18.3 Implementing Leadership and Management into Nursing Practice

Interdisciplinary Referrals

A critical component of patient care coordination, interdisciplinary referrals allow for a holistic approach to health care. When a primary care provider identifies a need beyond their expertise or resources, best practice is to refer the patient to a specialist to address specific health issues (Morris et al., 2021). For nurse managers and leaders, facilitating an interdisciplinary referral involves ensuring that it is appropriate, that the specialist has all the necessary information to provide targeted care, and that there is a seamless communication loop between all parties involved, including the patient. For example, a patient with heart failure may require a referral to a cardiologist at an advanced heart failure center. Many healthcare facilities utilize an electronic medical record (EMR) system, enabling practitioners to electronically submit interdisciplinary referrals. The nurse manager plays a role in facilitating this process for the primary care provider. This involves ensuring that the patient’s EMR is transmitted to the cardiologist, scheduling appointments as necessary, and educating the patient about the significance of the appointment with the specialist.

Case Management Duties

The role of a case manager, often fulfilled by a nurse, is integral to patient care coordination, particularly for patients with chronic illnesses or long-term conditions. Case managers assess patients’ needs, develop personalized care plans, and coordinate the various services and resources required to implement these plans. They act as advocates for the patient, navigating the healthcare system to ensure timely access to necessary treatments and interventions. Moreover, they monitor the patient’s progress and adjust care plans as needed, in consultation with other healthcare professionals and the patient themselves (Western Governors University, n.d.). For instance, a case manager working with a patient with congestive heart failure would coordinate care among cardiologists, dietitians, physical therapists, and home health services, ensuring that all aspects of the patient’s care are addressed in a cohesive and integrated manner. Nurse managers and leaders support case managers by providing the necessary resources, guidance, and leadership to ensure that comprehensive, patient-centered care is delivered efficiently and effectively.

Knowledge of Scope of Practice

Recall the five “rights” of delegation (Table 18.5), which were also discussed in 15.4 Nursing Standards of Delegation. To ensure all these rights are upheld, nurse leaders and managers must know the scope of practice of all potential delegates and ensure all staff also understand the scope of practice of their coworkers. As discussed in 1.3 Nursing as a Profession, scope of practice refers to the defined limits and parameters within which a professional within a particular field is authorized to work, make decisions, and provide services (ANA, 2021). Nurse leaders and managers also have the task of promoting teamwork and building a supportive environment where nurses are empowered and confident in delegating appropriate tasks, and UAP are receptive to receiving tasks (Campbell et al., 2020).

Determination of Clinical Ability

The determination of clinical ability is a critical aspect of delegating patient care, requiring nurse managers to assess the skills and competencies of their team members accurately. This involves not just a general understanding of each team member’s qualifications and experience but also an ongoing evaluation of their performance and professional development. When determining clinical ability, nurse managers must consider the following:

• The complexity of the care needs of the patient and whether the staff member has demonstrated proficiency in similar tasks.
• The staff member’s current workload and the potential impact of additional responsibilities on their ability to deliver safe, quality care.
• The need for, and availability of, additional training or support to equip the staff member with the skills needed to perform the delegated task successfully.

For example, before delegating a task such as wound care for a patient with diabetes, a nurse manager would need to assess whether the UAP has the requisite knowledge of diabetes management and wound care principles and the ability to recognize and report signs of infection or other complications. This might involve reviewing the assistant’s training records, observing their performance in related tasks, or arranging for a more-experienced nurse to provide mentorship and oversight initially. By carefully assessing clinical competency, nurse managers ensure that delegation enhances patient care without compromising safety or quality.

Mentorship

Mentorship plays a vital role in the professional development of nurses, offering guidance, support, and knowledge-sharing that can significantly impact a nurse’s career trajectory. A mentor is an experienced practitioner who serves as a role model, adviser, and advocate for a student or less-experienced colleague, facilitating their professional and personal growth. This relationship can help the mentee navigate the complexities of the healthcare environment, develop critical thinking and decision-making skills, and set and achieve career goals. For instance, a mentor might help a new nurse develop confidence in patient interactions, provide feedback on clinical skills, or offer advice on balancing work and continuing education. Effective mentorship creates a supportive learning environment that encourages curiosity, innovation, and excellence, enhancing the overall quality of care provided to patients (ANA, n.d.-b).

Preceptorship

Preceptorship is another key component of professional development, focusing on the practical application of nursing skills and knowledge in clinical settings. A preceptor is a licensed professional who coaches and supervises students or new nurses during their clinical rotations, providing hands-on learning opportunities, real-time feedback, and evaluation. This one-on-one relationship allows the preceptee to gain valuable clinical experience under the guidance of an experienced nurse, bridging the gap between theoretical knowledge and practice. For example, a preceptor working in a critical care unit might guide a nursing student through the process of monitoring a patient’s vital signs, interpreting data from medical equipment, and responding to emergent situations. Through preceptorship, novice nurses learn to apply their knowledge confidently and competently, preparing them for independent practice and contributing to their professional competence and growth (Baylor University, n.d.).

