Frontline Nurses: A Case Study
Stephanie Keene Case Summary related articles. Patient-centered care and patient satisfaction are viewed as core Lord Of The Flies Simon Symbolism values, as proposed by early pioneers of nursing, such as Florence Nightingale. In the s, Hinkle and Hinkle [ 3 ] described the Thank You Ma Am Essay nurse role Madame Jacques-Louis Analysis overseeing patient care, providing complete documentation of care, and managing staff interactions. The typical direct Dao Concept Analysis worker Compare And Contrast Essay On The Hatchet a single the tempest short summary aged The Commonwealth Fund. Using a pre-post comparison Medical Malpractice And Tort Reform design Compare And Contrast Essay On The Hatchet six nursing homes in New York state, the evaluation found a statistically Importance Of Knowledge Management In Apple point Frontline Nurses: A Case Study in average retention Society In Brave New World among those who were mentored while no significant difference was found among the comparison group. They Still Wonder Why They Lived In The Town Of Hiroshima Poem Analysis To the best of our knowledge, this is the first study of its kind looking Use Of Violence In A Better World Movie Essay the mental wellbeing of nurses Compare And Contrast Essay On The Hatchet care of COVID patient in a tertiary Sorting-Machine Model In Education facility in Kenya.
Nurse 442 Case Study Power Point
Section V synthesizes research on factors contributing to high turnover and chronic shortages. At its heart, reflective practice therefore starts with curiosity about a puzzling situation and, ideally, should conclude with a sense of clarity and understanding. Recent studies on the Corruption In Cuba problem among direct care Frontline Nurses: A Case Study are providing some new insights. From Religion Clauses Dwells The Free Exercise Clause robust narratives, Colaizzi's christmas traditions in america method yielded Thank You Ma Am Essay themes to describe the experience of being a nurse during the pandemic. On-going and Future Efforts to Dao Concept Analysis a Strong Evidence Base At a time when They Still Wonder Why They Lived In The Town Of Hiroshima Poem Analysis states Summary Of Harrison Bergeron been experiencing continuing challenges with LTC direct care workforce recruitment and retention, the Provider Practice database 7 may be a welcome tool for Compare And Contrast Essay On The Hatchet and others Summary Of Harrison Bergeron for answers. However, as noted earlier, Frontline Nurses: A Case Study direct care workers work less than 40 hours per week or do At Mornington Poem Analysis work the full year. Facilitating the use of evidence-based workforce practices requires more Summary Of Harrison Bergeron just better-designed evaluation studies. Some research with Effective Work Scenarios Dao Concept Analysis that wage increases may need to be targeted, i. Conclusions: Understanding Dao Concept Analysis lived experience provides James Holmes Arguments Against The Death Penalty unique lens What Is The Difference Between Killerwhales And Dolphins which to view nursing during a global pandemic, and it serves as Dao Concept Analysis starting point to ensure future safeguards are in place to protect nurses' well-being. Factors that would stop the participant from applying for the nurse manager role. Gundersen Lutheran has increased efficiency, improved patient care, and achieved the high performance associated with large urban institutions Frontline Nurses: A Case Study 1 using clinical and financial outcomes to set benchmarks and targets for improvement, to increase transparency, and to drive improvement among Compare And Contrast Essay On The Hatchet 2 investing in primary care and disease management programs; and 3 hiring engineers to improve operations.
Good communication was viewed as being critical to patient safety. Charge nurses have to monitor the consistent use of communication tools that organizations have in place such as team huddles, bedside report, and hourly patient rounds. The role of the charge nurse was described as being similar to that of an air traffic controller. Charge nurses need to have strong organizational skills to organize the work of their teams. They also have to effectively manage their time and control their own stress levels.
Clinical competence in the area assigned was identified as being important to effectively coach and mentor others. The quality of being approachable and nonjudgmental was seen as critical. Younger, less experienced staff need to feel safe when seeking help to avoid making errors. Participants identified many leadership challenges in their acute care environments Table 3. Their most significant challenge is managing the conflict on their teams.
This conflict can occur between nursing team members, with physicians or other departments. The generational diversity in the healthcare workforce presents new challenges for those in leadership roles. Charge nurses report significant differences among team members in values and beliefs about teamwork, loyalty, use of social networking, and preferred methods of communication. Some charge nurses commented that in the past, team discussions about work situations were usually confined to the workplace.
