NUR 605 Week 7 Assignment 1: Nurse Leader Interview

An interview with Ms. Ndagire was conducted via zoom. This interview was to analyze her leadership skills as a certified nurse practitioner. Ms. Ndagire has been practicing as an Adult-gerontology nurse practitioner for the 5 years.

Ms. Ndagire graduated with her MSN from the Regis College -The Young school of Nursing, which is accredited by the Accreditation Commission for Education in nursing. During the interview, Ms. Ndagire stated that she felt prepared to practice as a nurse practitioner when she graduated because of her fifteen years of experience working as a registered nurse (RN) in the geriatric population especially in nursing homes. She is employed by a physician who is affiliated with Massachusetts General hospital (MGH). Her team consists of 4 doctors, 2 nurse practitioners, registered nurses, social worker, certified nurse’s aide, dietary and they specialize in adult geriatrics and these patients’ ages range from 25 to 100 plus years. Part of her interprofessional collaboration is working with her whole team as well as outside services to draft a plan of care for her patients. This involves attending Medicare meetings, discussing any discharge plans, checking what the patient’s baseline status is, are they well enough to go home, or are they candidates of an assisted living facility or nursing home. She also makes sure to know what the plan of care will be for a patient that is discharged home. Do they have home care services, are they set up? All these things have to be consisted in patient care, that is part of she collaborates with her team. She informed me that she utilizes social workers, nurses, aides, dietary and rehabilitation staff at the buildings she visits, since her office is only limited to a small number of employees. When asked how she transitioned into the ARNP position, she stated that the transition was easier since she was a nurse before and knew the health care system quite well. She knew how to communicate with doctors and fellow staff, the patients and their families. In her opinion, nothing major had changed, it was just a change in title and maybe more delegation and assessments. However, she mentioned that the only time she felt that she was not ready to start practice was when she realized that the information, they taught at school was completely different from the real world. She felt that information was generalized at school, and that she had to learn more practical skills and ways to deal with patients while on the job, nevertheless it worked for her because of the prior healthcare experience.

Ms. Ndagire is board certified through the American Nurses Credentialing Center (ANCC) as a certified nurse practitioner.  Since graduation, she has been working with the adult geriatric group that range from 25 to 100 plus years old. Prior to graduating from Regis College, Ms. Ndagire went to Middlesex Community College where she attained her associates degree as a registered nurse and with that, she specialized in the geriatric population for fifteen years. And before she even came to this country, she had graduated from Makerere university, one of the top universities in Uganda with a Bachelor of Arts, Social Sciences (Administration/Economics).

Among her responsibilities, Ms. Ndagire is licensed to diagnose and treat health conditions which may include acute, chronic and complex medical conditions according to AMA (2021). She also does assessments for patients status post hospitalization, medication reviews, ordering lab work, conducting monthly assessments on her long-term patients as well as those in hospitals, follow up on patients that were hospitalization, health education for patients and staff on various topics in health care that may contribute to better patient outcomes, signing orders and changing patient orders accordingly. In the order of command, she works under the supervision of the doctor. She is superior to the nurses and other staff that fall under her in terms of educational hierarchy. Even though she is boss to the nurses, medical assistants and secretaries, Ms. Ndagire points out that she needs her staff in order to accomplish her job and they also need her. And because of that, they all have mutual respect for one another, and they have strong bonds because of it.

Ms. Ndagire works at various nursing home facilities and a few home cases. She has specific facilities she covers on a daily basis, and if any more assignments are to be added onto her list, she will be notified during morning meeting. Her day typically starts at 8 AM when she heads to her first facility. There, she sees any patients that have had any medical changes like change in mental status, fevers, on antibiotics, to name a few. She also orders labs for patients that need them, sign any recommendations from other providers, see new patients that were admitted to the facility the day before, and complete a full assessment on them. She states that the new admissions take most of her time because she has to know everything about them, from admitting diagnosis to medications and any miscellaneous information like lab orders, diet, and all other kinds of therapy that apply to that particular patient. After she is done with seeing patients at the first facility, she goes onto the next one, and the same cycle repeats itself. Ms. Ndagire reports that sometimes the other facilities will call her requesting orders on patients especially those that have had a change in condition. They usually call with requests for labs, orders to send patients to hospitals for further evaluation, and she says this is a normal thing for her to be called, and she encourages the nurses to call so that patients get treatment when it is needed. She mentioned that if an extra location is added, she will go there first instead of her usual first stop.

