Running head: NURSING’S LEADERSHIP ROLE
Nursing’s Leadership Role in Adolescent Girl’s Sexual Health in Kent County
Kelly J. Lockhart
Ferris State University
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Abstract
When looking at community health data, the author and other group participants identified the
population of adolescent girls in Kent County, Michigan to be at an increased risk for developing
Sexually Transmitted Diseases. The purpose of this paper is to look at ways for nurses to serve
as leaders and focus on affecting health outcomes in this specified population. The author looks
at a direct and indirect nursing role, evaluates their roles in implementing a school based
education program for adolescent girls, and leadership duties in each role. The American Nurses
Association’s Standards of Professional Nursing Practice are introduced based on the relevance
to each role. The author also reflects on each role and what would be potential options to
transition into the leadership roles discussed.
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According to the Michigan Department of community Health (MDCH), in 2012,
gonorrhea and chlamydia cases were higher in adolescent girls than boys. In 2013, MDCH also
reported that there was a significant increase of 20-24 year olds being diagnosed with human
immunodeficiency virus (HIV) (MDCH, 2013). This indicates that because of the delay between
contracting the virus and being diagnosed, much of this population was probably exposed as an
adolescent. The Center for Disease Control (CDC) stated in 2004 that “females aged 13-19 years
account for 89% of recently heterosexually acquired HIV infections” (DiNoia & Schinke, 2007).
Population Based Need
The previously identified statistics indicate need to address sexual health among
adolescent girls in Kent County. One venue to reach a large number of this identified population
is through the public schools. Introduction of a school based, nurse led sexual health curriculum
in the public schools would provide primary prevention education to this population. Primary
prevention would apply to this health topic because “clients have some level of control over the
trajectory of health or wellness” (Harkness & DeMarco, 2012 p. 71). Sexually transmitted
diseases (STDs) are preventable. Nurses can play an important role in educating young girls of
risks and health behaviors. The health belief model would provide appropriate framework for
the program by promoting healthy behaviors and helping adolescents conceptualize their risks
(Harkness & DeMarco, 2012 p. 77).
Direct Care Nurse
According to the 2012 Community Health Improvement Plan (CHIP), which is a
documented action plan for a 3-5 year period, one of Kent County’s improvement goals is to
“Engage and empower youth to reduce disparities in risk and protective factors” (KCHD, 2012,
p. 20). As a direct contact nurse, a school nurse would play an important role in engaging and
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empowering youth about the topic of their sexual health. A school nurse has a unique
opportunity to reach the students in the targeted age group individually and in the classroom.
With a school health program, the school nurse should discuss with students sexuality health,
prevention and control of disease, and personal health (Harkness & DeMarco, 2012, p. 436).
Typically, one school nurse will oversee an entire campus or district. The consistency of
the individual allows for more personalized relationships to form, often allowing for open
communication between the students and nurse and allowing an independent health assessment.
With that, the nurse is able to implement appropriate interventions and discuss individualized
health promotion behaviors for that student. The nurse may also focus on a population based
assessment, looking at a group of students and health concerns (Harkness & DeMarco, 2012, p.
436-437).
One important piece of the school nurse is health education. Sexually transmitted
diseases (STD’s) are preventable. Implementing an educational program for adolescent girls
within Kent County Public Schools would potentially decrease the incidence rates of STDs. The
school nurse’s role in this program would be to educate the children and staff about risks and
prevention relating to STDs and treatment and testing options.
Leadership
Though not in a formal leadership or management position, the school nurse would take
on a leadership role in implementing the program. The nurse would advocate to the board of
education and show the alarming statistics of the population. Data would be presented to indicate
need for the educational program. During the planning phase, the nurse would be instrumental in
organizing the program and educating staff about their roles. The nurse would also need to
coordinate with the health department, because education alone is not adequate (Harkness &
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DeMarco, 2012, p. 448). According to the community school model, collaboration providing
structured preventative services could include after school programs, parent outreach and crisis
intervention and would involve community resources outside of the school (Harkness &
DeMarco, 2012, p. 448).
Leadership is an important characteristic for all nurses. In her role with the
implementation of a school wide educational program, it would be necessary for the nurse to
demonstrate leadership. “The fundamental nature of leadership can be described as the ability to
influence others toward accomplishing common goals” (ANA, 2010, p. 163). The nurse would
demonstrate leadership among staff, community, and students. To be effective in this role, the
nurse would show patience, organization and inspiration. Transformational leadership would be
an appropriate leadership style for the nurse to utilize in order to organize and implement the
program, keeping in mind that all involved would be working toward the same goal (AANAC,
2013).
ANA Standards of Professional Practice
According to the American Nurses Association (ANA) standards describe how
practitioners are accountable for their profession and also framework for the evaluation of their
practice. The standards also define nursing’s accountability to the public (ANA, 2012). A
professional school nurse would include the ANA standards of professional practice in their
daily practice by including all of the standards. Specifically, standards one (assessment), two
(diagnosis), three (outcomes identification), four (planning), and five (implementation). The
nurse would utilize her health assessment data to identify the need for the education program and
work to focus the program on desired outcomes and begin teaching the program. Other
standards such as fifteen, resource utilization, would be important to the nurse so that she could
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provide the education to the students and also connect the students to necessary resources within
the community. Standard fourteen, professional practice evaluation, would be an important piece
for the nurse to assess the effectiveness of the program once implemented.
