Fifteen Questions on Nursing - Essay Example

Discuss why absenteeism and turnover in nursing are costly to the organization. Absenteeism and turnover in nursing are costly to the organization because nurses play a significant role in the delivery of patient care (Hunt, 2009, p. 3). The cost of losing one nurse has been estimated at twice the annual salary of one nurse. All in all, cost to healthcare for nursing turnovers registers at about $15 million a year (Hunt, 2009, p. 3). Nursing turnover has also a negative impact in terms of the quality of nursing care which is often significantly decreased; such decreased quality also implies increased length of hospital care. Hospitals also report that they have had to turn away patients to other health facilities because they did not have enough staff to care for these patients (Hunt, 2009, p. 4). Hospitals have also been forced to consider contract nurses to fill in nursing shortages caused by turnovers; this often costs twice as much as nurses employed by the hospitals. Nurse turnover has also been known to increase shortage in staff which has then led to increases in the workload of the remaining nurses. This has then created high levels of stress and exhaustion during work and in turn, an increase in the probability of medical errors (Hunt, 2009, p. 4). Eventually, many nurses end up quitting and choosing other careers in order to get away from these difficult work conditions. High levels of nurse turnover have also created an unstable workplace which then has negatively affected the retention of other health professionals. The cost of recruiting, hiring, and training new nurses has been increased by high turnover rates. The hospitals have also found themselves hard up in trying to recruit new nurses because of the unfavourable stories shared by other nurses regarding the work conditions of the nursing profession (Hunt, 2009, p. 3). Accidents and absenteeism have also increased in incidence in the workplace. Accidents are caused by work stress and exhaustion. Reduced work enjoyment and fulfilment have also caused frequent absences. 2) Providing privacy for patients is an important consideration for health service planners and providers. What factors should be considered in regard to privacy when providing nursing care? There are various factors which must be considered with regard to privacy of patients in the provision of nursing care. First and foremost, nurses and patients sometimes do not clearly understand the difference between privacy and confidentiality. Not knowing what privacy and confidentiality makes a health provider likely to abuse such practices. Nurses sometimes do not know that privacy refers to the right of individuals to control access to their information; on the other hand, confidentiality refers to how nurses treat private information once it has been revealed to other people, including themselves (Erikson and Millar, 2005). This privacy is now difficult to protect because of the current practices of digital and electronic technology, including electronic health records. These forms of technology are more difficult to secure and as such securing the privacy of patients is also more difficult. Nurses and other health professionals may sometimes be careless in accessing information about their patients that they allow such information open to other health professionals who are not part of the patient’s care team, and to other individuals in the hospital (Erikson and Millar, 2005). The current practice of using electronic mails and charting is also vulnerable to errors with mails and messages being sent to the wrong party or being read by the wrong party, thereby violating the privacy of the patient. Electronic information can also be sent easily to other care providers and this limits the privacy of the patient, limiting his ability to prevent his personal and medical information from being shared to other health professionals (Erikson and Millar, 2005). Health professionals themselves have become complacent in their duty in securing their patient’s confidentiality. They often discuss patient cases with their colleagues on corridors, easily overheard by anyone within hearing range. Patient information is also thrown haphazardly in trash bins, un-shredded and easily accessible to other individuals. As a result, patient’s privacy is not adequately secured. 3) Discuss the importance of policy, protocol and procedure manuals in hospital wards. Policies, protocols, and procedure manuals are an important tool in hospital wards. They serve as guidelines for the health professionals in the conduct of their duties. These manuals specify the mission, objectives, and vision of the organization – guiding the actions of the employees and the administrators at all time. They also serve as standard practices for the health professionals to easily refer while carrying out their duties and responsibilities. These manuals also serve as guidelines for hospital administrators in the assessment, evaluation, and monitoring of employee actions and activities. These policy manuals also provide procedures for the management of hospital issues and grievances. Once set, these guidelines cannot easily be changed without proper notification