Running head: FINAL REFLECTION

Final Reflection
Genevieve Givens
University of Arizona

Overview of Clinical Systems Leadership Education Process

As an associate degree nurse I felt that I was behind, despite seven years-experience and
an exceptional work history I was overlooked for less experienced nurses that had their
Bachelors and Masters degrees. Two years ago my personal goals were to obtain a cutting edge
in the healthcare world as my organization began transitioning into clinical systems thinking and
never falling behind again.
Important aspects of clinical systems leadership
Upon starting this program, I believed that leadership and management were synonymous
and that governing meant making unilateral decisions to best serve the interests of the goal or
organization. Throughout this program I learned that true leadership included shared governance,

engaging and inspiring those you lead to identify the root cause of problems and assist in
problem solving versus complaining. This understanding of shared governance has shaped my
thinking into engaging staff to promote initiatives that improve patient outcomes and maintain a
skilled workforce. Shared governance promotes knowledge sharing, empowerment, and gives the
frontline the ability to actively participate in decision making (Kowalski, 2015). All of these
components demonstrate promoting an optimal healing environment, negates lateral violence,
and improves patient care outcomes (Kowalski, 2015).
In addition, I have learned that leading does not mean having all the answers or knowing
everything but understanding the larger picture and the influence of emotional intelligence in
leadership (Heckemann, Schols, & Halfens, 2015). Emotional intelligence encompasses the
overall ability to lead by fully understanding the effects of human emotion, including their own
(Savel & Munro, 2016). Emotional intelligent leaders use this understanding to identify, regulate,
and motivate their team by utilizing the empathy and relational skills to direct others toward
productive work (Savel & Munro, 2016).
Highlights of this journey
As the past two years went on, my understanding of true leadership developed. I too
understood the intricacies of leading and making sustainable change, issues that seemed like
unsurmountable barriers became smaller and smaller. I could utilize acquired knowledge and
experience to address problems in a way that I could never have before.
Program Outcomes
Design and Lead Patient-Centered Care
This programs outcomes have included that understanding the patient perspective in
health care delivery is one of the first steps in the design of patient centered care initiatives.

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Incorporating these initiatives into current practice promotes achieving patient goals. My
acquired education and understanding of patient centered care has changed processes within
cardiopulmonary rehabilitation (CR). I have developed a working relationship with our exercise
physiologists (EPs) and have clearly demonstrated the importance of patient perspective in the
delivery of care. For example, in my current practice when patients begin CR a member of the
licensed staff does an intake interview and assessment, after that is completed an EP continues
the appointment. Integrating patient centeredness in this process has included the patient as a
member of the team in the handoff between the licensed staff and EP, in this handoff the patients
personal goals and plan of care are reviewed by all improving knowledge sharing and patient
outcomes.
Interprofessional Collaboration
The programs outcome on my understanding and application of interprofessional
collaboration includes effectively meeting the patients needs through a multi-disciplinary
holistic approach to the health-illness continuum. Collaborating with other clinicians, specialties,
and programs allows for expertise in multiple areas. Although my practice has been within the
cardiovascular service line multiple patient co-morbidities must be addressed for patient goals to
be met. This includes addressing attributing conditions such as diabetes mellitus type two (DM).
Approximately 60% of patients that participate in CR have been diagnosed with DM, optimizing
cardiovascular health for these patients includes appropriate management of this condition. In
my current organization there is a profound lack of DM resources in the inpatient and outpatient
setting, because of this need I have facilitated a partnership with the local health department to
provide their DM education on our site. This facilitation has filled a need and promotes the
wellness for this population.

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Application and Evaluation of Integrative Healing

The programs outcome of integrative healing is an understanding of the mind, body, and
spirit on healing and includes the interconnectedness of treating the response to health and
illness. In CR the prevalence of depression and anxiety is high for patients and is often
misunderstood by them and their family. I currently have a 43 year old patient recovering from
valve surgery, physically he was fine but upon further assessment it was found that this patient
was struggling with depression and grief. He has since learned effective coping techniques
through complementary modalities and obtained grief counseling which has resulted in improved
healing and perception of health.
Incorporation of Healthcare Technology
The programs outcome of incorporating healthcare technology has increased my
understanding of utilizing technology to improve access and quality. Information technology
allows for rapid transfer of data and knowledge sharing. Healthcare technology within my
current practice allows for the tracking patients and their outcomes to identify and understand the
quantifiable effects of initiatives on patient care outcomes. In CR, I have been able to measure
readmission rates of patients that participate in CR versus those only receiving medical
management, my productivity, and the organizations referral rate since I began this role. In
addition, technology in the form of patient monitoring equipment facilitates monitoring of
symptoms and medication compliance.
Care Coordination of the Healthcare Continuum
As a nurse that has worked in many areas of the cardiovascular service line I have had the
unique opportunity to see the transition of care between settings. This knowledge has facilitated
creating processes that allow for integrating care coordination between settings. For example, in

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my current role of a cardiopulmonary rehabilitation (CR) nurse I serve as the transitional

clinician for patients post heart surgery. This includes inpatient education, outpatient risk
stratification, and health promotion. When I began this role, I took on the responsibility of
completely fulfilling this role for patients, enabling the program, organization, and patients to
rely exclusively on my practice. During this program I have changed this structure by developing
standard work to ensure that patients are given consistent quality care by all clinicians, utilizing
the system versus a single person for sole success.
Application of Theory and Knowledge to Design, Coordinate, and Evaluate Systems
Leading in the design of the optimal healing environment requires a transformational
approach that incorporates the complexity of the system. Leading on the edge of chaos is
constant, with continuous assessment and reassessment of the application of evidence-based
practice that extends throughout health care settings with efficient care coordination. As an
informal leader I have shown my team that improvement projects and never finished, that I want
to know what they think, how we can do better and that we can always try again this shift in
adopting the complexity of healthcare has led to improving patient wait times, patient
satisfaction, and staff retention.
Conclusion

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As a healthcare leader I have realized that linear, machine like, and authoritarian
leadership does not promote a healing environment and patient outcomes. What I have learned is
that leading in this industry is the understanding that this system is composed of integrated
pieces that all work together for goals to be met. So, my goals have evolved as I truly understand
what this education has done for myself, my family, my workplace, my profession, and my
patients. I do not know if I would have ever understood this without this program. I will take this
with me and I know that I will never fall behind again because this is the beginning of
continuous improvement and will never end. I have learned that my personal strengths include
strength, empathy, and perseverance. During this program I lost my grandmother, had my third
child, and lost my father and during this time I made mistakes in coping and dealing with my
personal life but I never quit. This is how I will lead, I will flex with complexity, I will make
mistakes, but I will not quit and I will move forward. Furthermore, I will keep in my mind that it
matters less that I always do the right thing, but that I work to ensure that the right thing is
always done and that is what leadership means to me.
References
Heckemann, B., Schols, J., & Halfens, R. (2015). A reflective framework to foster emotionally
intelligent leadership in nursing. Journal of Nursing Management, 23, 744-753.
doi:10.1111/jonm.12204
Kowalski, K. (2015). Building teams through communication and partnerships. In P. S. YoderWise (Ed.), Leading and managing in nursing (6th ed., pp. 321-345). St. Louis, MO:
Elsevier.
Savel, R. H., & Munro, C. L. (2016). Emotional intelligence: For the leader in us all [Editorial].
American Journal of Critical Care, 25(2), 104-106. doi:10.4037/ajcc2016969

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