NR 532 Week 1 Graded Discussion 1: Leadership and Management Theories (Latest Update) Already Graded A+

NR 532 Week 1 Graded Discussion 1: Leadership and Management Theories Week 1 #1 In your readings this week, six distinguishing traits of integrated leader-managers were presented. Choose one of the distinguishing traits and discuss how you currently, or how you would like to, integrate this trait in your role as a nurse leader. Share a specific example. Professor and Class, After reading in Marquis and Houston, I have found that the one trait that I would like to integrate into my practice when in a leadership role would be “They think longer term” (2017, P. 53). According to the description, this leadership trait will help the leader to think long term and how the decisions that they make for their department and organization will affect the company down the road. This is important because quick fixes may work temporarily, however when leaders look at problems in the long term, it will help to fix the problems so that they don’t happen again. I think that one of the biggest steps to integrating this leadership trait into my practice would be to look at the company and departmental goals. I know that there are company goals, but as of right now, we as staff members never know the departmental goals. Obviously, there are certain requirements working in the OR such as decreased infection rates and increased patient satisfaction. However, I think that it is just as important to talk with staff members and come up with a list of goals that we can work on together to maintain these. Things such as decreased turnover times for the operating rooms and surgeon preference card utilization will help to decrease the amount of money wasted and increase revenue. I think that these types of goals and how we are doing to meet these goals should also be posted in order for them to be visualized daily. A good option to help with meeting this goal would be to set higher expectations when goal setting. Research conducted by Harvey Whitney found that “higher expectations lead to higher performance” because people tend to live up to the expectations that management set for them (Whitney, 2017, p. 1221). Whitney, A.K. Harvey. (2017). The Power of Great Expectations. American Journal of Health-System Pharmacy (pp. ). Fort Mill, SC: College of Pharmacy, Northeast Ohio Medical University. Marquis, B. L., & Huston, C. J. (2017). Quality Control. In Leadership Roles and Management Functions in Nursing: Theory and Application (pp. 610-704). China: Wolters Kluwer. #2 Healthcare systems are complex. You are the chief nurse executive (CNE) at a healthcare organization. Share the type of healthcare delivery system you would implement for your team. Discuss the rationale for your decision. Professor and Class, Choosing a healthcare delivery system is an important job of the chief nursing executives. It will help to define to organization and to obtain goals for the present and the future. As the chief nursing executive, I would like to implement the usage of evidenced based healthcare. It important that the patients and families along with the community-based organizations look at all of the types of changes that are happening on a daily basis. With the use of evidenced based research and practice, management can implement polices that have true evidenced based results behind them. For example, while working in the operating room, we have switched from using betadine to chlorhexidine. This is because management and physicians worked together to research the usage and found that it helped to decrease surgical site infection rates. The end result was that in certain cases we now use chlorhexidine instead of betadine and the number of surgical site infections have decreased. Once the chief nursing executive implements the healthcare delivery system and puts it into place, an ongoing monitoring and revision plan should also be put into place (Chamberlain College of Nursing, 2018). This will ensure that the system works and that there are no hold ups or missed steps/gaps that need to be addressed. One study that I found addresses the use of evidenced based practice in the surgical setting. It was found that there were many barriers that effected the implementation of evidenced based practice including knowledge deficit and organizational demands being to high that EBP decreased (Hjelen & Sagbakken, 2018). This is an important finding because it recognizes the need that the surgical services area needs for introducing evidenced based research into practice in order to help decrease surgical site infections. Chamberlain College of Nursing. (2018, July 4). Week 1 Online Lesson: Introduction to Course and Healthcare Delivery Systems. Retrieved from Chamberlain College of Nursing: Healthcare Operational Planning and Management: Hjelen, W., & Sagbakken, M. (2018). Surgical nurses lack the time and competence to work in an evidence-based manner. Norwegian Journal Of Clinical Nursing / Sykepleien Forskning, 1-21. doi:10.4220/Sykepleienf.2018.69422lesson?module_item_id= Week 2 In your reading this week, five traditional patient-care-delivery systems were discussed. Share which delivery method you would utilize if you were the nurse executive at a healthcare organization and explain your rationale. Organizational charts are utilized in many healthcare organizations. Share one advantage and one disadvantage. As a nurse leader, would you utilize organizational charts? Share your rationale. Week 3 List one opportunity or threat to nursing external to the organization. An example may be