Nursing Administration Specialist
Dr. M's dilemma

Strengths

The hospital has a very strong reputation within the community and an over hundred-year history.

The hospital has just been purchased by a university hospital system with an equally stalwart reputation.

The new management seems committed to changing the hospital for the better and restoring it to its former glory.

There is a commitment to change amongst Dr. M.

Patients desire change.

Weaknesses

The hospital has rapidly grown in size from 50 to 300 beds and its standard operating procedures have not kept up with the current needs of patients.

It is losing money.

There are serious delays in transferring patients which could lead to a compromise of overall quality of patient health and also to inaccuracies in paperwork when patients are in a state of limbo. Not only do the transfers take place late at night, but the documentation is left to late night staff that has been working longer hours and is…...

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References

Chapman, A. (2013). SWOT. Business Balls. Retrieved from:

 http://www.businessballs.com/swotanalysisfreetemplate.htm

Nursing Administration -- Controlling
Nursing Admin-Controlling

Situation analysis

The FOCUS model requires the nursing administrator to find out what the main problem is, obtain information about this problem, communicate effectively with the nurses and patient, understand the needs of the nurses and the patient, and finally summarize these findings for the patient and nurses Dlugacz, 2009.

In this scenario, the process to be improved is responsiveness and willingness of the nurses to help the patient's situation.

Using the FOCUS model, the nursing leader should identify and clearly define the problem. To do this, they must recognize the role of the patient and the nurses in the situation and prioritize the potential improvements in the process Kreitner, 2008.

They also need to draft this problem statement in a clear way. The problem statement for this scenario is that the nurses feel inadequate in responding to the situation where the patient needs complex psychological, medical and social care.…...

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References

Dlugacz, Y.D. (2009). Value-Based Health Care: Linking Finance and Quality. New York: Wiley.

Kleespies, P.M., & Association, A.P. (2009). Behavioral Emergencies: An Evidence-Based Resource for Evaluating and Managing Risk of Suicide, Violence, and Victimization. Washington, D.C., DC: American Psychological Association.

Kreitner, R. (2008). Management. Mason, OH: Houghton Mifflin Company.

Zun, L.S., Chepenik, L.G., & Mallory, M.N.S. (2013). Behavioral Emergencies for the Emergency Physician. Cambridge, United Kingdom: Cambridge University Press.

It is thus possible for the institution to retain nurses by strengthening the interpersonal leadership and management skills that lead to empowerment within the healthcare environment. This is especially supported by studies that found that despite the fact that a nurses' pay is important, it is not as critical in enhancing retention as a positive work place or an empowered environment that promotes teamwork and encourages ongoing learning, trust, and respect. (Chan, 2001).
It must always be remembered that nursing retention is the result of a combination of factors. There is no easy solution, and managers and leaders need to choose the combination of approaches that will be effective in their specific organization, since there is no one range or combination of strategies that will fit all.

eferences

Buerhaus, P., Staiger, D.O. & Auerbach, D.I. (2003) Is the Current Shortage of Hospital Nurses Ending? Health Affairs 22: 191-198.

Chan, C.C.A. (2001). Implications of…...

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References

Buerhaus, P., Staiger, D.O. & Auerbach, D.I. (2003) Is the Current Shortage of Hospital Nurses Ending? Health Affairs 22: 191-198.

Chan, C.C.A. (2001). Implications of organizational learning for nursing managers from the cultural, interpersonal and systems thinking perspectives. Nursing Inquiry, 8(3), 196-199.

Faulkner, J., & Laschinger, H. (2008). The effects of structural and psychological empowerment on perceived respect in acute care nurses. Journal of Nursing Management. 16(2): 214-221.

Kanter, R.M. (1979). Power failure in management circuits. Harvard Business Review, 65-75.

In interacting, factors may also modify each other:

nurse who might return to work for a higher salary might decide to do so only later when her children are older. The incentive of salary is therefore modified by the factor of young children.

The table is significantly complicated by the inclusion of more than two factors:

Any combination of the factors could result in the majority of nurses returning to work. Individually, each nurse has his or her own motivations for doing so.

The iterative proportional fitting procedure can be used to calculate expected frequencies.

Note: pecifically, the indication of this study is that nurses would return to work were certain factors in the work situation to change. pecifically, the highest frequencies are assigned to work load and hours. These are also the two most common factors in causing burnout and stress in the profession. Concomitantly, if inactive nurses were to return to work under…...

