Organizational leadership and management in Nursing

Leadership and management in organizations in nursing
The health care systems of today need strong nursing leadership to solve issues and guide the change that is happening. The health care business is changing quickly, which is causing changes in how services are given, such as the use of technology in everyday patient care. Improving and promoting patient safety and quality care are two of the most important things a leader in health care should do. Quality care means that healthcare services are given to the patient in a way that meets their needs, while safety means that mistakes and bad effects related to patient care are avoided. To deal with these problems, nurse leaders focus on improving the patient experience, lowering costs, making the healthcare provider’s job easier, and addressing concerns about the health of the whole community. This talk points out a problem in health care that needs a change in practice and shows how nursing leadership can help improve quality and patient safety in the company.

Clinical/Organizational Problem

How well nurses and patients talk to each other has a big effect on how well the patient does. Nurses are at the front of patient care, and it is their job to share information about patients with all other healthcare workers, as well as with the patient’s family. In my healthcare company, a problem is that nurses don’t talk to each other well. There aren’t enough clear ways to talk to each other, especially when switching shifts. This causes more mistakes with medications and makes patients unhappy. A quality improvement program is needed to deal with the problem of communication between nursing teams in the company. This is to make sure that the quality of care improves and that patients are safe.

Explaining the Problem

A lot of bad things happen in healthcare because of problems with communication, especially when nurses and other workers don’t pass on information well. (Achrekar et al., 2016) says that accurate information is passed on to other providers through both technical and relational contact during shift report handover. Also, the switching process should include asking questions and getting patients involved to help everyone understand. There are several reasons why nurses in the company have trouble talking to each other. The first reason why healthcare teams can’t talk to each other well is that their organizations don’t pay enough attention to the problems that come up. For example, the organization’s most recent quality improvement projects have focused on improving patient care with a focus on patient outcomes rather than addressing the issues’ root causes. Based on information from the office of nursing education, classes that help healthcare teams communicate better were last looked at five years ago. Changing the organization’s attention to how healthcare workers talk to each other might help solve the problem.

Scholars talk a lot about how important it is for healthcare team members to talk to each other better. As an example, the main reason to improve communication in healthcare is to improve quality and patient safety. Because there is more competition in the healthcare field, groups in this field need to be careful about quality and safety. (Dalky et al., 2020) says that bad communication hurts good quality measures by making death rates, patient readmissions, and hospital stays longer. Second, improving conversation in healthcare is seen as a step toward providing care that is focused on the patient. Patient-centered care means giving care that takes into account each person’s preferences, needs, and values, and making sure that all clinical choices are based on what the patient wants. Better conversation during handoffs will make sure that all of the patient’s needs are met, and it will also give patients a chance to plan for their care. Lastly, nurses and patients are likely to get along better if the group works on its communication problems. Good relationships will help people work together and reduce problems that could get in the way of giving good care to patients.

Causes Broken Down

During the change of shifts between nursing teams, there are contradictions in the way people talk. People and the system both play a role in why this problem exists in the company. For example, some health care workers may have trouble communicating, which can lead to mistakes when switching shifts. Other things that seem to add to the problem are bad documentation of written information in patient files and the lack of standardized ways to communicate between shifts. The problem in the building is also caused by the fact that information is not being recorded in the electronic record system. This means that information is not being sent out correctly. More and more evidence shows that the EHR system can be used to share about 84.6% of the information shared during shift handoffs (Achrekar et al., 2016). If this information is in the EHR, nurses will be able to find it quickly and use it to help with regular patient care.

The changing nature of healthcare and the growing complexity of patients’ needs can make it hard to communicate in healthcare. One of the things that has been found to contribute to the communication problem is not having enough time to give shift handover notes. When nurses take care of a lot of patients and write down correct information about each one, they face problems. The lack of a well-designed system for passing on information about patients has been named as the biggest problem that makes it hard for nurses to talk to each other. Most providers would rather share information at the nursing station than at the patient’s bedside, which is where shift updates are usually given. To make sure nurses can interact well, they need to use a standard tool for communication and get training on how to use it.