given to all parties concerned. The employees are therefore assured that they can easily refer to the procedures in the manual to seek redress for their grievances. Moreover, the hospital administrators can also easily refer to the guidelines and procedures in the hospital manual to correct and to address employee behaviour and missteps. These manuals therefore help provide order in the hospital processes. It serves as prior notice to all hospital employees and administrators. In other words, they help ensure the application of the due process law, as well as the equal protection of rights. There may be different types of hospital manuals. The most common and most standard manual would be the human resources manual. This manual would specify hospital policies in relation to the management of hospital personnel, in relation to the following functions and concerns: dual employment, compensation, leaves of absence, emergency loan, absences, training policies, nepotism, separation, discipline, demotion, sexual harassment, workplace diversity, workplace violence, disability, civic responsibility leaves, sick leaves, holidays, holiday pay, maternity leaves, and similar other concerns. Other manuals also specify and describe the organizational structure. This structure would specify the hierarchical authority in the hospital, and detailing the functions of all members of the organization and who the members can approach for their concerns. Policy and procedure manuals also specify performance management. Such a manual would detail employee rights, duties, and roles in the organization, as well as their possible liabilities. 4) Define the term ‘skill mix’, and explain why ‘team nursing’ is ‘skill mix’. Skill mix is defined by Nerrsling (1990, as cited by Clark and Copcutt, p. 196) as “the balance between trained and untrained, qualified and unqualified and supervisory and operative staff within a service area as well as between staff groups”. In effect, skill mix is the mix of skills, mostly between those who have been adequately trained in the practice and those who have no adequate training. It is a broad term which can also refer to the mix or combination of work responsibilities or the differentiation of roles among the staff members. Most skill mix practices and applications now refer to the skill mix between the doctors and nurses (Buchan and Calman, 2004, p. 3). Skill mix also refers to team nursing because team nursing includes the combination of skills from the trained to the untrained or from the experienced to the inexperienced nurses. Skill mix may also require the combination of nursing skills, including the registered nurses, clinical nurse specialists, the enrolled nurses, the ward assistants, and the personal care assistants (Duffield, et.al., 2005, p. 14). Skill mix and team nursing have similar qualities because they may also arise due to the same financial reasons and considerations. Nurses comprise the largest work force in the health care industry and the combination of their skills is essential in the delivery of adequate nursing care. Team nursing is also skill mix because the combination and the coordination of care and nursing skills by the different nurses necessarily entail the mixing of skills (Duffield, et.al., 2005, p. 14). The team of nurses usually have different functions and skills set, and they also have varying years of experience. Throughout the years, they have honed these skills, and skills mix allows for the same coordination and combination of skills within the practice, even those who are less skilled or even the less experienced. 5) Discuss the important avenues of government in relation to health services. 6) Explain how industrial instruments support the nursing profession. Industrial instruments have assisted in controlling and managing workloads. These instruments may serve to be labour-saving devices and make the workload lighter and easier for the nurses and ultimately assisting in the patient’s recovery as well. Industrial instruments help provide faster and more efficient ways to carry out patient interventions, and they produce the same and sometimes even better and more accurate results from the patients (Daly, 2004, p. 136). Industrial instruments, in effect, help ensure that nurses are able to care for patients in the fastest and the most efficient way possible. As a means of managing the workload, it also helps redistribute the interventions without having to burden nurses for such interventions. In other words, it helps also deal with the nursing shortage. Industrial instruments also help provide safe staffing levels (Daly, et.al., 2004, p. 137). Since the work is efficiently carried out via industrial instruments, fewer nurses are needed to carry out nursing tasks. In the end, these nurses are able to care for other patients who have more immediate human concerns. The safety of nursing care has also been improved with the use of industrial instruments. These instruments are more mechanical and less prone to errors, thereby promoting patient safety and accurate nursing care (Daly, et.al., 2004, p. 127). They make possible the safe and accurate delivery of medication; and also ensure the accurate and timely monitoring of patient condition