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Sources

StatSoft, Inc. (2008). Log-Linear Analysis of Frequency Tables.  http://www.statsoft.com/textbook/stloglin.html 

Williams, Kimberly a., Stotts, R., Jacob, Susan R., Stebauer, Cheryl C.; Roussel, Linda, & Carter, Donna (2006, April). Inactive Nurses: A source for alleviating the nursing shortage? In Journal of Nursing Administration, Vol. 36(4).

Nursing Leadership
Batcheller, J.A. (2011). On-boarding and enculturation of new chief nursing officers.

Journal of Nursing Administration, 41(5), 235-239.

This article examines the on-boarding process for new chief nursing officers by examining the onboarding process for 6 new chief nursing officers. The examination is aimed at determining what type of support leaders new to an executive role requires and how to on-board leaders who are experienced, but who are new to a particular organization. The possible implications of this research is that if the on-boarding process is insufficient, then it may contribute to high turnover rates and the short length of chief nursing officer positions.

Carlson, C.L. & Plonczynski, D. (2008). Has the BARRIER cale changed nursing practice? An integrative review. Journal of Advanced Nursing, 63(4), 322-333.

This article examines whether the BARRIER cale, which identifies nurses' barriers to using evidence-based practice, contributed to an increase in the use of evidence-based practice. The BARRIER cale…...

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Storch, J., Rodney, P., Pauly, B., & Fulton, T.R., Stevenson, L., Newton, L., & Makaroff,

K. (2009). Enhancing ethical climates in nursing work environments. Retrieved September 27, 2014 from Canadian Nurse website:  http://www.canadian-nurse.com/en/articles/issues/2009/march-2009/enhancing-ethical-climates-in-nursing-work-environments 

The article examines the outcomes of the Leadership for Ethical Policy and Practice, which was a three-year participatory action research survey aimed at nurses, managers, and other team members. The respondents found that nurse leader support was a critical component when enacting ethical leadership initiatives. They also found that an ethical leadership model resulted in higher levels of job-related satisfaction at all levels of the healthcare management team.

Resources needed include manpower and positional aids mentioned previously in this report. Evaluation of the effectiveness of the change would be accomplished through data collection related to the frequency of pressure ulcer occurrence in patients and nurse compliance in the four hours supine positional rotation of patients. Questionnaires will also be administered to nursing staff in order to gain insight as to their attitudes, behaviors and perceived barriers to pressure ulcer prevention.
Phase V: Transplantation and Application

This study concludes that positional rotations of every four hours has been shown to be the most effective prevention of pressure ulcer formation in older patients in elderly care homes and further that that attitudes, behaviors and perceptions of barriers in the view of staff nurses predicts the effectiveness of the implementation of such a prevention program for pressure ulcer care. (Moore and Price, 2006)

Exact Nature of Practice Implications

____ Change the practice

____X__ Support he…...

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Bibliography

Moore, Z. And Price, P. (2004) Nurses' Attitudes, Behaviors, and Perceived Barriers Towards Pressure Ulcer Prevention Journal of Clinical Nursing 13, 2004.

Vanderwee, K.; Grypdonck, D.; Bacquer, De and Defloor, T. (2006) Effectiveness of Turning with Unequal Time Intervals on the Incidence of Pressure Ulcer lesions. JAN Original Research 10 July 2006.

Nursing: Utilization Review

Perceptual and attitudinal changes are needed to motivate readiness to learn. Self-directed education is key to adult learning and especially to continuing education in the health professions (McClaran et. al, 1999, p. 184). Studies show that nurses will identify their specific needs for training and education and seek them out. They are also able to learn from previous experiences and build upon them to expand their proficiency of management skills. They seek personal mastery, vision, and team learning in order to grow as individuals and team members. These adult learners, as Knowles expressed, are motivated to learn and seek out the information they need. With education to understand the realities of healthcare management and a chance to develop management skills, nurses have both expanded opportunities and responsibilities that can impact the world of healthcare and provide safer and more satisfactory patient care.

eferences

Goddard NL. Financial management. (1987).

In Vestal KW. Management concepts…...

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References

Goddard NL. Financial management. (1987).