In nursing, preceptors differ from other guidance roles such as mentors, coaches, and supervisors. A mentor is a trusted individual who provides long-term guidance on the nurse’s career and professional development. Coaches help nurses work on specific performance improvements by asking questions that promote reflection and problem-solving. Supervisors oversee the nurse’s day-to-day work activities by ensuring adherence to policies, evaluating performance, and encouraging staff accountability.

Professional Organizations

As discussed in 1.2 Nursing Education Programs, professional nursing organizations are collective bodies formed by nurses to represent and advocate for the interests of the nursing profession. These organizations play a crucial role in supporting the development of nurse leaders and managers and provide numerous resources and opportunities for professional growth and networking.

Professional nursing organizations offer educational programs, conferences, and workshops designed for nurse leaders and managers. These events typically cover topics such as leadership development, healthcare administration, policy and advocacy, as well as the latest trends and best practices in nursing management. Nurse leaders and managers can enhance their knowledge, skills, and competencies by attending these events, particularly if they want to learn how to more effectively lead and manage their teams, drive innovation, and navigate the challenges of the healthcare industry. Examples of the benefits of being part of and active in a professional nursing network include the following:

• Networking opportunities: Nurse leaders and managers gain access to a broad network of peers and mentors through professional associations. Networking events (virtual and in person) facilitate the exchange of ideas, sharing of best practices, and collaborations between professionals that can influence policy and practice on a much larger scale.
• Continuing education and professional development: Many nursing organizations offer workshops, seminars, and conferences throughout the year that are designed to enhance nursing leadership skills. These educational opportunities help nurses stay current regarding the latest trends, innovations, and regulations in health care, and give them the knowledge they need to remain competent and competitive in their field. Many professional nursing organizations also provide specialized certifications and credentialing programs for nurse leaders and managers. Examples of these certifications are discussed in previous sections (e.g., NE-BC, NEA-BC, CNML, CENP).
• Advocacy and influence: Nurse leaders who are part of professional organizations are well positioned to become advocates for changes in healthcare policy, nursing practice, and patient care standards. Professional bodies often have the resources and political influence necessary to successfully lobby for legislative changes that can significantly affect the nursing profession and healthcare delivery systems.
• Research and resources: Access to cutting-edge research and a wealth of academic resources, including case studies, white papers, and evidence-based practice guidelines, supports nurse managers with learning about and implementing effective patient care strategies and operational improvements within their organizations.
• Leadership and volunteer opportunities: Participating in committees or holding office within these organizations gives nurse leaders the chance to develop critical management and decision-making skills. These roles provide them practical experience in leading diverse teams and projects, significantly enhancing their leadership capabilities and helping them feel more confident and at ease in leadership roles.
• Recognition and awards: Professional organizations often recognize outstanding contributions to the nursing field by giving awards and acknowledgments. This type of public recognition not only bolsters an individual’s career but also highlights the critical role that nurse leaders play in advancing health care.

Nurse leaders and managers may also choose to take on various roles within these professional organizations, such as serving on boards or committees, presenting at conferences, or contributing to research and publications. Examples of these roles may include the following:

• Committee membership: Serve on committees that focus on ethics, practice standards, education, and policy, providing strategic direction and making pivotal decisions that shape the profession.
• Mentorship programs: Lead mentorship initiatives to prepare less-experienced nurses for future leadership roles, enhancing the profession’s overall strength and sustainability.
• Policy development: Engage in policy development efforts that directly influence clinical practices and healthcare outcomes.
• Educational speaker: Serve as speakers or panelists at professional conferences, sharing knowledge and innovations that can educate and inspire other nursing professionals.

By actively participating in these organizations, nurse leaders can enhance their professional development and contribute to the advancement of the nursing profession as a whole. Table 18.6 lists some of the major national and international nurse leadership organizations and their respective missions, highlighting the diverse resources and opportunities available to nurse leaders and managers.

Additionally, each nursing specialty has its own professional organization, such as the Academy of Medical-Surgical Nurses, the Emergency Nurses Association, and Society of Pediatric Nurses. Most states also have multiple professional organizations, in addition to a board of nursing (BON), which oversees the practice of nursing within that state.

Continuing Education

A cornerstone of nursing practice is continuing education (CE). By participating in ongoing educational activities, nurses remain at the forefront of medical knowledge, technological advancements, and best practices in patient care. Continuing education is essential for personal and professional growth. These activities can range from workshops, seminars, and conferences to online courses and academic programs, all designed to keep nursing professionals informed and competent in their practice.

For nurse leaders and managers, supporting and encouraging CE is crucial for fostering a culture of lifelong learning within their teams. This support can manifest in various ways, such as providing time off for staff to attend CE events, offering reimbursement for educational courses, or organizing in-house training sessions on emerging healthcare trends. For example, a nurse manager might coordinate a series of workshops on the latest evidence-based practices in wound care, enabling the nursing staff to update their skills and apply new techniques to improve patient outcomes.

Moreover, CE is not only about enhancing clinical skills but also about developing leadership, communication, and critical thinking abilities that are vital for effective nursing practice. It prepares nurses to adapt to changes in healthcare delivery, meet the challenges of modern nursing, and take on advanced roles within the healthcare system. By prioritizing CE, nurse managers and leaders ensure that their teams are not only competent but also confident and innovative, contributing to the overall excellence in healthcare services.