- Email: [email protected]
Assessing the value of external resources
Assessing the Value of
External Resources Julian S.A. Cicatiello, MA, MEd, RN, CNAA, and Marjorie Beyers, RN, PhD, FAAN t’s Monday. The day is lined up and the week is full, but the goals are pushing the edges. Targets, incentives, bottom lines—the long-term view frequently gets pushed back by daily demands of people, crises, relationships, and events. So what is a nurse executive to do? You can scream, you can pray, you can call a staff meeting, or you can call in external help—maybe all of the above. If your primary option is getting external help, how do you know whom to call, what to ask for, and how to know if you will get value for your money and time? This article explores these questions.
I
Why does the chief nursing officer (CNO) or client use external services? • To get a job done • To verify, clarify, and validate current work • To design or implement a project • To evaluate the work or improve work design • To install a new system Although these reasons are not inclusive, they represent types of work that can be outsourced. What is the right option for you?
ARE EXTERNAL RESOURCES RIGHT FOR YOUR ORGANIZATION? The decision to use external resources is value-laden. The organizational culture, resources needed, nature of the work, and responses of senior management and nursing staff all must be considered. Your own perspective of your effectiveness is a factor. Peter Drucker1 identified eight practices of effective executives. He writes that effective executives “asked what needs to be done, what is right for the enterprise; they developed action plans, took responsibility for decisions, for communicating. They focused on opportunities rather than problems and ran productive meetings. Finally, they thought and said ‘we’ December 2005
rather than ‘I.’” CNOs can apply these practices when making decisions about using external resources. In today’s environment, change is the norm.2 Most CNOs do more with less. They are adept at making the business case for operational resources, improvements, and projects. Most have multifunctioning skeleton staffs that focus on daily operations. Few have resources for new initiatives to cope with current and future change. Such forces for change include keeping practices up-to-date, providing quality care, and ensuring patient safety. Strong drivers for change do place stress on staff, which encourages the CNO to seek external help to meet organizational targets. Whether to use external services falls to the organization and the CNO. Many organizations routinely use external services for financial consultation, audits, construction projects, and installation of information systems or medical technology. In some organizations, internal staff members are expected to keep up with changing demands. Many CNOs are skeptical about consultants, having experienced the pain of often ineffective restructuring and downsizing. Others may think that using external services places a pall on their performance, sending the message that they cannot meet goals. If someone like the chief ex-
Nurse Leader 51
ecutive officer (CEO) or chief financial officer (CFO) recommends external resources, the CNO may wonder what drives the recommendation. Is job security an issue? The prevailing concern for the CNO is being smart about getting the work done. When workload exceeds staff resources, the wide range of external services available is enticing. Because nursing affects four of the main cost factors—liability, labor, credit, and capital3-6—CNOs contribute greatly to the organization’s reputation and ability to deal with today’s economic changes through their work to make patient care services the best they can be.
CONSULTANT ROLES Building the business case for new projects begins with prioritizing the project and establishing outcomes. CNOs evaluate whether or not use of external resources is a costeffective way to successfully complete the work and strengthen the staff capability for core functions. Consultants can be engaged for all or part of a new activity and may serve as change agents, advocates, information specialists, educators, or problem solvers. Cost, capability of existing staff, time frame, and completion targets are all considered. The CNO might tap external resources to: • Change a core function. Consultants can help with planning, startup, and educating staff. • Install new software, such as a staffing or scheduling system that uses existing parameters. • Install information technology that involves in-depth evaluation of the nursing care delivery model, language and processes used for documentation, orders and intradepartmental communication, and staff education. • Change practice, such as implementing disease management or achieving Magnet Hospital recognition. • Perform a service, such as education. Consultants selected for expertise and effectiveness in program presentation may identify courses and assist with selection and startup. • Design or adapt services to care for new patients or changing volumes of patient populations. • Evaluate or provide credibility for nursing practice models or aspects of patient care services to which the consultants serve as credible external experts. The choice of selecting either in-house staff or external services is a value judgment made through cost-benefit analysis. Consultants may bring expertise and credibility to the organization, but developing staff may have a more long-term benefit. A combination of services may be best. Using internal staff may involve temporarily shifting staff responsibilities, deferring or deleting some activities, or bringing in temporary replacement staff. Engaging an external project director involves matching the scope of expertise needed with that offered, fees or salary, resources needed, and staff involvement. Which approach best enhances the organization’s capability to perform? External expertise may be less expensive, 52 Nurse Leader
but having regular staff develop and complete the project may have a better long-term effect. The wise CNO understands that, whatever decision is made, bringing in new ideas, personalities, and insights may have unanticipated effects that may or may not be beneficial.
