Unit 1 Module 1 - Introduction to Leadership

Nursing Leadership:
● Nursing leadership is “... about the competent and engaged practice of nurses, who
provide exemplary care, think critically and independently, inform their practice
with evidence, delegate and take charge appropriately, advocate for patients and
communities, insist on practicing to their full and legal scope and push the
boundaries of practice to innovative new levels”
● All nurses are leaders from their nursing program and throughout their career,
regardless of where they practice
● Leadership and management are interdependent
● Nurse leaders provide exemplary evidence-informed care
● They use research and help contribute to healthy public policy
● They are innovative and visionary
● They are executives and decision makers
● They think critically and are advocates
● Leadership evolves and can be learned
● Nurse leadership includes mentoring, coaching, and more.

Qualities and Traits of Exemplary Nurse Leaders:

● Key qualities or traits of exemplary nurse leaders include:
- Passion for nursing - optimism
- A moral center: integrity and respect
- Ability to manage crisis - knowledge and expertise
- Personal connection with nurses - teamwork and communication
- Interest in facilitating professional growth - mentoring and modeling

Nursing Leadership in the 21st Century:

● Nursing leadership is not easy
● Nurse leaders face many challenges (complexity science):
- Limited resources
- Complex work
- Completing properties
● Technology and information advances present constant change affecting the challenges
listed above

Transformational Leadership:
● Five practices of transformational leaders:
1. Building relationships and trust
2. Creating an empowering work environment
3. Creating a culture that supports knowledge development and integration
4. Leading and sustaining change
5. Balancing the complexities of the system, managing competing values and
priorities
Nursing Leadership:
● Standard 4 - Service to the Public:
- The registered nurse demonstrates leadership in quality and ethical nursing
practice, delivery of health care services and establishing professional
relationships
- Number 40: providing and supporting leadership in nursing for optimal
coordination and provision of care

Emotional Intelligence and Nursing Leadership:

● Emotionally intelligent leaders are reflective and self-aware and understand the impact
of their emotions:
- They bring out the best in their staff
- They inspire shared values and vision
- They have moral values
- They inspire lifelong learning and passion
- They care
● These attributes enhance staff performance and helps to create a healthy supportive
workplace
● Personal competency:
- Self-awareness: knowing one’s self
- Self-regulation: managing one’s self
- Motivation: sentiments and passions that facilitate the attainment of goals
● Social competency:
- Empathy: understanding of others and compassion toward them
- Expertise in inspiring others to be in agreement
● Emotional intelligence emphasizes empowerment through the management of emotion
● Being self-aware, having the capacity to establish purpose and direction, and motivating
and inspiring teams are essential for clinical practice

Emotional Intelligence and Nursing Leadership:

● Someone who is emotionally intelligent is described as having four distinct skills:
1. The ability to perceive emotion:
- Example: your patient received a terminal diagnosis, how would you
interpret this patient to react?
2. To use emotion to facilitate thought:
- Example: same patient with terminal diagnosis, what is your role in this
situation? Is there a problem you need to facilitate? What other resources
can you draw upon?
3. To understand emotions:
- It is easy to understand how a patient with a terminal diagnosis might
become anxious, scared, angry, sad. What does this teach you about
yourself? What are your feelings and reactions?
4. To manage emotions:
 - When taking care of a patient who just found out they have a terminal
diagnosis, how do you manage your emotions? Do you cry with the
patient or become anxious with them? Do you worry about how they will
be able to take care of their family? What do you need to feel good about
yourself in this situation?

Week 2 Module 1 - Defining Leadership and Management:

Nursing Management:
● Managers… manage
● Nurses who are managers handle the day-to-day operations like staffing, budget, and
resource availability and allocation
● They provide direction, leadership, coordination and organization of care and support
their team
● They are responsible for reporting and to ensure safe staffing through assessing
workload, environment, care, needs, and more
● Nursing leadership and management are interdependent
● Service to the public:
- #43: managing resources to provide safe, effective, and efficient care

Followership and Nursing Leadership:

● Effective followership is important - it’s an upward that helps leadership to be successful
● Effective followers help effective team functioning and this contributes to safe patient
care and outcomes
● It requires courageous collaboration
● It is everyone’s responsibility
● It is based on good communication, raising concerns as appropriate, and the ability to
influence leaders positively for safe, quality care

Mentorship and Nursing Leadership:

● Mentorship is defined as “a formal supportive relationship between two or more health
professionals that has the potential to result in professional growth and development for
both mentors and mentees”
● Mentors help develop leaders? They provide:
- Emotional support
- Career guidance
● Trust and respect are key to mentorship
● Mentorship can be toxic and can negatively impact the mentee, so choosing a mentor
carefully is important
● As well, being a positive mentor role-model to others is important
● Service to the public #48: RNs act as a formal/informal mentor to registered nurses,
nursing students and colleagues to enhance and support professional growth
Week 3 Module 1 - Understanding Leadership Styles, Roles, Organizational
Culture

Mission, Vision, Values of an Organization and Nursing Leadership:

● When you have a mission, vision and values, it provides direction. You can always refer
yourself and others back to that
● It is like a guide that keeps people aligned and on the right path, especially when there
are complexities and uncertainties
● It shows the heart and establishes the culture of the organization and what they, and you
as part of that organization, stand for

Demographic, Social, Technological Forces Impact on Nursing Leadership:

● Nurse leaders need to constantly consider the dynamic relationships which influence
health beyond just one patient and situation
● The healthcare system is complex
● For example:
- How can duplicate services be reduced?
- What services are missing?
- How does the new technology align with the organizational direction?
- How can they ensure quality care is fostered so patients have best outcomes

Leadership Styles:
● Traditional, task-focused leadership styles:
- Authoritarian
- Laissez-faire
- Democratic
● Relational leadership styles:
- Transactional
- Transformational
- Servant
- Authentic
- Visionary
● Point of care leadership

Authoritarian - Traditional Leadership:

● Leader makes decisions; useful in emergency situations
● Helpful when there is no time for discussion and action is needed
● Useful when the group doesn’t have knowledge or skills yet (ex. In ER or ICU)
● Negative reinforcement, punishment, lack of input, limit discussion on ideas, does not
promote teamwork

Laissez-Faire - Traditional Leadership:

● Flexible and effective when team is highly motivated and skilled and there is routine
work
 ● Not as useful when change is needed
● Reactive not proactive
● Little or no direction from the leader
● “Hands off approach”
● Often used by new or inexperienced leaders or leaders whose situation will be changing
soon

Democratic - Traditional Leadership:

● Advantages:
- Staff participation in decision-making
- Open communication
- Staff are responsible and accountable and are given feedback about their
performance
● Disadvantages:
- If opinions are unclear,
~ Might lead to communication challenges
~ Might lead to incomplete projects
- Not productive with inexperience members

Transactional Leadership - Relational Style:

● It is based on an exchange or transaction
● The leader gives a reward for those who perform well and punishes those who do not
perform to set standards
● These leaders stay out of the team’s way and only intervene when an employee
performance expectations are not met
● Characteristics of the leader:
- Not self motivated
- Follow clearly defined goals
- Must be closely monitored and managed
● Example: mom gives their child a treat for putting their toys away
● Transactional leaders are:
- Direct
- Less open to change
- Practical
- Reactive
- Encourages efficiency
- Favors structure over flexibility
- Has less personal connection
● Advantages:
- Efficient, clear boundaries; they do not go beyond organizational line and policies
- Consistent, order in order
- Clear chain of command
- Stable, abiding by the rules
● Disadvantages:
 - Inflexible; not ready to adopt changes
- Lack of innovation
- Demotivating
- Rigid

Transformational - Relational Leadership Style:

● Inspire people to perform their best - even beyond the leader’s expectations; motivate
people to be positive - however, sometimes people lose that inspiration and motivation
● Shared vision and mission
● Influential - leaders need to ensure appropriate influence
● Leaders have a personal connection with their team and care about them as people but
might overemphasize certain people
● Have a charismatic approach; observes values and morals
● This type of leadership drives change
● This type of leadership can reduce medication errors, lower patient deaths, reduce staff
turnover, and promote a safe climate

Servant - Relational Leadership Style:

● Main goal is to serve
● Care for the needs of their team and puts their needs as people first
● Shares power with their team
● Helps people grow and perform their best
● Jesus is a servant leader and a transformational leader

Authentic - Relational Leadership Style:

● The leader is genuine and real/authentic and “in tune” with who they are
● They have strong ethical convictions

Visionary - Relational Leadership Style:

● Similar to transformational - primarily concerned with the future and focusing on what is
needing to be achieved ahead

Point of Care Leadership:

● This leadership is carried out by point of care nurses who are not in a formal
administrative role
● Plays a key role in clinical decision making
● Clinical nurses engage others in clinical practice change, practice research, quality
improvements
● Builds trust and relationships
● Empowers others
● Contributes to an environment that supports knowledge integration
● Leading, supporting and sustaining change
● Balances complexities of the system and facilitates work life balance
 ● Leaders who value cooperation and competition amongst staff can lead to increased
productivity

Lead Self:
● Nurses must lead themselves first before leading others
● Effective leaders combine caring with who they are (being) and how they act (doing)
● When caring is combined with doing, authentic leadership comes to life in action and
leaders can influence the actions of others to create meaningful change
● Pangman and Pangman stress the need for the leader to balance data and intuition by
circulating the workplace, observing and providing support or suggesting a different way
of doing things when a problem is identified
● Example: elderly dementia patient keeps climbing out of bed. As a point of care leader,
what is the best way to support this patient to ensure safety? What different ways can
the patient be supported in a nursing unit?

