The VP for Nursing at BIDMC

If you were the VP for Nursing at BIDMC, what strategies would you implement to have a positive impact on the organizational environment as it affects nursing practice? The most important strategy for increasing the quality of patient care is implementing more stringent safety solutions. The purpose of safety solutions is to redesign the care process of patients. The inevitability of human error in the area of patient care is staggering. The definition of Patient Safety Solutions is “Any system design or intervention that has demonstrated the ability to prevent or mitigate patient harm stemming from the processes of health care”.

There are nine Patient Safety Solutions approved for dissemination by the World Alliance for Patient Safety (“Patient Safety Solutions”, 2007). The first safety solution understands that the most common error in the dispensing of medicine is in the form of sound-alike names. A significant amount of errors occur because of the confusion of brand or generic name recognition. Similar packaging is the cause of many errors in patient safety (“Patient Safety Solutions”, 2007). Patient identification is a continuing failure that is widespread throughout health care.

Correctly identifying patients can prevent the wrong medicine being dispensed, testing errors from occurring, the wrong type of blood from being transfused, wrong procedures from occurring and babies being released to the wrong families. These first patient safety solutions are founded in communication. Communication is the third patient safety solution. Gaps in hand-over communication is critical to assuring the correct care gets to the correct patient. Communication between nurses in patient care units and amongst care teams must never breakdown if patient safety is to be ensured.

Continuity in care and treatment hinges on appropriate communication between nurses (“Patient Safety Solutions”, 2007). Cases that involve wrong procedures or site surgery are founded in lack of communication or miscommunication. The lack of preoperative standardized processes is the cause of many procedural errors. The concentration of electrolyte solutions used for injections can be dangerous to patient safety if nurses are not aware of the dangers. Part of medication accuracy is to assure that transitions of medications are error free (“Patient Safety Solutions”, 2007).

Catheters, syringes and tubing are currently designed in such a way that it is quite easy to make an error in connecting them. The error that occurs from connecting tubing, catheters and syringes wrong (remove this word) is in the delivery of medication or fluids—such deliveries often cause the death of the patient (“Patient Safety Solutions”, 2007). Single use injections is a major concern worldwide since multiple use of injection devices can cause the spread of AIDS and Hepatitis C. Hand hygiene is associated with the spread of disease and infections in terms of patient care.

Currently there are 1. 4 million people in the world suffering from infections that they caught at clinics and hospitals. This ninth patient safety solution is very basic—wash your(just the spacing) hands before you handle anything or touch a patient (“Patient Safety Solutions”, 2007). Strategic initiatives in the key area of patient safety are the focus of the Disclosure Guidelines created by nursing organizations. The work of nursing organizations to provide leadership and support in the form of a framework for all areas of healthcare workers is a working strategy.

Patient safety is the highest priority in nursing. What is needed is to make patient safety a higher priority than money(consider rephrasing, or just make the sentence clear). In other words, given the results of the merger, what could be done to write the next chapter in the history of the organization? Nursing administrators face many challenges. The main challenge in the 21st Century is the impact of culture on medicine. The cultural impact in combination with hands-on nursing as is called for by Evidence Based Medicine (EBM) is burdening nursing leaders and makes it a challenge to practice medicine.

Nursing administrators need to focus their energies on strategic long-term outcomes of providing the highest quality of care. Leadership in nursing is becoming an oxymoron. Nursing administration is becoming nearly impossible with the combined impact of culture, education and emphasis of EBM (Rosswurm & Larrabee, 1999). This deadly combination is threatening nurse administrator’s ability to lead. Nurse administrators are tied down by their tactical role. There is no time for vision and futuristic thinking in nursing today.

Leadership in nursing is in danger. It is imperative that nursing administrators shift their focus to strategic thinking that focuses on the larger picture instead of the day-to-day functions of nursing. It is necessary to have direct reports be able to carry on with the tactical while envisioning the future of their profession. The relationship between nurse administrators and nurse managers needs to become interdependent. Both sides must work together to deliver efficient health care while making sure the future of nursing changes with the times.

