Scenario Analysis : Filling My Toolbox

Standing (2011), defines clinical decision-making as a complex process that involves observation, gathering information, critical thinking, evaluating evidence, applying necessary knowledge, reflection and problem-solving skills. Every day nurses make important clinical decisions and these decisions have important implications for patient outcomes and deserve serious consideration. Therefore, it is important for nurses to have a better insight of the decision-making process, be able to deliver holistic care and meet essential and complex physical and mental health needs of the patient.

As already discussed it became apparent that the workload management system needed to be developed and changed to enable staff to meet the required targets, especially as current policy and political agenda was highlighting this as a significant issue in respect of work load and work load management (Munro 2011). As this was known to be impacting on production, cost and linked to serious case reviews throughout

This “incorporates the roles of assessing, critical thinking, communicating, providing care, teaching and leading” (Grand Canyon University, para. 7). I also believe that an individual’s maturity over a four-year period has time to evolve with the concepts of critical thinking and decision making the BSN framework offers. The difference in cost and time from ADN to BSN programs is a deciding factor in many educational decisions. The economy and decrease in job opportunities has driven many into the nursing profession that may not have initially considered it a career option. Sadly, I believe that has contributed to the lack of interest in pursing an advanced education. The professional choice wasn’t driven out of a motivation to help humanity or a sense of altruism; it was merely an employment opportunity.

The Institute of Medicine’s 2010 report on The Future of Nursing: Leading Change, Advancing Health acknowledges the changing healthcare sector in the US and describes future vision of healthcare and the role of nurses to fulfill that vision. The United States always strives to provide affordable and quality healthcare to the entire population of the country. In order to achieve this goal an overall restructuring of the healthcare system was necessitated. Nurses are considered to be the central part of the healthcare system to provide high quality and safe patient care. Nursing in the US is the single largest segment of the healthcare workforce with almost 3 million nurses working in different areas across the county. The changing

“The purpose of public policy is to direct problems to government and secure government’s response, while politics is the use of influence to direct the responses toward goals” (Milstead, 2013, p. 12). Policies are used as guidelines to reach a common goal. In healthcare, policies can affect and have an impact on how we provide care for our patients’. For this reason, it is important for nurses to be knowledgeable and involved in important healthcare decisions. “Knowledgeable nurses in advanced practice must demonstrate their commitment to action by being a part of relevant decisions that will ensure the delivery of quality health care by appropriate providers in a cost-effective manner” (Milstead, 2013, p. 1).

Across the United States, hospitals are experiencing a nursing shortage. Yet, according to the American Association of Colleges of Nursing, 63,857 students graduated from nursing school in 2015 alone and enrollment is increasing. It seems like a lot of new nurses to fill those vacancies, does it not? Studies show, however, that within a year, about thirty percent of those new graduates have voluntarily left their job (Hillman). Further studies have attributed the high turnover rate to new nurses’ lack of competency to handle conflict, make critical decisions, and function autonomously (Bratt). Many of the new graduates are disappointed with the hospital’s orientation, or lack thereof. Lack of knowledgeable preceptors and lack of nursing staffing in general has led to new nurses being thrown into autonomous function more quickly. Without proper training, these nurses must make sound clinical judgements and provide competent care to patients, which anyone can imagine is stressful. Today, Nurse Residency Programs (NRPs) are being instituted in numerous hospitals as a way to improve new graduate nursing skill, but research shows many other benefits to these programs. NRPs also reduce hospital spending costs, increase patient safety, and most importantly increase new nurse retention rates.

Over the past few decades, many drastic changes occurred in U.S health care delivery.   Our current healthcare trends demand nurses to take more active role in the health care decisions in hospital setting, long term care setting and in community healthcare setting. Since “nursing is based upon a body of knowledge that is always changing with new discoveries and innovation” Potter and Perry (2005), nursing profession is compelled to grow from being just a traditional bedside nurse. IOM’s future of nursing report which is released in 2010 calls nurses to be “more highly educated, diverse nursing workforce”.

