Consultative change recommendation paper
The nursing profession has been experiencing changes over the years, and their role has been hard to define due to the complexity of the task nowadays. The patients with different problems arrive at any time in the hospitals and need to be attended to by the nurses, thus making their job difficult as there are no time limits to work. The broad population of patients with different problems has led the task been one of the most complicated professions in the modern world. To cater to the variations of the difficulties affecting the patients and lack of time limits of patient reception nursing profession requires several professional roles to enable them to be useful in their work. The functions in the nursing profession may, in most cases, lack the domain of authority; thus, leadership is required, which may either be formal leadership or informal leadership.
Introduction
Purpose of consultation
The central theme of the paper is to recognize the change, which is necessary at Maryland Hospital and the improvement which the Hospital needs to undertake through the nurses to better the services it offers to its clients. The basis of the analysis will be through external measures such as metric use, needs of the community, comparison with the available facilities in the place and HCAHOS scores. After the analysis, the problematic areas in the Hospital will be recognized, and the necessary recommendations will be issued to the management board of the organization. The proposals to the problems arising will be obtained through careful and systematic analysis of all the factors mentioned. They will purpose a positive change to the organization on the services and the management of the organization. The changes in the organization based on the provided recommendations will lead to the quality of the services, thus better care for the patients.
Overview of consultation change recommendation process
Chief executive of the nurses was interviewed orally for two hours, and a lot of information concerning the nursing profession and the services in the Hospital were obtained. The interview lasted for two hours whereby the chief nurse executive was interviewed through a face to face communication. His roles within the Hospital were discovered as he made improvements in the quality services which he has championed since becoming a leader. Through a collection of the data and its analysis through various means, health needs were identified, which needed rectification. The study of the collected data was done by considering several patients who access health care, health status, and other health indicators. The benchmarking comparison was also made together with other assessments done by other organizations.
Organizational analysis
Description of the organization
Maryland Hospital is one of the determined health centers for giving health services to its clients in New York City. It has operated for over fifty years and has opened other branches in Manhattan and Winchester County. The Hospital receives and gives treatment to patients suffering from different illnesses within New York City for a profit. Its employees include nurses, physicians, doctors, and therapists who work hand in hand to provide the best service to the clients. Comfort and care is given by the hospital workers for twenty four hours thus ensuring patients can get treatment any time of the day. The administration of Maryland is very determined to offering services to the clients and supervising the activities of the Hospital. Among the administration are very qualified nurses who oversee the activities of the nurses within the Hospital. The Hospital serves across the city and all its surroundings and is among the famous caregivers within the town believed to have highly experienced workers.
Different departments within the Hospital deal with varying complications of the client, which include intensive care unit department, mild and severely impaired units, after service stay for surgery or other illnesses that receive different patients according to the complexity of their illnesses. It also offers outpatient services for patients who are not severely affected by diseases who receive treatment and go home. The Hospital gives intensive care for all its clients to maintain competence with other hospitals around. There are open day centers within the Hospital, and the care offered is based on the expertise of the workers and the complexity of the problem which the patient has.
Home care options for the elderly are well made with senior-friendly environment where all the services for the elderly impaired are offered. For forty years, the organization has been offering such services to the residents of New York until recently when the services are now available for its surroundings. The management of the organization includes vice presidents of different departments in the Hospital, vice president for finance and that of human resource. There is also vice president for communication and other for clinical excellence within the Hospital. Above all the vice presidents is the Chief Executive Officer (CEO) who is the overall and the head of the institution. The vice presidents of each department are responsible for managing them and ensuring that everything in the department works out as required while the CEO is responsible for ensuring that everything in the organization works as required.
Maryland hospital also has board of directors who are responsible for giving counsel to the organization as well as overseeing the plans of the Hospital with an aim of ensuring achievement of its mission and vision with integrity of the highest order. The map of each department was not available for the public as they were not there in their websites or other documents available for the public. The number of the employees in the organization was a challenge to know due to the unavailability of such information in their websites or other documents. The report does not include either the number of the workers in the organization or the departmental maps due to their unavailability to the public. The order of the ranks for the officials of the organization is however available in the report as it was readily available.
Needs of the population which the organization serves
The address for the Hospital is more than five counties is available which are all served by the organization. The community served by the Hospital has a population which of roughly six million with the elderly people above the age of 65 years increasing rapidly. The Manhattan and Brooklyn counties experience higher rates of poverty compared to the rest and most of its population group is elderly people. Among the nurses, 58% are non whites and among the non whites 33% are Hispanic and 73% base their origin from the community since 2015. Bronx County which is rated the worst within the state in terms of socio economic status showed health disparities for those with poor income and minority group within the county.
