Nursing Leadership and Management Field Experience
Project Proposal
Caroline Waweru
Western Governors University
Attached:
-A. Organization Approval Letter
-B. Preceptor Agreement Form
Nursing Leadership and Management Field Experience
Clinical/Organizational Problem
HCAHPS is a publically available data set which can be used to evaluate the quality of the hospital. There exist limited nurse to nurse communication and patients in plan care discussions. Winchester hospital located in Winchester, Massachusetts is providing healthcare services to the population. The behavior of nurses with the patients and their families is sometimes unsatisfactory which is catastrophic for an organization’s HCAPHS.
Causes of problem
Compared to most healthcare centers in the US, the performance of Winchester Hospital is below average at the very best. This is because of lack of effective communication within the hospital, along with a rapid decrease in level of health care services, which are two of the most crucial factors for the welfare of the patients, but the health care organization as well ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"nb2auq3O","properties":{"formattedCitation":"(Dempsey, Reilly, & Buhlman, 2014)","plainCitation":"(Dempsey, Reilly, & Buhlman, 2014)","noteIndex":0},"citationItems":[{"id":"EmFT1DOb/zYRUllb7","uris":["http://zotero.org/users/local/0omESN17/items/BVZ4W6S7"],"uri":["http://zotero.org/users/local/0omESN17/items/BVZ4W6S7"],"itemData":{"id":63,"type":"article-journal","title":"Improving the patient experience: real-world strategies for engaging nurses","container-title":"Journal of Nursing Administration","page":"142-151","volume":"44","issue":"3","author":[{"family":"Dempsey","given":"Christina"},{"family":"Reilly","given":"Barbara"},{"family":"Buhlman","given":"Nell"}],"issued":{"date-parts":[["2014"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Dempsey, Reilly, & Buhlman, 2014). An avid lack of communication between the physicians and nurses, physicians and other physicians and physicians with nurses is catastrophic in terms of providing quality care to the patients. Add in the unsatisfactory levels of communication between the healthcare practitioners and the nurses with the patients and their families, the HCAHPS survey has plenty of evidence it needs to improve the present level of communication between healthcare practitioners, patients and their caregivers.
The primary goal of a patient-centered care is to treat the patient’s illness. If a patient is hindered in any way to effectively communicate the reason for his suffering, courtesy of his health issues, an ongoing disability, effects of an administered medication or a language barrier, it will certainly effect the HCAHPS for that particular hospital ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"0TeRDT7s","properties":{"formattedCitation":"(Dempsey, Wojciechowski, McConville, & Drain, 2014)","plainCitation":"(Dempsey, Wojciechowski, McConville, & Drain, 2014)","noteIndex":0},"citationItems":[{"id":"EmFT1DOb/XYLsiip5","uris":["http://zotero.org/users/local/0omESN17/items/SHIKUFEQ"],"uri":["http://zotero.org/users/local/0omESN17/items/SHIKUFEQ"],"itemData":{"id":65,"type":"article-journal","title":"Reducing patient suffering through compassionate connected care","container-title":"Journal of Nursing Administration","page":"517-524","volume":"44","issue":"10","author":[{"family":"Dempsey","given":"Christina"},{"family":"Wojciechowski","given":"Sharyl"},{"family":"McConville","given":"Elizabeth"},{"family":"Drain","given":"Maxwell"}],"issued":{"date-parts":[["2014"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Dempsey, Wojciechowski, McConville, & Drain, 2014). This lack of communication between the hospital’s care staff and the patient results in poor levels of communication and ultimately the hospital may have to suffer for it. On the other hand, while it is the duty of the hospital, as a healthcare center, to look out for the needs of its patients and their caregivers, at the very same time they are responsible for the staff working for them as well. In order to maintain their HCAHPS score, it is crucial that hospitals do not earn the non-satisfaction of their patients by short staffing the number of nurses needed to work. According to ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"g6thI5Du","properties":{"formattedCitation":"(McFarland, Shen, Parker, Meyerson, & Holcombe, 2017)","plainCitation":"(McFarland, Shen, Parker, Meyerson, & Holcombe, 2017)","noteIndex":0},"citationItems":[{"id":"EmFT1DOb/Ybm3pUgO","uris":["http://zotero.org/users/local/0omESN17/items/DX7ZELIP"],"uri":["http://zotero.org/users/local/0omESN17/items/DX7ZELIP"],"itemData":{"id":66,"type":"article-journal","title":"Does hospital size affect patient satisfaction?","container-title":"Quality management in health care","page":"205-209","volume":"26","issue":"4","author":[{"family":"McFarland","given":"Daniel C."},{"family":"Shen","given":"Megan Johnson"},{"family":"Parker","given":"Patricia"},{"family":"Meyerson","given":"Sandra"},{"family":"Holcombe","given":"Randall F."}],"issued":{"date-parts":[["2017"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (McFarland, Shen, Parker, Meyerson, & Holcombe, 2017), hospitals where nurses have a better work environment, more favourable staffing ratios and better general collaboration with the physicians, patient satisfaction as well as the satisfaction of his caregivers in vastly improved. This is another area where Winchester Hospital needs improvement. Its working environment is poor, the staffing ratio of the individuals at work needs improvement and the collaboration of the nurses with physicians is unsatisfactory as well. If these reasons were improved, the nurses would be able to provide better care to their clients and at the same time improve their low HCAHPS score.