a competing organization within close proximity offering sign-on bonuses. Discuss the severity of the opportunity or threat and the probability that it may occur in an organization. Professor and Class, After thinking about external factors that could eventually affect the organization that I work for, One threat that has a great probability of becoming a factor in the organization would be that one of the areas orthopedic organization is building their own out-patient surgery centers. This building will be available to complete patients’ joint replacements and allow them to stay for up to 48 hours. They will also be able to complete all types of outpatient surgeries such as arthroscopies and ORIF surgeries. As of right now, our organization and the 3 other hospitals in the city all complete their orthopedic surgeries and cover any types of emergencies that they have. There has been a shift within their organization over the past few years where they are trying to see their patients, including emergencies in their ortho-now program. They have their own ortho emergency room in their office building. This has decreased emergency room visits. One article that I found talks about the shift that they have seen is Ontario to more of a 23 hour stay for orthopedic surgeries. The article cites the usage of regional anesthesia and new innovative pain control options are allowing patients to return home sooner (Webster, 2017). This threat to the organization is fairly large. The organization makes most of its money through surgeries and orthopedic surgery is definitely one of the biggest profits that they hospital will see. With the shift to a private outpatient setting, the only orthopedic surgeries that will be performed within the hospital setting will be any patient who is more complex and requires advanced care or anesthesia. The other type of surgeries that we will see will be the complex revision surgery or the infectious joints, where the hospitals will provide complex anesthesia and a longer length of stay. Cassie Arvidson Webster, P. (2017). An outpatient "evolution" in orthopedic surgery. CMAJ: Canadian Medical Association Journal = Journal De L'association Medicale Canadienne, 189(50), E1568. doi:10.1503/cmaj.109-5534 Restate the opportunity or threat chosen in discussion one. Discuss how your role as the nurse leader may influence the opportunity or threat. Explain your rationale. Professor and Class, The threat that I looked at and discussed in the first post was the building and opening of a private orthopedic surgery center. This is scheduled to open over the next 2 years. This will take more than 75% of the orthopedic surgeries that are performed in this hospital and the other 3 surrounding hospitals away and will reduce the amount of revenue that is usually gained. As a nurse leader, it is important to look at possible solutions to the drop-in revenue that will be coming and the difference in money that will be gained. There has been a shift even in Ontario that orthopedic surgeries are now going to be performed in an outpatient setting. This is due to the fact that there have been advancements made in anesthesia and pain control, allowing for patients to be discharge sooner (Webster, 2017). As the nursing leader, I would be looking at how we could attract new doctors to our area and maybe we need to focus on a different type of surgery. We previously have looked at becoming the robotic institute for our area. This would be a great opportunity to attract more doctors and free up block time. I know that there has been discussions about adding more robots in our surgical services line. The initial cost would be high, but if we could add more surgeons who are looking to use the robot and free up more time for the already robotically trained surgeons, we would be able to increase our revenue and be able to offer patients a truly unique experience that is better for visualization and easier with instrumentation (Montroy et al., 2018). Some more advantages that could be advertised to the patients include, less time in the hospital, quicker recovery and less blood loss (Montroy el al., 2018). Cassie Arvidson Montroy, J., Elzayat, E., Morash, C., Blew, B., Lavallée, L. T., Cagiannos, I., & ... Breau, R. H. (2018). Long-term patient outcomes from the first year of a robotic surgery program using multi-surgeon implementation. Canadian Urological Association Journal, 12(2), 38-43. doi:10.5489/cuaj.4528 Webster, P. (2017). An outpatient "evolution" in orthopedic surgery. CMAJ: Canadian Medical Association Journal = Journal De L'association Medicale Canadienne, 189(50), E1568. doi:10.1503/cmaj.109-5534 Week 4 The number of malpractice claims at your facility has doubled in the last quarter. Discuss a strategic plan to reduce the number of claims. Be specific with your example and explanation. Professor and Class, It is important when looking at the number of malpractice claims increasing, to look to the patients for their feedback (Levin & Hopkins, 2014). They can clue you in as to what the issues are. My strategic plan would be to introduce a feedback system from the patients. Surveys that are completed when the patient is leaving the facility can help to determine issues right after they happened. This will help to limit the number of malpractice claims because we can fix the problems so that they do not get worse or continue with more and more patients/family members. Risk management is a great tool that will help to identify the organizations risks by looking at frequency and severity of adverse events (Mennella, 2014). Risk management can