The Nurse Journal's Workflow Process

Kurt Lewin's Change Theory consists of three distinct and vital stages, "Unfreezing", "Moving to a new level or Change" and "Refreezing" (1995,Schein). The three step process provides a high level approach to change, as it help us implement a change effort with a framework. Unfreezing will involve finding a method of making it possible for people to let go of an old pattern that was counterproductive in some way. If a structure that is not secure has been in place for a long time, habits, and routines naturally settle in. It has been observed that St.Michael's Hospital nursing staff in M3 have a standard process that has strayed off course when it comes to hand off report. The SBAR sheet and verbal report as stated in the hospital protocol for shift report, is not being applied as stated. Nurses have shown to leave out important information from outgoing nurse to oncoming nurse and have been observed throughout the hallway and nurses station having discussions for hand off report, and a few have not used the SBAR sheet at all. The whole process of hand off report is unorganized and lacks in communication. Unfreezing will get nurses to gain a new perspective on

Workload was described to be heavy, stressful, increase in intensity and overtime hours. As a result 25.8% consider resigning, 20.2% consider retiring and 25.6% consider leaving profession. Another problem that was observed at individual level was poor commitment to care. One of the factors that often limited nurses to provide therapeutic care was the change in nurse to patient ratio. As nurses assignments increase with the increase in the number of patients (i.e. 1 nurse to 6-8 patients) the quality of care provided decreases. Nurses’ ability to maintain safe environment became challenging. As part of caring, nurses also showed decreased amount of time spent with their patient. This eventually led to nurses being less satisfied with their current job. Self – efficacy was often low. Nurses felt that they did not have enough knowledge and skills required for professional practice (Newhouse, Hoffman, & Hairston, 2007). This often led into stressful transition and the ability to care for a patient even harder. New graduate nurses often had difficulty maintaining leadership role. They often felt that they did not have the ability to self advocate and raise their voice to be heard by others. They often feared that they would be over heard and that no one would listen to them (Mooney, 2007).

As a nurse leader, there are many ways to engage staff through various methods of leadership. Creating an environment that values teamwork and communication is a method that would bring about success on the unit through many ways. Teamwork builds trust, creates an environment where the employees are accountable, and sets a moto that everyone is in this together, and no one is left to fend for themselves. In order to have a successful team, there needs to be great communication. Communication skills will be an important asset for the team members to have because it will make the work day flow smoothly and will also keep everyone involved in a patient’s care up to date. Teamwork and communication are needed to provide a positive outcome for the patient; to teach nurses that they are not alone, and that help can be given if they communicate properly; and that patient care and safety is a clear representation of how well a team works and communicates with one another.

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

Bottlenecks in processes can and often do exist in any organization and workplace setting, including in nursing settings. The bottlenecks identified in this case are delivery of service, staff buy in, leadership role, and follow through; though these are all problems for learning and development processes in the nursing unit they are not all equal in their prevalence or their effects. In order to effectively manage the different bottlenecks and the potential remedies for these bottlenecks, accurate and meaningful measurements of certain quantitative aspects of the nurse setting and the identified problems must be accomplished. Statistical analysis is one way to accomplish this measurement and assign varying degrees of significance, attention, and resources to the different areas of concern that arise in this case. In this way, statistical analysis can lead directly to practical action meant to improve knowledge and practice in the nursing unit, not simply providing esoteric and or large-scale interpretations of past data.

The nurse manager stated that her vision for her unit was to have her entire staff be clinically sound and function confidently under adverse client load. She expects upmost teamwork from her staff and expects the unit to operate efficiently with upmost regard for staff and client safety.

The purpose and problem statements are relevant to nursing because a poor work environment can lead to various issues such as: burnout, job disconnect, emotional and physical exhaustion, patient dissatisfaction and poor patient outcomes (Lang et al., 2012, p. 275). This is significant because they want to learn how to improve the environment to avoid nursing burnout and fatigue.

