Management in Nursing - Essay Example

? Management in Nursing Discuss why absenteeism and turnover in nursing are costly to the organization Nursing absenteeism and turnover is a serious issue impacting the operation, performance and profitability of healthcare organizations and places a continual strain on healthcare institutions. Some of the factors that drive rates of absenteeism and nurse turnover include perceptions of work burdens, lack of role clarity, low wages and benefits, lack of trust and collaboration with colleagues, poor communication with management regarding critical issues, and absence of career opportunities (Rowland and Rowland 1997, p.530). Absenteeism and turnover negatively impacts on the healthcare organization’s bottom line in several ways, which include reduced quality of patient care, enhanced contingent staff costs, enhanced staffing costs, loss of patients, and enhanced accident rates. Costs may stem from replacement costs associated with the turnover. Turnover will require hiring replacement staff, which incorporates recruitment costs ranging from advertisement placement, and costs flowing from payments to employment agencies. Absenteeism may as well have an indirect cost implication as the new recruits will require training in the facility’s policies and work procedures. The higher the turnover level, the more training required, and subsequently the higher the training costs that the organization incurs. Similarly, the recruits’ unfamiliarity with the organization’s policies and procedures may render them less efficient and less productive (Rowland and Rowland 1997, p.533). Furthermore, high rates of absenteeism and turnover may yield extensive periods of understaffing; the “short” staffing conditions may force the existing staff to work overtime, which is comparatively more expensive. High absenteeism and turnover rates could be detrimental to patient’s health and wellbeing owing to disruption in continuity of care and personal relationships between nurses and patients. While it may be essential to highlight that low levels of turnover may be beneficial as they mirror the adjustment of an organization to its workforce and vice versa, extensive absenteeism and turnover is costly, as well as disruptive to the organization’s functioning. # 2 Providing privacy for patients is an important consideration for health service planner and providers. What factors should be considered in regard to privacy when providing nursing care? Medical privacy is an essential consideration for health service providers as it influences practice. Individuals may avoid treatment in case they are not confident that the information about them will remain confidential. Similarly, patients who seek treatment may withhold critical information out of concern for privacy. Patients have reportedly engaged in behaviors fashioned at protecting their privacy such as avoiding their regular doctor, requesting the healthcare personnel not to record their health information, or “fudging” diagnosis (paying out of pocket in order not to file insurance). This may be detrimental as it may prevent patients from receiving full and appropriate treatment (Douglas, et al. 2009, p.257). Guaranteeing privacy may remedy these concerns, besides promoting effective communication between physicians and patients, enhancing autonomy, and averting economic harm, discrimination, and embarrassment. In an institutional setting, healthcare professionals (in this case nurses) may be anxious on matters regarding privacy and confidentiality as they have an obligation (moral) to protect the rights of patients entrusted to their care. This duty heralds patient-nurse relationship as one of the supporting factors that should be considered. There are a several factors that apply with regard to privacy when availing nursing care such as individuality and diversity, as individuals have their own distinct values, attitudes, beliefs and preferences. The most significant factors supporting privacy hinge on social relationships and the physical environment (Kilpi-Leino et al. 2000, p.93). The internal factors on privacy to be considered when availing nursing care include the patient’s age and subject’s sense of privacy as molded by his or her values, beliefs, and cultural heritage. Patients have distinct cultural preferences, which influence perceptions on space and distance, eye contact, touch, and communication. The moral concern for privacy demands constant vigilance against unnecessary monitoring, examining, and questioning of clients. The lack of physical space can also be regarded as bearing a restrictive effect on privacy. # 3 Discuss the importance of policy, protocol and procedure manuals in hospital wards Procedures refer to detailed, step-by-step instructions detailing how to undertake a certain task. Policies, on the other hand, describe the rules of an organization. Procedures mainly describe in detail the manner in which a policy is translated into action, while a protocol detail a series of steps that the medical personnel should take in accomplishing a certain task and are likely to incorporate issues of quality, risk