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Running head: NURSING LEADERSHIP ROLE IN POPULATION BASED ISSUES

Nursing Roles in Prevention of Domestic Violence

Kaitlyn Baldwin
Ferris State University

NURSING LEADERSHIP ROLE IN POPULATION BASED ISSUES

Abstract
Public health nursing is expanding in diversity of care delivered to patients. This paper will
summarize the nurses role in relationship to a community change project to improve outcomes
of patients who are victim to domestic violence. One nursing role summarized will be the direct
contact nurse. A second nursing role will be from the stand point of a nurse manager/leader. The
paper will analyze how each role is similar and different when compared to each other. The
nurse will reflect upon her own strengths and weaknesses in relation to each role discussed.

NURSING LEADERSHIP ROLE IN POPULATION BASED ISSUES

Nursing Roles in Prevention of Domestic Violence
Community based nursing is increasingly becoming in demand as we are moving into the
21st century. Public health nursing is also in demand to promote healthy outcomes and prevent
illness or injury. According to Harkness and DeMarco community-based direct nursing cares is,
illness care provided to patients outside of the acute care setting where people work, live, or
attend school. The public health nurse revolves around a population-based practice where disease
and injury are prevented from a service management stand point. Both areas of nursing overlap
and can provide clients with the necessary clinical services. A well prepared public health nurse
may provide clinical services as a response to a community need while continuing to work on
interdisciplinary public health teams to improve the health of communities (Harkness &
DeMarco, 2012, p.8). According to the World Health Organization Violence is the intentional
use of physical force or power, threatened or actual, against oneself, another person, or against a
group or community, which either results in or has a high likelihood of resulting in injury, death,
psychological harm, maldevelopment, or deprivation (WHO, 2013). The nursing roles in
prevention of domestic violence are based in both community-based direct nursing care and
population-based preventative management services.
Community-Based Direct Contact Nurse
The direct contact nurse practices in agencies that provide care for patients of all ages.
They practice in areas such as community health clinics, free clinics, home health care and
school clinics. A direct contact nurse can practice with a basic nursing education level like an
associate degree or diploma. The role that the direct contact nurse has in patient care includes
tasks such as caregiver, case manager, advocate, collaborator and also information researcher.

NURSING LEADERSHIP ROLE IN POPULATION BASED ISSUES

According to the ANA code of ethics The nurses primary commitment is to the patient, whether
an individual, family, group or community(ANA, 2010). This commitment is important to apply
when caring for individuals who have been victim to domestic violence. Domestic violence can
happen in multiple situations under several circumstances. In any area of nursing, from geriatric
to pediatric, it is so important to be aware of the signs and symptoms of injuries created from
domestic violence.
An important role that the direct contact nurse will have, when caring for a person who is
victim to domestic violence, is being a collaborator. This leadership responsibility the nurse has
toward the patient could save their life and at minimum improve their environment where they
live. It is the nurses ethical duty to report suspected abuse to the authorities. This type of
collaboration is difficult but necessary. In provision three of the ANA standards of nursing
practice: The nurse promotes, advocates for, and strives to protect the health, safety, and rights
of the patient(ANA, 2010). The direct contact nurse will collaborate with law enforcement
agencies, social work agencies, the patient and family members to participate in a joint decisionmaking process to change the domestic environment where the abuse is happening. Nurses in
community health work with diverse partners and providers to address complex challenges in the
community(Meadows, 2009).
Effective leadership characteristics needed to be effective in carrying out the role as a
collaborator include (but are not limited to) through analytic abilities, good communication
skills, effective liaison between the agency and other healthcare systems, and advocate for the
patients best interest. When a direct care nurse has determined with through analysis of a risk
assessment that a patient is suspected to have been victim to domestic abuse a domino effect
begins. Whoever is conducting the safety assessment needs to seek advanced training on risk

NURSING LEADERSHIP ROLE IN POPULATION BASED ISSUES

assessment and be aware of community resources(Harkness & DeMarco, 2012, p. 296). Part of
being an effective advocate, liaison, and communicator is becoming educated in specialized
training. Seeking out knowledge is a leadership skill that the direct care nurse must have. Some
essential leadership skills should already be in place from professional training, such as effective
listening, understanding accountability, empowerment, observation, networking, and relationship
building(Adams, 2010).
Population-Based Nurse Manager
The population-based nurse manager practices in agencies like official, proprietary or
voluntary agencies. The education level of a nurse manager is typically higher education at the
bachelorette or masters level and there is a specialty area of focus (Harkness & DeMarco, 2012,
p.196). The role that the nurse manager would take goes beyond the role of a direct care nurse.
The role of the nurse manager extends as a researcher, a policy advocate, political activist,
community wide coalition builder, and identifier of conditions that negatively affect the
community as a whole. The ANA standards of practice state that The nurse participates in
establishing, maintaining, and improving health care environments and conditions of
employment conducive to the conditions of quality health care and consistent with the values of
the profession through individual and collective action(ANA, 2010).
The nurse manager would take on a leadership role by developing or maintaining an
existing public program that help individuals who are victim to domestic violence. The
leadership characteristics needed to effectively carry out such a proposal include working with
clinical specialists to establish new innovative services where they might bring benefit,
collecting data and demonstrating outcomes from their activities(Adams, 2010). The nurse