Stakeholders Needed to Be Found

When healthcare groups try to make a change, they need input from different stakeholders. Administrators, patients, providers, policymakers, and payers are some of these stakeholders. They make sure that enough money is available for process change. To fix the problem with communication in the business, the registered nurses, the hospital administration, and the IT team will be the most important people to talk to.

Talk about Stakeholders

Nurses

Nurses are an important part of any healthcare organization’s change process because they make up the biggest part of the team. Changes that will improve communication in the building will be made with the help of the nursing team. They will take part in education and training events to make sure they know how to use the new tools for communication. The nurses are interested in the project because it is meant to make care safer and better for patients. As advocates for their patients, nurses will want to improve dialogue to reduce medical mistakes and other bad things that can happen when people don’t talk to each other well. The nurses can decide whether or not to go along with the suggested changes that would make communication better in the facility. In terms of influence, if nurses agree to the proposed change, other healthcare workers, such as doctors, will be more likely to adopt and back the strategy.

Hospital administration

The hospital administration is in charge of making policies and making plans for how to improve the level of care. These managers have the power to make rules about policy, systems, procedures, and the culture of a company in order to improve quality and safety. To improve communication in the business, the first step will be to ask the administrators for permission. The idea can be accepted or turned down by the people in charge of the hospital. The hospital administration has a say in the project because their choice about whether or not to support the new change will affect how other stakeholders accept and work on the project. Employees often look to the management for direction and advice on how to make things better. The new change is important to the hospital’s management because it will make the hospital better and keep patients safer. The administration wants workers who work together to improve patient care and make sure that patients are very happy.

Team for Information Technology

There are many ways that health information technology can improve and change healthcare today. The use of technology in health care has led to good results, such as fewer mistakes with medications and easier coordination of care for patients. The IT team will be one of the groups working to make sure that a plan to improve communication in the company is put into action. The team will work to make sure that communication tools like SBAR are used well in electronic health record systems (EHRs) to make shift report delivery more efficient. The IT team doesn’t have much say over how the new change is put into place, but their presence, help, and experience will make sure the project goes well. The team is interested in the new change because it will help with process improvement and the rethink of health care. Their support for the project will affect how nurses and other members of the health care team feel about the plan.

Describe the Project

Effective dialogue is a key part of a patient’s healthcare throughout the whole process. Nurses are mostly in charge of telling patients, their families, and other healthcare workers about what is going on. Effective communication in healthcare is thought to help doctors give patients personalized care that takes their values and desires into account. In healthcare, communication helps not only the patients but also the staff. It makes it possible for staff members to get along well and increases the happiness of healthcare workers. Every company tries to improve communication, but process improvement in the facilities needs to be guided by evidence-based strategies and best practices. The goal of this project is to improve how nurses talk to each other, especially when they switch shifts. People have noticed that the problem with communication affects how well patients are cared for and how safe the facility is. For example, the number of drug mistakes has gone up in the facility.

To solve the problem of communication in the company, this project will use the latest research to find the best interventions for the nursing field. The best evidence-based practices will be found through a review of the literature to make sure that the method chosen is right for the organization and the nursing team. This project will not only help solve the organization’s communication problems, but it will also help me grow as a professional by letting me use study to develop key competencies of my field. For example, when the project is done, it will show a synthesis of professional competencies in areas like communication and building relationships, understanding of the healthcare environment, leadership, collaboration, and organizational business administration.

