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Concept of Influence in NursingTerm Paper

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Rethinking the Concept of Influence in Relation to Nursing Pracitce

The objective of this study is to examine the concept of influence in relation to the nursing practice. Towards this end. This study will review material that is academic and peer-reviewed in nature as well a professionally published documents in this area of inquiry.

Nursing practice has the power to influence the concept of healthcare and the outcomes for patients in this realm. This study intends to show this capacity in the field of professional nursing. The work of Roussell (nd) states that safety of patients as well as quality initiatives contain six objective for improvement that includes the following: (1) Safety lf health care; (2) effectiveness of health care; (3) timely healthcare; (4) waste reduction in health care and (5) equity in healthcare. (Rousell, nd, p. 20) Nurse directed healthcare is new in the field of healthcare. This study will first examine the role of the nursing professional in order to conduct a thorough review of the areas in which the nursing professional is able to use the concept of influence in their nursing practice. Secondly, this study will examine nursing leadership concepts which will add to the knowledge of the ability of the nursing professional to utilize the concept of influence in their nursing practice.

I. Nurse Practitioners and Nursing Professional Education, Training and Roles

The nurse practitioner is reported as a registered nurse (RN) that has "additional training, usually at the master's level. The graduate training builds on nursing roles in patient advocacy and education, and incorporates physical assessment and diagnostic skills, along with management of acute, chronic and episodic diseases. This includes taking a patient history, performing a physical exam, ordering and interpreting laboratory tests, providing medication, referring to specialists and promoting healthy lifestyles." (Wessell, 2005, p. 2) Wessell (2005) reports that the first NP program began in 1965 in the state of Colorado and involved training of nurses in the provision of pediatric care to populations that were underserved. It is reported that there are an estimated 40,000 nurse practitioner and that by the year 2000 that the number had risen to more than 62,000 nurse practitioners. By 2004, it is reported that more than 100,000 nurse practitioner were practicing. (Wessell, 2005, p. 2) Nurse practitioners are reported to practice in areas that include "women's health, pediatrics, school health, psychiatry, neonatology, and oncology, while others seeks a broader focus in family medicine." (Wessell, 2005, p. 2) Nurse practitioners are state regulated and are required to adhere to laws set by states and this involves "certification with national credentialing organizations." (Wessell, 2005, p. 2) It is reported that some states "allow NPs to practice completely independently, others require a collaborative agreement with an MD that defines the scope of practice for that work site, while others do not recognize practice by NPs at all. While the level of prescriptive authority also varies by state, NPs have prescriptive authority in most states, including the opportunity to apply for a Drug Enforcement Agency (DEA) number, allowing them to prescribe controlled substances. One of the many policy issues NP organizations are focusing on is that of allowing managed care patients to choose an NP as their primary care provider." (Wessell, 2005, p.3) It is reported that nurse practitioners in addition to Physician's Assistants (PAs) and Certified Nurse Midwives (CNMs), "are often referred to as midlevel providers or physician extenders. Some NPs and PAs object to these terms, arguing that they imply the NP, PA or CNM occupies a lower position than a physician. However one resolves such concerns, few would disagree that there is a role for every person in the complex health system, including physicians, nurses, social workers, pastoral care ministers, and NPs and Pas." (Wessell, 2005, p. 3)

It is reported in a recent journal published in the Wall Street Journal and written by Ann O'Sullivan, an NP at University of Pennsylvania that NPs and doctors working in collaboration result in the best possible results. O'Sullivan is reported as stating that in one case that a patient who needed to stop smoking involved the explanation by the physician of the "physiological problems with smoking while the NP looks at the psychological factors in smoking and the personal barriers to smoking cessation." (Wessell, 2005, p. 4)

Wessell (2005) reports that studies on satisfaction of patients have demonstrated that HPs are rated with "high favorability. The most effective role of the NP in the primary care setting is that of a provider who combines medical knowledge, diagnostic ability, and prescriptive authority with education regarding disease management and lifestyle modifications, and works in a team with others. Nurse Practitioners are in a favorable position to develop an ongoing relationship and to build on patient strengths, taking into account real life demands of the patient." (p. 4)

