Nursing Management Theory Paper

According to Porter-O’Grady, 2016 et al p 324, our healthcare systems today are at the center of what is considered major change. Much of the change today is directly related to the foundational principles, concepts and associated with complexity in systems and relationships, and an understanding by nurse leader and follower; of what it takes to make meaningful change. Nurse Leaders, registered nurses, advance practice nurses, and other followers, at every level of our organizations must be increasingly aware of meaningful and sustainable changes that improves our healthcare systems (Porter-O’Grady, 2016 et al p 324).

The purpose of this paper is to create a concept analysis and identify a nursing concept that is within a nursing theory. A concept analysis is a process where concepts and their characteristics are researched and clarified. The eight steps on conducting a concept analysis include selection of a concept used in a nursing theory, identification of the aims or purposes of the analysis, identification of possible use of the selected concept, determination of defining attributes, identification of model cases, identification of antecedents and consequences, and lastly definition of empirical referents (Walker & Avant, 2011). The nursing concept selected for this paper is “empowerment” within the nursing profession. The nursing theory from which the empowerment concept was obtained is Kanter’s Theory on Structural Empowerment. In order to empower someone, an individual needs the tools and resources to feel powered. According to Laschinger, Gilbert, Smith, & Leslie (2010), Kanter defines power as the ability to mobilize information, resources and support to get things done in an organization. The role of management is to provide employees with power tools that empower them to maximize their ability to accomplish their work in a meaningful way. Kanter goes on to describe two primary empowerment structures in organizations, first being the structure of opportunity and second the structure of power. The structure of opportunity relates to job conditions that provide

“Nursing is informed caring for the well-being of others” (Swanson, 1993, p. 352). Kristen Swanson’s relationship-based caring theory encompasses maintaining belief, knowing, being with, doing for, and enabling. Nursing is a profession with vast opportunities for growth and development. Each nurse has his or her individual passions; mine reside within obstetrics, women’s health, and nursing leadership. Nurse leaders play an integral role in the success of healthcare organizations. Nurse leaders shape the roles of nurses within their organizations. Nurse leaders seek methods to improve patient care. They also use innovation to gain efficiencies in care delivery and decrease healthcare cost. Many nurse leaders have an ultimate goal to aspire to be a chief nursing officer in a healthcare

There are many challenges facing today’s nursing leaders and managers. From staffing and scheduling, to budget cuts and reduced reimbursements, today’s nursing leaders must evolve to meet the ever changing health care environment. Constance Schmidt, Chief Nursing Officer at Cheyenne Regional Medical Center (CRMC), identified retaining experienced registered nurses (RN) as one of the biggest problems she faces as a nursing leader. She went on to state “Nationally, most hospitals have more than 60% of their nurses with at least 5 years of experience. At CRMC, it’s the reverse. We have more than 60% of our nurses with less than 5 years of experience” (personal communication, March 28, 2014). The two largest factors affecting those numbers are the nursing shortage and nursing retention. The first, the nursing shortage, was identified years ago and has been researched countless times. Some projections indicate the number representing the gap between available registered nurses, and the positions needing to be filled, could be over a million before the end of the current decade. The latter, retention of nurses, is a problem in every health care facility in the nation. Nursing turnover results in both a significant financial cost to hospitals, and a significant impact on the community through its effects on patient outcome.

Implementing a change in practice within these environments can produce anxiety or fear of failure in nurses, leading to a resistance to change. Several studies (Bozak, 2003; Lehman, 2008; Spetz, Burgess & Phibbs, 2012) expounded the need for a concise plan and clear communication between nurses and management when implementing a change of this nature. The use of Lewin’s Change Management theory can support nurses through the transitions and identify areas of strengths and resistances prior to implementing change. Without a framework for guidance, it can be difficult to keep on track.