management, complaints procedure, clinical governance, health and safety, harm minimization, and confidentiality (Fisher 2005, p.20). Policies, procedures, and operational protocols are subject to incessant processes of development and appraisal. Policies, procedures, and protocol all play a role in the overall efficiency and effectiveness of an organization by availing concise operational standards for the highest possible quality of patient care. Policy, protocol, and procedure manuals in hospital wards are essential in making healthcare facilities safe from disasters and adverse situations such as medical errors. Policies and procedures reduce risks of inconsistency in patient care to the lowest level reasonably practicable. Operational protocols and procedures within healthcare facilities seek to safeguard quality of care, and are crucial for the wellbeing and safety of patients, staff, and visitors (Fisher 2005, p.21). Policies, procedures, and operational protocols within a hospital ward seek to guide and inform medical personnel of their rights, but most importantly their responsibilities. Policies and procedures are essential in guiding medical personnel in performing their roles efficiently and professionally. Policies, procedures, and protocols avail a guideline and a reference to the healthcare personnel in key aspects of their responsibilities, as well as what actions to take when certain situations arise. This aids in ensuring that there is consistency of approach (standardization) by all healthcare personnel when certain incidents arise (Fisher 2005, p.22). All care setting such as hospital wards feature policies and policies to ensure and guarantee implementation of quality practice. # 4 Identify which of the following models of care is the most versatile in the terms of 'skill mix': Functional/ task nursing Team nursing Total patient care. In your response define the term skill mix and present a justification for the Model of Care selected. The term “skills mix” can refer to the mix of posts within an establishment; the mix of employees in a post; the mix of skills available at a certain time; or the combination of diverse activities that comprise each role, instead of combination of diverse job titles. An optimal balance of skills mix can aid in attaining better patient outcomes and satisfaction, besides minimizing cost (Buchan and Dal 2002, p.575). Functional nursing refers to nursing modality that is task-oriented with nursing function assigned to each worker. For instance, a registered nurse may be responsible for giving medications, while another nurse is responsible for admission and discharge. Functional nursing hinges on the efficacy model and apportions nursing work into functional units. Team nursing encompass use of team leader and team members in availing various aspects of nursing care to a group of patients. In team nursing, medications may be given by one nurse, while physical care is given by a nursing assistant under the supervision of a nurse team leader. Team nursing is grounded in philosophy in which groups of professional and non professional personnel work together in identifying, planning, implementing and evaluating comprehensive patient-centred care. Total patient care delivery model infers a model in which a professional nurse is accountable to avail, and coordinate the care of a patient or group of patients as assigned during the working hours. The model reinforces nursing care based on the needs of patients, their families, and significant others. The team approach is the most appropriate organizational approach as it delivers versatility in skills mix. Skill mixes incorporate experienced and specially qualified nurses to nursing orderlies (Buchan and Dal 2002, p.578). The model allows the medical personnel to work together toward a common goal. The model avails qualitative comprehensive nursing care. Team nursing permits members to play a part in their own unique expertise or skills. # 5 Discuss the important avenues of governance in relation to health services Governance in healthcare facilities infers systems for enhancing the standard of clinical practice. The overall tenets of governance typically incorporate diverse aspects such as respect for individual rights, fairness and impartiality, transparency, and democratic accountability. A cross-case analysis indicates several common governance challenges that confront healthcare facilities, namely: making health information more transparent, available and useful; empowering clients in order to offer input on services and quality; embracing stewardship for accountable utilization of resources, service provision, and policy formulation and implementation; reinforcing regulatory capacity to oversee both public and private providers, and instituting and maintaining consistent and up-to-date quality frameworks (Scholarly Editions 2012, p.78). Governance within healthcare facilities seeks to ensure that maintenance of optimum standards of care, and guarantee continuous improvement, backed by statutory duty for quality as espoused by regulatory bodies. The core motivation for governance in health services revolve