Management Skills Required by the Newly Qualified Staff Nurse - Coursework Example

Management skills required by the newly qualified staff nurse The purpose of this assay is to discuss the management and leadership organizational skills which a newly qualified nurse will need to acquire in order to enhance patient/client care. Health care system is the cornerstone of a nation’s success, unless a nation is healthy physically, mentally and socially, she can not be healthy financially or economically. There have been a continues delivery of hard work, efforts, and newly designed strategies in making the health care system satisfactory but there still have been areas where we are lacking and main reason of this delay in progress is the fact that the main care providers which is the nursing staff is either ignored in making a policy or they are just not qualified enough to become a part of policy establishment. In order to ensure a good flow of a good health care provision it is very important to make sure that nursing practice is up to the requirement. The management skills that will be focused in the essay include: communication, problem solving, and delegation- prioritizing workload and time management. This essay will also be discussing leadership styles and theories, which a newly qualified may adopt, such as: democratic, autocratic, and laissez-faire, transformational and transactional ((Sullivan and Decker, 2001). According to Yoder-Wise (2007) management can be defined as “the work of an individual who channels others through a series of routines, procedures, or predefined practice guidelines. However, management can also be defined as the focus of maintaining order, planning, organizing, coordinating resources and attending to rules and details” (Jennings et al, 2007) Nursing staff is the major operator of the health care system; they are the ones physically more in contact with the clients. In- order to have them work better towards achieving the set goals we need to keep them up to date. “Learning theorists say that the hardest aspect of learning, particularly for highly educated and successful individuals such as nurses and doctors, is unlearning. A person who would learn (or even better create) something new must have a mindset willing to doubt what he or she knows. Only after admitting that what we know might be inaccurate or incomplete or non-functional, can we consider alternatives. Thus, we must unlearn in order to learn”. (Waldman, D. & Yourstone, S.A.2007). in order to have a sound health care system only through upgrading clinical practice it has to happen in a systematic way, Nursing staff has to have a continuum of learning, dedication to the profession, and they also have to be an active body in the chain of people that are working towards empowering health care system to fulfill the newly emerging needs. There is a theory that is being in use in the design of the health care system in most of the health care system it says that one should be learning new useful tasks and unlearning the ones that get obsolete on continues basis and this can lead to affective advancement. In this new era where information available on each and every aspect of life, patients come to us with a good deal of information in their minds regarding their disease but most of the time it will not be an authentic information so there a nursing staff needs to have an appropriate amount of knowledge and leadership skills to handle that. By contrast, leadership can mean the act of an individual who does not have a specific management role, but whose thoughtful and convincing ideas substantially influence the efficiency of work flow and exercising leadership skills (Sullivan and Decker, 2005). Nevertheless, (Marquis and Huston, 2006) defines leadership in its broadest sense as the process of moving a group of people in some direction through non-coercive means. A leader may expect others to help realize a vision, but a manager will expect others to fulfill their mission or purpose. According Finkelman, (2006) the manager imitates, while the leader originates. The manager maintains while the leader develops. In management the individual may not need a follower; however every leader needs a follower. Similarly everyday there is emergence of new medical problems and most of them require techniques to prevent the spread of them or to make the recovery of them quicker and that all can be achieved easily by an up to date nursing staff. For a nursing staff as a beginner Kramer (1974) states that a newly qualified nurse passes through four stages during their transitional period. These stages are skill and routine mastery, social integration, moral outrage and conflict resolution in addition Benner (1984) suggests that a there are five stages of proficiency, which a newly qualified nurse will go through in order to improve and acquire new skills. These stages are; novice, advanced beginner, competent, proficient and the expert. For instance, the novice will be focused on mastering the technical aspects whilst providing care. Whereas the expert will not be caught up with the same technical details when proving care (Dracup and Bryan-Brown, 2004). There are different leadership styles and theories, which a newly qualified nurse can utilize. However, the author will focus on the democratic style, autocratic style, laissez –faire, transformational and transactional theory style (Sullivan and Decker, 2001). Effective leadership is very important in the accomplishment of an organization such as the National Health Service (NHS), therefore it is extremely vital for the newly qualified nurse to possess a leadership