Discussion 4 responses
by Alexandria Demers – Friday, April 10, 2020, 10:35 PM
Number of replies: 0
Mangers spend time addressing conflicts. If these are not handled correctly they can lead to undesirable outcomes (Iglesias & Vallejo, 2012). Currently at my workplace, one of my supervisors made a decision in regards to care of individuals that are suspected or positive for COVID19. Our organization had to decide if we were going to isolate these individuals in their group homes or create a setting where they can be quarantined elsewhere. Our medical services director made the decision to open up a quarantine site where the individuals can be placed and have 24/7 nursing care. In the uncertain time I believe this was the right decision. She worked out staffing issues, concerns about PPE and put policies in place to guide the care of the individuals. By doing so, she showed qualities of servant leadership, putting the needs of others (our individuals) before all else (Marquis & Huston, 2015). I believe this has led to positive outcomes. The individuals were able to receive appropriate care and monitoring by nurses at all times. As we currently do not have many cases within in the agency so I believe that we have helped slow the spread not only throughout the agency but also prevented the spread to the other individuals that they live with.
References
Iglesias, M. E. L., & Vallejo, R. B. d. B. (2012). Conflict resolution styles in the nursing profession. Contemporary Nurse : A Journal for the Australian Nursing Profession, 43(1), 73-80. Retrieved from http://americansentinel.idm.oclc.org/login?url=https://search-proquest-com.americansentinel.idm.oclc.org/docview/1314752911?accountid=169658
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application. Philadelphia, PA: Wolters Kluwer.
282 words
Response
Hi Alexandria, conflicts at the workplace are inevitable. They not only pose challenges to our daily work but also strengthen us. Challenges require that leaders demonstrate specific characters to solve them. In the healthcare system, the leader leads the staff to ensure quality and safe care. Therefore, servant leadership is appropriate in this situation (McCann et al. 2014). Servant leadership is a set of practices that enhances an organization’s performance, builds its staff, and creates a just and caring world (McCann et al. 2014). Due to the recent pandemic, COVID-19, healthcare organizations around the globe have made decisions to curb the spread of the virus. I believe your organization has achieved its optimal outcome since quarantine centers prevent the spread of the infectious disease at the community level (WHO, 2020). Besides, by protecting the healthcare workers by the provision of personal protective equipment, sorting out staffing concerns, and putting in place policies to guide the care of the individuals in the quarantine site, your leader demonstrated care towards their staff. Thus, higher job satisfaction and better patient outcomes.
References
McCann, J. T., Graves, D., & Cox, L. (2014). Servant leadership, employee satisfaction, and organizational performance in rural community hospitals. International Journal of Business and Management, 9(10), 28.
World Health Organization. (2020). Coronavirus disease 2019 (COVID-19): situation report, 72.
Discussion 4 Question 1
by Davney Bunch – Thursday, April 9, 2020, 2:33 PM
Number of replies: 2
Nurse managers spend much of their time dealing with staffing issues and employee conflict (Iglesias & Vallejo, 2012). A good manager can manage these issues with the best outcomes for all and it can affect the entire morale for the unit. An example of when my manager was able to manage a challenge with staffing was when our department was busy and we had a call in. It takes creative thinking to adjust staffing to fit the needs of the department and patients. I work in women services and we all work closely together. This particular day, there was a call in on postpartum. It was busy, they had 9 patients and one of those was a GYN surgery. There was also 3 deliveries to come that day. This staffing issue involved PP, NSY and L&D. Our manager was able to move people around to have adequate staffing available. One PP nurse took the GYN surgery with other moms and a NSY nurse that can also take care of mom’s became a mom/baby nurse and that left one nurse in NSY to take a few babies and catch all the deliveries with help from the NICU charge. This provided safe and competent care. This was a positive ending to what could have been negative. Also, our manager is always willing to come in and help in a staffing crisis. It is good for staff to see their manager work with them through the not safe staffing times, it promotes unity and morale. Managerial support for nursing care can be associated with patient satisfaction, quality and safety of care, and nurse workforce outcomes (Aiken et. all, 2012).