For a nurse administrator to be recognized as a leader in the medical profession the old way of operational thinking must transition into strategic or reflective thought. The combination of action and thought is a deadly force. Action and thought will position nurse administrators to carve a better future for the nursing profession within medicine. To regain strength in nursing administration what exactly are nurse managers doing on the job needs to be examined. How much time a nurse spends in crises management is the first question that needs answering.

Nurse Managers who spend more than 15% of their time in crisis management mode needs to change the way she functions. If a nurse manager is working in crisis management mode then she is not leading. The next question to be asked is are all the crisis the nurse administrator managing nursing related or is time spent cleaning up other departments messes. The nurse administrator works at an interdependent level with other departments in the hospital–because of this reality there is often a gray area for nurse administrators. It is easy to be caught up in a crisis situation that is not your responsibility to fix.

Lack of self-discipline is the downfall of many nurse administrators. The interdependent relationship between a nurse administrator and other departments in a hospital is interdependent as mentioned above. The nurse administrator is recognized as an intricate part of a variety of subgroups within a hospital. The nurse administrator has an effect on the subgroup just like the subgroup effects the nurse administrator. It is important to realize that a nurse administrator is not an independent state—a nurse administrator needs to function within subgroups to perform at the highest level of care giving.

It is because of this interdependent relation that many nursing administration initiatives fail. For a revamping in the nursing system to occur there needs to be cooperation from all the subgroups the nurse administrator works with. Even though many nursing initiatives fail, it is still the nursing profession who is looked to as the leader in change for the health care system. The nature of nursing itself makes it difficult for the administrators to be strategic instead of operational. There is always a patient in pain, meds to be given, vital signs to be taken and the list goes on and on.

It is at the detriment of the profession, however, that nurse administrators fall short of having the self-discipline to not get caught up in the daily operational tasks. Years of clinical experience may make a good nurse, but it doesn’t always make for a good nurse administrator. Compounding the problem of operational thinking by nurse administrators and managers is the reality that a nurse’s function is to respond immediately to urgent situations and issues. Administrators who come up in ranks do what they know best—they manage the crisis.

The cultural impact of an organization forces the nurse administrator to manage in crisis mode. Short-term emergencies take over the leadership efforts of the nurse administrator. This is of course at the expense of the profession as a whole. Long-term direction is more important than short-term emergencies. Getting the health care system to believe this theory is the challenge of nurse administrator. At the management level you will find many nurse administrators who have decades of clinical experience. These nurse administrators go to work and do what they do best—they handle the day-to-day operations.

Instead of leading their nurse managers, the nurse administrator steps back into the role of a tactician. She becomes who she is suppose to manage. The lack of strategic focus of the nurse administrator not only hurts her subordinates it creates stress in her workload. She finds herself fulfilling all her administrative responsibilities as well as performing tactician in the daily operations of running the floor. Not every situation of the floor is a crisis that needs the managerial attention of the nurse administrator.

The nurse administrator needs to stop reacting out of habit and take a very important step back and let her subordinates do their job while she watches and thinks reflectively at the situation and responds accordingly. To ensure the well-being of patients it is necessary that a crisis be handled immediately, but at the same time, the nurse administrator has a responsibility to create and adopt varying approaches to daily operations (Allen, Nelson, Netting and Cox, 2007). Time for assessment is key to being a successful nurse administrator.

The core competencies of the nursing staff need to be assessed and reassessed on a regular basis. As a nurse administrator you need to know if your staff can handle a crisis, communicate effectively and represent you when necessary. The checklist approach to assessment is not going to be an effective way to measure your bench depth (Scanlon, 2005). The assessment of your staff will serve as a building block for your strategies and initiatives. Remember you will be using your staff as role models for the rest of the hospital.

The development and measurement of competencies does not end when the crisis ends. Debriefing your staff is crucial to skill building and generating bench depth. The current trend in nursing administration is reductionism rather than expansionism. Expansionism takes a situation and learns the factors that created the issue and opens these factors up so that a wide range of resolutions can be developed and enacted. Reductionism takes the problem and breaks it into smaller units and fixes the parts in hopes that the whole will eventually be fixed (Simons, 2006).

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