Running head: NURSING LEADERSHIP PHILOSOPHY 1

Nursing Leadership Philosophy

Delaware Technical Community College - Stanton Campus

NUR 400: Nursing Leadership

Megan Couden

February 21, 2020

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Nursing Leadership Philosophy

The nursing profession covers a broad range of roles and responsibilities when it comes

to promoting health and wellness. Nurses provide direct care in healthcare facilities or

communities, educate new nurses, research current practice looking for areas in need of

improvement, advocate for healthcare initiatives in government policy, and more. Throughout all

the areas in the nursing spectrum, a common trait is that successful caring comes with teamwork.

The team may be multidisciplinary with a goal to provide exceptional patient care or may consist

of a group of multilevel nurses working to create a change improving current practices. Within

those teams, nursing leaders have the standout ability to identify potential needs, recognize

strengths in others, and can motivate members to work together, stay united, keep lines of

communication open, problem-solve, and work towards common goals in providing top level

care.

Nursing Leadership Model

While some leaders are naturally gifted, others develop their skills through adopting a

leadership model that can be applied to the nurse’s particular specialty. One such model is

Drucker’s Theory. Peter Drucker, the “father of modern management” (Finkelman, 2016, p. 8),

viewed successful management as being participatory in that staff are encouraged to be involved

in planning and establishing goals, recognizes how the strength of the individual can contribute

to the strength of the organization, and acknowledges that leadership can be learned and nurtured

for continued growth and success (Finkelman, 2016).

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In the nursing specialty of pediatric home health care, Drucker’s Theory can be easily

applied. Home health nurses often work for an agency and carry out direct nursing duties

independently within the community. Drucker believed in having management by objectives,

where all members of the agency do their individual specialized part while working together

towards commonly established goals (Alderton, n.d.). Similar to the nursing process, Drucker

felt managers should utilize SMART goals (Caramela, 2018) and set objectives, organize tasks

and motivate teams, communicate, analyze, and measure outcomes, all while developing people,

including him/herself (British Library, n.d.). Home health agencies typically employ directors,

schedulers, educators, administrative staff, nurse clinical managers, and field nurses who provide

direct client care on a routine basis to ensure clients receive the best possible care while

operating under larger corporate policy directives. Progress is monitored and evaluated by

agency management and staff together, measureable milestones are identified, and rewards and

feedback inspire the team to grow personally and professionally (Alderton, n.d). Field nurses

may be encouraged to become preceptors for new nurses, take additional education to widen

skillsets with more high tech clients, or transition to educator or nurse manager positions.

Individual client care plans are developed by the nurse clinical manager following a

comprehensive assessment including client history, current diagnosis, medical needs,

psychosocial and environmental needs, and insurance coverage. Collaboration within a

multidisciplinary team coordinates every aspect of the client’s care, ensuring needs are met and

establishing a home environment that is capable of providing full service nursing care. Once the

case has opened, field nurses orient to the client and begin providing independent care,

performing thorough assessments, identifying any changes, evaluating whether all needs are met,

and advocating for change as needed. Supported by Drucker’s Theory, the autonomy of the role
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of the field nurse requires independent decision making and initiative to communicate to nurse

managers and physicians if and when a client’s status changes, as well as adapting any associated

goals addressing the necessary changes. New nurses on the case are as valuable as experienced

nurses because they are the eyes and ears of the multidisciplinary team in the home.

Understanding how and when to speak up for the client can be learned as experience is gained

and changes are more readily identified and interpreted.

Becoming an Effective Leader

As a field nurse in pediatric home healthcare, Drucker’s Theory is embraced as it gives

all voices meaning and supports an open line of communication with other nurses and nurse

managers. Before stepping into a management position, Drucker suggests looking inward to

develop self-management skills or emotional intelligence to “understand and control what we

feel (our emotions) and the way we act (our response to these emotions)” which can relate to

how communications and actions might be received by others (Sherman, 2015, para. 1).

Emotional intelligence can be used by field nurses when caring for clients and interacting with

families as well as with other nurses.

Official leadership opportunities in home health care progress through field nurse,

preceptor, clinical manager, nurse educator, director, and higher positions up the corporate ladder

allowing many opportunities for growth and lifelong learning. Unofficial positions also exist

within each client case as different nurses with varying degrees of experience and history with

the client take on different roles and responsibilities of care. For example, a nurse who has been

on a case for ten years, works multiple consistent day shifts, and is present for appointments and

therapies has the opportunity to be in a more active leadership position because they have an

established rapport with the client and family, firsthand experience with treatments and changes,
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and can communicate new information to the rest of the nurses. The night shift nurse can also

take on leadership responsibility with managing tasks such as rotating supplies, changing tubing

circuits, taking inventory, listing medications that need to be ordered, and cleaning while the

client sleeps. All nursing positions have a role and potential for leadership.

