Developed by M. Cooke 113017, rev 22518, 72918, 12218,.docx

Developed by M. Cooke 11/30/17, rev 2/25/18, 7/29/18,
12/2/18, 8/9/19, 7/20/20, 8/13/21
NORTHERN ILLINOIS UNIVERSITY
School of Nursing
NURS 432 Processes for Nursing Leadership
Nursing Leadership Paper
Overview and Purpose:
The purpose of this assignment is to integrate the concepts and
materials from this course into a final 5-6-
page paper delineating the student’s unique perspective of
nursing leadership in the role and setting where
they hope to practice either now or in the future.
The assignment will encompass identifying an area and setting
for practice, summarizing 2 specific issues
affecting either the role or the setting, providing a description
as to what the student hopes to impact in the
role/setting, developing a personal vision for how they will
contribute to improving the identified issue(s)

and describing their leadership approach using their strengths
from the Strengths Finders activities.
This assignment is worth 100 points of your final grade and
must be submitted via Blackboard by the date
listed on the course calendar.
Guidelines
1. Identify an area and setting in which you want to practice
(either now or in the future).
a. Examples of area include pediatrics, infection prevention,
etc.
b. Examples of setting include acute care hospital, ambulatory
care, long-term care, critical
access hospital, etc.
c. Provide a description for why you want to work in this area
and setting
d. Description should be brief and succinct and not more than
one page.
2. Summarize 2 specific issues effecting your selected
role/environment/patient population
a. Example of types of issues: reimbursement issues, regulatory
issues, practice issues, safety

issues, ethical issues, risk management issues, quality
improvement issues etc.
b. Describe why these are issues in your area of practice using
literature to support the
rationale. Cite peer-reviewed, U.S. based literature that is not
greater than 7 years old.
c. Describe the impact of the issues on
patients/staff/organization using literature to support the
rationale. Cite peer-reviewed, U.S. based literature that is not
greater than 7 years old.
3. Discuss how, in your role as a nurse leader, you can impact 1
of the identified issues.
a. Identify an approach to change/innovation that is evidence-
based.
b. Use peer-reviewed, U.S. based literature that is not greater
than 7 years old to support the
approach.
TIPS for writing the paper
- All written assignments must be typed using 12-point font
with 1inch margins and comply with
current APA manual guidelines (7th edition). This includes a
title page, reference page and
appropriate paper headings.

- Grammar, spelling, punctuation, sentence structure and
general overall look of the paper are
included in the evaluation of assignments.
- It is expected that all written assignments will be done in a
professional, scholarly manner using
peer-reviewed, U.S. based literature that is not greater than 7
years old.
- Writing in the "first person" is generally not acceptable in
APA format, however for this paper it is
acceptable to write in the "first person" for the following
sections: Practice setting and area and
Leadership impact. This paper is not a reflection paper and
should be written in a scholarly manner.
- Limit use of direct quotes
Developed by M. Cooke 11/30/17, rev 2/25/18, 7/29/18,
12/2/18, 8/9/19, 7/20/20, 8/13/21
Excellent Good Fair Poor
Overall
content and
purpose
10 points

9-10 points 7-8 points 5-6 points 0-4 points
− Content and purpose of the writing are
clear and insightful
− Content addresses assignment including
course concepts
− Content is consistent with purpose
− Content is adequate and addresses
assignment
− Content is inconsistent about purpose and
clarity of thought
− Content inadequately addresses
assignment
− Content is incomplete
Practice
setting and
practice
area
10 points
− Practice setting and practice area identified
− Description/justification for working in this
area and setting is provided with clear
rationale and insight

