Introduction
In the nursing profession, the ability of nursing staff to implement positive practice changes relevant to the served population’s needs is essential. As research shows, substance use disorder in pregnant women is a significant public health issue that relates to mental health and jeopardizes the safety of the impacted patients (Peltier et al., 2022). To identify and proactively respond to the tentative health issues related to SUD in pregnant women, competently implemented evidence-based practice is required. The plan for quality improvement integrating cognitive-behavioral therapy as a model for SUD management is addressed in this paper through the lens of a nurse leader’s responsibilities.
Nurse Leader’s Role
When implementing a quality improvement plan, a nurse leader, as a responsible manager of the operations, bears multiple responsibilities. They include the supervision of the implementation of the plan according to the schedule and the establishment of effective teamwork. According to Heinen et al. (2019), leadership in nursing entails advocacy for patient care through proper facilitation of team communication, engagement of stakeholders, risks assessment and addressing in a timely manner, and efficient use of budget. Moreover, a competent nurse leader is expected to apply proper change management models to achieve anticipated outcomes.
Nurse Leader’s Role in Communication with Stakeholders
Across all stages of the plan implementation, the leader is expected to engage in close communication with all the involved stakeholders. Depending on the responsible stakeholders, the leader will shift communication roles throughout the team to engage the responsible parties more actively in information exchange. Communication skills are essential to ensure clarity of goals, stakeholder engagement, risks addressing, and adjustment of team members’ roles along the way (Heinen et al., 2019). Thus, the nurse leader implementing the SUD management project among pregnant women will communicate differently with the involved stakeholders depending on the level of their responsibilities. The stakeholders involved in the current plan implementation are the nursing staff, therapists, and community-based non-profits for SUD management. The leader will ensure to conduct whole team meetings regularly to update all stakeholders on the advancement of the project. Both in-person and virtual communication will be used to ensure the tracking of data exchange and the facilitation of teamwork. In particular, the leader will have separate communication routes for the nursing staff who will perform the assessment, diagnosis, and referral of patients and therapists who will conduct cognitive-behavioral treatment (Magill et al., 2019; Volkow, 2020). In such a manner, the leader will serve a role of a facilitator in the communication process between the stakeholders.
Nurse Leader’s Role in Training
Training is another essential part of the plan implementation process due to the necessity of each stakeholder to acquire a specific set of skills and knowledge necessary for performing their roles. In particular, the nurse leader will identify training needs and engage in arranging the training process for the nursing staff to ensure the involved individuals are properly instructed on the assessment of patients with SUD among pregnant women (Peltier et al., 2022). They should also be trained in the identification of specific mental illnesses characteristic of SUD in pregnant women. Therapists should be trained for the addressing of the particularities of working with pregnant women in the context of their mental condition under the impact of child bearing and additional factors. They should be trained skills of patient education according to the cognitive-behavioral model contextualized for pregnant women with concurrent mental disorders. In addition, the training for the staff of the involved community-based non-profit organization working with patients with SUD should be guided by the nurse leader, who should ensure that the particularities of the served population are properly addressed. In particular, the training should involve the integration of pregnant women’s needs while staying at the facility; furthermore, the employees with the community facility should be informed on the proper methods of empowering women with the proper knowledge and skills appropriate to their mothers roles. As for the general training for all the involved team members, the nurse leader should initiate the training for teamwork improvement. It will include training sessions for communication skills development and the facilitation of collaborative strategies for effective project goals achievement.
Nurse Leader’s Role in Budget Management
Budgeting is an important managerial responsibility of a nurse leader in the organization due to the pivotal role of monetary resources in the ability to implement planned changes. Indeed, patient outcomes directly depend on the accuracy of resource allocation and their reasonable distribution for the achievement of the best outcomes (Heinen et al., 2019). Within the framework of the implemented quality improvement plan, the role of the nurse leader is to ensure that the required resources are allocated by the organization to cover employee work and the necessary means of work. For that matter, it is the responsibility of the leader to articulate the urgency of the resource need and validate the benefits of their investment in the facilitation of the mental health of pregnant women with SUD (Peltier et al., 2022). Furthermore, the nurse leader should discuss and agree on the available resource when establishing the payment with the stakeholders to distribute the available resources reasonably and efficiently. To facilitate the distribution of the budget according to the needs of the project and minimize the costs, the leader will diversify the management of the budget by several approaches. Firstly, the organizational budget allocated for the project implementation will be retrieved by means of a persuasive delivery of the plan’s importance to the decision-makers. Secondly, volunteers will be engaged (especially among the workers of the non-profit organization) to minimize employee payment costs. Thirdly, Fundraising activities will be initiated to encourage the public and organizations to donate for the benefit of the vulnerable community.
