Power

What? Power. We learn in chapter 13 that power is “that which enables one to accomplish goals; the capacity to act or the strength and potency to accomplish something”. The specific types of power outlined in the text are reward (granting favors or other rewards), coercive (using punishment for unmet expectations), legitimate (positional), expert (gained through knowledge, expertise or experience), referent (through positions or what a person symbolizes), charismatic (personal attributes), informational (obtained by having information necessary for others to accomplish their goals), and feminist or self (power gained over one’s own life) powers.

So What? Understanding the different types of power will help leaders be more effective in using their power. Additionally, it is important to distinguish between power and authority, the right to command. Perhaps of even greater importance is the ability to recognize what power is not. Though some legitimate power is inherently given to certain leadership positions, misuse of power can be catastrophic. Stan Lee, an American writer and memoirist penned the phrase (and was later quoted in the popular Spiderman movie in 2002) “with great power comes great responsibility”. Followers initially give little respect to their leaders regardless of how much power may be anointed by their positions. Power alone means little unless a leader also develops a relationship of trust and loyalty with his or her subordinates.

Now What? Power has been proven to be dichotomous by nature. Those who want it often don’t want it for virtuous reasons, while those who would use power for noble purposes rarely seek it. Abraham Lincoln once said “a leader takes people where they want to go, but a great leader takes people where they ought to be”. Leaders who use their power for virtuous reasons often see their power and influence among their followers grow exponentially. Understanding the true source of power is a vital step in leadership.

Philosophy

What? We learn form our textbook that a philosophy flows from the purpose or mission statement and delineates the set of values and beliefs that guide all actions of an organization. Furthermore, organizational philosophy provides the basis for developing nursing philosophies at the unit level and for nursing service as a whole.

So What? It is important to understand one’s philosophy in order to appreciate the core values driving their actions. In a corporate setting, one can learn a lot about an organization by studying their mission statement, a summation of their philosophy. Mission statements are typically generated to give a foundation on which all other actions should be based.

Now What? The following is the mission statement of one of my employers, Utah Valley Specialty Hospital, as read from their corporate website:

Mission: The mission of Ernest Health, Inc. (EHI) is the development and operation of rehabilitation and related post-acute healthcare facilities dedicated to the recovery of individuals who have functional deficits as a result of injury or illness.

Guiding Principles

•	We treat all patients and employees with dignity and respect.
•	We value teamwork; respect is earned, not assigned based on job title or position.
•	We are only as good as our last patient outcome; therefore, we constantly strive to improve our patients’ satisfaction and functional gains.
•	We are first and foremost passionate patient caregivers and team members, connected at our core by the treatment needs of our patients.
•	We embrace the ever-present challenge of achieving maximum, measurable patient outcomes through the provision of affordable, cost-effective care.
•	We promote a healing and nurturing environment at each of our facilities, responding to the medical, physical, psychological and social needs of our patients.
•	We respect the regulatory environment in which we operate; compliance and quality performance audits will be built into the growth of all business lines.
•	We recognize our duty as a corporate citizen, with a charitable intent toward each of the communities that we serve.
•	We are mindful of our fiduciary responsibility to our shareholders, providing a reasonable return to our investors.

As a nurse in a Neuroscience Critical Care Center as well as the long-term acute care center (Utah Valley Specialty Hospital), my personal nursing philosophy is based on my core beliefs and code of ethics. I believe that my responsibility is to assist in the healing process, for people who are unable to help themselves. It is my responsibility to manage care, while providing safety and reassurance to the patient of their ability to heal, as well as my ability to provide care. I do this regardless of race, religion, ethnicity, or gender. If I am ever impaired physically, mentally, or in any other way to perform my job responsibilities, then it is my duty to remove myself from the possibility of causing harm. I owe the same responsibility to myself and to my family as I do to the patient population I serve. It is a privilege to work in the health care system of America, and I should treat my employment with respect. I have a responsibility to educate patients and family on the recovery process, as well as provide an honest outlook for patient’s prognoses as well as quality of life and level of functioning after recovery.

How does my philosophy differ from my employer’s? Being that I work on two units, my scope of coverage is wider, with more specific details. Also, I feel like I advocate more for patient outcomes, where my employer, a for-profit company, focuses more on the financial aspects of providing care.

How is it the same? The primary objective, delivering care to patients who cannot help themselves is the same, as well as the general goal of healing. In order for an organization to function well, all individual components must work together in a synergistic manner to produce an entity greater than the sum of its parts. Subsequently, all employees of any organization must share at least some common philosophies.

What are the areas of conflict and how do you resolve them? One of the major areas of conflict at UVSH is sick calls. If you speak with any infectious control manager at any hospital they tell you to stay home if you are sick. However, UVSH gives such strict rules regarding sick calls that hardly make it possible to call in sick. They put time frames on sick calls for instance, saying you must call in 6 hours before the start of your shift (as if you know at midnight that you are going to start vomiting at 3 am). While I appreciate the difficulties of staffing an organization operating 24/7, I more adamantly feel that in order to confidently tell our patients and families that we truly “promote a healing and nurturing environment” and “respect the regulatory environment in which we operate”, the call off process should be a realistic option and we should not be treated like criminals when we have to make such calls.

Patient Advocacy

What? Advocacy, according to Merriam Webster, is the “active support of an idea or cause, especially the act of pleading or arguing for something.” This definition gives us the foundation of patient advocacy. Based on this definition, we could say that patient advocacy means actively supporting, pleading, or arguing for our patients.

So What? So why is patient advocacy so important? Why do we, as nurses carry the responsibility of acting as patient advocates? As nurses, we often serve as liaisons in a multidisciplinary team. We speak to doctors, therapists (PT, OT, ST, RT, etc.), family and friends, and other health care providers to share assessments and suggestions. We are asked questions- sometimes, a lot of questions. We assume the role as patient advocate for patients who are unconscious, obtunded, confused, being pressured by family/friends, or are otherwise unable to advocate for themselves.

Now what? Any nurse serving any patient population should expect to serve as a patient advocate. Additionally, we need to understand the responsibility befalls us as advocates. Patients and their families use information from nurses to make critical decisions, sometimes involving life and death situations. It is important that we do our best to provide accurate information with regards to patient’s long-term prognoses without being overly grim.

In the Neuroscience Critical Care Unit I work in, we often serve as patient advocates for patients who cannot speak, or who may never recover from their condition and will likely have a poor quality of life if they do survive. We are expected to help families understand what the patient may or may not be experiencing and give them information on which they will base end-of-life decisions. We often influence (intentionally or not) decisions that literally impact people’s lives. I think it is easy to become jaded, or numb to this process at times. However, it is important that we maintain a sensitive approach with people, as they encounter these live changing crossroads.