Introduction
Presently, the modern economic environment has changed from what it was in the past. The poor state of the economy impacts nursing practices in several ways from budget cuts to layoffs and service delivery. The success of any organization depends on its ability to adapt to the prevailing economic environment. However, this can only be realized with good leadership. A transformational nursing leadership philosophy is a modern concept that helps healthcare organizations to adapt to present exterior environmental strains. This concept forms my personal nursing philosophy.
History and evolution of transformational theory
The idea of transformational leadership was established by diplomatic writer James Burns in 1978. Burn’s philosophy encourages leaders to create a greater vision to organizational wants, inspires nurses to set high goals, and stimulates mutual relationships through a common governance attitude. A transformational leader acts to exploit the desires of the follower and clearly shows commitment to the dreams and missions of the organization. He also motivates other people to support the group by empowerment, co-operation and enabling participation and production workflow. Bernard Bass further advanced this concept in the 1970s. According to him, there are four aspects of transformational leadership. These are Intellectual Encouragement, Individual Contemplation, Motivating Inspiration, and Perfect Influence. Intellectual Encouragement provokes nurses to be inventive and allows examination of fresh ideas (Marshall, 2011).
According to Marshall (2011), Individual contemplation is the reinforcement and clear communication that leaders need to show to allow their subjects to express and share thoughts in order to be acknowledged for distinctive contributions. On the other hand, motivational inspiration is the transformational leader’s capacity to openly communicate and stimulate followers to have the same wish for attaining the dreams and missions of the organization. Finally, perfect influence is the transformational leader’s personality and connection to nurses, which encourages trust, reverence, and co-ownership in accomplishing goals (Grossman &Valiga, 2013).
The dreams and missions of the organization create the basis for the structure of its administrative leadership. For instance, I have worked in several hospitals for the past four years, and I have seen two managerial approaches.
The present management hired a consultant group to reorganize the organization. The consequence of restructuring over the past two years has encouraged remarkable growth and a consistent alignment at all the management stages to the goals and visions of the organization. Partly, this growth has been achieved by application of transformational leadership. As one of the administrators in the organization, the change I was guided through felt quite natural and was aligned to his individual attitude essential in the foundation of a transformational leader. Dedication to improvement and development of staff calls for transparency in giving information both on the part of a manager and a staff member. Mutual governance nurtures this capacity, which intelligently motivates all the levels of workers in an organization. This brings staff together and builds goals, purposes, and measurable results (Grossman &Valiga, 2013).
Personal experience
Personally, I have been involved in working at hospitals for the past two years. I have witnessed and have been involved in several educational, inspirational, and responsibility programs developed in the organization I have been working for. They can be associated directly with the transformational leadership philosophy. Such initiatives have proved to be quite helpful for the achievement of organizational success and respect. Several respect principles guide the work of nurses within the organization. Some of these principles include responsibility, Client-First, Integrity, Reverence, and Excellence. The philosophies of transformational leadership are naturally acceptable from my perception of leadership and how I view me as a future leader. My governance principles have never changed from the beginning of my studies. Following the experience in the hospitals where I have worked, I have become more conscious of the worldwide effects of good transformational leadership on organizations.
Future envision
In the future, I would exhibit personal consideration by meeting every member of staff personally and confidentially to discuss work progress and changes that need to be incorporated, if there are any. Again, I should know if they have all the necessary requirements to accomplish their work. On top of staff meetings every month, I would uphold honesty and integrity policies. Motivational inspiration grows from free communications during direct meetings. I would be able to seek interesting areas and allocate staff duties that would prove meaningful to them. This would help in steering the organization to achieve both long-term and short-term goals. Also, I would develop online training programs to improve intellectual capacity. Staff members would find this initiative interesting. Additionally, I would bring in a professional to train staff members on how to benefit from online-based training software. Staff members would then be given a chance to respond to such initiatives if it satisfies their learning. Perfect influence would be exhibited in my personal desire for contributing positively towards the organization and stimulating others to the same desire. Events that encourage team spirit would be used to support and strengthen relations and maintain an organized group. In conclusion, the transformational leadership philosophy is the key to success in many modern organizations. Therefore, it is my best nursing philosophy.