Nurse Leadership, Job Satisfaction and Organizational Commitment:

● Transformational leadership positively correlates with a nurse's job, work, and
professional satisfaction.
- It reduces medication errors, positively impacts the team environment, and
reduces staff turnover.
- It can enhance well-being and performance and commitment to the organization
● Transactional leadership in high pressure settings like critical care and emergency may
have a better impact than transformational leadership on job satisfaction

Week 4 Module 2 - Quality Management and Safety

Common Problems that Happen When Providing Care:

● Adverse drug events
● Burns
● Equipment failure
● Failure to provide prophylactic treatment
● Falls
● Improper transfusions
● Misdiagnosis, delay in diagnosis, or failure to utilize the appropriate test as well as a
failure to act on the laboratory results
● Mistaken patient identities
● Pressure ulcers and deep vein thrombosis
● Preventable suicides
● Restraint-related death
● Surgical injuries
● Under and overtreatment or errors in administering treatment (wrong dose or wrong site
of administration)
● Wrong-site surgery
Quality Management:
● The philosophy of a health care culture that emphasizes patient satisfaction,
innovation and employee involvement

Quality Assurance:
● Regular monitoring and evaluation of services to ensure that they meet the established
standards of practice

Quality Improvement:
● The ongoing work required to support optimum health for patients, through continued
review and revision of processes and procedures according to best practices,
emphasizing patient satisfaction, innovation, and employee involvement
● A discontinued medication is highlighted out in yellow to indicate to the care team that
the medication has been changed.
- This is a visual improvement to stop the nurse from giving the medication that
has been discontinued

Medication Safety:
● Medication safety is a good example of quality improvement
● 10 rights of medication safety
● 3 medication checks
● 2 patient identifiers
● These practices are in place to keep patients safe while in nurse’s care

Patient Safety Culture:

● Patient safety culture in the integrated pattern of individual and organizational behavior,
based upon shared beliefs and values that continuously seek to minimize patient harm,
which may result from the processes of care delivery
● Safety culture consists of “seven subcultures, including leadership, teamwork, evidence-
based practice, communication, learning, just (a culture that identifies errors as systems
failures rather than individual failures) and patient-centered”
● A safety culture focuses on improving the system. Example: “medical errors are
challenges than can be overcome”
● Mistakes and errors happen. They can be learned from, and you can work to prevent
them
● Everyone plays a role in making healthcare safer - the whole interprofessional team
● Blaming or punishing people does not improve safety or address the root cause. A
punishment culture can reduce reporting of errors rather than a prevention education
culture

Patient Safety Culture - Reflection:

● Providers may:
- Feel angry, guilty, or inadequate
- Feel depressed or suicidal
 - Worry about legal action
- Have decreased clinical confidence
- Feel like they have failed
- Feel like they have breached public trust
- Feel that they broke their ethical mandate of “do no harm”

Magnetic Hospital Model:

● Developed to improve RN recruitment and retention
● Healthy work environments with appropriate staffing improve patient outcomes
● Providing safe patient care is cost-effective since it reduced costs associated with illness
caused by the medical system (iatrogenic)

Plan, Do, Study, Act:

● This cycle is one type of quality improvement tool used to improve patient care
● It is a tool used to evaluate current practice and to test and develop innovative ideas
● For example, if a nurse on the unit sees that a diabetic patient receives their meal tray
before they can take a blood glucose level, a PDSA cycle may be used to determine
how this can be improved

Evidence-Informed Care:
● Is associated with positive outcomes for patients, such as lower rates of injury and
mortality, and less burnout and turnover for nurses

CRNS Practice Standards:

● RNs are expected to participate in the development and integration of quality
improvement principles
● The RN recognizes, acts on, and reports harmful incidences, near misses and no harm
incidences
● RNs take action to create a safe work environment
● The RN uses evidence-informed communication skills to build trusting, compassionate
and therapeutic relationships with patients

Summary:
● Quality management, quality assurance, and quality improvement are all very similar in
their definitions and essentially all refer to improving nursing practice
● Medication safety is one area that has had a lot of work done to prevent medication
errors
● RNs are required to participate and implement quality improvement projects

Week 5 Module 2 - Conflict Resolution and Reconciliation

Leadership and Reconciliation:
● Health leaders (and nursing leaders) are responsible to enact the Truth and
Reconciliation Calls to Action with First Nations, Metis and Inuit peoples to enhance
health and wellbeing through:
 - Direct and ongoing input and consultation
- Building relationships
- Ongoing education
- Leading policy-based action for change in healthcare
- Acknowledgement of the harms
- Prioritize cultural safety
- Addressing inequities
- Improving access to healthcare
- “Skills-based training in intercultural competency, conflict resolution, human
rights and anti-racism”

Supporting Reconciliation:
1. Cultural humility:
- Understand the importance of valuing diversity and promoting cultural humility at
the individual and organizational levels
2. Community partnerships:
- Learn about the value of partnerships with community organizations to promote
reconciliation and healing in the broader community
3. Leadership actions:
- Identify actions that nurse leaders can take to promote healing and reconciliation
in the workplace and beyond

Racial Microaggressions:
● Racial microaggressions are words or actions that are racialized insults and offenses
which cause painful and traumatic experiences to the recipients”:
- Happen frequently
- Said or done casually
- Often attributed to unconscious bias
- Perpetuator is often unaware

Types of Microaggressions:
● Microinsults:
- Subtle insults
- Rude or insensitive messages that demean a person’s identity
● Microinvalidations:
- Communications, either conscious or unconscious
- Dismiss, negate, or invalidate the thoughts, ideas, or contributions of a racialized
person
● Microassaults:
- Deliberate and mindful
- Actions or words that offend and discriminate racialized persons

Impacts of Microaggressions:
● Alienation
 ● Invisibility
● Hurt
● Decreased sense of belonging
● Hypervigilance
● Internalization of microaggression effects:
- Can lead to students not using additional support services because they are
afraid of experiencing further microaggressions
● Rumination about exposure
● Anticipatory stress
● Continuously measuring stakes and power dynamics
● The recipient of the microaggression is always faced with the dilemma of either choosing
to be silent or absorbing the effects of the microaggression.
- This choice often leads to feelings of guilt for responding, or not responding, and
exposing or not exposing the perpetuator, which can lead to being misinterpreted
as being over-sensitive or aggressive
● Which leads to:
- Cumulative effects that impact mental, physical wellbeing
- Increased cognitive load leading to decreased academic performance
- Impaired relationships
- Exhaustion, minority stress, and racial battle fatigue
- Allostatic overload - the cumulative burden of chronic stress and life events;
involves the interaction of different physiological systems at varying degrees of
activity. When environmental challenges exceed the individual’s ability to cope,
then allostatic overload happens

Preventing and Addressing Microaggressions:

● Increased cultural intelligence, cultural humility, and anti-racism:
- The majority group must learn the rules and social environment of the minority
groups and apply them effectively as interactions occur
- The majority group must be supportive when BIPOC individuals challenge
oppression and seek to disrupt status quo
● For microaggression recipients:
- Coping, self-care, self-protection, agency and belonging, affirmations from social
groups, affinity spaces for community building (place where people gather with
others based on shared identities, activities, or interests)
● The onus is not on racialized people to change their reactions to microaggressions. The
onus is on the dominant culture, in our case white people, to stop microaggressions

