Empowering Nurses to Lead
Every Nurse in Every Setting
North Dakota Action Coalition Leadership Program
Copyright ND Center for Nursing 2014
The North Dakota Action Coalition is a member of the
Campaign for Action that was established in response to
Institute of Medicine Future of Nursing
Recommendations.
Website: www.campaignforaction.org
Institute of Medicine Report
High-quality, patient-centered
health care for all will require a
transformation of the health care
delivery system
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Campaign for Action Areas of Focus
Leadership
Practice & Care
Interprofessional
Collaboration
Education
Diversity
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The North Dakota Action Coalition is focused on the
leadership development area of focus from the National
Campaign.
We have been working in
groups over the last two years
to develop leadership training
customized to the needs of
North Dakota nurses.
www.ndcenterfornursing.org/nd-action-coalition/
Every Nurse
in Every Setting
Nationally, it has been shown that when nurses are positioned
to influence system practice and policies
it leads to improvements in quality of care,
wellness, and reduced medical errors.
Nurse-led initiatives have:
• Reduced falls with harm
• Reduced “code blue” calls
• Reduced 30-day re-admissions
• Improved care transitions.
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What Can You Do as a Nurse Leader?
• Volunteer
• Speak up at workplace
• Pursue lifelong learning
• Serve on boards and enter policy
debates
• Mentor
• Seek out committees
• Share the Institute of Medicine report
• Support academic progression
• Teach the next generation
• Join the North Dakota Action Coalition
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The North Dakota Action Coalition is co-lead by:the
ND Action
Coalition
North Dakota Center for Nursing
• Patricia Moulton, PhD Executive Director
• Established in 2011
• 501c3 non-profit organization
• Vision: A unified voice for nursing
excellence
• Mission: Guide the ongoing development
of a well-prepared and diverse nursing
workforce to meet the needs of the
citizens of North Dakota through
research, education, recruitment and
retention, advocacy and public policy.
www.ndcenterfornursing.org
University of Mary Harold Schaefer
Emerging Leaders Academy
• Cheryl Kalberer, MED, Coordinator,
Emerging Leaders Academy
Coordinator at the University of
Mary
• Established in 1998
• Experiential leadership development
program for select students
• Mission: To identify and develop
servant leaders of moral courage
• Guided by an external advisory
board of representatives from across
the health care profession
• http://www.umary.edu/academics/e
mergingleadersacademy/ela_tab1.p
hp
Leadership
Is…….
Is not…….
• Everybody’s business
• Relational
• Learned
• Self-development
• An ongoing process
• A title
• A right
• A job
• In your genetic makeup
• A means for power
Leaders and Managers : Change Agents
MANAGER:
• Administers
• Maintains
• Accepts reality
• Focuses on system and
structure
• Accepts status quo
• Asks how and when
• Does things right
LEADER:
• Innovates
• Develops
• Investigates reality
• Focuses on people
• Challenges status quo
• Asks what and why
• Does the right thing
The North Dakota Action Coalition Leadership Program
is divided into 4 modules.
Communication is foundational
for learning and understanding
about systems. Knowledge of
how systems function is
necessary to institute change.
The ability to accept and
engage in change is necessary
to be an advocate for health
policy.
North Dakota Action Coalition Leadership Module
Authorship
Module Chair(s):
Module Consultant:
Module Committee Members:
The learning module
begins with the next
slide.
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ECHO
Essential Communication
Hearing Ourselves
Presented by the North Dakota Action Coalition
Communication Group
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The purpose for this learning activity is to introduce the 5 factor model for
becoming a skilled communicator and to provide reflective practice tools
that grow your communication skills.
Objectives
1. Define communication.
2. Review the 5 factor model for becoming a skilled communicator.
3. Review the use of self-reflection.
4. Review frameworks/ standards/ codes that inform the practice of selfreflection in nursing.
5. Use self-reflection to develop expertise for becoming a skilled
communicator.
6. Develop your personal action plan to become a skilled communicator
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To successfully complete this learning activity
and be awarded contact hours:
• The learner must
• Complete the module and the additional reading assignments.
• Complete the learning activities.
• You will need to write in a journal during this learning activity, you may do so either on
paper or by using your computer. Save your work so you can access it and re-read your
thoughts.
• Complete course and self evaluations.
• To earn a certificate of Achievement in Leadership Development you will need
to complete the additional project as described at the end of this learning
activity.
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Opportunities for further
learning are presented
through-out this learning
activity.
You are urged to take time
to engage in these extra
learning activities.
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Communication is
far more than speaking ….
It is about HEARING not only
what others say to us but
HEARING what we say to
others.
To become a skilled
communicator we must learn
to hear ourselves.