When considering a change in practice we need to firstly understand why we need to make a change? Secondly when making a change, we need to justify a decision. This can be achieved by exploring the components which encompass decision making within nursing practice. Cullum et al (2007) identifies four requirements:-Clinical experience, valid researched evidence, available resources and lastly but no less important the patient

The healthcare industry has intensely advanced throughout the world, in turn changing the principles that incorporate the practice and culture of nursing practice. Altering the model of care to a patient-centered mode signifies an organizational culture shift and requires the participation of executives at the senior level (Cliff, 2012). To practice this care to provide the best care possible, it goes beyond the nurse to all healthcare professionals and senior leadership. The days of patients and nurses following a physician’s order without favor to care has now loaned themselves to more of an interdisciplinary approach to practice. Though, it is encouraged that the patient makes decisions for themselves, after receiving the proper education and information on their condition. Part of the patient-centered care is to be the patients’ advocate, by letting them know you are there for them when they are unable to speak and advocate for themselves and what is in their best interest. That goes in hand with educating them on “self-management of care, health literacy, patient, and family education through nurse-patient communication and interaction (Finkelman & Kenner, 2016, p. 271).”

An article written by Robert Hanks (2012b) from The University of Texas at Health Science School of Nursing titled “Practical Approaches to Patient Advocacy Barriers” highlights the key components of the nurse’s responsibilities regarding patient advocacy. Dr. Hanks (2012b) determined that “only the patient can decide what is in the patient’s best interest and the role of the nurse is to then support the decision-making process.” A therapeutic relationship and effective communication between the nurse and the patient is essential to ensure quality of care. The nurse must support the patient in making their own decisions pertaining to their care, speak on behalf of the patient to communicate the patient’s choices for care, as well as act

Nursing is an age-honored tradition and plays one of the most important roles in the healthcare environment. Nurses are essential to patient safety and play a key element in patient advocacy. Unfortunately, a changing economy and declining finances have created a shortage of nurses in the United States (US). Legislature allows citizens of the US to affect change in order to adequately meet the needs of its people. Therefore, it has become necessary to create a bill that speaks to the nursing shortage in the US. The National Nursing Shortage Reform and Patient Advocacy Act (§ 864, 2015-2016) addresses the current shortage of nurses in the United States. Within the bill are specifics in regards to acceptable nurse-patient ratios, the role of nurses as patient advocates, and mandates regarding job security and licensure

The role of the Advanced Practice Nurse has become a worldwide trend and is constantly being explored for its usefulness in other healthcare services such as policies (Schober, Gerrish, McDonnell, 2015). The contribution that nurses can contribute to policies, policy development and it’s implementation is colossal (Grady, 2016). The Institute of Medicine’s (IOM) recommendation in 2010 was cited, “Public, private, and governmental health care decision makers at every level should include representation from nursing on boards, on executive management teams, and in other key leadership positions.” It was further stated that nurses have both the knowledge and skills to bring their practice insights into theory and policy development. The IOM’s

There are over three million nursing professional in United States and they make the largest segment of nation’s health care workforce. Nurses can play a vital role in helping to realize the objectives set forth in the 2010 affordable act, legislation that represents the broadest health care overhaul since the 1965 creation of Medicare and Medicaid program (IOM 2010). Due to the restricting barriers nurses were not able to respond effectively to the changing health care systems. In 2008, The

It is undeniable that nurses are continually asked to make a multitude of decisions while caring for their clients. Decisions made by nurses influence the effectiveness of their care. They impact patients’ lives and affect their experiences within the health care system. Understanding how nurses make decisions is important to facilitate further learning and to help them generate conclusions that are the most effective. Research in this area will also have an impact on how new nurses are educated to make decisions. Theories used to guide this research will shape the future of education and make the decisions made by current nurses more in effectual. This paper critiques the use of Hammonds cognitive continuum theory to guide

Changes in the Health Care System and the Practice of Nursing have become complex. Technological changes, complicated client needs, short hospital length of stay, and departure from acute care to community based care, all these changes have underscore the need for professional nurses to think critically in order to provide safe and effective client care. A better educated nursing workforce can provide good health education to patients and their families. The affordable care of 2010 has required the need for nurses to expand their role of practice to meet complicated patient demands. This has prompted the Institute Of Medicine to review the “Future of Nursing, Leading change and Advancing Health”. {Creasia & Fribery,2011}