Indirect care nurse
Working closely with the school health nurse in this project would be the Kent County
Health Department (KCHD). According to the KCHD, their community nursing “builds healthy
foundations for youth and families in Kent County” (KCHD, 2013). The Community nursing
director at the health department would act as a stakeholder in implementing an educational
program at the school. The director would not have a direct role in educating the students, but
would work with the school nurse in developing the curriculum and supporting the program.
The role of this nurse would be more involved at the political level, potentially obtaining grant
monies for funding at the school, lobbying for governmental support, or analyzing statistical
county-wide data and making it available to the school nurse.
Leadership
The director serves in a formal leadership role. This role would require collaboration
between many stakeholders in the community including government, schools, and community
members. This formal leader would oversee initiation of the program and delegate to key
stakeholders during the process. Democratic leadership would be an effective leadership style in
this role. The democratic leader “encourages open communication and staff participation in
decisions. Workers are given responsibility, accountability, and feedback regarding their
performance. Relationships are important to this leader who places a focus on quality
improvement of systems and processes” (AANAC, 2013). This leader would oversee other
employees in the community health field. They would be responsible for hiring and managing
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employees, and would require exceptional leadership skills. This leader would need to possess
characteristics to facilitate communication and productivity. These would include resourceful,
organized, and able to delegate.
ANA Standards of Professional Practice
The community nursing director would perform in accordance to the ANA Standards of
Professional Practice. This role would be especially important in the planning, outcome
identification and implementation portions of this program (standards 3, 4 & 5). Formal leaders
are more focused on the execution of a project (ANA, 2012, p. 164). A nurse in the director role
would facilitate a highly functioning program based on educational standards (standard 8) and
ensure that all pieced of the implemented program are evidence based (standard 9) and utilize
appropriate resources in the community (standard 15).
Analysis
The roles of the school nurse and the community nursing director have some similarities.
Both roles would guide their practice based on the desired outcomes for the targeted population
group. However, this is not the only project or job duty that they would be responsible for. This
project would be carried out simultaneously to their daily responsibilities in each role.
When looking at making a program, the school nurse is more involved in delivering the
information. The director would act as a reference person and not have interaction with the
students, because this is an indirect care role. The director would have more responsibility at the
higher level, linking the program to government funding, and presenting information to
stakeholders such as the school board and the Department of Community Health. While the
school nurse would be responsible for delivery of the program, the director would monitor the
statistics for effectiveness of the implementation. This process would be ongoing and take years
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to track. Both roles would involve continued monitoring for effectiveness and revisions to the
program.
The director, since employed by a government agency would have a more direct role in
the political arena. This role would allow for the knowledge sharing of the process for purposes
of redefining the health systems to meet the needs of this population. With today’s changing
health care systems, leadership skills are necessary for advancing the profession of nursing.
While yesterday’s leaders focused on stabilization, “today's leaders must transform their
organization's values, beliefs, and behaviors” (ANCC, 2014). The director would be involved
above and beyond the county level. Representing Kent County at the state or national level and
advocating for resources or presenting the information about the program would be required.
The director role would require higher levels of education, a masters or doctoral prepared
nurse would be found in this role. The advanced level of education would support the nurse with
the skills required in their decision making and management of employees and special projects.
Reflection
While leadership is the responsibility of all professional nurses, leadership skills and
characteristics are at different levels. In order to take on project implementation, the author
would require advancement with organizational and leadership skills. Through further nursing
experience, the author will continue to build these skills. To enhance development of these
skills, the nurse should focus on project management at the unit based and organizational level,
which would help prepare for a larger scale, county wide initiative. The author’s continued role
in shared governance is a great venue to build transformational leadership skills. This
experience would provide knowledge to move into a formal leadership role in the future.
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In either role, the author would require additional nursing experience. The first role
discussed, a school nurse, would be the quickest to transition to, if desired. The experience in
acute care has provided opportunity to develop skills to educate others. The age group would be
a new challenge for the author, and difficult to adapt the teaching style. As a school nurse, much
of the interaction is with children. To transition into this role, the author could benefit from
instruction regarding growth, development and communication specific to this age group. A
mentor could assist with this transition, and may not require additional formal education.
In order to pursue a formal leadership role or become the community nursing director, the
nurse would require additional formal education. She would also benefit to coaching from other
formal leaders. Assisting with conflict resolution is something that the nurse could presently
engage in to better prepare for a formal leadership role, as this is something she feels that is a
weakness.
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References
American Association of Nurse Assessment Coordination (AANAC). (2013). Nursing
leadership: management and leadership styles. Retrieved from: http://www.aanac.
org/docs/white-papers/2013-nursing-leadership---management-leadershipstyles.pdf?sfvrsn=2.
American Nurses Association (ANA) (2012). The essential guide to nursing practice: applying
the ANA’s scope and standards in practice and education. K. White & A. O’Sullivan
(Eds.). Silver Spring, MD: ANA.
American Nurses Credentialing Center (ANCC) (2014). Magnet Recognition Program® model.
Retrieved from: http://www.nursecredentialing.org/Magnet/ProgramOverview/NewMagnet-Model#TransformationalLeadership on February 21, 2014.
DiNoia, J.& Schinke, S. (2007). Gender-specific HIV prevention with urban early-adolescent
girls: outcomes of the Keepin’ It Safe program. AIDS Education and Prevention. 19 (6),
479-488.
Harkness, G. & DeMarco, R. (2012). Community and public health nursing: evidence for
practice. Philadelphia, PA: Lippincott Williams & Wilkins.
Kent County Health Department (KCHD) (2013). 2012 annual report. Retrieved from
http://www.accesskent.com/Health/Publications/pdfs/2012_annual_report.pdf on
February 21, 2014.