Leadership and nursing care management

Leadership and nursing care management

MOBILIZATION PLAN Learner’s Name Capella University ORGANIZATIONAL AND SYSTEMS MANAGEMENT FOR QUALITY OUTCOMES May, 2017

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International Medical Mission for Nursing Professionals

Mobilization plan for the international medical mission.

Plan will consider the following aspects:

Understanding the impact of mobilization on staffing patterns and nursing at a health care organization.

Determining organizational structure and distribution of power in the mission team using case studies.

Examining potential multicultural and power issues the team may encounter during the medical mission to Africa.

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Mobilization of international missions are complex undertakings that require (a) meticulous planning of resources: human, fiscal, and material resources; (b) careful structuring of team member roles and authority; and (c) empowering the team to complete missions goals. The social structures, health care regulations and infrastructure, and needs of the host country also factor in the mobilization plan (Hawkins, 2013). Team members have to be prepared for the individual, professional, and organizational factors of moving temporarily to a new country.

 

The scenario:

A medical center has committed 20 nursing professionals (NPs) to a four-month-long multinational health mission in Liberia, West Africa, to treat patients affected by a highly contagious virus in a ‘hot zone.’ The team will also include administrative staff and physicians who will work with the NPs to achieve common goals. NPs are the primary care givers in any health setting. They are the ones assisting physicians, administering treatment and monitoring patient status in the clinical setting. Therefore, the majority of the staff on the medical mission will be NPs.

 

This presentation will detail plans for the mobilization of interprofessional health care workers to Africa. It will focus on the following points:

 

Identifying major stakeholders in the health care organization who will be affected by the mobilization plan.

Determining the impact of mobilization on staffing patterns and nursing at the organization.

Describing the organizational structure of the international medical mission and how power will be distributed among the team members.

Assessing team member empowerment derived from organizational structure.

Identifying key actions that should be taken by team members to ensure that patients receive quality and safe care. The key actions should also ensure the safety of team members during fieldwork.

Evaluating potential multicultural and diversity issues team members may encounter in the host country.

Evaluating potential power conflicts that may arise when dealing with a multinational contingent.

 

 

 

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Stakeholders Affected by the Mobilization Plan

Major stakeholders affected by the mobilization

Organizational leadership and management staff

Investors

Nursing leadership and professionals

Physicians

Patients

How does mobilization impact staffing and care patterns in the medical Center?

It will cause shortage of staff.

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Major stakeholders affected by the mobilization are as follows:

Organizational leadership and management staff

Investors

Nursing leadership and professionals

Physicians

Patients

As a recognized medical Center known for its research studies on and treatment of contagious diseases, the organization is suitable for the medical mission.

 

How does mobilization impact staffing and care patterns in the medical center?

It will cause shortage of staff. As 20 NPs will be reassigned to the mission, the impact on nursing departments will be

Longer shift hours among NPs

High frequency of floating

Imbalance in nurse-to-patient ratio

Increased workload on NPs

 

According to systems theory, an organization is a collection of different parts that work in tandem to achieve organizational goals. However, changes in any one part can cause changes or affect the functioning of other parts as well (Huber, 2017). Therefore, organizational changes like mobilization of health care staff from different professional areas—administration, nursing, and medicine—will impact other areas of the medical center.

 

Organizational leadership, management staff, and investors will have to manage the medical center with fewer administrators, which will cause problems during allocation of resources and maintenance of facilities.

In the clinical setting, the shortage of NPs and physicians will affect patient outcomes as patients depend on their nurses and physicians to provide quality and safe care. According to Huber, when the number of NPs on a shift is high, patients are more satisfied because they can easily approach NPs for care-related problems. Increased approachability also empowers patients.

 

The medical center in this scenario is one of foremost centers in the United States known for its research studies on and treatment of contagious diseases. The organization’s health care professionals are experts who can help the African nationals affected by the viral contagion. Also, health care organizations have an obligation to use their human and material resources to help disadvantaged populations within and outside their community (Hawkins, 2013).

 

Other factors that make the medical center suitable for the medical mission is its achievement of Magnet recognition.

Incorporating the standards of Magnet, the organization has established shared governance in its leadership and management styles.