NURSING LEADERSHIP ROLE IN POPULATION BASED ISSUES

manager who performs leadership duties to improve the outcomes of the patients who suffer
from domestic violence advance their profession by contributing in some way to the leadership,
activities and the viability of their professional organizations(ANA, 2010).
Some of the leadership responsibilities that are specific to a nurse manager include the
ability to organize the tasks that need to be accomplished to achieve the goal of running a
successful population-based organization. Patient care, advocacy, and collaboration are part of
the skill set. There is the business side of leadership that is specific to the nurse managers duties.
Planning and financial responsibilities fall in this category to carry out effective patient care for a
population-based program that helps domestic violence victims.
The nurse manager should have the ability to build relationships, and to communicate
and negotiate effectively. The development of effective communication skills is having the
responsibility and autonomy to act, the opportunity to practice anda hierarchy of support is in
place within new community provider organizations through mentoring and clinical supervision
(Adams, 2010). Much of the support that the nurse manager will be providing will be for the
direct care nurses and ancillary staff who are working in the organization.
Analysis of Nursing Roles
The direct care nurse and the nurse manager in a community health environment need
multiple leadership qualities in order to care for patients who are victim to domestic violence. A
list of core competencies has been determined to strengthen the infrastructure of public health.
There are eight competency domains:

Analytic assessment skills

Policy development/program planning skills

NURSING LEADERSHIP ROLE IN POPULATION BASED ISSUES

Communication skills

Cultural competency skills

Community dimensions of practice skills

Leadership and systems thinking skills

Financial planning and management skills (COL Between Academia and Public Health
Practice, 2004) (Bigbee et al., 2010).

Self-reported competencies in a study on public health nursing found that there was a difference
between the staff (direct care) nurses and nurses in leadership. A masters prepared nurse
practitioner may, for example, be more aware of the complexity of policy development and
program planning skills necessary in public health practice(Bigbee et al., 2010). The associate
prepared nurse or even a baccalaureate prepared nurse may be aware of the skills needed to be
effective as a public health nurse but do not comprehend the depth of knowledge base as a
masters prepared nurse may.
Each role is similar in the leadership skills needed to carry out the task of successfully
collaborating together in an organization that helps domestic violence victims. The main
difference is in how much education and experience the nurse has. Nurses who have more
education and experience in population based care the more active they are in the management
roles (Bigbeeet al., 2010).
The political arena is impacted by community-based nursing. There is a lack of nursing
involvement in policy changes historically. Its typical for health departments to formulate
response and disease prevention plans, bring nurses in at the last minute or without consulting
them at all says Joy F. Reed, EdD, RN, head of Public Health Nursing and Professional
Development in North Carolina(Fateux, 2013). This trend is beginning to change because there

NURSING LEADERSHIP ROLE IN POPULATION BASED ISSUES

have been negative impacts on the community without nurse involvement in planning and
implementation of new public health policies and laws. Putting senior nurse leaders at the table
with senior government officials when policy and plans are formulated and financial resources
are allocated. The position also gives nurses at the grassroots a voice at the state level, assists
health departments in meeting workforce challenges and improves the quality of care by
establishing standards for clinical procedures and protocols(Fateux, 2013).
The implications for the different skills needed to support senior nurse leaders who are
advocating for new policy on the state level are changing. Nurses are actively using their voices
to change the recognition of the profession across state boundaries for the benefit of the entire
national community. The American Nurses Association (ANA) supports an alternative way of
addressing the need for a flexible response capability. The ANA advocates that states adopt a
uniform Emergency Volunteer Health Practitioners Act prepared by the Uniform Law
Commission(Fateux.2013). In Michigan a new chief nurse executive (CNE) position has been
created to focus on policy and legislation that supports nursing. Michigans CNE has created a
program to educate second-degree nursing programs to assist in boosting the working economy
and encourage nurses to continue higher education (Fateux, 2013). As discussed earlier nurses
who have more education and experience in population based care the more active they are in the
management roles (Bigbeeet al., 2010).
Reflection of Nursing Skills
My skills are limited to a basic level of education. I have an associate degree in nursing
and in completing that first degree I did not get much education in the realm of community based
nursing. I however am continuing my education and am actively pursuing my baccalaureate
degree in nursing. I do have nearly six years of experience under my belt where I have developed

NURSING LEADERSHIP ROLE IN POPULATION BASED ISSUES

my abilities by being an effective advocate, liaison, and communicator. I have also become
educated in specialized training with becoming certified in advanced cardiac life support,
pediatric life support and I also seek out knowledge which is a leadership skill I have. In time I
believe I could become competent in both the direct care community nurse role and also the
population based nurse manager role.

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NURSING LEADERSHIP ROLE IN POPULATION BASED ISSUES

References
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