References
Grossman, S., & Valiga, M. (2013). The new leadership challenge: Creating the future of nursing. Philadelphia: F.A. Davis.
Marshall, S. (2011). Transformational leadership in nursing: From expert clinician to influential leader. New York, NY: Springer.
The National Education Association’s Activity And Issues
Introduction
The presence of a powerful Union is a prerequisite for industrial peace. Decisions made in the collective bargaining process and agreements between employers and workers are usually productive. Trade unions have an important role to play and are beneficial in successful cooperation between workers and management. They offer guidance and support to ensure that disagreements do not contribute to major disputes. The primary role of a union is to represent workers. Nonetheless, they still have a larger role to play in defending the employees’ rights. They also play a significant role in arranging courses for their members on a wide variety of subjects. The quest for a fair and secure working environment is also a prominent aspect of the trade union. This essay will focus on the National Education Association (NEA) by giving a brief history, a highlight on its operations, and also look at the challenges it has encountered.
Union Profile
The NEA is the dominant labor union in the United States, with far more than three million members more than the second-largest union. They consist of full-time and temporary teaching assistants, school administrators, and most education-related institutions (Advocating for Change, 2020). What distinguishes this union from many others is its cause. The association is a symbol of protection and benefits of education practitioners; and has been a champion for those who have been the beneficiaries of the career for over 160 years. It was formed during the summer of 1857 in Philadelphia when teachers joined together to create the union. They rallied around the appeal to improve the standard, in which children and teachers operated. The NEA felt that the ability to read and write was directly related to democracy. Because of this, they became ardent supporters of the civil rights movement over the years. Their main argument was that all individuals were entitled to a decent education.
The organization is largely funded by membership fees, which was totaling to over $360 million in 2016 (National Education Association, 2020). The union is actively involved in politics and has a long history of supporting the Democratic Party. It expended more than thirty million dollars in 2016 through direct donations and campaigning to help legislators who could advance the cause and strengthen its mission as well (Yammine & Zheng, 2016). The association is present in all 50 states and has its headquarters in Washington, D.C., enabling it to conduct its lobbying at the national stage within its advocacy areas.
Legal Disputes
Being a large trade group, the NEA has had many issues that needed to be resolved. For instance, the outfit has had over one thousand accusations of unfair labor practices filed against it with the National Labor Relations Board. Yammine and Zheng (2016) claim that the most famous and prominent case concerning the NEA was Friedrichs v. California Teachers Association. The premise of the case was that labor unions are performing a service for people within an industry. Nonetheless, the people felt it was their 1st Amendment right not to join the union and have to pay union dues, yet still earn the rewards of the union’s efforts. The complainants, in this case, were state government employees in the education field. Under California law, people who may not wish to join the organization should pay a reasonable share service charge equivalent to the total of union membership. This was to enable the trade union capitol to lobby and participate in collective bargaining on account of the industry. Since the fees are received directly from the workers’ salaries, the staff could not strike by not paying the fees.
The district court had upheld that it was relevant to compel employees to pay union charges because they were beneficiaries of services. This was then referred to the Supreme court to rule. Regrettably, at the time, the court was down one member due to an untimely death, so the likelihood of a tie, reaffirming the lower court’s opinion, was high. The final result was a divided 4-4 ruling by the Supreme Court, affirming the district court’s judgment in March of 2016 (Guthrie, n.d.). In this case, the opposition vowed to find a way to have the case reheard when the Supreme Court is back at full strength.
Values are different in Tennessee than they are in California. Tennessee is known to be a ‘right to work’ territory where, while the trade unions have a stronghold, they do not have a monopoly. In 2011, Dewey Esquinance, a Tennessee teacher, won a lawsuit (Guthrie, n.d.). All his union fees and dues were reimbursed because it was alleged that the labor union spent his fees on political issues that he did not endorse, nor did he have a right to choose. Unlike in California, the union attorneys determined that because the workers could not vote on labor contracts. In this case, it would be much better to negotiate than to set a legal precedent.