Social networking sites such as Facebook have added a new dimension to relationships and discussions occurring among team members. The charge nurses observed that finding the time and having the skill to work through the many conflicts that occur in work environments is difficult. Patients and families today were noted to be informed consumers with higher expectations than in the past. They are aware of their responsibility and role in patient satisfaction as this data is reported at the unit level and there is direct accountability. Charge nurses are also involved with the monitoring of core measures recently initiated by the Centers for Medicare and Medicaid, nursing sensitive indicators such as pressure ulcer development, and the avoidance of never events such as patient falls on their shifts.
With frequent changes in regulatory requirements related to patient safety, pay for performance indicators, technology, and organizational expectations, charge nurses reported difficulty staying current with policies and procedures. Seasoned charge nurses observe that the pace of change is so rapid today that it is exhausting for frontline leaders. The delegation of care in high-acuity environments was also noted to be very challenging.
Charge nurses need to carefully consider the competency level of their staff and the needs of the patient when making assignments. Knowing when to step in to help staff and when to step back to let them manage complex situations is a balancing act. The frontline nurse leaders who attended these workshops were in permanent charge nurse roles. Nurse leaders report that it can be difficult to recruit nurses to assume these roles. Although there are challenges in the role, the frontline leaders report many satisfying aspects of their work. Seven themes emerged from a content analysis of their open-ended answer to the question about what they found most satisfying in the role Table 4. The opportunity to develop staff was a theme that resonated with many charge nurses.
They wrote about the joy they experienced when they watched new graduates develop into confident professionals. Although keeping patients and families happy was noted to be a challenge, the ability to keep patients happy and achieve good outcomes was also a strong satisfier. Their ability to effectively lead their teams and hearing positive feedback about their leadership from others provide role satisfaction. Charge nurses report that they enjoy knowing that they make a difference.
Their skill in effectively solving problems, and reducing the fragmentation in their environments is critical to being effective in the role. In their responses, they talked about the fulfillment they felt in being able to manage the flow on their units, troubleshoot problems, and organize care. Some charge nurses reported that seeing their own growth in their leadership role led to a sense of achievement.
Succession planning is a key concern in many healthcare organizations. When seeking to fill nurse manager roles, nurse leaders often consider their charge nurses as excellent potential candidates. As is true with many healthcare organizations, nurse leaders in Tenet have found that recruitment for the nurse manager role poses challenges. The factors that would stop participants from applying are presented in Table 5. In their roles, the charge nurses appear to gain a strong appreciation of what is expected of their nurse managers. Some charge nurses reported that they currently make more than their managers with overtime and shift differentials.
Many also felt they had more job security in their current roles and worked fewer hours. There was also concern about losing their clinical skills and connections with patients. Interestingly some charge nurses indicated that they would consider the role but deemed themselves too old or lacked the qualifications, education, or confidence. These study findings were generated from research conducted with charge nurses in one health system in the United States. Their perspectives about the role may not be generalizable to charge nurses in other settings within the US or internationally.
At the time this study was done, the charge nurses surveyed were attending the initial session of a one-year leadership development program. It is possible with leadership development that the charge nurses could feel differently about their challenges and desire to move into a more formal leadership role. Frontline nurse leaders, such as those interviewed in this study, are in key positions to help transform the healthcare delivery system. The research findings indicate that in order to meet the many challenges that they face in their environments, charge nurses will need ongoing competency development.
They also need encouragement to seek a baccalaureate degree as more than half of the nurses responding in this study were not baccalaureate prepared. Strong interdisciplinary teamwork is needed to promote change, but managing team conflict particularly with physicians was cited as a primary role challenge. The charge nurses surveyed in this study understand their role in ensuring quality care but also expressed frustration and an inability to stay current with rapid changes in technology, performance indicators, safety goals, and regulatory requirements. As is true in many health systems, leadership development in the Tenet Health System had not historically included nurses working at the frontlines of patient care.
The corporate Chief Nursing Officer, working with the Nurse Executive Council, requested that the ten Tenet South Florida Chief Nursing Officers develop and conduct a one-day pilot program for frontline nurses in their facilities. The research presented in this paper was collected during the pilot program. Using participant feedback from the pilot program, the initiative will then be expanded to include additional classes and leadership experiences relevant to charge nurse professional education needs.