look at all of the recent claims and try to identify a common theme within them. They can also look back at the policies and procedures that the hospital has created in order to determine if a change would be suggested. It is also very important that the nursing staff are aware and understand the policies and procedures. It could be that they misunderstood the policy or that they were aware that they did not follow proper procedures. Nurses should be fully aware of their expectations or they will continue to make the same mistakes over and over. First, I would sit with risk management and review all recent claims for malpractice. We need to review each one and look for any common themes. Then we will review all current policies and procedures. I would talk with each staff member that the claim is regarding and find out if there is additional information that was left out. We need to do a complete root cause analysis of each situation. We will then need to re-educate staff about policies and procedures. Lastly, I will put into place a survey that patients can fill out at the end of their stay. This will give more accurate and up to date information on anything that they felt could have been improved or better. I would also create a position for guest relations within the hospital. It would be available for patients to contact if they feel that there is an issue. This will help to solve issues right away and not let patients sit and stew on it. Cassie Arvidson Levin, C. M., & Hopkins, J. (2014). Creating a Patient Complaint Capture and Resolution Process to Incorporate Best Practices for Patient-Centered Representation. The Joint Commission Journal On Quality And Patient Safety, 40484,AP1-492,AP12. doi:10.1016/S(14)40063-1 Mennella, H. A., & Boling, B. C. (2018). Delegation of Authority: Risk Management. CINAHL Nursing Guide, Identify a patient-safety issue at your current or previous organization. Share your plan to prevent or eliminate the issue. Professor and Class, One current patient-safety issue that has been seen in my organization is the lack of communication between departments. I work in the operating room and the patients come from the 5th floor where they are admitted for surgery. We have a large lack in communication with the patients coming down for surgery with their belongings or wearing jewelry. We also find that the patients are very annoyed that while the nursing staff that admits them upstairs, ask all the questions and find out all the information that is needed for their procedure. When they reach the holding area prior to surgery, we don’t have the electronic medical record like the rest of the hospital. We still are working with paper charting, so we are constantly missing information and we have to reverify everything with the patient. It is very time consuming, but it can be unsafe. There are many times where we are missing h&p records or cardiac clearance letters. Another patient-safety issue that I have seen while working in the holding area is that the hospital does not have a policy on pregnancy testing of female patients undergoing anesthesia procedures. This has become a bigger issue as of late because a few years ago, there was a patient who was undergoing a bariatric procedure. The patient did not have a pregnancy test and was questioned as to whether or not she was pregnant. There was no policy preventing the surgery and therefore it continued on. When the surgeon made entry into the abdomen, it was evident that the patient was pregnant, and we later found out she was around 17 weeks. She was a fairly large patient and it was not immediately evident that she was pregnant. After this happened, there has been many different conversations about why we are the only hospital in the area that does not require pregnancy testing, and eventually a loose plan was put in place. However, the patients can still just sign a waiver saying that they are not pregnant. I would propose that we create a policy and procedure about adding a pregnancy test to all menstruating females that come in for surgery. If they have had a hysterectomy, they can be exempt. The test should be completed within 7 days of surgery or completed upon arrival to the hospital for their procedure. I believe that this would help to decrease the chance of performing surgery on a pregnant female. One study that I looked at, started performing pregnancy tests on the day of surgery for an orthopedic procedure. Over a 23-month period they found 7 positive results and the overall cost was a little over $1000 dollars (Hutzler, Kraemer, Palmer, Albert, & Bosco, 2014). This proves that the cost was minimal compared to the potential complications that these women could have seen, had the pregnancy testing not be completed and the women received anesthesia while pregnant. Cassie Arvidson Hutzler, L., Kraemer, K., Palmer, N., Albert, D., & Bosco, J. A. (2014). Cost Benefit Analysis of Same Day Pregnancy Tests in Elective Orthopaedic Surgery. Bulletin Of The Hospital For Joint Diseases, 72(2), 164-166. Week 5 A difficult situation can result when personal and working relationships are combined. You have been assigned to a new area as the nurse leader, where a good friend of the family has worked for many years. You are made aware of multiple issues of tardiness by your friend over the last few months. Discuss how you would handle the situation. 