Leadership -- nursing Discover and/or create an image, poem, quote, or selection of music that symbolizes, or speaks to you of, what it means to be a caring nurse in the organizational context. Describe why you have selected this symbol. Link your personal understanding gained by reflecting on your authentic "piece" to course literature to reveal resonance, differences and new insights.

According to Bonnie Raingruber in "Meanings in Child and Adolescent Mental Health Nursing" from the Jan-Mar 2004 edition of The Journal of Child and Adolescent Psycatric Nursing by familiarizing the nurse or patient reader and nurse and patient writer with new worlds of experience, poetry increases one's capacity to tolerate pain, understand oneself, and other people. Poetry is "dialogical: it seeks in the listener an ally whose empathy will take the form of sharing the survivor's anguish and struggle" (Kaminsky, 1998, p. 408). In light of this insight, poetry is an excellent source of inspiration for the nurse practioner to seek when considering how best to define and go about fulfilling his or her mission in today's difficult healthcare climate.

One such a poem that may prove inspiring to a nurse practioner is the following by Walt Whitman, entitled "When I Heard The Learn'd Astronomer." This great American poem is as follows:

When the proofs, the figures, were ranged in columns before me;

When I was shown the charts and the diagrams, to add, divide, and measure them;

When I, sitting, heard the astronomer, where he lectured with much applause in the lecture-room,

How soon, unaccountable, I became tired and sick;

Till rising and gliding out, I wander'd off by myself,

In the mystical moist night-air, and from time to time,

Look'd up in perfect silence at the stars.

The nurse, like the poet Whitman, must thus appreciate the silence (and the noise) in other words, the intrinsic humanity of his or her patient as well as the science of the human body that he or she must attend to in nursing practice. Of course, unlike Whitman, the nurse cannot barge out of the lecture hall, unconscious of the need to provide care in a systematic fashion. The nurse must be both a caregiver and caring human being, scientist and poet. For example as noted by Wendt and Vale in Yoder-Wise (pp. 173-189, 1999) today nurses who are working short staffed departments, caused by the nursing shortage, must often make crucial and clinical decisions to review quality care procedures under poor or barely adequate staffing conditions.

However, although the overall supply of nurses from a manager's perspective may be needed to be increased, to be able to provide quality care in the long-term, nurses must still provide care for patients on an individual patient-by-patient basis, and accept that for every patient, no matter how minor the complaint, the patient's body is still significant to the patient and the patient's family and loved ones. Under difficult circumstances, both physical and organizational, nurses must combine goals of quality management and work on contributing new ideas for improving quality care.

Lastly, Whitman offers one last breath of inspiration for the nurse -- he too, was a nurse, during the Civil War, in the field, under perhaps the most difficult battlefield circumstances one can imagine, and frequently lacking in doctor's advice, proper remedies, and other things modern nurses might be apt to take for granted!

Question 2

With reference to a nursing theorist, that you use to inform your practice, examine the nursing meta-paradigm constructs of health, person, environment or nursing. Describe how your learning from leadership course has expanded your understandings of at least two of these constructs and the relationship between these constructs in the context of thinking about leadership in healthcare organizations.

The Neuman Systems Model (Neuman & Fawsett, 2002) can provide a nurse with an ideal, unique, systems-based perspective and a unifying focus for approaching a wide range of nursing concerns within a variety of organizations and at potential sites of care. The value of the Neuman System Model comes from its author Betty Neuman's simultaneous attempt to provide a theoretical framework of nursing systems of care through a holistic overview of the physiological, psychological, socio-cultural and developmental aspects of human beings in a nursing environment.

For example when treating a patient suffering the initial stages of emphysema, a nurse would of course first have to treat the physiologic variable of the patient in terms of primary prevention, stressing that the patient must discontinue his or her...

But, acknowledging that mere knowledge of the dangers of addiction is not adequate, the nurse would also have to treat a variety of psychological and human or personal variables the patient would have to deal with upon quitting, including abandoning the patient's non-physical affection for the habit, and the depression that can come from withdrawal. Also the patient might dwell in a social environment that continued to encourage and support the habit of smoking, such as belonging to a club or enjoying a favorite meeting place such as a bar filled with smoking spouses, friends, or relatives.
On a secondary level, the Neuman System model would also counsel prevention of return to the habit by providing continuing support and counseling for such potential feelings of sadness, depression through referring the patient to outside organizational support systems, such as a counseling group for those individuals trying to quit. The nurse additionally might need, Neuman would suggest, to take into socio-cultural variables, such as a community where smoking is acceptable, to reinforce tertiary prevention methods such as increasing social support with peers in the outside environment for the person. The nurse may lastly need to refer to Neuman developmental variables regarding the environment, remembering that the patient may be at a certain life stage, such as moving into retirement that can exacerbate such spiritual conflicts as resisting change, and provide nursing psychological as well as physical support in such areas.

Question 3

Explore the concepts of leader, manager and follower as you have come to understand them from the course literature, from your own personal experience and from other sources. Trace the development of your own thinking from week one including examples of how your thinking has been changed, affirmed and expanded. Discuss how your understandings will influence your nursing practice.

An effective nurse must functions as a leader, manager, and follower within any organization he or she is a part of, not merely act as a follower with in that organizational context. On a basic, managerial level, a nurse must function the daily leader of physician's assistants and other functionaries in the hospital regarding patient care. A nurse may be appointed within a hospital context as a leader and manager of other nurses. Even in a small doctor's office, a nurse may function as a leader of secretarial or administrative support staff.

But a nurse, less obviously, must also be a leader of patients in health maintenance, prevention, and cure, as well as an advisor and manager of treatment care plans. The nurse may follow the doctor in certain care functions, such as in surgery, but need not always defer to the doctor's expertise in all functions of patient care and nursing. Rather, the nurse must be aware of his or her unique insights into holistic patient care and deploy them to both the patient and doctor's advantage. A nurse may also be called upon to give practical advice to office managers regarding time saving techniques, rotating the schedules of different staff members, or the effects of sleep deprivation regarding various schedules upon members of his or her staff.

Because the nurse may see certain patients every day when a doctor does not, a nurse may additionally have to act as a leader in terms of setting realistic parameters for outpatient care, given the patient's social as well as physical limitations. A nurse must be cognizant of the particular situation the patient dwells in, of the patient's psychological and spiritual needs, and how this relates to the patient's overall wellness. Thus, in such a capacity, the nurse must also be a leader -- but also, to some extent, a 'follower' of the needs of the patient's needs.

The nurse must also similarly act as a leader and a follower of the other nurse's own experiences and expertise, both learning from her fellow colleagues as well as leading them in a variety of capacities. A student nurse who is very familiar with a patient's medical and life needs may even in fact 'lead' a more experienced nurse in some aspects of patient care, even while expertise provides the managing guidance and hand of the overall plan of care.

Question 4

Develop a personal vision and mission statement. With reference to course literature and other sources discuss how and why this exercise has been important for you in gaining a deeper understanding of exemplary leadership, follower-ship and management. Discuss new insights that arose as you constructed your statement, as well as the implications for how you may need to be in charting your future course as a person, as a nurse…