A Leader...Who, Me?!?! Discovering yourself as a leader and

champion for school health

Debra Kramlich, MSN, RN, CCRN

School Nurse Summer Institute 2014

How do you see yourself?

School Nurse Roles

• Facilitator

• LEADER

• Provider

• Case manager

• Collaborator

National Association of School Nurses, 2011

Structure for Professional Nursing Practice

• Ownership

• Code of ethics

• Accountability

• Practice

• Quality

• Competence

• Knowledge management

Autonomy

• Reframing from feeling “isolated”

• Essence of Autonomy

• Limitations

• Leadership – “I would hope that all school nurses would have leadership qualities…”

School Nurse Competencies • Adapted from Benner’s Novice to Expert model

– Emergent

– Competent

– Proficient

– Expert

• 16 Standards

– Standard 15: Leadership

– “The school nurse provides leadership in the professional practice setting & the profession”

Accountability & Delegation

• Delegation is a necessity

• Always follow state nurse practice act

• The RN may delegate components of care but does not delegate the nursing process itself. The practice pervasive functions of assessment, planning, evaluation and nursing judgment cannot be delegated.

• Speak the language of safety

• Legislated ratios

Affordable Care Act & Triple Aim • Improving individual experience of care

– Quality

– Access

– Availability

– Reliability

• Improving health of populations

• Reducing per capita cost of care for populations

– Think of the broader community

– Systemic thinking

– Public health principles :

empowerment & knowledge

School Nurses as Safety Net • Advocate for those without a voice

• Poverty – 19% Maine children

– > 30% in Washington county

– 25% living with hunger

• Consequences – Poor health

– Trauma

– Adverse childhood experiences (ACEs)

– Depression & anxiety

– Epigenetics

Cost-Benefit Analysis • $1 school health investment = $2.20 society gain

– Saved medical care costs

– Parent productivity

– Teacher productivity

• Additional benefits not quantified – Higher graduation rates

– Improved grades & standardized test scores

– Reduced use of emergency medical services

– Improved medical compliance

– Reduced transmission of infections

– Earlier diagnosis & treatment

School Nursing Data Indicators

• Mirrors the ANA’s Nursing Sensitive Indicators

• Variables

– Staffing

– Risk management

– Health promotion/illness prevention

– Episodic care

– Care coordination

• Arm yourself with data

• “If you can’t measure it, you can’t fix it”

Use of Research & EBP

• Rogers’ Diffusion of Innovation Theory

– Social networks

– Interactive workshops

– Partnerships with organizations & academic centers

• Health promotion & disease prevention agenda

• Documentation & data collection

• Basing all policies & procedures on evidence – references!

Change & Innovation

• Build a case for change

• Challenges & opportunities

• Goal-directed

• Identify & engage stakeholders

• Build consensus

• Start small but THINK BIG

• Expect resistance but never give up

Collaboration • Importance of interdisciplinary practice –

REGARDLESS OF THE SETTING

• Learn effective team dynamics

• Consider your “frequent flyers”

– Complex issues

– Learn principles of root cause analysis

Collaboration & “Bundled Care” • Example: Asthma Management

• Problems:

– Adherence

– Under-identification

– Multiple barriers

• Opportunities for “perfect asthma care”

• Bundled care for management of other chronic conditions

– Diabetes

– ?

Healthy School Environments

• Mirrors the Healthy Work Environment initiative established by AACN

• Coordinated School Health Programs

• Health promotion for ALL

• Authentic Leadership

Becoming an authentic leader requires a personal journey of self-discovery, self improvement, reflection, and renewal.

Positive Deviance • Positive deviance is the observation that in most settings

a few at risk individuals follow uncommon, beneficial practices and consequently experience better outcomes than their neighbors who share similar risks.

• School nurses are highly skilled in complex environments

– Flexibility

– Adaptability

– Communication

– Relationships

– Cultural & spiritual sensitivity

“Leadership is the capacity to translate vision into reality”

Warren Bennis

• What is your vision?

• Where are your opportunities?

Select References Adams, S. (2009). Use of evidence-based practice in school nursing:

Survey of school nurses at a national conference. The Journal of School Nursing, 25, 302-313. doi: 10.1177/1059840509335008

Connecticut State Department of Education. (2009). Competency in school nurse practice. Retrieved from www.sde.ct.gov/sde/lib/sde/PDF/deps/student/health/Nursing_Competencies.pdf

Frankowski, B. L., Keating, K., Rexroad, A., Delaney, T., McEwing, S. M., Wasko, N., Lynn, S., & Shaw, J. (2006). Community collaboration: Concurrent physician and school nurse education and cooperation increases the use of asthma action plans. Journal of School Health, 76, 303-306.

Select References

Gibbons, L. J., Wesoloski, M. A., Lawinger, S., & Fishman, D. (2012). Discovering the leader within yourself: School nurses as leaders. NASN School Nurse, 27, 82-87. doi: 10.1177/1942602X11434208

Johnson, K. H., Bergren, M. D., & Westbrook, L. O. (2012). The promise of a standardized data collection: School health variables identified by states. The Journal of School Nursing, 28, 95-107. doi: 10.1177/1059840511426434

Ladd, V. J. (2009). School nurses: Positive deviant leaders in the school setting. The Journal of School Nursing, 35, 6-14. doi: 10.1177/1059840508327628

Select References Resha, C. (2010). Delegation in the school setting: Is it safe

practice? The Online Journal of Issues in Nursing, 15(2). doi: 10.3912/OJIN.Vol15No02Man05

Simmons, D. R. (2002). Autonomy in practice: A qualitative study of school nurses’ perceptions. The Journal of School Nursing, 18(2), 87-94. doi: 10.1177/10598405020180020501

Toole, K. (2013). Helping children gain asthma control: Bundled school-based interventions. Pediatric Nursing, 39(3), 115-124.

Wang, L. Y., Vernon-Smiley, M., Gapinski, M. A., Desisto, M., Mauhgan, E., & Sheetz, A. (2014). Cost-benefit study of school nursing services. JAMA Pediatrics, 168(7),642-648. doi:10.1001/jamapediatrics.2013.5441