Selection of Consultants Identifying consultants is facilitated by networking with colleagues. Selection involves reviewing the consultants’ projects and making site visits to locations where they have worked. References and interviews help determine effectiveness and whether your organization and the consultant fit. Sample questions that help focus the interview include: • Does the consultant relate well to the CNO and the staff? • What resources does the consultant need to accomplish the work? • How does the consultant communicate progress and issues and make adjustments as needed? • Will the consultant maintain ethical practices and protect the organization’s privacy? • If an external firm or vendor is selected, are the consultants who will be working on the project competent? Is there a fit with the organizational culture and operational mores? • Are the approach and process compatible with those of others in the organization?
KEYS TO SUCCESSFUL PLANNING AND IMPLEMENTATION Collaboration within the organization is essential in project planning.7 Involving the CEO and CFO and affected staff in discussion from the beginning helps gain final project approval. The proposed project is evaluated against other projects that may be under way to assess how much change the organization can tolerate and how projects can be dovetailed, managed, monitored, and evaluated for optimal organizational performance. Project implementation benefits include up-front planning to agree on the rationale, the approach, expected outcomes, methods, people involved, and timelines for progress monitoring, review, and adjustment. Another key to successful implementation is identifying a point person to work with the consultant to keep the project connected.
CONSULTING PHASES Lippitt and Lippitt8 define the six phases of consulting as engagement and entry, contract formulation, problem identification, goal-setting and planning, implementation and evaluation, and contract completion and termination. It is of utmost importance to discuss the phases of consulting early on, especially problem identification, goal-setting, and planning. The goal of consultation is to provide advice and assistance within a problem-solving situation that brings about change. Successful consultation must be a collaborative effort, working jointly to identify, define, and resolve issues. December 2005
Tips
FOR
Success
The 21st century consultant needs to understand that the challenges have become more compelling as a result of increased intensity, complexity, and pace of change. What once took years to achieve now takes months. Today, because of less reimbursement to health care organizations, resources are very scarce, so the client must be mindful in investing in external resources and should do a thorough cost and benefit analysis before seeking external assistance. Here is a list of helpful tips: • Integrate the consultant. He or she should meet senior management, nursing management, and the workforce. • Define a plan of action that is well articulated with measurable goals and objectives. • Provide timely feedback to all parties on an ongoing basis. • Deal head-on with staff ambivalence regarding change. • Establish task forces to assist with problem-solving. • Develop strategies to sustain the changes that are made. • Identify an internal candidate to take over the consultant functions once the contract is terminated.
Engagement/Entry An individual may enter and engage into the work environment as a consultant in several ways. One common method is by the referral process. In this situation, a professional colleague knows of another professional with outstanding academic credentials and in-depth experience in nursing administration. In this process, a professional colleague contacts and recommends an individual to a CNO who is interested in receiving assistance from a consultant. Another avenue that may be used for entry and engagement is through the cooperation of nursing professional organizations, such as the American Nurses Association or the American Organization of Nurses Executives, both of which have a list of active consultants. The nursing organizations usually provide a number of names for the CNO to contact and discuss tentative projects. Most consultants have websites whereby the client may learn more through independent research.
Contract Formulation A contract should be formulated once the CNO makes a decision to offer a consultant the opportunity to provide professional services. The contract should encompass goal-setting, implementation, evaluation, and the termination of the relationship. Sebastian and Stanhope9 state, “Consultation is an action-oriented intervention that is by definition focused on change and forward movement from an existing state to a desired state.” Some of the components that may be used in a contract include the following: • Define a general statement or purpose of project goals. • Describe the tasks and services to be provided by the consultant. • Identify the support functions from the client. Considerations to be addressed: 1. Estimate approximate number of consultation sessions. 2. Define a time schedule for the services and deliverables to client. December 2005
3. Identify the criteria that will be used to evaluate the outcomes. 4. Include a statement for possible contract modifications. 5. Articulate a statement on confidentiality. 6. Define conditions of payment of fees and expenses. 7. Obtain signatures of the contracting parties.