Whether day shift or night shift, nurses can elect to become a nurse preceptor for new

nurses intending to work independently with clients. This position is recognized by the company,

requires an instructional course to complete prior to precepting, and preceptors receive incentives

for each shift where they train a new nurse. Preceptors must maintain open collaboration which

establishes a running dialogue to identify the new nurse’s strengths and experiences. Gaining

insight on the skill level of the new nurse identifies what interventions and treatments should be

focused on and practiced pertaining to the client’s specific needs and preferences. Openly

assessing whether the nurse is ready to safely and confidently take on the client independently

occurs through discussion as the preceptor actively listens to the nurse’s self-evaluation and

provides feedback. For example, the nurse preceptor shares which techniques work best to clear

a particular client’s airway and what the order of interventions are that work most efficiently to

clear thicker secretions. The nurse then performs those techniques with real time, respectful,

feedback. Any clarification or questions can be answered and situations discussed about how to

handle status changes and emergencies. The new nurse has the opportunity to state whether he or

she feels comfortable and prepared to work independently or if further orientation is needed.

While collaborating, the nurse preceptor also has the opportunity to learn any other strategies

from the new nurse that may be beneficial when caring for this client, increasing efficiency and

quality of care through evidenced based practice and innovation in order to provide the best care

(Caramela, 2018).
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Patient Advocate and Team Collaborator

At the very heart of pediatric home health nursing lies the client. Children in need of

chronic medical care and treatment, with the ability to remain in the comfort of home, rely on

nurses to follow their care plan and be an advocate for their health and wellbeing. As the

pediatric population is often lacking the ability to fully understand their diagnosis or clearly

communicate needs, the nurse must be cognizant of client status and act on their behalf. Not only

must nurses be aware of needs related to the diagnosis, but also assess the psychosocial and

environmental aspects of care for safety, family support, and foresee any future changes that

should be prepared for as the child grows or conditions change. Nurses can also act as silent

advocates by arriving to their shifts on time and being reliable to look and act professionally.

Nurses following Drucker’s theory act autonomously in the home and speak up on the

client and family’s behalf by collaborating with the multidisciplinary team as needs arise.

Despite being independent in the home, a team of providers surround the client working towards

achieving patient-centered goals. Using problem-solving skills, acting as a change agent when

needed, and developing SMART goals enables home health care nurses to actively work with

other members of management and care providers to enable the client to reach their greatest

potential and highest quality of life (Finkelman, 2016).

Future Goals

Peter Drucker once said "look out the window and see what's visible but not yet seen"

(Alderton, n.d., para. 23). As a nurse, following this astute piece of advice gives way to embracing

potential changes as the needs arise. Advancements in the medical field allow for continuous

growth and development of the nursing profession as evidence based practices are re-evaluated
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and adopted. Staying knowledgeable and adaptable to change aids in improving client care.

Teaching other nurses to care for existing clients and orienting to new clients maintains ongoing

opportunities for personal and professional growth through skills and leadership. Nurses in home

care have the unique opportunity to not only learn about and provide interventions directly related

to the clients’ diagnoses, but almost become a member of the family through a professional

capacity, staying compassionate and always vigilant for what has yet to be seen.
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References

Alderton, M. (n.d.). Learn about Peter Drucker's management theory and how it can help your

business. Retrieved Januray 20, 2020, from

https://www.business.com/articles/management-theory-of-peter-

drucker/?q=sammi+caramela&_ga=2.76377756.864310957.1579565987-

2066749212.1579565984

Caramela, S. (2018, March 16). 4 ways to implement Peter Drucker’s theory of management.

Retrieved from https://www.businessnewsdaily.com/10634-peter-drucker-management-

theory.html

Finkelman, A. (2016). Leadership and management for nurses: Core competencies for quality

care. United States of America: Pearson Education.

Peter Drucker. (n.d.). Retrieved January 20, 2020, from the British Library website:

https://www.bl.uk/people/peter-drucker

Sherman, R. (2015, May 28). Self-management in leadership. Retrieved from

https://www.emergingrnleader.com/self-management-in-leadership/