Stakeholders
Clinical Nurse Leaders need to improve the health care services in the organization so that they can meet the objectives of higher HCAHPS score. Nurse leaders play a critical role in health care organization as they are responsible to improve the quality of care by influencing the medical staff. Their presence in the patients’ ward is beneficial to encourage others to enhance their performance. Nurse leaders have the power to influence the performance level of all the nurses with the objective of providing better healthcare services for the patients i.e. based on their actual needs. Patients and their advocates, that are willing to obtain better health care services. often tend to get medical services for hospitals who have higher HCAHPS scores. The patient plays an integral role in the healthcare organization for the management of their health. Patients have the right to speak up and ask questions about their treatment plan. Meeting the demands and expectations of patients in the health care organization is effective method to improve the HCAHPS score. Patients have the power to influence the overall perspective of healthcare and safety developed in the form of HCAHPS. The medical staff such as health care practitioners and nurses have a major role in providing medical effective medical services to patients. If they enhance their skills and communication abilities, then they can easily improve their capabilities to provide effective health care services. Nurses have the responsibility to provide satisfactory care to the patient and support them through health and illness. Their effective care has the potential to increase the overall HCAHPS score. When it comes to the main interest of nurses as the main stakeholder than it is important to establish that effective quality care of patients ultimately enhances the domain of nurses’ performance level.
Discussion of Stakeholders
There are six primary stakeholders in healthcare system. The insurer, pharmaceutical companies, physicians, nurses, patients and government. Although, in this scenario, the key stakeholders are the physicians, the nurses and the patients. Patient satisfaction controls the HCAHPS score, while it is the job performance at stake for both the physicians and the nurses ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"4g0hnd2v","properties":{"formattedCitation":"(Rodriguez-Osorio & Dominguez-Cherit, 2008)","plainCitation":"(Rodriguez-Osorio & Dominguez-Cherit, 2008)","noteIndex":0},"citationItems":[{"id":"EmFT1DOb/EHHbXI41","uris":["http://zotero.org/users/local/0omESN17/items/59I87Q8Q"],"uri":["http://zotero.org/users/local/0omESN17/items/59I87Q8Q"],"itemData":{"id":71,"type":"article-journal","title":"Medical decision making: paternalism versus patient-centered (autonomous) care","container-title":"Current opinion in critical care","page":"708-713","volume":"14","issue":"6","author":[{"family":"Rodriguez-Osorio","given":"Carlos A."},{"family":"Dominguez-Cherit","given":"Guillermo"}],"issued":{"date-parts":[["2008"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Rodriguez-Osorio & Dominguez-Cherit, 2008). While the doctors knows best regarding the wellbeing of a patients, a patient is also ethically responsible for his or her own wellbeing. Thus, ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"Fr6WWzwO","properties":{"formattedCitation":"(Bodenheimer, Lo, & Casalino, 1999)","plainCitation":"(Bodenheimer, Lo, & Casalino, 1999)","noteIndex":0},"citationItems":[{"id":"EmFT1DOb/mMIaTHQJ","uris":["http://zotero.org/users/local/0omESN17/items/MV6KDRV4"],"uri":["http://zotero.org/users/local/0omESN17/items/MV6KDRV4"],"itemData":{"id":67,"type":"article-journal","title":"Primary care physicians should be coordinators, not gatekeepers","container-title":"Jama","page":"2045-2049","volume":"281","issue":"21","author":[{"family":"Bodenheimer","given":"Thomas"},{"family":"Lo","given":"Bernard"},{"family":"Casalino","given":"Lawrence"}],"issued":{"date-parts":[["1999"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Bodenheimer, Lo, & Casalino, 1999). Thus, if they work in tandem, with doctors and nurses taking care of the patient’s needs, and the patient, and his/her caregivers, in turn tries to explain and communicate in an effective manner, the system would work rather well, and the performance of the hospital, along with the HCAHPS score, would improve.
