Fall 2003 TN Nurse Feature Article

Nurse Leaders in Tennessee

Professional nurse leaders are vital to promoting and protecting the registered nurse and advancing the practice of nursing in order to assure a healthier Tennessee. The Tennessee Nurse is featuring three of many Tennessee nurse leaders in this issue, including:

Elizabeth J. Lund, MSN, RN

Sharron Grindstaff, MSN, RN

What a coincidence to be asked to write some words on nursing leadership after recently spending a week at a nursing leadership retreat. The message I share reflects the shared wisdom from that collaboration facilitated by Kathy Malloch, PhD, MBA, RN, a member of the Arizona Board of Nursing.

Think of your favorite television commercial or billboard. If you could create a billboard for nursing, what would you say? For the executive director of the board of nursing, it would say “The responsibility and accountability for protecting the public is my job!” 

As executive director of the Tennessee Board of Nursing, I am responsible and accountable for both the day to day activities of running the board office and the more difficult job of effective and efficient regulation of the practice of Tennessee’s largest health profession (92,0000 actively practicing RNs and LPNs). What does this involve? 

The law regulating the practice of nursing in Tennessee sets out in T.C.A. 63-7-101, the purpose of the board “is to safeguard life and health by requiring that each person who is practicing…nursing…submit evidence that the person is qualified to practice and to be licensed…” In T.C.A. 63-7-209 the law goes on to describe the duties of the executive director. Among the duties enumerated is one which sets nursing apart from other licensing boards that is the authority of the executive director to issue licenses. The executive director of the board of nursing, unlike the other health related boards, does not need authority from the board to make a decision to grant or deny a license. While this greatly enhances efficiency in 5,300 nurses per year, it is an awesome responsibility. 

In order to carry out the responsibilities (and sleep at night), I’ve developed policies, procedures and guidelines for making licensure decisions. The board periodically reviews and approves these policies for relevancy and our office of general counsel provides legal review. 

Board responsibilities fall into four major categories: licensing (initial by examination, endorsement from another state, renewal and reinstatement), practice (rules, scope of practice, policy statements and declaratory orders), discipline (complaints against licensees, alternative dispute resolution, settlements and action against a license) and education (initial and continuing approval of schools of nursing). Obviously, it takes many people with different expertise to pull it all together. My job is to provide leadership and maintain accountability for these activities so that the board meets both its statutory mandates and expectation for excellence. 

As is the case in many organizations, I have a board to which I am accountable. The law, T.C. A. 63-7-207, describes the powers and duties of the board of nursing. These duties, such as “cause the prosecution of persons violating the provisions of this chapter, prescribing minimum standards for schools of nursing and conducting examinations to ascertain the qualifications and fitness of applicants” require a very steep learning curve. I see board member development as essential for successful outcomes. Since the membership continually changes with new appointments, I have a duty to mentor new board members, find new and untapped potential and encourage leadership skills.  

I give credit to the National Council of State Boards of Nursing (NCSBN) for providing the support to grow in my position and to offer resources for the board to do its job. I’ve had many mentors. Ruth Elliott, my predecessor in this position, shared her wisdom and encouraged my participation in NCSBN activities. First I served on and then chaired the Bylaws Committee through a comprehensive revision. The lesson I took away is that bylaws of an organization should be flexible, a living document to empower the organization to progress. Next I chaired the Regulation Committee, better known as the Multistate Licensure Committee. Our charge: to define nursing licensure for the future. The lesson learned: set characteristics of an ideal model, examine existing models, think globally and think creatively without fear of losing your own job. My experience with the Commitment to Ongoing Regulatory Excellence Committee gave me a tool to measure the effectiveness of our board of nursing in protecting the public and laid out 17 best practices. Some examples of these best practices include: establish a high level of involvement with the statewide nursing community, apply discipline consistently, provide consultative as well as evaluative services to state education programs and make an aggressive commitment to customer service. 

What do I feel I have accomplished in my leadership role? There are four successes that I would like to share. First is the responsibility for developing the procedures for and implementing the nursing alternative dispute resolution (screening panel), the first in the country, which has decreased investigation-to-hearing time to one to two months and has shortened board time spent on formal hearings by one half. Second is the role I played, along with Judy Eads, board chairman at the time, and representatives of the Tennessee Nurses Foundation, in bringing the Tennessee Professional Assistance Program from a volunteer peer assistance format to a centralized board-funded alternative to discipline program for nurses with chemical, physical and emotional impairments. This program provides monitoring and support for over 400 nurses who would otherwise be subject to licensure action and possibly lost to the profession. 

Third is the Tennessee Center for Nursing, the research arm of the board which provides evidence-based data needed for planning and decision making. My primary contribution there is communicating the needs of the board into the research agenda. This organization’s data provides an invaluable resource for researchers, educators and policy makers. Fourth, Tennessee joined the multi-state compact July 1, 2003, improving access to care, reducing the barriers to licensing and facilitating investigations of nurses.  

Now that we know what is on the front of the billboard, it’s time to take a look at the back of the billboard. Kathy Malloch describes it as “What is making you crazy or managing the unmanageable.” By any title, most leaders will identify with the challenges: a new generation of staff, unfunded mandates, federal/state regulations, constant interruptions, insufficient resources, “the board said,” expectation for instant responses, difficult people and lack of consensus.  

How does one manage if one does not know everything? While traditional leadership eschews vulnerability, Malloch reports that vulnerability is the standard for leadership in the information age. An openness to others and new ideas, self awareness of strengths/limitations, collaboration and trust are among the characteristics of vulnerability.  When you make a mistake, “own it and love it” she says. “You are a member of the human race.” 