Problem Identification, Goal-Setting If this process is not done thoroughly and accurately, the outcomes will differ from expectations. There must be a collaborative understanding and agreement between the consultant and the CNO on the definition of the problem. When the consultant acquires a clear diagnostic sensitivity to the current situation and the operating problems, the client and the consultant are prepared for goal-setting and planning. The planning phase is a step-by-step process whereby brainstorming may be used in addition to asking the questions regarding what should be done, who should be involved, and how will it be done. Goal-setting is a collaborative process that articulates action statements with time lines so that all who participate are familiar with the plan of action.
Implementation/Evaluation The implementation phase is exciting, but for the plan to be successful, the people who play a part in the implementation process must be prepared and ready to perform the new skills they have been taught by the consultant. Participant readiness is essential for change to take place. It is very important for the consultant to seek feedback from the participants on a daily basis and listen to their concerns. The consultant should also be prepared to provide feedback on the comments made by the participants so they realize that they have been listened to. During the entire process, the consultant’s role is to assist and provide ongoing development so that participants’
Nurse Leader 53
new skills enable them to increase their abilities and chances of success. Another important responsibility for the consultant is to teach the individuals new methods so that they will be able to sustain the changes that have been made. In addition, the consultant, in collaboration with the CNO, must develop the necessary support systems so the process may continue after the contract concludes.
any strategy or plan of action that may be implemented. However, the client makes the decision regarding the course of action. Another thing to remember is that sometimes value statements enter into the equation opposite factual statements. Value statements are based on beliefs and desires; factual statements are evidence-based.
Contract Completion
MAKING IT WORK
Before completion of the contract, the consultant, in collaboration with the CNO, needs to identify an internal candidate who participated in the process and demonstrated strong skills in leadership and communication. The consultant needs to work with this individual to take over the functions for which he or she had accountability. In a related note, staff members always appreciate celebration of the changes and achievements made, and it is important to recognize everyone for a job well done.
Seeking some type of external assistance is almost inevitable given the changes, challenges, and complexities of the 21st century. To be successful, the CNO must be cognizant of the consultant’s limitations and inclinations, remembering that his or her style will strongly influence the role and the interventions. The consultant also must be astute to the chemistry and fit with the environment. If the consulting engagement is not working for any reason, it takes courage on the part of the consultant and the CNO to close the agreement and move on. However, the greater the versatility and the experiences of the consultant, the more likely he or she will be successful in assisting the organization.
ETHICAL ISSUES ASSOCIATED WITH CONSULTING A number of ethical issues and dilemmas underlie a consultant practice. Because a consultant’s role involves helping, guiding, and directing, his or her relationship with the CNO must be built on trust. Ethics in consulting will be discussed as they relate to accountability, confidentiality, and veracity. Nurse consultants have a professional code of ethics that was articulated by the American Nurses Association10 in 1986 and revised in 1996 and in 2001. This code of ethics states, “Accountability and confidentiality are not only ethical duties but legal requirement, whereas veracity is essential to the ongoing success of the nurse consultant’s professional career.” Accountability is defined simply as providing an explanation to the client for what has been done. Fry11 says, “The nurse consultant is responsible for the delivery of competent, quality services and is accountable to self, the client, and the profession.” The consultant must also understand that all interactions with the client are regarded as confidential. If confidentiality is breached, it will impair the relationship. Once this breach occurs, the client may not be in a position to convey all the details necessary for the consultant to address and correct a problem, resulting in incorrect and inappropriate recommendations. The tenets of veracity and integrity are essential tools of any nurse consultant. This means the consultant respects the clients served and understands that clients are self-determining and autonomous. However, the consultant has an obligation to be truthful about the scope of services and abilities he or she can provide. The consultant must also be truthful with the client about the findings in a project and any other contributing factor gleaned during the process that was not discussed initially. Consultants must always keep in mind that they are providing contracted services to a client and that their role is to recommend, suggest, and explain the pros and cons of 54 Nurse Leader