Purpose of the Project
The purpose of this project is to highlight the challenges that are being faced by Winchester hospital. Lack of communication between nurses and patients is hindering the provision of quality health care services. The healthcare practitioners at the hospital, along with the nurses, courtesy of being understaffed, are not behaving in the appropriate manner with patients and their caregivers. This leaves the patients and caregivers unsatisfied with the care they have received which directly impacts the HCAHPS score of Winchester hospital, correlating with the significant drop in its profit margin.
Proposed Solution
There is an immense need to implement effective practices in the health care organizations in order to improve the quality of health care. The rounds taken by the nurse leader is one of the most effective strategies that help to highlight the areas of improvement in the hospital. Nurse leader rounding is beneficial to understand the concerns of patients and their family ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"uPjEJPRV","properties":{"formattedCitation":"(Morton, Brekhus, Reynolds, & Dykes, 2014)","plainCitation":"(Morton, Brekhus, Reynolds, & Dykes, 2014)","noteIndex":0},"citationItems":[{"id":"EmFT1DOb/H9cifoVV","uris":["http://zotero.org/users/local/0omESN17/items/DJKD7JHZ"],"uri":["http://zotero.org/users/local/0omESN17/items/DJKD7JHZ"],"itemData":{"id":72,"type":"article-journal","title":"Improving the patient experience through nurse leader rounds","container-title":"Patient Experience Journal","page":"53-61","volume":"1","issue":"2","author":[{"family":"Morton","given":"Judy C."},{"family":"Brekhus","given":"Jodi"},{"family":"Reynolds","given":"Megan"},{"family":"Dykes","given":"Anna Kay"}],"issued":{"date-parts":[["2014"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Morton, Brekhus, Reynolds, & Dykes, 2014). By understanding the problem, nurse leaders can easily propose solutions to improve the overall health care services in the organization. It is notable to mention that nurse leader rounding promotes the sense of satisfaction in patients which can ultimately improve the overall HCAHPS score of Winchester hospital ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"fuDnqGVz","properties":{"formattedCitation":"(Merrifield, Frier, Lewis, & Walker, 2016)","plainCitation":"(Merrifield, Frier, Lewis, & Walker, 2016)","noteIndex":0},"citationItems":[{"id":"EmFT1DOb/kOFtzcb7","uris":["http://zotero.org/users/local/0omESN17/items/ZGSLE4LX"],"uri":["http://zotero.org/users/local/0omESN17/items/ZGSLE4LX"],"itemData":{"id":73,"type":"article-journal","title":"Improving care and accountability in a busy Emergency Department through the use of intentional rounding: The journey so far","author":[{"family":"Merrifield","given":"Josephine"},{"family":"Frier","given":"Rosemarie"},{"family":"Lewis","given":"Lydia"},{"family":"Walker","given":"Emma Jayne"}],"issued":{"date-parts":[["2016"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Merrifield, Frier, Lewis, & Walker, 2016).