− Practice setting and practice area
identified
− Description/justification for working
in this area and setting is provided
with a clear rationale
− Practice setting and practice area identified
− Description/justification for working in this
area and setting includes basic information
− Practice setting and practice area is
ambiguous
− Description/justification for working
in this area and setting includes
limited information
Summary of
relevant
issues
30 points
− Includes a summary of 2 specific relevant
issues and provides an accurate and
insightful synthesis of the important
concepts and impact
− Supported by evidence, examples,
observations, and appropriate citations
− Includes a summary of 2 specific

relevant issues and provides an
accurate synthesis of the important
concepts and issues
− Supported by evidence and
appropriate citations
− Includes a summary of 1 specific relevant
issues and demonstrates an incomplete
understanding of the important concepts
and/or does not address all three issues
− Supported by some evidence with citations
− Demonstrates severe
misconceptions about the issues
and/or does not address/include all
issues
− Illogically supported and citations
are less than appropriate
Leadership
impact on
issue
30 points
− Demonstrates a thorough understanding of
the impact of leadership on one issue,
provides analysis and insight
− Describes an approach to
change/innovation that is substantive,

evidence-based and includes
driving/restraining forces
− Supported by appropriate literature
− Demonstrates an accurate
understanding of the impact of
leadership on one issue and provides
analysis
− Identifies an approach to
change/innovation and includes
driving/restraining forces
− Supported by evidence and
appropriate citations
− Demonstrates a basic understanding of the
impact of leadership on one issue and
provides limited insight
− Approach to change/innovation is
incomplete and does not include driving
and/or restraining forces
− Supported by some evidence with citations
− Demonstrates a limited
understanding of the impact of
leadership on the issue and
generalizations
− Does not address an approach to
change/innovation and/or driving/
restraining forces

− Illogically supported and citations
are less than appropriate
Organization
& Structure
10 points
− Structure of the paper is clear and easy to
follow
− Paragraph transitions are logical and
maintain the flow of thought throughout
the paper
− Conclusion is logical and flows from the
body of the paper
− No APA format errors
− Structure is mostly clear and easy to
follow
− Paragraph transitions are present
− Conclusion is logical
− 1-2 minor APA errors
− 1 major APA error
− Structure of the paper is not easy to follow
− Paragraph transitions need improvement

− Conclusion is missing, or if provided, does
not flow from the body of the paper
− >3 minor APA errors or >1 major APA error
− Organization and structure detract
from the message of the writer
− Paragraphs are disjointed and lack
transition of thoughts
− Paper lacks most elements of APA
formatting
Grammar,
Punctuation
& Spelling
10 points
− Rules of grammar, usage, and punctuation
are followed; spelling is correct 100% of the
time
− Language is clear and precise; sentences
display consistently strong, varied structure
− Rules of grammar, usage, and
punctuation are followed with minor
errors
− Spelling is correct 100% of the time

− Paper contains few grammatical,
punctuation and spelling errors
− Language lacks clarity or includes the use of
some jargon or conversational tone
− Paper contains numerous
grammatical, punctuation, and
spelling errors
− Language uses jargon or
conversational tone
Running head: NURSING LEADERSHIP 1
Nursing Leadership: Bedside Shift Report and Catheter-
Associated Urinary Tract Infections
Mickey Mouse
Northern Illinois University

NURSING LEADERSHIP 2
Practice Setting
In considering areas to begin my nursing career, I find that I am
drawn to medical-
surgical float-pool nursing in an acute care hospital setting. I
believe working in this setting
would be beneficial as a new graduate nurse to gain experience
and continue learning with
bedside care within a diverse population of patients. Practicing
nursing care with patients who
are being treated for a variety of conditions will allow me to
build upon the foundational
knowledge I have gained in the classroom setting and the
clinical experiences I received though

the Northern Illinois University nursing program. I believe
being part of the float-pool will either
motivate me to decide on a specific area of interest to focus on,
such as Cardiac. If I continue to
work within the float-pool I believe it will give me the
opportunity to actively create deeper
connections between optimal patient care and outcomes to
classroom lessons, clinical practice
skills and evidence-based research. I want to be able to
positively impact the hospital and
patients I work with by contributing to multiple units. In my
capstone clinical I had the
opportunity to float through medical-surgical units at Advocate
Good Samaritan Hospital.
Working with other float nurses gave me insight on the job
benefits for both the nurse, the
hospital and other healthcare professionals. I enjoy the
rewarding possibilities given to the float
nurses, as scheduling seems to be more flexible, and each day
the float nurse can be placed
where she is needed most to help short-staffed units or units
with a higher ratio of patients than
usual requiring additional attention due to acuity.
Medical-Surgical Issues