The Definition of Conflict:

● Conflict occurs when interdependent parties experience negative emotions due to
perceived disagreements and interference with their goals
● Standard 1 - Professional Responsibility and Accountability:
- #5: demonstrating effective collaborative practice, including communication,
problem-solving strategies, decision-making and conflict resolution
 ● Standard 3 - Ethical practice:
- #27: identifying the effect of own values, beliefs and experiences in relationships
with clients, recognizing and addressing potential conflicts
- #29: communicating respectfully and effectively in collaboration with client,
family, colleagues and others, and resolving conflict should it occur
● Standard 5 - Self-regulation:
- #54: collaborating with the employer and other organizations as needed to
resolve professional practice issues

Conflict - General Points:

● Conflict will happen but can be prevented:
- Building relationships and trust, having positive and clear communication, mutual
acceptance, unconditional positive regard and understanding helps prevent
conflict
● Managing conflict is a key expectation of registered nurses:
- Effective leaders learn how to manage conflict well
● Different approaches work better than others in different situations:
- Nurses need to use their professional judgment to determine which one is most
effective at that time
● Conflict can be positive. If managed well, it can:
- Lead to effective outcomes for people and the organization
- Enhance quality client care
- Contribute to a healthy workplace
- Bring people closer together and strengthen teams
- May result in new ideas and initiatives
● Conflict can escalate quickly, especially when emotions are involved:
- This can lead to bullying, horizontal violence, ostracism, incivility and abuse
- It can lead to negative outcomes that have lasting impact (stressful workplace,
job satisfaction, weak commitment/absenteeism, poor morale, poor relationships,
reduced well-being, burnout, turnover, etc.)
- It can lead to critical incidents - debriefing will be foundational
● Understanding the meaning behind behaviors and effectively communicating and
providing person-centered care can reduce conflict from escalating:
- Example: What is really going on? What is the other person’s perspective (ex.
Are they in pain? Are they scared? Frustrated? Is there a power imbalance?
● Reasons that can contribute to conflict between a nurse and client:
- Intoxicated client or client withdrawing from substances
- Restrained client, tired or overstimulated
- Worried or scared or disoriented
- History of aggressive behavior, medical or psychiatric condition
- Ineffective coping skills or lack of support
- Difficulty communicating
● Conflict between a nurse and colleagues:
- Bullying
 - Put in situations beyond capabilities; unsupported
- Fear of reprisal, lack of awareness; different perspectives
● Conflict between a nurse and workplace:
- Lack of policies regarding human rights code or managing conflict
- Policies are not communicated; lack of performance feedback
- Workplace culture, leader abuse, favoritism/not addressing poor behaviors
- Lack of role clarity, unhealthy/poor working conditions

Types of Conflict:
● Data conflicts:
- Conflicts over data arise when people lack the knowledge essential to make
informed judgments
● Relationship conflicts:
- Arise from perceptions, bad communication, stereotypes, and other factors, and
are brought on by the existence of strong emotions (such as jealousy, mistrust,
or hatred)
● Value conflicts:
- Value conflicts only arise when individuals try to impose their own set of values
on others or assert exclusive value systems that forbid conflicting viewpoints
● Structural conflicts:
- Human relationship patterns that are oppressive are what lead to structural
problems
- These trends are frequently shaped by factors independent of the parties
involved
- A structural issue placed on their relationship is frequently the only factor driving
the dispute between the parties

Characteristics of Conflict:
● Types of conflict:
- Understand the difference between interpersonal, intrapersonal, and
organizational conflicts
● Effects of conflict:
- The negative consequences of unresolved conflict, including decreased morale,
increased stress, and lower job satisfaction
● Causes of conflict:
- Perceived and actual differences that may contribute to conflict include but are
not limited to: professional identity; cultural identity; gender; gender identity;
nationality; race or ethnic origin; color; religion; age; sexual orientation; marital
status; educational background; disability; work values; goals and interest

The Impact on Working Relationships:

● Collaboration:
- Conflict can result in a breakdown in collaboration between coworkers
- This can make it difficult to complete projects effectively and on time
 ● Communication:
- When conflict is present, communication can become strained
- This can result in misunderstandings and decreased productivity
● Teamwork:
- Conflict can weaken the teamwork dynamic, resulting in less supportive and
cohesive working relationships

Common Ways to Deal with Conflict:

● Avoiding: downplaying/pretending the conflict isn’t there
● Competing: prioritizing own needs and goals over others
● Accommodating: cooperate
● Compromising: flexible, give and take
● Collaborating: solution that works for all

Dealing with Conflict - Avoiding:

● Pros:
- Helps maintain peaceful relationships, gives time for people to work through
feelings
● Challenges:
- Issues don’t get resolved and communication suffers leading to damaged
relationships and tension
- Low satisfaction
- Stress spreads
● Useful when the issue isn’t important or there is another priority
● Useful when the timing to deal with it is not appropriate
● Many different ways of avoiding (physical run, mentally withdrawing, changing the
subject, denial, postponement, use of emotions, etc.)

Dealing with Conflict - Competing:

● Pros:
- Can enhance assertiveness and can demonstrate confidence and to be your best
self
● Challenges:
- Can come across as aggressive and hostile
- Reduces communication and trust
- Increases likelihood of future issues
● Useful when quick action needs to be taken
● Useful when the issue is trivial
● Useful when tough decisions need to be made
● Using your authority or position - may escalate the conflict; reduces communication and
trust
● Helpful when there is a potential for an error and the other nurse needs to intervene in
interest of client safety
Dealing with Conflict - Accommodating:
● Pros:
- Maintain relationships, generous and kind atmosphere
- Positive social environment
- Develop teamwork and sense of community
● Challenges:
- Lack of assertiveness and may sacrifice own needs and desires
- Can lead to resentment
- Doesn’t improve communication
● Useful when you can be flexible for the outcome
● Useful when harmony is the priority or you’re in the relationship building stage
● Useful for when you are wrong

Dealing with Conflict - Compromising:

● Pros:
- Fairness and balance and cooperation
- Communication for a mutual acceptable outcome
- Split the difference
- Find the middle ground
● Challenges:
- Can give up too much and feel dissatisfied
- Might forget to stand up for own needs
- Doesn’t explore the issue in depth
● Useful when there are time pressures and you need a quick solution
● When you can’t collaborate or compete, this is useful
● Good for a short term solution

Dealing with Conflict - Collaborating:

● Pros:
- Leads to mutual respect and understanding
- Foster creativity, innovation, considers multiple perspectives
- Builds relationships
- Win-win solution
● Challenges:
- It takes a high level of trust and communication
- Win-win solution can be time consuming
● Useful when you want everyone’s concerns to be met and when there is time
● Ex. team building/team meeting

Effective Conflict Resolution Strategies:

● Collaboration:
- Working together to find common ground can help resolve conflicts in a way that
is mutually beneficial for everyone
● Mediation:
 - Utilizing the services of a mediator can help guide the conflict resolution process
in a neutral and unbiased way
● Effective communication:
- Open and honest communication can allow conflicting parties to express their
perspectives, needs, and feelings in a constructive manner

De-escalation Behaviors:
● Assume a calm, firm stance
● Speak clearly and calmly
● Acknowledge feelings and paraphrase
● Avoid interrupting or problem solving
● Maintain a respectful tone
● Use your communication skills (active listening, etc.)
● Sometimes speaking quietly helps to calm the situation down
● Focus not on your intent, but on the impact of the situation to the other person first
● Seek to understand and then be understood
● Stick to the facts
● See if you can adjust the environmental climate - ex. Turn the lights lower, make music
quieter, sit down at eye level angled toward each other but not direct, etc.
● Have open hands not crossed arms
● Keep words simple - less is more. Be firm but gentle if needed
● Try to look at it from a place of unconditional love for the other person and genuinely
wanting the best for them and you

Managing Conflict as a Nurse Leader:

● Nurses in formal leadership positions are responsible for helping their team manage
conflict effectively:
- They can empower staff
- Make conflict resolution a priority
- Support nurses with autonomy in decision-making and professional development
- Address factors contributing to conflict
- Help staff develop conflict management approaches
- Understand impact of change
- Support their staff to become more comfortable in dealing with conflict

Union Leadership and Addressing Conflict:

● Through collective bargaining, unions work with the employer to look at key issues such
as wages, work conditions, job security, and supporting workers if there is conflict
● For registered nurses, unions have helped through addressing things such as limitations
for work requirements to help reduce fatigue, overtime rates, the right for breaks, safe
staffing and workloads, and helping the provider to maintain their professional standards.
● One of the main unions in Saskatchewan for Registered Nurses is the Saskatchewan
Union of Nurses (SUN). Their mandate is to support RNs in the many issues they face.
 ● Recently SUN had a campaign with the catchphrase “I am the registered nurse - Nursing
voices from the frontlines of healthcare in Saskatchewan”. RNs would share stories
about some of the issues and conflict they were facing to raise awareness

Bullying Toward Nurse Leadership:

● Bullying unfortunately happens in healthcare and this type of conflict is very stressful for
nurse leaders. There aren’t any easy solutions
● Bullying negatively impacts the workplace - people leave, it affects their mental and
physical health, the bullied person can become a bully themselves
● Takes a team to address bullying
● Nurse leaders who have been victims of bullying need to be careful not to blame
themselves, and to work with the organization to address bullying through policies, early
interventions and in setting limits and confrontation as appropriate
● They need to focus on what is in their control, to keep bringing their best, to get support
and to learn about effective strategies to address bullying. High resilience and emotional
intelligence helps
● The most commonly identified strategies used to address workplace bullying include
confrontation, crucial conversations, leaving the organization and avoidance. Each
situation is different and may require a different strategy

Organizational Commitment:
● When employees feel a strong sense of commitment and loyalty to an organization, they
will more likely stay engaged, motivated and productive
● Unfortunately, workplace conflict can have the opposite effect, leading to a weaker
sense of commitment overall

Preventing Conflict in the Workplace:

● Training programs:
- Can teach employees how to communicate effectively and resolve conflicts in a
constructive manner
● Organizational policies:
- Implement clear and effective policies can help prevent conflict in the workplace,
by ensuring that everyone understands their roles and responsibilities
● Emphasis on positive relationships:
- Creating a positive workplace culture, where people feel supported and valued,
can go a long way towards minimizing the potential for conflict

Week 6 Module 2 - Inter/Intraprofessional Collaboration

Marie Rollet Hebert:
● Early contributor to healthcare in Canada
● Consulted with Indigenous peoples regarding healing methods
● She helped her husband (an apothecary) in Quebec City care for early settlers

Jeanne Mance:
 ● Canada’s first lay nurse with medical and surgical skills
● Established a hospital in Montreal and is said to have co-founded the city of Montreal

Grey Nuns:
● Leader = Marie-Marguerite d’Youville
● Group of women that turned a bankrupt hospital into a hospice for aged men and
women, orphans and “fallen” women

Lady Aberdeen:
● Wife of Governor General of Canada
● Played a pivotal role in establishing the Victorian Order of Nurses (VON) in the late 19th
century
● Purpose of VON was to offer home healthcare services to those in need
● Lady Aberdeen heard stories where people were dying because they weren’t able to
access medical and nursing aid in isolated rural and remote areas in Canada, so she
advocated for change even in the face of resistance
● The VON traveled to areas without medical or health services and established small
cottage hospitals
● They worked with the community and did prenatal education, clinics, school health
services, programming and more
● Communities fundraised for VON services and built a sense of community for people to
work together and help eachother

World War 1 and 2:

● 47 nurses died in world war one
● 13 nurses died in world war two
● In WWI, Canadian nurses were nicknamed the bluebirds - blue dresses and white veils;
courageous, compassionate and admired

Dr. Mussallem:
● First Canadian nurse to complete a PhD in nursing
● Research on revising nursing education in Canada

Male Nurses:
● The first two male nurses in Canada graduated from Victoria General Hospital School of
Nursing in Halifax in 1892

Intraprofessional Collaboration:
● Intra means within - “within nursing” - It is about regulated nurse colleagues working
together (intraprofessionally) to provide care for the people they serve
● This supports interprofessional collaboration
● Nurses need the following to practice intra-professionally:
- Role clarification amongst regulated nurses
- Leadership
 - Respectful communication
- Positive engagement and managing conflict effectively
- Knowledge of legislation and regulations of scope of practice
● Regulated nurses include:
- Registered nurses
- Registered psychiatric nurses
- Licensed practical nurses
● They are regulated by their respective regulatory organization:
- RN - college of registered nurses of Saskatchewan (CRNS)
- RPN - Registered Psychatric Nurses Association of Saskatchewan (RPNAS)
- LPN - Saskatchewan Association of Licensed Practical Nurses (SALPN)

Interprofessional Collaboration:
● Different healthcare professionals from different areas of expertise working together
(interrelated) for best patient, family and community health outcomes
● Patients are partners in the process and the focus
● Healthcare is complex and interprofessional collaboration is important to help address
these complexities better than any one professional alone

RN Standards:
● RNs need to understand their own role and scope and articulate that as well as the
scope and role of other professions
● RNs also are responsible to advocate for clear roles and responsibilities and
communicate effectively and advocate for client safety
● RNs collaborate on research and in working through complex health challenges
 ● Respectful communication is key, as well as enhancing healthy teams for safe client
outcomes
● RNs need to report unsafe practices of registered nurses and other health care team
members and work together to resolve issues
● RNs need to assign care sometimes to unregulated care providers
● RNs give feedback in a way that helps people grow professionally and be open to
receive feedback too

Nurse Leaders and Collaborative Practice:

● Nurses lead collaboratively through a horizontal relationship with other professionals
● They require emotional intelligence, self reflection and to understand concepts of shared
leadership and appreciative inquiry
● Shared interprofessional leadership and collaborative practice is foundational to nursing
leadership practice to help address complex client care needs

10 Lessons in Collaboration:
1. Know thyself
2. Learn to value and manage diversity
3. Develop constructive conflict resolution skills
4. Use your power to create win-win situations
5. Master interpersonal and process skills
6. Recognize that collaboration is a journey
7. Leverage multidisciplinary forums to increase collaboration
8. Appreciate that collaboration can occur spontaneously
9. Balance autonomy and unity in collaborative relationships
10. Collaboration is not required for all decisions

Role of Nursing Organizations in Leadership, Delegation, Collaboration:

● The collaborative decision making framework (CDMF) is a document the nursing
regulatory bodies developed to help enhance the healthcare teams understanding of:
- Scope of practice, roles and responsibilities of each nursing designation
- The unique value and key contributions of each professional nursing designation
as part of collaborative team-focused care environment
- The collaborative expectations of healthcare providers to promote high
functioning teams
- How the framework can assist nursing and non-nursing leaders to determine the
optimal staff mix of LPNs, RNs and RPNs so each client receives the right care
at the right time from the right provider resulting in optimal health outcomes
● The collaborative decision making framework (CDMF) shares:
- Overarching and guiding principles of collaborative nursing practice
- A framework for nursing practice
- Describes the scope of nursing practice and educational preparation of each
designation
- Discusses entry-level competencies of each designation
 - Factors to consider for the most effective utilization of LPNs, RNs and RPNs:
- This document concludes that when LPN, RN, and RPNs collaborate to provide
safe, competent ethical nursing care, it benefits clients and leads to optimal
health outcomes

Delegation/Working with Unregulated Care Providers:

● The CRNS, SALPN and RPNAS has moved away from the term “delegation” to “working
with”. Delegation occurs when a task is assigned from a regulated nurse to an
unregulated care provider (UCP)
● Regulated nurses must be aware of the UCP job description, education and training as
well as consider the client’s needs/condition and the practice environment. They must
apply the nursing process when coordinating and assigning care for safe client
outcomes, while being accountable to their professional standards
● The employer, UCP and regulated nurse all have shared responsibilities in regard to
assignment of tasks

Week 7 Module 3 Influencing Change and Change Theories

Why Change Matters:
● Leaders in Healthcare must advocate for positive change because change occurs
continuously around us
● Innovation - with new technologies and treatments emerging regularly, the nursing
profession must adapt to stay current
● New roles and responsibilities - as nursing continues to modernize and become more
complex, the role of nurses is also changing
● Diverse population - nurses must be able to understand and address the unique
healthcare needs of an increasingly diverse patient population

Types of Organizational Change:

● Incremental change: small alterations to organizational practices that do not challenge
the current state, rather focusing on improving existing practices within the organization
● Transformational change: substantial alterations within an organizational framework
have the potential to disrupt core elements of the organization, including its procedures
and structures:
- While transformational change can energize certain employees, it can also cause
considerable disruption and stress for others within the organization
● Strategic change: change that is either incremental or transformational, that helps
support the strategic mission, vision, and values of an organization’s operations