around the expectation of quality will improve incrementally in the future. The elements of clinical governance include openness, education, clinical audit, clinical effectiveness, risk management, research and development. The line of accountability for clinical performance ties with corporate governance accountability in pursuit of aspects such as health improvement programmes, practice development planning, and organizational development plans and strategies directed at enhancing the quality via application of resources. The tool of governance employed in assessing the contours of governance within health services can range broadly depending on scope, intention, and ramifications. There are several governance tools in relation to health services that can be identified; these include economic regulations, social regulations, and statutory regulations. The essential avenues of governance in relation to health services encompass research and development, education and training, clinical audit, and risk management (Scholarly Editions 2012, p.79). The approaches to governance within health services links with key planning processes such as health improvement programmes, person development planning, and accountability agreements. # 6 Explain how industrial instruments support the nursing profession Industrial relations, like nursing profession, can be considered to be both an art and a science. Knowledge and expertise in industrial relations are an essential attributes that nurse leaders and managers should possess. Industrial relations encompass a tripartite process between unions, the government, and employers. Knowledge and understanding of industrial relations avails confidence and facilitates cooperation in highlighting and addressing industrial issues (Daly, Speedy and Jackson 2007, p.135). Nurses usually join professional organizations whose core business incorporates industrial and professional representation of their membership. In addition, the organizations pursue the development of policy in nursing, nursing regulation, veteran’s affairs, health and community services, education and training, occupational health and safety, and industrial relations (such as wages and conditions of employment). Industrial instruments can be essential in facilitating nursing career paths. Nursing awards and agreements mirror the career structure presently in place for the nursing profession by attaching the suitable remuneration to each point in the career path, and to sustain appropriate relativity between the diverse classifications. Nursing industrial instruments encompass all nursing classifications; clinical nurse, nurse manager, nurse researcher, enrolled nurse, assistant in nursing, and nurse educator. Industrial instruments may be employed in an effort to manage nursing workloads into nursing awards and agreements (Daly, Speedy and Jackson 2007, p.136). Similarly, industrial instruments can be employed in an effort to attain safe staffing levels and promote safe practice. This demonstrates that industrial instruments can effectively respond to nursing practice issues. Some of the issues that are prominent in application of industrial instruments pay (award) and career options (nursing career path), professional status, and issues regarding control of the nurse’s workload. Nurses utilize industrial instruments to lobby for better pay (with remuneration linked to experience and qualifications) and flexibility within the workplace embodied by manageable workloads (with clauses on such aspects such as occupational health and safety). # 7 Discuss the meaning and implications of information technology for nursing care Information technology infers both the hardware and software employed to convert transmit, store, protect, process, and securely retrieve information. The utilization of IT in nursing encompass combination of computer science, nursing science, and information science designed at assisting in the management and processing of nursing data, knowledge, and information critical to reinforcing the practice of nursing and delivery of nursing care. Information technology has had significant benefits to the medical field by enhancing healthcare quality, preventing medical errors, minimizing healthcare costs, enhancing administrative efficiencies, decreasing paperwork, and expanding access to afforded care (Kelly 2012, p.142). The present application of information technology in nursing falls into five key areas; storage and retrieval, computing clinical and statistical data, accessing educational materials, facilitating patient care plan, care audit, and conducting nursing research. Information technology enables nurses to retrieve and review the patient’s records according to the nursing diagnosis. Furthermore, IT is used in implementation and evaluation of patient care where computers record interventions, patient information, and facilitate information sharing with other departments. The application of IT in nursing research is certainly advantageous to researchers by saving time, broadening platform, and enhancing the scope of research. IT is used as a tool by nursing administrators as a data management