Running head: NURSING'S LEADERSHIP ROLE IN POPULATION BASED

Nursing's Leadership Role in Population Based Issues Tori Gwilt Ferris State University

NURSING'S LEADERSHIP ROLE IN POPULATION BASED Abstract

Mental health is a nursing topic that is often overlooked and ignored. Specifically, suicide (both ideations and actual attempts) is a mounting problem of arduous nature that continues to trouble the Kent County area. Studies show that the rate of suicide attempts and successes is growing rapidly in the region. Many strides must be taken in order to control this ever growing predicament. Nurses have the opportunity to assist and support in the treatment and healing of individuals who suffer from mental issues, such as suicidal thoughts and actions. There are many different ways for nurses to become involved in this process. Some nurses take a primary role in the care and counseling of patients, whereas other nurses help by assuming more of an administrative role by leading teams, researching statistics, or developing action plans. Both roles are vastly different, yet equally important to help the patient overcome the emotional rollercoaster associated with suicidal thoughts and attempted actions.

NURSING'S LEADERSHIP ROLE IN POPULATION BASED Nursing's Leadership Role in Population Based Issues Nurses have profound and varied roles in the field of healthcare. One of the primary goals of a nurse is to safely guide the patient towards a healthy and happy lifestyle. The topic my group chose for the community change proposal project focuses on mental health, an issue that many people choose to disregard. Specifically, the theme of the group project discusses suicide rates for young adults and the middle age category, 18-40 years old. Harkness and

DeMarco (2012), state that throughout the world, approximately half of all violent deaths are due to suicide (49.1%) exceeding deaths from both homicides (31.3%) and war (18.6%). A research article written in the Morbidity and Mortality Weekly Report states that in the United States in 2008, 36,035 persons died as a result of suicide and an estimated 666,000 persons visited hospital emergency departments for nonfatal, self-inflicted injuries (Crosby, Han, Ortega, Parks, & Gfroerer, 2011). The same article states that during the period of 2008-2009 in the United States, an estimated 8.3 millionadults aged 18 years (3.7% of the adult U.S. population) reported having suicidal thoughts and that approximately 2.2 millionadults in the United States (1.0% of the adult U.S. population) reported having made suicide plans in the past year (Crosby, et al., 2011). In relation to Kent County, one report states that the frequency of suicide in the area is steadily growing, even more so than the rate of suicide in the state of Michigan itself. The research article, published by the Michigan Public Health Institute (2011), states that per 100,000 people, the Michigan rate of suicide increased from 11.2 to 11.7 from 2004 to 2008. In the same time period, Kent Countys approximate suicide ratio rose from 9.2 to 12.0 per 100,000 people (Michigan Public Health Institute, 2011). After careful consideration of these statistics, I believe the nurse best suited for the direct contact individual is the local mental health nurse from the Kent County Public Health Department. The nurse who I believe would be

NURSING'S LEADERSHIP ROLE IN POPULATION BASED the best match for overseeing this project is employed by the Michigan Department of Community Health. Public Health Department Direct Contact Nurse

According to a research article written by the National Institute of Mental Health (2008), more than 90 percent of individuals who perish as a result of suicide have certain risk factors, including depression and other mental disorders, or a substance-abuse disorder (often in combination with other mental disorders),family history of suicide, family violence and a previous suicide attempt. With this information in mind, the Kent County Public Health Department developed a program that provides an array of services for citizens who reside in the area, including mental health assistance. Termed Network 180, this subset of Kent Countys public mental health system is known as the gateway to a wide array of mental health, substance use disorder, and developmental disability services (Kent County Public Health Department, 2013). This organization lists a variety of 24 services available to help navigate through the stages and severity of different mental illnesses. In relation to suicide prevention, the services provided range from counseling sessions, psychiatric support, case management programs, and crisis intervention treatments. In addition, Network 180 offers outreach programs used to identify, support, and sustain people who currently have mental illnesses or are at risk for the development of suicidal behavior (Kent County Public Health Department, 2013). Leadership Role I believe the community mental health nurse of Kent County has the opportunity to play an active and substantial role in the support and treatment of patients who suffer with mental health issues, such as depression, anxiety, and suicidal thoughts and ideations. The nurse employed by this facility has the chance to research and be knowledgeable about a variety of

NURSING'S LEADERSHIP ROLE IN POPULATION BASED mental illnesses and their effects on both the patient and family members. The nurse is responsible for providing education to the target audience (young adults to middle age persons).

