Nursing management III
In the face of rapid changes in the health environment, critical thinking is highly relevant in problem-solving even in a nurse’s professional environment. Consistent with research studies, nurses have been found “to likely use addictive substances due to the accessibility of drugs in the workplace” (Thomas, 54). Although the study also revealed that older nurses are more addicted to alcohol than male nurses, drug dependency as a complex phenomenon can not necessarily be discounted. Finding out a colleague’s probable drug dependency is therefore not a shocking phenomenon because a nurse’s holistic approach at a problem requires her to move toward the situation in a supportive and non-judgmental way. She has however to make sure that her judgments are unbiased and free from hostile thoughts towards the other nurse yet all her findings must be supported by necessary facts.
The necessary assessment tool however she must employ at best is to initiate a discussion about substance dependency between the co-workers. Initially, the drug unit may report complaints of loss of narcotic and habit-forming drugs within the ward occasionally; this is enough bases to warrant an investigation. As a junior nurse, one’s duty is therefore to report to the Ward Manager about the situation. However if one already has the proof of a co-worker’s dependency, it is highly inexcusable not to report the situation. It is “not kindness to overlook a nurse who exhibits symptoms of drug addiction” because the heavy use of one substance leads to the use of others (Thomas, 54). Before long, the problem might be too much to handle and the stigma attached to excessive drug use in the medical profession may in the long run proved useless. Thus a nurse’s decision-making skills are aided by the supportive measure she can extend to her colleague through a proper referral of the other person’s problem to the ward manager and allow others to support the dependent nurse through Peer Assistance or Impaired Nurse Programs.
Delegating and Supervising
In delegating work “which involves entrusting certain tasks to another staff member”; a charge nurse needs to understand that although the responsibility has been assigned, there is no end to her accountability (Nelson, 2006: 6). It is therefore important that tasks are properly assigned “within the scope of a staff member’s ability and practice” (Lippincott, 2005: 718). As the Charge Nurse in this particular unit, the only LPN can be tasked to assume the Medication Nurse’s role and at the same time handle the seriously ill patient with major dressings, parenteral nutrition and controlled analgesia with morphine.
The duty shall however start with the usual data collection and endorsement, with further assessment of each patient’s condition. The day’s duty shall commence with the Nurse Assistants taking all the Vital Signs prior to the delegation of their duties.
Post-Operative Abdominal hysterectomy patients are an increasing burden on the staff because of their unstable condition. The two Nursing Assistants can therefore work to promote ambulation and monitor their needs.
The first Assistant Nurse assisted by the Nursing student who has been taught to handle and move patients can be assigned at least the three (3) hysterectomy post-op patients and the other three 2nd day post-op patients.
While the second Assistant Nurse can handle the remaining two hysterectomy post-op patients who are physically stronger (with stable vital signs) and willing to move about with assistance. She can also take in the five (5) 3rd day post-op patients with the minor assistance from the LPN. The second Assistant Nurse can also seek assistance from the Medication Nurse when needed.
Assuming that the four patients scheduled for surgery have been given pre-op meds the night before as the usual practice requires, the Charge Nurse can handle their minimal needs and going over any legal and documentary necessities immediately prior to surgery.
Since the four patients scheduled for discharge needs minimal supervision, the two Assistant Nurses can share monitoring their progress with the Charge Nurse’s offering the discharge teaching.
Situational Actions for the Charge Nurse
In the order of events, the waiting physician and the patient needing a change of dressing should be attended at best by the Charge Nurse. The Admitting Department should be called and be informed of the current workload in the department. The family member’s complaint can be entertained right after the procedure though. The needs of the patient as reported by the unit secretary can be attended by the LPN who is assigned as the Medication Nurse. After the rest of the responsibilities and needs of everyone have been met, the Charge Nurse shall immediately call the Admitting Department and inform them that they are now ready to take in a new patient. A Charge Nurse who is always ready takes in the responsibility of having herself prepared for a hectic day. She is therefore prepared to have her dinner elsewhere outside the cafeteria when the need arises.
As an important competency, assessment is important in conflict management. When the conflict interferes with ongoing functional relationships at work “the participants must be persuaded to rethink their views” (Roussel and Swansburg, 2006: 206). In this case, a third party can therefore assess the situation and understand the roots of opposition between Maria and Josephine. The boiling antagonism between the two parties spins from a misunderstanding of their workloads that has further branched out into other conflicting issues. It is highly understandable that this misconstruction can be alleviated through positive explanation and understanding of views. A third party also be invited to mediate who can be someone not directly connected with the two opposing parties yet a person commanding respect and authority.
