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9 Nurses Leading Change
Pages 275-300

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From page 275...
... Even so, educational institutions and health systems can better prepare and empower new and practicing nurses, in cluding licensed practical nurses, registered nurses, advanced practice registered nurses, and those with doctoral degrees to develop and grow in leadership roles. To this end, it will be necessary to place more inten tional focus on providing models and opportunities for the emergence of more diverse nurse leaders who can reflect the people and families they care for and can mentor and serve as role models for underrepresented students.
From page 276...
... . This chapter focuses on how nurse leaders can, and do, address social determinants of health (SDOH)
From page 277...
... Nurses leading community organizations often lead team members and partner with community members and organizations in other sectors. Nurses serving on health care boards can exert leadership influence on the organization's policies and structures while not leading day-to-day organizational operations.
From page 278...
... . Each of the various leadership roles described above involves different skills and responsibilities, as shown in the framework for nurse leadership in Table 9-1.
From page 279...
... NURSES LEADING CHANGE 279 A FRAMEWORK FOR NURSE LEADERSHIP TABLE 9-1 A Framework for Nurse Leadership Nurses Leading Leadership Nurses Nurses Leading Nurses Leading Beyond Health Role Leading Self Others Health Care Care Engage the Get to Facilitate Assess community Lead and work community know the opportunities needs and with community, community to become engage with the state, and and its unique involved in the community and national coalitions strengths and community other partners to to address needs address them structural and systemic barriers Represent Provide Lead and serve Lead and Serve on boards and the nursing participate in and expert communicate perspective groups, serve multisectoral panels, pursue the nursing with other as a union collaborations, perspective health representative, serve in and appointed professionals, participate in professional political patients, and interprofessional associations and positions, hold communities collaboration organizations C-suite positions Advocate Advocate Advocate for Advocate for Advocate for for self others, help organizational legislative and (e.g., report other nurses policies and regulatory workplace be healthy and structures that changes hazards and well, advocate support nurses at the bullying, for patient and and promote community, speak up for community equity state, and self) needs national levels Improve Practice Set a culture of Lead with a Work to equity nursing with equity, diversity, health equity dismantle compassion and inclusion lens; implement structural and cultural policies and racism and humility, systems that discrimination understand promote and address equity and own bias address racism, discrimination, and bias in the organization Improve Provide Encourage Implement Pursue policies health care quality health innovation programs and and systems at care and quality lead/translate the state and improvement research and federal levels evidence to that ensure workplace improve quality access to quality of care, address care for all structural barriers, and reach underserved populations SOURCE: CCL, 2010.
From page 280...
... Nurses Leading Health Care Nurses lead in numerous ways within health care, both in health care organizations and beyond their organizational boundaries. Within an organization, nurses can assess the organization's readiness to address issues of equity and recommend related improvement.
From page 281...
... For example, public health nurse leaders can bring together representatives of the community served along with leaders from other sectors, including health care, transportation, housing, and food security, to address community needs (see the section below on leading multisector partnerships)
From page 282...
... LEADERSHIP COMPETENCIES FOR ADVANCING HEALTH EQUITY While nurses' specific leadership roles vary depending on the focus of their work, the setting in which they work, and the people whom they lead, there are certain skills and competencies on which all nurse leaders need to draw as they work to advance health equity by creating a vision and culture of equity, putting the necessary structures and supports in place, and working both within and across boundaries to achieve the vision of health for all. The committee identified eight skills and competencies that are essential for nurse leadership in nearly every setting, which are described in turn below: • visioning for health equity, • leading multisector partnerships, • leading change, • innovating and improving, • teaming across boundaries, 1 The full committee hearing is available at https://edlabor.house.gov/hearings/inequities-exposed how-covid-19-widened-racial-inequities-in-education-health-and-the-workforce- (accessed April 8, 2021)
From page 283...
... One established mechanism in which nurse leaders can engage is community health needs assessments, which are a statutory requirement for nonprofit hospitals (see Chapter 4 for a fuller description)
From page 284...