Its health care professionals show high-levels of autonomy, shared decision-making, and evidence-based practice and are capable of systematically solving organizational issues.

Magnet recognition improves organizational performance by (a) changing personnel policies and programs, (b) focussing on professional development, (c) improving relationships between community and health care organizations, and (d) improving the image of nursing (Luzinski, 2012).

 

The diversion of human resources from the medical center to the mission can cause a severe staff shortage. The nursing department will be affected the most because it will have to fill 20 positions to manage day-to-day tasks efficiently. Shortages in staff have been tied to problems such as negative patient outcomes; job dissatisfaction among health care professionals: NPs, physicians, and clinical technicians; decreased productivity of workforce, and disorder in the health care organization (Currie & Carr Hill, 2012). According to systems theory, problems in staffing will affect processes and structures in other departments of the medical center. Also, since all health care professionals depend on NPs to accomplish patient-related tasks, a shortage of nursing staff can affect patient care and administration of treatment.

 

Longer shifts for nurses can cause burnout (Huber, 2017). Shifts of more than nine hours affect the efficiency of NPs and will negatively affect their motivation to stay in the medical center, causing job dissatisfaction.

Floating is the redistribution of NPs from overstaffed units to understaffed units. However, floating is not possible when NPs have been mobilized for a medical mission, as all units face a shortage of staff (Huber, 2017).

Patients are assigned to NPs after careful planning and assessment of the workforce. If NPs are assigned too many patients, they may not be able to give equal quality of care and safety to all patients, which in turn may lead to negative patient outcomes (Huber, 2017).

During nurse shortages, existing nursing workforces are forced to fill the empty positions by taking up extra work. However, too many patient assignments, long shift hours, and inability to manage different duties can cause job dissatisfaction and even lead to harmful patient care practices (Huber, 2017).

 

 

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Impact of Mobilization on Staffing and Care Patterns (2/2)

Strategies to maximize staffing and maintain high level of patient care:

Recruitment of NPs.

Unit size

Leadership styles

Retention strategies

Shared governance model of nursing management (Currie & Carr Hill, 2012).

 

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Organizational decisions such as the mobilization of staff are often the underlying factors behind problems in nurse staffing and delivery of patient care (Currie & Carr Hill, 2012). Ignoring these factors can worsen problems, as described by studies on systems theory effects on health care. In fact, the causes of systems problems vary every time. Therefore, strategies devised to mitigate problems must be flexible and must target the identified individual causes. The strategies described here take into account the changing nature of organizational systems and help nursing professionals adapt to problems.

 

Recruitment and retention strategies: The medical center should recruit more NPs to fill the gaps in nursing practice. It can strategize by targeting young professionals. Young or newly graduated NPs show better adaptability in nursing practice and are more satisfied with their job. In parallel, the medical center should also invest in retention strategies targeted at older NPs, who are more likely to retire or change jobs when dissatisfied with the work environment (Currie & Carr Hill, 2012). Retention strategies include providing opportunities for professional growth through training, setting up communication lines that allow NPs to express any work-related grievances, allowing sharing of workload among nurses, and assigning mentors to NPs so that they can better adapt to organizational change (Huber, 2017).

 

Unit size: Reorganizing nursing teams into smaller, but numerous autonomous teams within different units might improve staff conditions and avoid dissatisfaction, and mitigate turnover (Currie & Carr Hill, 2012). This is because smaller teams are better able to practice shared governance and decision-making in quality and safe patient care.

 

Leadership style: Managing staffing and care patterns are important nursing leadership duties. However, in order to execute staff management policies, nurse leaders have to develop effective leadership styles (Huber, 2017). Studies have shown that relational leadership styles, which focus on building productive relationships with people, have helped nurse leaders implement effective staff management strategies. Relational styles also develop authenticity in a nurse leader’s work, which is essential for building strong teams. A leader who develops authenticity in his or her work, builds trust, shares information and communicates with team members, and motivates staff to achieve organizational and health care goals. These leadership activities further empower NPs (Körner, Wirtz, Bengel, & Göritz, 2015).