and vital signs. Industrial instruments have become a normal part of nursing care and the nursing profession has already fashioned its practice around these industrial instruments. These instruments support and promote nursing care by helping the nurses accomplish all the necessary tasks for the patients in the most efficient time and the most efficient means and methods possible. In effect, these instruments prevent medical errors, medical issues, and delays in the administration of care. 7) Discuss the meaning and implications of information technology for nursing care. Information technology has become an indispensable part of our lives. People withdraw money from ATMs, they download music from the internet, they buy and sell items on eBay, they email each other, they send text messages to each other and in the health care industry, information technology has infiltrated as well. Information technology has modernized the health care industry. It has incorporated various innovations into the nursing practice which have served labour-saving purposes and have made the practice easier and faster to carry out (Royal College of Nursing, 2006, p. 3). Evidence-based practice has been considered the best means of securing the best type of health care delivery. And the best way of keeping up with the ever changing knowledge base is to use IT. Information technology gives nurses immediate access to the information needed, including recent research and guidelines for the practice (Royal College of Nursing, 2006, p. 3). Information technology also helps provide an easy and convenient access to new developments in the practice. Patients would also have access to the same type of information, and as some practitioners do not consider this favourable for health care, the nursing practice considers this a welcome aspect of IT. It empowers patients and gives them the necessary tools to be engaged in their care. It also helps nurses explain to patients about their illness and the interventions needed in order to secure their care (Royal College of Nursing, 2006, p. 4). IT can also provide advanced and sophisticated decision support processes, like those seen among nurses working in NHS Direct, NHS 24, in the walk-in centres and Out of Hours (OOH) centres (Royal College of Nursing, 2006, p. 4). IT can also assist in the efficient management of chronic disease patients. These patients usually have various physiological signs which need monitoring and IT helps ensure that all these signs are adequately and efficiently monitored. This efficient means of monitoring also ensures quality and timely care for the patient. 8) Explain what constitutes a Registered Nurse’s scope of practice. Discuss the role of the Registered Nurse in an environment of varying skill mix. There are various elements of registered nurses’ practice. A registered nurse is a nurse who has finished a Bachelor’s Degree in Nursing from an accredited university and has passed the necessary licensure examinations issued by the state or the governing nursing board. Registered nurses function to promote the health of the people, to prevent their illness, and to assist patients in coping with their illness (Bureau of Labour Statistics, 2000). They assist the physicians in the administration of patient care and in carrying out patient orders. They are also advocates and health educators for the patients, their families, and the communities. In delivering direct patient care, their function is to observe, assess, and evaluate symptoms, reactions, and patient progress (Bureau of Labour Statistics, 2000). They administer medications as ordered by the physicians, and assist the patients in their recovery and rehabilitation. They also provide nursing education to the patients, teaching them about their disease and instructing them about the different interventions which have to be implemented in their favour, and the rationale behind each intervention. These RNs also plan and establish a plan of care which is based on the symptoms and diagnosis for the patient (Bureau of Labour Statistics, 2000). They also teach the patients and their families what they can do after discharge in order to manage their disease, to promote recovery, and to prevent relapse. In an environment of varying skill mix, the registered nurse’s role is to coordinate and collaborate with other health professionals, including other nurses. The registered nurse’s role does not and is not supposed to exist in a bubble, it is supposed to be carried out alongside other roles and other skills from other health professionals. It is therefore important for the registered nurse to coordinate with other professionals to ensure that her plan of care and her interventions do not contradict the plan of care of other health professionals. With the coordination of all health professionals, an efficient plan of care can be secured. 