Running Head: LEADERSHIP PROJECT

Amanda Wise
Leadership Project
NUR 4144 Professional Role Development
October 22, 2016
Dr. Ellcessor
I Pledge Amanda Wise

A Code Fx or code fracture must be called for all patients suspected of having a
long bone fracture; this includes any bones in the arms or legs, including fingers and toes

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(Minick et al.,212). A code fx has very specific guidelines; a pediatric patient is any
patient suspected of having a long bone fracture within the age range of 2-18 years and an
adult patient is anyone who is 18 years or older (Bergman et al., 220). A long bone
fracture is suspected with any patient complaint of pain from an injury to an upper or
lower extremity or any patient with this complaint and an obvious deformity (RCH Code
Fx Worksheet). Within 10 minutes of arrival to the ED the code is to be called, no matter
the age of the patient. Within 15 minutes the provider is to be notified no matter the age
of the patient. A height and weight must also be obtained for pediatric patients and an
adult patient must be weighed; this is for correct dosing during medication
administration. The provider needs this information to be able to order the correct dose of
analgesics. An analgesic must be ordered within 20 minutes of patients arrival (RCH
Code Fx Worksheet). The medication prescribed will differ depending on the deformity
of the extremity. A pediatric patient without obvious deformity will receive ibuprofen or
acetaminophen; while an adult patient will receive ibuprofen, Tylenol, or Norco. All of
the medications will be given by mouth for a patient without obvious deformity; a patient
with an obvious deformity will receive medications by mouth, intramuscular,
intravenous, or intranasal. The time goal to the patient receiving pain medication is 28
minutes from arrival to the ED (RCH Code Fx Worksheet). At Richmond Community
Hospital, a code fx worksheet has been implemented to encourage the success of this
project. To implement this quality improvement project the nurse manager must use their
heart, head, hands, and habits.

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The heart of a servant leader is not motivated by self-interest but called to serve
the patients needs and best interests. To encourage implementation of this project I
would propose my ideas, such as using a worksheet to help nurses complete all tasks and
documentation, and would accept feedback as a gift not a treat (Blanchard & Hodges).
Feedback is a gift because if the ultimate goal is decreased time to medications for
patients and nurses implement the protocols; therefore, having the nurses on board and
following a protocol or worksheet that works for them increases the chances of success.
Being a servant leader and leading with your heart is dependent on how you influence
others. As we have learned, if you did not document it you did not do it. While reading
the article by Jackson et al., I became aware that the nurse can influence the team by
facilitating documentation on the patients pain. As nurses we ask about pain every time
we go into the room but if that assessment is not documented then when charts are
audited they appear to be lacking.
The head of a servant leader holds a visionary role that attempts to achieve a higher
goal. A servant leader asks where are we going and why? (Blanchard & Hodges) This
vision seeks to inspire and motivate people. To picture the future a nurse manager must
imagine what the future looks like. When a nurse manager has this type of imagination to
be able to imagine what the future will look like a unit can achieve great things.
According to Minick et al., a study was done on a number of hospitals implemented
nurse-initiated protocols for pain management, this implementation decreased the time to
pain medication and increased patient satisfaction. As a nurse manager I would take this
information and attempt to implement the protocol within my unit because patient
satisfaction is at the bases of all Bon Secours values.

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The hands of a servant leader depend on the amount of guidance the nurse
manager gives the staff. Day-to-day coaching makes goals clear and focuses on
accomplishing goals (Blanchard & Hodges). Accomplishing goals lead to good
performance evaluations. Performance evaluations are a great way to provide staff with
feedback, direction, and encouragement (Blanchard & Hodges). Part of guidance is
helping staff achieve goals, and part of leading with your hands is delegating. In the
instance of a code fx the nurse could delegate tasks to a patient care technician so that the
nurse can obtain pain medication for a patient more quickly. And in return a patient care
technician can make a nurse aware when medication orders are entered to decrease time
to pain medication.
The habits of a servant leader are described in five leadership habits according to
Blanchard & Hodges; these five habits include solitude, prayer, study and application of
scripture, accepting and responding to Gods unconditional love, and involvement in
supportive relationships. The nurse leader needs to be alone with God to find his will.
During this time prayer should also be utilized. Using prayer in the beginning of a
problem can be the leaders most reliable resource. Using the study and application of
scripture will cause the nurse manager to lead like Jesus. In the implementation of code
fx a nurse leader can use the five leadership habits to show the staff how to act in all
scenarios whether they be critical as with a long bone deformity or not critical as with no
deformity. A leader attempting implementation of a code fx should first pray and find
solitude to imagine the scenario reversed. We must all nurse the way we would want
ourselves and our loved ones nursed. Taking the time for solitude and prayer will allow

