Course: Leadership and Management. Textbook: Leadership
in Nursing Practice.3rd
edition by Dan Weberg.
Chapter 15 Scenario
Michele is
the chair of the Practice Council. There has been much discussion on the unit
about implementing evidence-based practices in all of the nursing practice
protocols. However, the staff knows little about the foundations and principles
of evidence-based practices and do not understand the implications of changing
practice patterns to reflect the related principles and applications into every
nurse’s role.
A number
of members of the Practice Council have expressed negative feelings about
changing to incorporate evidence-grounded practices into their roles. One of
them asked, “if what we are doing is not broken, why fix it?” This person has
managed to get a couple of the other members of the Council to support her
opposition. The nursing manager is insisting that the Council seriously
undertake this work because it is a “mandate” from the nurse executive, and the
unit manager’s “reputation is on the line.”
Michel has
some concerns about implementing changes in response to a mandate from above.
The organization has been operating within a shared governance structure for
some time. To Michele, it appears that the move to evidence-based practice
should be a staff initiative and come from the wider nursing division Practice
Council rather than as a mandate from the nurse executive.
For
Michele, evidence-based practice reflects a fundamental principle of accountability
on the part of the staff. She feels that staff should want to validate their
practice choices and application with data and demonstrate best practices in
their clinical performance. She has
noted that some questions have arisen regarding the level of understanding and
commitment to personal accountability among all members of the staff. Michele
knows that if evidence-based practice is to succeed, it will need the support
of leadership and staff throughout its implementation.
Question
1)
What preparations does Michele need to do
in relation to her knowledge base about evidence-based practice before she
brings the issue to the unit Practice Council? What information will she need
to gather and provide for the Council members before they meet?
2)
How
will Michele present the concept to the council, and what will she need to do
to help them engage the concept and work to make it happen?
3)
Michele
has some conflict issues regarding evidence-based practice with Council
members. How will she address the conflict? Which approaches should she use to
persuade those who are opposed to the idea to embrace and work with the Council
to make it happen?
4)
Michele has some concerns about
evidence-based practice being a response to a mandate. In keeping with the
principles of shared governance, where does legitimate accountability lie for
generating evidence-based practice? Where should the direction come from for
requiring its implementation, and which shares governance mechanisms should
drive it? What is the legitimate role of the manager in the requirement for and
the process of implementing evidence-based practice on the unit?
5)
Michele
has expressed concerns about staff accountability. Because evidence-based
practice depends strongly on staff’s personal accountability for its successful
implementation, what will Michele need to do to generate interest and
accountability in the staff for practicing in a way that demonstrates
evidentiary foundations for practice? How will she know when accountability is
present?
6)
Is there a point in time when the Practice
Council should move ahead without full consensus? What are the criteria to do
so? List the advantages and disadvantages of taking this step.
7)
Create a mind map or visual graphic
presentation of the problems and issues Michele must address and the ways in
which she should deal with them as she leads implementation of evidence-based
practice on the unit. Share your indicators of success for each element of the
process that will demonstrate that you are making successful progress in making
it work on the unit.