Running head: LEADERSHIP STRATEGY ANALYSIS

Leadership Strategy Analysis

LeeAnn Bush, Krishanda Decker, Angela Farris & JoAnn Norman-Metcalf
Ferris State University

Abstract

Nurses have a duty to the patients they serve to provide safe, quality care. Traditionally, nurses
have utilized conference rooms, nurses stations, and break rooms for reporting vital patient
information and changes in the plan of care without the inclusion of the patient. The evaluation
of quality care has moved to examining patient outcomes, safety, and patient reported
satisfaction scores. Bedside reporting allows the nurse to visualize the patient and ask questions
about the plan of care. It also allows patients to be involved in and have knowledge of their
treatment plan and plan of care. The goal of bedside reporting is to increase patient safety and
improving the overall patient care experience.

Keywords: bedside report, safety, change of shift, patient satisfaction

Leadership Strategy Analysis

Through quality management (QM) and quality improvement (QI) initiatives, nurses
have the ability to be involved in process change used in current practices that impact the quality
and safety of patients entrusted to our care. The purpose of this paper is to highlight the elements
of conducting a leadership strategy analysis by using quality improvement initiatives to analyze
current clinical activity aimed at improving clinical processes and patient outcomes.
Clinical Need
As a profession we have a goal to provide safe and quality care to the populations we
serve. Caring for patients in the hospital is a twenty four hour a day job. With long shifts, most
being twelve hours or longer, a lot of things happen in a patients care in that time. The handoff
of patient care from one nurse to another is an important step. If key points of information are
missed or not communicated, patient safety is at risk. According to Jeffs et al. (2013), There is
growing evidence that nurse to-nurse handoff at the bedside (referred to as bedside shift
reporting) involving the patients in the reporting interaction has positive outcomes for patients,
nurses, clinical teams, and organizations. In fact, the importance of proper hand off
communication is so important that it was a component in national patient safety goals in 2007
(Laws, Amato 2010). Patients being involved in their own care not only allows them to feel like
an important part of their healing process, but allows the patient to be another check system in
the information during report.

Collaborative Team
Change is difficult in all aspects of life. When changes have the potential to impact the
lives that are entrusted to healthcare providers .As a healthcare provider ,to provide the quality of

LEADERSHIP STRATEGY ANALYSIS

care our patients deserve changes the way we view changes made in practice that impact the
quality of care we provide . To change the status quo, it takes a carefully designed
interdisciplinary team to fit the needs of the objective. These individuals share in the mission and
values of the project and are committed to the teams purpose and function. For bedside
reporting, the team will include: clinical education, the unit manager, champion staff nurses, as
well as selected non-licensed clinical personnel. According to Yoder-Wise (2015) the
Scientifically derived approach to evidenced-based organizational practice optimizes
professional roles and practice and coordinates activities (p. 4).
The clinical educator is responsible for the development of educational activities that
provide a clear understanding of the guidelines for the project. In conjunction with this, the
educator provides competencies to evaluate learner success through various models such as
online activities and rehearsed scripting.
The unit manager has the ability to reach all staff members through staff meetings as well
as unit-based email. The unit manager will hold staff meetings for all shifts to further educate the
staff as well as prepare them for the change. This will offer staff an opportunity to engage in the
process, ask questions, and create an opportunity to avoid potential barriers that may exist.
The staff nurse champions are nurses who are already involved in unit-based initiatives
and improvements. Champion staff nurses possess ambition, positive attitudes, and share in the
goals and mission of the unit. They are well-respected members of their unit and have influence
on their co-workers to promote positive changes. They will be the first to trial bedside reporting
and in turn, encourage and teach other staff nurses to positively participate in the project goals.
The clinical non-licensed personnel, while not directly involved in the change itself, are
cheerleaders for the unit who understand the goals and mission, engaging others in positive

LEADERSHIP STRATEGY ANALYSIS

conversation about the project. As noted by Rowe & Najed (2009) this is an example of shared
values and clear vision that allows employees to make decisions with minimal formal monitoring
or control mechanisms (para. 9).

Data Collection
In order to obtain data before the project, a literature review should be completed by the
interdisciplinary team. Finding data of previous facilities experience in changing to bedside shift
reporting and ways other facilities where able to monitor the change will aid the team to build
the educational program for their own facility. When the team has the knowledge base it will
build confidence from staff when actual implementation of the change happens. Also,
comparisons need to be researched. Other types of shift reporting and the data on the effect on
patient safety should be reviewed. Lastly, before a final plan is made interviewing staff can help
while making the plans for change. Collaborating with nurses and extending that to
collaboration with members of other disciplines to identify desired outcomes will enhance the
ultimate success of an evidence based project (Yoder-Wise, 2015).
Outcomes
Bedside reporting can be beneficial to both nurses and patients. The intended outcomes
include improving effective communication between staff while incorporating the patients
involvement in care. This can be achieved through post discharge phone calls on every patient
with feedback recorded and posted for nurses to see progress toward goals.According to Caruso
(2007), nurse-to-nurse bedside report includes positive patient outcomes such as patient
empowerment, patient involvement, and the patient being an additional resource in diagnosis and
treatment. During bedside report, the patient can confirm that the report is professional, geared