Example of Incremental Change:

● The gradual adoption and integration of telemedicine services within an existing
healthcare system
● Telemedicine involves using technology to provide remote clinical services to patients,
enabling healthcare professionals to consult, diagnose, and treat individuals without in-
person visits
 ● This shift represents incremental change as it introduces advancements to existing
healthcare practices without drastically altering the fundamental structure of healthcare
delivery

Example of Transformational Change:

● A significant example of transformational change in healthcare is the widespread
adoption of electronic health records (EHRs)
● This shift from paper-based records to digital systems has revolutionized how patient
data is collected,stored, and accessed within healthcare systems

The Nursing Process as the Change Process:

● Assessment - you are very familiar with this process. By collecting and analyzing the
data, the leader will have a clear and accurate understanding of the problem
● Planning - this requires the staff to participate which can then lead to less resistance of
the change
● Implementation - change agents sets the tone for a positive and supportive climate, and
methods are used to continue persuading members toward the change
● Evaluation - this step determines whether the goals have been met and successful
change has been accomplished

Medicine Wheel Guides Healthy Change:

● The medicine wheel guides healthy change and can be individualized to the specific
needs of the client or community
● The medicine wheel considers the context of culture, socioeconomic status, family
situation, disease process, and other significant factors, culminating in balance, healing,
and growth in all four aspects
● The medicine wheel guides healthy change
● It can be individualized to the specific needs of the client or community

Force Field and Unfreezing - Change-Refreezing Models:

● Kurt Lewin is known as an innovator in the research and development theories about
organizational change and group dynamics as they relate to change
● He theorized a model that has three-stages in order to identify and examine the factors
and forces that influence a situation:
- Unfreezing + change + refreezing
● Requires leaders to discard prior knowledge and replace it with new information
Theories and Models of Change Theories:
● Unfreezing is the first stage, involving the process of convincing individuals of the validity
of the change, therefore letting go of an old practice and enabling individuals in
overcoming conflict and leading to group conformity.
- A successful change involves reinforcement the “why” we should change and
weakening the forces that are preventing change
● The second stage, moving or change, involves the process of a change in thoughts,
feelings, and/or behaviors. Lewin describes three actions that can assist in movement:
- Persuading others that the current practice is not beneficial and encouraging
others to view a problem with a fresh perspective
- Working with others to find new, applicable information that can help influence
the desired change
- Connecting with powerful leaders who also support the change
● Lastly, stage three, which Lewin called refreezing, involves instituting the change as a
new habit. The third stage is essential to ensure that the change embedded into practice
(in the second stage) and will stick over time
● Although Lewin’s model on change is known and widely accepted in healthcare, there
are critics of it, for being too basic and linear to capture the complexities of healthcare
● Change is often unpredictable and multifaceted. Therefore, an effective leader must be
aware of many change models
Additional Common Change Theories:
● Havelock’s Model - 6 phases of change:
1. Building a relationship
2. Diagnosing the problem
3. Acquire resources for change
4. Selecting a pathway for the solution
5. Establish and accept change
6. Maintenance and separation
● Chaos Theory:
- Considered to be a subset of complexity science
- Emerged from the early work of Edward Lorenz in the 1960s to improve weather
forecasting techniques
- This non linear model refers to a controlled randomness, which may be
associated with recognizable and somewhat predictable patterns
- Regardless of the best of intents to improve organizational functionality and
advance quality and safety of patient care, circumstantial influences may be be
fully understood or considered in the change process
The Role of Leadership:
● Effective nursing leaders can inspire change and ensure that staff are equipped with the
skills and resources necessary to bring about positive change in patient care
● Building trust among staff and patients is an essential component of effective leadership
in nursing
 ● Encouraging collaboration and a team-based approach can lead to more effective and
efficient care provision
Effective Change Strategies:
● Providing ongoing education and training opportunities can ensure that staff have the
skills and knowledge necessary to keep up with the latest developments in healthcare
● Adopting new technologies can improve the efficiency and effectiveness of nursing care,
while also improving patient outcomes
● Regular communication with staff can help ensure that everyone is aligned with
organizational goals and objectives
● Implementing clinical decision support systems can help nurses make more accurate
diagnoses and treatment decisions
Overcoming Barriers:
● Implementing change can be expensive, and may require significant investments in
training, technology and other resources
● Many nurses are comfortable with existing practices and may resist change. Leaders
must listen to staff concerns and address them in a productive and collaborative manner
● Lack of time - nurses are often overworked and may be hesitant to take on additional
responsibilities
Allowing and Encouraging Change:
● Nursing is changing with new technologies, evolving roles and changing client
demographics. Nursing isnt what it used to be, nor should we want it to be, it is an
evolving science.
● Leadership is key! Effective leadership is an essential component of influencing positive
change in nursing
● Strategies for Success - through education and training, technology adoption, and
collaboration, nurses and leaders can work together to drive positive change

Week 8 Module 2 - Advocacy and Leadership

What is Advocacy:
● Advocacy encompasses actively involving others, using ones voice, and leveraging
evidence to impact policy and practice
● It entails taking a stand against unfairness and disparity, engaging in political processes
both directly and indirectly, and recognizing the crucial influence of evidence, power
dynamics, and politics in advancing various policy alternatives
Power of Nursing Advocacy:
● Patient Empowerment: advocacy enables nurses to empower patients, ensuring their
rights are respected throughout their healthcare journey
● Improving healthcare policies - nursing advocacy plays a crucial role in shaping
healthcare policies and advocating for changes that benefit patients, nurses, and the
community at large
● Social justice: nursing advocates work towards achieving social justice by addressing
health inequities and advocating for equal access to quality healthcare for all
Power and Advocacy:
 ● Personal power: based on the nurse’s authenticity, trust, and integrity within
communities
● Expert power: based on the nurses’ specialized set of skills and knowledge that others
who are not nurses, likely do not possess
● Position power: based on the nurses’ position in an organization
● Perceived/Symbolic power: based on nurses’ reputation of one’s workplace, profession.
Nursing for example, has a lot of symbolic power because of the trust the public puts in
nurses
● Connection power: ensuing from your association with, or links to, powerful people
Example of Expert Power Shift:
● Expert power - based on nurses’ access to critical information
● There has been a shift in access to knowledge
● Clients can access their personal medical information and independent online inquiries,
which can foster self advocacy, transparency, and engagement in their healthcare
experience
● The challenge exists when the client may lack technical knowledge, some patients are
also unable to critically assess or might misinterpret health information
● This become apparent in the midst of COVID-19 pandemic, where wild unfounded
medical information was flooding the internet and social media, ultimately causing
mistrust in healthcare providers
Advocacy and Leadership in Nursing - Part 1:
● Inspiring others:
- Nurse leaders have the power to inspire and motivate their teams, creating a
work environment that fosters excellence in patient care
● Strategic decision making:
- Nurse leaders utilize their expertise to make strategic decisions that impact
patient outcomes and drive positive changes within healthcare organizations
● Mentoring and coaching:
- Effective nurse leaders serve as mentors and coaches, guiding and supporting
the professional growth and development of their team members
● Primary values:
- Safe, compassionate care
- Promoting health and well-being
- Honoring dignity
- Promoting justice
- Being accountable
● Ethics in action:
- The nurse leader is required to critically analyze situations and take appropriate
action with regards to practices that may threaten a patient's health and safety
● Ultimate goal: To promote the wellbeing of patients through the delivery of good nursing
care

Three Main Ethical Principles Related to Advocacy:

● Nurses uphold their convictions by embodying principled conduct in their practice
 ● Nurses acknowledge that not all approaches suit each patient, providing ethical
guidance in uncertain circumstances
● Nurses are receptive to individuals’ worries and offer equitable and impartial resolutions

Allyship:
● Allyship encompasses fulfilling an ethical responsibility, by actively intervening,
advocating, and supporting to eradicate harmful actions. Language, and behaviors:
- This involves creating opportunities to amplify the voices that are typically
unheard, overlooked, or unwelcomed
● Allyship recognizes continuous learning and growth as essentials as it is a never-ending
commitment
● Effective allyship is not an automatic consequence of good intentions but is a skill that
can and must be learned
● Allies recognize their own power and privilege and use it to support the rights of
marginalized people
● Keys to being an ally:
- Read; research and educate yourself
- Confront your own biases
- Speak up for others
- Always self-reflect
- Respond with empathy
- Lift up others by advocating
- Have open dialogue
- Hold others and yourself accountable
Skills for Nursing Advocacy:
● Active listening - by actively listening to patients’ concerns and needs, nurses can
identify opportunities for advocacy and tailor their care accordingly
● Effective communication - Strong communication skills enable nurses to articulate their
advocacy efforts, effectively collaborate with interprofessional teams, and advocate for
patient rights
● Critical thinking - Nurses must possess critical thinking skills to assess complex
situations, identify ethical dilemmas, and advocate for the best interests of their patients

Nursing Advocacy for Health Equity:

● Nurse leaders can advocate for changes to address health inequities by engaging in
community collaborations and leveraging their expertise to influence policy
● They can promote cultural humility, promote diversity and inclusivity, and challenge
health disparities through education and advocacy initiatives
● Nurse leaders serve as allies, working collaboratively with marginalized populations to
address the social determinants of health and promote health equity
● Through advocacy, nurses can influence change to mitigate health disparities and
ensure equitable access to healthcare for all.

