I encountered a "wicked problem" at a nursing home (NH) that includes the “wicked” dimensions of “unstructured” and “cross-cutting.” It remains to be seen if the problem also falls into the “relentless” dimension; however, I believe it does.
During more than three years of my partnership with the NH, I have developed a positive relationship with members of the nursing management team. The managers have a strong focus on person-centered care, to the extent that they work long hours to write grant proposals for implementing such programs as OMA and music on iPods and to search for innovative methods to educate staff on best practices for working with persons who have dementia (such as having nursing students plan and implement a mandatory in-service: free!). Indeed, they sacrifice family time to fulfill the roles of Director of Nursing (DON), who is on duty/call 24/7, and Unit Manager. Each expressed to me the commitment to the residents of this facility. Therefore, I felt surprised to learn that the DON resigned the
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position to become the MDS nurse and, after accepting a leadership change to manage a unit that had attitudinal problems of staff, the Unit Manager requested me as a reference for a job search. This manager would be expected to make staffing changes and change the culture of the unit. As a partial “outsider,” I began to wonder about what was happening within the organization and what the root cause of these resignations might be.
Knowing that these leaders work long hours, to the chagrin of their families, I began thinking it might include family pressure. Next, I considered one manager’s comment that a potential employer would pay for further education; could these additional benefits fill a professional goal? Were the role changes too difficult? Were poor staff attitudes insurmountable? My questions address the “unstructured” aspect of wicked problems: Causes and effects are difficult to apply. Additionally, there are multiple stakeholders (including residents, families, top administration, staff, and the nurse managers) and these management sources take on added importance, creating “cross-cutting” dimensions of the issue. Finally, these events are fairly recent, and, therefore, I wonder if they will become
“relentless”. Although the “wicked” problem I identified focuses on management changes, I thought about staffing issues, pay rates/benefits levels, burn-out, relationships with upper administration and the Board of Directors, stressors from regulating bodies, and many other possible influencers on the decision-making of these respected nurse administrators. Next, I am unsure if the problem is relentless; however, I think it is continuous. Hiring strategies for nursing assistants, nurses, physical therapists, respiratory therapists, and other staff may need to be changed to promote personnel who have positive attitudes; skills can be taught! Some staff members have been with the organization for many years: I wonder if these staff members feel “stuck” because they are underqualified to find a higher paying position, or if they are passionate about working with older adults. In turn, nurse administrators are expected to “fix” attitudes of staff. “Fixing” other people is impossible, so are these nurse leaders are in a “wicked” position. Although I don’t know the underlying issues, I perceive that the nursing administrators’ desire for change indicates an underlying, “wicked problem.” One thing that surprised me about today's guest speaker's comments was the frequency of ombudsman involvement in discharges/evictions for behavior that was inconsistent with NH expectations. I always wondered what happened with people who committed battery against other residents and/or staff. I think this may be a "wicked" problem: how do we maintain safety of ALL residents and staff while offering a home to the people who have a disease causing unsafe behavior? This is a bigger "wicked" problem than NH leaders who cannot find a way to change "wicked" problems!
Presented issues such as lack of nursing opportunities for nursing graduates, lack of respect for the nursing profession and nurses being viewed as a threat by doctors continues to be of an existence today. As a nurse, I feel that it is of high importance to highlight these presented issues from the film not only because they were the most outstanding to me but because the nursing profession needs more
In researching for my own post, I came across an interesting article regarding the resignation of the ER nurse manger
Ornstein, C., & Weber, T. (2009, July 10). When caregivers harm: Problem nurses stay on the job as patients suffer. Retrieved February 9, 2014, from ProPublica: http://www.propublica.org/article/california-eyes-discipline-for-2000-nurses-sanctioned-by-other-states
Even though leadership can be an essential place for development, if certainly not of greater importance, is the desire to create your conditions, which service and boost new models of leadership. Another dimension regarding consideration inside the implementation regarding clinical governance as well as leadership would be the disempowerment from the nursing profession. Hitchcock (2013) supported this view, asserting that yesterday’s methods do not work in the permanent white-water world, where managers traditionally manage within the system and focus on doing things according to the rules.
In healthcare it is very important to have strong leaders, especially in the nursing profession. A nurse leader typically uses several styles of leadership depending on the situation presented; this is known as situational leadership. It is important that the professional nurse choose the right style of leadership for any given situation to ensure their employees are performing at their highest potential. Depending on which leadership style a nurse leader uses, it can affect staff retention and the morale of the employees as well as nurse job satisfaction (Azaare & Gross, 2011.) “Nursing leaders have the responsibility to create and maintain a work environment which not only promotes positive patient outcomes but also positively influences teams and individual nurses” (Malloy & Penprase, 2010.) Let’s explore two different leadership styles and discuss how they can enhance or diminish the nursing process.
