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Item type Presentation
Format Text-based Document
Title The Geriatric Nursing Leadership Academy: Sustainabilityin Influence and Impact
Authors Cleeter, Deborah F.; Reynolds, Karen; Rowe, Meredeth;Beverly, Claudia Jean; Roscoe-Herbert, Catherine
Downloaded 18-May-2018 17:26:37
Link to item http://hdl.handle.net/10755/601539
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Geriatric Nursing
Leadership Academy
Sustainability in Influence and Impact
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Geriatric Nursing Leadership Academy
Deborah Cleeter, MSN, EdD, RN
Meredeth Rowe, PhD, RN, FGSA, FAAN
Karen Reynolds, DNP, CNS-BC, FGNLA
Catherine Roscoe-Herbert, DNP, APRN, FGNLA
Claudia Beverly, PhD, RN, FAAN
Presenters
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Geriatric Nursing Leadership Academy
Need for Geriatric Nurse
Leaders• World’s population of persons age 65 & older grows by
800,000 per month
• Persons 80 and above are fastest growing component of
population
• Life expectancy is increasing
o Japan: 84
o Singapore: 84
o Switzerland, Australia, Italy: 82
o Sweden, Canada, France, Spain, Israel, Bermuda: 81
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Geriatric Nursing Leadership Academy
Purpose
• To prepare and position nurses in leadership roles in various
health care settings to lead interprofessional teams in the
improvement of health care quality for older adults and
their families
• To develop skills that lead to the promotion of health
policies for the geriatric population in diverse and global
health care settings
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Geriatric Nursing Leadership Academy
Fellow
Leadership
Mentor
Faculty
GNLA Academy Participant
Impact Across North America
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Geriatric Nursing Leadership Academy
GNLA History
Four cohorts:
• 2008-2009 US
• 2010-2011 US
• 2012-2013 US
• 2014-2015 US & Canada
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Geriatric Nursing Leadership Academy
Leadership Development Model
• Self-awareness and Self-assessment
• Behavioral focus
• Reflective analysis
• Relationship foundation – triads
• Kouzes-Posner “Leadership Challenge”
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Geriatric Nursing Leadership Academy
GNLA Structure Overview
• Competitive selection
• 18 month guided leadership journey
• Two three-day workshops
• Fellow & Leadership Mentor relationships
• Individual leadership development plan
• Self development
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Geriatric Nursing Leadership Academy
GNLA Structure Overview
• Faculty consultation
• Facilitated site visits by the academy faculty
• Monthly faculty led learning activities & discussion groups
• Design & implementation of interprofessional team leadership
project
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Geriatric Nursing Leadership Academy
GNLA Structure Overview
• Journaling
• Evaluation of experience and project
• Dissemination of results
• Professional presentations of project outcomes and
experience
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Geriatric Nursing Leadership Academy
Three Learning Domains
• Individual leadership development
• Advancing nursing practice through an interprofessional team
leadership project
• Expanding scope of influence:
Organization, Community, Profession
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Geriatric Nursing Leadership Academy
Individual Leadership
Development
• Self-assessment – Leadership Practices Inventory (LPI),
reflection, advisors, 360 feedback
• Individual leadership development plan
• Interprofessional project team feedback
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Geriatric Nursing Leadership Academy
Individual Leadership
Development
• Professional activities
• Commitment from organizational leadership
• GNLA national networking
• Engagement in policy & advocacy activities
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Geriatric Nursing Leadership Academy
Advancing Practice Through
Interprofessional Team
Leadership Projects
• 44 interprofessional team
projects
• Practice outcomes
• Sustaining activities
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Geriatric Nursing Leadership Academy
Advancing Practice Through
Interprofessional Team
Leadership Projects
• Acute care settings
• Long term care facilities
• Community health agencies
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Geriatric Nursing Leadership Academy
Expanded Scope of Influence: Organization, Community, Profession
• Environmental scan
• Stakeholder analysis
• Two site visits
• Organizational advisors
• Organizational outcomes
• Sustaining efforts
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Geriatric Nursing Leadership Academy
Expanded Scope of Influence
• Expectation of all Fellows
• An organizational, community, and profession
• Intentional relationship building
• Appointments
• Advanced formal education
• Promotions and new positions
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Geriatric Nursing Leadership Academy
Expanded Scope of Influence
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Developing Successful
Fellow – Leadership Mentor
RelationshipsMeredeth Rowe, PhD, RN
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Geriatric Nursing Leadership Academy
GNLA Mentoring Model
• Triad
o Fellow, Leadership Mentor, and Faculty Advisor
o Fellow – self-select for application to the program
o Leadership Mentor
chosen by Fellow
expertise in leadership in clinical setting and previous experience
in mentoring
o Faculty Advisor
assigned by GNLA to complement the team
• Key point
o Mentoring is a team sport
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Geriatric Nursing Leadership Academy
Purpose
To prepare and position nurses
• in leadership roles
• in various health care settings
• to lead interprofessional teams
• in the improvement of health care quality for older adults and
their families
MENTORIN
G
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Geriatric Nursing Leadership Academy
My GNLA Experience• Worked with Karen Reynolds (Sarasota Memorial Health Care
System)
• Prior relationship
o Student in online statistical analysis course in DNP program
• My expertise
o Clinical experience from 1975-1990 as a Clinical Nurse Specialist
o Academic position 1994-present
o Had expertise in geriatrics clinically and as a researcher
o Multiple mentoring opportunities
• Karen Reynolds’ goals
o Improve geriatric care in her institution
• Welcome to GNLA
o Clarifying expectations and roles
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Geriatric Nursing Leadership Academy
The Leadership Challenge
Kouzes, James M. and Barry Z. Posner. The Leadership Challenge.