Tools for Effective Nursing Advocacy:

● Data and evidence: nurse advocates utilize data and evidence to support their
arguments, making a compelling case for policy changes and improved patient care
● Engagement and collaboration: collaboration with diverse stakeholders, including
patients, healthcare professionals, and policymakers, enhances the impact of nursing
advocacy efforts
● Leveraging technology: the effective use of technology tools and platforms can amplify
nursing advocacy efforts, enabling communication and widespread dissemination of
essential information

Overcoming Barriers to Nursing Advocacy:

● Resistance to change:
- some individuals and organizations may resist changes advocated by nurses.
- Persistence, education, and collaboration can help overcome this barrier
● Time constraints:
- Nurses often face time constraints in their daily work
- By prioritizing and allocating time specifically for advocacy, nurses can overcome
this challenge
● Limited resources:
- Scarce resources hinder advocacy efforts
- Nurses can seek partnerships, apply for grants, and creatively utilize existing
resources to make an impact

Week 9 Module 4 Nursing Leadership & Ethics

Key Ethical Principles in Nursing Practice:
● Autonomy - respecting patients’ rights to make their own decisions regarding their care
● Beneficence - promoting actions that benefit patients and ensure their well-being
● Non-maleficence - avoiding harm to patients and minimizing risks associated with
nursing care
● Promoting justice - nurses uphold justice principles by protecting human rights, ensuring
equality and fairness, and advancing the welfare of the public

Nursing Values and Ethical Responsibilities:

● Providing safe, compassionate, competent and ethical care
● Promoting health and well being
● Promoting and respecting informed decision-making
● Honoring dignity
● Maintaining privacy and confidentiality
● Promoting justice
● Being accountable

Nursing Responsibilities:
● Make a conscious effort to build trustworthy relationships
● Act with honesty and take action to prevent or minimize patient safety incidents
● Ensure attention to the safety of persons receiving care and adherence to informed
consent
● Work toward preventing and minimizing all forms of violence by anticipating and
assessing the risk of violent situations

Providing Safe, Compassionate, Competent and Ethical Care:

● Nurses have a responsibility to conduct themselves with clients and teammates in
accordance with the code of ethics
● Nurses must question, intervene, report and address unsafe, non-compassionate,
unethical work situations
● Nurses support, use and engage in research and other activities that promote ethical
principles
● Nurses work toward preventing and minimizing all forms of violence by anticipating and
assessing the risks
● When conflicts arise with members of the healthcare team, nurses seek constructive and
collaborative approaches to resolve conflict

Promoting Health and Well-Being:

● Nurses prioritizing the provision of care aimed at the wellness and health of individuals
under their care, while embracing the fundamental principles of primary healthcare
● They engage with individuals in their care to navigate the array of healthcare options
available, acknowledging that certain social, economic, geographic, or other disparities
may limit some individuals’ choices
 ● In situations where healthcare interventions may impinge on individuals’ rights, nurses
advocate for and implement the least intrusive measures feasible for those they care for
● Moreover, nurses actively engage in collaborative efforts with fellow healthcare providers
and diverse stakeholders to optimize the health outcomes for those under their care

Promoting and Respecting Informed Decision-Making:

● Nurses respect the wishes of capable persons receiving care to decline to receive
information about their health condition
● Nurses recognize and support a capable person’s right to refuse or withdraw consent for
care or treatment at any time
● If a person receiving care is clearly incapable of consent, the nurse respects the law on
capacity assessment and substitute decision-making in the nurse’s jurisdiction

Honoring Dignity:
● Nurses maintain appropriate professional boundaries and ensure their relationships are
always for the benefit of the person
● Nurses do not exploit their trust and dependency in a way that might compromise the
therapeutic relationship
● Nurses understand the law so as to consider how they will respond to medical
assistance in dying

Maintaining Privacy and Confidentiality:

● In all areas of practice, nurses safeguard the impact new and emerging technologies can
have on patient privacy and confidentiality, professional boundaries, and the
professional image of individual nurses and the organizations in which they work

Promoting Justice:
● Nurses do not discriminate based on a person’s race, ethnicity, culture, political and
spiritual beliefs, social or marital status, gender, gender identity, gender expression,
sexual orientation, age, health status, place of origin, lifestyle, mental or physical ability,
socio-economic status, or any other attribute
● Nurses provide care for all persons including those seen as victims/abusers and refrain
from any form of workplace bullying
● Nurses respect the special history and interests of Indigenous peoples (TRC)
● Nurses refrain from judging, labeling, stigmatizing and humiliating behaviors towards
others
● Nurses work collaboratively to develop a moral community
● Nurses advocate for evidence-informed decision-making to promote health

Being Accountable:
● Nurses maintain fitness to practice
● Nurses identify and address conflicts of interest
● Nurses advocate for more comprehensive and equitable holistic health care services
across age groups, socio-cultural backgrounds and geographic regions
Health Information Protection Act:
● HIPAA identifies specific rights that individuals have with respect to their personal health
information
● These rights include:
- The right to revoke consent for the collection, use and disclosure of your
personal health information
- The right to be informed about the anticipated uses and disclosures of your
personal health information
- The right to refuse to provide health services number as identification for a non-
health service
- The right to access personal health information about yourself
- The right to request amendments to records of personal health info
- The right to request a review by the information and privacy commissioner about
a decision by a trustee and the right to appeal to a court
- The right to designate another person to make decisions about personal health
information

Effective Communication Strategies for Ethical Decision-Making:

● Active listening:
- Master the art of listening attentively to better understand the perspectives of
patients and healthcare professionals
● Empathetic communication:
- Hone your ability to communicate with empathy and compassion, fostering trust
and understanding
● Collaborative Decision-making:
- Learn how to involve all stakeholders in the decision-making process to promote
ethical solutions

Responsibilities of Leaders to Achieve Safe, Reliable, and Effective Operational

Excellence:
● Guarding the learning system:
- Completely immersing in self-reflection to foster transparency, grasping and
implementing improvement science, reliability science, and ongoing learning, and
instilling this philosophy across the organization
● Creating psychological safety:
- Ensuring that everyone within the organization, including patients and families,
feels at ease expressing concerns, offering suggestions, and presenting ideas for
change
● Fostering trust:
- Establishing an atmosphere where unwavering respect is paramount, ensuring
individuals feel their perspectives hold significance, and prompt addressing any
negative or abusive conduct
● Ensuring value alignment:
 - Implementing organizational values in every decision, whether aimed at safety,
effectiveness, patient focus, timeliness, efficiency, or fairness

Leadership and Power:

● Leaders determine:
- A command and control plan - who will be in charge if the main person is unable
to
- Functional roles and responsibilities
- A communication system - cellphones, radios
- A legal basis for response to include isolation strategies as needed for infection
control
- An infectious disease plan
- The maintaining of emergency facilities, equipment, and supplies
- Disaster preparedness training for emergencies

The Role of Nursing Leaders in Shaping Organizational Culture and Ethics:

● Visionary leadership:
- Visionary leaders create a positive work culture that promotes ethical practices
● Education and training:
- It is important to provide ongoing education and training to empower nurses to
navigate complex ethical situations
● Accountability and role modeling:
- Nursing leaders hold themselves and others accountable for upholding ethical
standards

Ethical Leadership + Planning = Effective Emergency Response:

● Emergency response takes place at all levels of government:
- Federal, provincial, territorial, and municipal
- It also includes social services, safety, transportation, meteorology, and voluntary
sectors
● Nurses with their expertise in primary health care, extensive experience with
interdisciplinary teamwork, and strong collaborative skills are the ideal leaders in
disaster preparedness
● Emergency preparedness needs to guide the way of the people affected by the
emergency, as well as having trust of the people to take care of them during and after
the disaster

Disaster Recovery:
● Disaster recovery follows the response phase and is defined by the short-term and long-
term actions acquired to return the community to a normal state
● Characteristics of these responses include:
- Emotional reactions to events
- Loss of ability to function
- Feeling overwhelmed
 - Increased use of resources

Week 10 Module 4 - Evidence Informed Practice & Nursing Informatics

Why Evidence Matters:

● Care guided by evidence is linked to favorable patient outcomes, including reduced
injury and mortality rates
● Contributes to lower burnout and turnover among nurses
● Clinical judgment + Patient values + best evidence = Evidence-based practice

Different Types of Nurses and Their Impact on Innovation:

● Innovators:
- The origin of suggested changes, these individuals actively engage with scientific
journals, attend conferences, and stay updated on best practices
- They maintain strong connections with external evidence sources and
reintroduce concepts and insights back into organization
● Early adopters:
- Hold strong connections within the organization, these are influential leaders
possessing authority and impact
- Their formal power allows them to drive initiatives and effect change
- They strongly advocate for innovation and actively support innovators within the
organization
● Early majority:
- The staff members who volunteer to test the innovation
- Often this group includes newly graduated nurses enthusiastic about embracing
novel approaches
● Late majority:
- The remaining staff who observed positive outcomes will now adopt the
innovation
● Laggards:
- The remaining staff that remain resistant to change
- Leaders should listen to the concerns, but realize they may never change and
should not spend excessive time trying to get them to buy in

Position Statements:
● Typically evidence based documents that can be found on websites of professional
organizations, regulatory colleges, unions, and the government
● Although these documents are often referenced and fact-checked, they may also include
guiding principles that reflect their organization’s mission, vision, and values
● It is important for nurses, therefore, to seek guidance from organizations that reflect
professional nursing standards and code of ethics
● These documents are great resources which also provide an introduction to the
professional principles that define who we are as nurses
As Nurses Leaders, we MUST:
● Lead the way with respect to knowing the research evidence on topics that affect our
patients, and more broadly , Canadian public health and well-being
● Create an awareness around topics that are significant to nurses at local, provincial and
national levels - even globally

Innovation is our Future:

● Innovation stands as a cornerstone in healthcare, fostering advancements critical for
addressing evolving patient needs. It drives improvements in patient outcomes and
experiences
● Through innovative technologies, treatments, and procedures have been adapted to
meet the complex and dynamic health challenges faced by individuals. From precision
medicine tailored to unique genetic profiles to the development of minimally invasive
surgeries, innovation enhances the quality of care and expands treatment options.
● Additionally, innovation in healthcare contributes significantly to cost-effectiveness and
efficiency. Streamlined processes, automated systems, and novel therapies not only
improve patient care but also optimize resource utilization.
● Moreover, innovation in healthcare acts as a catalyst for progress on a broader scale.
It drives scientific research, encourages interdisciplinary collaboration, and fosters a
culture of continuous improvement. Ultimately, innovation fuels a cycle of discovery,
implementation, and refinement, essential for the ongoing evolution of healthcare
practices and systems.

Week 11 Module 4 - Leadership Application to Population Health

What are Biases:
● Biases are unfounded judgments, prejudices, or attitudes based on the characteristics of
people or groups of people or groups of people that can be positive or negative
● Implicit biases are unconscious beliefs, attitudes, feelings or judgments and can be
contrary to what we think ourselves. It is not intentional but impacts the quality of life of
nurses and patient outcomes
● We can uncover our biases, examine them, mitigate them, and change them

We all have Biases:

● Whether we mean to or not, as healthcare professionals we ALL have biases,
stereotyping and prejudice.
● This causes many health inequities and contributes to health disparities for our patients
and teams
● Nurses and nurse leaders are ethically responsible to address this

Examples of Biases in Healthcare:

● White patients were more likely to receive better care quality than Black, Native
American, Alaska Native, Hispanic, and Native Hawaiian/Pacific Islander patients
● Some physicians were significantly more likely to recommend white patients for bypass
surgery than black patients
 ● Some medical professionals dismissed chronic pain in women than in men
● Some medical students had an implicit bias against lesbian and gay people
● Some healthcare professionals are less likely to recommend older adults for invasive
procedure, thinking they are being more compassionate, yet that can cause lower quality
of life or death for the older adults
● Some healthcare professionals preferred to care for people without disabilities
● Some people who are overweight are viewed as lazy, weak, lacking self control,
unwilling to stick to treatments or follow recommendations
● People with low socioeconomic backgrounds may be seen as less intelligent or
compliant
● People are not treated well if they smell/are unkempt, struggle with addictions, speak
another language

Address Bias In Healthcare:

● More education on health disparities
● Positive and frequent intergroup contact with different historically marginalized groups
● Providing patients with a list of questions to ask regarding their condition, which can lead
to extended and more in-depth conversations with their HCPs
● An awareness of the additional needs of patients with disabilities
● Empathy
● Personal reflection - treat with dignity, respect, empathy, compassion, unconditional
positive regard

Eight Strategies to Combat Biases:

Introspection Identify own bias

Mindfulness Reduce own stress to increase ability to

engage with your team and patients

Perspective-taking Consider others’ perspectives, engage with

your team and others with diverse
experiences/backgrounds

Learn to slow down Before interacting, reflect on your own bias

with people of certain groups

Individuation Evaluate people on their own characteristics,

not those of an identified group

Check your messaging Practice and use statements promoting

inclusion to welcome and embrace others

Institutionalize fairness Promote organizational practices that

examine social accountability in health equity

Take two Practice humility as a lifelong process

 including self-reflection and self-critic and
examining how nurse-patient relationships
are influenced by power/bias

Racism Against Nurse:

● Many nurses experienced or observed racism or discrimination from patients or
colleagues
● Asian and black nurses are likely to have experienced racial aggression and it affected
their mental well-being
● Communities and healthcare leaders need to conduct and do research about racism and
how it affects health
● Develop interventions to counter racism
● Promote/develop policies across sectors like transportation, education and housing
● Commit to change policies that are harmful, unfair, or racist
● Demonstrate familiarity with the role of the nurse leaders in addressing health inequities
● Identify interests, values, and responsibilities as a nurse leader in promoting social
justice

Inequities in Health:
● Health equity, social justice and the social determinants of health (ex. Income,
education, employment, housing, etc.) are foundational health concepts. No matter
where people live, who they are, what they do, that have the right to have the same
ability to be healthy
● Many people experience health inequities (unfair health status or distribution of
resources among populations) in healthcare because of discrimination
● People who are disadvantaged socially and economically are more likely to face barriers
in accessing the healthcare they need
● Individuals who are marginalized are unevenly affected by health issues like
cardiovascular disease, mental health disorders, cancers and infectious diseases
● Nurses have a role to play in doing something about this

Nurse Leader Roles in Addressing Inequities, Bias and Promoting Social Justice
● Nursing leadership is ethically responsible to address bias and to create safe spaces.
They need to model behaviors that set an example
● Promoting diversity on teams is important where each person feels heard and accepted -
this leads to reducing health disparities
● According to the ICN code of ethics for nurses, nurses must advocate for equity and
social justice, dignity and human worth as part of their core values. They advocate for
policies and programs to address the social determinants of health. They speak up, raise
awareness, and educate people and work together interprofessionally
● They collaborate together for health through policies, programs, services

Addressing Biases and Promoting Health Equity and Social Justice:

● Are key expectations of RNs in Saskatchewan
 ● 2.5: identifies the influence of personal values, beliefs, and positional power on clients
and the healthcare team and acts to reduce bias and influences
● 7.4 Advocates for health equity for all, particularly for vulnerable/diverse clients and
populations
● 7.8 Supports healthy public policy and principles of social justice - social justice is
considered to be: The fair distribution of society’s benefits and responsibilities and their
consequences. It focuses on the relative position of one social group in relation to others
in society as well as on the root causes of disparities and what can be done to eliminate
them
● 7.11 Uses knowledge of population health, determinants of health, primary health care
and health promotion to achieve health equity

Ethical Value - Honoring Dignity:

● Nurses recognize and respect the intrinsic worth of each person
● In health-care decision making, in treatment and in care, nurses work with persons
receiving care to take into account their values, customs and spiritual beliefs, as well as
their social and economic circumstances without judgment or bias