 

Shared governance models: Distributing power among nurses allow NPs to make decisions to improve their units and productivity such as self-scheduling tasks or sharing workload without seeking approval from organizational leaders. Shared governance also improves job satisfaction and the self-worth of NPs by granting more autonomy (Currie & Carr Hill, 2012).

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Organizational Structure of the Medical Mission Team

Characteristics of the organizational structure:

Shared governance model:

Lean and decentralized

Shared distribution of governance and management

Autonomy and independence

Nonhierarchical model:

Leaders do not have the final decision-making power. That power is equally distributed among all health care professionals—administrators, NPs, and physicians.

Team members will be structurally empowered during mission duties (Wong & Laschinger, 2014).

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Conflicts often arise in medical mission teams because of communication gaps and the lack of clarity on individual roles, communication gaps. Some members may also feel they have less power compared to other team members (Currie & Carr Hill, 2012). To instill unity in the mission team, leaders from all three fields—medicine, administration, and nursing—must collaborate with other team members and share leadership roles and responsibilities.

 

The shared governance model emphasizes decentralized and lean forms of governance. It encourages NPs to be autonomous and independent from the influence of physicians and administrators. Leadership roles are equally distributed among team members (Currie & Carr Hill, 2012).

Therefore, power is not concentrated to a few leaders in the team. All team members have the power to make decisions about their work and patient care. However, they should ensure that health care standards such as evidence-based practice, quality of care, and patient safety are maintained.

The distribution of power also allows team members, especially NPs, to develop leadership skills themselves. In a multinational effort, NPs who are allowed to participate in patient care rounds, organize resources and staff, and consult with other health care professionals are able to grow professionally (Currie & Carr Hill, 2012).

 

The decentralization of power structures also implies lack of hierarchy in health care practice. Leaders in the mission team have the practical purpose of being points of contact for other teams in the multinational effort. However, all information gathered during meetings with multinational teams is shared with the NPs, administrative staff, and physicians. Decisions made have the combined input from all team members.

 

The shared governance model also allows the team to become structurally empowered. Structural empowerment is the presence of social structures such as autonomy and leadership that enable health care professionals to accomplish work in meaningful ways. Structurally empowered NPs have access to educational and professional development resources, information about policies and goals, and opportunities to contribute and execute ideas, without the need for multiple layers of approval (Wong & Laschinger, 2014).

 

 

 

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Organizational Structure of the Medical Mission Team

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Leadership

Team members

The mission head or mission coordinator is the first level of leadership. The main roles include coordinating efforts with and being the point of contact for leaders from other multinational teams. The mission head’s decision-making processes involve the administrative head, nurse leader, and physician leader, as well team members.

 

The administrative head is the point of contact for the administrative team. He or she is responsible for working with the mission head to manage resources and staff, and establishing communication lines.

 

The nurse leader is responsible for managing nursing resources and staff and coordinates with the mission head to organize nursing teams for clinical duties. The nurse leader also supervises the 20 NPs assigned to the mission team.

 

The physician leader manages doctors on clinical duty, assigns clinicians to rounds, and coordinates with the nurse leader and NPs on patient assignments and treatment.

 

All team members work closely together and communicate frequently, while providing regular reports to the field leaders and the mission head. This is done to prevent wastage of resources, and to manage time and costs effectively.

 

Leadership is essential to this scenario as he or she helps mobilize teams to action and represents the team in the multinational effort. However, the power to make decisions is not centralized to leadership. It is distributed among all team members. Information that leaders gather during meetings with other leaders are shared with team members, who will in turn provide feedback or ideas.

 

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Mission Goal

 

 

Mission head

 

 

Admin head

 

 

Physician

 

 

Physician leader

 

 

Admin staff

 

 

Nurse leader

 

 

NP

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Organizational Structure Empowering Team Members

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Leaders empower team members to make independent decisions.

Leaders gain authenticity by empowering their teams (Körner, Wirtz, Bengel, & Göritz, 2015).

Empowered team members grow professionally and individually.

For example: Interprofessional teams working out of Eastern Cape Province, South Africa, were able to facilitate exchange of skills between teams and leaders as well as participation from locals who were given information about treatment and disease prevention by enlightened and empowered health care professionals such as nurses(World Health Organization, 2013).

