In nursing administration sometimes addressing a nursing issue is a lesson in futility because of the interdependent relationships with other departments in the hospital. Many times an issue appears to be a nursing issue when in actuality it is not. This is where the gray area of nursing lies. Nurse administrators need to be self-disciplined enough to not accept what is left at their door—if the issue belongs to nurses then fine fix the problem, but if the problem is really that of another department then it must be given back for that department to manage.
Understanding the factors that make a problem cannot be successful if the nurse administrator is in operational thinking mode. Deciphering between nursing issues and departmental issues involves strategic thinking (Allen, Nelson, Netting and Cox, 2007). A good nurse administrator will embrace a system approach because it makes her less likely to assume the burden of issues within the hospital that are not hers. Her ability to be disciplined in her work benefits the patient and her subordinates. A self-conscious approach to time management is a nurse administrator’s best friend.
If the nurse administrator is spending more time strategizing than doing then she is managing her position correctly. A nurse administrator creates her own work environment. What she does with the events of her day is up to her. She makes the choice daily to be an operational thinker or a strategic one. A good nurse administrator will go through her day attending to some events while ignoring others—she will talk to people about what they are doing or should be doing and make suggestions along the way. The way the nurse administrator conducts her day shapes the environment of the whole hospital.
Nurse administrators who are operational create organizational environments that are in a crisis all the time. Nurse administrators who are strategic thinkers create a reality of communication, learning and futuristic thinking. What changes would you make? I don’t believe that complaining is a way to change anything. Competent persistent action is the only way for nurses to make a real change. Above I addressed hospital management solutions, but in this section I would like to focus on how nurses can change their own careers. I believe there are five basic principles in nurse education.
The responsibility of all nurses is to teach these five basic principles to the novice nurse. Principle one is to find people to mentor you. Every nurse needs a mentor. It is not uncommon to have more than one mentor. In fact, it is rare to find just one person who has all the qualities to help you grow into your own moral clarity (Kerfoot, 1997). The second principle is about sponsorship. Find sponsors who will help you find your way into the advanced positions you want in your career. A sponsor is different than a mentor. A sponsor has the ability to open doors for you within the nursing profession.
Your sponsor will believe in you, your convictions and your ability to work in the realm of moral certainty. A sponsor will market your skills and abilities to key people in your health care organization and other organizations. Balance is important in sponsorship. You want a broad base of sponsorship within your organization and without. If you do not have this balance then you need to figure out why and rectify the situation immediately (Kerfoot, 1997). The third principle is reciprocity. Mentoring and sponsor is not only about you—they both are a two-way street.
Balance in this relationship is often a challenge. There is no entitlement in mentoring or sponsorship. Exploitive relationships are unhealthy. Reciprocity is about interdependence–it is a relationship between people that is genuine, honest and equal. What you can do for others is a question you have to answer for yourself. It is important that you figure out what you can do for your mentors, your sponsors and your health care organization (Kerfoot, 1997). The fourth principle (just stick to the fourth, the third, etc. ) is about self-conception. I think of myself as my own business.
I have an established mission and I know just how much you are willing to invest in my plan for the future. I must always remember that I am a product of my business—I must always be aware of just what it is I have to offer. Determining my value is key to marketing myself. If I am unsuccessful at reaching my goals then I need to figure out why? This is where my mentor can help me. To turn my business around and make it successful I need to find the opportunities available to do just that—turn myself around. My goal is to become valuable to my health institution (Kerfoot, 1997).
The final principle is about caring. You genuinely need to be able to care for other people. A nurse cannot be taught compassion and caring. This may sound contrite, but not everyone has the ability to genuinely care for people. I can find these people in nursing very easily—they are the ones complaining and with the negative attitude—they come to work late and are always trying to leave early—they are poison to the nursing profession. I feel my role as a successful nurse is to shine brighter than those who lack compassion and caring (Kerfoot, 1997).
An interview with the clinical director of Holisticare Hospice A company I work work for undergoing an acquisition, although not a hospital but a hospice company, has followed some of the same errors that have caused the unsuccessful merger of BIDHMC. The company which was privately owned was sold on 5 September 2008 for 7. 4 million dollars to a corporate organization. The company went from a company of 125 employees to 33,000 employees. We have anticipated the corporate office coming in and taking over, which oddly has not occurred.
The reactions by the staff present at the announcement on September 4, 2008 the feelings of loss are definitely something you go through. Since I belong to the middle management, I had no direct contact with the corporate office, and could not tell the staff about the way I felt, hence the lack of support, for me, was very evident. I have kept one major focus throughout this transition and this is to complete my BSN. As I think about it, I realize that there is one person that supports me as I support her, and that is my sister-in-law, who is our office manager.
We tend to get together and talk after office hours, and majority of our discussion include statements like “only trust us” and “we have to stick together”. The original owner that is no longer with the company has been a major loss to the functioning of the company since he covered multiple tasks, e. g. billing, payroll and human resources. We had lax rules and the team had control of patient care and the resources needed. Notice my use of the word “team” as this is how we function regardless of our position and the roles we play.
Now the changes are gradually being felt as supplies and materials are being replaced with those of less cost. Oddly there were no directions for the nursing staff on how to complete patient care and the proper forms to use. We have new federal regulated Conditions of Participation that need to be in place by January and still nothing is being done. No one from the corporate office has given us any communication, in fact no one has bothered to visit and see how we function, except for payroll for two days. (G. Zimmerman, Personal communication November 10, 2008). The Future
This book is definitely an eye opener that if an acquisition is done improperly or is solely-based on the theory of cost and increased productivity, and patient care needs are not taken into consideration, the company will definitely not survive the stronger counterparts. After reading this book, I requested a meeting with the administrator/previous owner and expressed my concerns of all the systems and accountability not in place. I also expressed my goals in my own professional growth. I would like to put a proposal in place for this new company and present it to them as an educational opportunity.
Reality wise, they have 6 other hospices spread throughout the USA, none were due to an acquisition and all are much smaller than us. I believe that the new company thought we would be better prepared to demonstrate to them how to merge the multiple systems and operations this is unfortunately not the case and may lead to a failed merger.
References
Drazen, E. , & Kueber, M. (1998). Mergers in healthcare: avoiding divorce IDS style. HFM (Healthcare Financial Management) , 52 (8), 33-36. Retrieved October 24, 2008 from CINAHL Plus with Full Text database.Groff,G. , Lien, D. and Su, J. (2007). Measuring Efficiency Gains From Hospital Mergers. Research in Healthcare Financial Management, 11(1): p. 77–90. Idel, M. , Melamed, S. , Merlob, P. , Yahav, J . , Hendel, T. and Kaplan, B. (2003). Influence of a merger on nurses’ emotional well-being: the importance of self-efficacy and emotional reactivity. Journal of Nursing Management, 11, p. 59–63. Katz, J. , & Clemons, P. (1995). Surviving a merger. Nursing , 25 (12), 40-41. Retrieved October 24, 2008 from CINAHL Plus with Full Text database.