Leadership in Nursing: Analyzing EHR Implementation and Leadership

This report examines the application of leadership principles in a nursing context, specifically focusing on the implementation of an Electronic Health Record (EHR) system within a hospital setting. The report begins by highlighting the benefits of technology in healthcare, emphasizing the need for EHR systems to improve patient care and reduce medical errors. It then details the challenges faced by the leader, including resistance from nurses, fear of change, and the spread of negative rumors. The core of the report centers on the transformational leadership style adopted to address these challenges. The leader focused on building trust, fostering strong relationships, and motivating staff through various strategies. The report discusses the importance of aligning nurses with the organization's vision, emphasizing the benefits of EHR for patient care, and implementing motivational theories like Hertzberg's Two-Factor Theory and the Hawthorne effect to boost morale and productivity. The report highlights the significance of consistent communication, training, and creating a supportive work environment to ensure the successful integration of the EHR system and improve overall healthcare delivery.

Running head: LEADERSHIP IN NURSING
LEADERSHIP IN NURSING
Name of the student:
Name of the university:
Author note:

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Introduction:
With the advancements in the technological fields, the works of human beings have
become easier. Technology has helped human beings to be more efficient and complete a task
more accurately and at a faster pace in comparison to domains where technologies are not
applied. Similarly, in the healthcare industries, different types of technological advancements
have been made so that care delivery to patients becomes easier (Nguyen, Belucci and Nguyen
2014). Technologies have been proposed to provide safe care to patients and also to increase
patient satisfaction and decrease their stays in the hospitals. Often treatment of different diseases
like cancer, chronic kidney disorder and many others have been made easier due to utilization of
important instruments like dialyzers, instruments associated with radiotherapy, chemotherapy
and many others. Therefore, technology has now become an integrated part of the healthcare
industries (Nelson and Staggers 2016). However, there are many professionals in the healthcare
industries who dislike the use of technology. They had criticized that recent technological
advancements have reduced the development of proper relationship between the patients, nurses
and other professionals. Many also feel demotivated to change their working procedures when
new technologies are incorporated in the working environment. Fear, lack of confidence, apathy
to change the traditional working style, apathy to change habits and many others become the sole
reasons for the creation of issues in workplace (Boonstra, Verslius and Vos 2014). A similar
issue was faced by me when as a leader; I tried to implement the electronic health record system
in the working facility of the hospital. Several protests from the older nurses had been noted after
the implementation of the Electronic health record system which is also called the EHR.
Therefore, the assignment will mainly be based on the leadership style that I had adopted in such
scenario which helped me to handle my team effectively. Moreover, I will also discuss different

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theories which I had followed to make them comfortable with the new changed working
environment. Ultimately the issue was resolved and smooth flow of work was continued.
Rationale for the Necessity of the new technology:
An audit conducted in the healthcare center had showed that there had been an increased
number of medication errors in the past six months. This has mainly been due to the inability of
the nursing professionals to document the record of the patients properly. Often due to improper
communication, delegation and incomplete filling up of the documentation record sheets of the
patients, inappropriate delegation of care services were taking place. Medication errors,
complaints from patients and families and minor accidents have taken place. Therefore the
higher authorities wanted to implement a proper system which will reduce the medical errors and
will increase the accuracy of the systems. Therefore, I was assigned the duty to properly lead my
team through the implementation of the systems and providing proper guidance and training so
that they can correctly handle the systems.
Importance of HER:
The main reason for which I had selected the implementation of the HER in the system is
that it provides accurate as well as up to date and complete information about patients at the
point of care. It also enables quick access to patient records so that more coordinated and
efficient care is provided to them. It also helps in securely sharing electronic information with
not only patients but also with other clinicians (Ben-Asuli 2015). Moreover, this system also help
providers to more accurately diagnose patients, reduce medical errors an also provide safer care.
Besides, improvement in patient as well as provider interaction and communication it also helps
in different healthcare convenience. It also ensures safer as well as more reliable prescribing. It