... . The ability to develop and lead multisector partnerships is critical to achieving health equity for a number of reasons (NASEM, 2017)
From page 285...
... Leading Change Reducing disparities and achieving health equity will require nurse leaders to be skilled in leading change. To be effective, these efforts will need to be anchored in the theoretical constructs of change management and occur at multiple levels, within clinical practice, organizations, communities, populations, health authorities, and nations (Browne et al., 2018)
From page 286...
... . Likewise, nurse leaders working in the community or in multisector partnerships can encourage communication and collaboration without regard for traditional boundaries and recognize that innovative ideas can surface from an array of
From page 287...
... A partnership between the Robert Wood Johnson Foundation and IHI, TCAB created learning collaboratives at the front lines of care on medical-surgical units that engaged nurses and other front-line staff in generating and testing ideas that led to processes and practices that improved the efficiency, safety, and satisfaction of care.3 This process has the potential to be equally successful in addressing SDOH and health equity (IHI, 2020)
From page 288...
... 20) call on nurse leaders to "urge their colleagues and students to characterize, name, contest, and transform the norms, traditions, structures, and establishments that preserve White supremacy through continued effects of American colonialism." Over the past few years, the nursing literature, including statements issued by national nursing organizations, has reflected increased attention to these issues.
From page 289...
... . Nurse leaders need to be knowledgeable about and able to lead others in cultural humility and culturally competent practices, which are critical for reducing health disparities and improving access to high-quality health care (Powell, 2016)
From page 290...
... A particularly critical role for nurse leaders is mentoring nurses from traditionally underrepresented communities to build a more diverse nursing workforce and increase the number of nurses from underrepresented groups in leadership positions (Phillips and Malone, 2014)
From page 291...
... To achieve the committee's vision, however, a significant investment in broader and deeper development of nurse leadership will be needed. New and established nurse leaders -- at all levels and in all settings -- are needed to lead change that results in meeting social needs, eliminating health disparities, addressing SDOH, and ultimately achieving equity in health and health care, with the aim of improved health for all individuals and communities.
From page 292...
... To fully support the goal of diversity in nurse leadership, such programs will need to be evaluated and scaled. Nursing Education, Fellowships, and Certificates While nursing school curricula often include some information about public health, SDOH, and health equity, they do not always prepare students to engage 6  Cultural taxation refers to the phenomenon whereby faculty who are individuals of color are asked routinely to take on extra, uncompensated work to address a lack of diversity in their institutions.
From page 293...
... These types of fellowships present opportunities for nurses to grow their leadership skills, to collaborate and innovate with professionals from multiple disciplines and sectors, and to develop and implement projects within their areas of interest that relate directly to achieving health equity. In addition to equity-specific fellowships, a wide variety of fellowships available for nurses are focused on general leadership skills that can be transferred to any area and any setting, including addressing SDOH and pursuing health equity.
From page 294...
... . These organizations offer leadership courses, resources, and support, most pertaining to leadership in general rather than leadership on health equity, for current and aspiring nurse leaders.
From page 295...
... , the National Black Nurses Association, and the Philippine Nurses Association of America. One of the five strategic goals of the NCEMNA is to "promote ethnic minority nurse leadership in areas of health policy, practice, education and research" through the implementation of leadership development and mentorship programs (NCEMNA, 2020)
From page 296...
... Conclusion 9-5: A critical role for nurse leaders is mentoring and sponsoring nurses from traditionally underrepresented communities in order to build a more diverse nursing workforce and increase the number of underrepresented nurses in leadership positions. REFERENCES AACN (American Association of Colleges of Nursing)
From page 297...
... 2016. Growing nurse leaders: Their perspectives on nursing leadership and today's practice environment.
From page 298...
... 2018. Understanding the invisibility of black nurse leaders using a black feminist poststructuralist framework.
From page 299...
... 2020. The role of nurses in eliminating health disparities and achieving health equity.
From page 300...
... 2019. A new generation of nurse leaders.


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