This could be accomplished through one-on-one conversations, newsletters, e-mails, daily online blog posts, and educational seminars. The Kent County public health nurse is also responsible for cooperating with other medical professionals (doctors, psychiatrists, and psychologists) in an effort to provide comprehensive care to the patient. Another nursing responsibility includes implementing and coordinating interventions recommended and ordered by collaborating health care professionals, such as medication and therapy sessions. In addition, the nurse is responsible for providing support and encouragement to the patient and family. Leadership Characteristics A nurse employed in this type of position will need to exemplify certain personality traits in order to effectively and efficiently perform the required duties of this job. First of all, the nurse needs to be caring, compassionate, and non-judgmental with patients who are feeling vulnerable and ashamed of their current health situation. In addition, the nurse will need to hone direct and honest communication skills whilst displaying an understanding nature. The nurse will also need to epitomize good organizational and time management skills in correlation with the collaboration between different health care specialties. ANA Standards of Professional Practice The American Nurses Association (ANA) has established and adapted a set of nursing practice standards which are to be utilized to assist a public health nurses daily work routine. These standards, termed the Eight Domains of Public Health Nursing Practice, aid in the advancement and progression of this nursing specialty whilst benefiting both the nurse and patient (Harkness & DeMarco, 2012). I believe that the nurse in this position must demonstrate

NURSING'S LEADERSHIP ROLE IN POPULATION BASED good analytic and assessment skills in combination with adequate communication in order to methodically and comprehensively care for the patient who suffers with suicidal tendencies. Cultural competency is a must for this nurse, as she must deal with people from many different backgrounds and belief systems. Furthermore, I believe that a competent public health nurse

must personify basic public health and science skills in an effort to identify people at risk for the development of mental illness which may lead to suicide (Harkness & DeMarco, 2012). Michigan Health Department Leader Nurse I believe the nurse best suited to oversee, lead, and direct this venture is employed by the Mental Health Department located within the Michigan Department of Community Health (MDCH). The MDCH provides a wide range of services to Michigan residents, such as information on topics including mental health, behavioral health, and substance abuse. Specifically, the Mental Health Department functions as a portal that provides resources to find a program that tailors to each individuals needs. In addition, this organization performs the required tasks to promote health and wellness set forth in the Michigan Mental Health Code and the Michigan Public Health Code (Michigan Department of Community Health, 2013). Leadership Role I believe the nurse employed in the Mental Health Department within the Michigan Department of Community Health plays a crucial supportive role in the mental health programs located in Michigan. This job entails being a director of the many resources this organization has to offer. In addition, this nursing position involves working in conjunction with different public health departments throughout the state in order to provide easily accessible, quality mental health programs. Collaboration is another key component, as the nurse must deal with the community mental health programs of different regions within the state. I also believe this

NURSING'S LEADERSHIP ROLE IN POPULATION BASED type of position requires a significant amount of research, as the nurse looks at mental health trends within the state. Another aspect of research involves investigating the successfulness of specific mental health services in an effort to decrease the prevalence of ineffective programs. Leadership Characteristics

Much like the direct contact nurse role, it is imperative that the leader nurse is effective in communication, organization, and time management. Additionally, this nurse will need to display great teamwork and collaboration in order to effectively work with local community programs. Moreover, this nurse will need to exhibit superior analytical skills to assess the productiveness versus ineffective mental health programs currently in place. ANA Standards of Professional Practice The public health nursing arena contains text entitled the Eight Domains of Public Health Nursing Practice (Harkness & DeMarco, 2012). This text advocates the types of skills which should be present in successful and competent public health nurses. I believe that the leader nurse should exhibit qualities similar to the aforementioned direct contact nurse. In addition, the nurse in this position needs to have adequate policy development and program planning skills. This skill set is utilized as the nurse assists in assessing current mental health programs and collaborating with others to create new effective programs. In line with this statement, I also believe it is necessary for this nurse to have leadership abilities along with systems thinking skills. Financial planning and management skills come into play as the nurse requests money to aid and build mental health programs and facilities in various areas throughout the state. Analysis There are several ways in which the direct contact nurse and the leader nurse roles share similarities. First of all, both roles require stellar communication skills. The direct contact nurse

