Issues With Governance And Leadership Practices In The Nursing Unit

Factors Affecting The Nursing Unit

The assessment critically evaluates the given clinical scenario to analyze the potential issues associated with governance and leadership practices of the Organization. The aim of the essay is to specifically examine the factors affecting the delay in recruitment process, unfilled posts, difficult work culture, high rate of staff turnover, and overtime practices in the long term nursing unit. The essay concisely describes the scenario and context which affect the delivery of quality care at the work place. It evaluates the different issues faced by the unit which affect the patients, and staff. Finally on the basis of evaluations, it recommends the strategies which can be implemented to assist the delivery of professional quality care. Governance And Leadership Practices In The Nursing Unit Discussion Paper The discussion only focuses on the given clinical scenario. It will be argued that inefficient management, leadership and governance at the workplace (as shown in the scenario) can lower down the productivity of the unit and may worsen the quality of care.

The most important factors affecting the long term nursing unit are: lack of experienced leadership (Manager), delayed recruitment process and many unfilled posts, difficult work culture, high rate of staff turnover, high rate of sick leaves among employees, and overtime pressure to fill roster deficits. Hiring the inexperienced graduates has resulted into increased incidents of consumer falls and medication errors since last 6 months. There are several problems in recruiting the senior and experienced registered nurses in the unit so the management started hiring young graduates at respective vacant posts for minimizing the overtime load on the existing staff.  Hiring the young inexperienced graduates resulted into increased consumer falls and medication errors. None of the nurse already working at the manager’s post has shown keen interest in continuing her job at the same post. Around 25% of the fulltime jobs at the unit are vacant. Hiring the inexperienced candidates further increased the incidents of aggression among the patients and the staff members. Moreover, the lack of permanent experienced and professionally qualified nurse educator and clinical facilitator has lowered the quality of staff training and education at the unit.

The most important factor influencing the quality of care is ‘unfilled posts’. The management is careless about completing the annual recruitments on time. Most of the posts like that of manager are vacant since two years.

The clinical scenario reflects several issues related to filling leadership roles at the unit, lack of quality training of nurses, shortage of experienced staff, inadequate compensation and salary, improper behavioral management of nurses and increasing complaints from the patients.

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Importance Of Adequate Staffing

Inadequate Staffing- Lack of experienced staff threatens the patient safety and health in the unit. It also increases the rate of injury and fatigue in the staff and compels the existing clinicians to work for longer hours under stressful work conditions. Inadequate staffing may impede the efforts of the nurses at work to perform the care processes. According to the Hospital Readmission Reduction Program by Affordable Care Act, the hospitals having higher nurse staffs are penalized to 25% lesser extent than the hospitals having lower staff (Gooch, 2015). According to the reviews of Minnesota Department of Health, the lower levels of nursing staff is linked to higher patients mortality, falls and failure to rescue during hospitalization (Gooch, 2015). Moreover, the unavailability of skilled nurses at the unit either due to increasing sick leaves or due to high staff turnover rate also adversely affects the delivery of quality care. Shortness of staff makes it compulsory for the nurses to take additional shifts at work, to fulfill the role of absent coworker, which may be done by missing out going at family functions and leaving no room for family time (Park, Jeon, Hong & Cho, 2014). It can deteriorate their social life. Having no time to relax and care for own self may make the staff unsatisfied and frustrated from the job thereby increasing the intention to escape from the job.

High rate of turnover- The high rate of turnover and intent to leave job may be due to inadequate compensation in comparison to the workload and stress imposed. The nurses working in poor working environment and having excessive patient overload are found to be more dissatisfied with their jobs (McHugh & Ma, 2014). The long shifts and inadequate sleep increases fatigue, giving rise to negative cognitive emotions and dissatisfaction at work (Gooch, 2015). The wages though play a significant role however they do not solely lead to better outcomes. Adequate staffing and favorable work environment is essentially important to retain the employees at their posts. High rate of sick leaves may be a way to escape the work pressure and highly complex working environment.

Job Dissatisfaction- The unwillingness of nurses to remain at the same post for longer shows tough and stressful working conditions and inadequate compensation for the assigned work (McClellend, 2017). The decision of filling up the vacant positions with graduates is also not a responsible step. The decision may be taken up for cutting down the costs by the management. It increases dissatisfaction and rates of complaints among the patients. Greater patient-to-nurse ratio may lead to higher burnouts and job dissatisfaction (Er & Sokmen, 2018). High workload makes the routine exhaustive and renders the recovery difficult. It makes the job satisfaction unachievable. Many nurses doing long shifts regularly may suffer from shoulder pain, cardiovascular diseases and other chronic medical health conditions. It may deteriorate the mental ability and the capacity to take proper decisions and may harness the safety of patients (Bettencourt, 2017).