References 1. Drucker P. What makes an effective executive? Harvard Business Review 2004;26:59-63. 2. Thrall TH. How ready are we for reform? Hospitals & Health Networks 2004;784:34-44. 3. Haugh R. Cost drivers. Credit. Hospitals & Health Networks 2004;786:48,57. 4. Larkin H. Cost drivers. Liability. Responding to patients quickly and with candor can avert costly lawsuits. Hospitals & Health Networks 2004;786:38-40,42. 5. Serb C. Cost drivers. Labor. Five strategies, backed by real-time data, help hospitals gain control over staffing costs. Hospitals & Health Networks 2004;786:42-4,46,48. 6. Towne J. Capital access. Hospitals & Health Networks 2004;786:49-56,2. 7. Linden R. The discipline of collaboration. Leader to Leader 2003;Summer:41-7. 8. Lippitt G, Lippitt R. The consulting process in action. 2nd ed. San Francisco: Jossey-Bass/Pheifer Publishing; 1986. p 11. 9. Sebastian JG, Stanhope M. Consultation as a tool for change. In: Lancaster J. Nursing issues in leading and managing change. St. Louis: Mosby; 1999. p. 587-8. 10. American Nurses Association. Code for nurses with interpretative statements. Washington (DC): American Nurses Association; 1986 & 1996, revised. 11. Fry S. Ethics in community health nursing practice. In: Stanhope M, Lancaster J, editors. Community health nursing: promoting health of aggregates, families and individuals. St. Louis MO: Mosby; 1996. pp. 93-116.
Julian S.A. Cicatiello, MA, Med, RN, CNAA, is a health care consultant in Youngstown, Ohio. He can be reached at [email protected]. Marjorie Beyers, RN, PhD, FAAN, is a nurse consultant in Barrington, Ill. 1541-4612/ $ - See front matter Copyright 2005 by Mosby, Inc. All rights reserved. doi:10.1016/j.mnl.2005.01.013
December 2005
External Resources Julian S.A. Cicatiello, MA, MEd, RN, CNAA, and Marjorie Beyers, RN, PhD, FAAN t’s Monday. The day is lined up and the week is full, but the goals are pushing the edges. Targets, incentives, bottom lines—the long-term view frequently gets pushed back by daily demands of people, crises, relationships, and events. So what is a nurse executive to do? You can scream, you can pray, you can call a staff meeting, or you can call in external help—maybe all of the above. If your primary option is getting external help, how do you know whom to call, what to ask for, and how to know if you will get value for your money and time? This article explores these questions.
I
Why does the chief nursing officer (CNO) or client use external services? • To get a job done • To verify, clarify, and validate current work • To design or implement a project • To evaluate the work or improve work design • To install a new system Although these reasons are not inclusive, they represent types of work that can be outsourced. What is the right option for you?
ARE EXTERNAL RESOURCES RIGHT FOR YOUR ORGANIZATION? The decision to use external resources is value-laden. The organizational culture, resources needed, nature of the work, and responses of senior management and nursing staff all must be considered. Your own perspective of your effectiveness is a factor. Peter Drucker1 identified eight practices of effective executives. He writes that effective executives “asked what needs to be done, what is right for the enterprise; they developed action plans, took responsibility for decisions, for communicating. They focused on opportunities rather than problems and ran productive meetings. Finally, they thought and said ‘we’ December 2005
rather than ‘I.’” CNOs can apply these practices when making decisions about using external resources. In today’s environment, change is the norm.2 Most CNOs do more with less. They are adept at making the business case for operational resources, improvements, and projects. Most have multifunctioning skeleton staffs that focus on daily operations. Few have resources for new initiatives to cope with current and future change. Such forces for change include keeping practices up-to-date, providing quality care, and ensuring patient safety. Strong drivers for change do place stress on staff, which encourages the CNO to seek external help to meet organizational targets. Whether to use external services falls to the organization and the CNO. Many organizations routinely use external services for financial consultation, audits, construction projects, and installation of information systems or medical technology. In some organizations, internal staff members are expected to keep up with changing demands. Many CNOs are skeptical about consultants, having experienced the pain of often ineffective restructuring and downsizing. Others may think that using external services places a pall on their performance, sending the message that they cannot meet goals. If someone like the chief ex-
Nurse Leader 51
ecutive officer (CEO) or chief financial officer (CFO) recommends external resources, the CNO may wonder what drives the recommendation. Is job security an issue? The prevailing concern for the CNO is being smart about getting the work done. When workload exceeds staff resources, the wide range of external services available is enticing. Because nursing affects four of the main cost factors—liability, labor, credit, and capital3-6—CNOs contribute greatly to the organization’s reputation and ability to deal with today’s economic changes through their work to make patient care services the best they can be.
