Competencies in Advanced Practice Nursing - Essay Example

Competencies in Advanced Practice Nursing Collaborative Practice The healthcare system as a whole benefits from collaborative practice. The healthcare system of the future will require workers who are more multi-skilled than today. There will be a more necessary involvement by families and advanced practice nurses will be leaders in the role (Trofino, 1995). Neonatal intensive care will be right in the midst of these needs for change. Leadership practices will change out of necessity as leading will become even more complicated in neonatal intensive care nurseries where the average neonatal patient is extremely small and extremely complicated in their care needs.(McClung, 2006) and where patient care outcomes are extremely important. Practice improvement movements in neonatal intensive care are participating in multidisciplinary collaborative practice to make those improvements happen. The advanced practice nurse in neonatal nursery is leading that change and is improving outcomes because of it. Collaboration is a complex process that comes from communication. It is a process used by a team of healthcare workers to provide patient care interdependently within the framework of their respective scopes of practice for the good of the patient (Martin, O'Brian, Heyworth, & Meyer, 2008). In healthcare, collaborative practice is more than cooperation, compromise and good negotiation. It is a way to work together while respecting everyone on the team for the knowledge and skills that they possess (Chittly & Black, 2007). Advanced practice nursing is able to experience greater opportunity in the utilization of their knowledge and skills when collaborative practice occurs, allowing for increased quality of care throughout the system. (Martin et al 2008). Through its changing history, the field of neonatology has advanced rapidly in terms of the knowledge base and expertise needed to care for increasing numbers of small, sick newborn infants. Nurses working in this area have developed a tremendous skills base (Busby, 2000). This need for continually improving skills bases has led to the advent of the advanced practice neonatal nurse with a consistently changing role for leadership and collaboration. . Neonatal intensive care continues to change. Nurses and doctors in neonatal intensive care units have to have skills in interpersonal communication as well as technical expertise in order to survive in this fast changing specialty (Harris, 1994). The skill of mentoring becomes extremely important to help in the provision of vision, security, integration of needs and the fulfillment of self image as the changes in this practice occur. Advanced practice neonatal intensive care nurses work with babies who cannot communicate and have tremendous amounts of technological equipment around them. Therefore their needs must be predicted and planned for by the staff who care for them. This staff works in very close contact with the parents, all of whom are anxious and some of whom are grief stricken (Hamric, 2009). With all the technological developments, rapidly changing structures in management, politics being involved because of political climates and professional observation, as well as financial and beurocratic demands, the advanced practice neonatology nurse must have advanced skills in both communication and leadership. Often at the center point of a neonatal care team, she must be able to communicate at many different levels and skills as well as be able to communicate with families that have no understanding of medicine. In order to have a successful team, she must be able to facilitate the skill mix of the all players. She must be able to bring about a practical application for all the team members, including parents, through a collaborative effort throughout the team. This can only occur if her communication skills are superior (Nicholson, et. al. 2005). The ANNP manages to care for a caseload using consultation, collaboration, and medical supervision by a physician. She establishes and evaluates standards of care within the unit she works while assessing and analyzing the needs of the family as a whole. . She must design and implement appropriate and still interesting educational programs on the basis of needs that have been identified while providing consultation for others in the nursery and community as a whole. She will find herself part of research being done as well as participating in data collection and then implementing the indicated changes found. She will need to be able to communicate those studies, new policies, educational findings and data to a myriad of different levels of people (Manley, 1998). She will do this through the communication and collaboration shills she has mastered in her program. Communication sometimes has to occur in the neonatal nursery under the most difficult circumstances (Taylor, 1998). These are babies at risk and the ANNP may often be involved with patients and their families during times of end of life. An example would be withdrawal of life support. The support and communication that this ANNP gives may have a tremendous effect on the family and their ability to cope with the death of their infant. ANNP's are in a unique spot to create a trusting relationship with this family and the t staff that is caring for this infant (Engler, Cusson, Brockett, 2004). This care is both stressful and rewarding. The ANNP will find herself using all of her communication and collaborative skills to bring this situation to a reasonable outcome. In conclusion there are numerous obstacles and challenges to providing care to this group of patients (McGee, 2009). The demands for quality and skilled care are very high and continue to be higher. The scrutiny of care in these units is great and the need for better outcomes tremendous. The care that is needed in these units comes from commitment, professionalism, compassion and the ability to communicate with the whole team while at the same time understanding and including the family in the care of their infant. This takes highly skilled and able communicators to allow for achievable outcomes (Morgan, 2009). The ANNP is in perfect position with the training needed to advance these skills and achieve better outcomes. Transformational Leadership Transformational leadership is a necessary part of the ANNP's job. She must be able to use all of her knowledge and training to further the knowledge and training of the team that she is leading. In today's medicine, it is extremely important to consistently be aware of and stay abreast with changes. This is especially true of neonatal intensive care where tiny lives are at stake. The aspects of transformational leadership are having vision, being strategic, having confidence in ones self, establishing credibility and trust, having excellent communication skills, being responsive to and able to initiate change, motivating and influencing people towards shared goals, fostering team work, continually challenging and developing, and fostering the development of others. In this paper we will discuss the ability to motivate others and initiating change through the transformational leadership style. The transformation leader is able to raise our level of awareness and our level of consciousness. This allows us to see the value of changing needs for outcomes through the eyes of this leader. We are able to be less concerned with our own needs and self interests, allowing us to be able to take on the needs and interests of the team or organization as a whole. This is especially important in the neonatal nursery where it is often difficult to leave our