The needs of the residents which were identified were health insurance, primary care and preventive care services. According to the observations made, there was no enough knowledge on the resources for health care. The other several barriers to care were lack of social and family support, financial difficulties, and lack of insurance coverage and transportation issues which delayed many from accessing health care. Due to poverty in the community affordability of coverage and health was the big problem and many stayed at homes when they became sick until severe cases. Another significant health problem to the community was failure to access mental health care thus many of them lived with depression and anxiety which was across all the age groups.
The mental problems facing the residents within the organization was led by stress due to poverty, financial hardships and social factors. The problems which arise due to the factors include autism, trauma, psychosis, domestic violence and suicide cases which were all evident within the community served by Maryland hospital. Other health problems within the community are chronic diseases due to lifestyle with the adolescents leading in infection. These diseases include diabetes, obesity and overweight problem which further leads to cardiovascular risk, hypertensions and cancer. Accessibility of fast foods which are affordable to the residents was the leading factor towards chronic infections. Lack of exercise was also a leading factor towards chronic infection among the community members since they never got time to exercise. The important factor that led to health problem was ethnic barriers and other environmental determinants which discouraged the community members from seeking medical attention.
The difficulties which the community members went through arose due to failures of some members of the family, poor dietary choices and mistrust of the medicines in the Hospital along with stigma due to some disease infections. Pollution of the environment contributed by vehicles, power generation which use lead based petroleum products was a great threat to the health of the residents of the community. Dust due to construction, poor housing and more vendors selling fast cheap foods were the main contributor of asthma, diabetes and obesity. Lack of important basic needs and insecurity was a great risk to their health with some conducting sexually transmitted infections such as AIDS. Poverty has been the greatest threat to the residents of the community which Maryland hospital serves thus interring effective treatment and care for the people which has to be paid for by every patient.
Nurse leader interview summary
The role of the nurse leader
According to the interview conducted to John Martin who is the chief nurse executive, a lot was obtained were he explained the role of leadership as a fundamental aspect in the nursing profession. According to him, nursing role in the Hospital entails leadership while in their jobs as they tackle their daily activities. In Maryland hospital, the role of the nurses was goal oriented whereby which majorly aimed at improving the health of the clients. The nurses were to work as an association with an aim of inspiring each other to provide comfort to the patients and give hope to their family members. The role of nursing according to their leader in the Hospital is very complex and requires a lot of attention in some cases since the daily activities keep on varying. They have to attend to all patients and ensure they are comfortable through provision of care to them.
According to John, nursing is a holistic profession which requires patient oriented approach in order to achieve their welfare successfully. Achieving all the goals of nursing profession requires mainly that of influencing others towards a common goal, nurses need to be effective communicators with the ability to apply good communication skills as they speak with others. John elaborated his encounters in the nursing profession and concluded that it was tough and requires hard work for the best healthcare to be provided to the patients. The nurses have to monitor health status changes of the patients and develop a plan on how to care for them to gain their full health. The nurses have the obligation of offering clinical nursing to the patients and ensure that their self-care while in the wards.
John reiterated the leadership role of nurses as very essential in the field and is important in giving directions on the actions to be taken on a certain situation. Nurses are distributed across all ranks from the executive nurse officer to the lowest ranks of nurses who serve in the wards within Maryland Hospital. Irrespective of the different ranks owned by the nurses in the Hospital, they all work on patient oriented bases to ensure the best health care is provided to the patients. Being a leader in the nursing profession means that being very hard working and with relevant skills in the profession to be as role model for the other nurses. The nurses need to have the information on the challenges in sociopolitical and economic which are faced by their leaders and remain obedient to their service.
The factors which base the working arrangements in Maryland Hospital as discussed were helpful in determining the strengths and the weaknesses in their service. On looking on the daily problems which arise in the nursing profession at Maryland hospital, improvements can be made for the better services to the patients. Any changes in the models of care which might need to be implemented will fully involve the nurses who will take different roles in the model thus very crucial in the process. John concluded the interview by stating his achievements which include creating effective communication across all the ranks of nurses in the organization and building reasonable relationships with external stakeholders including, patients, families and the local government.
Characteristics of the organization
Strengths
The nurses in Maryland hospital work across are the sectors and make up a strong healthcare system for the patients. They deliver many services to the patients from long term care to short term care, homecare and post acute rehabilitation care to the elderly. The overlapping roles in the nursing profession are all done by the nurses who include coordination of patient care, education, improvements of quality and safety for patients and clinical care are some of the strengths in the nursing profession in Maryland hospital.
