HA410 Unit 3 Adaptive Leadership Theory Paper Example

The Nursery Light Still On at Two in the Morning: A Theory Application Paper Reading a Stalled Rooming-In Policy on a Composite Postpartum Unit Through Adaptive Leadership and Finding What the Old Night Routine Protected

[Student Name]

Purdue University Global

HA410: Health Care Leadership

Unit 3 Theory Application Paper

[Instructor Name]

[Date]

The unit, the audit figures and the staff are composite and bracketed; the clinical points are simplified for a leadership paper and are not practice guidance.

The Case

A composite [28]-bed postpartum unit in a [300]-bed hospital adopted a policy [eight] months ago that healthy newborns stay in the mother's room around the clock unless there is a medical reason or the mother requests otherwise after being informed. Day audits show rooming-in for [92] percent of healthy newborns. Night audits, taken at 0200, show [41] percent. The unit tried three fixes. A laminated script for discussing the nursery with mothers lifted the night figure to [58] percent for two weeks. A training module on the benefits of rooming-in lifted it to [55] percent for about the same time. Weekly posting of audit figures by shift produced a brief rise and some resentment on nights. Each time, the figure drifted back.

Technical and Adaptive Work

Heifetz and colleagues separate two kinds of work (Heifetz et al., 2009). Some problems have known answers that someone in authority can apply. Others can be resolved only when the people involved shift their own priorities, habits or loyalties, a process they feel as a loss, and these the authors call adaptive. A technical fix applied to an adaptive challenge tends to produce a short improvement and then a return to the old pattern. All three fixes treated the problem as technical: nurses lacked the right words, the right knowledge or the right feedback. The two-week pattern suggests otherwise. Night nurses already knew the benefits; most could recite them. Something else was holding the old routine in place. Each fix taught night nurses something they already knew, and none asked what they would lose by changing.

Getting on the Balcony

Adaptive leadership asks a leader to step back from the action and watch the pattern, which the authors call getting on the balcony. The nurse manager spent [five] nights on the unit between 2300 and 0400 without auditing, simply observing. What she saw:

1. Most nursery transfers happened after a mother said she was exhausted, often after a long labor or a cesarean birth.

2. Nurses offered the nursery before the mother asked, usually with kind intent: "Why don't I take her so you can sleep?"

3. Two nurses described near misses in which a mother fell asleep while holding her baby in bed.

4. With [six] mother-baby pairs each, night nurses felt they could not check on every room often enough to feel safe.

What the Old Routine Protected

The nursery at night was protecting three things. For mothers, it protected sleep after an exhausting birth. For babies, in the nurses' view, it protected against falls and unsafe sleep in an adult bed, a real risk that guidance on newborn care explicitly addresses (Feldman-Winter et al., 2016). For nurses, it protected their identity as caregivers who look after exhausted mothers, and their sense of control on a busy night. Rooming-in asked night nurses to give up all three without offering anything in return. The day shift, with more staff and awake mothers, lost almost nothing, which explains the difference between day and night audits.

The Evidence Nurses Know

Rooming-in is associated with longer breastfeeding in some studies, though the evidence is limited in quality (Jaafar et al., 2016). Nurses on this unit were not unaware of the benefits; several said in interviews that they support rooming-in "in principle." The disagreement is not about whether rooming-in is good but about whether it is safe and kind at two in the morning with six pairs.

Regulating the Distress

Adaptive work requires keeping people in a productive range of discomfort: enough pressure to change, not so much that they resist or shut down. The weekly audit postings raised distress without offering any way to address the real concerns, which is why they produced resentment. The manager will lower the pressure from postings and raise the conversation about safety. Audit results will be shared privately with each shift rather than posted, and a night staff meeting will begin with the question, "What would make rooming-in safe for you at two in the morning?"

Giving the Work Back

Adaptive leadership holds that the people with the problem must do the work. The manager will not design the solution herself. Instead, night nurses will form a small group to test changes for [six] weeks. Likely candidates, raised in the first meeting:

1. A safe sleep check on every hourly round, with a bassinet placed at the bedside before the mother falls asleep.

2. A short conversation with each mother in the evening about how she will rest, so the nursery is not offered at 0200 by default.

3. A partner or support person encouraged to stay overnight to help.

4. A lower ratio on nights with several cesarean births, negotiated with the director.

5. The nursery kept available on request, with the mother's informed choice documented.

Protecting the Voices of Dissent

Two senior night nurses have been the most open critics of the policy. Adaptive leadership treats dissenters as sources of information about what the change threatens. The manager will invite both to the group, where their concerns about falls and fatigue can shape the safeguards.

Measures

The group will track night rooming-in rates, near misses involving infants in adult beds, mothers' satisfaction with rest and nurse-reported safety. If near misses rise, the group will adjust before pushing the rate higher.

Limits of the Model

Adaptive leadership offers a way to see the problem but not a quick solution. It depends on time, trust and a manager willing to tolerate a slower climb. Staffing, a technical resource, may still be needed; the model does not replace a ratio conversation.

What a Technical Leader Would Have Done Next

A fourth technical fix was already being planned: a requirement that nurses document a reason for every night nursery transfer. It would likely have produced another two-week rise and further resentment, because it would have added paperwork to the same unresolved concerns.

Conclusion

The stall was not a knowledge problem. Night nurses were protecting mothers' rest, infants' safety and their own sense of good care. Reading the case through adaptive leadership turns the next step from another script into a conversation about loss and safety, led by the people who work the night shift.

References

Feldman-Winter, L., Goldsmith, J. P., Committee on Fetus and Newborn, & Task Force on Sudden Infant Death Syndrome. (2016). Safe sleep and skin-to-skin care in the neonatal period for healthy term newborns. Pediatrics, 138(3), Article e20161889. https://doi.org/10.1542/peds.2016-1889

Heifetz, R. A., Grashow, A., & Linsky, M. (2009). The practice of adaptive leadership: Tools and tactics for changing your organization and the world. Harvard Business Press.

Jaafar, S. H., Ho, J. J., & Lee, K. S. (2016). Rooming-in for new mother and infant versus separate care for increasing the duration of breastfeeding. Cochrane Database of Systematic Reviews, 2016(8), Article CD006641. https://doi.org/10.1002/14651858.CD006641.pub3