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Becoming a skilled communicator requires 5 factors:
 Becoming aware of self-deception
 Becoming reflective
 Becoming authentic
 Becoming mindful
 Becoming candid
The foundation for this learning activity is based on the Five Factor Model of Becoming
a Skilled Communicator (Kupperschmidt, Kientz, Ward, and Reinholz, 2010).
http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/
OJIN/TableofContents/Vol152010/No1Jan2010/A-Healthy-Work-Environment-andYou.html
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Becoming reflective exposes
self-deception, which leads to
discovering your authentic self.
The act of reflection leads to
heightened awareness /
alertness to verbal and
nonverbal communication
(emotional intelligence) which
is being mindful.
These states of becoming
prepare one to speak
purposefully, to express and
listen truthfully also known as
being candid.
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When we speak we count
on others to listen and
hear our meaning… When
we listen others count on
us to hear their meaning…
Communication is
about meaning making.
listen
speak
communication
meaning
hear
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Meaning making requires we reflect on the way we process
and store the stories of our experiences…depending on one’s
world view and adult development level shared experiences
may end up being a different story to another person.
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As we process the bits of data we
constantly receive during the act of
communicating.
We translate those bits into streams of
information.
It is in reflecting/ thinking that we turn
all those bits into knowledge and
eventually wisdom.
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We need to HEAR what we say to others….
We need to HEAR what others say to us.
25
“Most people talk
so they won’t
hear”
May Sarton, Belgian American writer
26
Communication is often filtered,
we need to inspect, clean and
sometimes replace our filters.
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There are a number of strategies and
tools to help you practice reflection
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Becoming reflective is. . .
• The process of pondering, carefully and persistently, the MEANING of
an experience.
• Creating meaning from past or current events that guide future
behavior.
• Self-questioning so situations become more clear and coherent.
• Systematically examining the past and the present to inform the
future.
• Bulman, C., & Schutz, S. (2013). Reflective Practice in Nursing, 5th ed.
Hoboken, NJ: Wiley-Black.
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What is the benefit of reflective practice in
nursing?
• Helps you learn from experiences
• Opens up your practice for others to examine - requires openmindedness and courage.
• Requires you to take on and act on criticism.
• Is intermingled with feelings and emotions.
• These feelings and emotions lead to deeper reflection.
• Fuels motivation to improve one’s practice.
Bulman, C., & Schutz, S. (2013). Reflective Practice in Nursing, 5th ed. Hoboken, NJ: Wiley-Black.
30
What specific skills are involved in reflection?
• Self-awareness
• Aware of character, beliefs, values, qualities, strengths, and limitations
• Description
• Ability to state characteristics or appearance WITHOUT expressing judgment
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Skills involved in reflection (cont.)
• Critical analysis
•
•
•
•
•
Separation of the whole into its component parts
Undertake a detailed examination of structure, elements, or parts.
Understand the nature of, how parts relate to, and influence other parts.
Include the manner ways of knowing (empirical, aesthetic, personal, ethical)
Challenge assumptions
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Skills involved in reflection (cont.)
• Synthesis (opposite of analysis)
• The process of result of building up separate elements, ideas, into a
connected and coherent whole
• Evaluation
• Make a judgment about the value of something
• Use of predefined criteria or standards
33
Reflective
thinking is a
process that
grows
knowledge,
skills,
attitudes, and
judgment
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Reflection is meant to grow and challenge our thinking…..
35
Frameworks are maps
to help guide us in
reflection.
36
Frameworks ask
a common set of
questions that
can guide our
thinking.
Gibbs Reflective Cycle
37
There are many
frameworks to choose
from or you can create
your own.
38
One framework used in
nursing is Tanner’s Clinical
Judgment Model
Consider how it compares
to the Nursing Process
•
•
•
•
•
•
•
•
•
•
•
•
•
Introduction
Background
Noticing
Interpreting
Responding
Reflection-in-action
Reflection-on-Action
Nielsen, A., Stragnell, S., & Jester, P. (2007).
Guide for reflecting using the clinical judgment
model. Journal of Nursing Education, 4(11), 513516.
Assessment
Diagnosis
Outcomes identification
Planning
Implementation
Evaluation
ANA’s Nursing Scope and Standards, 2nd
Edition, 2010
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The Nursing Process & Tanner’s Clinical Judgment Model
Introduction (Assessment)
Your view of the situation
(Be aware of your viewpoint)
Background (Assessment)
Relationship, experiences, formal knowledge
(Be aware of the factors that create your background)
Noticing (Assessment)
Initial and later
(Be aware of your patterns for sensing situations)
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The Nursing Process & Tanner’s Clinical Judgment Model
Interpreting (Diagnosis)
Cause, patterns, similarities, differences, observations, data
(Be aware of your viewpoint, how does it impact your meaning
making)
Responding (Outcome planning, Implementation)
Actions, stressors, feelings
(Be aware of your patterns)
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The Nursing Process & Tanner’s Clinical Judgment Model
Reflection-in-Action (Evaluation)
Think about practice while doing it
(This takes practice)
Reflection-on-Action (Evaluation)
Thinking back on what we have done to discover how we may have
contributed to the outcome or unexpected outcome.