2. Professor and Class, When a nurse gives the wrong does of medication to a patient, the nurse has performed a breech of duty. According to the reading, The element of liability include the the "Duty to use due care, Failure to meet standard of care, Foresee-ability of harm, A direct relationship between failure to meet the standard of care and injury can be proved, and Injury" (Marquis & Huston, 2017, p. 114). The duty of use due care means that the medication should have been given accurately, completely and on time, the way that any reasonable nurse would have done. A breach of duty was completed when the nurse failed to give the medication accurately. Foresee-ability of harm refers to the nurse having access to information about the dosages and drug handbook knowing that the wrong dose could cause harm (Marquis & Huston, 2017). When the patient is harmed because of the medication error, a relationship is created between breach of standard of care and injury. The injury in the actual harm that is the result of the patients medication error by the nurse. It is the nurse and the management team teams responsibility for nursing errors. Management must ensure that all nurses are capable of giving medications and are aware of side effects of wrong dosages of medications. There should be policies and procedures in place to help eliminate medication errors. There should also be a drug book available so that medication errors are kept to a minimum. "You must rely on nursing education by administering the medication safely and appropriately the now “six rights” of drug administration, the right drug, the right patient, the right dosage, right route, right time, and accurate documentation of the order, patient assessment and reaction in the medical record with your signature and title"(Brown, 2016, p. 26). Cassie Arvidson Brown, G. (2016). Averting Malpractice Issues in Today's Nursing Practice. ABNF Journal, 27(2), 25-27. Marquis, B. L., & Huston, C. J. (2017). Quality Control. In Leadership Roles and Management Functions in Nursing: Theory and Application (pp. 610-704). China: Wolters Kluwer. Week 6 #1 Discuss two strategies you could implement to ensure confidentiality and protection of patient health information at your facility. Professor and Class, Since the introduction of the Health Insurance Portability and Accountability Act (HIPAA) in 1996, the emphasis on the need to keep patient information confidential is at an all-time high (Roussel, Thomas, & Harris, 2016, p. 291). There are many strategies that healthcare facilities can utilize to help ensure the patients information is kept protected and confidentiality. One strategy that can be implemented would be the use of passwords from employees to log in to patient charting systems. With the use of electronic charting, computers are all over healthcare facilities. It is important to change passwords frequently and never give out your password to anyone (Kornusky, 2018). Logging off computer charting systems right away will also help to ensure that patient information is kept confidential. Another strategy that can be implemented to ensure that patient confidentiality is maintained would be by providing all employees with a HIPAA class yearly as a mandatory CBL. This will serve as a constant reminder of the importance to maintain HIPAA policies for both the facility and for the patient. This will also allow for any issues or concerns to be addressed because technology is always changing. “The right to privacy, involving protection of personal data and demand for solitude without any disturbances, requires protection mainly because of the rapid development of technology” (Kirimlioglu, 2017, p. 1464). Cassie Arvidson Kirimlioglu, N. (2017). "The right to privacy" and the patient views in the context of the personal data protection in the field of health. Biomedical Research (0970-938X), 28(4), . Kornusky, J. M., & Caple, C. M. (2018). Health Insurance Portability and Accountability Act (HIPAA): Nursing Practice. CINAHL Nursing Guide. Roussel, L., Thomas, P., & Harris, J. (2016). Management and leadership for nurse administrators. Burlington, MA: Jones & Bartlett. #2 Discuss one example where simulation technology could be beneficial for nursing. Explain your rationale. Professor and class, Simulation technology is a form of technology that is used to provide a realistic environment for learning training and practice (Sanko, 2017). There are many examples where simulation technology can be beneficial for nursing. When I just started my nursing career, I started at a hospital that has its own nursing school. They had a simulation lab that both nursing students and nursing staff would use for training. I started in the operating room, so while on orientation, our team leader would bring us over to the OR sim lab and we would practice emergency situations. Some of the situations would include OB emergencies with C-sections and cardiac arrest during surgery. These simulation lab situations were very helpful in teaching or trying to show how an emergency may look and try to make us more comfortable with the whole situation. When we first were introduced to electronic medical records, we used simulations to help learn the program and find where we could locate patient information. This was helpful and made the transition to EMR charting very smooth. My favorite part and I think probably the most useful part of the simulation lab experiences was the debriefing that was completed afterwards. It can be very intimidating when instructors are watching, and you are the lead person in the scenario, however when completed, it is nice to be able to talk to one another. We would discuss that things that went well and the things that we missed. While in nursing school, they taped our sim labs that way we could re-watch