. M. (2005). Moral courage. New York: Harper Collins Publishers.
Lachman, V. D. (2009) Developing your moral compass. New York: Springer Publishing.
Lachman, V. D. (2007). Moral courage: A virtue in need of development? MedSurg Nursing, 16(2), 131-133.
LaSala, C. (2009). Moral accountability and integrity in nursing practice. In D. Bjarnason and M. A. Carter (Eds.), Nursing Clinics of North America: Legal and Ethical Issues: To Know, To Reason, To Act (pp. 423-434). Philadelphia: W.B. Saunders.
Leininger, M. (1991). Transcultural nursing: the study and practice field. Imprint, 38, 55-66.
Manojilovich, M. (2007). Power and empowerment in nursing: Looking backward to inform the future. Online Journal of Issues in Nursing. Retrieved July 18, 2010, from www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume122007/No1Jan07/LookingBackwardtoInformtheFuture.aspx
Maraldo, P. J. (1992). NLN's first century, Nursing & Health Care, 13(5) 227-228.
Matthews, S., Spence Laschinger, H. K., & Johnstone, L. (2006). Staff nurse empowerment in line and staff organizational structures for chief nurse executives. Journal of Nursing Administration, 36(11), 526-533.
McClure, M., Poulin M., Sovie M. & Wandelt M. (1983). Magnet hospitals: Attraction retention of professional nurses. Kansas City, MO: American Academy of Nursing.
Miller, B. K., Adams, D., & Beck, L. (1993). A behavioral inventory for professionalism in nursing. Journal of Professional Nursing, 9(5) 290-295.
Murray, J. S. (2007). Creating ethical environments in nursing. American Nurse Today, 2(10), 48-49.
Ning, S., Zhong, Z., Wang, L., & Qiujie, L. (2009). The impact of nurse empowerment on job satisfaction. Journal of Advanced Nursing, 65(12), 2642-2648. doi:10.1111/j.1365-2648.2009.05133x
Nightingale, F. (1914). Florence Nightingale to her nurses: A selection from Miss Nightingale's addresses to probationers and nurses of the Nightingale School at St. Thomas' Hospital. London: Macmillan & Co. (p. 90; May 26, 1875, Address).
Packard, J. S. & Ferrara, M. (1988). In search of the moral foundation of nursing. Advances in Nursing Science, 10(4), 60-71.
Pendry, P. S. (2007). Moral distress: Recognizing it to retain nurses. Nursing Economics, 25(4), 217-221.
Purtilo, R. B. (2000). Moral courage in times of change: Visions for the future. Journal of Physical Therapy Education, 14(3), 4-6.
Sekerka, L. E. & Bagozzi, R. P. (2007). Moral courage in the workplace: Moving to and from the desire and decision to act. 16(2), 132-149.
Shirey, M. R. (2005). Ethical climate in nursing practice: The leader's role. Journal of Nursing Administration's Healthcare Law, Ethics, and Regulation, 7(2), 59-67.
Styles, M. M. (2006). Nursing speaks for itself: A declaration on the education and work environment of the nurseforce. American Nurses Association. Silver Spring, MD: Nursebooks.org.
The Joint Commission (2009). The Joint Commission 2009 requirements that support effective communication. Retrieved March 31, 2010, fromwww.jointcommission.org/NR/rdonlyres/B48B39E3-107D-496A-9032-24C3EBD96176/0/PDF32009HAPSupportingStds.pdf
Tronto, J. C. (1994). Moral boundaries: A political argument for the ethic of care. New York: Routledge, Chapman, and Hall.
Ulrich, B. T. (1992). Leadership and management according to Florence Nightingale. Norwalk, CT: Appleton & Lange.
U.S. Department of Health and Human Services. (2001). National standards for culturally and linguistically appropriate services in health care. Retrieved June 4, 2009, from www.omhrc.gov/assets/pdf/checked/finalreport.pdf
Walston, S. F. (2003). Courage and caring: Step up to your next level of nursing excellence. Patient Care Management, 19(4), 4-6.