High Rate Of Turnover

Recruiting more nurses consistently improves the productivity of the hospital, lowers down the retraining costs and turnover thereby enhancing the patient outcomes positively (McHugh & Ma, 2014).

Poor work environment- The employees used to work overtime in every shift to overcome the deficits in the roster. The nursing unit observes nearly 25% vacancy at the full time job positions. Inexperienced fresh graduates don’t have behavioral skills to deal with the patients. Lack of proper training increases the aggressive behavior among the staff and the patients. They do not know how to manage their attitude and behavior while being with the patients. Governance And Leadership Practices In The Nursing Unit Discussion Paper There is no permanent trainer employed at the post of nurse educator and the post observed four nurse educators since the last 9 months. The post of clinical facilitator is also unoccupied.

Necessary developments and improvements should be done to create nurse friendly working conditions in the long term care unit. The management should emphasize on creation of a hospital policy to support the professionally favorable environment. Such initiatives may improve the staffing and nurse retention, safety of the patients and the quality of care leading to further improvements in the nursing practices (Er & sokemen, 2018).

The unit should have a strong permanent clinical leadership. There should be chief nurses to manage the nursing workforce. Standard training should be imparted to the staff to improve their competence level. Professional judgments can be replaced by the policies, protocols and rules. There should be focus on Quality Improvements and streamlining process to achieve better outcomes.

Inadequate staffing may be addressed by reducing the patient to nurse ratio. The institutions can be made more competitive. Treatment processes can be streamlined to achieve a decline in medication errors, morbidity, length of stay, mortality and hospital re-hospitalization rates (Izumi, 2012).

Highly competent, experienced and skilled nurses with better communication may reduce the rate of patient falls, medical errors, and mortality (Paulsen, 2018). There should be minimum set of prescribed skills and expertise for every post at the unit. Hiring fresh graduates at the responsible posts should not be allowed. After hiring, proper training should be provided by the standard nurse educator to facilitate effective implementation.

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Quality Improvement Strategies may involve Computer based Reminder Systems and decision support for care providers,  regular conferences and workshops to improve knowledge, promotion of patient education, feedback and audits to assess the performance of  care providers (Daly, Jackson, Mannix, Davidson & Hutchinson, 2014). The incentives and compensation should be provided to nurses on basis of their performance and assessment of quality indicators. There should be requirements of license for the nurses to be hired at senior posts.

Weak leadership framework should be strengthened and leadership related interventions can be framed to improve the delivery of quality care. The processes of HR management must hire the candidates with clinical expertise and experience for the related post (Govender, Gerwel, & Kader, 2018). Timely recruitment must be done at all the posts. The individual level performance of the nurses should be assessed to encourage better performance.

Conclusion

The clinical scenario provided for critical analysis and evaluation involves several issues related to inefficient management, lack of effective governance and policies, shortage of adequate staffing, job dissatisfaction among nurses, a number of vacant posts, and recruitment of inexperienced graduates at the permanent posts for temporary time period to overcome the roster deficits. The staff has to do overtime most of the times which reduces the overall productivity of the delivered care. The recommendations to improve the condition involve timely recruitment of all the vacant posts with skilled and expert candidates. Regular training and quality assessment of staff can improve the condition effectively

References

Bettencourt, E,(2017). Five problems nurses face today. Retrieved from https://blog.diversitynursing.com/blog/5-problems-nurses-face-today

Daly, J., Jackson,D., Mannix,J., Davidson,P.M., & Hutchinson,M. (2014). The importance of clinical leadership in hospital setting. Journal of healthcare leadership. 2014(6).75-83. Doi: https://doi.org/10.2147/JHL.S46161

Er,F. & Sokmen,S.(2018). Investigation of the working conditions of nurses in public hospitals on the basis of nurse-friendly hospital criteria. International Journal of Nursing Sciences. 5(2). 206-212. Doi: https://doi.org/10.1016/j.ijnss.2018.01.001Gooch,K.(2015). 5 of the biggest issues nurses face today.  Retrieved from https://www.beckershospitalreview.com/human-capital-and-risk/5-of-the-biggest-issues-nurses-face-today.html

Govender, S., Gerwel Proches, C. N., & Kader, A. (2018). Examining leadership as a strategy to enhance health care service delivery in regional hospitals in South Africa. Journal of multidisciplinary healthcare, 11, 157-166. doi:10.2147/JMDH.S151534

Izumi S. (2012). Quality improvement in nursing: administrative mandate or professional responsibility?. Nursing forum, 47(4), 260-7.  Governance And Leadership Practices In The Nursing Unit Discussion Paper