Skills Required to Provide Clinical Leadership in Mental Health Nursing

The role of nurses within the healthcare industry has always been a pivotal one. Increasingly, nurses have started assuming greater significance in providing necessary technical assistance as well as adding a humane touch to the patients and their families. An area of particular interest is leadership in nursing mental health, as greater number of people is seeking assistance for psychiatric and psychological problems such as anxiety, depression, schizophrenia, senility, etc. In this context, an analysis of the wide array of skills required to provide clinical leadership in nursing mental health is of importance. The rest of the essay will broadly foray into these required skills. One of the most requisite skills for nursing officers is conviction and courage in handling financial decisions for their hospital or clinic. With healthcare insurance becoming unaffordable for an increasing number of Americans, people end up in hospital wards with insufficient finances. While running a hospital or a clinic has a business element to it, its first priority is to serve needy patients, especially the ones suffering from mental ailments. An ethically conscious leader will always keep this in mind and put the interests of the patient before that of the organization. While this may sound a touch idealistic and its implementation may seem unfeasible in a competitive healthcare industry, it is nevertheless an ideal worth persevering for. According to Shawn Ulreich, the chief Nursing Officer at Spectrum Health, “It is time to bridge the gap between nursing--and all of operations--and finance…Nursing leadership entails measures to tackle the massively flawed payment system. Other times, it is demonstrating that you sincerely care about patient care” (Fifer, 2007). Continuing in a similar vein, leaders in Nursing should reverse recent trends of high employment dissatisfaction among nurses and other support staff. Nurses across the country are not happy with the remuneration package handed to them and consequently shifting to jobs that pay more. Another reason cited for this state of affairs is the lack of mutual understanding between the business and nursing wings of the healthcare organizations. For example, according to a recent survey, “Approximately 38 percent of the respondents reported having left a CNO position--13 percent within two years before the survey and 25 percent within five years before the survey. When asked about the context of their departure, a high percentage reported leaving their position to pursue another CNO position (50 percent) or for career advancement (30 percent); approximately 26 percent reported leaving because of conflicts with the chief executive officer. Of great concern is the finding that approximately 62 percent of respondents anticipate making a job change in less than five years, slightly more than one-quarter for retirement” (Jones, 2008). From the above statistics it is clear that the onus is on the community of nurses, including that of the Chief Nursing Officers to put their collective cause before personal gains. At a time when catering to mental illnesses has become a specialized field in itself, such apathy toward mentally disordered patients is unbecoming of a nurse or a nursing officer. This point need be adopted and reinforced by the leaders themselves, so that those lower in the nursing hierarchy can emulate worthy role models. Another area where nurses in mental healthcare should advance their skills is “management development” activities. With mental healthcare becoming a more specialized and complex industry, the expected nursing skills are also equally more elaborate. Nursing leaders should adopt an “activity competency model” to assess the prevailing state of nursing skills within their organization (Lin Li-Min, et. al., 2007). Later, depending on the findings, they can implement training programs that would inculcate nurses catering to mental health patients on the intricacies and nuances involved therein. Nursing Officers play am important role in hospitals and other healthcare centers. They should communicate effectively with other departments within the organization as well as interact with other allied organizations, so that they can “manage nursing resources, influence hospital strategy, and plan nursing activities to cope with the hospital's competitive environment” (Lin Li-Min, et. al., 2007). Lately, Nursing Officers have come to be treated as the crucial resource for the hospital. Commensurate with this new capacity, their range of skills has also widened. For example, they are being asked to maximize and optimize available resources at hand. But the level of training and their competence in fulfilling this expanded role is still lagging behind. Among all the skills and qualities that is required of mental health Nursing Officers, only a few are actually evident in practice. In general, Nursing Officers were found up to mark in such competencies as “analysis and judgment, planning and organizing, and monitoring and controlling”; but they were found wanting in such skills as “learning and adapting, multilingual, and information processing” (Lin Li-Min, et. al., 2007). This discrepancy is of grave concern to the industry as a whole. This is an area where strong and motivational leadership can make a difference. In my professional practice as well, I see the aforementioned deficiencies manifest themselves while providing mental patients quality care. For the modern mental healthcare systems in place, nurses need to gain multiple skills, some of which might have been thought quite removed from nursing per se. The following list of skills has been identified as essential ones to provide quality healthcare for patients diagnosed with psychiatric or psychological disorders: 1. Analysis and judgment skill 2. Creativity (innovation) skill 3. Planning and organizing skill 4. Leadership skill 5. Monitoring and controlling skill 6. Communication and coordination skill 7. Learning and adapting skill 8. Social skill 9. Multilingual skill and 10. Information processing skill (Jones, 2008) There are some studies that indicate that mental healthcare for the elderly has failed to catch up with advancements in other aspects of healthcare. Given the fact that elderly patients are more susceptible to dementia, senility, and other conditions that worsen with age such as Parkinson’s disease, Alzheimer’s disease, etc., special training and education need be incorporated into the nursing college curricula to alleviate this deficiency. The reason why clinical leadership in mental healthcare for the elderly is imperative is based on the fact that administrative understanding is as important as core professional competencies such as diagnosis and treatment. The quality of the management team that leads the hospital organization can have a significant impact on the clinical efficiency and innovation. Hence, managerial ability is another key skill that is expected of nursing leadership and the team. A case in point is the