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Geriatric Nursing Leadership Academy
Challenges and Opportunities
• Initial Stages Major Challenge
o Develop relationship with leadership mentors
o Doing whilst one is learning
o Practicing skills just learned
Fits and starts to the project
Mea culpa
o Distant leadership mentor
• Initial Stages Major Opportunity
o Listen, learn, understand needs and skills/talents
o Regular contact
Committed time
Appreciating the complexity of the task
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Geriatric Nursing Leadership Academy
Transitions Over Time
• 3 GNLA workshops
o beginning, middle, end
o 3.5 days of learning activities for both fellow and leadership mentor
• Major challenges in year 1
o shifting from changing practice as a clinical expert
o to changing practice by leadership in the institution
o interprofessional project
vehicle to learn to make this transition
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Geriatric Nursing Leadership Academy
Challenges and Opportunities
• Clinical project did not have a clear path
o Created a lot of uncertainty in Fellow and team
Leadership was more difficult
Required more team cohesiveness to make a decision
o Required re-examination of leader role
Team decision versus facilitated decision
• Mentoring
o Sustain energy
o Facilitate productive problem solving
o Emotional support
o Balance between high expectations and supporting process required
for achieving outcomes
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Geriatric Nursing Leadership Academy
Fellow Challenges
• Working with key stakeholders
o Sitting at the table with the ‘senior executives’
• Influencing system level changes
• Broadening reach of who sees you as an expert capable of
leading institution in new directions
o Redefining role as a staff member/unit leader
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Geriatric Nursing Leadership Academy
Mentoring Moments
• Lunch in the courtyard
• Second intensive workshop
• Sit back/enjoy
• Be humbled
• Long term respect and relationship
• Third intensive workshop
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Geriatric Nursing Leadership Academy
Finishing the Transition
• Developing skill set makes the processes easier
• Getting to the point of change activates the resistors
o Competing influencers
• Self-questioning effort versus the outcome
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Geriatric Nursing Leadership Academy
Long Term Outcomes Triad
• Leadership Mentor and Faculty Advisor
o Withdrawal of ongoing direct support to Fellow
o Provide episodic and emergency support
o Facilitating new connections and relationships that allow Fellow to
continue to expand sphere of influence
• Fellow
o Support efforts of triad
o Promote success of Faculty Advisor by giving back to the GNLA
o Understand how to facilitate success of Leadership Mentor
what outcomes move their career forward related to mentoring
role
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A Leadership JourneyKaren Reynolds, DNP, CNS-BC, FGNLA
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Geriatric Nursing Leadership Academy
Objectives
• Share my experience of the geriatric leadership fellowship
• Discuss how leadership development in geriatrics can improve
outcomes for older adults
• Identify how collaboration supports improved outcomes for
older adults
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Geriatric Nursing Leadership Academy
Diversity
became
our
strength!
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Geriatric Nursing Leadership Academy
Individual Leadership
Development
• Self Assessment
• Deep Dive into the Principles
• Individual Leadership Development Plan
• Mentor – Dyad
• Mentor and Faculty Advisor – Triad
• Leadership Advisory Team - SMHCS
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Geriatric Nursing Leadership Academy
Challenges and Opportunities
• Becoming a new person in your old environment
o Overcoming internal perceptions of limits of one’s abilities and ‘making
waves’
o Understanding influence of stakeholders that are affected
o Balancing mentoring recommendations with situation being
experienced
o Development from the “Inside Out”
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Geriatric Nursing Leadership Academy
“From Salad to Bread”
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Geriatric Nursing Leadership Academy
Self Awareness - Rebranding
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Geriatric Nursing Leadership Academy
Increased confident and assertive communication to generate and
influence a shared vision • Introspection, self assessment, Leadership Practices Inventory (LPI),
feedback from leadership advisors, mentoring
• Preparation and clarity of communication & affirmation of values
Sustained relationships and establishment of new relationships with
key influential stakeholders• ILDP, mentoring, networking
• Established relationship with CNO and Strategic Marketing Manager
Increased involvement in opportunities to network and advocate for
older adults• Introspection, Self Awareness
• Relationship building in the organization and in the community
Goals / Strategies Critical to
Success
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Geriatric Nursing Leadership Academy
Overview of Project
• Brainstorming Delirium Project – Critical Care
o Delirium- acute iatrogenic effect in acute care
o Implementation of an evidence based assessment and interventions for
identification and treatment of delirium in critical care
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Geriatric Nursing Leadership Academy
Facilitating the Success of Others
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Geriatric Nursing Leadership Academy
“Be you, go quietly and confidently
about it, give others the chance to
shine. The outcomes will guide the
evaluation of you!”
