Leadership and Nursing Systems Management - Essay Example

? Changing to Bedside Shift Reporting in the Gynecological Unit CHANGING TO BEDSIDE SHIFT REPORTING GYNECOLOGICAL UNIT Background Leadership Theory of Organization At Highland Hospital, the leadership theory used is transformational leadership, which gains added importance during the change to bedside shift reporting. Transformational leadership at the facility can be seen where nursing leaders and nurses help one another to advance towards an increased level of motivation and morale (Tomey, 2009). Every member of the Gynecological unit at Highland Hospital is a knowledgeable leader with their input and voices being valued and supported by the unit. The nursing staff from the bedside and on up have the capability to make decisions. The hospital’s transformational leaders, via the strength of their personality and vision, have the ability to inspire their followers to change motivations, perceptions, and expectations in order to work towards common objectives (Tomey, 2009). Transformational leadership at Highland Hospital requires that the nursing leaders have clinical knowledge, influence, vision, and strong expertise in professional nursing practice in order for the other nurses to follow them. The transformational leader’s key components are strategic planning, influence and advocacy, and communication, accessibility, and visibility of the leader. Organizational Structure With Highland Hospital holding the lives of patients in their hands, there is a need for them to function precisely in the execution of high quality services at all times. Highland Hospital, therefore, has a vertical organization structure that has numerous management levels with a majority of the nurses involved in low authority, narrow, and specific roles. These different levels are designed in order to ensure that mistakes in one unit, or innovations that are being tried in one unit, cannot hold back the entire hospital in case of emergencies or failure (Tomey, 2009). At the top level are the directors who consist of influential healthcare members and representatives from the local community. The next level is made up of executives, including the CEO, CFO, CIO, chief medical officer, and chief nursing officer. The next level consists of department administrators who are responsible for operational and medical services (Tomey, 2009). Patient care managers form the next level, and these oversee patient care directly. Finally, the service providers are at the lowest level and include nurses and physical therapists. Meeting the Mission Highland Hospital recognizes that everyone has value and is guided by their commitment to leadership and excellence. The Hospital demonstrates this through provision of emotional and physical care for patients and their families, balancing continued commitment to needy patients with highly specialized care for its broader community, creating a working environment that values everyone and offers them the opportunity for professional and personal growth, and fosters a culture of innovation and health science research. Values in Action The four core values at Highland Hospital are service, dignity, justice, and excellence, which guide the actions of its staff. Everyone on the staff is committed to the values indicated and work towards ensuring they are present in their relationship with one another and the patients and their families. Each interaction acts as an opportunity for the staff to serve patients, their families, and one another. Excellence is acted out in their professional development, innovation, accountability, and quality commitment. With regards to dignity, every member of the staff and the patients are valuable members of the community. Finally, with regards to justice, the hospital advocates for structures and systems attuned to the requirements of needy and vulnerable patients. Proposed Change Description and Rationale The shift handover is an essential part of the process of communication among nurses that occurs twice within the gynecological unit nurses’ day at work. On top of the handover and report’s purpose, it is important to acknowledge the report’s meaning to a nurse, which may underlie their willingness during the report to welcome families and patients (Chaboyer & Willis, 2010). The report could have emotional meaning for them as it is a time during which they meet and connect with other nurses and share struggles and distress that they have endured during their shift. In addition, the bedside shift report also acts as a time for the nurses to socialize and come together to share updates about themselves and other colleagues’ personal lives. Therefore, it is important to address the implementation process of a new bedside handover system at Highland Hospital’s Gynecological unit. This system will seek to put the patient at the center of the entire process in care management, while also addressing various shortcomings of the handover system as traditionally carried out (Chaboyer & Willis, 2010). Most nurses in the gynecological unit at Highland Hospital were frustrated because of poor communication during their shift changes. Outgoing nurses were forced to work overtime since it took some forty minutes for them to review the information on patients with nurses on the incoming shift. In addition, patients were also frustrated and dissatisfied with the lengthy process (Chaboyer & Willis, 2010). Some of the staff nurses missed vital information on the patient at the shift report, which led to on duty nurses calling home