system (Kelly 2012, p.144). In addition, nursing utilizes IT in computerized documentation of medication, administration records, nursing notes, nursing assessments, client care plans, and discharge plans. IT can be perceived as a promising tool for enhancing the overall quality, safety, and efficiency of the health delivery system. The application of IT in nursing has generated diverse attitudes within the nursing fraternity. However, IT has generated positive responses such as facilitating standardized care plans and quality standards (Kelly 2012, p.147). It has enabled the provision of high-quality, safe, and efficient, patient care. Moreover, IT has been integral in enhancing working conditions for nursing practice. # 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. Scope of practice infers the activities that registered nurses are educated and authorized to perform. A registered nurse scope of practice is established by the regional college or association, as well as authorities (government) responsible for health care. The regulations outline that registered nurses may practice nursing. Nursing in this case refers to health profession in which an individual renders the following services like healthcare for facilitating, maintaining, and restoring health; prevention, treatment, and palliation of diseases and injuries via assessment of the health status, planning, evaluation, and implementation of interventions, as well as coordination of health services. Overall, clinical practice, administration, education, and research are also considered as an essential part of practice for registered nurses (College of Registered Nurses of British Columbia 2012, p.5). Registered nurses employ their knowledge, skills, and judgement to carry out diverse roles and responsibilities such as coordinating, supervising, monitoring, and evaluating the provision of health services. Registered nurses (RNs) usually employ nursing knowledge and judgement in assessing health needs and providing care to patients. Registered nurses facilitate interventions within a range of settings that require considerable scientific and professional knowledge, skills, and clinical decision making (College of Registered Nurses of British Columbia 2012, p.6). Similarly, RNs may utilize their expertise to manage, teach, evaluate, and conduct research within nursing practice. Skill mix models may incorporate registered nurses, including clinical nurse specialists. Another model may encompass a combination of RNs, enrolled nurses, or other categories of unlicensed personnel such as assistants in nursing, or personal care assistants. Registered nurses mainly practice autonomously and in partnership with other healthcare personnel in performing nursing functions. In addition to being nursing leader in the provision of patient care, RNs also engage in the provision of direct care and case management. RNs are participants, developer, and leader in quality improvement activities directed at enhancing patient care. # 9 Describe key strategies for managing nursing workload and time management practices Nurse workload refers to number of patients cared for by a single nurse (patient-to-nurse ratio). Nurses often face several conflicting challenges embodied in balancing the quality of care versus quantity of patients, prioritizing between elective and emergency caseloads, besides balancing administration and medical responsibilities. Effective management of nursing workload avails better patient care and safety and enhances job satisfaction for the nursing professionals (Clark 2009, p.104). The strong relationship between nursing care and patient outcomes has obliged nurses to define, describe, measure, and cost the nature of their work. Nurses can monitor workloads through the application of information systems combined with quality improvement activities that facilitate the three core elements of quality, skill mix, and cost of nursing care (Clark 2009, p.106). Undoubtedly, nurses should perceive technology and health informatics as enabling features of practice and managing nursing workload. Determining priorities and communicating decisions to both patients and staff colleagues are critical in facilitating efforts designed at managing nursing workload. The benefits that can be derived from the effective time management are self evident as it aids nurses to have a clear focus and a sense of purpose. This contributes to enhanced productivity and aids in reducing nursing stress. The dynamic nature of nursing practice dictates that activities and priorities must be both adaptive and flexible. Prioritizing workload is one of the approaches that can be implemented to minimize nursing workload and time management. Prioritizing workload, devoid of external pressures, is highly likely to contribute to the correct decision making. Effective delegation can aid nurses to minimize workloads and enhance time management (Clark 2009, p.107). This is informed by the fact that poor delegation of tasks perplexes, aggravates, induces stress and contributes to probable failure when undertaking a certain task. Taking the time to plan the working shift can