Nurses want to give complete and quality care, but are unable to, due to the constant needs of their workload and inadequate staffing. They have to prioritize their patients needs based on the most critical treatments first. Then whatever time is left, they fill in what treatments they can. Some reasons that nursing treatments are missed include: too few staff, time required for the nursing intervention, poor use of existing staff resources and ineffective delegation.” (Kalisch, 2006) Many nurses become emotionally stressed and unsatisfied with their jobs. (Halm et al., 2005; Kalisch,
Nursing Home Abuse With over 1.5 million elderly and dependent adults now living in nursing homes throughout the country, abuse and neglect has become a widespread problem. Even though some nursing homes provide good care, many are subjecting helpless residents to needless suffering and death. Most residents in nursing homes are dependent on the staff for most or all their needs such as food, water, medicine, toileting, grooming- almost all their daily care. Unfortunately, many residents in nursing homes today are starved, dehydrated, over-medicated, and suffer painful pressure sores. They are often isolated, ignored, and deprived of social contact and stimulation.
Donnelly GF (2003). Why Leadership is important to nursing. In S Austin, M Brewer, G,
Poor staffing stresses every nurse and makes them despite what they once loved to do. Nurses are overworked and because of that they may not provide adequate patient care.
Nurses are uniquely qualified to fill a demand for change through leadership. Unlike business minded individuals whose primary outcome concern is monetary, a nurses’ primary concern is organic: a living, breathing, tangible being. In a leadership role, a nurse might consider an organization as if it were a grouping of patients, or perhaps an individual patient, each limb with its own characteristics and distinct concerns. They can effectively categorize and prioritize important personal and professional matters and are therefore ideally positioned to lead change efforts. Perhaps most importantly, effective nurse leaders can provide clarity to the common goal and empower others to see their self-interests served by a better common good (Yancer, 2012).
The nursing leadership problem is there are not enough bachelor prepared nurses to staff hospitals nationwide, because Magnet hospitals have a goal to have 80% of nurses in the hospitals to have a four year Bachelor of Science in nursing degree by the year 2020 (Sarver, Cichra, & Kline, 2015). This problem of the shortage of nurses stems from the baby boomers retiring and needing more medical care. So to offset the need for nurses, more two year programs for nurses have begun around the area to increase the nurse population to accommodate the baby boomers. The problem is leading to the nurses who are working short staffed becoming dissatisfied with their job and jumping around from hospital to hospital causing high turnover rates
It did affect her ability to be an effective leader because we did not believe in her, she did not like the initiative and she was trying to convince the staff of the benefits of something she did not believe. She did not have communication skills, she did not take our concerns to the chief nursing officer, contrary to that she lied saying that nurses love the idea. There was no trust, the communication was not effective, and there was not motivation, and the environment turn hostile. The director was not in the unit anymore, she tried to avoid meetings, and any activity with staff members.
During my interview with Regina Martinez, BS RN and currently an Assistant Director of a home health agency, I discovered her leadership style matched the above quote. Martinez had extensive experience in management prior to joining the medical field. As a single working mother, she worked her way up from waitress to manger of a popular seafood restaurant. However, her dream had always been to become a nurse and she began her medical career as a certified nurse’s aide (CNA), while working through college. She graduated from nursing school with a Bachelor’s degree in Science and has been a Registered Nurse (RN) for more than two decades. She quickly earned the respect of doctors and fellow nurses, becoming a Charge Nurse on the floors she worked. She has worked as Medical Surgery nurse, emergency room, and as Director of Nursing for home health and long-term care facilities where she was responsible for over 150 employees.
...ntinually evolve, a certain degree of freedom must be felt by its members, bureaucracy represents and organization from which chaos has completely been eliminated. Nurse Executives, therefore, will need to encourage staff to challenge existing practice. Given the current environment, creative conflict will need to be supported in order for our continued growth.” (McGuire, 1999, p. 9) I believe that Capital Health is on a path for success. They have modernized there organization chart causing a more decentralized environment. This new atmosphere fosters empowerment of its nursing staff. This sense of ownership over their practice provides growth not only for individual nurse, but the entire profession. This positive proactive change of the organizational structure will allow the hospital to experience continued growth and development that is propelled from within.
In today’s society, leadership is a common yet useful trait used in every aspect of life and how we use this trait depends on our role. What defines leadership is when someone has the capability to lead an organization or a group of people. There are many examples that display a great sense of leadership such being an educator in health, a parent to their child, or even a nurse. In the medical field, leadership is highly used among nurses, doctors, nurse managers, director of nursing, and even the vice president of patient care services. Among the many positions in the nursing field, one who is a nurse manager shows great leadership. The reason why nurse manager plays an important role in patient care is because it is known to be the most difficult position. As a nurse manager, one must deal with many patient care issues, relationships with medical staff, staff concerns, supplies, as well as maintaining work-life balance. Also, a nurse manager represents leadership by being accountable for the many responsibilities he or she holds. Furthermore, this position is a collaborative yet vital role because they provide the connection between nursing staff and higher level superiors, as well as giving direction and organization to accomplish tasks and goals. In addition, nurse managers provide nurse-patient ratios and the amount of workload nursing staff has. It is their responsibility to make sure that nursing staff is productive and well balanced between their work and personal lives.