~~~~~~~~
By Cynthia Ann LaSala, MS, RN and Dana Bjarnason, PhD, RN, NE-BC
Cynthia Ann LaSala, MS, RN is a Clinical Nurse Specialist in general medicine at Massachusetts General Hospital (MGH). Ms. LaSala has extensive experience in clinical and educational roles and more than 30 years of professional organizational experience, serving in a variety of positions at local, state, and national levels. In 2006, Ms. LaSala was appointed to a four-year term on the Ethics Advisory Board for the American Nurses Association Center for Ethics and Human Rights. She has a vested interest in the specialty of ethics and is currently the coach for the MGH Patient Care Services Ethics in Clinical Practice Committee (EICP), a member of the EICP Advance Care Planning Task Force, the MGH Ethics Task Force, the American Society of Bioethics and Humanities (ASBH), and the ASBH Nurse Affinity Group. Ms. LaSala has authored and co-authored journal manuscripts, textbooks, and newsletters and has presented on a variety of clinical and educational topics.
Dr. Bjarnason serves as the Associate Administrator & Chief Nursing Officer for the Ben Taub General Hospital and the Quentin Mease Community Hospital in Houston, Texas. Dr. Bjarnason is active in a number of professional nursing organizations, including the American Nurses Association (ANA), where she serves as an appointed member of the ANA Board of Ethics and Human Rights; the Texas Nurses Association District 9; Sigma Theta Tau - Alpha Delta Chapter; the Southern Nursing Research Society; and the American Organization of Nurse Executives. She has authored/co-authored several peer-reviewed articles for professional journals. In addition to healthcare regulation and accreditation, Dr. Bjarnason's interests include patient self-determination, end-of-life care, advocacy, professionalism, and practice. She was awarded a doctorate in nursing from the University of Texas Medical Branch Graduate School of Biomedical Science (Galveston) in 2007 and has been a certified nurse executive since 1999.
________________________________________
Copyright of Online Journal of Issues in Nursing is the property of American Nurses Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Source: Online Journal of Issues in Nursing, 2010; 15(3)
Item Number: 2010890002

Essay Instructions: ***LEADERSHIP APPLICATIONS IN CRIMINAL JUSTICE***

Module 2

Self-Assessment Report /Leadership Skill-Building Exercises

Continue organizing your Course Project (Leadership Self-Reflection Portfolio) by completing Leadership Skill-Building Exercises 3-3 and 4-6.
Submit a written report (not to exceed 1,000 words) that covers both of the portfolio building leadership skill-building exercises. The report should also incorporate your findings and conclusions from the self-assessment quizzes in this module, and from personal reflection.


Leadership Self-Assessment Quizzes

The Leadership Self-Assessment Quizzes are an important component of the Written Exercise for this module. The quizzes are intended to reveal certain personality traits and leadership behaviors that you may not be fully aware of. By no means are these quizzes regarded as ?all knowing? of your leadership skills, and thus the results should not be taken as the end, but rather as the beginning, of the self-assessment process. You are expected to critically analyze the results and not just accept them at face value.

Take the following Leadership Self-Assessment Quizzes in the text:
? Leadership Self-Assessment Quiz 3-1: The Emotional Expressiveness Scale
? Leadership Self-Assessment Quiz 3-2: The Dual-Level Transformational Leadership (TFL) Scale
? Leadership Self-Assessment Quiz 4-1: Task-Oriented Attitudes and Behaviors
? Leadership Self-Assessment Quiz 4-2: What Style of Leader Are You or Would You Be?
? Leadership Self-Assessment Quiz 4-3: What is Your Propensity for Taking Risks?

Essay Instructions: Effective Approaches in Leadership and Management

In this assignment, you will be writing a 1,000-1,250-word essay describing the differing approaches of nursing leaders and managers to issues in practice. To complete this assignment, do the following:

1) Select an issue from among those listed below: Selected as below per the instructor:

a) Nursing shortage and nurse turn-over

2) Compare and contrast how you would expect nursing leaders and managers to approach your selected issue. Support your rationale by using the theories, principles, skills, and roles of the leader versus manager described in your readings.