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us to see Gods unconditional love for all and allow that to be expressed through us and
therefore lead like Jesus. (Blanchard & Hodges).
Every nurse leader effectively leads using the five practices of leadership. The
nurse must model the way by setting an example and adjusting their actions with their
values. To do this the nurse leader must clarify their personal values. When reading
through the articles for this project I did not come across a single article that talked about
modeling the way but in the book lead like Jesus it is a major concept. The second
practice of leadership is, inspire a shared vision, in the code fx the nurse manager would
envision the future. For example envision the ease of imitating the code and having pain
medication for the patient before the allotted time had passed. To inspire a shared vision
the nurse leader would encourage staff to see the big picture and see how important the
goal of 28 minutes to pain medication is to the patients healing. The nurse manager
challenges the process by being innovative and finding opportunities for improvement.
This is done by experimenting and taking risks, not all ideas will be successful and
mistakes will be made but each success can be celebrated as an accomplishment and
being one step closer to achieving the goal of a successful code fx. Enabling others to ask
is the fourth practice of leadership and a leader does this by cultivating collaboration to
harvest trust and strengthen bonds within the team. This fosters teamwork and when
teamwork occurs goals can be met with ease. In a code fx scenario teamwork would
mean triage calls the code to alert the doctor, nurse, and patient care technician of the
situation and the goal of 28 minutes can be met without hiccup. The fifth practice of
leadership is encouraging the heart, for the nurse manager this means recognizing when a
goal is met and celebrating that accomplishment. This can be small goal or big goals and

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can be an individual or group accomplishment. When people work hard and change their
ways to better the quality of care for everyone it is a real achievement and celebrating
these achievements can foster future teamwork and model the way for the next set of
goals.
The personal practice implications for the code fx are the improvement of quality
care for all patients, this includes patient satisfaction and successful pain management.
According to Bergman et al., nurses felt the barriers to pain management included nurses
felling overwhelmed due to inadequate staffing, perceive abuse of the emergency
department, lack of cohesion between doctors and nurses, and unrealistic expectations of
the nurses role. As the nurse leader I would remind the staff, doctors and nurses a like that
our jobs are about the patient and not ourselves and remember to treat as we would want
ourselves and our loved ones to be treated. A nurse leader is able to see the frustration but
recognize that pain without deformity can still be treated with Tylenol and as part of this
code the expectation is not to over medicate. Quality care for all patients is all about
managing the pain and as we have learned each patients pain is their own and must be
treated as such. Another personal practice implication for code fx would be decreased
tissue injury and the possibility for permanent damage due to decreased movement
because of pain. As a patient continues to be in pain the less likely they are to move the
extremity and this increases healing time and increases the chance for permanent
deformity and pain.
Throughout this project I have touched on many barriers to pain management as a
way to show the difficulty of implicating something we see as a simple code fracture. On
paper this code seems very straight forward and uncomplicated but reality is there are

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many obstacles to overcome with each new implementation because so many people are
involved. But with a manager that can lead like Jesus and pull the staff through these
obstacles the possibilities are endless and outcomes will reflect that. According to Stang
et al., a systemic review of pain management in the emergency department concludes that
a pain assessment and reassessment score can decrease delays in medication
administration and help determine inconsistencies that impede time to pain medication.
With the correct use of code fx and the administration of pain medication within 28
minutes of the patients arrival we can successfully eliminate patient dissatisfaction,
increase quality of care, and decrease time of healing.

References

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Bergman, C. L. (n.d.). Emergency Nurses' Percieved Barriers to Demonstrating Carig

when Managing Adult Patients' Pain. Journal of Emergency Medicine, 38(13),
218-225. doi:10.1016/j.jen.2010.09.017
Blanchard, K. & Hodges, P. (2005). Lead like Jesus. Nashville, TN: Thomas Nelson.
Marquis, B. L. & Huston, C. J. (2015). Leadership roles and management functions in
nursing: Theory and application (8th ed). Philadelphia, PA: Wolters Kluwer
Minick, P., Clark, P., Dalton, J. A., Horne, E., Greene, D., & Brown, M. (2011,
March/April). Long-bone Fractue Pain Management in the Emergency
Department. Journal of Emergency Medicine, 38(3), 211-217.
doi:10.1016.j.jen.2010.11.001
Jackson, S. E., & NJ, E. (2010, January). The Efficacy on an Educational Intervention on
Documentation of Pain Management for the Elderly Patient with a Hip Fracture in
the Emergency Department. Journal of Emergency Medicine, 36(1), 10-15.
doi:10.1016/j.jen.2008.08.022
RCH Code Fx Worksheet [Chart]. (2016). Bon Secours.
Stag, A., Hartling, L., Fera, C., Johnson, D., & Ali, S. (2014, November/December).
Quality Indicatiors for the Assessment and Management of Pain in the Energency
Department: A Systemic Review. Pain Research Management, 19, 9th ser., 179190.