As a second-order consequence, Tennessee revised its legislation to ensure that non-union workers would still have some power when negotiating wages, remunerations, and working standards. The most common complaints against the NEA have been a refusal to bargain and bad faith negotiating; however, the list of alleged violations is spread across the entire labor laws spectrum. As experienced negotiators, the unions are competent to resolve issues without acknowledging guilt, as establishing such a priority would allow many more allegations to be raised.
In October 2002, Washington State Attorney General and the Evergreen Freedom Foundation office filed a lawsuit against the NEA, claiming that non-member union fees were used to fund political agendas (Guthrie, n.d.). While it is not unlawful to do so, approval must be given before doing so in Washington State. The case lasted for more than eight years and seemed to stall before the complexity and cost of continuing litigation forced both parties to agree. In this case, the settlement sum eventually cost the NEA $85,000, which went to both civil penalties and legal fees for the Evergreen Freedom Foundation (Guthrie, n.d.). Nevertheless, NEA did not show any admission of guilt in the whole issue. The union maintains that it stands under a vision of offering greater education for every learner.
The union’s membership advocates for excellence, justice, and equal opportunities for all. Regrettably, the understanding of these values is still open to debate, particularly at the national level. They are also criticized for using the worthy purpose of children’s future and education to advance their interests. They are overwhelmingly inclined towards the welfare of teachers as compared to students. Some people take this to be an unfair critique, as they think the NEA’s work has provided significant changes to the American educational system. Their decentralized model of policies enables local groups to foster their ideals in society with the support of the state’s leading labor union. The biggest share of lawsuits brought against the union represents change and a chance to improve the association to better support students and educators in education.
Conclusion
National Education Association is mandated to protect the interests of those they serve; in this case, teachers and students. Members’ rights should be represented well whenever they are needed to. The union should remember that it exists mainly because of not only the educators but learners as well. They should therefore strive to ensure that both parties’ best interests are always observed and properly represented.
References
Advocating for Change | NEA. (2020). Web.
Guthrie, J. (n.d.). National Education Association to pay $85,000 to settle eight-year-old suit | Washington State. Web.
National Education Association (NEA) (2020). Influence Watch. Web.
Yammine, R., & Zheng, T. (2016). Friedrichs, et al. v. California Teachers Association, et. al. LII / Legal Information Institute. Web.
Encainide And Flecainide Effect On Mortality In A Trial Of Arrhythmia Suppression
Design: Case control study.
Setting: CAST Centres.
Sample Population: 4400 patients, who had attended various CAST centres and had suffered from myocardial infarction, had been analyzed through the Holter test. Furthermore, the patients were required to have experienced six or more premature depolarisations within an hour.
Inclusion Criteria
Case patients: persons who had suffered myocardial infarction and whose premature depolarisations in an hour exceeded six as evidenced by the Holter test. The patients would also receive Encainide and Flecaidine in recommended doses. Patients who had responded to the drugs were then further analyzed.
Control Subjects: patients who had suffered from myocardial infarction, whose premature depolarisations in an hour exceeded six and who responded to Encainide and Flecaidine. Unlike the case patients, these patients were given the placebo instead of the drugs.
Exclusion Criteria
Non responsiveness to Encainide and Flecaidine.
Intervention: No active intervention.
Outcome Measures
Primary: The relationship between mortality and active drugs was measured as a percentage of the total deaths observed within the whole population. The results were analyzed after ten months and presented at 95 percent confidence level.
Secondary: Correlation between death and reduction in quality of life, and the use of anti-arrhythmic drugs.
Titration
Patients were given Encainide and Flecaidine in relation to their ejection fraction measured by Holter in a 24 hour period for 4 to 10 days.
Randomization and Follow-up
Follow-up was only done to patients who were seen to be responding to the drugs and this was done over the telephone.
Statistical analysis
The study employed the traditional two-sided log rank was employed to establish the survival rate of patients who had received the active drug in comparison to the patients who had received the placebo. (The log rank test is a tool employed to confirm a null hypothesis, in this case that there was no variations in probability of death between patients who had taken the drug and the ones who had taken the placebo). The analysis employed a one-tailed test aimed at establishing whether the drug had positive medical effects or negative medical effects. The alpha level was 0.025 with a power of around 0.85. The nominal p value was adjusted for multiple groups. The objective was not aimed at establishing whether anti-arrhythmic drugs were harmful or not.
