Chapter 1 Case Study  – What considerations come into play

Chapter 1 Case Study 

Case Study 1-1

The study described in the Research Perspective (Hauck, Winsett, & Kuric, 2012) was about the introduction of evidence-based practice (EBP) for a hospital. (Article available in Engage Week 1). Rogers’s theory of diffusion of innovation served as the theoretical framework for that study. Diffusion of innovations is a theory that seeks to explain how, why, and at what rate new ideas and technology spread. However, other theoretical perspectives are present. Based on situational-contingency theory, describe factors that the nurse researcher, as the leader of the implementation team, would need to consider. Consider the following:

1. What considerations come into play that are outside of the group targeted for the change initiative? Are there any external stakeholders? What are the internal factors that would drive or limit change from being successful?

2. How do people behave individually and in groups when it comes to adopting a practice-based change? Is there a difference between individual and group behaviors? If so, why does this occur?

3. What should the nurse leader do to plan for and address potentially negative attitudes of staff regarding the implementation of EBP? How should the nurse leader use nurses with positive attitudes toward the implementation of EBP?

4. How can previous interactions with the nurse leader impact the success or failure of implementing EBP?

5. What are the resource requirements? What are the regulatory requirements?

Case Study 1-2

The night charge nurse and the day charge nurse are discussing patient priorities for the next shift. The night charge nurse indicates that most of the night staff prefer a detailed checklist of tasks to be completed during the 12-hour shift. The day charge nurse replies that there are too many unexpected events that can happen during any shift to rely only on a checklist. However, both charge nurses agree that patient outcomes are the first priority for the nursing unit.

1. Explain the perspectives of each charge nurse based on the concepts of leading, managing, and following.

2. How might each charge nurse further explain their position to the chief nursing officer?

Chapter 1 Exercises

Exercise 1-1 

Identify a clinical scenario in which complexity influences difficult problems. For example, consider how nurses can ensure that drug levels are drawn before and after a medication or how nurses ensure that equipment shared among patients is adequately cleaned and maintained. Who would you include in a team to engage in creative problem solving? How would you go about linking to other key stakeholders if the problem were bigger than your immediate contacts? Concentrate on the power of these influencing individuals. What role would the patient and family and community play in co-creating the resolution strategies? How would you encourage nonhierarchical interaction among nurses, patients, families, and others involved in this situation?

Exercise 1-2

Ponder the leadership theories presented here. Does one seem to make more sense to you than another? Consider, for example, what you were doing the last time you were in the clinical area. Does one theory suggest that you were using it as you enacted your role? Identify one way you can incorporate a leadership theoretical perspective into a daily clinical routine.

Exercise 1-3

The tasks of management are designed to enact Gardner’s tasks of leadership. For example, although the leader may create a culture of trust, the manager offers rewards that reinforce that value. Consider an environment in which you currently work (or worked in the past). Did the roles of a leader and manager illustrate Gardner’s tasks? Why or why not? Even if the tasks of the leader(s) and the manager(s) are different, do their behaviors represent a common vision? Why or why not?

Exercise 1-4

Using the definitions for leading, managing, and following noted previously, observe how work is organized in a clinical unit. What situations occurred that could not be predicted? What work followed a routine nature or was driven by protocol? Identify an activity that was driven by principles rather than by formal evidence. Identify an activity that was driven by evidence-based practice or evidence-based organizational practice. Then, notice team functioning. Who led? Who managed? Who followed? Did this happen seamlessly or were there times when there was tension in efforts? Did the roles change depending on the situation? If so, in what way?

ANSWERS TO QUESTIONS IN THE 

Chapter 1 Class Activities

Activity 1-1

1. What words come to mind when you think of leader?

2. What words come to mind when you think of follower?

3. Analyze the differences between the two lists. Do you think of leaders in different ways than you think of followers?

4. Recall pairs of leaders–followers from politics, science, education, the media, or personal experience. As you recall these pairs of individuals, what made one the “leader” and the other the “follower”? How did the leader contribute to the follower’s success? How did the follower contribute to the leader’s success? At times, did the leader function more as the follower? At other times, did the follower function more as the leader? What does this analysis tell you about the nature of leader-follower relationships?

Activity 1-2

Write a short analysis of the similarities and differences between managers and leaders on a unit of a hospital with which you are familiar. Discuss these similarities and differences with others (staff nurses, nurse managers, and other students).

Activity 1-3

1. Write a list of 3+ positive consequences (beneficial outcomes) that occur when one manages well, when one leads well, and when one follows well.

2. Write a list of 3+ negative consequences or outcomes of (or difficulties caused by) overemphasizing managing to the exclusion of leading, and then of overemphasizing leading to the exclusion of managing.

3. List 3+ negative outcomes of ineffective or passive followership.

4. Discuss with at least one other person the benefits and negative results (all lists) of leading and managing. List specific ways you could (or have seen others) shift emphasis between leading and managing.

a. What behaviors, policies, procedures, and so forth facilitate a shift of emphasis from managing to leading and back again in the institution(s) you have chosen for Activity 1-2?

b. What behaviors, policies, procedures, and so forth block this shifting emphasis in the institution(s) you have chosen?

c. What new behaviors, policies, procedures, and so forth would produce an effective shifting in the future in the institution(s) you have chosen?

Each of the portions of this question depends on the nature of the contributions students can make, which may be dependent on their clinical sites.

Activity 1-4

1. Team up with another student in your class. Separately, compile a list of what you each believe are leadership behaviors. Try to list at least 10.

2. Review your lists and mark your initials beside each behavior that you believe describes some of your own behaviors. Do this without input from anyone else. Using the same lists, mark your partner’s initials beside behaviors you have observed in the other student. Do this activity without any input from the other student. When finished, compare lists.

3. What do you notice about the differences in both how you view yourselves and how you view one another?

4. What did you learn about yourself?

5. Do others see you as having more or fewer leadership traits than you believe you have? Why?

Activity 1-5

Divide the class into small groups and assign each group a leadership theory to review and find a relevant journal article. Ask each group to either make an 8- to 10-minute presentation on their work or make a posting to the discussion board of the course management system. As part of their report, ask them to provide an example from clinical practice of how the assigned theory can be applied. Ask them to assess relevancy to the healthcare arena today.

The intent of this activity is to help students see how leadership theories can be applied in either practice or research. Encourage the students to think beyond the Theory Box in Chapter 1. Their critique of the assigned theories can facilitate the transition to discussing complexity science.

Chapter 1: NCLEX Review Questions

1. Which best demonstrates the concept of followership?

a. Completing the tasks associated with your patient assignment without deviation with the intent of receiving praise from your manager

b. Preparing for a committee meeting by reviewing the agenda and supplemental materials, so that you can be an active participant in the meeting

c. Assessing a clinical situation and following a set of guidelines in order to delegate tasks to unlicensed personnel

d. Administering medications to patients in conjunction with other nursing actions in order to make effective use of your time

2. What is involved in systematic thinking?

a. Being able to consider the “big picture” beyond the needs of your unit

b. Considering what nursing tasks need to be completed before the next medication pass

c. Focusing on the number of patients each nurse is assigned, unrelated to patient acuity

d. Refusing to come to staff meetings on your day off

3. Which statement is true regarding complexity theory?

a. Complexity theory is used to predict the health and illness trajectory of critically ill patients.

b. Nurses can understand the dynamic nature of health care processes using complexity theory.

c. The need for additional staff can be justified based on complexity theory.

d. Complexity theory is used to explain the relationships among leading, managing, and following.

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