In Vestal KW. Management concepts for the new nurse. Philadelphia: JB Lippincott, 127-152

Gotoh H. Continuing education changes nursing. Japanese Journal of Nursing Administration. 1992, 2 (1) 62-69.

Hiemstra, R., and Sisco, B. (1990) Individualizing Instruction: Making Learning Personal, Empowering, and Successful. San Francisco: Jossey-Bass.

Nursing and Issue of Falls
Falls are responsible for considerable morbidity, immobility, and mortality among older persons, especially those living in nursing homes. Falls can occur in a home, community, long-term rehabilitation, or acute care Setting (Laurence Z.. et.al, 1994). The risk of falls can be related mostly to mobility status, exposure to hazardous environments and risk-taking behaviors such as climbing ladders for seniors living in the community setting. Factors for a fall in hospitalized adults are greatly influenced by acute illness that often has a marked, albeit temporary, impact on physical and cognitive function compounded by care provided in unfamiliar surroundings in the long-term care setting, the risk factors for falls are influenced by impaired cognition, wandering or impulsive behavior, use of psychotropic medications, incontinence and urgency, lack of Exercise, unsafe environments, and low staffing levels. Patient falls are serious problems

In acute care hospitals and are used as a standard…...

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References

Anuradha Thirumalai, (1998). Nursing Compliance with Standard Fall Prevention

Protocol Among Acute Care Hospital Nurses. Retrieved September 26, 2012 from  http://digitalscholarship.unlv.edu/cgi/viewcontent.cgi?article=1191&context=thesesdissertations&sei-redir=1&referer=http%3A%2F%2Fwww.google.co.ke%2Furl%3Fsa%3Dt%26rct%3Dj%26q%3Dnursing%2520compliance%2520with%2520standard%2520fall%2520preventionprotocol%2520among%2520acute%2520care%2520hospital%2520nurses%26source%3Dweb%26cd%3D1%26ved%3D0CCAQFjAA%26url%3Dhttp%253A%252F%252Fdigitalscholarship.unlv.edu%252Fcgi%252Fviewcontent.cgi%253Farticle%253D1191%2526context%253Dthesesdissertations%26ei%3Dg-NiUPW8CuLB0QW_r4DgAw%26usg%3DAFQjCNE6__5zNu8vjRxc-jIFBXbBfKVIng#search=%22nursing%20compliance%20standard%20fall%20preventionprotocol%20among%20acute%20care%20hospital%20nurses%22 

Dykes, P.C., Carroll, D.L., Hurley, A.C., Benoit, A., & Middleton, B. (2009). Why do patients in acute care hospitals fall? Can falls be prevented? Journal of Nursing Administration, 39(6), 299-304. doi:10.1097/NNA.0b013e3181a7788a

Laurence Z. Rubenstein, Karen R. Josephson & Alan S. Robbins, (1994). Falls in the Nursing

, 2010). It is perfectly conceivable that this nurse leader would welcome more collaborative or shared leadership responsibilities, particularly since the setting for empirical clinical research on this very issue was, in fact, an ICU (osengren, Bondas, Nordholm, et al., 2010).
Finally, it appears from this interview subject's input into this project that she is a competent and effective nursing leader, largely by virtue of her description of her supervisory and administrative style and inclination. However, her input lacked any substantial data on the basis of which a reviewer could evaluate her effectiveness as a clinical leader more specifically. Those particular skill sets may occur in combination but they undoubtedly also occur individually within different leaders (Stanley & Sherratt, 2010). A review of historical literature (such as in connection with Florence Nightingale) clearly demonstrates that good nursing leaders may or may not necessarily also be equally good clinical leaders (Stanley &…...

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References

Armstrong, P.W. "A time for transformative leadership in academic health sciences."

Clinical & Investigative Medicine, 30(3); 2007: E127-132.

Davidson, S.J. "Complex responsive processes: a new lens for leadership in twenty-first-

century health care." Nursing Forum, 45(2); 2010: 108-117.