skill (Snow, 2003). According to (Finkelman, 2006) newly qualified nurses tend to use leadership; this is because it is included in the criteria and competencies whilst as a student. To enable the newly qualified nurse to manage time they will need to priorities work (Hill, 2002). Prioritization is an important skill in nursing; a deficit in this skill can have serious consequences for the patient if this skill is lacking (Hendry and Walker, 2004). Recent studies suggest that prioritization may be a difficult skill for newly qualified nurses to acquire and not enough attention is given towards this skill in nursing education (Hendry and Walker, 2004). Management makes a scheme of system, doctors do not directly deal with the system most of the times but nursing staff most of the time does that so they are the most effective people to get hold of and make them implement the changes. Whole of this should be an active process and they should be doing it out of their own knowledge and not by just merely asking them. “The aphorism practice makes perfect is generally considered the way to improve. In common parlance, it translates to repeating the same action or thought process. Practice can be in three modes: (1) Rote practice, such as creating muscle memory in athletes or mental grooves in anyone; (2) Practice choosing, such as airline pilots do in simulators; and (3) Practice creating (practicing for the unknown)”.(Waldman, D. & Yourstone, S.A 2007). Doctors in our system maximally show two or three times a day to in-patients but the nursing staff are the ones stay by the in-patients every min and then deal with everything, whether eating, drinking, taking medicine, their all other biological functions. Nursing staff are the ones needed to be there all the time to entertain any queries from the patients or their families. Similarly on out patient basis again patients go through basic health assessment with a nursing staff that asks all the important pertinent points and put them down on a medical record sheet and then the patient is forwarded for a very brief time to review the whole previous time with the nursing staff. “As a leader the newly qualified should demonstrate their ability to problem solve, for instance when admitting a patient the first assessment of the patient should trigger critical thinking which will lead to creating a care plan in order to solve the current clinical problem of the patient” (Taylor, 2000). Taylor (2000) suggests that problem solving is still an inconsistent skill for the graduated nurses and it has very little position in the nursing curriculum. The ability for the for the newly qualified nurse to provide competent care depends on their clinical problem solving skills (Taylor, 2000), This scenario makes the position of a nurse very clear in the provision of health care system. In book Diffusion of Innovations, Rogers defines the diffusion process as one "which is the spread of a new idea from its source of invention or creation to its ultimate users or adopters". Rogers differentiates the adoption process from the diffusion process in that the diffusion process occurs within society, as a group process; whereas, the adoption process is pertains to an individual. Rogers defines "the adoption process as the mental process through which an individual passes from first hearing about an innovation to final adoption". (2007) therefore there is a need for newly qualified nurses to have a better understanding of clinical problem solving strategies, which is used in the clinical practice setting (Benner, 1984). At times the staff available on duty will be good in terms of their knowledge and understanding of the issues but will just not be putting efforts in achieving the set goal. In the acquirement of new skills Kramer (1974) states, that a newly qualified nurses passes through four stages during their transitional period. These stages are skill and routine mastery, social integration, moral outrage and conflict resolution. In addition Benner (1984) suggests that a there are five stages of proficiency, which a newly qualified nurse will go through in order to improve and acquire new skills. These stages are; novice, advanced beginner, competent, proficient and the expert. For instance, the novice will be focused on mastering the technical aspects whilst providing care. Whereas the expert will not be caught up with the same technical details when proving care (Dracup and Bryan-Brown, 2004). The newly appointed staff has to start working on building leadership skills in him/her so that they are able to take up responsibilities when they will be working independently. They should consider their self as captain of the ship at certain times and they should be running the ship while asking others to follow. Here the staff just needs to have a realization in the serious nature of this business and should have the willingness to serve. It needs a lot of dedication and trustworthiness on their part to deal with people’s lives. I will quote an example from daily life: A nurse that is very well educated about sudden hypoglycemia secondary to any cause, the staff is appointed at CICU and is at work at 5am and she finds out that a patient’s blood sugar level is 50, she gave some dextrose and then no further action till it gets checked again after an hour according to the set protocol of hourly check and this time it had dropped to 27 she again administered some dextrose and slept on it for 20 minutes. Nazarko, (2007) suggests that there is a clear distinction between managers and leader, for instance a nurse manager monitors boundaries and defines limits while a leader