Nursing and Midwifery Leadership in the Clinical Setting

1. Nursing and Midwifery Leadership in the Clinical Setting Mary Nyakinyi Kamau Matron, Coptic Hospital Email: mkamau@coptichospital.org 2nd “Building Capacity for Nursing and Midwifery Leadership in Africa” Conference13th & 14th June 2019

2. Objective • To mentor / inspire nurses aspiring to rise in their respective health institutions to leadership positions.

3. The Coptic Hospital

4. What is leadership? • Many definitions (Howieson & Thiagarajah 2011). • The process of getting people to do their best to achieve a desired result (Carragher and Gormley,2017). • Developing and communicating a vision for the future, motivating people and gaining their engagement (Armstrong 2009, p.4).

5. What is leadership? Cont... • The appeal of Armstrong's view is that leadership as a social construct can be supported and developed rather than being reliant on the characteristics of an individual. • In other words, contrary to the traditional trait theories of leadership, leaders are not just born, they can also be made (Gentry et al.2012).

6. A Clinical Leader • A clinical leader wields clinical expertise in specialist practice domains and uses interpersonal communication skills to support nurses and other healthcare providers to deliver high-quality patient care ( Harper 1995)

7. Leader(ship) and Patient Outcomes. • According to the American Association of colleges of nursing(2007),hospital nurse leader can improve patient outcomes, enhance patient care and advocate for reforming health care delivery(Adatara et al 2016) • Schein (2004) stated that effective and efficient nursing leadership is the driving force of the success or failure of every health care organization.

8. Clinical Nursing Leader(ship) L- Lead, Love, Learn E- Enthusiastic, Energetic A- Assertive, Achiever D- Dedicated and serious E- Effective, Efficient R-Responsible

9. The Power of Clinical Leadership. Vision Where we are going = Leadership and Innovation Method The way that improvement will happen Expectations How people will have to change

10. The Clinical Leadership Model • The model has 4 ELEMENTS that help explain clinical leadership: • Experience. • Understanding. • The internal environment. • The external environment.

11. Attributes of a Clinical Leader. • Clinically competent and Visible in practice • Effective communication skills. • Supportive. • Values and beliefs focused. • Approachable. • A motivator and Role model for others. • Decision maker. • Focused on excellence and quality care

12. The Coptic Leadership influence: ‘

14. The Coptic Leadership: My Influence. • Proverbs 29:18 • I use Transformational Leadership style. • Transformational leaders have: • Charisma to communicate vision, • Confidence to act in an inspirational way. • Staff respect and loyalty.

15. Areas of challenges. • Hospital challenges are global. • The CMH challenges fell into 3 categories. • Inefficient healthcare systems. • Lack of systematic quality evaluations. • Insufficient staffing. • Each challenge called for a different, yet intertwined approach to improve quality of care

16. Strategies Employed. • Introduction of the CQI Department in the hospital and training the staff. • Identification of Nursing Clinical Care Indicators in the hospital. • Introduction of Quarterly Clinical Audits • Training of the Staff On Audits Tools. • Weekly Nursing CME has been emphasized. • Monthly skill checks on the nursing care aspects

17. Strategies Employed Cont... • Introduction of ward Monthly Ward Audit. • Introduction of NCK guideline on Nurse- Patient Ratio. • Recruitment of Highly Skilled Nurses to head the departments. • Introduction of a Detailed Orientation Program for the new nurses.

18. Strategies Employed Cont… • Introduction of SBAR inreport handover. • Introduction of several nursing documentation tools. • Introduction of the Nursing Process. • The introduction of Clocking System at the ward level for all the shift.

19. Strategies employed Cont... • Introduction of primary nursing model of care as opposed to team nursing model. • Introduction of sister covering in the hospital to offer around the clock monitoring of the nursing activities in the hospital. • Introduction of Two Weekly Charge nurses meeting. • Introduction of the nurses at the central booking point.

20. Challenges Encountered as a Nurse Leader. • Young workforce. • High nursing staff turnover leading to Shortages. • Poor skill-mix. • Inability to attract and retain best nurses. • Lack of caring and compassion among staff as well as Incompetent Leadership. • Engagement with none nursing issues which consume nursing time.

21. Nurses Voices: a Recent Survey • Poor employment conditions. • Heavy workloads. • Lack of career prospects. • Inadequate support from managers. • Lack of work-life balance. • Workplace conflict/Bullying. • Limited time and opportunities for CPD (Gabrielle et al. 2008)

22. Leadership Principles Tapped into to Overcome the Challenges. • Exhibit passion. • The best way to motivate the employees is by being utterly passionate about the job we do. • Know yourself. • A leader needs to be, know and do. • Be:- Having strong values that guide your life. • Know:- Being acutely aware of the structure of your hospital and your personal responsibilities. • Do:- Executing the ideas you have.

