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Ruth Hansten
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In these turbulent times, with budget cuts and lack of healthcare coverage for the disadvantaged, we nurses may feel out of control. Our personal and professional values are challenged. The ANA Code for Nurses and our Nightingale Pledge would support care for all human beings and our participation in national efforts to meet the health needs of our society, yet hard choices are being made related to health insurance and the public safety net. With these challenges afoot, we could potentially lapse into depression or inertia. However, what we can do, in addition to political advocacy, is to develop our leadership efficacy, and the RROHC program does just that, one person and one organization at a time!
We believe that the quality of nursing leadership affects patient outcomes. A study by Cummings, et al., highlighted in the March AJN examined leaders' emotional intelligence and leadership resonance. The study included 21,570 patients and 5228 patients at 90 hospitals from the Hospital Inpatient Database, examining discharge abstracts of patients with acute MI, CHF, COPD, pneumonia or stroke, for 30-day mortality. After adjusting for demographics, co-morbidities, hospital factors and nursing factors, "leadership style was found to contribute 5% of the total 72% variance of mortality across hospitals." Lower inpatient mortality was seen in hospitals with highly resonant leadership (26% lower odds). (News from the AJN, March 2011, p. 63; Cummings GG et al. Nursing Research 2010; 59(5): 331-9.)
The results of our own analysis of leadership competencies are completed! Pre- and post-RROHC Specialist Level 1 training (i.e., our 20 week instructor-guided self-study course) with 25 worksheets applied to actual clinical areas, shows an amazing increase in skill levels, showing subjective competence, as well as leadership competence.With nearly 600 participants, analysis based on years of service as an RN showed different improvements based on the needs of each group. The largest degree of improvement occurred in the novices, in such issues as basic delegation and supervision (offering initial direction, planning a shift, asking for feedback), while the next senior group (1-5 years) grew in shift report clarity, using checkpoints with assistive personnel for supervision, and using critical thinking skills. All groups found that they were more able to spend time reflecting on the impact they made with patients (the only value that is intended to be lower on the graphs). RNs were less likely to be "too busy" to reflect on the results the patient/family were obtaining due to the RNs coordination of care and healing touch.
For novice students, their confidence in assigning tasks (delegation) was rated at 48% improvement. 37% progress was noted in a clear shift plan, and 39% began asking for feedback from the team. Initial direction showed 27% enhancement. What a testimony to the study and application of RROHC concepts that has occurred in these cohorts, along with the coordination that has occurred in each organization! We congratulate these students and their leaders!
For more information about the RROHC Patient Care Delivery Model, visit: Improve Delegation Skills, Outcome and Patient Care or Email Ruth Hansten.
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Let's face it. Many nurses are not comfortable with delegation and supervision of assistive personnel. The best use of those available to aid the nurses and the patients is not realized because of lack of leadership skills present in the nursing personnel. What would it mean to your institution if delegation skills were improved by 37%? Our 20-week instructor guided self-study develops this striking improvement in your nurses...from novices to experts.