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also helps in the promoting of legible and complete documentation and accurate billing and
streamlined coding (McAlraly et al. 2015). It ensures privacy and security of the different patient
data. Another important area where it would be increasingly helpful is that it helps in improving
productivity as well as work life balance. It would also enable providers to improve efficiency
and also meet their business goals (Sinsky et al. 2014). It also decreases cost through decreased
amount of paperwork reducing duplication of testing and improving health.
After implementation of the system and calling a meeting to discuss about the changes
that would now be incorporated in the environment, I came across several issues. One of the
barriers that I faced after the change in the working environment is a large number of behavioral
issues from the nursing professionals. Many of the nurses, mainly the veteran nurses exhibited in
regards to the perception and satisfaction towards information technology. They were also upset
about the time that they would have to spend documenting for the patient information
(Englebright, Aldirch and Taylor 2014) They mainly had doubts that whether they would be able
to work in a nursing environment with such high level of technology. Although I provided them
with reference guides, screenshots and cheat sheets, they were grateful of the new technology
and stated that they might not get adapted to the new technology and make mistakes which may
harm hospital resources as well as patient lives. A rumor had also circulated that the procedures
are very difficult to handle and the machines may break down at any time. All such rumors had
made the environment very tensed and even the new nurses who were initially enthusiastic were
now lacking confidence. While some of them complained of the having a hard time in adjusting
to electronic charting, there were also many who were filled with anxiety and fear. One such fear
discussed by a senior nurse is clicking at the wrong places while working with the computerized
charts. They become aggravated when they cannot perform their electronic tasks. Besides, the

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fear and uncertainty being some of the barriers faced by nurses in the new working protocol, it
was also seen that there were many veteran nurses who were reluctant to change their working
procedure. They believed that their habits are working fine with the system of the hospitals and
therefore there was very little need for new technologies. They were just not ready to accept it as
a part of the system. From all these I realized that they were basically suffering from lack of
confidence and motivation. The rumors and the negative environment created were making the
nurses demotivated (Englebright et al. 2014). These were affecting them physically and mentally
and were also interrupting the smooth care delivery of the patients. Hence, it became very
important for me to motivate them, to enlighten them about the new technique and help them
ponder on the positivity. As a leader is also ha to help them get over their fear and develop skills
which would ensure safe care delivery.
Leadership styles:
I mainly prefer following a transformational leadership styles. In this style of leadership,
the leader mainly works with the subordinates in order to identify the proper changes and thereby
create visions. He helps the subordinates by guiding them through the changes by properly
motivating them and providing inspiration (Kruse et al. 2015). He also believes in executing the
changes in tandem with committed members of the group. This type of leadership styles mainly
helps to enhance the motivation, morale as well as the job performance of the employee with the
help of a number of initiatives (Weng et al. 2015). This leader mainly does so by connecting the
team member’s sense of identity and self to the project. It also helps to align the subordinates
with the collective identity of the organization.

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Development of strong bonds and influencing them with the positive perspectives:
Therefore, my main aim would be to first align the nursing professionals to align with
the mission and vision of the organization. I have to make them understand that main rationale
for implementing the system s that they can appraise the necessity for the technology
implemented in the healthcare sector (Frankel and Pcgms 2017). They should be properly made
to understand that how these systems would ultimately help in developing the quality of the care
that is provided to the patients. They must be made to recognize that how EHR system is
ultimately helping them to meet with the main principle of nursing – providing safest and best
evidence based care to patients (Gillett et al. 2013). At first a proper relationship should be
developed with the nurses so that the bonds between me and the nurses become strong and
trustworthy. Trust based relationships help in making the working environment smooth and also
makes its stress free. Here the team members trust each other and the leaders and thereby
communication and productivity get increased. Once trustworthy relationship is developed, I can
help them look at the positive aspects of the technology (Lavoie et al. 2016). I can also
encourage them to overcome their fear and try their best to adapt to the new working procedure.
After the building of strong relationships, my next aim would be to motivate them to try out the
new initiatives which they fear to take. They should be motivated to buy and deliver the vision.
They should be influenced by giving them enough scopes to participate in the training
procedures, in group discussion, in feedback meetings and many others (Grosman and Valiga
2016). The old nurses as well as the new nurses should be influenced about how such changes
should not only develop patient care but would make their work much easier. They would also
prevent them from developing job stress, mental and physical disabilities and others.

