Barbara Norris: Leading Change in the General Surgery Unit Fall 2010

What are the most important issues confronting Sheila Mason? Explain you priority of important issues.

Providing the best care to each patient starts with providing the proper amount of staff members to each unit. Looking at the needs of different units not only allows administration to see areas for improvement, but also areas that are being handled correctly. Utilizing the indicators provided by The Joint Commission, 4 East, a pediatric medical/surgical floor, has a high rate of falls and nosocomial pressure ulcers that appears to be related to the increase overtime nurses have been working for that floor (Nightingale, 2010). Research has shown increases in adverse events have been related to nurses working over 40 hours a week (Bae, 2012).

The case scenario portrayed Jackie, as a typical nurse who was conflicted and stressed out from both the demands of family and of the workplace environment. At home, she was pressured by her husband to take on extra overtime to supplement and augment the family’s income. Thus, in spite of feeling that her skills were not current, Jackie signed up with her previous hospital to be on the flexible staffing pool (Badzek, et al., 1998). As expected, “Jackie found the work extremely stressful. She rarely had the same unit and patient assignment” (Badzek, et al., 1998).

Current internal and external hospital stressors are impacting NCs nursing shortage. With the release of many reports from different sources suggesting a change is needed. Most have been accurate in their projections; however, the struggle continues. Strong implications for the direction the crisis is heading, from campaign research to thesis and dissertations, written by professional groups and organizations add credibility to the cause; however, the shortage remains. Although some would argue that job satisfaction has no bearing on the nursing shortage and more pressing problems are prevalent; for example, the ageing population, undereducated nurses, patient safety and more positive patient outcomes; therefore, this paper highlights suggestions for change, with a concentration on nursing dissatisfaction and the nursing shortage.

Question Two: What are the problems faced by Sally and what could the organization have done to address her problems?

Although originally written in 1983, The Managed Heart is still an up to date look at an interesting concept: combining emotional feelings with the work one does. At first glance, the notion that emotions may have an impact on one’s work environment seems almost a non-issue. However, Hochschild is not saying that; rather, Hochschild looks at the effect of emotions in the workplace, but also the interaction of those emotions with the work itself. The author’s interest in this topic began at an early age, 12, when she recounts an event in her life: her parents, part of the U.S. Foreign Service, entertained diplomats. Hochschild describes the question that came to her mind as she looked up into the smiling face of a

Inconsistent nurse-patient ratios are a concern in hospitals across the nation because they limit nurse’s ability to provide safe patient care. Healthcare professionals such as nurses and physicians agree that current nurse staffing systems are inadequate and unreliable and not only affect patient health outcomes, but also create job dissatisfaction among medical staff (Avalere Health, 2015). A 2002 study led by RN and PhD Linda Aiken suggests that "forty percent of hospitals nurses have burnout levels that exceed the norms for healthcare workers" (Aiken, Clarke, Sloane, Sochalski & Silber, 2002). These data represents the constant struggle of nurses when trying to provide high quality care in a hospital setting.

The case loads from these RNs had to be covered by the remaining staff. Staff started working even longer hours (twelve to sixteen hours) on several days weekly. Staff felt like they did not have the opportunity to provide care that was quality and meaningful. They were not able to use the knowledge and skills they acquired to make an impact on another’s health status as they thought would be. The job became more of completing assigned tasks rather than using nursing knowledge and judgment. According to Chan (2009) “When nurses perceive a lack of autonomy in their job, this is a leading cause of job dissatisfaction for nurses and a major factor when deciding to leave the job” (p. 21).

I was particularly impressed by way this meeting dissected critical issues. The participants of this gathering welcomed openness and honesty from all. This meeting investigated ethical issues regarding patient care, and scenarios in which one’s discretion licensed him/her to question a patient’s judgments. This gathering also addressed the issue of productivity, in terms of sustaining it and enhancing it amid a taxing and demanding environment. The participants then proceeded to address common relational issues, which involved disagreements among nurses, and conflict mitigation. After witnessing the dynamics of this meeting, it became readily apparent that conflict

Additionally, the study found that a high patient to nurse ratio resulted in greater emotional exhaustion and greater job dissatisfaction amongst nurses. Each additional patient per nurse was associated with a 23% increase in the likelihood of nurse burnout, and a 15% increase in the likelihood of job dissatisfaction. Moreover, 40% of hospital nurses have burnout levels exceeding the normal level for healthcare workers, and job dissatisfaction among hospital nurses is four times greater than the average for all US workers. 43% of nurses involved in this study that reported job dissatisfaction intended to leave their job within the upcoming year. (Aiken et al.)