LEADERSHIP STRATEGY ANALYSIS

towards healthcare needs, and gives the opportunity to correct misconceptions. Patients are also
able to observe a safe and effective handover of responsibilities.
Bedside reporting allows the oncoming nurse to visualize the patient immediately and
confirm the previous shift report (Laws & Amato, 2010). It also helps to obtain a baseline
assessment and for the nurse to plan and prioritize patient care while helping to manage the
patient load more effectively (Laws & Amato, 2010). Staff relationships will be enhanced as
nurse-to-nurse and nurse-to-patient communication is improved. Ultimately, employee and
patient satisfaction will greatly increase with the use of bedside reporting.
Implementation Strategies
In order to implement bedside reporting, all employees must obtain a collective vision
and focus. Informing staff of the rationale and information regarding the positives and research
to bedside reporting will encourage the idea. Once the unit is on the same page, and has a good
understanding for the implementation of bedside reporting, specific strategies will need to be
created. The most valuable implementation strategy includes the use of a report template. Once a
template is drawn up, the nursing staff will use this to obtain a consistent report format. This
allows for safe, effective, and consistent communication (Caruso, 2007).
The patients will need to be informed of bedside reporting upon entering the unit. They
can be notified by the use of information pamphlets and as part of the standard new patient
nursing admission. Also, signs can be posted that say, Ask your nurse about bedside report
(Caruso, 2007). This will encourage patients and family members to inquire about bedside
reporting to enhance understanding. Upon nearing the end of the nurses schedule, the nurse
should round on all of the patients, reminding them of the upcoming report. At this time, the
nurse would make sure all patient needs have been met in order to avoid interruptions during

LEADERSHIP STRATEGY ANALYSIS

bedside reporting. In order for the implementation of bedside reporting to be successful, a
combined understanding, a collaboration of team members, and effective strategies must all be
set in place.
Evaluation
All members of the interdisciplinary team will need to be involved in continual
assessment and evaluation of the implementation and impact of bedside reporting. Unit
managers and educators will need to assess how bedside reporting is impacting staff and patients.
Feedback from patients should be sought by staff and managers so that improvements may be
made. In short term this can be achieved through discharge phone calls 1-2 days post discharge
and long term through patient satisfaction scores. In a study in the International Journal of
Nursing Practice, patients reported feeling more in control and confident (Lu, 2013, p. 454)
regarding their care after being involved in bedside reporting. However, sensitive issues need to
be avoided such as sexually transmitted diseases or mental illness. Also patients may not feel
comfortable with bedside shift report if they are sharing a room with another patient.
Staff nurses will need to mentor one another and hold one another accountable for
participating in bedside shift report. Champion nurses can assist in mentoring fellow nurses and
encourage participation by answering questions and promoting positive communication about
new changes taking place. We all struggle with change, but supporting one another and having a
positive attitude often help with adjusting to a new procedure. The interdisciplinary team will
need to encourage a team culture, in which everyone works toward a common goal (Gesme,
2010, p. 259). Staff will also need continual education and support through the change process
by providing online education and educational forums provided by nurse educators. Evaluation
of goal achievement is necessary and achieved through surveys conducted. A increase in patient

LEADERSHIP STRATEGY ANALYSIS

satisfaction and a feeling of empowerment should result with bedside shift report as evidenced
by increased patient satisfaction scores. The nurse should feel more connected to her patient and
more informed compared to traditional shift reporting. Also, staff should be better able to
prioritize and assess the patients need with the new process successfully implemented.

Conclusion
Patient centered care is the focus of healthcare providers. Involving patients in their care
and empowering them also helps them to take ownership of their healthcare. Bedside reporting
helps accomplish these goals. However, when implementing any new process there are
challenges to be faced. Staff may struggle with what type of information should be exchanged or
with how much to involve patients and families in bedside reporting. Educators and nurse
managers may want to provide a template or structured outline of what bedside reporting should
include.
For the patients and their families, written documentation about bedside reporting is
useful. Explaining what to expect and when reporting occurs will help the family and patient
feel prepared and included. Communication to patient and staff is imperative in order for
bedside reporting to be implemented and to be effective.

LEADERSHIP STRATEGY ANALYSIS

References
Caruso, E. M. (2007). The evolution of nurse-to-nurse bedside report on a medical-surgical
cardiology unit 16(1). Retrieved from:
http://www.mc.vanderbilt.edu/root/pdfs/nursing/evolution_of_nurse-tonurse_bedside_report_on_a_med_sx_card_unit.pdf
Gesme, D., & Wiseman, M. (2010). How to Implement Change in Practice. Journal of Oncology
Practice, 6(5), 257259. http://doi.org/10.1200/JOP.000089
Jeffs, L., Acott, A. Simpson, E. Campbell, H. Irwin, T. Lo, J. Beswick, S. Cardoso, R. (2013).
The value of bedside shift reporting enhancing nurse surveillance, accountablitiy, and
patient safety. Journal of Nursing Care Quality. 28(3) 226-32. doi:
10.1097/NCQ.0b013e3182852f46.
Laws, D. & Amato, S. (2010). Incorporating bedside reporting into change-of-shift report 35(2).
doi: 10.1002/j.2048-7940.2010.tb00034.x
Lu, S., Kerr, D., & McKinlay, L. (2014). Bedside nursing handover: Patients' opinions.
International Journal of Nursing Practice, 20, 451-459. doi:10.1111/ijn.12158
Rowe, G. & Nejad, M. (2009). Strategic leadership: short-term stability and long-term viability.
Retrieved from: www.http://iveybusinessjournal.com/publication/strategic-leadershipshort-term-stability-and-long-term-viability/
Yoder-Wise, P. S. (2015). Leading and managing in nursing (6th ed.). St. Louis, MO: Elsevier.