How Leadership Skills and Management Tools Can Help the DNS Drive Change

Implementing and sustaining a new process or system may seem like an overwhelming proposition to a busy director of nursing services (DNS). However, good leadership skills and the right management tools for the job can make a world of difference. Taking the following steps will help the DNS be better prepared for change management:

1. Assess the management skills of nurse leaders (and do some self-reflection)

Michelle Stuercke, RN, MSN, DNP, MPA, LNHA, QCP, chief clinical officer for TCM Consulting and Management

From the charge nurses to the DNS, nurse leaders need leadership skills to implement changes effectively and efficiently. “Nurse leaders are often fabulous bedside nurses who take on management positions with absolutely no training or education on what it means to be a leader,” says Michelle Stuercke, RN, MSN, DNP, MPA, LNHA, QCP, chief clinical officer for TCM Consulting and Management in Chicago, IL.

As a result, nurse leaders end up using management practices that they have picked up from their own prior managers. “Those managers may have been good leaders, but they just as easily may have been indifferent or even bad leaders,” Stuercke adds.

Nurses need leadership education to thrive as leaders. “Especially when promoting nurses from within, your organization should provide leadership development or training so that every member of your nursing management team has the leadership skills that their position requires to guide staff successfully,” explains Stuercke.

Leadership development or training is especially important for the DNS. “Especially if you have been promoted from within to the DNS position, it’s very easy to burn out and choose to return to bedside nursing,” says Stuercke. “You must have adequate training to become familiar with everything that you need to do from a leadership perspective, including change management.”

Examples of leadership skills that a nurse leader may need to learn depending on their role include the following “how to’s,”:

• Develop a leadership style
• Get to know team members
• Delegate appropriately
• Communicate effectively and handle difficult conversations
• Provide feedback
• Move from a peer role to a manager role
• Lead with emotional intelligence
• Show appreciation and gratitude
• Interview job applicants

“All of these are really important lessons,” notes Stuercke. “While there isn’t time to teach a nurse all of that before they step into their role, a high-performing organization will have ongoing leadership development or training for new nurse leaders so that they learn how to successfully apply these skills and lead more effectively on a day-to-day basis and through periods of change.”

2. Take PDSA outside of QAPI

The Plan-Do-Study-Act (PDSA) cycle is a management tool for testing change that is widely used in Quality Assurance and Performance Improvement (QAPI) programs, notes Stuercke. “However, PDSA also can be a valuable tool for implementing process or system changes outside of your QAPI program. It’s especially important to do this type of small-scale testing of changes to processes or systems if you employ a lot of agency staff,” she says.

Amy Catherine Franklin, RN, DNS-MT, RAC-MT, legal risk nurse manager at Majestic Care

PDSA may be used to test any type of change. “The key is not to abbreviate the process. Sometimes, managers will focus on the planning (i.e., Plan) and the execution (i.e., Do), but not pay as much attention to analyzing the data (i.e., Study) and refining the change (i.e., Act),” Stuercke explains.

However, taking the time to find and work out the kinks before the full-scale roll-out is critical. “Achieving the best change for your facility could even require making refinements through more than one PDSA cycle,” she says.

“PDSA works far beyond QAPI—any time that you need to do a simple pilot,” agrees Amy Catherine Franklin, RN, DNS-MT, RAC-MT, a legal risk nurse manager at Majestic Care and a nurse consultant based in Durand, MI. “However, when using PDSA, nurse leaders should avoid giving staff yet another acronym to understand. Quality improvement jargon will turn off a lot of people. Break down what you want to do in plain English.”

Franklin offers the following chart to show how to do that:

Learn more about effective PDSA cycle use, including how to test multiple changes at once and how to link PDSA cycles, here and here.

3. Consider using a management model for larger projects 

While a PDSA cycle is ideal for testing change on a small scale, nurse leaders may need to implement a more complex management model for a wide-scale roll-out and/or more detailed issues. “You should choose a management model based on the dynamic of what you want to do,” says Franklin. “For example, some models are better suited to system-based changes, while others work well with staff-based changes.”

Franklin offers the following summaries of three management models that are commonly used in healthcare and how nurse leaders could use them to effect change in comparison to PDSA:

The models may seem daunting, acknowledges Franklin. “However, you practice change management any time you do a plan of correction for survey,” she says. “So, you are more than capable of using any of these approaches. Just use the same step-by-step mindset that you would use for a plan of correction.”

Learn more about managing resistance to change and available change management models here and here.

Caralyn Davis

Caralyn Davis is a freelance writer specializing in the post-acute care sector. Email her at: caralynd@outlook.com.