enhance efficiency, and should be guided by risk management plan. # 10 Discuss the advantages of an intranet clinical information system into the hospital Clinical information system is an umbrella term applied to a wide range of clinical information technology and various configurations of clinical application components, inclusive of networks such as intranets and extranets. Intranet implementation can be demarcated in areas of communication, managing and distributing information, and application linkage (Dudeck, Blobel and Lordieck1997, p.102). By implementing intranet, a hospital may derive benefits such as enhancing knowledge management, enhancing availability of data and information, enhancing customer satisfaction, saving costs of manual systems, and using the present information systems and their applications. Networks have over the years become an integral part of hospital information system architecture, especially in facilitating information transfer and distribution. Some of the benefits emanating from the implementation of intranet centres largely on enhancing the quality of care, besides improving the working environment and minimizing cost in the long term (Dudeck, Blobel and Lordieck1997, p.108). Studies have indicated a correlation between implementation of intranets clinical information system with cost/savings/productivity, as well as contributing to professionalism and employee retention. Clinical information systems such as intranets also avail convenience, control, speed, mobility, and flexibility to the organization. Other advantages of intranet include aiding as a decision support system, especially in the formulation of policies. Similarly, intranet contributes to improvement of information integrity by minimizing the risk or occurrences of transcription errors and duplication of information entries, which is prominent in paperwork. The implementation of intranet in clinical information system eases access to patient data, thus enhancing continuity of care (Dudeck, Blobel and Lordieck1997, p.106). In conclusion, clinical information system continues to mould the work environment and enhance the quality of care. The implementation of intranet guarantees distribution of high quality clinical data essential for audit, research, and unit management purposes. A hospital’s implementation of intranet must be modular, systematic and planned according to prevailing economic, technological, and organizational aspects of the healthcare facility. # 11 Identify how an individual can cope with the processes of change? The process of change places individuals at the centre of attention, with forces for change battling against an individual’s resistance to change embodied by habits and routines, and aversion of insecurity and the unknown. Some researchers perceive the inability to change (inertia) as essentially flowing from forces at the organizational level such as institutionalized routines and practices built into the organizational structure and culture (Woodward and Hendry2004, p.155). The psychology of change outlines that individuals construct or enact reality in a way that aligns with their initial expectations. In instances in which the change is initiated by outside forces, the window to reject the change may not be apparent. Individuals should perceive change as a means rather than end; an opportunity rather than a threat. Individuals should approach change as a process. There are four decision-making styles that individuals typically follow in developing a coping strategy; analytical, directive, conceptual, and behavioural. Individual analytical coping strategy views change as a challenging puzzle to be solved. In the conceptual coping strategy, the individual is interested in analysing how change aligns with the big picture culture (Woodward and Hendry2004, p.158). The model outlines that the individual is interested in defining what needs to change and why, and would resist change where they feel excluded from the change process. Behavioural coping strategy, on the other hand, the individual pursues to know how everyone feels concerning the changes ahead to make sure that the whole group is supportive of each other and that everyone champions the change process. In the event that the change adversely affects someone within the group, the individual will perceive the change as a crisis culture (Woodward and Hendry2004, p.160). In directive coping strategy, the individual seeks details concerning how the change will affect him or her, as well as pursuing the individual’s role during the process. # 12 It is said within organizations resistance to change can be positive. Explain how resistance to change can be positive. While some resistance to change may be considered as inevitable, the resistance to change in organizations may in essence be positive. Studies have shown that people tend to resist change even in instances in which the change represents growth and development. Resistance to change is a customary response; the attitude towards resistance is essential to successful change. Managers within an organization must accommodate some resistance to change when they are