• Meredeth Rowe - 2013
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Geriatric Nursing Leadership Academy
Exchanging Breadth for Depth
• Set the course for your future
• Career mapping
• Branding
• Align actions and behaviors with your goals - intentional
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Geriatric Nursing Leadership Academy
Expanding Scope of Influence
How I changed the organization
• Hospital Board Influence – Geriatric Specific Acute Care
• Initiating discussion and data analysis specific to outcomes and
population health for older adults
• Integration of Acute Care of Older Adults in our established service lines
Present: Geriatric APN, Project lead for PEACE Project (Patient Experience for Acute Care Elders, Project lead for Organizational Delirium Assessment and Interventions)
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Geriatric Nursing Leadership Academy
Expanding Scope of Influence
How I impacted the community
• Acute Care/Advanced Practice Nurse Representative Community
Stakeholders for Aging Consortium
• Facilitator for Local County Aging Network – Knowledge regarding
Communicating with Older Adults in Acute Care & focus on advocacy
and Health Literacy
• Adjunct Faculty for Gerontology Courses at SCF
Present: County Commission Appointed Geriatric Representative
from a local hospital on Sarasota County Senior Advisory Board
term until 2018, Author of Aging Well Blog on SMH.com
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Geriatric Nursing Leadership Academy
Actualizing My Potential
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Geriatric Nursing Leadership Academy
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Geriatric Nursing Leadership Academy
What’s Next?
• National Learning Collaborative for Pain, Agitation, Delirium
Guidelines (60 hospitals) & NIH Grant (10 hospitals)
• Innovations Institute with National Press Ganey – PEACE Project
for improved Patient Experience for Older Adults
• Policy Institute – Hartford Change AGEnts – Washington, DC –
June 2015
• Present at STTI Research Congress Puerto Rico, July 2015
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Geriatric Nursing Leadership Academy
“For tomorrow belongs to the
people who prepare for it today”-
African Proverb
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Inspiring Leadership:
the Journey Beyond GNLA Catherine Roscoe-Herbert, DNP, APRN-BC, FGNLA
University Hospitals Case Medical
Cleveland, Ohio
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Geriatric Nursing Leadership Academy
July/2011:crh
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Geriatric Nursing Leadership Academy
GNLA Fellow Characteristics
• Strength & Tenacity
• Team Oriented
• Utility
• Focus
• Faithful
• Excellence
• Deliberate
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Geriatric Nursing Leadership Academy
Expanding Scope of InfluenceOrganization, Community, Profession
• Deficient Geriatric Nursing
o <10% / 2009
• Improve overall life-care quality for older adults
o Build cadre of geriatric nurses
o EBP education program
o NICHE Geriatric Resource
o Nurse core curriculum
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Geriatric Nursing Leadership Academy
Expanding Scope of InfluenceOrganization, Community, Profession
• Team Building / Leadership
o Kouzes & Posner – KP-5
• System Integration
o 8/8 sites; 400(+) nurses exposed
o Health care continuum engaged
o LTC, SNF, home care, hospice
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Geriatric Nursing Leadership Academy
Kouzes – Posner Exemplary
Leadership Practices• Model the Way
• Inspire a Shared Vision
• Challenge the Process
• Enable Others to Act
• Encourage the Heart
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Geriatric Nursing Leadership Academy2015 Associates in Process Improvement
Making Changes
(PDSA) cycle was originally developed by Walter A. Shewhart; modified by Deming
• Forming the Team
• Setting Aims
• Establishing Measures
• Selecting Changes
• Testing Changes
• Implementing Changes
• Spreading Changes
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Geriatric Nursing Leadership Academy
Inspiration
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Geriatric Nursing Leadership Academy
National Presentations• GNLA / STTI Conference & Convention 2011
o Independent Leadership Project (ILP) Poster
o Special Session Podium presentation
• NICHE Conference Faculty 2011- present
o Long-term Care (LTC), and
o Skilled Nursing Facility specialist
• GSA / GNLA 2012
o Annual Conference presentation
• GNLA / STTI Conference & Convention 2013
o Mentee / Mentor (ILP) Poster
o Mentee Special Session Podium presentation
• NICHE Conference Speaker 2014 & 2015
o System integration
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Geriatric Nursing Leadership Academy
Sustainability of Expanded Scope
of Influence
• Organization
o NICHE Exemplar Status
o UH Case Medical Center
