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One of the biggest leadership issues is identifying gaps in the healthcare system and

finding ways to close those gaps.

In my opinion an area which contributes to a


in the health

care system

is lack of knowledge, specifically the l

ack of knowledge

that is associated with

patient safety. Finding a way to fill this gap is a priority of this writer. It is also a priorit

y of

this writer to be a good leader. An organization must have good leaders in order to be effective.

Organizations must have a mission, vision and values.

The Albatross Health System’s


mission is to help people live healthier lives and to help

make the health system work better for

everyone. The values are integrity, compassion, relationships, innovation and performance. It is

a leader’s responsibility to help the staff live up to this mission and to live the values in and out

of work. Leade

rship priorities are needed to not only live up to the mission, but to help staff

understand what it takes to live the values.

The purpose of

this paper is to focus


one main nursing priority that is

in need of

improvement. It wi

ll also offer



to this issue


It will show how improving this



can have the ultimate positive result

; a

healthy patient. The

nursing priori

ty this paper

will focus on is

lack of education to both


e nurses

and the patients

. T

his paper will fo

cus not

only on healthcar

e in general, but specifically o

n chronic kidney disease (CKD) and end stage

renal disease (ESRD) and a telephonic program designed to help these patients live healthier

lives. Having a telephonic program in place can lead to grea

ter outreach than in person



This paper will show how the organization of this writer is in line with the goal of

improving the level of education for the patient as well as providers.

In order to be an effective leader, it is necessary to have

the appropriate resources and

tools. There are different forms of leadership that work well as resources. This paper will focus



on transformational leadership and transactional leadership as tools. Leaders also must have

resources such as seminars, a

nd what



learn sources

which are mini courses with

quizzes. Some

learn sources

are mandatory, but there are a multitude of them that are not, and

they are there solely to allow an employee to build knowledge and become more proficient.


this paper will also take a look at how multiculturalism and diversity play a role in

helping the telephonic program be effective. It will show how the organization values all culture


makes it a goal to include this in the education.

The lack of education in healthcare can be harmful. The lack of education in chronic

kidney disease (CKD) and end stage renal disease (ESRD) can be fatal. “Preparation for end

stage renal disease (ESRD) is widely acknowledged to be suboptimal in the Unit

ed States”

(Kurella, Li, Chen, Cavanaugh, Whaley

Connell, McCullough & Mehrotra,


, p 686).

According to Lopez

Vargas, Tong, Phoon, Chadban, Shen, and Craig (


), the lack of

knowledge in CKD and ESRD patients can cause the patients to deny their di

sease leading to

fatal consequences.

With CKD on the rise, it is important to educate Americans on the causes, risk factors,

preventative care, and signs and symptoms to look for. The problem is, there are many doctors

who are not honest with their patie

nts or they simply do not understand the consequences or risk

factors of CKD themselves. Diabetes Mellitus (DM) is one of the major risk factors for CKD

along with Hypertension (HTN). According to McK

inlay, Piccolo, and Marceau (1994

), 60.9

percent of do

ctors did not diagnose DM when there were many symptoms present. In



was estimated that 285 million people were diagnosed with DM and it was projected that by

2030 that number would increase to 439 million. This is extremely important to CKD since

it is

a major risk factor. In order to prevent CKD from developing in these diabetic patients, the



patients must be educated about the symptoms and the providers must be educated to screen for

DM and recognize the symptoms.

There are programs offered

by many organizat

ions such as this writer’s organization that

are free of charge for patients as part of their insurance benefits. These programs educate on

signs and symptoms of CKD as well as

diabetes mellitus (




hypertension (



. They


mostly telephonically, in regard to preventative measures such as diet, exercise, and

avoidance of certain over the counter (OTC) medications including avoidance of intravenous

contrast dye. It is important to make sure diabetics are monitoring their blo

od glucose, and

patients with HTN are monitoring their blood pressure and recording the results to bring to the

provider’s office.

In today’s very sophisticated, complicated world, technology is no stranger to most

people. However, it is slow to be acce

pted in healthcare education. It is widely used for college

courses, such as this one, where all classes are solely web based, but when it comes to using

technology to reach its employees and also its patients, it could be used so much more.

“Telehealth i

s the delivery of health care services at a distance, using information and

communication technology” (Wade, Karnon, Elshaug, & Hiller,


, p. 1). According to

Wade, Karnon Elshaug and Hiller (


) telehealth can be used with video in real time. This

could be such a great tool, not only for the patients, but also for the staff. This writer has a staff

that is spread over several states. Imagine the impact telehealth programs brought directly to

smart phones or tablets could have. Imagine the impact

those nurses using that technology could

then have on the patients.