planning to implement change. Indeed, some resistance to change may even be positive since it slows down the speed with which innovation might otherwise proceed (Ford and Ford 2010, p.24). This allows time for people to adjust to the change. Blaming resistance is deficient since it ignores the functional value of resistance. However, resistance can be a vital instrument in the successful accomplishment of change. Executives and managers should not perceive resistance to change as part of the problem of change, but should focus on overcoming it rather than engaging it. Responding negatively to resistance behaviour can dent goodwill, as well as valuable relationships and opportunities to learn how to enhance change implementation. Similarly, managers should perceive change as a form of feedback, which compels managers to reshape certain aspects of change (Ford and Ford 2010, p.25). Therefore, resistance enhances the likelihood of success. Resistance to change can be useful to the successful accomplishment of change in the following ways. First, resistance to change guides managers to focus on the purpose of the change and also aids organizations to enhance the change plan. Similarly, resistance to change is a vehicle that can be employed to gain people’s involvement in the change process. Resistance to change can be appreciated as a form of committed expression; a tool that can be productively engaged. Resistance to change completes issues from the past, besides aiding in clarification of objectives and strategies. # 13 Briefly describe key features of Kurt Lewin's 'Force Field' model for change Change is a perpetual feature of organizational life and the capability to manage it can be perceived as a core competence of successful organizations. Social psychologist Kurt Lewin advanced a “force field analysis” model (1951) that details that any current level of performance incorporates a state of equilibrium between the driving forces and the constraining restraining forces. The driving forces of change are mainly positive, reasonable, logical, conscious, and economic. The restraining forces, on the other hand, are mainly negative, emotional, illogical, social/psychological, and unaware (Burnes 2004, P.309). Both sets of forces are apparent and should be considered when reacting and dealing with change, or managing change. Force field Analysis Restraining forces (against change) Current equilibrium Driving forces (for change) Enhancing the driving forces may not be enough for change since the restraining forces remain in place, and as long as they remain entrenched, it becomes complicated to use the driving forces. Hence, unless both the driving and restraining forces are in equilibrium, a form of yo-yo effect results; a change and then reversion back, and then a change, and then a reversion back, et Cetera (Burnes 2004, P.312). Lewin’s Change Model The first step details unfreezing in which the main task incorporates minimizing strength of forces, which sustain the present equilibrium. This step encompasses reducing the forces that maintain the status quo and dismantling the present status quo. The second step encompasses transition or developing fresh organizational values, attitudes, and behaviours essential in propelling the organization structure and process changes and development techniques. Lastly, the third step entails refreezing (crystallizing and the adaptation of ownership to the new changes) whereby the core task details stabilizing after effecting changes (Burnes 2004, P.315). This is critical in gaining a fresh equilibrium since the organization may revert to previous ways of undertaking things at this point unless the fresh changes are reinforced via freezing. # 14 What is 'Reality Shock' and how can it be prevented? Reality shock infers the shock like reaction of new graduate nurses the moment they realize that the work situation for which they have been prepared, does not align with the ideals they had hoped. This reaction is orchestrated by the discrepancy between the culture in the educational setting, and work setting (Masters 2009, P.134). Reality shock emanate largely from incongruity in expectations. Some of the expectations that new nurses may possess include the capacity to execute and manage care, expertise in technical skills, and ability to carry out work assignment in a timely manner. Nevertheless, many new nurses become discouraged and upset after realizing that real life practice could be considerably different from the training they received at school. The conflict may stem from role perception, especially bureaucratic and professional conceptions. The disillusionment may constrain their capability to meet the expectations and may even prod them to quit nursing practice altogether. Adjustments begin to occur as the graduate nurse adapts to the reality of the practice of nursing. There are four phases of adaptation to reality shock as defined by Marlene Kramer (1974), namely: honeymoon, shock and rejection, recovery, and resolution and bicultural adaptation. Some of the strategies that nurses can utilize to minimize reality shock include admitting that reality shock does