Hospital Elder Life Program (HELP) that had seen widespread implementation across the country. A core component of the program pertains to mental health of the elderly. Here, more that anywhere else, successful leadership becomes a key factor in patient outcomes. With life expectancy on the rise across the world due to various medical advancements and a stagnant birth rate, the elderly have come to comprise a larger section of the demography. In this scenario treating common geriatric mental conditions, including dementia, delirium, functional decline and senility have assumed greater significance; and special skills are to be acquired to cater to mental conditions that are unique to the group (Bradley et. al, 2006). The following table shows how, of all allied professionals, nurses are the most sought after for treatment. They come next only to occupational therapists in dispensing psychological counseling to the patients. TABLE --Profession of initial assessor for mental health. Values in parentheses are percentages. Total Study Assessor's profession (n378) (n100) Medical: 123 (33) 33 (33) Consultant 36 (10) 6 (6) Clinical assistant 40 (11) 1 (1) Senior registrar 16 (4) 0 Registrar 24 (6) 20 (20) Senior house officer 7 (2) 6 (6) Non-medical: 255 (68) 67 (67) Social worker 62 (16) 25 (25) Community psychiatric nurse 85 (23) 24 (24) Occupational therapist 86 (23) 18 (18) Psychologist 22 (6) 0 (Bradley et. al., 2006) These days, with the growing number of identified mental disorders, caring for patients at their homes has become commonplace. Subsequently “inpatient medical care, rehabilitation and convalescence is often continued and completed in the community”. County and liaison nurses have a role to play in continuing patient care after discharge from hospital. Most of these nurses are generally employed by hospitals and offer their professional services and serve as a link between the healthcare industry and autonomous community health centers. Their competence and skills can determine how successfully patients have adapted to their home/community environment from the confines of the hospital. These nurses can also “liaise with social service departments and help to assess patients' needs; identify and respond to problems occurring at the point of discharge; and improve communication between services” (Pushpangadan, 1996) . Here too Nursing Officers should encourage their team to acquire additional skills (mostly Public Relations skills) in order to fulfill their expanded role in a community care environment. Their range of skills in the new post-hospitalization period is succinctly captured in the following lines: “Nurses provide treatment and support to patients and their caregivers within a variety of community settings--patients' own homes, health centers, and residential homes. They are key people in the community; the vast range of their work includes practical work such as dressing ulcers and pressure sores, maintaining bowel and bladder care and giving injections, as well as supportive components--for example, in palliative care. Referrals for continued nursing care are through general practitioners or through hospital based doctors or nurses. This service has usually been available in the daytime only, but some areas now have a night nursing service. Specialists nurses provide specific services such as palliative care, continence management, alongside regular psychiatric services.” (Pushpangadan, 1996) In the last decade or so, the nature of nursing had undergone many changes in that mental healthcare had become an integrated discipline offering different set of therapeutic approaches for treating organic and functional mental illnesses. Clinical leadership can make a difference in the quality of outcomes. For example, a strong leader will exhibit people management and organization skills in bringing together disparate specialists like “community psychiatric nurses, psychologists, occupational therapists, and physiotherapists” and address all aspects of the prescribed prognosis. It is also expected of nurses to offer monitoring services, wherein they gauge the mental state of the patient and the efficacy of the medication prescribed to them. In addition to these, skills such as “anxiety management, relaxation techniques, and management of cognitive and behavioral problems” will add professional value to the practitioners (Pushpangadan, 1996). With extensive research being done on psychotherapeutic techniques, a working knowledge of clinical psychology will be of utility. This will entail providing psychological assessment, gauging cognitive competencies, and monitoring aspects of behavior and personality. Further, “They may contribute to the non-pharmacological management of psychiatric symptoms, such as anxiety or behavioral difficulties. Occupational therapists and physiotherapists provide assessments and treatment to optimize independence in all activities of daily living. Some areas have extended home respite schemes, which provide support to patients in their own home, thus reducing the strain on informal caregivers. These serve patients with mental illness, especially dementia.” (Fifer, 2007) In summary, it could be inferred, based on extensive literature on the subject as well as my own personal experience during recent practice, that the skills and expertise required to be a successful nurse are multi-dimensional. Apart from their traditional competencies in hospital-ward and operation-theatre assistance, nurses are expected to peruse managerial and administrative skills as well. While nurses of all ranks should possess these skills, those in leadership positions in clinics should be better versed in these subjects. Only then will their leadership will be effective in inspiring and motivation those lower in the hierarchy to achieve professional excellence. References: Fifer, J J (April 2007). Bridging the gap between nursing and finance: courage in leadership means showing that you care about patient care in your organization.(Courage IN LEADERSHIP)., Healthcare Financial Management, 61, 4. p.28(1). Jones, C B, Havens, D S, Thompson, P A, & Knodel, L J (March-April 2008). Chief nursing officer retention and turnover: a crisis brewing? Results of a national survey.(Survey)., Journal of Healthcare Management, 53, 2. p.89(18). Lin, L.-M. , Wu, J.-H. , Huang, I.-C. , Tseng, K.-H. , Lawler, J J, & Vestal, K. (May-June 2007). Management development: a study of nurse managerial activities and skills., Journal of Healthcare Management, 52, 3. p.156(14). Bradley, E H, Webster, T R, Schlesinger, M., Baker, D., Inouye, S K, Levy, M., & Levy, S F (Sept-Oct 2006)., The roles of senior management in improving hospital experiences for frail older adults., Journal of Healthcare Management, 51, 5. p.323(15). Pushpangadan, M, & Burns, E (Sept 28, 1996). Community services: health. British Medical Journal, 313, n7060. p.805(4). Gillen, S. (Feb 17, 2005)., Mental health; Practitioners welcome review's aim to define mental health nurses' role., Community Care, p.16.

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