Evidence Summary
Nurse leadership rounding is an effective strategy that improves the overall satisfaction of patients. Nurse leadership rounding involves direct observation and evaluation of the patient, staff, global view of patient status, clinical environment and unit functioning. Nursing leadership rounding provides opportunities to excel patients’ life expectancy by listening to their concerns ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"XIDnOvNs","properties":{"formattedCitation":"(Reimer & Herbener, 2014)","plainCitation":"(Reimer & Herbener, 2014)","noteIndex":0},"citationItems":[{"id":67,"uris":["http://zotero.org/users/local/5VyEEXyp/items/Y2R6ZCFC"],"uri":["http://zotero.org/users/local/5VyEEXyp/items/Y2R6ZCFC"],"itemData":{"id":67,"type":"article-journal","title":"Round and round we go: rounding strategies to impact exemplary professional practice.","container-title":"Clinical journal of oncology nursing","volume":"18","issue":"6","author":[{"family":"Reimer","given":"Nicole"},{"family":"Herbener","given":"Laura"}],"issued":{"date-parts":[["2014"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Reimer & Herbener, 2014). Day to day nurse leader rounds are valuable for proactive assessment of nursing quality regarding their care to the patients. This assessment of quality helps in providing immediate feedback to particular nurses. Nurse leader rounding provides these patients with the chance to share their concerns in an appropriate way. According to Merrifield et al. (2016), the efficiency of nurse leadership rounding enhances the leader's capability to deliver effective care. The authors state that a leader can utilize such practice to move staff, mission, and goals in order to ensure the delivery of safe and high-quality practices. The presence of a nurse leader on the floors helps in encouraging and motivating patients that higher management is concerned about their health. Patients tend to share their feelings in an appropriate manner when they believe that nursing leadership is concerned about their healthcare in the hospital ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"UGnhYWrl","properties":{"formattedCitation":"(Walker, Duff, & Fitzgerald, 2015)","plainCitation":"(Walker, Duff, & Fitzgerald, 2015)","noteIndex":0},"citationItems":[{"id":70,"uris":["http://zotero.org/users/local/5VyEEXyp/items/J7EYA82G"],"uri":["http://zotero.org/users/local/5VyEEXyp/items/J7EYA82G"],"itemData":{"id":70,"type":"article-journal","title":"‘Rounding’for better patient care: An evaluation of an improvement intervention implementation","container-title":"International journal of nursing practice","page":"207-213","volume":"21","issue":"2","author":[{"family":"Walker","given":"Kim"},{"family":"Duff","given":"Jed"},{"family":"Fitzgerald","given":"Katherine"}],"issued":{"date-parts":[["2015"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Walker, Duff, & Fitzgerald, 2015). Effective communication with patients help nurse leaders to understand their experience in the hospital, and it provides valuable insights about weak areas that might need some improvement to improve patients’ perception of care ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"0VOHCjMq","properties":{"formattedCitation":"(Dempsey, Reilly, et al., 2014)","plainCitation":"(Dempsey, Reilly, et al., 2014)","noteIndex":0},"citationItems":[{"id":"EmFT1DOb/zYRUllb7","uris":["http://zotero.org/users/local/0omESN17/items/BVZ4W6S7"],"uri":["http://zotero.org/users/local/0omESN17/items/BVZ4W6S7"],"itemData":{"id":"EmFT1DOb/zYRUllb7","type":"article-journal","title":"Improving the patient experience: real-world strategies for engaging nurses","container-title":"Journal of Nursing Administration","page":"142-151","volume":"44","issue":"3","author":[{"family":"Dempsey","given":"Christina"},{"family":"Reilly","given":"Barbara"},{"family":"Buhlman","given":"Nell"}],"issued":{"date-parts":[["2014"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Dempsey, Reilly, et al., 2014). A nurse leader needs to pay attention to better care of patients in order to successfully obtain a high rating in the HCAHPS score. Nurse leader needs to practice rounding in the hospital in order to integrate effective communication skills among staff members. Walker, Duff & Fitzgerald emphasize on the importance of nurse leadership rounding to improve the collaboration between nursing staff and physicians. Nurse leaders can improve the collaboration between nurses and physicians by keeping an eye on them through rounding the wards. Morton et al. demonstrate the significance of nurse leader rounding to eliminate negative environment which hinders the capabilities of nurses to provide effective healthcare services.
Implementation plan
In order to improve the health care services of the Winchester Hospital, it is necessary to implement the practice of leadership rounding. For this purpose, the hospital management needs to increase the workforce so that the routine leadership practices may not get disturbed. Hourly leader rounding must be implemented to identify the areas of improvement in the Winchester Hospital. After that, possible solutions must be proposed to improve the health care services in order to get better HCAHPS score. Cash is an important tangible source that is required during the entire process of nurse leadership rounding. Nurse leader needs to connect with an entire team of competent nurses to meet the standards of health care services. This specific objective can only achieve through the proper allocation of financial means. When it comes to the acquisition of nurse leadership rounding plan, there is a prior need of training of concerned individuals that can only be possible with the proper utilization of some necessary tangible resources such as cash, inventory, and adequate building space.
Step one: This author will meet with preceptor and identify possible problems within the facility. We will analyze and utilize the discharge patient satisfaction surveys. With those results a problem will be identified that is affecting the satisfaction of care given to patients in this facility. A problem has now been identified and a change is now required.
Step two: Author will begin her research by collecting peer review articles. Collect copious information regarding the topic of choice. This information will help support your proposal.
Step three: A problem was identified and upon numerous researches provided. With the research is has been identified why this problem is of important and whom are the stake holders and whom are affected mostly by the problem identified a possible solution has been identified and will require to be tested.
Step four: With enough evidence compiled in support of the problem Identified, this author will create a draft proposal and present to the preceptor. The preceptor will be provided with answers relating to topic ex: who its affected, how? etc.