CONSULTANT ROLES Building the business case for new projects begins with prioritizing the project and establishing outcomes. CNOs evaluate whether or not use of external resources is a costeffective way to successfully complete the work and strengthen the staff capability for core functions. Consultants can be engaged for all or part of a new activity and may serve as change agents, advocates, information specialists, educators, or problem solvers. Cost, capability of existing staff, time frame, and completion targets are all considered. The CNO might tap external resources to: • Change a core function. Consultants can help with planning, startup, and educating staff. • Install new software, such as a staffing or scheduling system that uses existing parameters. • Install information technology that involves in-depth evaluation of the nursing care delivery model, language and processes used for documentation, orders and intradepartmental communication, and staff education. • Change practice, such as implementing disease management or achieving Magnet Hospital recognition. • Perform a service, such as education. Consultants selected for expertise and effectiveness in program presentation may identify courses and assist with selection and startup. • Design or adapt services to care for new patients or changing volumes of patient populations. • Evaluate or provide credibility for nursing practice models or aspects of patient care services to which the consultants serve as credible external experts. The choice of selecting either in-house staff or external services is a value judgment made through cost-benefit analysis. Consultants may bring expertise and credibility to the organization, but developing staff may have a more long-term benefit. A combination of services may be best. Using internal staff may involve temporarily shifting staff responsibilities, deferring or deleting some activities, or bringing in temporary replacement staff. Engaging an external project director involves matching the scope of expertise needed with that offered, fees or salary, resources needed, and staff involvement. Which approach best enhances the organization’s capability to perform? External expertise may be less expensive, 52 Nurse Leader
but having regular staff develop and complete the project may have a better long-term effect. The wise CNO understands that, whatever decision is made, bringing in new ideas, personalities, and insights may have unanticipated effects that may or may not be beneficial.
Selection of Consultants Identifying consultants is facilitated by networking with colleagues. Selection involves reviewing the consultants’ projects and making site visits to locations where they have worked. References and interviews help determine effectiveness and whether your organization and the consultant fit. Sample questions that help focus the interview include: • Does the consultant relate well to the CNO and the staff? • What resources does the consultant need to accomplish the work? • How does the consultant communicate progress and issues and make adjustments as needed? • Will the consultant maintain ethical practices and protect the organization’s privacy? • If an external firm or vendor is selected, are the consultants who will be working on the project competent? Is there a fit with the organizational culture and operational mores? • Are the approach and process compatible with those of others in the organization?
KEYS TO SUCCESSFUL PLANNING AND IMPLEMENTATION Collaboration within the organization is essential in project planning.7 Involving the CEO and CFO and affected staff in discussion from the beginning helps gain final project approval. The proposed project is evaluated against other projects that may be under way to assess how much change the organization can tolerate and how projects can be dovetailed, managed, monitored, and evaluated for optimal organizational performance. Project implementation benefits include up-front planning to agree on the rationale, the approach, expected outcomes, methods, people involved, and timelines for progress monitoring, review, and adjustment. Another key to successful implementation is identifying a point person to work with the consultant to keep the project connected.