The development of authentic leaders, who display high levels of trust and respect for their team members, are directly related to empowerment and indirectly related to delivery of quality and safe patient care (Körner, Wirtz, Bengel, & Göritz, 2015).

 

Empowerment improves job satisfaction, thereby motivating team members to perform better.

Team members feel empowered when authentic leaders help them realize their professional and individual capabilities. Authentic leaders also encourage team members to contribute ideas and help them in accessing important resources for bettering health care goals.

Authentic leadership also rewards excellence, which further motivates team members.

The organizational structure will create an interactive and participative work environment that clears a path for team members to advance in their careers.

 

In a case study by World Health Organization (WHO), the interprofessional team working out of South Africa—medical officers, nurses, pharmacists, community care nurses, midwives, and nurse educators—were able to improve their own skill and knowledge because the organizational structure empowered them to take up mentorship roles, improve quality of care, communicate important information to locals, and facilitate exchange of skills and information between locals, team members, and leaders (WHO, 2013). These activities are usually performed by the group leader. Such a structure, when applied to the medical mission, will empower team members to simultaneously take up new roles and duties such as that of practitioners, leaders, and educators. By the time team members complete the mission, they will have grown professionally and individually and learned new skills.

 

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Key Actions to Assure Quality of Care and Patient Safety

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The following are six key actions that mission team members should consider to ensure that patients receive quality and safe treatment. These actions also ensure a safe work environment for health care personnel.

Interprofessional communication

Patient-centered care

Role clarification

Team functioning

Collaborative leadership

Conflict resolution (Hepp et al., 2014)

 

Interprofessional communication is a key action for achieving good patient outcomes and maintaining effective interpersonal relationships between the mission team members. It includes consistent and formal communication methods, open-door policy and approachability of team members, and use of written, oral, electronic, or verbal forms of communication to record patient history, progress notes, and patient charts. With effective communication, team members are also able to build productive relationships with one another that will help them work collaboratively in the clinical setting.

 

Health care professionals must be dedicated to patient-centered care. It involves centering care and decision-making processes on patients and families. It includes a more holistic form of treatment that allows team members to customize care to patients and develop productive work relationships.

 

When leaders clarify individual roles in the team, team members develop an understanding of their own competencies. As team members take up new roles, they need to understand which tasks are more appropriate for them. This ensures that team members do not take up duties outside their boundaries of expertise. It also ensures better team dynamics as individuals learn to work with other health care providers and respect others’ expertise on clinical matters.

 

Team functioning ensures that the team functions like a well-oiled machine. Team members assist colleagues in work matters, value and respect each other’s contributions, and share a deeper sense of responsibility and accountability. Focusing on improving team functioning helps empower each team member, which improves job satisfaction. Teams members learn to delegate or share the workload, which are essential skills in the high-stress clinical environment.

 

Collaborative leadership is created when leaders work together on all matters with their teams. Hierarchy is not visible and nurse leaders and their NPs have a larger role to play in decisions as compared to decisions being made only by physicians or management.

 

Conflict resolution is a major problem in interprofessional and multinational efforts. Patient discharge is a common source of conflict, with one team leader taking over all the decision-making processes. The solution to conflict lies in teams trusting each other to make the right decision about patients and leaders giving autonomy to NPs to make such decisions (Hepp et al., 2014).

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Potential Multicultural and Diversity Issues in the Mission

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Potential multicultural and diversity issues in the mission team:

Language barriers

Different medical practice standards of the host country

Lack of consideration for cultural differences

Forcing personal beliefs on patients or other multinational teams (Hawkins, 2013).

Solutions to address each issue

Multicultural and diversity issues are unavoidable in any interprofessional and multinational effort. In this case, the team heading to Africa will encounter a racially and ethnically different country. Cultures, values, traditions, social norms and structures, behaviors, and family structures will be very different from what the team has experienced. Language barriers, differences in medical practice standards of the country, lack of consideration of patient’s cultural differences, and forceful endorsement of personal beliefs on the patient or other teams can impede efforts for ensuring quality and safe care. In such a scenario, it is the responsibility of health care professionals to adapt and respect the cultural differences and assimilate them into medical practice (Hawkins, 2013).