9) Describe key strategies for managing nursing workload and time management practices. There are various strategies which can be used in order to manage the nursing workload. Carayon and Gurses (2008) suggest that a human factors engineering approach be applied to manage nursing workload and ensure patient safety. This approach is based on the SEIPS model of work system and patient safety. The first element of this approach is to understand how the work system of the nurses all impact on their workload. Human factors engineers can help develop assessment methods in order to evaluate each aspect of the work system model, as well as the interaction between the different elements involved. These elements may include the interviews, the focus groups, and the survey of workers (Carayon and Gurses, 2008). Once the different elements and characteristics have been identified, the workload can be redesigned with the end goal of reducing the workload. The redesign can follow two basic principles: eliminating the source of the excess workload and compensating or balancing out the workload (Carayon and Gurses, 2008). Another important element of the human factors engineering approach to nursing workload is related to the work system, where any changes in one aspect of the work system can impact on other aspects of the work system in a negative or a positive way. For example, the work hour limitations for physicians have impacted on the schedules of nurses. As a result, nurses sometimes have to work overtime in order to make up for the reduced work hours of physicians (Carayon and Gurses, 2008). There is therefore a need to balance the changes in the system to ensure an efficient management of the workload. In order to implement adequate time management, the prioritization of care and efficient planning must be applied. An easy way of determining which task must be prioritized is simply by asking oneself what would the consequence if the task is not done immediately (University of Nottingham, 2011). It is also important for the nurse to list the activities to be done, to estimate the time needed to carry out the activity, to allow time for the unexpected errors, to prioritize activities, and to assess activities of the day (University of Nottingham, 2011). 10). Discuss the advantages of an intranet clinical information system in the hospital. There are various advantages which can be seen in an intranet clinical information system in the hospital. These advantages take off from the same advantages gained from the use of the internet in almost all our activities. First and foremost, this intranet system can improve the functionality of the hospital information systems. For example, emails can provide support for communication among nurses and physicians (Lenz and Kuhn, 2001, p. 102). Secondly, such technology can also be utilized in order to provide a venue for independent access to various information, including guidelines, electronic textbooks, and similar information. In opening the intranet to the internet, it is possible to direct laboratory results to outside sources which can assist in the establishment of interventions and even diagnoses. Moreover, the hospital intranet communication system can assist in improving communication with other hospitals which can assist in the care of the patient or with whom the patient can be referred (Lenz and Kuhn, 2001, p. 102). Patient records can also be built by linking the different departments with each other – from his entry to the ER to his admission to the ward, including his laboratory results, nursing, notes, physician notes, diet recommendations, medication recommendations, his scheduled medications, his surgery, blood transfusion, his referral to other physicians, and even his future check-up. In so doing, a virtual electronic patient record can be established through the links to the various patient-related documents (Lenz and Kuhn, 2001, p. 102). And, “this is a very straightforward way of combining documents from different sources by simply providing access through one single user interface” (Lenz and Kuhn, 2001, p. 102). This means of relaying information is actually cheaper, yet more efficient for the hospital, and ultimately for the patient. This intranet clinical system allows for the health professionals to coordinate with each other without having to see each other personally. In effect, less time is consumed and more essential tasks are accomplished for the patient. 11) Identify how an individual can cope with the processes of change. Various individuals have different ways of coping with the processes of change. For most people, reality is their anchor to their lives, and changing such reality can often create tumultuous results. Nevertheless, there are ways for people to cope with such change. Based on an individual’s outlook on life, such coping strategies can emerge. For those who are at the surviving level of their lives, they view life in an inexperienced way and are sometimes not capable of understanding that there’s a reason to life (Taylor, 2006). These people are sometimes unable to handle life’s complexities. They may face changes with an intense fear and through a complete withdrawal or even resistance. For these individuals, there is a need to shift their attitudes towards less panicky and extreme reactions to change. For learning individuals, their view of life is that it is structured and it has limits and rules. Change overwhelms and confuses them (Taylor, 2006). In coping with change, they may sometimes react with belligerence and resistance. It is therefore important to