3) Identify the approach that best fits your personal and professional philosophy of nursing and explain why the approach is suited to your personal leadership style.

4) Use at least two references other than your text and those provided in the course.

5) Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

6) This assignment uses a grading rubric that can be viewed at the assignment's drop box. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment.
The grading rubric is provided as below:

Criteria Achievement Level
Unsatisfactory
(0-71%) Less than Satisfactory
(72-75%) Satisfactory
(76-83%) Good
(84-94%) Excellent
(95-100%)
Compare and contrast how you would expect nursing leaders and managers to approach your selected issue. Support your rationale by using the theories, principles, skills, and roles of the leader versus manager described in your readings. 4.26 points
The comparison and contrast of how you would expect nursing leaders and managers to approach your selected issue is not provided. 4.5 points
The comparison and contrast of how you would expect nursing leaders and managers to approach your selected issue is provided; however, relevant information is missing, such as not providing support for your rationale by using the theories, principles, skills and roles of the leader versus manager described in your readings, or not providing at least two references beyond your text. 4.98 points
The comparison and contrast of how you would expect nursing leaders and managers to approach your selected issue is provided and meets the basic criteria for the assignment as indicated by the assignment instructions. 5.64 points
The comparison and contrast of how you would expect nursing leaders and managers to approach your selected issue meets all criteria for the assignment, and is provided in detail. 6 points
The comparison and contrast of how you would expect nursing leaders and managers to approach your selected issue meets all criteria for the assignment, is provided in detail. Higher level thinking is demonstrated by incorporating prior learning or reflective thought.
Identify the approach that best fits your personal and professional philosophy of nursing and explain why the approach is suited to your personal leadership style. 4.26 points
The identification of the approach that best fits your personal and professional philosophy of nursing is not provided. 4.5 points
The identification of the approach that best fits your personal and professional philosophy of nursing is provided; however, relevant information is missing, such as an explanation to why the approach is suited to your personal leadership style. 4.98 points
The identification of the approach that best fits your personal and professional philosophy of nursing is provided and meets the basic criteria for the assignment. 5.64 points
The identification of the approach that best fits your personal and professional philosophy of nursing, along with an explanation to why the approach is suited to your personal leadership style, is provided in detail. 6 points
The identification of the approach that best fits your personal and professional philosophy of nursing meets all criteria for the assignment, and is provided in detail. Higher level thinking is demonstrated by incorporating prior learning or reflective thought.
Thesis Development and Purpose


0.53 points
Paper lacks any discernible overall purpose or organizing claim.

0.56 points
Thesis and/or main claim are insufficiently developed and/or vague; purpose is not clear. 0.62 points
Thesis and/or main claim are apparent and appropriate to purpose. 0.71 points
Thesis and/or main claim are clear and forecast the development of the pap. It is descriptive and reflective of the arguments and appropriate to the purpose. 0.75 points
Thesis and/or main claim are comprehensive; contained within the thesis is the essence of the paper. Thesis statement makes the purpose of the paper clear.
Paragraph Development and Transitions

0.53 points
Paragraphs and transitions consistently lack unity and coherence. No apparent connections between paragraphs are established. Transitions are inappropriate to purpose and scope. Organization is disjointed. . 0.56 points
Some paragraphs and transitions may lack logical progression of ideas, unity, coherence, and/or cohesiveness. Some degree of organization is evident. 0.62 points
Paragraphs are generally competent, but ideas may show some inconsistency in organization and/or in their relationships to each other. 0.71 points
A logical progression of ideas between paragraphs is apparent. Paragraphs exhibit a unity, coherence, and cohesiveness. Topic sentences and concluding remarks are appropriate to purpose. 0.75 points
There is a sophisticated construction of paragraphs and transitions. Ideas progress and relate to each other. Paragraph and transition construction guide the reader. Paragraph structure is seamless.