(Consider working with someone you trust to help clarify your point of view)
http://simulation.laerdal.com/forum/forums/storage/14/4049/thinkinglikea
nurse.pdf
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You are strongly encouraged to utilize these
frameworks for self care in becoming a skilled
communicator.
43
For the reflective process to be
effective, we must reflect on how
we see ourselves in any situation.
What self-deceptions do we hold?
Have you examined your role and
perceptions about
miscommunications that have
occurred?
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Reflective exercise to
become aware of self-deception
Reflective Exercise
 Do I fully appreciate the work of nursing and the environment in which that work takes place?
 Do I base my practice on the Code of Ethics for Nurses?
 Do I assume responsibility for attaining and maintaining my work environment?
 What is my definition of my work environment?
 Is my definition complete?
 How would others describe the workplace?
 Is that description how all members feel?
 If there is collective unhappiness what is my responsibility in perpetuating the perceived shortcomings?
 Am I open and trustworthy?
 Do I acknowledge and change routines and behaviors that have hindered communication?
 Commit at least 10 minutes to each question, write your reflections in your journal.
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Authentic – Are you the real deal?
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Over the next several slides Nursing’s Standards of Professional
Performance are briefly reviewed. These standards describe a
competent level of behavior in the professional role.
Standard 7. Ethics
Standard 8. Education
Standard 9. Evidence-Based Practice and Research
Standard 10. Quality of Practice
Standard 11. Communication
Standard 12. Leadership
Standard 13. Collaboration
Standard 14. Professional Practice Evaluation
Standard 15. Resource Utilization
Standard 16. Environmental Health
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• Standard 7. Ethics
• Practices ethically
Review the ANA Code of Ethics for Nurses
http://nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/E
thicsStandards/CodeofEthics.aspx
Review the International Code of Ethics for Nurses
http://www.icn.ch/about-icn/code-of-ethics-for-nurses/
• Standard 8. Education
• Attains knowledge and competencies that reflect current nursing
practice
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• Standard 9. Evidence-Based Practice and Research
• Integrates evidence and research findings into practice
• Standard 10. Quality of Practice
• Contributes to quality nursing practice
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• Standard 11. Communication
• Communicates effectively in all areas of practice
• Standard 12. Leadership
• Demonstrates leadership in the professional practice
setting and the profession
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• Standard 13. Collaboration
• Collaborates with the healthcare consumer, family, and
others in the conduct of nursing practice
• Standard 14. Professional Practice Evaluation
• Evaluates her or his own nursing practice in relation to
professional practice standards and guidelines, relevant
statutes, rules, and regulations
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• Standard 15. Resource Utilization
• Utilizes appropriate resources to plan and provide nursing
services that are safe, effective, and financially
responsible
• Standard 16. Environmental Health
• Practices in an environmentally safe and healthy manner
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Your performance as a nurse. . .
Reflective
Exercise
• Do you practice ethically?
• Do you attain knowledge and competencies that reflect current nursing
practice?
• Do you integrate evidence and research findings into practice?
• Do you contribute to quality nursing practice?
• Do you communicate effectively in all areas of practice?
• Do you demonstrate leadership?
• Do you collaborate with the health care team, patient, family, and others in
conducting your practice?
• Do you evaluate your practice in relation to professional standards?
• Do you use appropriate resources and provide safe, effective, and
financially responsible nursing service?
• Do you practice in an environment that is safe and healthy?
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Authentic Leadership
• Acknowledge your strengths and weaknesses
• List both your strengths and your weaknesses
Reflective
Exercise
• Consider your weaknesses your initial guide for self-development
• What is your purpose?
• Do you hold and practice professional values?
• Do you role model professional behaviors?
• Do you practice through your heart as well as your mind?
• Do you have enduring relationships?
• Do you treat others with respect?
• Do you practice self discipline?
• Do you seek out and act on feedback?
• How do you behave when you receive feedback?
• Commit one hour to writing your responses in your reflective journal.
• Bulman, C., & Schutz, S. (2013). Reflective Practice in Nursing, 5th ed. Hoboken, NJ: Wiley-Black.
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Brief side track on the topic of emotional
intelligence . . .
Emotional intelligence (EI) refers to the ability to perceive, control and
evaluate emotions.
