NR 351 Week 7: Discussion: Leaders and Systems-Based Practice (Graded)

Systems based practice involves thinking about the entire healthcare system in relation to your patient care. This means not only focusing on the skill and level of care delivery at the point of care but also how that care is and was able to be provided and how it will be in the future. This may mean that a leader may have to think about the larger picture of healthcare delivery when it comes to effective patient care and the business of patient care that they practice in. One must think of the interrelationships involved within the system at every level and how each part affects the system functioning smoothly and maintaining relationships that meet the goals of the organization. Within an organization the overall goal of a leader is to represent the values and standards of an organization, mitigate potential liability, ensure patient safety and meet performance goals and quality metrics. (Masters ,2020.) When it comes to leadership style and the ability to help their team meet the goal of effective and safe patient care, I feel that the style may change based on the individual needs of the team.  A statement used by Fennimore et al. (2017) was that “Effective leadership preparation and commitment of the nurse manager can lead to enhanced staff nurse retention, reduced turnover costs, and improved quality and financial outcomes for healthcare institutions”.  I feel no one style is going to always be effective in every situation and the aspect of a leader is to be not only reliable but adaptable to the needs of the unit with the constant end goal in mind to meet quality standards and growth as a team. At times this may look like collaboration, communication, coaching, teaching, and guiding those around them how to improve and empower themselves, other times it may look democratic to assess the values of the team and discussion on how to come to a conclusion that meets everyone needs. Other times an authoritarian style is needed to establish boundaries, establish a set of expectations and goals or provide direction when an agreement can not be made or in the case of an emergency. Other times it means delegating effectively to the skills of the person being delegated to. Or it could be developing relationships that support and foster the values of the team. I liked the analogy used within our reading that compared the leader to a symphony conductor, not as a one-man band or expert on every instrument but rather as a visionary and director assisting meet goals and achieve results. (Masters ,2020.)

Fennimore, & Wolf, G. (2017). Nurse Manager Leadership Development: Leveraging the Evidence and System-Level Support. The Journal of Nursing Administration, 47(10), S20–S26.

Links to an external site.

Masters, K. (2020). Role development in professional nursing practice (5th ed.). Jones & Bartlett.

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I will use principles of systems-based practice to grow as a leader in nursing through participation. Participation and involvement are a key component of the hospital that I work for and highly encouraged – our hospital is very much employee driven; so much so that our current CEO was a staff nurse at our hospital and this is the case with a large majority of our leadership.

In addition to our daily, AM and PM huddle with RN’s, PA’s, case managers and social work – everyone is required to attend, our unit also hosts unit board meetings. Our unit board meetings take place one a month, we host the meetings in person but also use a zoom link for those who can’t attend in person or are off of work and just want to dial in; it is not a requirement but most of our nurses do attend if possible. Typically, these meetings involve our staff nurses, manager and floor educator. We discuss any changes to practice/policy, updates for the unit or discuss any concern or ideas anyone wants to bring to the table. In addition, we have nurses who are part of separate board or committees who also bring pertinent updates. I am part of the professional development board and bring any updates in that regard. I think being involved is what brings about change.

Our hospital has a clinical ladder program with three different levels, it is hourly pay based incentive for those that participate and the requirements have to be renewed every year but it is a great way to promote involvement. Each tier has a required project, which involves evidence based research for presentation – some of these projects have resulted in hospital wide policy changes. I know sometimes it feels difficult to find the time to participate but having perspective from those that work on the floor is so important; we see a lot that leadership may not that directly impacts patient care. In an article, Meeting Mondays, Douillard explains that designating one day a month, at a specific time for meetings increased frontline nurses’ involvement in committees and councils (2014). This is exactly the case and what makes being involved in committees/boards at our hospital possible.


Drouillard. (2014). “Meeting Mondays”. American Nurse Today, 9(1), 44.

This week’s module focused on leaders in professional nursing as well as systems-based practice. According to the module, “The goal of systems-based practice for the nurse of the future is to enhance and improve the interdisciplinary system of patient care while understanding the legal, political, regulatory and economic factors that influence the delivery of health care” (Massachusetts Action Coalition Future of Nursing, 2016, p. 10). In my current work situation, we could benefit from systems-based practice. The nurses in my hospital brought in a union because they did not feel that they were being heard by the leadership throughout the hospital. If the leadership of the hospital implemented systems-based practice sooner, they may have been able to avoid the bringing in of the union. Now with the union involved, staff members cannot meet with management to discuss anything without a union representative being present. There are downfalls and benefits of the union, but the point I am trying to make is that because the pre-existing management of the hospital and their lack of using a systems-based practice approach, it forced staff to look for leadership and empowerment elsewhere.

According to an article titled Where do we go from here? Moving from systems-based practice process measures to true competency via developmental milestones, the authors introduce an idea that has six core principles to aid in success.  “1) work effectively in various health care delivery settings and systems relevant to their clinical specialty; 2) coordinate care within the health care system relevant to their clinical specialty; 3) incorporate considerations of cost awareness and risk benefit analysis in patient and/or population-based care, as appropriate; 4) advocate for quality patient care and optimal patient care systems; 5) work in interprofessional teams to enhance patient safety and improve patient care quality; and 6) participate in identifying system errors and implementing potential solutions.” (Johanna Martinez, 2014) By incorporating this approach into healthcare systems, it would empower nurses which would lead to better patient outcomes and higher satisfaction rates.


Chamberlain College of Nursing (2021). NR351 Transition in Professional Nursing: Week 7 lesson. Chicago, IL: Online Publication.

Johanna Martinez, E. P. (2014). Where do we go from here? Moving from systems based practice process measures to true competency via                                   developmental milestones. US National Library of Medicine National Institutes of Health, doi: 10.3402/meo.v19.24441.

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