The Solution Suggested

A common theme in the writings about handoffs is the need to pass on important information to the next shift. A standard way of communication has been suggested to make sure that information is passed on to other staff members correctly. (Shahid & Thomas, 2018) say that the SBAR communication method is the best way for nurses and other health care teams to talk to each other better. The tool gives members of the healthcare team a way to talk to each other. It starts with a short statement about the patient’s condition, then gives background information, an assessment of the patient, and a final suggestion about what could be done. The Institute for Healthcare Improvement (IHI) gives a standardized SBAR checklist that lists the most important ways for nurses, doctors, and other healthcare teams to communicate so that the strategy can be used successfully. The tool gives you a concrete way to frame any talk, especially when something important is happening.

The organization’s plan to use SBAR communication is meant to improve dialogue during shift changes. The main focus of the new change will be on the nursing team, since they are in charge of handing off shifts several times a day across all healthcare units. The nursing instructor will be a part of the project and will help teach nurses how to use the IHI SBAR communication tool. When the training is done, the nurses will use the tool to share information about patients. The goal is to improve communication, which will lead to better care and patient safety.

Summary of the Proof

Handoffs are a very important part of building a shared understanding of a patient’s situation. The SBAR method is one of the tools that are used to help improve dialogue in health care. (Dalky et al., 2020) This tool gives a concrete way to frame talks about care transitions during routine nursing care and in emergencies. This tool was chosen because it gives nurses a useful way to use a non-hierarchical communication model to improve the quality of clinical care (Bonds, 2018). The SBAR communication tool, which is backed by many professional groups, is very important for solving communication problems between clinicians and other members of healthcare teams. To find out if SBAR handoff could be used in healthcare, a narrative study was done. The results of the study show that SBAR is a reliable and validated communication tool that has been shown to reduce adverse events in a hospital setting, improve communication between health care workers, and improve patient safety (Shahid & Thomas, 2018). Putting this strategy into place in the company can help nursing teams communicate better in a big way.

A lot of evidence shows that the SBAR communication tool is very important for improving patient safety and quality results. The goal of a study done in the intensive care unit was to find out how well nurses follow SBAR dialogue and what happens when they do. After the study was done, the researchers came to the conclusion (Achrekar et al., 2016) that the use of standardized SBAR tools for bedside shift changeover can improve communication and make patients safer. The results of this study are the same as those from another study that looked at how SBAR affects patient safety. After looking at data from primary care, secondary care, and nursing homes, the systematic review found that SBAR communication can be used to improve patient safety, especially when used to structure conversation over the phone (Muller et al., 2018). This SBAR strategy has a clear framework that asks for important information to be given in a structured and logical way.

Plan of what to do

The plan for making the suggested change can be broken down into four steps. The first step is to meet with the teacher to talk about a health problem and figure out the best way to solve it. This talk will be about finding a nursing issue that needs to be changed and getting advice on how to do that change right. The second part will be to do a literature study on the topic and collect strategies that have been shown to work to solve the problem. The materials for the literature study will come from the WGU library. They will include original research studies that show how best practices should be done.

Based on what was found in the literature study, the next step will be to make a plan for how to solve the problem. Evidence-based practices from the literature will help the group figure out the best way to solve its communication problems. In the last step of putting the project into action, the proposed plan will be shown to the teacher. Due to the limitations of COVID-19, there will be no need for real implementation at the organizational level. The teacher will look over the plan and give feedback on it.

Timeline

It will take four weeks to fully plan and carry out the job. In week 1, you will meet with your preceptor to talk about a healthcare problem that needs a change in practice and to talk about the best ways to deal with it. In week 2, you will look for evidence-based literature to back the problem you found and find a solution. We will use the WGU library to find first-hand information about the topic. In the third week of the project, a plan will be made based on what was found in the literature study. In the plan, the answer and how it will be used to fix the health care problem will be talked about. During the last week, the proposed plan will be shown to the preceptor, who will look it over and give comments. At this point, any changes to the plan will also be made.

