Mindy Alternot Case Summary

My second clinical day took place on September 24th, 2015 at Saint Barnabas Hospital in Livingston, New Jersey. My preceptor Maria Brilhante, MSN, RN, allowed me to observe the morning huddle that took place with all the nurse managers that are in the hospital. The purpose of this huddle was to keep the director of nursing informed about the census on each unit. I found this processed to be very uniformed and professional because the DON was engaged. The day went on with me attending meetings on how managers could implement plans to contain cost for the hospital. Maria did her daily rounds on her patients and her nursing staff. She has a folder that contains papers on how each nurse is progressing from the time they get off orientation. Her motto to the nurses is, “You are good at what you do, so when I coach don’t take offense. I am only trying to get you to be great”. This boost their confidence which I thought to be important.

A unit that consists of 70 registered nurses (RNs) who care of (31) beds. Some of the nurses were met by the

An identified area in which healthcare managers are failing consistent effectiveness is in the retention of their nursing staff. With the need of nurses shaping the way many healthcare managers look at their staff, often it is the veteran nurse persuaded in staying. While in some settings this is truly beneficial, in others the cliché of nurses eating their young instills fear into new graduates; this fear and the lack of support ultimately leads to their exit (Rush, Adamack, Gordon, & Janke, 2014). With the associated costs of nursing attrition meeting rates of nearly $186,000 per registered nurse, it is imperative we institute nursing residency programs immediately and continually retaining staff and protecting healthcare institutions’ sustainability (Cubit, K.A. & Ryan, B., 2011; Lee, Tzeng, Lin, & Yeh, 2009).

There are times that there is the one nurse that seems to be notoriously late for their shift or always calling off. The manager not mentoring this nurse on this behavior causes disruption within the unit and division. Not following policy in disciplinary actions causes a lot of unwanted disharmony amongst the nurses. If disruptive behavior continues being overlooked or if the behavior is endured for long periods of time causes even more dissonance. There needs to be a team accountablity plan in place for responsiblities and to renew personal

The national nursing shortage is an ever-growing concern and it is essential for health care organizations to confront the looming issue. Possible solutions to the nursing shortage include retaining older nurses who are looking to retire, increasing the amount of students graduating from nursing schools, and drawing nurses who have left the nursing workforce back to the bedside (Hatcher, 2006). Leaders must assess the nursing turnover in their organization and strategize on ways to retain those nurses. Organizations must implement techniques to retain older nurses to help combat the national nursing shortage and prevent a national healthcare disaster (Keller & Burns, 2010). The purpose of this paper is to identify the demographic breakdown of an organization, explain how the organization’s environment is conducive and non-conducive to older workers, and describe tactics to retain older workers.

Being a certified nurse aide was the first job I had to do all my life, was it easy, I might be lying but it was definitely not as easy as I think. Since every person has a different temperament and sees a world differently, becoming a successful nurse aide is challenging. Among various of challenges, one of the greatest problems I had to face was working with overloaded information to better assist people with different issues is miserable. However, in order to make my work whole easier and enjoyable, I used some of the skills such as, communication skills, time management and knowing residence’s personal and medical history help me to overcome this problem and that’s what has contributed me to be promoted in a such a short period of time.

Seaside Convalescent Care Center (SCCC) has many issues that need to be addressed in order to be compliant with state and avoid fines. Due to SCCC high turnover rate tenured staff is not always readily available to train and mentor new staff. For months management tried offering incentives to make staff, particularly the nursing assistance feel like a valued member of the team. Nothing management did seem to stop the high turnover rate and motivate the staff not to be untrustworthy, undependable, and condescending (to residents). Management gave all responsibilities to the Director of Nursing(DON) in hopes that her tenure and experience would turn SCCC around. The DON used a coercive leadership style because she did not value her nursing assistance and assumed they would eventually quit anyway. The coercive leadership style should only be used when for very problematic subordinates

A new nursing aide does not receive adequate onboarding and job training when she begins working for hospice x. Because of this, she keeps making minor mistakes. Her mistakes are brought to her attention by other employees and her patients. Rather than evaluate her in an effort to determine if she needs training assistance, her supervisor makes subtle statements to her from time to time, telling her she doesn't seem to be working out as a CNA. Based on her supervisor's remarks, she begins to believe that she just doesn't have what it takes to be a clinical aide.

After meeting with her Senior Director and determining it was expected for her unit to improve their HCAPS scores, Dawn investigated what the current scored of her unit were. After looking up the unit’s HCAPS scores, she discovered the September of 2014 scores, in the categories of responsiveness of staff, and communications with nurses, were well below the average of like hospitals. She then started the managerial function of organizing by developing a plan to carry out the work needed to raise the unit’s HCAPS scores in these two areas.

The chief complaints for patients was that there were not receiving adequate care, poor emergency room management, being sent away because the hospital lacked space, physicians or other members of staff to provide the right care, and long wait times. The root cause

The case loads from these RNs had to be covered by the remaining staff. Staff started working even longer hours (twelve to sixteen hours) on several days weekly. Staff felt like they did not have the opportunity to provide care that was quality and meaningful. They were not able to use the knowledge and skills they acquired to make an impact on another’s health status as they thought would be. The job became more of completing assigned tasks rather than using nursing knowledge and judgment. According to Chan (2009) “When nurses perceive a lack of autonomy in their job, this is a leading cause of job dissatisfaction for nurses and a major factor when deciding to leave the job” (p. 21).

Westmount Nursing Inc. is a for profit chain with seven different nursing homes. It has a grown from a small few bed facility to a facility with 4 different divisions that made to help make seniors more independent. The Westmount Nursing Homes were in search for a chief executive officer and president, which was filled by Shirley Carpenter. After Shirley Carpenter came on to the company, many changes were made and implemented. Some implementations were successfully, but she was also challenged with many problems with the Union Federation of Nurses and the Board of directors regarding wages and total quality management implementation. My recommendation would be for Shirley to stop the implementation of total quality management and focus on

Financial implications regarding payment reimbursements from the government and insurance company have required many health care organizations to focus strictly on satisfying the patient experience. As a nurse manager, not only would I be responsible for creating a work atmosphere that is enticing for employees, but also a work environment that strives to deliver safe, quality, and patient-centered care. The business principles presented by Fisher (2008), decide who you serve, manage employees, and set goals and go after them are three out of ten that I will explain in greater detail.

Chris is the manager of the telemetry unit. On this particular unit, a problem exists with the staff and their poor morale. The morale issue has a variety of reasons, including a very busy workload, demanding physicians who are not as collegial as they could be, and a high turnover rate of new people who leave within a year. Almost half of the staff has been employed on the telemetry unit for more than 10 years. The new people who are leaving are not necessarily new to nursing, however, because a registered nurse must have a minimum of 1 year of experience to apply for a position on the unit.

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,