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Motivational Strategies:
Two motivational theories I can use here as the leaders. The first one would be the
Hertzberg’s Two-Factor Theory. It consists mainly of two important factors. The first are the
motivation factors which are actually the factors that lead to satisfaction and motivate employees
to accept the changes and work more. I can ensure motivating the employees by making them
feel recognized for the successful handling of the EHR, for properly documenting reports and
others (Alshemri, Shawn-Akl and Maude 2017). This will motivate the employee and will also
encourage the other nurse professionals. I will also look for their career progression for further
motivation. The second factors are the hygiene factors which if absent may lead to dissatisfaction
and lack of motivation among the employees. These include salary, benefits, company benefits
and also relationship with the managers and coworkers (Grossman and Valiga 2016). Therefore
I, as a leader would try to develop relationship among the co-workers as there remain a health
relationship among them. I would also try out new incentive scheme plans for those who would
be successfully handling the new technology and would be enthusiastic to learn about them.
These would motivate the employees to learn the new techniques. Another motivational theory
that can be also used in this context is the Hawthorn effect (Wong et al. 2013). It was named
after a series of social experiments on the influence of the physical conditions on productivity at
in the 1920s and 30 at Western Electric’s factory at Hawthorne, Chicago. The researchers
noticed that different factors like lighting, working hours, breaks and others are all important for
motivating individuals at work (Hawthorn et al. 2017). Therefore as a leader, I should take
initiatives to properly plan about the working hours, breaks, proper work life balance and others.
All these would ultimately make them feel that the organization is thinking for the betterment of

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the nurses and as a result they should also try their best to dedicate themselves for the
organization and try to align with their working professionals.
Communication in a consistent manner:
A change process always remains associated with large amount of confusion. This
confusion mainly arises from half heated information distributions, lack of proper knowledge
about the change among the subordinates, rumors that spread in the organization and many
others, issues also arise where individuals became concerned about their fate in the organization
and thereby get anxious about their position. All these make employees feel disoriented as the
organization lets o of the old process and embraces new procedures and structures (Mantos et al.
2014). Therefore researchers are of the opinion that transformational leaders in such situation
should establish effective communication with every of the team members so that the negative
outlooks of the employees could be known. Their issues need to be known clearly by properly
communicating with them (Know et al. 2017). Therefore effective communication should be
ensured by the leaders to stop the employees’ form feeling anxious and panicking about the new
establishments. While communicating with the nurses, I should first empathize with their
concerns. Impressing upon them the new procedures without giving scope to the nurses in
communicating their feelings may have negative impact on their work and productivity.
Therefore, gaining feedbacks form them and then analyzing them and communication they
correct strategies and benefits which are necessary (Behnia and Muller et al. 2014). I should
implement active listening skills and proper feedback receiving skills so that they can vice their
concern. Following them, I will give them proper explanations and empower them in ways by
which they would gain confidence to work with the new technology. The main attributes that I
will use effectively while communication with both the old and new nurses are effective verbal