She was independently in her position, Ms. Ndagire “makes a lot of practice decisions regarding patient care on her own. However, she has the support of the doctors on her team to consult with if need be, via phone, email or text message. She emphasized the importance of communication. In a research by Michel (2017), the author states that, communication is affected by electronic system

such as the electronic health records which was supposed to make things better. But made communication rather worse for the nurses and doctors, especially now that everything is virtual. Verbal communication between people is fading away as people have now resorted to texts, emails. This type of communication is not suitable especially when a nurse is trying to find a doctor because a patient has had a change in status. However, it has proven useful for direct entry such as lab orders, lab results. If there is a need to call, she does so to communicate new orders, follow up on patients. Even though new technology is taking over verbal communication, it has also been useful in other ways too. Ms. Ndagire emphasized the importance of communication, not only as a way to strengthen relationships with coworkers, but also as a pathway to treating patients effectively.

Ms. Ndagire has people above her in terms of leadership and those below her depending on educational level. She states that as a leader, she is democratic. Monsen and Pesut (2020) explored how nursing leadership can succeed in 4 different scenarios and they discovered that the subjects preferred an authoritarian, democratic, or laissez-faire type of management in those cases. All participants were nursing informatics leaders with experience ranging from 1-20 years. The authors concluded that the nurses were more satisfied with their jobs when a democratic/ collaborative style of leadership was used. A democratic leader puts his/her followers’ best interest by providing guidance, establishing rapport and sharing the decision-making process, allowing the followers to make their own decisions and providing support and feedback without pressure. (Northouse, 2018).

Ms. Ndagire points out that she prefers collaboration and teamwork instead of dictating to others. She believes in being approachable, that way her coworkers would not be afraid to go to her if they had some suggestions or grievances to share. She encourages communication with her team.

In her work, this provider is constantly faced with conflicts, and she suggested that the best way to hand a conflict is dealing with it earlier on before it escalates into something that can not be resolved. Ylitörmänen et al. (2018) conducted a study using 113 nurses to explore RN’s perceptions of conflict management and relationship between nurses’ background and conflict management. The authors discovered that younger nurses were likely to use avoiding and accommodating resolution styles than their more experienced nurses, pointing to a lack of conflict management resources. During the study 36 participants dropped out. The authors were able to analyze results and concluded that the 36 nurses that dropped out would have used accommodation and avoidance resolution styles were more inexperienced than the others. It makes sense because, as inexperienced nurses, sometimes they are intimidated and are afraid to speak up. That is why Ms. Ndagire handles her conflicts by identifying the problem and using it as an opportunity to learn from it or teach about it to her colleagues. She never wants nurses to feel intimidated or that they cannot talk to her, that is why she avails herself to her staff. She states that she uses herself as thermometer to read what kind of environment she’s in, whether to approach and how to approach. She never lets issues escalate to a point of yelling, and she’s always ready to apology if it will calm down the situation.

During the interview we discussed emotional intelligence and how she applies it in her work life. Emotional intelligence (EI) in leadership is getting to know oneself better, knowing one’s own strengths and weaknesses in order to better control and manage situations or crises. EI is about controlling one’s feelings or emotions towards one’s actions. Ms. Ndagire states that she tries to stay calm in all situations, because her staff is always watching her reaction especially as a leader. She admits that there have been times when she was visibly upset with staff or a patient, but in those moments, she excused herself, took a few moments to compose herself before going back to deal with whatever issue was going on. She warns that as a leader, she has to be careful how she displays her emotions, or what she says, because her team is learning from her and she does not want them to think it is alright to behavior a certain way that negatively impacts one as a leader.