Mechanics of Writing
(includes spelling, punctuation, grammar, language use)

0.53 points
Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice and/or sentence construction are used. 0.56 points
Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register); sentence structure, and/or word choice are present. 0.62 points
Some mechanical errors or typos are present, but are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used. 0.71 points
Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used. 0.75 points
Writer is clearly in command of standard, written, academic English.


Paper Format
(1- inch margins;
12-point-font;
double-spaced;
Times New Roman, Arial, or Courier)
0.21 points
Template is not used appropriately or documentation format is rarely followed correctly. 0.23 points
Template is used, but some elements are missing or mistaken; lack of control with formatting is apparent.

0.25 points
Template is used, and formatting is correct, although some minor errors may be present. 0.28 points
Template is fully used; There are virtually no errors in formatting style. 0.3 points
All format elements are correct.


Research Citations
(In-text citations for paraphrasing and direct quotes, and reference page listing and formatting, as appropriate to assignment)
0.32 points
No reference page is included. No citations are used. 0.34 points
Reference page is present. Citations are inconsistently used. 0.37 points
Reference page is included and lists sources used in the paper. Sources are appropriately documented, although some errors may be present. 0.42 points
Reference page is present and fully inclusive of all cited sources. Documentation is appropriate and GCU style is usually correct. 0.45 points
In-text citations and a reference page are complete. The documentation of cited sources is free of error.


The readings for #2 as stated in the instructions above, is provided as below:

READINGS:
Read chapters 8, 9, 11, and 17 in the text book.

Read "Communication Strategies for Getting the Results You Want" by Haeuser and Preston, from the Healthcare Executive (2005), located in the GCU eLibrary at http://library.gcu.edu:2048/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=bth&AN=15458261&site=ehost-live&scope=site

Read "Improve Your Environment Through Communication and Change" by Lefton, from Nursing Management (2007), located in the GCU eLibrary at http://library.gcu.edu:2048/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=2009384739&site=ehost-live&scope=site

Read "Persuasive Business Proposals: Writing to Win More Customers, Clients, and Contracts" by Obuchowski, from the Harvard Management Communication Letter (2005), located in the GCU eLibrary at http://library.gcu.edu:2048/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=bth&AN=17515580&site=ehost-live&scope=site

Wertheim, E. (n.d.). Guide for Written Communication. Northeastern University, College of Business Administration. Retrieved August 25, 2007, from http://web.archive.org/web/20080211140854/http://web.cba.neu.edu/~ewertheim/skills/writovv.htm

Read "Verbal Communication Model: An Idea", located on the Vtaide Web site at http://www.vtaide.com/lifeskills/verbalC.htm

Read the Module 2 Lecture.:

INTRODUCTION


Every organization needs both managers and leaders. Although these roles may be in conflict with each other in certain circumstances, the health care environment demands the contribution of both managers and leaders. The focus for this week will be on the roles and responsibilities of managers and leaders in health care organizations, their differences, their similarities, and how they may be integrated.




Roles and Responsibilities of the Manager

The role and responsibilities of the manager are to ensure that organizational resources are used effectively and efficiently. A manager's responsibility is to make sure staff has the tools required to accomplish the work. A manager is often perceived as being task-oriented.

According to Donnelly (2003), the skills of a manager can be divided into these categories: leadership skills, people skills, budgeting and finance, quality of care skills, and information technology skills. Leadership skills, although often differentiated from management skills, are absolutely essential for nursing managers. People skills include interviewing new employees, conducting staff meetings, and communicating effectively with the members of the team. Financial skills may be most often associated with managers and are important in every organization. For the nurse manager, finances are particularly important, as we need to be able to support the work of patient care with the resources necessary to provide that care. Quality of care skills include understanding how to gather, analyze, and interpret quality data and how to use that data to drive performance improvement. Information technology skills are increasingly important as healthcare becomes more automated and nurses become more dependent on computers as tools at the bedside.