Staff satisfaction is empirical in retention of nurses in any healthcare setting. Although a slight turnover is necessary to maintain the diversity of ideas, too much of it causes instability that might affect patient and employee satisfaction negatively (Marquis & Huston, 2015). The planned change is to be executed at a small, private hospital (SPH) in Los Angeles with a 200-bed capacity, which offers emergency and medical-surgical services for adults. After a six-week hospital orientation, only 20% of new RNs hired at SPH in 2015 rated their confidence levels at >70% (Appendix A). Out of 32 new hires, 7 left during orientation, and 12 left before reaching 1 year- leading to 41% retention or a 59% turnover (Appendix B). The RN turnover of SPH is thrice the

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

I agree that an organization’s structure plays an influential role in a nurse’s overall satisfaction. In fact, Buffington, Zwink, and Fink (2012) concur stating, “Creating an organizational culture committed to registered nurse (RN) retention is a strategy to reduce nurse turnover” (p. 273). Research reveals numerous hospitals today are restructuring their organizations to try and increase overall nurse satisfaction and retention. This “new recipe for healthcare leadership and organization is needed,” according to Miners, Hundert, and Lash (2015), not only to improve nurse satisfaction, but ultimately to improve quality of care and increase patient outcomes (p. 114).

In the increasingly complex, ever changing environment of today’s healthcare, effective leaders are essential to help drive positive change resulting in increased access to care with positive outcomes for as many as possible. In its 2010 report, The Future of Nursing: Leading Change, Advancing Health, the Institute of Medicine (IOM) recognized that nurses are well positioned to play a key role in the transformation of our healthcare system in the United States (U.S.) (Institute of Medicine [IOM], 2010). In The Essentials of Doctoral Education for Advanced Nursing Practice, the American Association of Colleges of Nursing (AACN) specifically identifies organizational and systems leadership as a core competency for advanced

Nurse leaders are faced with issues or problems on a daily basis that are often expected and sometimes unexpected. It “comes with the territory” so to speak. If there were no issues to solve or hurdles to overcome the necessity of designating a leader would not seem quite as important. Nurse leaders can tackle issues that occur in their work environment using nursing theory to guide them. Nursing theory provides a framework that nurse leaders can use to implement interventions or changes to positively impact the staff they lead. This framework of the theory will set the standards for achieving the desired outcomes and is based on knowledge that is gleaned from practice and/or research.

Belizario, S. (2011, August). Inspiring change. Boosting patient satisfaction scores-and nurses’ morale. Nursing 2011, 41(8), 18-21. Retrieved from: http://dx.doi.org/doi:http://dx.doi.org.proxy.library.ohiou.edu/10.1097/01.NURSE.0000399591.81228.3e.

Nurse turnover is defined as “the number of nurses changing jobs within an organization or leaving an organization within a given year” (Baumann 2010). Retaining nurses is one of the most important issues in health care as its effects range from challenges in human resource planning, to high costs in financial and organizational productivity (Beecroft et al, 2008), to workgroup processes and morale, to patient safety and quality of care (i.e. patient satisfaction, length of patient stay, patient falls, and medication errors) (Bae et al, 2010). Nursing Solutions Inc (NSI) reported the national average turnover rate for hospitals increased from 13.5% in 2012 to 14.7% last year. Nurses working in Med/Surg had more turnover

The purpose of this paper is to provide an introduction, purpose, and rational for selecting a nursing theory. I will describe the theory by identifying the purpose, concepts/definitions, relationships/structure, and assumptions. I will use the Chinn & Kramer evaluation criteria to critique this chosen theory. Finally I will describe a plan for implementing the theory into my practice setting, identifying any barriers and challenges.

The main focus of the theory is motivation, inspiration and empowerment to create changes. It is based on the idea of empowering others to facilitate overall goal. Bennis and Nanus (1985) describe this new leader as a leader who “commits people to action, who converts leaders into leaders, and who converts leaders into agents of change” (p.3).177. According to processes to engage and motivate staff article “Transformational leadership is important for high quality care delivery, and behaviors that nurse leaders inspire, role model and reinforce are instrumental in creating work practice that deliver optimum care”.

According to Sieloff and Raph (2011), nursing management theories are used to describe, explain, predict or prescribe nursing acts. There are a variety of ways to solve a nursing problem or issue, but nursing management theories are specifically designed for issues nurses and nurse managers come across on a daily basis. Hildebrandt and Persily’s theory of community empowerment is a perfect example of how nursing management could overcome the challenges of relocating to a new unit.