CONSULTING PHASES Lippitt and Lippitt8 define the six phases of consulting as engagement and entry, contract formulation, problem identification, goal-setting and planning, implementation and evaluation, and contract completion and termination. It is of utmost importance to discuss the phases of consulting early on, especially problem identification, goal-setting, and planning. The goal of consultation is to provide advice and assistance within a problem-solving situation that brings about change. Successful consultation must be a collaborative effort, working jointly to identify, define, and resolve issues. December 2005
Tips
FOR
Success
The 21st century consultant needs to understand that the challenges have become more compelling as a result of increased intensity, complexity, and pace of change. What once took years to achieve now takes months. Today, because of less reimbursement to health care organizations, resources are very scarce, so the client must be mindful in investing in external resources and should do a thorough cost and benefit analysis before seeking external assistance. Here is a list of helpful tips: • Integrate the consultant. He or she should meet senior management, nursing management, and the workforce. • Define a plan of action that is well articulated with measurable goals and objectives. • Provide timely feedback to all parties on an ongoing basis. • Deal head-on with staff ambivalence regarding change. • Establish task forces to assist with problem-solving. • Develop strategies to sustain the changes that are made. • Identify an internal candidate to take over the consultant functions once the contract is terminated.
Engagement/Entry An individual may enter and engage into the work environment as a consultant in several ways. One common method is by the referral process. In this situation, a professional colleague knows of another professional with outstanding academic credentials and in-depth experience in nursing administration. In this process, a professional colleague contacts and recommends an individual to a CNO who is interested in receiving assistance from a consultant. Another avenue that may be used for entry and engagement is through the cooperation of nursing professional organizations, such as the American Nurses Association or the American Organization of Nurses Executives, both of which have a list of active consultants. The nursing organizations usually provide a number of names for the CNO to contact and discuss tentative projects. Most consultants have websites whereby the client may learn more through independent research.
Contract Formulation A contract should be formulated once the CNO makes a decision to offer a consultant the opportunity to provide professional services. The contract should encompass goal-setting, implementation, evaluation, and the termination of the relationship. Sebastian and Stanhope9 state, “Consultation is an action-oriented intervention that is by definition focused on change and forward movement from an existing state to a desired state.” Some of the components that may be used in a contract include the following: • Define a general statement or purpose of project goals. • Describe the tasks and services to be provided by the consultant. • Identify the support functions from the client. Considerations to be addressed: 1. Estimate approximate number of consultation sessions. 2. Define a time schedule for the services and deliverables to client. December 2005
3. Identify the criteria that will be used to evaluate the outcomes. 4. Include a statement for possible contract modifications. 5. Articulate a statement on confidentiality. 6. Define conditions of payment of fees and expenses. 7. Obtain signatures of the contracting parties.
Problem Identification, Goal-Setting If this process is not done thoroughly and accurately, the outcomes will differ from expectations. There must be a collaborative understanding and agreement between the consultant and the CNO on the definition of the problem. When the consultant acquires a clear diagnostic sensitivity to the current situation and the operating problems, the client and the consultant are prepared for goal-setting and planning. The planning phase is a step-by-step process whereby brainstorming may be used in addition to asking the questions regarding what should be done, who should be involved, and how will it be done. Goal-setting is a collaborative process that articulates action statements with time lines so that all who participate are familiar with the plan of action.
Implementation/Evaluation The implementation phase is exciting, but for the plan to be successful, the people who play a part in the implementation process must be prepared and ready to perform the new skills they have been taught by the consultant. Participant readiness is essential for change to take place. It is very important for the consultant to seek feedback from the participants on a daily basis and listen to their concerns. The consultant should also be prepared to provide feedback on the comments made by the participants so they realize that they have been listened to. During the entire process, the consultant’s role is to assist and provide ongoing development so that participants’
Nurse Leader 53
new skills enable them to increase their abilities and chances of success. Another important responsibility for the consultant is to teach the individuals new methods so that they will be able to sustain the changes that have been made. In addition, the consultant, in collaboration with the CNO, must develop the necessary support systems so the process may continue after the contract concludes.
any strategy or plan of action that may be implemented. However, the client makes the decision regarding the course of action. Another thing to remember is that sometimes value statements enter into the equation opposite factual statements. Value statements are based on beliefs and desires; factual statements are evidence-based.
Contract Completion
MAKING IT WORK
Before completion of the contract, the consultant, in collaboration with the CNO, needs to identify an internal candidate who participated in the process and demonstrated strong skills in leadership and communication. The consultant needs to work with this individual to take over the functions for which he or she had accountability. In a related note, staff members always appreciate celebration of the changes and achievements made, and it is important to recognize everyone for a job well done.