There are many significant reason why there have been numerous issues or complaints in the field of nursing over the past several years. The issue that has been more common over the years is what I would considered to be the most important issue that nurses have to put up with on a regular bases is what effects does the working environment have on nurses that work in the environment they either have to conform to or find a way to put a stop to the issues the working environment has caused. There are positive and negative aspects that effect the working environment in the nursing field, because of the many things that coincide with what goes on in the working environment that is not seen by non-staff members. Among these complaints have been

Amy, I agree with you and can relate to your post. Writing for a nursing journal is not anything that I have considered either, truly I have had no interest. Finding something worthy to write about would be a personal challenge. I too would have numerous things that I would need to work on before considering to write for a nursing journal. Grammar and structure are two areas that would need to be perfected in my writing skills. Some of the articles that I started to read displayed the formal language and monotone, making it hard to hold my interest. I too had a hard time keeping on track finding it difficult to follow. Many times I would just exit out of the article and begin searching for a new one that was more interesting. Journal writings

According to the Joint Commission on the Accreditation of Hospitals (JCAHO) in July 2004 released a Sentinel Event Alert on the prevention of infant deaths. Its database showed that nearly three-quarters of hospitals cited communication break down and teamwork problems as a major reason for these deaths. The practice of teamwork and collaboration as a unit in patient care is especially important for the role as a professional nurse as it can make the job itself easier and more efficient. When teamwork is emphasized and valued in nursing the overall patient outcome is strongly enhanced. It is crucial all team members involved in the patient’s care work together and communicate effectively to reach the common shared goal. With the vast evolution of new knowledge and information in the medical field, patient care is more complex than ever. With such complex patient care, no one health care provider can treat a patient alone, it takes team work and collaboration between the multiple health care professionals involved in the patient care. Communication competencies should be emphasized to students as a vital aspect of a positive nursing environment during their educational experience.

Another strength comprises flexible internal policies which can be altered to provide nurses with better work conditions. At the same time, such weaknesses as the lack of trained nurse managers and poor planning of workload slow down the possible improvements. The organization is open to new opportunities. Thus, it supports the use of health IT such as electronic health record to make the work of nurses less loaded. Moreover, the organization is interested in continuous nurse education, which is beneficial both for nurse employees and the organization itself since it will get well-trained professionals. Finally, the organization is ready to review scheduling policies to reduce nurse fatigue and burnout. Still, there are some threats that can prevent the project implementation. There still is a high risk of burnout because of the necessity to work in shifts and working extra hours. Moreover, the lack of effective nurse leaders may not allow change

The team model allows the utility of nonprofessional nursing personnel such as LPNs and nursing assistants, through delegation and observation by an RN while holding a team leader accountable.( Tiedeman&Lookinland,2004) The focus is to work collaboratively and cooperatively with shared responsibilities, and to some extent accountabilities, for assessment, planning, delivering, and evaluation of patient care. ( Tiedeman&Lookinland,

In home health, the nurses are in the field, in patient homes and they perform their patient assessment, patient care, and documentation independently. Comprehending that the sequence in which each individual nurse performs their work is variable creates an obstacle to redesigning workflow secondary to the fact that there currently is not a standard workflow (Holman et al., 2016). Moreover, in order to create a standard workflow, observation of a statistically significant number of nurses to determine the most common current workflow would be required prior to any redesign.

For instance, management has not communicated effectively the need for the change in hospital’s senior management; therefore, the nursing staff experienced uncertainty and anxiety. Nurses are not conveying messages effectively to management, either. The nurses feel overworked, underpaid, unappreciated, and snubbed, even though they have expressed these concerns to management. Because senior management has not taken action to resolve present issues, a small group of nurses feel their concerns are not taken seriously. Such practices are a threat to building trustful working interpersonal relationships. When developing interpersonal relations in the workplace it is important to cultivate relationships based on trust, commitment or loyalty.

In a health care setting the pressure of providing the proper care shadows over the health care team. A basic health care team is composed of Administration, Doctors, Nurses, and Support staff (receptionists, secretaries, clerical staff, etc.). This team of professionals comes together to provide patient care, but the member that usually spends more time with a patient are the nurses. The nurse is like the head of the team when it comes to patient care because she tells the license vocational nurse as well as the certified nurse assistant what needs to be done towards a patient. A nurse works 12 hour shifts for three days a week they not only provide the care a patient needs but are there for them and their family in a time of physical and emotional situations. It is the demands of the profession that cause such pressure which leads to stress. Stress is like the starting point for depression which can lead to fatigue and adding drug accessibility to the mix can result in drug abuse for nurses. The number one current issue within the nursing culture is drug abuse.