Nurse Leader’s Role in Change Management
Leading change is one of the most challenging and demanding responsibilities of a nurse manager. It lies at the core of the nurse leader’s overall performance goal since continuous change toward the improvement of care drives the advancement of the nursing profession and the healthcare system in general. Across the implementation of the change within the project plan, the leader’s primary role will be in synchronizing the transition between the stages of all stakeholders, as well as the regulation of the stage-by-stage goal achievement for proper outcome obtainment.
Lewin’s Change Management Theory Implementation
Lewin’s three-step change management model is an effective tool in handling change in nursing. According to Teguh et al. (2019), the first step of the model is Unfreezing. At this stage, the leader will identify the need for SUD treatment, evaluate current assessment methods, raise employee awareness, instill the need for change, and engage stakeholders. The second stage is Change, which involves the actual implementation of the project activities to implement the change in the addressing of SUD among pregnant women with mental illness (Teguh et al., 2019). At this stage, the leader will modify patient assessment and diagnosis, establish effective referral patterns, encourage Cognitive-Behavioral therapy use, cooperation with non-profits, and patient education and empowerment. Finally, the third stage is refreezing, which involves the instilling of the achieved results for long-term use (Teguh et al., 2019). At this stage, the leader will evaluate project outcomes, assess performance indicators, make adjustments, collect feedback, and instill long-term implementation of the practices.
Authority Issues in Nurse Leader’s Role
For a successful performance as a nurse leader, an individual should be able to exert a proper level of authority to ensure that the relationships with the subordinates are balanced with mutual respect and diligence. According to McKenna and Jeske (2021), a nursing leader is challenged with the use of authority to mitigate the negative implications of nursing work and staff-related complications. In particular, one of the risks in the plan implementation for SUD management in pregnant women is the disruption of intended activities due to the incompetence of the stakeholders. For that matter, the leader will use their authority to discipline the staff and address this risk. Overall, ethical leadership will be applied to ensure that the stakeholders are properly engaged, and that their individual responsibilities and loyalty contribute to their performance excellence.
Conclusion
In summation, the analysis of the nurse leader’s role in the implementation of the quality improvement plan implementation across all its stages has revealed a number of particular responsibilities. In particular, the nurse leader will perform as a facilitator of the communication process between the stakeholders to ensure a timely and clear exchange of information. Furthermore, the leader will initiate separate and collaborative training for each stakeholder group to improve their skills and knowledge of working with pregnant women with SUD. In addition, the budget distribution will be conducted via cost-efficient strategies. Finally, the change implementation will be managed using Kotter’s 8-step change management model to ensure the sustainability and effectiveness of change.
References
Heinen, M., van Oostveen, C., Peters, J., Vermeulen, H., & Huis, A. (2019). An integrative review of leadership competencies and attributes in advanced nursing practice. Journal of Advanced Nursing, 75(11), 2378-2392.
Magill, M., Ray, L., Kiluk, B., Hoadley, A., Bernstein, M., Tonigan, J. S., & Carroll, K. (2019). A meta-analysis of cognitive-behavioral therapy for alcohol or other drug use disorders: Treatment efficacy by contrast condition. Journal of Consulting and Clinical Psychology, 87(12), 1-25.
McKenna, J., & Jeske, D. (2021). Ethical leadership and decision authority effects on nurses’ engagement, exhaustion, and turnover intention. Journal of Advanced Nursing, 77(1), 198-206.
Peltier, M. R., Roberts, W., Verplaetse, T. L., Burke, C., Zakiniaeiz, Y., Moore, K., & McKee, S. A. (2022). Licit and illicit drug use across trimesters in pregnant women endorsing past-year substance use: Results from National Survey on Drug Use and Health (2009–2019). Archives of Women’s Mental Health, 25(4), 819-827.
Teguh, A., Hariyati, R. T. S., & Muhaeriwati, T. (2019). Applicability of Lewin’s change management model for optimization management function in nursing delegation between head nurse and team leader: A mini project in Jakarta military hospital. International Journal of Nursing and Health Services, 2(2), 66-74.
Volkow, N. D. (2020). Personalizing the treatment of substance use disorders. American Journal of Psychiatry, 177(2), 113-116.