Changeable Medical Center Case Study

Change is a hard concept for most, but change in the hospital setting can be beneficial for both staff and patients. According to Mclean (2011), “Every change begins with an ending” (p.79). How people respond to change can make the process easy or hard depending on how the change is presented.

The profession of nursing is usually described as high-demand job, as well as stressful. The American Association of Critical-Care Nurses believes that nurses can empower their work environments and truly make a difference (AACN, 2016). Although nurses have the ability to join committees and help make changes slowly, there are many factors in the nursing that cannot be changed by nurses. “The global increase in the aged population, the intensity of health care problems, the incidence of chronic illnesses and advanced technology, nurses are faced with a variety of work-related stressors” (Lambert & Lambert, 2008, p. 38). Regardless of nursing communication and social aspects of units, nurses need to accept some stressors as they are and

Healthcare environments are often plagued with dysfunctional behaviors that create antisocial, self-defeating behaviors (Porter-O’Grady & Malloch, 2014). Traditionally, healthcare providers were males that dominated the profession which created a sense of personal entitlement and resistance to change (Porter-O’Grady & Malloch, 2014). With the advent of the Affordable Care Act (ACA), healthcare is in the midst of a paradigm shift that embraces change, efficiency and collaboration, a foreign concept to some traditional providers. Traditionally, prior to the implementation of the ACA, physicians felt empowered and in control (Porter-O’Grady & Malloch, 2014). Under the ACA, healthcare organizations fervently transformed their facilities to accommodate the mandates of the ACA, such as CPOE. With this loss of control, physicians are angry and passively transfer that anger to the supportive nursing staff. Because hospital leadership traditionally did not challenge the physician behavior, this anti-social behavior is tolerated. Consequently, nurses develop fear, distrust and discouragement, which compromises the collaboration that is necessary to produce quality patient outcomes. Porter-O’Grady and Malloch (2014) outline ten principles to minimize this type of organizational toxicity that manipulates progress and collaboration. These principles are tools that work to transform the dysfunctional, toxic environment into a healthier,

A positive force for change centers on the nurse’s strong desire to change current practices. The combination of the turnover rate, low morale, and higher percentage of new nurses, is the driving

Considered as top priority and central to the recovery plan of the unit, the operations of the unit have to be re-hauled, with higher emphasis on delivery of quality practices in preventing and controlling healthcare infection. The high risk areas of infection have to be curtailed with close monitoring, supervision of routine procedures of treatment. Exacting pressure has to be maintained to ensure there is no laxity among staff and all disposables are handled as per procedure and industry benchmarks achieved to the closet segment. Patient fall instances have to be contained by revisiting the existing physical layout of the unit, followed by examination and ad-hoc monitoring of the unit for obstacles in the path of patients. The budgetary allocations have to be handled with sagacity as nursing professional enhancement courses are primary in the current situation. The optimization of allocation of the limited budget would be prioritized with a maximum allocation provided to functions which would lead to immediate solutions for the unit to rebound as a top unit within the organization. The clinical goals would include (1) Holistic care of the highest quality standards (2) Patient-centric service delivery with optimized inter-professional cooperation. (3) Efficient and profitable management of resources (4) optimize healthcare integration scope.

Grippingly, the medical unit met the majority of the criteria of a highly functioning organization. Yet, areas for improvement still exist. On the Organizational Assessment, the answer to question #24, Is there evidence that all nursing personnel know the organizational structure and understand their assignments and those of their

In 1636 U.S. veteran administration hospitals were made to help and take care of the war veterans that come in injured or ill. Also, the bills for this should be taken care of so there are no worries for the most part, but none of this is happening the way it should be or how the system was created to be. Veterans are turned away and avoided by the U.S. veterans hospitals, they have a big thirst for money that has not been quenched and because of this, the veterans that come in are not being treated properly and this effect is turning out very negative.

Jean Watson’s Caring theory has been used in the development of many nursing conceptual models (Fawcett & DeSanto Madeya 2013). One of the tools derived from this theory is the daily goals sheet used in a variety of ICU’s around the country (Fawcett & DeSanto Madeya 2013). The daily goals sheet was derived as a way to improve patient care by keeping the patient safe, provide reliable care, improve communication between doctors and nurses, and help the nurse plan for the day (Rehder, Uhl, & Mistry, 2012). According to Fawcett and DeSanto Maydeya (2013), the goal of Watson’s theory is to help nurses become more “nursing-qua-medicine,” where nursing “needs to emerge as mature health profession, capable of interfacing with the medical profession” (2013 p. 405-406). An interdisciplinary care team was used to implement a time with no interruptions between providers. This time was used to discuss the care of the patient, include families, and ensure that all members agree of the care to be provided (Rehder, Uhl, & Mistry 2012). By having the nurses be a part of this team, they are able to interact and be a member of the team, which is the goal of Watson’s caring theory (Rehder, Uhl, &Mistry 2012). If there is teamwork, and all the members of the team understand the goals, then the daily goals can help decrease length of stay (LOS) in ICU’s, decrease hospital acquired infections