Step five: Will received feedback and utilize that feedback to revise proposal. Preceptor will guide author on areas that may require revision.
Step six: Final proposal with supporting evidence has been gathered, this proposal has been completed.
Actions
April – June
July- October
November- January
February-April
Feasibility of plan
Conduct meeting
Alignment of all the stakeholders
Accessibility of resources
Approval of plan
Implementation of plan
For this purpose, Clinical Nursing Leadership, higher management and medical staff of Winchester Hospital are required. These individuals will help to implement the practice of Nurse Leadership rounding in Winchester Hospital to improve the HCAHPS score.
Previously, there was no concept about nurse leadership rounding in the Winchester Hospital. There was a lack of effective communication between nurses and patients that hindered the process of quality health care services. Now, the implementation of nurse leadership rounding will help to improve the overall health care services in the organization. It will also help to improve areas of improvement which will ultimately increase the overall HCAHPS score of Winchester Hospital. Adverse rate of health care and the poor quality of healthcare services demands the organization to focus on the approach a change theory. The change theory used is Lewins three-stage model of change known as unfreezing-change-refreeze model. It is important for the facility to focus on different stages of the change theory to execute a better healthcare plan in the end. The first stage known as unfreezing took place when this author and preceptor identified the problem in this facility. It was concluded after analyzing several areas there is a need to propose hourly rounding to promote patient satisfaction which will improve HCAHPS scored. The second stage included further investigation in how to implement and this was done by reviewing numerous literature articles to support the change. In this area we were able to draw ideas and how to make this proposal. Lastly the unfreezing stage, in this area is where we decided to bring the proposal to the nursing manager with evidence of how this would affect and benefit the unit. When it comes to the perspective of change theory is widely considered a concept to determine better forms of healthcare services for the patients through the perspective of nursing. The concept of change theory comprised of three important stages helps to identify the need and action required for change. Exploration of the need for change eventually helps decision-makers to develop better strategies to apply suitable practical measures to enhance the aspect of quality healthcare. Adverse rate of health care and the poor quality of healthcare services demands organization to focus on the approach of change theory. It is important for the management to focus to different stages of the change theory to execute better healthcare plan in the end. When it comes to the perspective of change than change theory is widely considered concept to determine better forms of healthcare services for the patients through the perspective of nursing. The concept of change theory comprised on three important stages helps to identify the need of change. Exploration of need of change eventually helps decision-makers to develop better strategies to apply suitable practical measures to enhance the aspect of quality healthcare.
Non-collaboration of medical staff with the objectives of the health care organization, unrealistic targets and lack of effective communication is a potential barrier to implement the nurse leadership rounding
References
ADDIN ZOTERO_BIBL {"uncited":[],"omitted":[],"custom":[]} CSL_BIBLIOGRAPHY Bodenheimer, T., Lo, B., & Casalino, L. (1999). Primary care physicians should be coordinators, not gatekeepers. Jama, 281(21), 2045–2049.
Dempsey, C., Reilly, B., & Buhlman, N. (2014). Improving the patient experience: real-world strategies for engaging nurses. Journal of Nursing Administration, 44(3), 142–151.
Dempsey, C., Wojciechowski, S., McConville, E., & Drain, M. (2014). Reducing patient suffering through compassionate connected care. Journal of Nursing Administration, 44(10), 517–524.
McFarland, D. C., Shen, M. J., Parker, P., Meyerson, S., & Holcombe, R. F. (2017). Does hospital size affect patient satisfaction? Quality Management in Health Care, 26(4), 205–209.
Merrifield, J., Frier, R., Lewis, L., & Walker, E. J. (2016). Improving care and accountability in a busy Emergency Department through the use of intentional rounding: The journey so far.
Morton, J. C., Brekhus, J., Reynolds, M., & Dykes, A. K. (2014). Improving the patient experience through nurse leader rounds. Patient Experience Journal, 1(2), 53–61.
Reimer, N., & Herbener, L. (2014). Round and round we go: rounding strategies to impact exemplary professional practice. Clinical Journal of Oncology Nursing, 18(6).
Rodriguez-Osorio, C. A., & Dominguez-Cherit, G. (2008). Medical decision making: paternalism versus patient-centered (autonomous) care. Current Opinion in Critical Care, 14(6), 708–713.
Walker, K., Duff, J., & Fitzgerald, K. (2015). ‘Rounding’for better patient care: An evaluation of an improvement intervention implementation. International Journal of Nursing Practice, 21(2), 207–213.