Regardless of where the nurse is floated for the day, current
literature highlights the need
to focus on subjects that continuously effect medical-surgical
areas throughout hospitals such as
patient safety, patient satisfaction and infection prevention
(Mitchell et al., 2018). For the
purpose of this paper, two specific issues that will be focused
on include improving patient safety
and satisfaction through communication with nurse-to-nurse
handoff in the form of Bedside Shift
Report (BSR) and infection prevention of Catheter Associated
Urinary Tract Infections
(CAUTI).
Numerous studies have shown a positive correlation in BSR to
patient safety, higher rates
of nurse satisfaction and improved patient satisfaction (Mitchell
et al., 2018). In acute care
hospitals with various medical-surgical floors, accurate
professional team communication has
been noted as essential in providing pertinent, safe, high-

quality, patient-centered care (Evans et
al., 2012). A reliable and appropriate shift report from nurse to
nurse should include patient
information such as diagnosis, medical and nursing care plan,
medication information,
hemodynamic trends, any procedures performed during stay, and
other topics discussed during
rounding (Sadule-Rios et al., 2017). It may be more reliable if
nurses would follow a
standardized form to report with (McAllen et al., 2018).
Successful communication through
BSR and handoff has been shown to allow for continuity of
care, the active involvement of the
patient and family in decision making and the opportunity for
nurses to visually analyze the
patient and the environment (Maxson et al., 2012). As a result,
BSRs are associated with reduced
fall rates and reduced safety risks (McAllen et al., 2018).
Unfortunately, despite the evidence in its benefits, BSR is not a
standard in all hospitals
and some nurses are choosing not give shift reports near the
patient. In many cases, shift reports
are occurring outside of the patient rooms with nurses utilizing
self-developed report forms in

areas such as conference rooms, nursing stations, hallways, or
through electronic devices with no
face-to-face contact at all (McAllen et al., 2018). Two barriers
to utilizing BSR have been
reported. BSR increases time of patient reports due to
interrupted workflow by external sources,
or by patients and their families, while the nurses discuss care
(Tobiano et al., 2017). Second,
BSR may risk patient confidentiality if outsiders overhear
communication (Tobiano et al., 2017).
In contrast, evidence disproving these barriers is growing and
showing the negative
impact of not performing BSR. In one study, a team
implemented BSR on a 532-bed, acute care
hospital (McAllen et al, 2018. Prior to the introduction of BSR,
the hospital faced numerous
patients fall incidents, consistently scored below the goal of
90% on patient satisfaction and
below an 85% in communication (McAllen et al., 2018). In only
four months after introduction

and utilization of BSR at a compliance rate of 94%, patient
satisfaction scores significantly
improved and patient falls decreased by 24% overall with
orthopedics reducing falls by 55.6%,
neurology reducing falls by 16.9% and general surgery reducing
falls at 6.9% (McAllen et al.,
2018). Similarly, across the literature, another study found
increased results in patient
satisfaction and safety. After introduction of BSR, this study
further emphasized increased nurse
satisfaction from 37% to 78% and lowered total report time
from 45 minutes to 29 minutes
(Evans et al., 2012).
CAUTI is another issue in the medical-surgical area that is
ongoing has been related to
infection prevention. Despite the potential to eradicate CAUTI,
prevalence of the healthcare
associated urinary tract infection related to catheters is
estimated to cost the United States
between $876 to $10,197 per patient (Hollenbeak & Schilling,
2018). CAUTI is associated with
negative outcomes in patients in acute care including increased
lengths of hospital stay, urethral
inflammation, strictures, Clostridium difficile growth causing