Huber (2018) states that a leader’s behavior, patterns of actions, attitude, and performance, have a special impact on the team’s attitude, and behaviors on the context and character of work life (p.5). Ms. Ndagire states that she’s empathetic, truthful, has self-awareness, adapted good communication skills and problem-solving skills. She gives an example of when one of the nurses at a nursing home administered the wrong medication to a patient. This NP approached the patient when she got to the facility and explained to the patient about the medication error. She told the patient what possible side effects she could exhibit, what lab work was going to be drawn, and how she was rectifying the problem with the nurse that had administered the medication. Ms. Ndagire believes in being truthful because it shows honesty and credibility. She said she would rather be honest about the error than cover it up and lose her license together with that of the nurse.  As for the nurse, this NP took this as a teaching moment with the nurse and educated him about the patient rights before medication administration.

In a study by Shepherd et al., (2019), the authors were to explore the general perspective of health care providers in regard to culturally competent care, their experience with multi-cultural patients, their own levels of cultural competencies and whether these providers believed that their workplaces address cultural competence. 56 healthcare providers participated in the study through open-ended questions and multiple questions. It was concluded that there is a need for interventions that acknowledge the value of cultural awareness, while utilizing more cultural competencies and safety approaches. Ms. Ndagire looks beyond color, race, sexual orientation, gender. She emphasizes the importance of cultural sensitivity and being aware of other cultures. Matusiak (2013) defines cultural competence as the nurses viewing their patients through the patients’ perspective, other than their own or those of the western health care culture. In today’s world, there is a lot to learn about other people’s cultures and be respectful of them. She went ahead to mention the different religious practices for the Muslims, Jewish, Christians. We live in a diverse world now and therefore we have to honor and treat our patients in accordance with their cultures. Learning about various cultures is a step toward cultural awareness.

Ms. Ndagire follows the hierarchy system which according to Huber (2018) the hierarchy is used in healthcare and its authority is in the position not the person. Following this structure makes delegation easier because tasks are assigned on skills requirements. For instance, a registered nurse would never prescribe medication to a patient but can transcribe an order from the doctor. Worum et al., (2020) say that a democratic leader focuses on concern with their team members, their relationships, and helping them to achieve their goals. Ms. Ndagire is a democratic just by the way she treats her team and it’s because of her kindness, communication, patience, established leadership qualities that she has gained their trust in return. Successful managers in health care exhibit qualities that include making time for accountability, building trust, employee concerns, excellent communication skills, inspiring others and the ability to delegate and empower others.7 Successful managers must be available to allow their employees to seek advice or to present potential scenarios, without making employees feel like a bother. Huber (2018) explains empowerment as a state in which a nurse assumes control over their own practice, which enables them to successfully fulfill their responsibilities (154). Ms. Ndagire explains that she worked her way to empowerment one day at a time. There were days she went home feeling disappointed in herself because she had not completed her assignments promptly, but she never gave up. Instead, she persisted each day until when she felt completely empowered and in control of her duties. That is when she was confident enough to start looking at patients independently. This is why she choose to be a leader that can help motivate and encourage others. She believes that anyone can performs specific task if they set their mind to it. She is a good listener and is always willing to give advice to those that seek it.

Kilpatrick et al., (2012) launched a study to understand how nurse practitioners enact the medical and expanded nursing portions of their role in healthcare teams. They conducted individual or group interviews using content analysis to analyze the data. They concluded that the scope of practice for practitioners changed due to the pressure in the healthcare field. Ms. Ndagire’s intra organization responsibilities include recognizing her own power and using that to create collaboration among staff, open communication, conflict resolution effective leadership, giving all staff a chance to contribute and most of all, setting clear values that lead to quality patient care.