The focus of medical training while being on such as diagnosis and treatment is differentiated from NP training which has as its focus the care and prevention in health care. In the area of chronic disease, it is reported that "on-going education and reinforcement in the management of the disease is important. By empowering patients to take care of themselves, make lifestyle changes, and prevent acute exacerbations of disease, NPs help in the prevention of expensive hospital visits which will be financially beneficial to the medical system and personally beneficial to the patient." (Wessell, 2005, p. 5)

II. Nursing Leadership and Influence

It is reported in the work of Curtis, de Vries, and Sheerin (2011) that the importance of "effective leadership in health care has been emphasized" in a great deal of the literature. Dunham and Fisher (1990) emphasized the importance of leadership as did Hewison and Griffiths (2004) and Roussel et al. (2009). Specifically stated is that research in the area of leadership "has demonstrated a positive relationship with improved patient safety outcomes." (Tregunnoet al, 2009 cited in Curtis, de Vries and Sheerin, 2011, p. 306) In addition, effective leadership results in work environments that are healthy according to Shirey (2009) as well as in worker satisfaction (Heller, et al., 2004) and lower rates of turnover (Gelinas and Bohen, 2000) and finally patient outcomes that are better (Wong and Cummings, 2007).

There are many challenges that nursing professionals face in the present including such as "new roles, new technology, financial constraints, greater emphasis on participation, cultural diversity and education" however, it is held that it is not possible for nursing professionals to consider leadership to be "an optional role or function…Leadership must exist in every healthcare facility where effecting change and achieving high standards of patient care are stipulated in job titles, such as Director of Nursing, Nurse Consultant, or Modern Matron" (Sullivan and Garland, 2010 cited in Curtis de Vries and Sheerin, 2011, p. 306). It is critical however, for the nursing professional to understand that as stated by Curtis de Vries and Sheerin (2011) that "the taking on of a leadership role by itself is not sufficient for ensuring effectiveness. The leader must be knowledgeable about leadership and be able to apply leadership skills in all aspects of work." (p. 306)

According to Heller et al. (2004) overall, today's nursing professionals are ill-prepared for leadership roles during their educational programs and it is this "gap between adequate educational preparation and the demands of the clinical setting [which] can result in ineffective leadership in nursing." (Curtis, de Vries, and Sheerin, 2011, p. 306) Leadership is such that results in various images and ideas and may be inclusive of such as "power, influence, followership, dynamic personality, charisma, goals, autocratic behavior, innovation, cleverness, warmth and kindness." (Curtis, de Vries, and Sheerin, 2011, p. 307)

Researchers have examined the various ideas concerning leadership and have described as "The process by which an agent induces a subordinate to behave in a desired manner" as noted in the work of Bennis (1959) and cited in the work of Curtis, de Vries and Sheerin (2011, p. 307) In addition, leadership has been stated to be the "ability to influence people toward attainment of goals.' (Daft, 2000 cited in Curtis, de Vries and Sheerin, 2011, p. 307) Leadership is reported in the work of Weihrich and Koontz (2005) as influence of the "art or process of influencing people so that they will strive willingly and enthusiastically toward the achievement of group goals." (Curtis de Vries and Sheerin, 2011, p. 307)

According to Sullivan and Garland (2010) leadership relates to skills on an interpersonal level that may exert influence over others to reach specific achievement of goals. It is reported that a theme that is common and one that appears to "run through many definitions" is that leadership is relative to the influence of the "attitudes, beliefs, behaviors and feelings of other people." (Spector, 2006, cited in Curtis, de Vries and Sheerin, 2011, p. 307)

III. Various Theories of Leadership

The various theories concerning leadership are set out in the work of Spector (2006) as follows:

(1) the trait approach,… [END OF PREVIEW]

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