teach these individuals that rules can sometimes be bent and that it is possible to do things differently and with a different set of rules. For those individuals who are considered to have competing qualities, their focus is basically on competing and on making money and gaining recognition (Taylor, 2006). They usually enjoy change and sometimes make changes happen in order to be more competitive or to gain more recognition. For those individuals who are described as relating, they see life also as competitive, but they are more focused on partnership and on cooperation. They would likely initiate and welcome change and actively seek it (Taylor, 2006). Finally, for those who are considered to be teaching individuals, they see life in a detached manner and tend to tolerate people and their ideas. They seek change and initiate it, but are not concerned with personal transformations or on implementing change on a deeper level (Taylor, 2006). Coping with change is therefore a relative to each individual, based on personal qualities. 12) It is said that within organizations resistance to change can be positive. Explain how resistance to change can be positive. Resistance to change can be positive and beneficial for the organization. Organizational change often involves shifting conversations and patterns of discourse (Barrett, et.al., 1995). However, these new conversations can have difficulty in competing with existing conversations because they are new and unfamiliar. A challenge for new conversations is on how to be heard long enough for these conversations to take root (Barrett, et.al., 1995). Resistance to change can work in these instances because resistance keeps conversations alive. These conversations can sometimes involve complaints, and yet these complaints helps keeps topic ‘in-play,’ and giving change agents the chance to clarify and legitimize change (Ford, Ford, and Amelia, 2008, p. 370). Resistance is also a possible means of engaging with change and it often establishes a higher commitment to such change. Resistance to change is not always irrational, even if it does not agree with the normal standards of decision-making. Attitudes which are founded on information processing would likely invite scrutiny, and would therefore be much less vulnerable to persuasion. In other words, the recipients of change who are very much committed to the improvement of an organization, but who do not agree with the suggested changes may be involved in the change process by manifesting their concerns (Ford, et.al., 2008, p. 371). Resistance can therefore be used as a tool which would invite people to implement change in the sense that change agents can consider a target for resistance, using such resistance to help implement change. Resistance is also a type of conflict. And considering that conflict has often assisted in strengthening and improving the quality of decisions, it therefore stands to reasons that resistance can also establish a means of improving value during change (Ford, et.al., 2008, p. 371). Conflict and resistance to change is a means by which people can be inoculated to other subsequent changes, and even backsliding. It eventually provides a stronger commitment to change from recipients. 13) Briefly describe key features of Kurt Lewin’s ‘Force Field’ model for change. Kurt Lewin established the force-field analysis model in 1951 and this model established that the state of equilibrium is one where a balance is reached between the driving forces which encourage forward movement and the forces which restrict it. In essence, current equilibrium is seen because the various forces which change it are weighed in by the forces which want to prevent such change (University of Hull, 2011). The favourable forces of change are usually positive or reasonable and those which restrict it are often negative or illogical. These two sets of forces are very much real and have to be considered when managing change or when reacting to change (University of Hull, 2011). In this theory, improving the driving forces is not sufficient to implement change because the restraining forces stay in place and when they do, using the driving forces becomes more difficult. This may be likened to a spring which, when pushed harder is likely to spring harder as well. In effect, unless the driving and the restraining forces are in a balance, a yo-yo effect ensues. There is change, then a reversion, and then a change, and so on and so forth (University of Hull, 2011). Lewin’s model had three steps: unfreezing, moving, and refreezing. First, unfreezing means the reduction of strength of the forces which support the equilibrium or the status quo. Second, moving is about establishing new organizational values and behaviours in order to assist the organization towards, third, refreezing. Refreezing is about stabilizing after the changes have been implemented (University of Hull, 2011). There is a return to equilibrium and status quo as the third stage is reached. This model is sometimes criticized because of its simplicity and because many analysts do not believe that an organization can move quickly towards refreezing. There are also other variables which have to be considered in the application of this model. Lewis justifies all these queries by claiming that refreezing is not meant to be permanent, it is actually only meant to be short-term, but it is important to reach it because an organization needs stability (University of Hull, 2011). 