Magnet Hospital
On-going conference
• Community
o System Expansion
o Three new facility with geriatric programming
• Profession
o Maintaining focus
o Defeating adversity
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Geriatric Nursing Leadership Academy
Mentoring Exemplars
Mentor: C. Roscoe-Herbert, DNP, APRN, FGNLA• GNLA Cohort II
• University Hospitals Case Medical Center
• Adjunct Assistant Professor
o Case Western Reserve University / School of Nursing
Fellow: Abbey Baum-Beigie, MSN, APRN, FGNLA• GNLA Cohort III
• Bethany Nursing Facility
• Clinical Instructor
o Aultman Hospital School of Nursing
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Geriatric Nursing Leadership Academy
Healthcare Impact – Life/Care
Quality
A. Baum-Beigie, 2013
Delirium
Geriatric Syndromes:
Dehydration
Pressure Ulcers
Falls
Poor Pain Control
Urinary Retention
Fecal Impaction
Malnutrition
Aspiration
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Geriatric Nursing Leadership Academy
Delirium
FINANCIAL IMPACTS:
- Increased length of stay, Increased nursing time per patient, Higher per
day costs (2)
CONSUMER IMPACTS:
- Increased functional decline
- Increased geriatric syndromes, including: pressure ulcers, falls,
dehydration, malnutrition, urinary retention, fecal impaction,
malnutrition (3)
- Eight fold increase for developing dementia and/or acceleration of
dementia severity (4)
- 25 – 33% associated mortality (1)
- Decreased patient and family satisfaction
*************
EDUCATION
*************
A. Baum-Beigie, 2013
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Geriatric Nursing Leadership Academy
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Geriatric Nursing Leadership Academy
Regional Expansion Initiatives
• Newly acquired facility inclusion
o (3) hospitals
• Geriatric nursing specialization
o NICHE designation
• Expanding UH care standards
o Older Adults
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Geriatric Nursing Leadership Academy
GNLA Impact Relationships
Future of global leadership
• IOM Report
• San Juan, Puerto Rico
Advancements in care of older adults
• National -- Conference presentations
• Local -- curriculum development
o APRN (Advanced Practice Registered Nurse) Orientation
o President–Elect / Co-Chair APRN Council
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Extending Geriatric Nurse
Leadership into Global
ArenasClaudia J. Beverly, PhD, RN, FAAN
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Geriatric Nursing Leadership Academy
Our Goal
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Geriatric Nursing Leadership Academy
Key to Effective Leadership
Leadership and Engagement in International Health Care
Delivery System and Policy Arena
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Geriatric Nursing Leadership Academy
Extending Leadership into
Global Arenas
Geriatric Nursing Leadership is critical throughout the world and in
every country
• Legislative and government processes differ in each country
• Generate excitement and the need to know
• Know the health care delivery system and think broadly about the
nurses role
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Geriatric Nursing Leadership Academy
Value of Behavioral Leadership
Development
Personal Leadership Development
• Know thyself
• Leaders are born or are they made
• Self assessment
• Competencies
o Social and emotional
o Theoretical basis for leadership
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Geriatric Nursing Leadership Academy
Develop Cadre of Nursing
Leaders Globally
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Geriatric Nursing Leadership Academy
Impact of Nursing Leaders on
Health Systems
• Health care is global
• Major population needs
o World is aging
o Mothers and babies
o Eradicate diseases
o Provide intervention
• Systems of care
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Geriatric Nursing Leadership Academy
Examine leadership roles critical to lead inter -
professional teams that provide quality of care for
older adults and their families across health care
settings.
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Geriatric Nursing Leadership Academy
• Two real stakeholders in older adult health
• Older adults
• Caregivers
• Gerontological Nurse Leaders must move health care forward in
the areas of:
o Primary care
o Prevention
o Chronic care management
o Transitional care
The Role of Gerontological
Nurses in Shifting the Focus
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Geriatric Nursing Leadership Academy
• Set aside individual
concerns
• Pursue goals that are
important for the welfare
of society
Source: Hogan, R., et al, (1994). What We know about Leadership: Effectiveness and Personality.
American Psychologist, June: 1-33
Leaders
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Geriatric Nursing Leadership Academy
Innovation
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Where Do We Go From Here