According to Kotter, the result of an effective manager is "predictability and order which consistently produces key results for various stakeholders" (1990, p. 2). Managers make life easier for employees through concrete actions. Managers set the expectations and the rules to be followed, motivate the individual members of the team, and assist each staff member to develop their full potential.

Roles and Responsibilities of the Leader

"?let whoever is in charge keep this simple question in her head (not, how can I always do this right thing myself, but) how can I provide for this right thing to always be done?" (Florence Nightingale, Notes on Nursing)

Leaders are often seen as individuals who encourage the growth and progress of the organization. The word itself implies movement, and an effective leader will not let a person remain where they are in terms of rank or skill level. An effective leader promotes forward movement.

Leadership remains a vague concept, but ideas about what makes a great leader abound. According to The Teal Trust (n.d.), Warren Bennis defines leadership as a function of knowing yourself, having a vision that is well communicated, building trust among colleagues, and taking effective action to realize your own leadership potential. Leaders inspire, enable, encourage, and act as role models. A true leader will not let personal goals or conflicts affect the goals of the organization.

Leaders have four main responsibilities. The first is to establish direction, vision, and the strategy to reach that vision for the future. The second is to align people around the vision through communication. This step is critical for leadership because it is where buy-in of the vision occurs. The leader must establish support for the vision in order to make it a reality in the present. The third responsibility of leadership is to motivate and inspire. These two topics are most popular when discussing leadership. And finally, leaders must overcome political, bureaucratic, and resource barriers to make change happen.

Kowalski (2003) describes the Five C's of Leadership as character, commitment, connectedness, compassion, and confidence. Individuals should evaluate their personal leadership skills by evaluating their behavior in private situations. Is keeping one's word and valuing other people a common behavior?

Integrating the Roles of Manager and Leader

Not all leaders are managers, and not all managers are leaders. All managers have formal authority through title and position in the organization, but some leaders have no formal authority or title; these are informal leaders. Although the term manager and leader are often used interchangeably, distinct differences between the roles do exist, as well as overlap in the function of the two roles. For example, a leader may be able to articulate a compelling vision of a highly functioning unit in which patient care is exemplary and the staff is performing to their highest level. However, if the leader who articulates this vision is unable to ensure that day-to-day operations are carried out effectively, staff will not be inspired to work toward the goal(s) that have been set. Managers who find that they are weak on leadership must strive to develop their leadership skills. (Donnelly, 2003)

Nursing managers and leaders must understand their role in the importance of communication both within and outside of the organization. Each word, action, or statement may be taken out of context. Therefore, words must be weighed carefully. As discussed in Lecture 7, communication is imperative to conflict resolution. The focus for this week will be on the styles of communication and role of the leader in communicating a shared vision.

Non-verbal communication

According to Select, Assess and Train (2007), studies show that during interpersonal communication, 7% of the message is verbally communicated and 93% is nonverbally transmitted. Of the 93% that is nonverbal, 38% is through vocal tone and 55% is through facial expressions.

Body language might be the oldest language, and it can be the determining factor of whether leaders are successful. Good posture indicates that a leader is confident, and making eye contact tells the receiver that the speaker is interested in them, although it can be tricky due to varying cultural norms. Hand movements can reveal what the mind is thinking. Hands with little movement signify calmness. Hands that are active may indicate nervousness or tense situations. A person who is defensive and is rejecting a message will most likely fold their arms, cross their legs, or turn their body away from the speaker.

Listening is a key element in nonverbal communication. Gabor (1994) gives these tips for T-A-C-T-F-U-L conversations:

T = Think before you speak

A = Apologize quickly when you blunder

C = Converse, don't compete

T = Time your comments

F = Focus on behavior?not on personality

U = Uncover hidden feelings

L = Listen for feedback

In other words, what is said is not nearly as important as how it is said.