Nurse eg
egulations and Guidelines in nursing

The CMS-implemented Pay-for-Performance initiatives are designed to incentivize greater quality of care by all medical practitioners for all recipients of Medicare/Medicaid services (Fenter & Lewis, 2008). The fee-for-service model that the CMS still employs on a wide basis incentivizes a lower quality of care that leads to or includes more services, which has direct detrimental effects for patients and increases the cost burden on the Medicare and Medicaid programs and thus on the federal budget and on taxpayers (Fenter & Lewis, 2008). The Joint Commission on Accreditation of Health Organizations' Core Measures are a set of guidelines meant to modernize and standardize the processes and criteria of accreditation and ongoing measurement and quality assurance at health organizations (JCAHO, 2011). These standards are also related to care, but involve licensing and accreditation rather than payment and thus work as different incentives (JCAHO, 2011).

As a nursing leader/manager,…...

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References

Fenter, T. & Lewis, S. (2008). Pay-for-Performance Initiatives. Journal of Managed Care Pharmacy 14(6): S12-5.

JCAHO. (2011). Specifications Manual for Joint Commission National Quality Core Measures. Accessed 3 April 2012.  http://www.jointcommission.org/specifications_manual_joint_commission_national_quality_core_measures.aspx

Nursing Culture: Overcoming Barriers to Change
Introduction and Theoretical Framework

This program of study continues personal research and professional practice in the field of nursing within the area of public and private health systems. In an era characterized by increasing calls for more efficient approaches to healthcare delivery and accountability on the part of healthcare providers, there is a growing need for identifying opportunities to overcome organizational barriers to change that facilitate the implementation and sustainment of evidence-based practices over time. In order to accomplish this challenging enterprise, the nature of existing organizational barriers must be better understood, an issue that directly relates to the problem to be considered by the study proposed herein and which is discussed further below.

Statement of the Problem

According to Mannion, Davies and Marshall et al. (2005), the results of much of the research to date have identified a relationship between nursing culture and performance levels that requires…...

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References

Banyard, V.L., & Miller, K.E. (1998). The powerful potential of qualitative research for community psychology. American Journal of Community Psychology, 26(4), 485.

Burton, S., & Steane, P. (2004). Surviving your thesis. New York: Routledge.

Dennis, C., & Harris, L. (2002). Marketing the e-business. London: Routledge.

Department of Health. (2000). The NHS plan: A plan for investment, a plan for reform. London:

The authors describe findings from a survey designed to gather baseline data about changes organizations experience after implementing the Clinical Practice Model framework, and report how the Clinical Practice Model Resource Center staff used the survey findings to build the capacity of individuals accountable for implementing this integrated, interdisciplinary professional practice framework into the organization's operations." (2002) The following model has been created for monitoring the progress of the nursing staff at the MD Anderson Cancer Center MEDVACM specifically checking progress in Years 1,3, and 5.
MD ANDERSON CANCER CENTER MEDVAMC

Job Performance Review Guide

EMPLOYEE

Employee Name

Review Period

Department

Manager

PERFORMANCE GOALS AND OJECTIVES

YEAR 1

YEAR 3

YEAR 5

ecome familiar with your department's business goals.

Work with your manager to define and document your goals. Include what you are expected to produce by your first review, activities needed to accomplish results, and success criteria.

Make certain defined goals and criteria are realistic. Renegotiate if necessary.

Are you focusing your time…...

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Bibliography

Magnet Designation (2006) Inside UVA Online Vol. 36, Issue 14 August 26, 2006. Available at  http://www.virginia.edu/insideuva/nursing_excellence.html .

Bailey, F. Amos (2000) Balm of Gilead Center, Cooper Green Hospital Pioneer Programs in Palliative Care: Nine Case Studies - Robert Wood Johnson Foundation - Milbank Memorial Fund October 2000. Online available at  http://www.milbank.org/pppc/0011pppc.html#foreword .

Forrow, Lachlan (2000) Palliative Care Program, Beth Israel Deaconess Medical Center/CareGroupPioneer Programs in Palliative Care: Nine Case Studies - Robert Wood Johnson Foundation - Milbank Memorial Fund October 2000. Online available at

Nursing and Ethics
The emotional debate over abortion had been mischaracterized in the media, and hence disrupted any positive attempt to make progress in resolving the ethical and medical problems which have been created by the practice. A majority of Americans recognize and desire that abortion should be available when the life of the mother is at risk, or in the cases of rape or incest. However, liberal proponets like to expand this definition under the ubiquitous definition of the 'mothers health' which has been used to justify abortion on demand, for any reason. This latter expanded definition is significantly opposed by a majority of the ameircan population. In the midst of this struggle, comes the person needing medical care, who has neither been properly informed as to the dangers of the paractive, nor adequately counseled as to the options which exist regarding the future of her unborn child. The public…...