further infection, independence and
mobility impairment, unnecessary patient readmissions,
mechanical and urinary trauma, and
even mortality (Lo et al., 2014). At a national level, major
health initiatives by the Joint
Commission, Agency for Healthcare Research and Quality and
the Department of Health and
Human Services have set out with goals to eliminate or reduce
CAUTI (McAlearney et al.,
2017). Still, of all healthcare associated infections, indwelling
urinary catheters are responsible
for 70-80% and it is estimated that up to 16% of all adult
hospital patients will have a urinary
catheter at some time during inpatient admissions (Lo et al.,
2014). Current research supports
that CAUTI is continuing to occur for multiple reasons. In
review of the literature, experts
contribute unnecessary length of time or duration of
catherization use as the single most
important risk factor for developing a UTI (Lo et al., 2014).
Additionally, poor hygiene, failure

in aseptic technique, and improper management (including not
maintaining a closed drainage
system), are all major contributors to CAUTI (McAlearney et
al., 2017).
Leadership Impact Using Bedside Shift Report
According to the literature, hospitals across the United States
have started implementing
BSR (McAllen et al., 2018). Unfortunately, misconceptions of
BSR act as restraining forces,
making many nurses choose to continue to give and receive
patient reports away from the
bedside (McAllen et al., 2018). Evidence-based research should
be used as a driving force as it
continues to disprove the nonfactual perceptions or beliefs on
BSR, such as it is too time
consuming to include the patient and family and that it risks
breaching confidentially (Mitchell et
al., 2018). Instead, research shows that patient safety, nurse
satisfaction and patient satisfaction,
increases when nurses give report at the bedside (Mitchell et al.,
2018). With these facts, I
believe I can use my tested strengths as an achiever,
communicator, relator, activator and

commander to educate, and be an influence, to my future
healthcare team. By adopting BSR into
my daily routine, I will set an example to my peers and
positively impact the medical-surgical
units that I will work in. Experts discuss all registered nurses
can be leaders that act as
innovators, or agents of change, to promote improvements in
healthcare, aid in the development
of effective policies and practices, and introduce ideas that may
benefit patients, hospitals or
society (Thomas, Seifert, & Joyner, 2016).
On a smaller scale, in adopting BSR into my own daily routine,
I would inform patients
of BSR and the benefits for both staff and patients in
participating in this method. I would use a
standardized report form for communication with other nurses.
The literature proves that a
standardized report sheet is the safest way to deliver
communication in handoff that is accurate
and aids in the prevention of information gaps or errors in
patient care (Mitchell et al., 2018).

Additionally, nurses that use BSR increase nurse accountability
by allowing both the incoming
and outgoing nurse to visualize the patient, improve teamwork
among healthcare teams and plan
accordingly for patient care, allow more opportunities for
questions and clarification of patient
treatment plans, allow for inclusion and better understanding of
medical treatment for patients
and their family, and increase mentorship between nurses
(Mitchell et al., 2018).
Further, there have been many cases of nurses aiming for
change by getting the support
of co-workers, charge nurses and upper management. For
example, one nurse reported on her
journey to implement BSR as standard practice on the unit she
worked in. In this case, after
attending a conference on patient-center care, she and a
colleague were given a project to
improve patient safety (Ferris, 2013). She and her colleague
developed and practiced
standardized scripting in BSR with other healthcare
professionals with the support of their
administrative team, their clinical director and their chief nurse
(Ferris, 2013). Together, they all

participated in educating other nurses on the BSR initiative
supported by research and evidence-
based practice results (Ferris, 2013).
On a larger scale, inspired by stories such as the one previously
described, I would like to
volunteer to collaborate with upper management on BSR
protocol and advocate for BSR policy.
Once having gained support working with a team of
professionals, I would highlight the need for
implementing change in requiring BSR using a standardized
form on all medical-surgical units to
improve communication and patient safety. One standardized
report format that repeatedly
shows success in the implementation of BSR is the Introduction,
Situation, Background,
Assessment, Recommendation and Question (ISBARQ) form
(McAllen et al., 2018). As
described in the literature, I would additionally recommend
using Kotter’s Eight Stage Process
for Major Change, which has proven to be a successful guide to