Primary Health Care Principles:

● Accessibility
● Active public participation
● Health promotion and chronic disease prevention and management
● The use of appropriate technology
● Innovation

Primary Health Care:

● Our healthcare system is complex, which means we need a variety and diversity of
healthcare professionals to meet patients’ needs and for optimal patient outcomes
● Acute care tends to be the focus for healthcare, but it does not contribute to a
sustainable quality health system. The shift from a mainly acute care focus to primary
health care and culturally appropriate practices helps address complex client health
needs in the community, can minimize inappropriate hospitalizations and improve quality
of life and satisfaction
- The population of our world is aging, and older people require more of our
healthcare services
- Increased chronic conditions
- Indigenous seniors also experience complex health needs and may not have
easy access to care, and have experienced harms and inequities in the system
- Post acute care, palliative care, mental health home care was advocated by the
Romanow Commission

Multidisciplinary Team and Nursing Leadership:

 ● Leadership in the multidisciplinary team is shared and may shift based on the situation
and client needs. For example, the leader may be a professional from social services if
that is the priority at that time.
● What helps the multidisciplinary team to be effective is communication, sharing
responsibility and having a clear commitment to the patient first
● Registered nurses need to engage with clients and work to provide client and family
centered care

Week 12 Module 4 - Leadership and Collaborative Partnerships

Teams and Collaboration:
● Teams defined as functioning effectively with nursing and interprofessional teams
through open communication and mutual respect and sharing decision making
● Collaboration defined as health care professionals working collaboratively, sharing
responsibility for solving problems, making decision for plans of care; increases
awareness of each other’s knowledge, competencies and skills
● Effective teamwork leads to improved:
- Clinical effectiveness
- Job satisfaction
- Morale
- Patient satisfaction
- Safety
- Reduced lengths of stays

Challenges in Teams:
● Many patient handoffs - with that comes risk of misinformation
● Working with multiple health care practitioners with varying levels of education and
training (ex. A patient in the hospital may interact with 50 different employees in 4 days)
● Ineffective communication puts patient safety at risk (lack of critical info, missed critical
info, unclear orders, overlooked changes in status) leading to med errors, injury, death
● Perceived loss of autonomy
● Lack of confidence/trust in decisions
● Different perceptions; different priorities
● Turf protection
● Lack of understanding of team member abilities
● Social, relational, organization structures contribute to communication failures
● Conflicting information provided
● Patients unclear who actually is in charge
● Different communication styles and tools

Troubleshooting Challenges:
● Accurate and effective communication of critical information
● Remember communication is more than words said (crucial content), but delivery style
and nonverbal (how you stand, speak and look) important too
● Come with a mutual open attitude, respect, trust
 ● Standardized communication tools
● All members need to engage
● Leaders need to focus on the good of the patient

Multi-generational Work Team:

● Silent (1928 to 1945):
- 3% of workforce
- Sacrifice and hard work, loyal, respect authority
● Baby boomers (1946 to 1964):
- 32% of workforce
- Workaholic, question authority, team players, like recognition
● Generation X (1965 to 1980):
- 39% of workforce
- Loyal but uncompromising for personal or family well-being, independent,
comfortable with technology, flexible
● Generation Y (1981 to 1997):
- 26% of workforce
- More diverse, educated, technologically sophisticated, multitasker, networkers,
work-life balance
● Generation Z (1997 to current):
- 1% or currently students
- Confident but cautious, autonomy

Benefits of Multi Generational Teams:

● Innovation
● Skill diversity
● Multiple perspectives
● Better decision making
● Mature expertise combined with younger strengths retained
● Competitive advantage - attractive to be an inclusive employer
● Better performance and productivity
● Learn from colleagues from the different generations and the experiences they have
● Wisdom and energy of new practitioners
● Creatively learn together

Ways for Nurse Leaders to Support Multi-Generational Teams:

● Identify and have team discussions regarding group values and norms = common
understanding:
- Address concerns directly
- Don’t gossip
- Seek to understand and clarify
- Plan for covering breaks, sick class, floating, assignments
- Help each other out
 ● Team building exercises outside of work which helps build those relationships, trust and
commitment and that impacts the teamwork at work
● Examine own generation and impact to your identity and perspectives and think about
the perspective of other generations - self-reflection and understanding

Diversity in Healthcare:
● “There is a strong relationship between a culturally diverse nursing workforce and ability
to provide quality culturally competent care …and by failing to have nurses that
resemble the communities they serve, there are many who have left who feel excluded
from a system that already feels very distant and uncaring”
● Absenteeism, reduced staff satisfaction and reduced quality care may result from
misunderstandings and misinterpretations regarding cultural and generational
differences

Strategies for a Diverse Workforce:

● Be an example through valuing diversity - value and respect people
● Value cultural and generational perspectives
● Emphasize the positive
● Be non-judgmental
● Effective communication
● Set standards and hold people to them
● Be curious and learn more/about diversity
● Staff education on diversity and generational differences
● Pair up patients and workers with commonalities
● Flexible, approachable leadership open to differences
● Accommodate difference communication styles
● Share the benefits of diversity
● Recognize differences can be stressful or cause conflict (normal) and work through them
for effective teamwork
● Foster autonomy and professional growth through mentoring and coaching

Ethnocentrism:
● Ethnocentrism is when we think that our ways of being are the right ways
● Its tough to analyze our own racial biases, but we need to do this if we want to be
culturally safe and competent
● For cultural competence to occur, we need to be exposed to cultural diversity

Role of the Nurse in Providing Culturally Competent and Safe Care:

● CRNS Entry level competency 9.3: “Engages in self-reflection to interact from a place of
cultural humility and create culturally-safe environments where clients perceive respect
for their unique health care practices, preferences and decision.”
● Cultural competency doesn’t mean nurses have to know everything about every culture -
that is unrealistic. But they need to be open to learn and respectful and caring
● Nurses need to also be respectful and to communicate Indigenous ways of knowing
 ● Even with cultural competency, there is systemic and institutional barriers and unequal
access to the social determinants of health - this impacts health and health outcomes

Future Nursing Leadership:

● Nursing leaders of the future will face many challenges such as:
- Changing multigenerational workforce
- Changing demographics
- Staff engagement and retention and creating healthy work environments
- Rapidly changing intra and interprofessional teams and scope
- Managing in turbulent times with competing priorities and complex decision-
making requiring staff adjustments, training, new equipment, decommissioning
outdated equipment, redirecting priorities, introducing new programs.
- Rapidly changing teams and scope - ex. RN role expanding to RN prescribing for
instance, NP scope enhanced, pharmacist scope, etc.

How Can Future Nurse Leaders Face these Challenges?

● Business skills and tactics and solid judgment
● Patient and family coordination for care
● Focus on patient outcomes
● Education and advanced planning
● Coordinate budget
● Managing stress
● Self-care: you need to care for yourself so you can care for others

Your Future Nursing Leadership:

● Inconsistencies you may see in the workplace:
- Efficiency and productivity may be prioritized over effectiveness and quality in the
practice environment
- There may be tension between ethics and values and fiscal and human resource
limitations in the health care system
- There may be inconsistencies between what you think people expect, what you
expect of yourself, and your limitations as a new nurse - you aren’t an expert yet,
you are a novice
● Consult and complete leadership and management competencies
● Consider ways to incorporate emotional intelligence in decision making and work
● Consider your strengths as part of your strengths based leadership approach
● Take care of yourself and personal health
● Find a mentor to get professional feedback, advice and support
● Practice good time management skills
● Protect time in your work schedule to reflect and regroup
● When first starting work, aim to have work that is:
- stable/consistent - ex. Not constantly floating to other units
- Predictable - know what you’re expected to do, where you are doing it, when
you’ll do it, who you’ll be working with, and how you’ll do it
 - Familiarity - helps if you have seen it or done it before (do you need extra
orientation?)
- Consistency, and watching out for inconsistencies

Tips:
● Learn to manage your time with gradually increasing the complexity of work if possible
● Learn routine
● See what is normal or abnormal in situations
● Debrief
● Gain confidence in performing skills
● Learn to work on a team
● Learn the dynamics of the workplace
● Have a balanced personal and professional work life
● Learn who you are again, have fun!

Dean at a school is knowledgeable -

Preceptor is skillful - what type of power - personal, expert?

Sister knows someone - connection power

Nurse practitioner can diagnose - people trust them - perceived power?