Weaknesses
At almost all the stages of organization, nurses have lacked resources and official authority to operate at the highest effectiveness.
Evidence based practice activities
Maryland hospital has adopted the culture of reducing or limiting their patients to food and drinks strategies. The impact of the strategies has been witnessed as it has led to stimulus free, noxious and pleasant environment thus encouraging residents improve their performances on the daily activities. The nurses learn the residents’ preferences by considering individual approaches which help in the reduction of negative encounters. The supervision to the nurses is done to ensure they engage in communication with the residents to understand their preferences. The gained knowledge by the nurses is very useful when dealing with the residents in the Hospital because it guides them on the best kind of healthcare to give to them.
Due to the quality care which is provided in the Maryland hospital, the residents do not suffer from malnutrition, mood swings and poor sleeping habits as the pressure and ulcers rates, malnutrition and incontinence has reduced. There are no other life issues which affect the residents while in the Maryland hospital due to reduction of all those factors. Supervision of pain is through evidence and Certified Nursing Assistant (CNA) is assisted by the registered nurses to carry out research based acts to provide care to the patient affected. The strategies which are applied include use of feedback and audits, use of clinical reminders and prompt practices.
Quality improvement projects
At Maryland hospital, the leadership of the nurses has led to the overall change in the workplace and has positively affected the culture of the organization. Furthermore, nurse leadership has led to professional development and collaboration among different professions. The conflicts among the nurses have fully been counteracted by the nurse leadership in the Hospital and full control of the daily activities of nursing profession has been adhered. The effect of conflict reduction to the patients has been high productivity and recovering from their illnesses at a faster rate. The quality of care has improved in the Hospital due to the embracement of principles which are based on research. According to the research for example, the quality of nursing can be improved by holistic nursing of residents which will help in recognizing the intervention which is most suitable for them.
Prioritizing the care for the residents sleeping patterns, eating and drinking habit has been one of the positive actions to help them to be able to meet their basic needs. The method used by the nurses has been through minimization of discomfort among the residents which was identifiable in behavioral symptoms of the residents. In order for the organization to recognize the best way of staffing configuration, the models of staffing, supervisory and mentoring has been tested.
Recommendation for organization change
Recommendations
It is recommendable for the organization to have leaders at all management levels which should then take part in making executive decisions. Facilitation of mutual trust can be generated if the nurses will have representatives in the organizations management. The design of the work flows and the processes which need to be undertaken by the nurses will be easier due to the effective communication through involvement of the nurses in the decision making process. There is need for the organization to provide more resources to be acquired and used by the nursing staff which will help them make reasonable and knowledge based health care and in making the right decisions. The increased efficiency will be observed through trust among the stakeholders and the faster implementation of the executive decisions at the operational level.
Rationale
Engagement of the nurses to the leadership of the organization at all levels will lead to collaboration in the activities of the organization. Each will be responsible for the daily activities and implementation of the decisions will be smoothly be operated. By inclusive management it will be easy to listen to different wide perspectives in the decision making discussions which will lead to effective and best decisions made. All the health care givers and other management committee members will be able to fully participate and their ideas be heard by the organization governance to make final decisions. The resultant decisions made by the organization will suit the needs of the residents since the nurses have their perspectives.
Measurement of effectiveness
The changes proposed were measured through high standardization through the data which was collected through several practices including the interview done to the chief nurse executive. Management need to be standardized through inclusivity of all the levels of nurses in the organization. HCAHPS survey benchmark is the best benchmark which is more reliable and best to be used by the Hospital to evaluate itself and do the necessary corrections. HCAHPS is applicable in many parts of the nation and has most of the data which is required in the hospital care. The recommendation made for Maryland hospital care will lead to lead to collaboration among all the staffs in the Hospital thus effective services will be offered. It will help the Hospital remain high standards and quality health care given to the patients.
Conclusion
The role of nursing leadership is vital and need not to be undermined since effective and efficient leadership is necessary for quality health care in hospitals. The leadership and the working environment of nurses is critical since it affects their service to the patients. Nurses have great influence in hospitals; thus all the levels of the profession need to be involved in the leadership of the organization. The nurses need to work in an environment that is safe and secure from any intimidation or any threats for them to serve with effectiveness. The high quality outcome in health care will be obtained if the nurses will be motivated to work without tight supervision.
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