to the previous nurse in order to get the vital data. Since shift reporting did not occur at the bedside, the patients showed their dissatisfaction because they were not introduced to the nurses on the incoming shift, which caused increased use of call lights for patients. Therefore, the gynecological unit’s nurse manager sought to implement a shift report that was standardized in order to ensure the nurses were at the bedside during the shift report, as well as to improve reported information quality. In order to aid in the creation of this structure, the gynecology department manager went to the bedside nurses directly. This was in order to ascertain that the nurses were more satisfied as they came to work, which necessitated asking for input regarding required information for them to carry out their duties effectively (Chaboyer & Willis, 2010). Since the nurses were afforded a voice in the creation of a new shift reporting standard, communication in the bedside shift report was estimated to take be reduced by ten minutes, which enables the nurses to go home on time (Street et al, 2011). In the twenty-eight bed gynecological unit, there were twenty-one nurses and fourteen had RN qualification; with the rest being healthcare assistants with two to thirty three years of experience. The handover from one shift to the next is carried out as a ritual inheritance that occurs far from the patients’ vision and hearing, for example, at the nursing station or department manager’s office, which excludes participation of patients. This traditional handover involves one-way communication with the outgoing nurse giving relevant instructions and information to the incoming nurse. One feature of this handover was that there was no individual care planning and information on patients was written in nursing notes, patient files, or ward diaries (Street et al, 2011). The verbal shift handover occurred based on information written on the office board, including the medical diagnosis, bed number, patient’s name, and treating physician (Street et al, 2011). Unlike, bedside shift handover reporting, this handover is biomedical-focused, marginalizing aspects of psychosocial care. With a similar reporting style repeated with each shift, the contents sometimes degenerate to statements that are outdated and irrelevant, as well as unrelated to the progress of patients. In additional, they are also judgmental and could lead to omissions during the provision of care. Therefore, it is common for nurses for nurses to be questioned by the department manager or physician, which results in a culture of blame (Street et al, 2011). The patients also feel un-involved in care provision. Havelock’s Steps for change for the Bedside Shift Report Building Relationships In order to change to a bedside-based method of shift reporting, it is important to encourage nursing staff to think about the situation as it currently is and aid them to recognize that change is needed (Germain & Cummings, 2010). In order to do this, there needs to be considerable transformational leadership present in the unit, as well as a sense of direction. Transformational leadership in this case is essential in building relationships in order for the nurses to commit to excellence. Therefore, the first move involved the creation of awareness among the nurses through communicating the changes proposed to the shift report to those who would be affected in order for them to have a shared vision regarding improvement to the system of handover. Goal seeking behavior was demonstrated throughout the relationship-building process using a clear and logical action sequence (Germain & Cummings, 2010). The proposed changes to the shift handover were communicated in advance through several channels of communication, such as staff notice boards and with nurses individually. This led to the nurses being involved in informal discussions through the creation of cognitive dissonance that caused the nurses to search for more information with regards to the new system of handover (Germain & Cummings, 2010). This phase of relationship building and consultation allowed them to discuss and analyze clinical scenarios and benefits, as well as constraints, of the proposal. Group work also helps to identify the problems and make proposals. By using research articles and case studies on the topic, the nurses, were able to discuss the proposals with the administrator, which reinforces the staff’s belief that their present system is problematic and needs improvement. Through building relationships between nurses and with the administrator, the status quo was questioned, enabling the reduction of initial resistance (Germain & Cummings, 2010). Diagnosing the problem The problem’s root cause was identified as the handover model that the nurses used to communicate the information on their patients. Evidence-based findings were used in order to give strength and meaning to the changes being proposed (Germain & Cummings, 2010). Shift handovers at the bedside are an immediate solution to numerous issues that afflict traditional models of handover. Further, it has been advocated that handover at the bedside put additional emphasis on personalized care for patients, while reporting at the bedside is a frequently utilized handover model. This model ensures that patient care is central to the hospital and unit’s activities, rather than relying on verbal information. Similarly, patients who are involved in this model can access information, which, it is thought, leads to a speedy recovery and improved comfort (Germain & Cummings, 2010). Bedside reporting also ensures that it is possible for the incoming nursing shifts to get improved information and insight about required patient care. The patients are also able to ask questions, while it also improves continuity and consistency of care afforded to patients. Bedside shift reporting and handover is shorter, personal, informative, and comprehensive, which makes it a valid change option for the gynecology unit at Highland Hospital. Choosing the Solution Various solutions to this problem were explored, in addition to bedside shift reporting and handover. These included using IT for computer generated handover and handover based on tape recordings. The alternatives were evaluated for their feasibility using the S.M.A.R.T criteria in comparison to bedside reporting (Germain & Cummings, 2010). It was found that handover based on tape recordings needs a recorder to be taken around each ward for recording of interactions. Discussing this method with patients indicated that they were uncomfortable about recording their conversations. The computer-generated handover was also met with disapproval by patients since they felt they would not be fully engaged in the process. In addition, the implementation of these methods needed more technical and financial resources. In addition, staff and patients unanimously supported bedside handover and reporting. It was also more realistic with its application in the area of practice (Germain & Cummings, 2010), i.e. in the gynecology unit. It is specific, its performance can be measured, it is achievable, and it is grounded on evidence based practice. Gaining Acceptance Organization of several meetings was made with various nursing groups in order to explain the shortcomings, clarify any issues, and come to a consensus. This was meant to empower the nursing teams to oversee the change sans overbearing insight or instruction, especially because, coupled to transformational leadership present, it would have a lasting and effective transformation with regards to team spirit (Costedio et al, 2013). Empirical rational strategy was also utilized in ensuring that the nurses were convinced of the change’s veracity through references to documentary evidence on bedside reporting’s positive outcome, such as improvement of patient satisfaction. Informal leaders empowered by transformational leadership were also encouraged to own part of the change by entrusting to them various responsibilities as role models. This strategy is successful as it encourages nurses to participate in the creation of behavioral and attitude change. Eventually, there is more collaboration and acceptance from the nursing teams in the implementation of bedside reporting. The department manager also helps in reinforcing acceptance through paying compliments to the teams for their efforts at weekly staff meetings. The facilitative strategy will also involve giving the nurses new training in order for them to adapt to the skills required by the change to bedside handover and reporting (Costedio et al, 2013). The use of mock exercises of handover is used to demonstrate the various steps required in the change to various nursing groups. Stabilizing the Change One major difficulty that faces any change in nursing units, including the gynecology unit, is rallying all nurses behind the change. Re-education, therefore, will have to be used to aid nurses in valuing the change and new knowledge they will gain, as well as readying them to learn (Costedio et al, 2013). Different tasks, therefore, are identified for future use, such as how to deal with confidentiality issues and patients who may take up too much time in discussing their problems that could drag the handover shift longer, are allocated to nursing team members with regards to their area of expertise. This will prepare them to deal with any issues in the future that could threaten the use of bedside reporting. In dealing with various conflicts that could arise, a humanistic and flexible approach is adopted, while the resistance of some nurses should never be overlooked. Effort is made to ensure that a good relationship between nurses is maintained, while also highlighting safety needs and factors of motivation. The nurses should also be given constructive feedback for their attained performance levels, while positive actions and behaviors should be rewarded through praise and recognition, as well as a genuine and simple thank you (Costedio et al, 2013). This knowledge is to be applied from the first day of the new handover strategy via continuous mentorship, supervision, and coaching. This will ensure that the chances of future resistance to the change are reduced significantly. References Chaboyer, W., & Wallis, A. M. (2010). Bedside nursing handover: A case study. International Journal of Nursing Practice , 16 (1), 27–34. Costedio, E. Powers, J. & Stuart, T. (2013). Change-of-shift report: from hallways to the bedside. Nursing , 43 (8), 18-29. Germain, P. B., & Cummings, G. G. (2010). The influence of nursing leadership on nurse performance: a systematic literature review. Journal of Nursing Management , 18 (4), 425–439. Street, M., Eustace, P., Livingston, P. M., Craike, M. J., Kent, B., & Patterson, D. (2011). Communication at the bedside to enhance patient care: A survey of nurses' experience and perspective of handover. International Journal of Nursing Practice , 17 (2), 133–140. Tomey, A. M. (2009). Nursing leadership and management effects work environments. Journal of Nursing Management , 17 (1), 15–25. Read More