14) What is ‘Reality Shock’ and how can it be prevented. Reality shock is basically the term applied to nursing students initially being fielded in the practice and encountering the clinical reality of the practice. It is the term used to describe the transition from nursing student to registered nurse and the disparity between the theoretical role and the actual reality of the actual work environment (Opsahl, 2011). In order to prevent and to deal with reality shock, a nursing student needs to keep an open mind about the practice; in other words, she must suspend her naivete about the reality of the nursing practice. Student nurses also need to stay positive and to stay away from negative forces (Opsahl, 2011). They also need to improve and master their prioritization skills in order to avoid being overwhelmed by their work. Work can be adequately managed, even when they may number several significant tasks, as long as they are prioritized according to importance. It is also important for students to get and to stay organized (Opsahl, 2011). Student nurses need to make lists, to plan their day and their tasks efficiently and appropriately based on priorities and nursing needs. Student nurses also need to care for themselves in order to ensure that their physical and psychological faculties are functioning adequately. In order to prevent reality shock, student nurses also need to understand that there is more than one way of accomplishing a task (Opsahl, 2011). When newly graduated nurses start to work, they are also walking into an environment where other nurses have gotten used to working things in a certain way. But it is important for these new graduates to note that it is possible to have other new ways of accomplishing things and they must not be ashamed or be afraid to try these new methods for as long as they do not endanger the patient’s life. Finally, these student nurses must also not be afraid to ask for help (Opsahl, 2011). Most of the time, the older nurses are willing to help out the new nurses; it is those who are arrogant enough to think that they do not need any help who may fall into the pitfalls of reality shock. 15) Explain a process of organizational evaluation. Organizational evaluation is an important aspect of organizational management. With evaluation, the efficacy of the organization is assessed in terms of its functions, problems, and achievements in the behavioural and social systems aspect (Food and Agriculture Organization, 2011). Organizational assessment and evaluation includes the measurement of elements which relate to organization behaviour and efficacy. It plays a role in assisting managers in improving the efficacy of their functions and it can also be a tool in securing public support for the research programmes and other organization activities. This evaluation may be ex ante or ex post. Ex ante is carried out before implementation (FAO, 2011). It usually includes an assessment of internal and external consistency plans prior to implementation. The progress of an organization is determined during implementation. It assesses the impact of resources and materials and the execution of activities. Ex post evaluation is carried out after implementation and includes the assessment of results and their impact in relation to the set objectives (FAO, 2011). Various kinds of organizational evaluation may be carried out based on the goals of the evaluation. First, an economic impact evaluation would assess the efficacy of the research results and the organizational techniques in terms of a cost-benefit analysis (FAO, 2011). An impact evaluation, would assess impact in terms of long-term effects on variables which sought alteration through various activities. For example, impact evaluation in a research organization is usually carried out in order to assess the impact of research outputs on transfer of technology and returns to patients or clinical practitioners (FAO, 2011). Basic evaluation covers the part about analyzing the socio-economic and physical aspects which may be improved by research activities. An analytical evaluation would cover the socio-economic aspects of the organization, including its productivity and risk assessment. Operative evaluation would assess efficacy by carrying out comparative analysis between the materials and the resources used, as well as the activities carried out (FAO, 2011). Finally, an evaluation of results would cover quantitative as well as qualitative assessment of research results, including the probabilities of application or adoption. Works Cited Buchan, J. & Calman, J. (2004), OECD Health working papers number 17: skill mix and policy change in the health workforce: nurses in advanced roles, viewed 01 October 2011 from http://www.oecd.org/dataoecd/30/28/33857785.pdf Bureau of Labor Statistics, (2000), Registered Nurses, viewed 01 October 2011 from http://www.umsl.edu/services/govdocs/ooh20002001/71.htm Carayon, P. & Gurses, A. 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