 

Solutions include adding translators or multilingual health care professionals in the team, researching on various health care policies and standards of the host country and communicating that information to all team members (brochures or booklets are helpful in this regard), understanding and learning appropriate cultural behaviors, and respecting patient boundaries even if cultural differences are principally against the values of team members.

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Potential Power Issues in the Mission

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Team members are expected to work with their own teammates and members of other multinational teams to accomplish mission goals.

Potential power issues include:

Conflict of power

Insubordination and differences of opinion

Conflict due to cultural differences that involve authority or leadership

Conflict over jurisdiction and allocation of resources (Wong & Laschinger, 2012).

Top priorities and strategies

Working with a large multidisciplinary and multinational team can create imbalances in power. Nurse leaders may have to head different teams and have to take steps to maintain their level of power and authority. They may face insubordination from team members who are not familiar with the style of leadership, care practice, and cultural beliefs. Conversly, NPs may have to report to leaders who are demotivating and inconsiderate of team members’ opinions. In such instances, NPs may not be able to address their grievances to their leaders. Team members may also face issues of power when allocating limited resources and infrastructures to different teams and groups. Also, NPs may conflict with physicians who may dominate decision-making roles and ignore valuable input from nursing teams on patient care.

 

The top priority for the mission team when addressing power issues are conflict resolution—preventing and solving conflicts in power.

 

Strategies for conflict resolution include establishing clear role and responsibilities from the beginning of work and using relational leadership styles to command respect and authority. Relational leadership styles improves productivity and patient outcomes through relationship-building. They give equal decision-making power to other team members and maintain open lines of communication. These aspects are crucual while preventing and resolving conflicts in power (Hawkins, 2012; Wong & Laschinger, 2012).

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Conclusion

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Planning and undertaking a multinational interprofessional effort is no easy task. Even with enough planning, issues will still arise that affect delivery of quality and safe patient care and the dynamics of the team. Strategies such as culturally congruent practices help solve these problems and enrich the experiences of all people involved in the mission—health care providers and patients. By understanding the value of power and empowerment, trust, communication, and patient-centered practice, it is possible to achieve the goals of the mission team in Liberia.

 

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References

Currie, E. J. & Carr Hill, R. A. (2012). What are the reasons for high turnover in nursing? A discussion of presumed causal factors and remedies. International Journal of Nursing Studies, 49(9), 1180-1189. http://dx.doi.org/10.1016/j.ijnurstu.2012.01.001

Hawkins, J. (2013). Potential pitfalls of short-term medical missions. Journal of Christian Nursing, 30(4), E1-E6. https://dx.doi.org/10.1097/01.CNJ.0000435282.54160.0d

Hepp, S. L., Suter, E., Jackson, K., Deutschlander, S., Makwarimba, E., Jennings, J., & Birmingham, L. (2015). Using an interprofessional competency framework to examine collaborative practice. Journal of Interprofessional Care, 29(2), 131-137. https://dx.doi.org/10.3109/13561820.2014.955910

Huber, D. L. (2017). Leadership and nursing care management (6th ed.) Philadelphia: W.B. Saunders. http://dx.doi.org/10.7748/nm.21.6.13.s14

 

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Körner, M., Wirtz, M. A., Bengel, J., & Göritz, A. S. (2015). Relationship of organizational culture, teamwork and job satisfaction in interprofessional teams (Webpage). BMC Health Services Research, 15(1). . https://dx.doi.org/10.1186/s12913-015-0888-y

Luzinski, C. (2012). An innovative environment where empowered nurses flourish. Journal of Nursing Administration, 42(1), 3–4. https://dx.doi.org/10.1097/NNA.0b013e31823c16fc

Wong, C. A., & Laschinger, H. K. (2013). Authentic leadership, performance, and job satisfaction: the mediating role of empowerment. Journal of Advanced Nursing, 69(4), 947-959. https://dx.doi.org/10.1111/j.1478- 5153.2010.00398.x

World Health Organization. (2013). Interprofessional collaborative practice in primary health care: Nursing and midwifery perspective—Case studies. Retrieved from http://www.who.int/hrh/resources IPE_SixCaseStudies.pdf

 

 

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