Seeking some type of external assistance is almost inevitable given the changes, challenges, and complexities of the 21st century. To be successful, the CNO must be cognizant of the consultant’s limitations and inclinations, remembering that his or her style will strongly influence the role and the interventions. The consultant also must be astute to the chemistry and fit with the environment. If the consulting engagement is not working for any reason, it takes courage on the part of the consultant and the CNO to close the agreement and move on. However, the greater the versatility and the experiences of the consultant, the more likely he or she will be successful in assisting the organization.
ETHICAL ISSUES ASSOCIATED WITH CONSULTING A number of ethical issues and dilemmas underlie a consultant practice. Because a consultant’s role involves helping, guiding, and directing, his or her relationship with the CNO must be built on trust. Ethics in consulting will be discussed as they relate to accountability, confidentiality, and veracity. Nurse consultants have a professional code of ethics that was articulated by the American Nurses Association10 in 1986 and revised in 1996 and in 2001. This code of ethics states, “Accountability and confidentiality are not only ethical duties but legal requirement, whereas veracity is essential to the ongoing success of the nurse consultant’s professional career.” Accountability is defined simply as providing an explanation to the client for what has been done. Fry11 says, “The nurse consultant is responsible for the delivery of competent, quality services and is accountable to self, the client, and the profession.” The consultant must also understand that all interactions with the client are regarded as confidential. If confidentiality is breached, it will impair the relationship. Once this breach occurs, the client may not be in a position to convey all the details necessary for the consultant to address and correct a problem, resulting in incorrect and inappropriate recommendations. The tenets of veracity and integrity are essential tools of any nurse consultant. This means the consultant respects the clients served and understands that clients are self-determining and autonomous. However, the consultant has an obligation to be truthful about the scope of services and abilities he or she can provide. The consultant must also be truthful with the client about the findings in a project and any other contributing factor gleaned during the process that was not discussed initially. Consultants must always keep in mind that they are providing contracted services to a client and that their role is to recommend, suggest, and explain the pros and cons of 54 Nurse Leader
References 1. Drucker P. What makes an effective executive? Harvard Business Review 2004;26:59-63. 2. Thrall TH. How ready are we for reform? Hospitals & Health Networks 2004;784:34-44. 3. Haugh R. Cost drivers. Credit. Hospitals & Health Networks 2004;786:48,57. 4. Larkin H. Cost drivers. Liability. Responding to patients quickly and with candor can avert costly lawsuits. Hospitals & Health Networks 2004;786:38-40,42. 5. Serb C. Cost drivers. Labor. Five strategies, backed by real-time data, help hospitals gain control over staffing costs. Hospitals & Health Networks 2004;786:42-4,46,48. 6. Towne J. Capital access. Hospitals & Health Networks 2004;786:49-56,2. 7. Linden R. The discipline of collaboration. Leader to Leader 2003;Summer:41-7. 8. Lippitt G, Lippitt R. The consulting process in action. 2nd ed. San Francisco: Jossey-Bass/Pheifer Publishing; 1986. p 11. 9. Sebastian JG, Stanhope M. Consultation as a tool for change. In: Lancaster J. Nursing issues in leading and managing change. St. Louis: Mosby; 1999. p. 587-8. 10. American Nurses Association. Code for nurses with interpretative statements. Washington (DC): American Nurses Association; 1986 & 1996, revised. 11. Fry S. Ethics in community health nursing practice. In: Stanhope M, Lancaster J, editors. Community health nursing: promoting health of aggregates, families and individuals. St. Louis MO: Mosby; 1996. pp. 93-116.
Julian S.A. Cicatiello, MA, Med, RN, CNAA, is a health care consultant in Youngstown, Ohio. He can be reached at [email protected]. Marjorie Beyers, RN, PhD, FAAN, is a nurse consultant in Barrington, Ill. 1541-4612/ $ - See front matter Copyright 2005 by Mosby, Inc. All rights reserved. doi:10.1016/j.mnl.2005.01.013
December 2005