Results
Subjects
2309 patients had been successfully recruited. Suppression of anti-arrhythmia had been achieved in 1727 of the patients and these were assigned to blind study. 1455 were assigned to receive the medication. The findings were similar in both groups in terms of age, ejection fraction; time elapsed since myocardial infarction and the use of beta blockers. Patients with different ejection fraction exhibited different reactions to the drugs.
Outcomes
The results observed that death regardless of whether it was caused by arrhythmia or not increased in groups where the active drugs were administered. This was regardless of age, use of beta blockers or digitalis. The risk of death in patients given Encainide and Flecainide was 4.5 % as compared to 1.2 % for patients given the placebo. This was recorded at 95 % confidence level. When the two drugs were considered differently the results were not different as Encainide and Flecainide recorded risk of death of 3.4 and 4.4 percent respectively. The mortality rate for patients under Encainide and Flecainide was also observed to be higher at 7.7 % as compared to 3.0 percent for the placebo. When the Encainide and Flecainide were considered differently the results were not different at 2.7 and 2.2 percent respectively.
Discussion
The rate of risk had been significantly reduced in patients under the placebo and there was concern whether the anti-arrhythmic drugs actually worsened the situation.
Strengths Noted by Author
- The study considered the possibility of other parameters except reduction of ventricular premature polarizations as being significant in arrhythmia.
- The study concentrated on the overall quality of life.
- Only patients at risk of arrhythmia were included in the study.
- The period of study was long enough to allow for the realization of long term effects.
Weaknesses Noted by Author
- The doctors might have not chosen the sickest of their patients.
- The results could not be extrapolated and further research needed to be conducted in the area.
Author’s Explanation of the Results
Although Encainide and Flecaidine may have the outcome of reducing classic arrhythmic effects, they actually have negative effects on patients with structural heart disease and complex arrhythmia
Clinical Study Evaluation
Strengths of the Study
- The study was conducted by a number of centres under the umbrella name of CAST (Cardiac Arrhythmia Suppression Trial), mandated to look into the effectiveness of anti-arrhythmic drugs in the prevention of risk factors after myocardial infarction. The degree of objectiveness and accountability is optimized when several professional centres are involved. Furthermore, the knowledge of the chemistry of the drugs in use ensured that adverse reactions were avoided and only the desirable effects were realized. This was due to a pilot study that had been conducted and where the effects of the drugs were realized.
- The choosing criteria for patients eligible for the research were conducted in a manner as to ensure that only patients at risk of arrhythmia were under study. This further increased the likelihood of the results being true. The sample size was also arrived at after simulation of the study. The resultant size was large enough ensuring that a significant population had been covered and that the disparities would be evident.
- The essence of the study was founded on clinical grounds and the results would add knowledge and value to the medical fraternity. The study sought to establish the extent to which the drugs under study managed to reduce the risks of patients who have had myocardial infarction, to suffer from arrhythmia.
- The researchers were also transparent enough to point out that there would be inconsistencies when extrapolating the data findings to a larger group. This is because the research was only based on a sub-group. The researchers however pointed out that the basis of the research was to bring into perspective important medical variables following the use of drugs in question on the risk group.
Weaknesses of the Study
- The variables under study were not conclusive enough as to determine whether the use of the drugs would actually result to death. Furthermore, there was no consideration of other aspects that may affect the variables for instance the quality of life.
- The research was such that drawing strong correlations between the mechanism of action of the drugs and the condition of the patients would be superficial or totally impossible.
- Midway through the study the research procedures had to be altered due to the realization that some of the procedures would be harmful. The credibility of the results would be questioned as it implies that not all of the objectives would be arrived at conclusively.
- The extrapolation of the results to other study groups would be difficult since the parameters in question were limiting in terms of objectives.
Applicability to Practice
Patients who have had myocardial infarction are already at a risk of developing arrhythmia that may be fatal. Therefore the consideration of only one parameter in terms of reducing arrhythmia is erroneous. Several aspects should be put into consideration before qualifying a drug as being effective. Some drugs may actually have a short term positive effect and a long term negative effect.