The subset of social intelligence that involves the ability to monitor one's
own and others' feelings and emotions, to discriminate among them and to
use this information to guide one's thinking and actions.
(Peter Salovey and John D. Mayer, 1990)
To read more
http://psychology.about.com/od/personalitydevelopment/a/emotionalintell.
htm
http://www.mindtools.com/pages/article/newLDR_45.htm
http://www.ei-nurses.com/2e.php
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Becoming Mindful. . .
Paying
attention in a
non-judgmental
manner. . .
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Exercise for becoming mindful
• What is mindfulness?
Mindfulness is the act of being intensely aware of what you're sensing and
feeling at every moment — without interpretation or judgment.
• Spending too much time planning, problem-solving, daydreaming, or
thinking negative or random thoughts can be draining. It can also make you
more likely to experience stress, anxiety and symptoms of depression.
• Practicing mindfulness exercises, on the other hand, can help you direct
your attention away from this kind of thinking and engage with the world
around you.
Http://www.mayoclinic.org/mindfulness-exercises/ART-20046356
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The art of reflection instead of reaction…
• PBR3
•
•
•
•
•
Pause (stop your negative thinking, your habitual response)
Breath (slow deep breathes, to trigger your parasympathetic nervous system)
Relax (comes with breathing)
Reflect (instead of reacting)
Re-write your story (don’t jump to conclusions, instead strive to cleanse
deceptions, what is the real story?)
• www.americannursetoday.com/.../11a8ce23-ea5c-4cff-b7ea-9a4fb5ca17
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Each person brings their
own unique ways of
speaking and listening
to communication.
Practice suspending
judgment while
listening to others.
Be fully present.
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Becoming Candid
The ability to speak frankly, free from bias, a
willingness to risk speaking/ hearing the truth.
Happens in environments where there is
sufficient trust.
Must be willing to suspend judgment while
listening to others.
Must be willing to hear what you are thinking
and quiet your mind.
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An approach for becoming candid. . .
Carefronting ends the blame game.
Reflective
Exercise
Stop and ask yourself:
• What is the respectful thing to do now? (Respect for both yourself
and others)
• Where do we go from here?
• When do we begin to discuss the conflict- if not now, when?
• Who will end the blame and help work toward the professional
practice environment we all deserve?
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More resources for Carefronting
Carefronting: An innovative approach to managing conflict October 2012 Vol. 7
No. 10 Author: Rose O. Sherman, EdD, RN, NEA-BC, FAAN
http://www.americannursetoday.com/article.aspx?id=9584&fid=9534
Addressing Multigenerational Conflict: Mutual Respect and Carefronting as
Strategy (Kupperschimidt, 2006)
http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodic
als/OJIN/TableofContents/Volume112006/No2May06/tpc30_316075.html
Dr. Betty Kupperschmidt an Associate Professor of Nursing at the University of
Oklahoma, has been a pioneer in bringing the concept of carefronting to nursing
practice.
http://www.emergingrnleader.com/carefronting/
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Bringing the Five Factors together – your
action plan, first a reminder. . .
Becoming reflective exposes selfdeception, which leads to discovering
your authentic self.
The act of reflection leads to
heightened awareness / alertness to
verbal and nonverbal communication
(emotional intelligence) which is
being mindful.
These states of becoming prepare
one to speak purposefully, to speak
and listen truthfully also known as
being candid.
63
Skilled communicator action plan
• Based on your responses to the reflective exercises, develop a
personal action plan to increase communication skills.
• Enlist trusted others to help you meet your goals.
• Consider the 5 factors when developing your plan.
 Becoming aware of self-deception
 Becoming reflective
 Becoming authentic
 Becoming mindful
 Becoming candid
• Implement your plan and evaluate the outcome.
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Leadership Development
To earn your certificate of achievement in leadership
development you will need to submit the following:
• Evidence of completion of Communication Module
• Document one additional instance of applying the 5 factor model for
skilled communication in your practice.
• Document one instance of using Carefronting and the outcome of
using this technique.
• While the 5 factor model will no doubt be helpful in all aspects of you life, we
ask your examples be from interactions as a nurse.
• You may compile all the additional requirements in a portfolio and submit all
the project requirements at the end of Module 4.
Additional Recommended Reading
Bulman, C., & Schutz, S. (2013). Reflective Practice in Nursing, 5th ed.
Hoboken, NJ: Wiley-Black.
Prather, H. (2000). The little book of letting go. Berkeley, CA: Conari
Press.
Senge, P., Scharmer, C.O., Jaworski, J., & Flowers, B.S. (2004). Presence:
Human purpose and the field of the future. New York: Crown Publishing
Group.
Vital Smarts (Crucial Conversations)
http://www.vitalsmarts.com/resource-center/
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