According to Hunt (2009), feeling overworked is the number one cause for nurse turnover in health care settings. Other reasons at the top of the list include, lack of support from employers and few opportunities for advancement. Due to the nursing shortage, staffing has been an issue in many healthcare facilities. As a result, units are consistently short staffed, causing nurses to feel overworked and unsupported by management. Cline (2004) highlighted nurse frustration when a participant in the study stated, “When you’re constantly short-staffed and feel your managers aren’t supporting you at least by saying, ‘Thank you, I know you must’ve had a hard

As nurse manager Barbara is responsible for managing the staff, scheduling and budgeting for the unit. Her staff includes twenty-five registered nurses and eight patient care assistants (PCA’s). The unit is known for its culture of confrontation, blaming, and favoritism. The staff is dissatisfied, unmotivated, and not functioning as a team to deliver quality patient care. In Barbara’s first month she has lost two RN’s and due to a hiring freeze at EMU Barbara was not able to replace the positions. The unit is short staffed, stress levels are high and employee morale is low. Barbara meets individually with twenty or so staff members and comes to the conclusion that no one is happy and she has a lot of work to do. There are multiple groups that Barbara has identified issues with and she must come up with an action plan to manage the discrepancies. She has found issues in downward management which involves senior nurses, newer nurses, and patient care assistants, and in upward management including administrators and physicians,

Effectively, interpersonal conflict was found to be one of the major sources of stress for nurses. Fudge (2006) affirmed overt and covert types of horizontal and vertical violence. Overt violence is obvious for everyone to see whereas covert is the complete opposite while still encouraging cruelty to one’s peers (Fudge, 2006). However, partnerships within health care settings may be declining due to the fact that some nurses may feel overworked and stressed. Jacoba Leiper (2005) stated that nurses are under pressure to complete their workload during their shift. Thus the nurse who’s having trouble completing her work on time, may skip breaks or stay late to avoid the ire of those on later shifts. But if she doesn’t take these steps and regularly fails to complete her tasks during her shifts, she may irritate her peers or take her anger out on her peers as well. Thus, the

Workload was described to be heavy, stressful, increase in intensity and overtime hours. As a result 25.8% consider resigning, 20.2% consider retiring and 25.6% consider leaving profession. Another problem that was observed at individual level was poor commitment to care. One of the factors that often limited nurses to provide therapeutic care was the change in nurse to patient ratio. As nurses assignments increase with the increase in the number of patients (i.e. 1 nurse to 6-8 patients) the quality of care provided decreases. Nurses’ ability to maintain safe environment became challenging. As part of caring, nurses also showed decreased amount of time spent with their patient. This eventually led to nurses being less satisfied with their current job. Self – efficacy was often low. Nurses felt that they did not have enough knowledge and skills required for professional practice (Newhouse, Hoffman, & Hairston, 2007). This often led into stressful transition and the ability to care for a patient even harder. New graduate nurses often had difficulty maintaining leadership role. They often felt that they did not have the ability to self advocate and raise their voice to be heard by others. They often feared that they would be over heard and that no one would listen to them (Mooney, 2007).

Barry Hill (2017) performed studies related to the quality of care that patients receive and what factors are associated with those perceptions. One area that was noted to be of importance and directly related to quality of care provided to patients is staff dissatisfaction and burnout. This study also found that longer shifts contributed to increased amounts of emotional exhaustion leading to decreased quality of care for patients. Addressing staffing needs early and intervening can decrease the amount of nurse burnout and dissatisfaction that is often seen. This study has shown that hiring additional competent nurses reduces medication errors, falls, infections, wounds, and decreases hospital litigation costs, while improving staff morale, patient experience and care, and cost-effectiveness for the hospital.