Resources
Aiken, L. H., Sermeus, W., Van den Heede, K., Sloane, D. M., Busse, R., McKee, M., . . . Kutney-Lee, A. (2012). Patient safety, satisfaction, and quality of hospital care: Cross sectional surveys of nurses and patients in 12 countries in europe and the united states. BMJ : British Medical Journal (Online), 344 doi:http://dx.doi.org.americansentinel.idm.oclc.org/10.1136/bmj.e1717
Iglesias, M. E. L., & Vallejo, R. B. d. B. (2012). Conflict resolution styles in the nursing profession. Contemporary Nurse : A Journal for the Australian Nursing Profession, 43(1), 73-80. Retrieved from http://americansentinel.idm.oclc.org/login?url=https://search-proquest-com.americansentinel.idm.oclc.org/docview/1314752911?accountid=169658
Response
Hello Davney, teamwork is crucial in times of nurse shortage. According to Zlatanova-Velikova (2010), nurse managers are often faced with situations that require them to make decisions that lead to staff satisfaction as well as patient safety. For instance, during a circumstance like the one you described. The healthcare system is facing severe shortages compared to any other organization, and the few professionals present at the institutions are highly trained (Zlatanova-Velikova, 2010). In cases of job dissatisfaction, these employees can easily find a vacancy in another facility. Therefore, managers need to consider employee satisfaction at any point in their practice. Besides, (Dyer et al. 2013) noted that patient satisfaction was lower in hospitals, which had an adequate number of nurses but experienced job dissatisfaction. Therefore, leaders should note that job satisfaction, employee morale, and low staff turnover is more significant compared to the number of staff one has. Teamwork, which promotes caring for patients using a team-based approach, enhances staff satisfaction. Also, when a manager encourages organizational and system learning when errors occur instead of instilling punishment, it boosts employee satisfaction (Dyer et al. 2013).
References
Dyer Jr, W. G., Dyer, J. H., & Dyer, W. G. (2013). Team building: Proven strategies for improving team performance. John Wiley & Sons.
Zlatanova-Velikova, R. (2010). The shortage of health workers globally. Trakia Journal of Sciences, 8(Suppl 2), 414-417.
To mask or not to mask… that is the question
by David Richardson – Wednesday, April 8, 2020, 10:38 AM
Number of replies: 11
Discussion Four, Question One
Early in the Covid-19 crisis there was directive that staff were not allowed to wear surgical masks while on the floor. Masks would only be allowed in isolation rooms to conserve PPE. An excellent nurse that was 7 months pregnant expressed that she wasn’t comfortable working without a surgical mask on due to being pregnant. Management felt that they had to take a hard line because of the potential surge in patients we may have leading to severe shortages in PPE. In addition to conserving PPE, management had sound reasoning to restrict mask use, as surgical masks can potentially become a source of cross contamination. Rubino and Choi (2017) wrote that
Another crucial issue is cross-infection/transmission. Because viruses and microorganisms can survive for at least a few hours to several days [4], masks and respirators become a source of infection for the wearer and others, thus limiting them to single use (pp. 908).
The nurse quit. After this, my manager was able to work with senior management and guidelines were created two days later allowing nurses to wear one mask per shift, which can be disposed of and replaced as need if grossly contaminated. It is a sad irony that the nurse who quit was standing up to do what is now the current CDC recommendation. On March 17, 2020 the CDC approved the implementation of the extended use of facemasks as a contingency capacity strategy:
Extended use of facemasks is the practice of wearing the same facemask for repeated close contact encounters with several different patients, without removing the facemask between patient encounters. The facemask should be removed and discarded if soiled, damaged, or hard to breathe through. HCP must take care not to touch their facemask. If they touch or adjust their facemask they must immediately perform hand hygiene. HCP should leave the patient care area if they need to remove the facemask (cdc.gov).
Currently, when coming in the building we use hand sanitizer, show on our cell phones that we have done our virtual health screen, don a surgical mask and use hand sanitizer at the main entrance of the hospital. The uncertainty surrounding the potential crisis we are facing was a major factor contributing to the decision of senior management to be inflexible when confronted by a frontline nurse. Minimizing the use of PPE before we face what may be the most challenging surge of patients to the hospital since the flu epidemic of 1918 is an important goal. The stress of an impending epidemic hardened the positions of both management and the employee leading to a negative outcome for the employee and the health system.
References
Centers for Disease Control and Prevention. (2020, March 17). Strategies for Optimizing the Supply of Facemasks: COVID-19. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/face-masks.html
Rubino, I., & Choi, H. (2017). Respiratory protection against pandemic and epidemic diseases. Trends in Biotechnology, 35(10), 907-910. doi:http://dx.doi.org.americansentinel.idm.oclc.org/10.1016/j.tibtech.2017.06.005
Response
Hello David, it is sad that a nurse who aired her views on the significance of the use of PPE was neglected, and she had to quit during this period when the healthcare system is in dire need of nurses. However, the health of healthcare practitioners must be put first, since we also have a right to good health and life. There were several signs of unpreparedness to protect healthcare personnel from the pandemic globally. For example, in China, 3300, healthcare practitioners reused damaged facemasks, which led to the death of 22 of them (Silv, 2020). In the US, healthcare workers have reported that hospitals were unprepared to provide them with the required PPE, especially at the beginning of the pandemic (Mason & Friese, 2020). It is, therefore, important for our healthcare executives to institute policies in place to be prepared for such a crisis. For instance, federal, state, and local governments should introduce and rely on guidelines that are evidence-based, reliable, and aligned with local decision making (Mason & Friese, 2020).