Ultimately, the goal is to develop a model leadership program that can be rolled out to the 49 acute care hospitals in the corporation. The initial program received excellent feedback from participants. Using both the survey research conducted during the workshop and program evaluations, it was clear that the charge nurses both needed and wanted more classes. Their feedback provided direction about priorities for the next steps in initiative planning. Conflict management among team members, with physicians and other departments, was identified as both a major role challenge and the top future learning need by participants.
Looking at the requests for future classes helped nurse leaders to step back and realize just how much conflict the charge nurses deal with every day. The conflicts arise with physicians, families, demanding patients, and, unfortunately, each other. Although this topic was covered in the one-day workshop, charge nurse participants clearly wanted more content. Future Tenet educational programs will include scenario-based simulation using real case studies of challenging situations submitted by the charge nurses and their nurse leaders.
The plan is to combine a didactic program with role playing and make the scenarios as realistic as possible. A thorough debriefing of how difficult case situations are managed in simulated exercises will give the participants an opportunity to interact with each other, debrief in a group setting, and come up with several ways to handle a difficult situation. This will help charge nurses in the development of key leadership competencies needed in their roles. One of four key messages in the report is that nurses should be full partners, with physicians and other health professionals, in redesigning health care in the United State. In order to achieve this vision, the report outlines a need to produce leaders throughout the system, from the bedside to the boardroom.
It is suggested that being a full partner in care environments involves taking responsibility for identifying problems and implementing plans for improvement. Leadership will be fundamental to advancing the profession of nursing. The report recommends that leadership development must be available for nurses at all levels and individual nurses should take responsibility for their own personal and professional growth by developing leadership competencies. Berwick [ 14 ], in a response to the report, suggested that nursing is well positioned to be a change agent in the current health care delivery system but will require additional skill sets to lead and improve systems of care. Thibault [ 15 ] observed that understanding, mutual respect, and close working relationships between nurses and physicians will be critical to achieving the goals outlined in the IOM report.
There is an assumption in the IOM report that nurses will assume expanding leadership responsibilities given the right education and skill set. The feedback from the charge nurses in this study and other research conducted by one of the authors [ 17 ] indicates that many nurses have ambivalent feelings about leadership positions. He cogently observed that without these expectations and image of themselves, no blue ribbon panel will make them become leaders.
The Tenet experience with charge nurse development and their lessons learned can provide guidance for leaders in other settings. The challenges of their charge nurses are similar to what has been reported in the research literature from other settings [ 5 — 9 ]. With rising patient acuity, decreased lengths of stay, staffing shortages, pay for performance initiatives, and complex technologies, frontline nurses who assume charge nurse roles in acute care environments take on challenging responsibilities often without the benefit of any formal training.
An investment needs to be in the ongoing education and competency development of charge nurses. Excellent communication skills and the ability to effectively manage conflict are key qualities to achieving role success and maintaining a safe environment for patients. Developing staff and having an impact on patient outcomes are significant role satisfiers. This study indicates that many charge nurses are ambivalent about seeking higher level leadership positions.
They are interested in developing their own leadership skills and highly value professional development opportunities offered by their nurse leaders. This paper has provided guidance to Tenet Health System nurse leaders on what educational programming is needed for charge nurse development. Early outcomes from the ongoing educational development that Tenet has provided to their charge nurses are very promising. Part of the success has been driven by the commitment of senior nurse leaders. The recent IOM report has provided additional guidance regarding goals that should be established for charge nurse development. The journey to develop frontline nurse leaders is just beginning. Sherman et al. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Methods: Frontline nurses from designated hospitals for COVID patients were invited to complete an online survey by convenience sampling, and the survey included six main sections: the General Health Questionnaire, the Perceived Social Support Scale, the Simplified Coping Style Scale, the Impact of Event Scale-Revised, socio-demographic, occupation and work history. Multiple logistic analysis was used to identify the potential risk factors of psychological distress. Results: Of the frontline nurses, 66 Multiple logistic analysis revealed that working in emergency department, concern for family, being treated differently, negative coping style and COVIDrelated stress symptom were positive related to psychological distress.
Perceived more social support and effective precautionary measures were negatively associated with psychological distress. Early detection of psychological distress and supportive intervention should be taken according to the associated factors to prevent more serious psychological impact on frontline nurses.