23. Leadership Principles Tapped into to Overcome the Challenges Cont… • Choose your team. • Team selection is imperative for a leader. • It shows your ability to find skills and knowledge. • When choosing the team, look for people who understand your vision and have a particular set of competencies. • Be responsible. • It took time for me to understand, as the leader in my hospital, that everything and everyone is my responsibility.

24. Leadership Principles Tapped into to Overcome the Challenges Cont… • Be responsible. • It means taking responsibility for everything in your organization, even when it's not your fault. • This helps you acknowledge mistakes and immediately find ways to correct and learn from them, rather than pointing fingers at colleagues or circumstances. • Be self-motivated. • Like happy children receiving praise from their parents, employees need a healthy diet of praise to feel empowered and motivated at work.

25. Leadership Principles Tapped into to Overcome the Challenges Cont… • Have a Clear Vision and Goals. • As a leader, you need to have a clear picture of the hospital’s future. • This means having a clear vision for your hospital, where it fits into the industry and how you plan to serve your customers. • Setting goals is a crucial step in realizing your Hospital’s vision.

26. Summary of Best Practices. • Implementation of nurse leader rounds to assess and improve patient satisfaction and loyalty. • LBWA Approach: Gives you the opportunity: • To observe team members interacting with patients and families, • Let your staff know you are interested in them and their work, • Evaluate the quality of care delivered, • Demonstrate your interest in daily operations

27. Our Success Stories. • The hospital have acquired a level six status hospital after being approved by the NCK to be a nursing training school • Tripled Patients numbers since Sept. 2015. • Tripled consultants with admitting rights. • Creation of new departments; • The first comprehensive stroke unit in the country • State of the art VIP wing. • Dialysis unit moved from dialyzing 15 -35 patients/day.

28. Our Success Stories. • The ICU has grown to a 19 bed capacity. • Has 8 ventilators from 5. • Has a doctor available 24-7. • Has ICU trained nurses. • Nurse patient ratio is 1:1 for ICU and 1:2 for HDU.

29. Our Success Stories. • The operating theatre have increased the operated cases from an average of 9 patients per day to 35 patients per day • Recruitment of peri-operative nurses. • The theatre operated with maximum 3-4 nurses now they have over 15 nurses among others staff. • Last year the theatre went into record as the first theatre in the country to perform the first lower and upper limb implantation in the country

30. Our Success Stories. • The maternity care delivery has greatly improved with a bed occupancy of 95% and above with high patient satisfaction rate based on patient feedback. • Improvement of new born unit into a state of the art NBU care center from an average of 1-3 babies to over 30 babies.

31. Private verses faith based leadership experiences. • Private practice patients get to the hospital ready to pay unlike in FB practice where they expect to be treated for free. • staff turnover in the faith based. • Young inexperienced workforce in faith based practice. • Lack of motivation in faith based practice . • Working atmosphere is less stressful in faith based practice.

32. In Leadership, SUCCESS IS SUCCESSION. • If someone coming along or behind me is NOT ABLE to take what I have offered and built on it then I have failed in my responsibility to the NEXT GENERATION.

34. Thank You

35. References • Adatara P, Kuug K, Avane M et al,. 2016. A cross sectional study to examine perspective of nursing unit managers on factors affecting the effective performance of their roles in the Volta regional hospital, Ghana. Pyrex Journal of Nursing and Midwifery. 2, 1, 1-6. [Google Scholar] • American Association of Colleges of Nursing,2007. White Paper on the Education and Role of the Clinical Nurse Leader. American Association of Colleges of Nursing, Washington DC.[Google Scholar] • Carragher.J and Gormley.K , 2 0 1 7. Leadership and emotional intelligence in nursing and midwifery education and practice: a discussion paper. Journal of Advanced Nursing 73(1), 85–96. doi: 10.1111/jan.13141 • Daly, J, Jackson, D, Mannix, J, Davidson, PM & Hutchinson, M. ,2014. 'The importance of clinical leadership in the hospital seting', Journal of Healthcare Leadership, vol. 2014, no. 6, pp. 75-83. Article available on Open Access • Schein, E., 2004. Organizational Culture and Leadership. Third edition. Jossey-Bass, San FranciscoCA.[Google Scholar]