NURSING'S LEADERSHIP ROLE IN POPULATION BASED will need to utilize these skills in discussions with the patient as well as collaborating health professionals. The leader nurse will also need to hone her skills for communication; generally for speaking with other health professionals as well as program directors and administrative leaders. In addition, both types of nurses will need to be passionate about helping people who are dealing with psychological issues, such as suicide. They must have a non-judgmental demeanor and be understanding of the population with which they are working. This type of behavior will aid in the healing and improvement of the patients. Just as the two nursing roles share similarities, they also share differences. I believe the primary dissimilarity lies in the education needed to be successful in each role. As a direct

contact nurse, I believe that a Bachelors Degree in Nursing will suffice for the duties required of the position. However, I believe that the leader nurse is responsible for managerial type of issues. This profession is most likely suited for a nurse who has completed her Masters Degree in Nursing. The direct contact nurse is responsible for working directly with the patients who suffer from depression, mental disorders, suicidal ideations, and prior suicide attempts. This nurse will have a primary impact as she is working on a daily basis to encourage, understand, respect, help, and create balance as each patient works to overcome this tumultuous time in his life. In contrast, I believe the leader nurses role is secondary; she is behind the scenes in a supervisory role. This nurse is responsible for compiling facts and figures related to mental illness conditions as well as the prevalence in each county in the state. I believe this nurse also utilizes research to determine the successfulness of certain interventions (education, therapy, support groups and medications) in order to recommend these advances to other county mental health programs

NURSING'S LEADERSHIP ROLE IN POPULATION BASED within the state. I also believe a responsibility of this nursing position is to present data to executives and directors of mental health programs. Reflection I believe my current set of nursing skills provide me with the knowledge to perform certain tasks within each nursing role. For example, I believe I have a non-judgmental caring attitude that would allow me to thrive in the role as the direct contact nurse. I also believe that I am organized and have good collaboration and team building skills needed for the leader nurse.

In light of this information, I believe my current skill set would be most appropriate for the direct contact nurse. I came to this decision as a result of two different notions. First of all, my current education level is an associates degree. As stated above, I believe the leader nurse needs to hold a masters degree. Secondly, I do not fancy myself a strong leader. I do not enjoy, nor does my talent lie in making important decisions for the masses or presenting speeches to department heads. If I were to apply for a position such as that of the leader nurse, I believe I would need to increase the effectiveness of my communication skills. I would also need to work on increasing my confidence in public speaking and presentations. I strongly believe that each nurse is naturally gifted with a certain set of skills that benefit the nursing profession and the patient population. Some nurses may be excellent communicators and leaders, whereas others may excel at caring and understanding. I truly believe that every nurse needs to asses her current skill level. From this point, the nurse needs to refine and enhance the naturally occurring skills and dedicate extra time to work on improving the skills that are not inherent. This exercise will provide competent and skill driven nurses for the future.

NURSING'S LEADERSHIP ROLE IN POPULATION BASED Reference

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Crosby, A.E., Han, B., Ortega, L.A.G., Parks, S.E., & Gfroerer, J. (2011). Suicidal thoughts and behaviors among adults aged 18 years --- United States, 2008-2009. Morbidity and Mortality Weekly Report, 60(SS13),1-22. Retrieved from http://www.cdc.gov/mmwr/ preview/mmwrhtml/ss6013a1.htm?source=govdelivery Harkness, G.A. & DeMarco, R.F. (2012). Community and Public Health Nursing: Evidence for Practice. Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins. Kent County Public Health Department. (2013). Mental illness. Network 180. Retrieved from http://www.network180.org/en/ Michigan Department of Community Health. (2013). Mental health and substance abuse. Retrieved from http://www.michigan.gov/mdch/0,4612,7-132-2941---,00.html Michigan Public Health Institute. (2011). Kent County 2011 community health needs assessment and health profile. Retrieved from www.kentcountychna.org/pdfs/healthprofile.pdf The National Institute of Mental Health. (2008). Suicide in the U.S.: Statistics and prevention. U.S. Department of Health and Human Services. Retrieved from http://www.nimh.nih.gov/health/publications/suicide-in-the-us-statistics-andprevention/index.shtm