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Resources

O'rourke, Kevin. PROXY CONSENT: DECIDING FOR OTHERS October 1980 accessed 23 April 2004. Available from:  http://www.op.org/domcentral/study/kor/80100202.htm .

Bernard Lo, (July 2, 1987) "Behind Closed Doors: Promises and Pitfalls of Ethics Committees." NEJM 317;46.

Toward a More Natural Science, (1985) New York: Free Press,; p.211.

Curzer, Howard J. (6/22/1993) Fry's concept of care in nursing ethics. (response to Sara T. Fry, Hypatia, vol. 4, no.2, p.88, 1989) Hypatia.

ecause this is true, it is critically clear that the nursing leadership manager's role is one of a vital nature and that support for nurses in their role is the primary component that must necessarily be integral to leadership in nursing in dialysis units if the turnover of nurses is reduced to the lowest possible level. The nursing leadership manager's role is one that must proactively deal with burnout of these dialysis unit nurses instead of attempting to address these as they occur. Prevention is 'key' toward this end. As the demands grow for quality and competent nursing staff so does the need grow for competency in leadership nursing manager roles. ecause the dialysis unit nurse is very closely involved in their patient's care and because these patients are required to report for treatment several days a week for several hours a day the nurse's mental, physical and emotional…...

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Bibliography

Aiken, L.H., & Patrician, P. (2000). Measuring organizational traits of hospitals: The Revised Nursing Work Index. Nursing Research, 49, 146-153.

Aiken, L.H., & Sloane, D.M. (1997). Effects of organization innovation in AIDS care on burnout among urban hospital nurses. Work Occupation, 42, 453-477.

Aiken, L.H., Clarke, S.P., Sloane, D.M., Sochalski, J., & Silber, J.H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction [Electronic version]. JAMA, 288, 1987-1993.

Aiken, L.H., Clarke, S.P., Sloane, D.M., Sochalski, J.A., Busse, R.A., Clarke, H., Giovanetti, P., Hunt, J., Rafferty, a.M., & Shamian, J. (2001). Nurses' reports on hospital care in five countries [Electronic version]. Health Affairs, 20, 43-53.

If nursing students are being asked to absorb 30-40% more information during undergraduate years, it is logical to see that they do so early in their academic career -- almost as a prerequisite for more advanced practicum.
Then, of course, there is the matter of the learning curve in professional education. If one compares schooling for registered nurses with that of physician's assistants or physicians, one often sees a growing gap between the clinical abilities of nursing staff and actual patient care needs. This cause has been attributed to deficiencies in some skill sets of new graduates -- which has the effect of pushing nursing schools and curriculum toward more robust materials (Berkow, Virkstsis, Sewart, and Conway, 2008). However, is the solution simply adding more materials to memorize and read, or might it be more efficient to take a look at the time frame of the educational experience and ask…...

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REFERENCES

Berkow, Virkstsis, Sewart, and Conway. (2008). Assessing New Graduate Nurse Performance. Journal of Nursing Administration, 38(11), 468-74.

Burritt and Steckel. (2009). Supporting the Learning Curve for Contemporary Nursing Practice. Journal of Nursing Administration, 39(11), 479-84.

Heller, Oros, and Durney-Crowley. (2009, July 30). The Future of Nursing Education: Ten Trends to Watch. Retrieved September 20, 2010, from http://www.nln.org/nlnjournal/infotrends.htm

Holzmer, W. (2006). Quality in Graduate Nursing Education. Nursing Education Perspectives, 26(4), 236-43.

## Thesis Statement:

A comprehensive and multifaceted approach, including enhanced communication, patient-centered care, staff empowerment, and data-driven decision-making, is necessary to effectively improve patient satisfaction in nurse quality care.

### Introduction:

Patient satisfaction is a crucial indicator of the quality of healthcare services. Enhancing patient satisfaction leads to improved clinical outcomes, increased patient loyalty, and reduced healthcare costs. Nurses play a pivotal role in shaping patient experiences and influencing satisfaction levels. This thesis will explore the multifaceted strategies that can be implemented to improve patient satisfaction in nurse quality care.

### Body:

1. Enhanced Communication:

Establish clear channels of communication between nurses and patients, allowing....