One of the issues that this writer encounters is a language barrier. In a telephonic

program, this can cause some very big problems. Many times our nurses use language lines as




ters and this does help, but it does not solve the problem completely since it can be

distracting having a question relayed through an interpreter. So how do we effectively solve this

problem? One of the suggestions of this writer and nurse is to hire a

more diverse

group of



ince there is

a lack of ethnically diverse nursing faculty as well,

mentorship shoul

d be

encouraged for all faculty” (



, p. 136). This could solve a very large gap in the

telephonic program.

Plan of Act



The values of


Health Care are integrity, compassion, relationships, innovation

and performance. These values need to be taken into consideration when planning a solution to

the lack of education in CKD and ESRD patients. The use of technology a

nd hiring a diverse


of nurses has to be part of the telephonic program. The values and structure of


needs to be taken into consideration.


mission is to help people live healthier lives. This fits

in with this writer’s plan to use a telep

honic program to close the gap in education provided to

CKD and ESRD patients as well as their providers.

If the patients are suffering from a lack of knowledge, a good leader must empower the

staff to educate the patients. How is that done? It is do

ne by educating the staff so they can then

educate the patients. “Low adherence to chronic kidney disease (CKD) guidelines may be due to

unrecognized CKD and lack of guideline awareness on the part of providers” (Drawz, Miller,

Singh, Watts, & Kern, 2



. In this case, who are the providers? It is the nurses. Leaders must

seek out the appropriate resources for their staff. Using professional organizations can help.

“Professional nursing organizations can make substantial contributions to the move heal


quality forward by providing EBP work

shops similar to those conducted by the American

Nephrology Nurses’ Association” (Hain,


, p.563).



According to





), a transactional leader is a manager or leader who also

can be seen as a

caregiver. They set goals for their staff and then reassess on a daily basis using

individual goals based on the employee’s personal ability. A transformational leader, however,

according to H




), provides a sense of direction for the staf

f motivating them to

their full potential. “Transformational leadership is believed to operate through four distinct, but

closely correlated, components of leader behavior, which encourage employees to exceed

expectations in terms of their own behavior” (

Clarke, 20


, p. 26).

How do either of these leadership styles act as a tool for good leadership that can help

with the priorities of education?

The right leader for the right group is extremely important.

Staff responds differently to different leader

s. Being a fairly new manager has taught this writer

that a combination of all leadership styles is best, and it is sometimes necessary to use different

styles with different employees. It is extremely important to know your own leadership style so

you c

an provide your staff with the resources they need to be effective.

According to H




, there are many leadership theories that are grouped in

three types including trait, attitudinal and situational.

The trait approach of leadership identif


certain characteristics of a leader.

The attitudinal approach looks at the attitude of the leader and

the situational looks at observed behavior.

To address the

lack of education problem,

I think a combination of all of the leadership

theory groups

should be used together.

A leader has to set a good example.

The saying do as I

say not as I do does not apply here.

The Leader must expect that the staff will do what they do.

If a leader has a bad attitude, so will the staff.

If a leader has a bad b

ehavior, so will the staff.

This all has to be taken into consideration when developing a program.






Performance Evaluation Plan

In order to know if my plan has been effective, I will put a performance evaluation plan

into effect. I will use before and after data to determine the increase in education by using the


test/post test process. I am currently looking through the lit

erature to find a reliable data

collection tool. I will compare the data to determine if the hospitalizations have decreased.

Have the deaths decreased? Are the patients living healthier lives? All of this will be considered

when comparing before and a

fter data.

My career goal is to become a nurse researcher which means I will eventually have to earn a

Ph.D. I’m starting now by implementing this performance improvement project at my hospital.

The biggest obstacle I will face in my envir

onment is finding a mentor. We currently do not

have a formal research department.

In conclusion


the l

ack of education is a leadership priority



and this writer take very

seriously. Having the proper resources and choosing the proper lead

ership style can make the

difference of a successful leader and a not so successful leader. In order to fulfill our mission,

vision and values, we must know what they are and lead the staff to live up to them. CKD and

ESRD are used in this paper as an ex

ample since this is the current experience of this writer,

however all fields of healthcare can benefit from these priorities. Using technology to educate

staff, and also patients is an element of nursing

that is becoming more popular.

Telephonic or


based learning is a great way to reach employees who can’t or d

on’t use in person seminars

including multi

cultural education.

All of these things together can make a great program even


An evaluation of the effectiveness of this program is also

an integral part of the program.

The knowledge if the program is effective is vital to the success of the program. The ultimate

goal is a healthier patient. This telephonic program can make that difference

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