The 3 Focuses of a Clinical Nurse Leader Working in Special Populations

• Clinical nurse leaders help set the pace for the nursing staff and ensure that all members are following the organization’s policies. 
• Oftentimes, the importance of clinical leadership and what it portrays to those working in the field with individuals with special needs and/or disabilities becomes overlooked. 
• As a clinical nurse leader working with populations that have developmental disabilities, there are three main areas of focus: vision, consistency, and autonomy. 

Having a clinical nurse leader on staff is of utmost importance in most healthcare settings, as they help set the pace for others to follow the standards within any organization.  

Working as a clinical nurse leader in the field with patients that have special needs or developmental disabilities can be incredibly challenging at times, but also extremely fulfilling.

Some overarching factors to consider as a leader in this field are vision, consistency, and autonomy.   

Focusing on these three areas is essential in any type of organization, but particularly in one that serves a population of individuals with developmental disabilities.  

Vision

In any leadership position, having a clear vision is one of the main priorities.

Whether it is focusing on goals, ideas, new ways of thinking, and identifying tactics that work (and eliminating those that don’t), enhancing the vision of an organization is extremely important when working with these special populations.

As one can imagine, these patients vary on many levels (i.e. cognitive level, physical abilities, ability to adjust to their environment and surroundings, medical issues, and various ways of communication).

With that being said, it is extremely important that a clinical nurse leader focuses on the vision that best fits each patient.  

However, whether this change is abrupt or subtle, it is vital that the care team understands the impact their changes have on patients, as some can struggle with adjusting to change.

 If a nurse has a client with various intellectual and developmental diagnoses and currently receives one-on-one in-home care services, it is evident that the care plan is solely focused on the individual client. For example, their strengths, weaknesses, likes, dislikes, abilities, areas that are difficult, and medical issues are all taken into account.

As a leader, the plan is reviewed, and changes are made based on input from both the patient’s care team and the client (pending that they can offer thoughts, ideas, goals, and desires based on his/her cognitive level) as well as their family.   

A common question these nurses might encounter might be, “what if the patient would benefit the most from moving into an alternate family living (AFL) facility?”

From there, the clinical nurse leader will decide and agree on this information with the other team members.

Careful steps must be taken when reaching this proposition, as this will be a huge change in environment for the patient that may ultimately affect behaviors, compliance, goals not being met, resistance, and possibly increased medical issues.  

Although the vision is clear that a change of living arrangements may be needed, careful steps must be taken in a gentle manner to allow the client to adjust effectively. 

Consistency

When formulating ideas, thoughts, plans, and strategies, a clinical nurse leader must first understand the importance of consistency; however, when working with patients with developmental disabilities, this can be a challenge. 

It is important to remember that in this special population, change is difficult, hard, and sometimes even threatening to these individuals as they focus on plans, events, their surroundings, and their environment as being consistent with little to no change.   

Despite change being hard, in some cases, it is essential for improving outcomes. A clinical nurse leader must be able to differentiate when changing a patient’s care plan is necessary or not.  

When it has been decided that change needs to take place, the clinical leader must ensure that the proper steps are taken and in a precise manner to maintain consistency with routines, daily care, activities, and medical needs being met.   

Understanding the importance of maintaining consistency for these individuals is vital in promoting positive outcomes and smooth transitions. 

Autonomy

Clients with developmental disabilities may have certain areas of incapacitation, but this does not mean they should be denied the right to participate in the decision-making process regarding their care, goals being reached and/or achieved, and their personal desires.   

Of course, if clients are unable to be a part of this process due to decreased cognitive ability or inability to assist with making decisions then this is fully understood but should only be used as an exception. 

Autonomy allows these individuals to participate in their plan of care, set and reach certain goals, request preferences, realize the expectations that the direct support professionals will be implementing in caring for them, and most importantly, autonomy remains client-focused which is the ultimate goal.   

Who doesn’t want to be included in their own personal plan of care and serve as an important factor in determining specific goals, outcomes, creative ways to reach these goals, and offering personal preferences to make progress?   

As a clinical nurse leader, it is vital that if the patient can participate in making decisions involving their care, that they are included in these conversations. 

Leading and managing well as a nurse can be a huge challenge in any setting and population of individuals served, but with maintaining the focus on these three mentioned areas, individuals with developmental disabilities can have an important, valuable, and integral role in the care and plan of treatment of these individuals.   

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