Hospitals have human lives in their hands and the greater responsibility to function with precision by delivering high-quality services twenty- four hours a day, seven days a week. Institutions such as hospitals, adopt organizational structures with the goal of facilitating communication, increasing job satisfaction, and improving patient care. This summer semester, I am completing my critical care and leadership preceptorship in the Burn ICU at New York Presbyterian Weill Cornell Medical Center. During my shifts, I experienced and researched how NYP Weill Cornell functions in the caregiver- patient, unit-based, and facility-wide manner by using the “Infonet” and gathering information from the unit manager, nurses and nurse’s aides. This leadership

J.L. reports to S.H. whom currently functions as the Chief Nursing Officer (CNO) and Chief Operating Officer (COO). The director J.L. also reports to the Chief financial officer (CFO) on a weekly basis to discuss high cost surgical cases for financial clearance. Currently, J.L. supervises approximately 62 employees, a combination of nurses and technicians. He proudly stated having low turnover. J.L currently holds a bachelor in science of nursing (BSN) degree. Additionally, he is currently enrolled in a Master’s of science in Nursing (MSN) specializing in nursing leadership. This director maintains an active membership with the Association of periOperative Registered Nurses (AORN) as a role model for his team of nurses.

During the team formation, a number of challenges manifested. Firstly, it was the fact that there were nurses from other units. Hence, there were fears that they may not be well informed with procedures undertaken in our unit. However, this challenged was effectively addressed by assigning the nurses from other units a nurse from our unit to help her during the emergency period.

Economist John Maynard Keynes once said that “the hardest thing is not to get people to accept new ideas; it is to get them to forget old ones” (Porter-O’Grady, Malloch, 2015). In the United States, the healthcare system is a testament to this. Both leadership styles and standards for creating healthy work environments are factors immediately affecting healthcare and its development today. Assessing current leaderships styles and suggesting the inclusion of more contemporary styles helps to spark growth and improvement among healthcare professionals. Likewise, assessing the current standards within healthcare settings helps to identify areas that could benefit from intervention. The American Association of Critical-Care Nurses (AACN) has recognized six standards for establishing a healthy work environment that evaluates skilled communication, true collaboration, effective decision making, appropriate staffing, meaningful recognition, authentic leadership within the organization (American Association of Critical-Care Nurses, 2016). By utilizing the AACN Assessment Questionnaire as an assessment of these six standards, I was able to evaluate the current working environment within my unit. In this project, I will elaborate on the concept of leadership and the standards making up a healthy work environment in an effort to effect change within my nursing practice and my health care environment as a whole.

In response to an email I received from Gayle Barthel seeking full-time nurses I have attached a copy of my resume. I have a strong desire to be a part of Select Specialty Hospital after speaking to Johnetta Prosser a few months ago. Johnetta shared with me the value of teamwork and training they share with their nurses to meet the needs of the patients. I feel I would be well suited there considering my compassion and desire to help patients from the time they are admitted to the end of their care. I’m looking forward to hearing from you. By texting me first is the best way to contact me or to let me know you will be calling or sending an email. Thank you in advance for considering me for the position.

It also created the feeling that she is out of touch with current issues and dynamics of bedside care. The lack of visible leadership caused frustration for the staff and lead to dissatisfaction and ethical erosion in the form of decreased loyalty. I am pleased to say that based on the results of our last several employee satisfaction surveys, and encouragement from her directors, this senior leader has recognized her disconnect with middle management and staff and has started to host meetings on the inpatient units where she will bring a meal and the staff can ask her questions. This was a courageous move for her and I was not certain how it would be received, however, I am pleased to say, the results have been positive. The staff is making an effort to attending their scheduled meeting and attendance has been good. Staff questions have been insightful and respectful. It has given staff the opportunity to see and hear from their senior leader, her vision and to understand her passion for patient care and the concern she has for staff, directly from her and for her to hear concerns and frustrations directly from staff. This simple effort to interact with staff on a more personal basis has significantly changed her reputation as a leader. She is dynamic and fully committed to her nursing staff and now the staff know it as well as her directors.

As nurse manager Barbara is responsible for managing the staff, scheduling and budgeting for the unit. Her staff includes twenty-five registered nurses and eight patient care assistants (PCA’s). The unit is known for its culture of confrontation, blaming, and favoritism. The staff is dissatisfied, unmotivated, and not functioning as a team to deliver quality patient care. In Barbara’s first month she has lost two RN’s and due to a hiring freeze at EMU Barbara was not able to replace the positions. The unit is short staffed, stress levels are high and employee morale is low. Barbara meets individually with twenty or so staff members and comes to the conclusion that no one is happy and she has a lot of work to do. There are multiple groups that Barbara has identified issues with and she must come up with an action plan to manage the discrepancies. She has found issues in downward management which involves senior nurses, newer nurses, and patient care assistants, and in upward management including administrators and physicians,