Needed Materials and People

Due to COVID-19’s restrictions, the project will only need a small amount of money to be carried out. The MSN capstone student, the WGU library, and the preceptor will be used as human resources for the project. The librarian will help the student do a literature review and find original research to back up the project. The preceptor will look over the plan and give the student comments. There will also be a need for time to go to the library, do the literature study, and talk with the preceptor about the project. Due to the way the job has to be done, there will be no need for money.

Proposed Theory of Change

Lewin’s change management model is the change theory that will be used to guide the project. Lewin’s model of change management is made up of three stages: “unfreezing,” “moving,” and “refreezing.” In the first stage, or “unfreezing” stage, employees need to be made aware that the company needs to change. (Hussain et al., 2018) To make sure employees accept the new change, it is important to communicate well and ask for support from leadership during this time. The second step is called “moving,” and it is where the real change happens. (Hussain et al., 2018) Lewin said that training and support for employees are important for this part to work well. In the last step, called “refreezing,” the change has already been accepted, but it needs to be reinforced to stay in place. At the same time, workers can’t go back to their old ways without communication and reinforcement.

During the implementation of SBAR communication, the unfreezing step will be shown by presenting the proposal to the administration and nursing team. There will be a presentation of data about the effects of poor communication in the building to make people aware of the need for change. Having the administration and other nurse leaders involved will make it clear that the organization needs a new change. The stage of moving or changing will be reached by educating and training nurses. Role-playing and simulations will help people get used to the new way of doing things. The project will also be successful because nurse leaders will keep an eye on how it is done. During the refreezing stage, the new change in the company will be reinforced by policies on how to use the SBAR communication strategy.

Problems with Getting Things Done

Even though many healthcare organizations use evidence-based methods to improve their communication, the problem is still there. Changing the organization’s mindset to include new ways of handing off shifts will be one of the problems that will be seen. Many doctors and nurses like to take short cuts. Many nurses already know how to do this. People may not like the new process because it is hard to give shift reports using the SBAR method, especially in busy places like the urgent care units. Given how busy nurses are these days, another problem could be that they don’t have enough time to train and learn. The COVID-19 pandemic will make it very hard to do study and communicate with the preceptor. Most of the talking will happen online, which will change how well the student understands the job.

References

Achrekar, M. S., Murthy, V., Kanan, S., Shetty, R., Nair, M., & Khattry, N. (2016). Introduction of situation, background, assessment, recommendation into nursing practice: A prospective study. Asia-Pacific Journal of Oncology Nursing, 3(1), 45–50. https://doi.org/10.4103/2347-5625.178171

Bonds, R. L. (2018). SBAR tool implementation to advance communication, teamwork, and the perception of patient safety culture. Creative Nursing, 24(2), 116–123. https://doi.org/10.1891/1078-4535.24.2.116

Dalky, H. F., Al-Jaradeen, R. S., & AbuAlRrub, R. F. (2020). Evaluation of the situation, background, assessment, and recommendation handover tool in improving communication and satisfaction among Jordanian nurses working in intensive care units. Dimensions of Critical Care Nursing : DCCN, 39(6), 339–347. https://doi.org/10.1097/DCC.0000000000000441

Hussain, S. T., Lei, S., Akram, T., Haider, M. J., Hussain, S. H., & Ali, M. (2018). Kurt Lewin’s change model: A critical review of the role of leadership and employee involvement in organizational change. Journal of Innovation & Knowledge, 3(3), 123-127. https://doi.org/10.1016/j.jik.2016.07.002

Müller, M., Jürgens, J., Redaèlli, M., Klingberg, K., Hautz, W. E., & Stock, S. (2018). Impact of the communication and patient hand-off tool SBAR on patient safety: A systematic review. BMJ Open, 8(8), e022202. https://doi.org/10.1136/bmjopen-2018-022202

Shahid, S., & Thomas, S. (2018). Situation, background, assessment, recommendation (SBAR) communication tool for handoff in health care–A narrative review. Safety in Health, 4(1), 7. https://doi.org/10.1186/s40886-018-0073-1

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