Running head: NURSING'S LEADERSHIP ROLE IN TEEN PREGNANCY

Nursing's Leadership Role in Teen Pregnancy Prevention

Jennifer J. Smith
Ferris State University

NURSING'S LEADERSHIP ROLE IN TEEN PREGNANCY

Abstract
Nursings leadership role in teen pregnancy prevention is vital to decrease the rates of teen
pregnancy. Kent County has a significant rate of teen pregnancy and was chosen as a group
community change project. A school direct contact nurse and a director of nursing for a
community health department are identified as roles that can have a significant impact on
decreasing teen pregnancy rates.

NURSING'S LEADERSHIP ROLE IN TEEN PREGNANCY

Nursing's Leadership Role in Teen Pregnancy Prevention

Teen pregnancy is a population based health issue that is experienced all over the United
States. In Michigan, the Kent County teen pregnancy rate is higher than all comparison counties
(Michigan Public Health Institute [MPHI], 2011). The Kent County teen birth rate per 1,000
females ages 15-19 is nearly twice that of the national benchmark (MPHI, 2011). Based on this
information, our group chose teen pregnancy prevention for females ages 15-19. Direct contact
nurses and nurse leaders play an important leadership role requiring important leadership
characteristics in preventing teen pregnancy in the community and across the country.
Direct Contact Nurse
A school nurse has direct contact with females 15-19 years old. The school nurse can
counsel teens and teach them about sexual health and education, along with birth control and
contraception. The role of the school nurse is to provide age- and developmentally-appropriate
information, learning strategies, teaching methods and materials for sexual health and teen
pregnancy prevention interventions (National Association of School Nurses, 2012). They can
also review evidence-based programs that have shown success with teen pregnancy prevention.
One of the programs available is the Safer Choices Project available through Planned Parenthood
of West and Northern Michigan, Inc. (PPWNM). PPWNM is an agency that the school nurse
can work with to promote the Safer Choices Project, which provides teens with the information,
skills, and support they need to develop healthy relationships; prevent early, unprotected
intercourse and pregnancy, as well as sexually transmitted infections; and increase
communication with their parents or other trusted adults (PPWNM, 2013).

NURSING'S LEADERSHIP ROLE IN TEEN PREGNANCY

Leadership Traits
One of the leadership traits the school nurse needs to demonstrate is being an effective
communicator. It is very important that the nurse can deliver messages in a way that adolescents
can relate to and understand. Communication skills are one of the eight principles of public
health nursing practice (Harkness & DeMarco, 2012). According to Will (2008), school nurses
need to provide nonjudgmental individual health and decision-making counseling to assist
students in pregnancy prevention regardless of their sexual activity choices.
Another important leadership trait is cultural competence and sensitivity. The school
nurse needs to understand the characteristics of the major cultural groups in the community and
to be aware of cultural interpretations so that they know how to determine appropriate
interventions (Harkness & DeMarco, 2012). They also need to be aware of their own beliefs and
cultural biases to prevent this from interfering in effective leadership in the school nurse role.
This is identified as another public health nursing practice domain of cultural competency skills
(Harkness & DeMarco, 2012).
In addition, the school nurse needs to be able to motivate adolescents into being
responsible for their sexual health in preventing pregnancy. Interventions need to be evidencebased and delivered in a creative way to be effective for adolescents. One of the American
Nurses Associations (ANA) standards of practice is standard 5B: health teaching and health
promotion (ANA, 2004). The registered nurse uses health promotion and health teaching
methods appropriate to the situation and the patients developmental level, learning needs,
readiness, ability to learn, language preference, and culture (ANA, 2004, p. 28). The school
nurse needs to know the age appropriate methods for teaching adolescents that will result in the
desired outcome of preventing teen pregnancy.

NURSING'S LEADERSHIP ROLE IN TEEN PREGNANCY

Nurse Leader
The Kent County Health Department is a possible agency for a director of nursing
leadership role. Being a director of nursing for a health department is beneficial for a teen
pregnancy prevention project as this role can advocate for evidence-based programs to
implement in the community. This nurse leader can be instrumental in collaborating with other
agencies or projects to develop strategies to prevent teen pregnancies. An article by Smith-Battle
(2012) encourages public health nurses to advocate for comprehensive reforms that will reduce
the wide and growing inequities in education, income, and health among U.S. citizens. A nurse
leader in a health department can utilize a national nursing association to lobby for policy
changes to decrease the amount of social determinants that create health disparities and
negatively affect the rates of teen pregnancy.
Leadership Traits
To be effective in this nurse leader role, the nurse needs to be knowledgeable of the
public health nursing role along with policies, strategic visions, and up to date public health
information. This links with one of the eight domains of public health nursing practice, basic
public health science skills (Harkness & DeMarco, 2012). A nurse leader in this agency needs to
be aware of local and national initiatives to prevent pregnancy.
Collaboration is another important skill for a nurse leader as this enhances the
effectiveness of a multidisciplinary team. Collaboration is a nursing standard of practice (ANA,
2004). This includes the nurse leader role being able to partner with others to enhance teen
pregnancy preventive care through interdisciplinary activities, such as education, consultation,
management, and research opportunities (ANA, 2004).