Verbal Communication

Verbal communication is the most common type of communication and perhaps the most dangerous. Leaders and managers must possess skills and knowledge to discern whether the information presented are the facts or whether the information is out of context. Adeptness in acquiring information and questioning will save the leader from communicating decisions with grave consequences.

Mistrust results when information is withheld, resources are allocated inconsistently, and employees have no support from management. It doesn't matter if these things have actually happened or not. As long as the perception exists that these situations are real, the climate of mistrust will escalate and employee alienation will grow (Fitzpatrick, 2003, p. 129).

Making presentations to groups or key individuals is a regular part of the leader's role. Delivering a comprehensible message that is required to gain support requires practice, review, and a willingness to overcome the greatest fear in communication?public speaking. In public speaking or when giving any presentation, it is imperative to know the subject. A speaker should be prepared for a situation in which the audience questions the content and its validity.

Technology can be a great aide to communication, except when it does not work. Having a backup plan is essential. In the early part of the presentation, the speaker should gain trust with the audience and intrigue them so that they want more information. The core of the presentation should be kept concise, and feedback should be asked for in the end so that the speaker will know how to improve for the next time. In a small group, feedback and questions can be asked for periodically.

Speaking one-on-one with an individual is quite different from a presentation, but it still has the potential to be intimidating, depending on the subject matter and situation. Techniques to overcome this uneasy feeling include the use of open-ended questions that encourage expression and open dialogue. A speaker may ask, "Would you mind telling me more about that?" He or she can also use eye contact and lean forward. Being natural and relaxed also helps. Paraphrasing the message in fewer words can confirm whether the message was received accurately. Throughout the conversation, the speaker should be conscious of his or her tone. Tone sets the stage for open or closed conversation. To conclude the conversation, the main points can be summarized to check that the receiver is in agreement with what has been said.

Written Communication

Many people are intimidated by writing because when something is in written form, it cannot be taken back and is open to scrutiny indefinitely. Thankfully, today's technology takes grammar, spelling, and punctuation to a new level of error prevention. Some basic tips when writing include the following:

1) Avoid the use of slang words or conjunctions.

2) Do not fall prey to repetitive words or phrases?when in doubt, consult a thesaurus.

3) Spell out all acronyms when first referring to an entity? once identified, you may then use the abbreviation.

4) Steer clear of the use of symbols.

5) Keep sentences short, but not choppy.

6) Check the spelling of names of people or companies.

Letter writing should start with an overall summary in the first paragraph. This tells the reader why this information is important to read. The body of the letter should explain the reason for the letter and the background information. The closing is the final impression a writer leaves and should emphasize the importance of an action item such as a follow-up. The writer should proofread the letter thoroughly for punctuation, content, conciseness, and flow. It is important to ensure that the message is clear. Finally, contact information should always be included.

In these modern times, most written communication in business is conducted via e-mail. Although one may feel tempted to treat e-mail more casually than a business letter, remember that this is still business communication. Perceptions of people are determined, in large part, by the tone set in e-mail and other forms of communication. When in doubt, err on the side of formality, rather than informality in e-mail. No one should write anything in an e-mail that they would not want others besides the sender to see. There is no way of knowing to whom the e-mail may be forwarded. Never use ALL CAPS in e-mail as this can be perceived as shouting at the reader. Finally, keep e-mails short. If the reader has to scroll down to read the end of the message, there is a good chance it will not be read.

Career Planning and Resume Development

Frank Lloyd Wright once said, "I know the price of success; dedication, hard work, and an unremitting devotion to the things you want to see happen." This requires, of course, that one knows what one wants in life and in a career. The first step then, in career planning, is self-reflection in order to discover what one's true desires are. Without spending time examining the wishes of the heart and mind, it is impossible to create a plan for success in one's career. Once a career plan has been defined, career goals can be set that will enable the end point to be reached.