implementation (McAllen et al.,
2018). Finally, I would also recommend the Plan, Do, Study,
Act (PDSA) cycles which have
shown to be beneficial in evaluating practice change throughout
the process (McAllen et al.,
2018).
Conclusion
The American Academy of Nursing calls to action nurse leaders
in healthcare as they
describe innovative ideas that can create permeant changes that
improve patient care and
promote a culture of safety in healthcare (Thomas, Seifert, &
Joyner, 2016). All Registered
Nurses have the power to recognize and use their unique skills
to make a positive difference in
patient outcomes as they advocate for patients through research,
studies, policy, and healthcare
initiatives. By applying nursing experience, medical knowledge,
and continuing education, nurse
leaders will be able to promote, achieve and revolutionize
healthcare. Achieving advancements
by directing change will not only impact the nurse leaders’
surroundings but can potentially

inspire other nurses to create positive changes that help to break
down barriers currently
inhibiting successful patient care. The first step in driving
change as a nurse leader is the
decision to focus on major issues within the field such as
CAUTI and BSR. For me, I hope to
leave an impact on safety and communication by diligently
working towards patient involvement
in care through a standardized form and BSR with all healthcare
staff. It is with great hope that
other nurses can become active in the process to advocate for
change by pushing forward and
vocalizing what they recognize as issues throughout healthcare
that require revision.

References
Dorvil, B. (2018). The secrets to successful nurse bedside shift
report implementation and
sustainability. Nursing Management, 49(6), 20.
Evans, D., Grunawait, J., McClish, D., Wood, W., & Friese, C.
R. (2012). Bedside shift-to-shift
nursing report: Implementation and outcomes. Medsurg
Nursing, 21(5).
Ferris, C. (2013). Implementing bedside shift report. American
Nurse Today, 8(3), 47-49.
Hollenbeak, C. S., & Schilling, A. L. (2018). The attributable
cost of catheter-associated urinary

tract infections in the United States: A systematic review.
American Journal of Infection
Control, 46(7), 751-757.
Lo, E., Nicolle, L. E., Coffin, S. E., Gould, C., Maragakis, L.
L., Meddings, J., Pegus, D. A.,
Pettis, A. M., Saint, S., & Yokoe, D. S. (2014). Strategies to
prevent catheter-associated
urinary tract infections in acute care hospitals: 2014 update.
Infection Control & Hospital
Epidemiology, 35(5), 464-479.
Maxson, P. M., Derby, K. M., Wrobleski, D. M., & Foss, D. M.
(2012). Bedside nurse-to-nurse
handoff promotes patient safety. Medsurg Nursing, 21(3), 140.
McAllen, E. R., Stephens, K., Swanson-Biearman, B., Kerr, K.,
& Whiteman, K. (2018). Moving
shift report to the bedside: An evidence-based quality
improvement project. OJIN: The
Online Journal of Issues in Nursing, 23(2).
McAlearney, A. S., Hefner, J. L., Sieck, C. J., Walker, D. M.,
Aldrich, A. M., Sova, L. N., ... &
Buck, J. (2017). Searching for management approaches to
reduce HAI transmission
(SMART): A study protocol. Implementation Science, 12(1), 82.

Mitchell, A., Gudeczauskas, K., Therrien, A., & Zauher, A.
(2018). Bedside reporting is a key
to communication. Journal of Healthcare Commuications, 3(1),
13.
Sadule-Rios, N., Lakey, K., Serrano, M., Uy, E., Gomez, J.,
Bezner, P., & Acosta, J. (2017). Off
to a good start: Bedside report. MedSurg Nursing, 26(5), 343-
345.
Thomas, T. W., Seifert, P. C., & Joyner, J. C. (2016).
Registered nurses leading innovative
changes. OJIN: The Online Journal of Issues in Nursing, 21(3).
Tobiano, G., Whitty, J. A., Bucknall, T., & Chaboyer, W.
(2017). Nurses’ perceived barriers to
bedside handover and their implication for clinical practice.
Worldviews on Evidence‐
Based Nursing, 14(5), 343-349.

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