NURSING'S LEADERSHIP ROLE IN TEEN PREGNANCY

Reyes (2011) presented a study about perceived leadership qualities of public health
nurse leaders and identified advocacy and influential leadership as important qualities. A
director of nursing needs to advocate for public health and the advancement of public health
nursing (Reyes, 2011). The nurse leader needs to be passionate about their job as this is an
effective way to promote public health nursing and promote their cause of preventing teen
pregnancy for this project. They need to be able to enhance trust and also have a strategic vision
that includes empowering nurses on the front line of direct patient care (Reyes, 2011).
Analysis
The school nurse role and the director of nursing roles are similar in that they both
require excellent communication and listening skills. They also need to be very knowledgeable
about public health and community nursing to have an impact on promoting responsible sexual
behavior in adolescents and preventing teen pregnancies. The school nurse has direct contact
with teens to provide sexual education and counseling and needs to be creative with their
approach. The director of nursing needs to be able to communicate effectively with
multidisciplinary teams to direct, plan, and implement evidence-based prevention programs.
Both roles require the use of the nursing process along with the ANAs (2004) standards of
professional performance of quality of practice, education, collegiality, collaboration, ethics, and
research.
The roles differ in their focus on teen pregnancy prevention. The school nurse works in
direct contact with teens, teachers, parents, and community organizations with a focus on
providing quality education and support to adolescents. The director of nursing works at a
different level. Their focus is more policy driven, managing budgets, collaborating with other
community and federal agencies to address the teen pregnancy issues. Their actions are aimed at

NURSING'S LEADERSHIP ROLE IN TEEN PREGNANCY

developing policies to enhance and sustain programs that are effective in decreasing teen
pregnancy. The director of nursings role includes looking at a bigger picture of causative
factors and social determinants that affect the effectiveness of prevention programs.
The school nurse and the director of nursings role influence the political arena by
providing vital information about teenage pregnancy prevention. The school nurse can provide
information and statistics from the community and school districts within their scope. The
director of nursing can support prevention programs that demonstrate the desired outcomes. The
director of nursing can also be a voice for political change by utilizing statistics to strengthen
political and economic support for multifaceted interventions to address teenage pregnancy.
Each role requires different skills to be effective within their scope of practice and influence, but
are both dependent on each other for successfully addressing teenage pregnancy prevention.
Reflection
I feel that my strength of effective communication and listening would be suited to the
school nurse role. I currently work with a variety of age groups and provide age appropriate
education in a way that is based on each learners needs. I am very comfortable providing direct
care to clients and their families with diverse cultural backgrounds and varying socioeconomic
classes.
Another skill suited to the school nurse role and the director of nursing role is my passion
for nursing and health promotion. My positive attitude and flexible approach for change can be
beneficial for either nursing role. This is important in any direct care or nursing leadership role.
My leadership skills and ability to work in multidisciplinary teams would suit either role.
I have had some experience leading teams to implement interventions to promote change and

NURSING'S LEADERSHIP ROLE IN TEEN PREGNANCY

improve client outcomes. Although, I do not feel my experience with leading teams or policy
changes is enough to fill the role requirements for a director of nursing.
Both roles require extensive knowledge and experience in public health nursing which I
do not possess. I also feel that my lack of knowledge on strategic visions, budgets, and political
influence would not be suited to the broader scope of director of nursing role. I would need
further management training with a focus on areas unique to the scope of responsibility for this
role. In order to be competent I would need to further my education and at a minimum complete
a masters degree for preparation for this expanded role.
In order to be competent in the school nurse role I would require further education on the
specialty of public health nursing. I am not experienced with population focused health
strategies as my current practice is tailored to individual health prevention and promotion
strategies. I also feel that to effectively work with adolescents on teen pregnancy prevention I
would need to become better acquainted with the social determinants that affect their perception
of sexual health and practices.
The school nurse role and the director of nursing role can both be instrumental roles in a
successful community change project to prevent teen pregnancy for Kent County, Michigan.
Each role has different scopes of practice and areas of responsibility, but both roles need to work
together to address this population based issue. Some of my strengths are suited to one or both
roles, but my lack of education in population based health care would require further education
and experience to be successful in this specialty area of nursing.

NURSING'S LEADERSHIP ROLE IN TEEN PREGNANCY

References
American Nurses Association (2004). Nursing: Scope and Standards of Practice. Silver Spring,
MD: Nursebooks.org.
Harkness, G. A. & DeMarco, R. F. (2012). Community and public health nursing: Evidence for
practice. Philadelphia, PA: Lippincott Williams & Wilkins.
Michigan Public Health Institute (2011). Kent County 2011 Health Needs Assessment and
Health Profile. Retrieved from http://www.kentcountychna.org/pdfs/healthprofile.pdf
National Association of School Nurses (2012). School health education about human sexuality.
Retrieved from http://www.nasn.org/PolicyAdvocacy/PositionPapersandReports/
NASNPositionStatementsFullView/tabid/462/ArticleId/43/School-Health-Educationabout-Human-Sexuality-Revised-2012
Planned Parenthood of West and Northern Michigan, Inc. (2013). Retrieved from
http://www.plannedparenthood.org/west-northern-michigan/
Reyes, D. (2011). Perceived leadership qualities of public health nurse leaders: Challenges in
advancing public health nursing. Retrieved from https://apha.confex.com/apha/139am/
webprogram/Paper238980.html
Will, S. (2008). CDC reports increase in teen birth rate: School nurses review pregnancy
prevention programs and student/parent support activities. NASN School Nurse, 23,
158-160. doi:10.1177/1942602X08322167