After this work has been done, one must create a resume that will enable the individual to gain employment in the organizations that will best facilitate one's career goals. In nursing, many positions at the front line do not require a resume but only an application. However, it is important to note that while the application may give the employer the information that they desire, the resume gives the applicant an opportunity to call attention to those values, skills, and interests which the nurse believes are of importance to the role in question. The resume should point out to the prospective employer the applicants strengths and passions, both professionally and personally.

Rather than beginning a resume with an objective, an innovative approach is to include a profile, written in an active voice. Whereas an objective tells the employer what the applicant is seeking, a profile highlights for the employer what the applicant brings to the role.

Guidelines for successful resume preparation from Marquis and Huston (2006) include:

1) Type the resume in a format/font that is easy to read.

2) Emphasize your strong points and minimize your weaknesses.

3) The resume should be free of grammatical or syntactical errors.

4) The resume should be written in a direct manner using active voice whenever possible.

Communicating a Shared Vision

"Vision without action is a daydream. Action without vision is a nightmare." ? Japanese proverb.

This statement illustrates well the importance of vision, and a vision is only as good as the extent to which it is communicated effectively to those who must make it come alive. Vision gives purpose to an organization and its employees and meaning to daily tasks. Leaders establish integrity when communicating vision, walking the walk, and talking the talk. Some of the core behaviors that leaders use to communicate vision include showing empathy, demonstrating ethical decision-making, and focusing on planning and the intricacies of impact when action is taken. It is critical to involve others and communicate vision through many different methods and with a variety of strategies. This tactic gives people the opportunity to adjust, adapt, and embrace the change that is inherent in moving towards the future. An open communication model is imperative to the success of the leader and the organization.

CONCLUSION


Although managers and leaders have distinct roles within an organization, the most effective people will blend the functions and roles in their work. Management keeps the wheels turning, making sure the lights are on, that people get paid, and that everyone is meeting their targets. Leadership involves taking risks, changing things that require change for the growth of the organization, sharing one's ideas and opinions, and exposing oneself to criticism. It takes both managers and leaders to keep an organization running and to move the organization into the future. If one person is both a manager and a leader, the organization benefits through efficiency and effectiveness.

A successful leader must be:

1) Known to those he or she hopes to lead?must be visible and approachable.

2) Expert in the development, execution, and evaluation of public relations plans.

3) Articulate with one-on-one conversation, small groups, or large audiences.

4) Capable of convincing all stakeholders of the possibilities inherent in the future.

5) A great listener, both inside and outside of the organization.





Leaders need to be keenly aware of their verbal and nonverbal communication styles. Having emotional intelligence in these areas can prevent chaos and support a flourishing organization.



REFERENCES


Donnelly, G. F. (2003). How leadership works: Myths and theories. Five keys to successful nursing management. Philadelphia: Lippincott, Williams, & Wilkins.

Fitzpatrick, M.A. (2003). Getting your team together. Five keys to successful nursing management. Philadelphia: Lippincott, Williams, & Wilkins.

Gabor, D. (1994). Speaking your mind in 101 difficult situations. New York: Simon & Schuster.

Kotter, J. (1990). A force for change: How leadership differs from management. New York: Free Press.

Kowalski, K., & Yoder-Wise, P. S. (2003). Five C's of leadership. Nurse Leader, 1(5), 26-31.

Marquis, B. L., & Huston, C. J. (2009). Leadership roles and management functions in nursing: Theory and application (6th ed.). Philadelphia: Lippincott, Williams, & Wilkins.

Select, Assess & Train. (2007). Non-verbal communication.

The Teal Trust. (n.d.). Our definition of leadership.

Ross, A., Wenzel, F. J., & Mitlyng, J. W. (2002). Leadership for the future: Core competencies in healthcare. Chicago: Health Administration Press.
Please let me know early if you need additional instructions for this order.
Thank you ,
Lucy Amenyo.