own needs behind and concentrate on the needs of the unit. We are all deeply affected by the needs of these infants and that often will cause us to grieve, not in a helpful but self interest way. The transformational leader is able to help us move past that and continue to improve overall outcomes. Transformational leadership is expected to influence staff at the level below. "There is a cascading effect similar to that of dominoes falling" (Murphy, 2005). Transformational leaders strive to elevate the needs of their followers aligning them with goals of the unit and organization through a charismatic attitude motivating them though necessary change. According to the literature, people who work for transformational leaders perform at their full potential (Ellis and Hartley, 2000).It is important in the atmosphere of a neonatal intensive care unit that all of the staff are working up to the level of their potential. The ANNP can improve this potential by her ability to teach others to use the most recent evidence based processes. Through her leadership abilities and her advanced knowledge she is able to move toward change by initiating their development toward that change. Transformational leadership makes the usual way of doing things obsolete. A learning environment becomes the way things are done which causes a consistent improvement in evidence based practice.Tthis happens because of the fact that nursing normally has a questioning mind (Watson, 2008) and the advanced practice neonatal intensive care nurse is able to use that questioning mind to facilitate learning. This questioning is improved through the trust generated by a transformational leader. Neonatology is advancing at a very fast rate, business as usual is no longer an accepted do things. Staff must become more accountable and ANNP's who are transformational leaders will help this happen. Transformational leaders are natural mentors who are able to inspire intellectual change. She is able to understand at what level the staff is presently performing and use her abilities to improve that level. As a visionary, she is able to see where they need to be and as a teacher is able to help bring them there. In doing these things, she able to reduce resistance to attitude change in followers and improve behavioral responses which causes an excitement in the learning and change. This is why the staff are more likely to move toward a new evidence based practice when the ANNP is a transformational leader. These leaders believe in what they are doing, create their vision and are able to transfer that vision to the staff through education and training. The training is better accepted because of the leadership abilities used by the ANNP. They exude determination, and are courageous and committed to the change (Bryant, Dicenso, 2004). Their strategic abilities are important in the neonatal intensive care nursery because it is important not only to know that a change needs to be made but how that change can be made in a way to improve care. They are not only able to see the vision but are able to transform it into workable pieces and commit a strategy to moving toward it. They are change managers. They are not afraid of change and are willing to help others move through change. They are usually very astute and very ethically and morally aware (Laohavichien, Fredendall, Cantrell, 2009). This becomes very important in today's healthcare world as we are scrutinized for our quality or care, as well as the morality of the care we give. When a child dies, it is unnatural. It seems to us that we have lost a piece of humanities potential, The dreams of a family is suddenly destroyed. Parents, siblings, and healthcare providers begin to grieve the loss of any child. The outcome of this kind of situation depends on the training of the individuals dealing with the situation. ANNP's can promote better outcomes for families and other healthcare workers by being transformational leaders with excellent communication skills. They are able to bring together the family and healthcare workers in a way to allow all some dignity and ability to move through the grieving process (Morgan, 2009). Nurse practitioners in the neonatal intensive care nursery are responsible for strengthening team cohesion and provide opportunities for shared problem solving. Certainly the loss of an infant is an opportunity to do this. Ego's, territories and power struggles often put up barriers to this kind of communication happening. We have our own Maslow's hierarchy of needs and we must be able to move past that which enhances the need for strong communication and collaboration skills. By having these as part of her transformational leadership style, the ANNP provides the transformational leadership skills necessary to facilitate the cohesion needed for these teams. Motivating change is the strength of transformational leadership. Many are touting this style as the leadership style for the 21st century and in the neonatal intensive care unit it may become critical as our tiny patients become more and more ill. Without strong leadership and good communication in a critical unit such as the neonatal nursery, the staff can become fragmented. Communication between those managing care and those assuming care can be confusing and sometimes ambiguous in nature. Quality care will suffer and very fragile babies may not receive the coordinated care that is necessary (Spain, Claire, Smith, 2004). As the evidence for care changes so the care will need to change. A transformational leader is able to continue to move the staff toward needed change as the research changes. The ANNP is able, through her leadership skills to help facilitate the training and motivation necessary between staff and management as well as family of these small babies. She is able to establish a vision and lead the team to the best way to do accomplish that vision through motivation and education. . She is able to help them find the right way for themselves and their patients. The leader who is transformational is able to do this because people gravitate toward allowing this leader to lead (Watson, 2008). Conclusion Healthcare will see many changes over the next few years. Many of those will involve the ANNP and neonatal intensive care. . Patient centered care will attempt to replace the care systems we have traditionally used. The quality and cost of healthcare will be scrutinized more closely than it has been. Standards of care will become even more important than they have in the past. Advanced practice nurses will require a more collaborative approach and their leadership style will need to include that of the transformational leader. This becomes even more important in the neonatal intensive care unit where the barriers to communication include the ability to move forward and the psychological content of very sick babies. The Advanced practice nurse must be prepared to assume their roles as leaders. They must understand what they are and are not able to do. They must understand leadership techniques that work and the ability to move healthcare teams forward. In all of this, they must be able to work closely with teams in such a way as to promote respect among the team members and promote their vision in such as way that it becomes the vision of the whole team. The ANNP must be able to leverage here collaborative abilities and her transformational style for the betterment of the neonatal nursery as a whole. She must be able to move the staff to a level of understanding that will allow patients, and families to come first, allowing for improved outcomes throughout the unit. . 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