indeed exist. Reality shock is part and parcel of the passage from novice to experienced nurse and is a normal transition process. Nurses should make the most from the in-service training program in order to develop competence and confidence (Masters 2009, P.135). Other strategies that graduate nurses can utilize in coping with reality shock include being flexible, finding a mentor, asking questions, time management and keeping a time log, being aware of self and job, having adequate knowledge on the provision of safe care, talking to colleagues, sharing feelings and experiences. # 15 Explain a process of organizational evaluation Organizational evaluation refers to a systematic approach directed at enhancing employee and organizational effectiveness via conscious interventions in laid processes and structures. Through organization evaluation (assessment), the effectiveness of an organization evaluated based on its functioning, problems and achievements from behavioural and social system points of view. Organizational assessment encompasses evaluation of variables concerning models of organizational behaviour and effectiveness (International Development Research Centre 2002, p.131). Evaluations aid in identifying whether the organization is adapting to new environments, changing technology, or changes in other external variables. Similarly, organizational evaluation aids in identifying areas which need improvement, modification, or reinforcement, as well as diverse modes to fulfil the needs of the clients. Organizational evaluation is essential as it represents sound professional practice, avails a basis for organizational learning, and key to the development of evidence based practice. Depending on the objectives of the evaluation, assessment may spotlight economic impact, basic evaluation, impact evaluation, analytical evaluation, operative evaluation, and personnel evaluation. There are several evaluation models; pre-evaluation, goal based model, realistic evaluation, experimental, constructivist evaluation, contingent evaluation, and action learning. The process of organizational evaluation takes a number of steps/phases, which include problem identification; data collection; diagnosis; planning and implementation; evaluation and feedback (International Development Research Centre 2002, p.132). Effective assessment of the performance of any organization requires analyzing the situation with respect to some critical dimensions. Some of the steps involved in organization assessment include outlining objectives of the assessment exercise, evaluating the size and nature of the organization, evaluating potential users of the assessment results and recommendations, and evaluating the organizational model on which the evaluation methodology is to be based. Other steps include assessing the framework for conducting the assessment exercise, selecting methods of collecting data and methodology for conducting the assessment practice, and reviewing results/findings and developing recommendations. Organizations should also develop and implement an action plan. References List Buchan, J. & Dal Poz, M. (2002). Skill mix in the healthcare workforce: Reviewing the evidence, Bulletin of the World Health Organization 80 (7). pp.575-580. Burnes, B. (2004). Kurt Lewin and complexity theories: Back to the future? Journal of Change Management 4 (4). pp.309-325. Clark, C. (2009). Creative nursing leadership and management, London, Jones and Bartlett. pp.104-108. College of Registered Nurses of British Columbia (2012). Scope of practice for registered nurses: Standards, limits, and conditions, Vancouver, College of Registered Nurses of British Columbia. pp.5-6. Daly, J., Speedy, S., & Jackson, D. (2007). Nursing leadership, Marrickville, Elsevier Australia. pp.135-138. Douglas, M. et al. (2009). Standards of practice for culturally competent nursing care: A request for comments, Trans-cultural Nursing 20 (3). pp.257-269. Dudeck, J., Blobel, B. & Lordieck, W. (1997). New technologies in hospital information systems, Oxford, IOS Press. pp.102-108. Fisher, A. (2005). Health and social care, Oxford, Heinemann Educational Publishers. pp.20-22. Ford, J.& Ford, L. (2010). Stop blaming resistance to change and start using it, Organizational Dynamics 39 (1). pp.24-36. International Development Research Centre & Inter-American Development Bank (2002). Organizational assessment: A framework for improving performance, Washington, International Development Research Centre. pp.131-135. Kelly, P. (2012). Nursing leadership & management, New York, Delmar. pp.142-147. Kilpi-Leino, H. et al. (2000). Patient’s autonomy, privacy and informed consent, Oxford, IOS Press. pp.93-97. Masters, K. (2009). Role development in professional nursing practice, London, Jones and Bartlett. pp.134. Rowland, H. & Rowland, B. (1997). Nursing administration handbook, Gaithersburg, Aspen. pp.530-534. Scholarly Editions (2012). Issues in healthcare management, economics, and education: 2011 Edition, Atlanta, Scholarly Editions. pp.78-79. Woodward, S. & Hendry, C. (2004). Leading and coping with change, Journal of Change Management 4 (2). pp.155-183. Read More