I am a democratic leader and believe in equal opportunities for all, fairness and justice. Huber (2018) states that effective leadership is a blend of leadership principles and characteristics with management principles and techniques. Ms. Ndagire and I share the same perceptions about leaders. We both believe in equal opportunities, being reliable, good communication skills. Poels et al. (2020) says that passive avoidant leadership styles which relate closely to laissez faire style are excessively present. This means that people may categorize themselves as authoritarian or democratic, but what they portray to people may be different from what they believe they are projecting. I believe that sometimes after I trust that a coworker knows what they are doing and what is expected of them, I tend to relax and completely trust them to do their job without me telling them what to do. We both believe that we have more than one style of leadership, and sometimes they overlap each other, depending on the situation. For instance, in an emergency, I might turn into an authoritarian and just give directions to people on what to do.

Ms. Ndagire is a nurse practitioner that is compassionate, empathetic, honesty, believes in justice for all. She prioritizes her patients above anything else. She emphasizes the use of open communication with teammates as it creates trust and leads to positive outcomes. She advocates for both her patients and staff and delivers competence care. She promotes cultural competence and sees patients beyond race, color, gender or sexual orientation. Some of her strengths include being a good communicator, she is patient and caring towards her patients. She encourages her staff to aim higher in life, further their education in order to have better futures. Her weaknesses are being over ambitious. She mentions that because she is so ambitious, it creates tension on her staff when she requests for things to be done, because then she expects feedback immediately.

LDR 600 The concept of leadership as a “vocation” greatly distinguishes leadership from a jobReference:

Huber, D. (2018). Leadership and nursing care management. In Leadership and nursing care management (pp. 1-206). St. Louis, MO, MO: Elsevier.

(2021, February 18). AMA. Retrieved February 21, 2021, from https://www.ama-assn.org/

Kersey-Matusiak, G. (2013). Delivering Culturally Competent Nursing Care. New York, New York: Springer Publishing Company.

Kilpatrick, K., Lavoie-Tremblay, M., Ritchie, J. A., Lamothe, L., Doran, D., & Rochefort, C. (2012). How are acute care nurse practitioners enacting their roles in healthcare teams? A descriptive multiple-case study. International Journal of Nursing Studies, 49(7), 850-862. doi:10.1016/j.ijnurstu.2012.01.011

Monsen, K. A., & Pesut, D. J. (2020). Pilot Test of a Theory-Based Instrument to Measure
Nursing Informatics Leadership Skills. Nursing Leadership (1910-622X), 33(1),100–111. 

Northouse, P. G. (2018). Introduction to leadership: Concepts and practice. In Introduction to leadership: Concepts and practice (4th ed., pp. 1-274). Los Angeles, CA: SAGE.

Poels, J., Verschueren, M., Milisen, K., & Vlaeyen, E. (2020). Leadership styles and leadership outcomes in nursing homes: a cross-sectional analysis. BMC Health Services Research, 20(1), N.PAG. 

Shepherd, S., Willis, C. E., Newton, D., Sivasubramaniam, D., & Paradies, Y. (2019). The challenge of cultural competence in the workplace: Perspectives of healthcare providers. The Challenge of Cultural Competence in the Workplace: Perspectives of Healthcare Providers, 19(1). doi:10.1186/s12913-019-3959-7

Worum, H., Lillekroken, D., Ahlsen, B., Roaldsen, K. S., & Bergland, A. (2020). Otago exercise programme-from evidence to practice: a qualitative study of physiotherapists’ perceptions of the importance of organisational factors of leadership, context and culture for knowledge translation in Norway. BMC Health Services Research, 20(1), 1–17. 

Ylitörmänen, T., Kvist, T., & Turunen, H. (2015). A Web-Based Survey of Finnish Nurses’ Perceptions of Conflict Management in Nurse-Nurse Collaboration. International Journal of Caring Sciences, 8(2), 263–273

Week 7 Assignment 1: Nurse Leader Interview