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communication and non verbal communication. Proper listening skills, active negotiations,
problem solving, decision making and assertiveness are attributes of communication (Valackiene
and Susinene 2013). Therefore all these would be maintained by me to make the nurses develop
their confidence.
Reinforcing and reminding:
A transformational leader does not only have the above mentioned duties. Researchers
are of the opinion that ‘reinforcing and reminding’ are two important attributes which need to be
incorporated in the leadership skills while managing change procedures. Although every
employees want to see immediate results but it is not possible always. It may take a time for the
employees to catch on the new methods. The employees will need to move through a
psychological transition. I, as the leader of the team, should not forcibly try to make them align
with the situation. In place, it is necessary for them to give the nursing professionals, time so that
they can psychologically adjust and thereby gets absorbed in the new working protocol
(Goestsch and Davis 2014). However, as a leader I should make sure that the time taken by the
nurses to adapt to the new system should not be long enough. For ensuring these, I need to
conduct meetings and training sessions in order to make sure that the nurses are gradually
coming out of their old habits and working styles. It should be sneered through the meetings and
classes, that they are getting adapted to the current scenarios.
Establishing accountability:
The leaders have to enforce the strategies taken by them in a proper pace and in proper
manner so that the employees do not slip into old patterns once again. Researchers are of the
opinion that accountability can be established through metrics and reports. Leaders should need

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to check in with the subordinates more frequently during the course of launching new
technologies in the healthcare centers. The leaders can conduct one to one meetings as well as
smaller team meetings. Researchers say that the advantages of the team meetings are that it
involves elements of collaboration which evokes an essence that all team members are working
together (Belias and Kouste 2014). This has one benefit. There is also an element of peer
pressure. Researchers have seen that when everyone of the group gets committed to change, then
those resistors of change will also give in due to the pressure to conform to the crowd. I as a
transformational leader should be extremely careful while establishing accountability. This is
mainly because I would never like to create an environment where employees would be asked to
police each other. Therefore, establishing accountability will ensure that the nurses would be
adhering with the new technology implemented in the working environment which would ensure
patient safety.
Employee feedback:
Another important step that I would take as a transformational leader is to invite proper
employee feedback. As the nursing professionals will be going through the change process with
their new working procedure, it becomes extremely important for the leaders about how they are
perceiving about the systems and whether they are facing any issues or not. The ways by which
feedback should be collected from the nurses would be by implementation of the employee
suggestion box and also employee surveys at the key checkpoints (Cameron and Green 2015).
Moreover, open discussion meetings should also be conducted by me where their issues would
be listed and accordingly important initiatives would be taken.

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Measurement and celebration of progress:
When a big goal is to be achieved, it requires time and the nursing professionals may feel
that they are not making enough progress. They may think that they may never be able to
successfully handle the EHR or would continue making mistakes. In order to prevent such
feelings of defeat, it is important for me to measure the progress. This will make the nurses
believe that their efforts towards change are making a big difference to the organization and also
helping in maintaining patient safety (Alkias et al. 2017). Moreover the focus on the metrics will
also create a feeling of teamwork. This will squelch rumors and would help the nurses to
overcome fear as well as anxiety about the new processes. Moreover it also becomes important
for the leader to celebrate incremental successes as it helps in renewing the staff and also provide
proper reward for their efforts.
Conclusion:
From the entire discussion above, it can be easily understood that any sort of change in
working procedure of the organization may result in different types of resistance from the
employees. When the new technological advancement of electrical health record was introduced
in the healthcare system, the nursing professionals were not comfortable with the change. They
were filled with fear, anxiety and lacked confidence. Not only that, they also showed apathy
towards the new change as they were reluctant to change their working styles. They gradually
started getting demotivated and hence their performance was gradually degrading. Therefore as a
transformational leader I had to initiate a number of strategies. After development of a strong
bind and trustworthy relationship, they were motivated by introduction of different schemes.
Proper communication was carried on so that they can proactively understand the rationale of the

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introduction of the strategies and the implementation of the technology and thereby try their best
to adapt to the new scenarios. Besides, I provided them enough time for preparing themselves
psychologically at the same time balancing that they are not providing themselves with enough
time where they get back to their old habits. Establishing accountability, employee feedback
gathering and thereby celebrating small successes also help the teams to adhere properly to the
new changes. For proper management of the new changes, effective leadership is required who
would ultimately help in stabilizing the unstable situations and help in maintaining smooth
workflow.