Future progress in nursing regulation is likely to be made in the areas of evolving scopes of practice, increasing globalization, greater development of evidence-based regulation and acceptance of the concept of a just culture. I believe that shaping the future of nursing in Tennessee requires embracing the concept of vulnerable leadership. Positive attributes of risk taking that encourage creativity, require continuous evaluation and that allows for mistakes must replace the artificial security of the status quo. Tennessee nurses expect nothing less. 

By Susan M. Sanders, MSN, RN, CNAA
Chief Nursing Officer
Bedford County Medical Center 

Nursing leadership in an acute care hospital environment encompasses numerous duties and responsibilities. As Chief Nursing Officer I am responsible for human and financial resource management assuring quality patient care. Other activities should include promoting professionalism in nursing and advocacy for patients as well as nurses. I represent the needs of nurses to the hospital board, administration and public. Providing a structure for fair compensation and the tools to accomplish the work is extremely important in my job. The tools for nurses to function properly include education and equipment along with resource allocation. 

Duties for nursing administration include planning, staffing, organizing, delegating and communication. The planning aspect must relate to standards of nursing care with development of goals/objectives, policies and procedures, budgeting. A large portion of an administrator’s job involves staffing of the facility. Many people believe staffing is only related to the scheduling of nurses, but it actually involves much more when you are faced with limited nursing personnel. The staffing requires attention to skill mix, safe staffing ratios, recruitment/retention, staff development and competency verification. 

Each day an administrator’s life is filled with multiple tasks; therefore organization is key. Juggling the follow-up on employment applications, regulatory standards, staffing, customer service issues, etc., can only be accomplished if you are organized. Nurses must always work together to accomplish more. By delegating, the nursing administrator can accomplish much more than any one individual. This delegation also allows for the professional growth of staff. 

I believe the most important function of the nursing administrator is communication, and within this communication, listening is essential. A variety of communication skills are required to provide information, encourage, delegate, motivate and manage conflict. Obtaining feedback not only from staff, but patients, physicians and other healthcare providers will assist you in determining the needs of the organization. 

Nurses are known for caring, compassion and listening. This must not end when a nurse leaves the bedside. To become a nurse leader, one must first see exemplary leadership. My journey to an administrative position evolved through education and positive role models.  These role models were evident in my work environment and through my association with professional nursing organizations such as the Tennessee Nurses Association. I believe it is incumbent upon each of us to set an example of professionalism in whatever nursing capacity we choose. Progress in nursing can only be attained through mentoring, coaching and quality nursing practice. 
 

By Sharron Grindstaff, MSN, RN
President
Tennessee Organization of Nurse Executives 

I am very fortunate to have the opportunity to serve as 2004 – 2005 President of the Tennessee Organization of Nurse Executives (TONE). As TONE president, I have been able to experience first hand the passion that Tennessee nurse leaders have about our patients, our practice and our nurses. There have been several nursing issues that Tennessee nurse leaders have dealt with this year requiring difficult discussions and compromises. At times this has been stressful, but I remind myself that this is actually necessary for the growth of Tennessee nurse leaders and the continuous advancement of our practice. I am energized by the tremendous nurse leaders I have had the opportunity to work with through the Tennessee Organization of Nurse Executives, the Tennessee Nurses Association, the Tennessee Center for Nursing and the Tennessee Hospital Association.      

As a nursing leader, I hope that I can inspire and motivate others to provide the best care possible and to constantly be searching for a higher standard of care and practice to better care for our patients. One of my primary roles is to constantly search for the balance of meeting patient care needs, nursing staff needs and financial efficiency while always striving for a higher standard of care and practice. Creating a positive nursing environment is also a major focus for every Tennessee nurse leader. Helping other nurses to see their strengths and weaknesses and mentoring them to grow professionally is another critical role of nurse leaders. It is essential that nurses be viewed as an asset and an investment. Nurse leaders are responsible for translating and communicating this value to our CEOs and CFOs.     

I was fortunate to have a mentor who provided me with challenging opportunities to grow professionally and guide my career path. Her wisdom and guidance also helped me to understand that an effective nurse leader is critical in translating the clinical aspect of patient care and nursing to those in other healthcare provider and administrative roles. Nurse leaders must understand that the role often requires being articulate, assertive, making difficult decisions and accepting responsibility for those decisions. One aspect of my philosophy of nursing leadership is to surround yourself with knowledgeable, highly competent and wonderful people. It is essential that a strong nursing leadership structure and staff base is established in addition to developing strong collaborative working relationships both internally and externally.

Unicoi County Memorial Hospital, Inc. (UCMH) is a small rural hospital in the beautiful mountains of Northeast Tennessee. I serve as the Chief Nursing Officer for UCMH and Administrator for Unicoi County Home Health in Erwin, Tennessee. I am truly blessed to have the opportunity to work with a tremendous nursing, hospital, administrative and medical staff. As is the case in many hospitals, my duties expand beyond nursing and home health to include coordinating performance improvement/quality improvement activities for the organization and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) activities.   

The future of nursing in Tennessee has multiple challenges, but I like to view these challenges as opportunities for success. Tennessee nurse leaders need to be more active in conducting and participating in research studies to support evidence based practice. Tennessee nurse leaders are in a wonderful position to develop strategies for nursing retention and recruitment to help decrease the impact of the nursing workforce shortage. The attributes defined by the ANCC Magnet Recognition Program can serve as an excellent template for those strategies. We should also encourage nurse leaders and organizations to strive for this recognition. The current healthcare environment presents Tennessee nurse leaders with multiple opportunities to positively impact patient care practices and the nurses’ work environment. In the midst of technological advances and innovation it is important that nurse leaders remember the basics of nursing while keeping the patient the center of all of our decisions and activities.