appeals to hope for dreams. Patient remained comatose for 3 days and her EEG was done which showed changes which were most likely because of hypoglycemic encephalopathy or in other words the patient that was recover post open heart surgery had a brain death due to hypoglycemia now here the staff writes the values of hourly check which are within normal range. In this whole scenario the point to me made clear is that health system is so strongly dependent on nursing staff, along with knowledge they also need to have a sound knowledge or morals and ethics I order to prevent major unfavorable things from happening. Roger in his book Diffusion of Innovations describes five adoption which are 1) awareness, (2) interest, (3) valuation, (4) trial, and (5) adoption. (2007) He further explains these components as in the awareness stage "the individual is exposed to the innovation but lacks complete information about it". At the interest or information stage "the individual becomes interested in the new idea and seeks additional information about it". At the evaluation stage the "individual mentally applies the innovation to his present and anticipated future situation, and then decides whether or not to try it". During the trial stage "the individual makes full use of the innovation". At the adoption stage "the individual decides to continue the full use of the innovation" (2007) if one is going through things according to learning theory, and innovation and adoption theory practicing health provision will become more rationalized. This relates to a problem in time management and prioritizing of their workload. However, these skills are difficult to teach and are better learnt through practice (Brick, 2000). The last but most important duty of a nurse is to consider herself a part of a health care provider team, to understand her/his position and her/his and duties in the team. Health care provision as all other critical cares is a very intricate chain of services. Gerrish (2000) states that newly qualified nurses have weak points when it comes to managerial skills such as prioritizing, delegating work and decision-making but this can be taken care of by placing them under supervision for some time with an experienced staff. A survey carried out by O’shea and Kelly (2007) shows that newly qualified nursing staff is usually lacking in a range of managerial skills. This relates to a problem in time management and prioritizing of their workload. However, these skills are difficult to teach and are better learnt through practice (Brick, 2000). We can simplify this concept by reconsidering this example of an in patient at CICU discussed in the above paragraph, which goes into hypoglycaemia due to some reasons. Problem-solving skills focus on clinical practice and have an important role in health care services (Terzioglu, 2006). Here every member of the team has a responsibility but one is bound to take the other one in consideration and not to take thing on him or herself alone. Like here the staff was to check the blood sugar level if it normal nothing to be done, low just watch and repeat it in half and hour, it is significantly low inform the doctor on duty and if its fatally low then give rush call for it. On the other hand its mildly high let the body take care of moderately high give insulin according to specific regimen established but if it is significantly high inform the doctor on duty. If this chain of responsibilities and command is taken care of a system will work in harmony towards the betterment of health and there will be no major flaws in the system. There should be set protocol and they should always be in action once one gets down the line this is where problems occur and the efficacy of the implemented system keeps going. Communication is very vital in nursing patients, whether it is verbal or nonverbal, writing a report, talking to a colleague during hand over or giving information to a patient. Communication is something that goes on all the time (Oxtoby, 2004). In order to have a good quality health care system nursing staff has a very crucial role to play. They are the ones kind of living with the patient. There are various skills which a newly qualified nurse must have, but the most important out of them that have been chosen by the administration at most of the places are; communication skills, problem solving capabilities and delegation – time management and prioritization. Doctors come and go but nursing staff is always there. They should be the one presenting their patients and issues related to them. Gerrish (2000) suggests that newly qualified nurses find it difficult to delegate work, because they are anxious and they do not want to be observed while working de to their high anxiety level. As a result the newly qualified staff would always rush to finish working without considering the quality of work in order to avoid being watched. This way she accomplishes the amount of work that is required from her but he/ she does not get the real essence of that work and ultimately the patients suffer (Gerrish, 2000). Delegation can also be defined as getting work done at times not by oneself but through others, for example, when a nurse tells a healthcare assistant to take a patient’s drug chart to the pharmacy (Marquis and Huston, 2006). Delegation to healthcare assistants has become a very essential component in patient care. However, improper delegation can disrupt normal procedures and put patients at risk (Whitman, 2005). The NMC (2004) states, that a nurse always remains accountable when work is delegated to a non-registered person. As a leader the newly qualified nurse will