ourselves. Cassie Arvidson Sanko, J. S. (2017). SIMULATION AS A TEACHING TECHNOLOGY: A Brief History of Its Use in Nursing Education. Quarterly Review Of Distance Education, 18(2), 77-85. Week 7 #1 Some organizations utilize centralized staffing while others utilize decentralized staffing. Choose either centralize or decentralized staffing and discuss the advantages and disadvantages. Professor and Class, I chose decentralized staffing to look at closer. This is what I have seen in the facilities that I have worked at. Usually it is one of the nursing supervisors that does the staff scheduling. For my current facility, staff members work either 8 hour shifts or 12-hour shifts. We put our requests into our scheduling program up to the cut off date and then the nursing supervisor takes the requests and looks at staffing ratios for the days. Based upon ratio needs we are either approved or denied. It is also first come first serve so the days are not guaranteed. Especially days that are highly requested such as holidays or the days before or after holidays. Decentralized staffing is when a nurse manager creates a staff work schedule that allows for the variances of sick time, personal/vacation time and holidays (Marquis & Huston, 2017). This helps to ensure that there is an adequate amount of staff to cover the number of patients that will be estimated on the floor. Although numbers may change for both staffing and patients, decentralized staffing allows the nurse manager to control scheduling and budgeting for the department. According to Mensik, decentralized staffing also allows nurses more freedom with flexible scheduling (Mensik,2014). Working in the operating room, I have seen my nursing supervisor working on the scheduling for staff. She not only looks at numbers of patients and staff, but she also must consider what staff can cover what service to ensure that we can cover them all. For example, there are only a handful of nursing and technicians that can work in DaVinci cases or eye cases. This is important to consider if there is a day that has many eye cases scheduled. She needs to ensure that there is staff to cover these rooms both during the day as well as evening shifts because more than likely these cases will continue past 3 when many of the staff members leave. Cassie Arvidson Mensik, J. (2014). What every nurse should know about staffing. American Nurse Today, 9(2), 1-11. Marquis, B. L., & Huston, C. J. (2017). Staffing Needs and Scheduling Policies. In Leadership Roles and Management Functions in Nursing: Theory and Application. China: Wolters Kluwer. #2 In the state where you reside, explore and share with your peers any mandated nursing staff ratios. Would you recommend any changes? Please explain your rationale. Professor and Class, I live in New York State. According to New York State Nurses Association, every portion of each healthcare facility has a regulated/mandated nurse to patient ratio that must be followed. In the area that I work, which is surgical services the mandated numbers are 1:1 because there is only one surgery per room and one nurse per room (New York State Nurses Association, 2013). This is standard, and I do not have any recommendations. The RN to patient ratio for the PACU is 1:2 unless that patient is deemed critical and then the numbers go back to 1:1. Looking at other ratios however NYS mandates that medical-surgical floors have a 1:4 nurse/patient ratio. This can become challenging because sometimes you have 2 or 3 extremely sick patients who need a lot of help or care. This means that those other 1 or 2 patients may not be receiving the care or attention that they need. I also noticed that rehab and sub-acute patient ratios are 1:5 (New York State Nurses Association, 2013). In my opinion this may need to be adjusted. Rehab patients are typically at rehab because they need the extra help and can’t do things on their own like they could at home. It would see that it would be very difficult to get to 5 patients all around the same time for assessments, meds, to help them to the bathroom, get up and out of bed and help them clean up. There are many things that patients that are in rehab require and having 5 patients may seem a little overwhelming. Staffing is an important topic for every facility. The increase in demand for nurses and the difficulty to recruit RNs has shown to be challenging for healthcare facilities all across the United States. Staffing is equally important to the health and safety of the patients that are cared for. “One study found that for each additional patient assigned to a given nurse, the patient has a 7% increase in the likelihood of dying within 30 days of admission and a 7% increase of failure to rescue” (Mensik, 2014). Mensik, J. (2014). What every nurse should know about staffing. American Nurse Today, 9(2), 1-11. New York State Nurses Association. (2013, December). Protecting Our Patients: Staffing in Health Care Settings. NY: NYSNA. Professor and Class, Patient-classification systems are used to help management staff according to the patients needs instead of looking at the number of patients. It is supposed to help management by promoting cost-effective care by identifying the hospital admission patients needs and staffing nursing levels accordingly (Mennella, 2017). One disadvantage of using patient classification systems is that the healthcare facilities must continuously monitor patient classifications in order to maintain mandated minimal numbers in staffing. Cassie Arvidson Mennella, H. A., & Marcel, C. B. (2017). Patient Classification Systems. CINAHL Nursing Guide,