References
Mason, D. J., & Friese, C. R. (2020, March). Protecting Health Care Workers Against COVID-19—and Being Prepared for Future Pandemics. In JAMA Health Forum (Vol. 1, No. 3, pp. e200353-e200353). American Medical Association.
Silv, M. (2020). COVID-19: too little, too late?. The Lancet, 395, 755.
Discussion 4
by Elishia Stillwell – Tuesday, April 7, 2020, 2:01 PM
Number of replies: 2
I am a former Director of Nursing for a skilled nursing facility that I proudly worked at for nine years. My last six months as a DON were challenging to say the least. “At the organizational and unit levels, nurse-leaders are being directed to address turnover rates by staff, an emerging shortage of qualified top-level nursing administrators, unionization, and intensified efforts to legislate minimum staffing ratios and eliminate mandatory overtime, while maintaining civil and productive work environments” (Marquis & Huston, 2017 p2863). This was a hospital attached facility that was part of a large corporation and neighbors to a college town. The nursing assistant’s that applied were typically nursing students that were looking to “get their foot in the door” and then move on to the hospital once they graduated or sooner if a tech position became available. The CNA school that was close by and completed clinicals at our facility closed. I found myself with a few open positions related to this and it unfortunately snowballed from there due to mandatory overtime and burnout.
I tried many things to help recruit staff including speaking with a new CNA school about our facility and beginning the legal process of inviting them to complete clinicals on our unit, increasing the resource/pool positions as well as increasing the minimum hours required to remain a resource employee. I also linked with the hospital float staff to assist in cover shifts, tried to get feedback and ideas from the CNA staff, gave hefty bonuses and spoke to the chief nursing officer about the possibility of using agency staffing to get us over the crisis. My request for agency staffing was denied and I was honestly at a loss as a leader. I was in contact with the human resources recruiter daily. The nurses volunteered to cover some shifts. I broke up the open shifts into four-hour blocks with mandatory pick up to cover. Unfortunately, all efforts were ineffective and after some time staff began to leave, continuing the snowball. The basic directive I got from my administrator and CNO was “deal with it”. “Evidence shows that work stress contributes to higher burnout levels among nurses and is associated with lower job satisfaction. Prolonged work stress negatively affects physical and mental health outcomes among nurses” (Khamisa, Peltzer, Ilic & Oldenburg, 2017). This situation led to a negative outcome because I chose to leave a job I loved for the lack of support I felt that I received and, because I was so inundated in staffing chaos I felt I was not being an effective leader.
References
Khamisa, N., Peltzer, K., Ilic, D., & Oldenburg, B. (2017). Effect of personal and work stress on burnout, job satisfaction and general health of hospital nurses in south africa. Health S A, 22, 252-258. doi:http://dx.doi.org.americansentinel.idm.oclc.org/10.1016/j.hsag.2016.10.001
Marquis, B. L., & Huston, C. J. (9th Ed.). (2017). Leadership roles and management functions in nursing: Theory and application. Philadelphia, PA: Wolters Kluwer. ISBN: 9781496349798
Response
Hi Elishia, stress up to a specific point enhances the performance of an individual. However, if stress becomes excessive if it losses its beneficial impact and causes harm. The nurses’ work environment is such one stressor. Nurses are required to care for sick individuals who have infections. Thus, they are predisposed to those biological agents. Also, long working hours, coupled with understaffing, causes physical stress and burnout. Psychological stress is also a significant concern for nurses; for instance, seeing patients suffer and die in their care can be emotionally draining (Rahman et al. 2017). According to (Kath et al. 2013), nurse managers experience higher levels of stress due to excessive workloads and hospital reshuffle. It is, however, essential to note that although nurse managers are faced with extreme pressure, few stress management seminars are conducted for their benefit. Instead, most hospital administrations have the “deal with it “attitude, which leaves more nurse managers vulnerable to mental health problems, or them quitting their jobs.
References
Kath, L. M., Stichler, J. F., Ehrhart, M. G., & Sievers, A. (2013). Predictors of nurse manager stress: A dominance analysis of potential work environment stressors. International journal of nursing studies, 50(11), 1474-1480.
Rahman, H. A., Abdul-Mumin, K., & Naing, L. (2017). Psychosocial work stressors, work fatigue, and musculoskeletal disorders: comparison between emergency and critical care nurses in Brunei Public Hospitals. Asian nursing research, 11(1), 13-18.