need to function as a role model and a resource person in delegating tasks to subordinates (Marquis and Huston, 2006). Prioritization is an important skill that nursing staff should have and should practice before taking an action all the time. This should be done so frequently that it becomes a part of subconscious for them. Practice from such a nursing staff that is deficient in this capability can lead to serious consequences for the patients and care givers and in turn can lead the emergence of a bad health care practice (Hendry and Walker, 2004). Recent studies suggest that prioritization may be a difficult skill for the newly assigned nursing staff and for them to acquire this skill takes time and in nursing practice it specifically needs to think. (Hendry and Walker, 2004). For instance, if a nurse leaves an agitated and restless patient (indication of pain) and then attends to another patient to clean their dentures. It will deprive one patient from getting a pain killer which he/she must receive to make sure a proper management (Alfaro-LeFevre, 1999). Prioritization is an important step for all care providers in all clinical scenarios; because delays might lead to serious consequences for the patient the nursing staff will stay deprived of a very important component of their daily practice. Nursing staff can identify and understand relationships/ interaction between problems, and can develop an effective plan which will bring an effective result out (Alfaro-LeFevre, 1999). The theories mentioned above are being used actively used and their use has brought positive changes in the system. General theory has got non health field related bodies involved in designing and assessing the system on timely basis and the diffusion innovation theory has made learning and adaptation the main theme of practice there. They should be knowledgeable enough to present their patient’s problems whether directly or indirectly related to health. The Essence of Care Patient – focused benchmark for clinical governance (2003) states that all health personnel needs to demonstrate effective interpersonal skills when communicating with patients or their carers. The NMC (2004), states that a qualified nurse, must communicate effectively, with other members of the team as required for the benefit of the patient. Communication is necessary when delegating a task (Marquis and Huston, 2006). on the other hand doctors should also give them their due respect and should deal directly as presenter of their patient. They should be kept trained and up to date for their learning of new emerging things in the system, unless there is continuity of learning practice can not keep up with the new demands. Similarly nursing staff has to understand the importance of their position and should not let things go out of their hands to be taken care of somebody else. They should have the willingness to dedicate their self to their profession. Along with above two very important factors they should also take care of the sequence of flow of responsibilities amongst the members of the health care provider’s team. If a nurse start taking up the responsibilities this will lead to discrepancies in the system and health care system is not the kind of system in which discrepancies can be afforded to have. Health care system is actually of system of dealing with lives so any measures that can it better should be taken whether it is regarding the system designing, system operation or training the staff, doctors and administration. Problem solving is related to the ability to critically think, which is fundamental in professional practice (Pardeu, 1987). The most easiest and practical approach to achieving this goal is to focus on the nursing staff because they are the ones influence this system the most. There is a nursing referencing system available which is very refined and precise and is actively functioning for programming nursing activities and keeping their knowledge up to date. Main difference in the responsibilities of a qualified nurse and a newly assigned nurse is the experience time they have. A new nurse should get exposed to a variety of situation under supervision and this will take care of all the major issues/flaws in the system. There will be minimal harm to the patients and the newly assigned staff will not be staying new for a long time and will start learning all the required tasks without causing any major harm to the patients. Nursing staff should be in a continue training programs and they should be a part of all the administration meeting launching for making decisions related to the patients. This will keep them more patients focused and more informed in terms of knowledge. This way we are creating awareness in them along with providing them with knowledge and understanding to make the practice easy and fruitful for them. References 1. Alfaro-LeFevre, R, (1999) Critical thinking in nursing: A practical Approach, 2nd edition. Saunders Co, USA. 2. Brick, C (2000) please help! I’m newly qualified. Nursing Standard. 14 p44-47 3. Bertalanffy,V.L (1986). General system theory. The quest for general system theory; George Braziller; Revised edition (March 1976) 4. Benner, P, (1984) From novice to expert: excellence and power in clinical nursing practice. Menio Park: Addison-Wesley 5. Deane Waldman, D. & Yourstone, S. A. Learning – the only way to improve Health-care outcomes. Health services management research; 20: 227–237. 6. Dracup, K and Bryan-Brown, l (2004) from novice to expert to mentor: shaping the future. American Journal of critical Care 13 (6) 448-451 7. 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