The interdependence of both parties is of vital importance in the workplace, and the continuity of interaction between them needs to be on the level to assure that the maximum level of care is available for the patients under their care. Both Maria and Josephine must therefore be made to understand the importance of minimizing any conflict in their unit. The question of their workloads must be raised with the Charge Nurse who has control over the assignment of duties. They must therefore be made aware that there is no need to raise issues against one another because it is the Charge Nurse who takes into account their different abilities and the assignment of duties commensurate to their qualifications. Conflict can therefore be resolved by way of compromise through “working out into a satisfactory action” resolution through mediation.
Adapting to Change is one major role nurses often encounter in the workplace. While it has been found that a majority of older nurses resist change, the younger ones find it more exciting. Learning how to cope with changes in the workplace and “helping others adapt to change is thereby considered a major role for professional nurses” (Hood and Leddy, 538). As a new nurse in a local hospital, one can be a vehicle for a positive approach to change by empathizing with others yet showing them the necessity of doing things the way they are meant to be done. Without imposing on their senior roles, showing them how to do it through an easier way helps them understand that relevant changes are imposed not to burden them but in fact to help them in different ways.
Oftentimes, nurses resist change because of the “psychological and emotional meaning attached to the old protocol” (Hood and Leddy, 539). Older nurses have a tendency to entertain such feelings of being deliberately left out and continue to refuse adapting to change. This is highly understandable at the beginning. One only needs to understand and show to them the positive side of adapting to change because nurses who are educationally trained will soon psychologically adapt to change in the long run. Other nurses who do not resist change can likewise be tapped by their positive involvement.
Lines of Communication
In the principles of command; “hierarchical relationships are best maintained in order to satisfy others in the organization” (Roussel and Swansburg, 114). It is important to identify and understand the organizational structure of the group in order to identify how communication flows through. Although in many modern nursing organizations, “communication flows freely in all directions”; in some, professional nurses may answer freely with other supervisors (Roussel and Swansburg, 114). However, it is still important to identify if the adjoining unit in question is covered by the span of control and authority of this specific medical/surgical supervisor. If it is within her responsibility, she has every right to know about this situation. If not, the best person to report to about this matter is through the charge nurse of one’s own unit.
Total Quality Management
To increase the effectivity of documentation in PRN medications, the recent technological advancement using Information Technology protocols have been designed to help nurses and the medical team correlate judgments and decision more effectively. As a suggestion, this protocol can be assessed and fully implemented because the over-all efficiency is high. Medications disbursed now be traced if indeed they were administered or not. IT records would reveal the efficiency because documentation can be recorded immediately. This protocol according to the Joint Commission Resources (2005) “is a process that has seen improvement which has also shown that the time spent charting or documenting medications electronically was not significantly larger than doing it on paper”.
In the evaluation process, an interdisciplinary team will likely be composed of the PI coordinator, practice committee, audit, management committees depending on the aggregate basis of complaint and severity. In this case, all information gathered will be forwarded to the board of directors if patient complaints have been entertained regarding the scenario. If not, and purely documentation problems were found, the stakeholders are often the clinical leaders and managers along with the supervisors and the audit team along with the committees tasked to conduct the study.
Older nurses ready for retirement often have tendencies of foregoing necessary policies in their institutions. Some cannot tolerate criticisms and “tend to get anxious and frustrated” (Roussel and Swansburg, 454). This is another pitfall for Performance Appraisal raters especially when they lack the skill to manage an appraisal system.
The case of Jane Adams, has indicated her plans for retirement and subsequent refusal to attend programs or workshops. The theory explaining how older workers have lower career aspirations is simply a myth. “Attributes and competencies are not related with age, at least up until they are 70” (Smedley and Whitten, 2006: 186). Jane is most likely feeling unwanted and “passed on”. She therefore needs to know that most hospitals are interested in RN retention specialists which is “an actual global response to achieve qualitative and quantitative change in the society” (Roussel and Swansburg, 454). This knowledge will keep her “on the go” for a new goal in life which is highly achievable for her. She only needs someone who can positively encourage her without sounding authoritative that “jobs are around for her that can increase her chances of getting recognized and gaining bonuses for taking actions related to achievement” (Roussel and Swansburg, 2004: 454).
Hood, Lucy J. and Leddy, Susan (2005). Leddy and Pepper’s Conceptual Bases of Professional Nursing. Philadelphia: Lippincott, Williams and Wilkins.
Joint Commission Resources (2005). Overcoming Performance Measurement Challenges for Hospitals. Joint Commission Resources.
Roussel, Linda and Swansburg, Richard J. (2006). Management and Leadership for Nurse Administrators. Massachusetts: Jones and Bartlett.
Smedley, Keren and Whitten Helen (2006). Age Matters: Employing, Motivating and Managing Older Employees. Hampshire: Gower Publishing.
Thomas, Sandra P. (2004). Transforming Nurses’ Stress and Anger: Steps towards Healing. New York: Springer Publishing.
Nelson, Audrey (2006). Safe Patient Handling and Movement: A Guide for Nurses and Other Health Care. New York: Springer Publishing.