Understanding How to Deliver Positive Patient Outcomes, Essay Example

Abstract

Examining the link between nursing and patient outcome has clearly established a link between effective nursing and positive patient outcomes. With the nursing profession facing critical shortages, it is more important than ever that effective recruiting and retention programs are put in place. Recruiting alone is not the answer; maintaining an effective nursing staff and achieving positive patient outcomes depends on effective Clinical Nursing Leadership. Cultivating an effective nursing staff means cultivation an environment where effective leadership can flourish.

It has been reported for decades now that the Nursing profession faces a critical shortage of competent professionals to fill the ranks. Nurses are retiring at higher rates than ever, and fewer nurses are stepping in to fill the gap. This does not just mean that “average” nurses are in short supply; the number of nurses who will take up leadership roles are dwindling as well. There is increasing evidence that competent nursing care is an integral component of positive patient outcomes, and faced with a short supply of nurses, it is ultimately patients who will suffer. Along with the link between superior nursing care and positive patient outcomes is the link between effective leadership among the nursing ranks and overall improvements in morale and performance among the nursing staff in organizations. Clinical Nursing Leadership is not just a boon to the patients; it is a boon to nurses as well.

Beginning in the 1990s in the United States many changes came over the Nursing profession and in health care in general (Ellis and Hartley, 2009). For decades, health care costs have been soaring (and not only in the United States, but in Australia as well), and this increased costs have led to increasing pressures on staff, and in many cases the staff that deals with the increasing pressure is short-handed because of budget cuts. Despite attention being paid to these issues, costs continue to rise and the pressure continues to build.

As a response to these increasing costs and increasing difficulties in the health care field, some health care organizations have responded by implementing sweeping changes. These changes involve looking at all the roles within the organization in new ways. Staffers are increasingly called upon to cross-train in different areas; this allows more people to deliver competent care in more areas, and also means that fresh ideas will often crop up, when someone with a different skill set than is typical for a certain area can examine a situation from a new perspective.

Change can come from both management and from staffers at all levels. Those who seek to make change happen, in this paradigm, are referred to as “change agents.” These change agents are responsible both for visualizing what changes could be implemtnted, and for managing these changes as they occur, to make sure that new processes or ways of doing things do not disrupt the continued application of wuality care.

In this change model, there are three basic types of change: Developmental change, transitional change, and transformational change. Developmental change involves making incremental changes to processes that are already in place. Transitional change refers to the sorts of change that take an organization from one process, or set of processes, to a new process or set of processes. Transformational change, in the end, is the result of these earlier types of change, where an organization is fundamentally transformed at all levels. If the processes of change have been both envisioned and managed effectively, the resulting transformation should, and often does, result in a positive outcome for the organization.

As noted, positive change requires effective leadership. It is imperative that effective leaders in any organization learn how to cultivate psotiverelstionships between themselves and those they lead, as well as among all of the staff members that are being led. Studies have shown that “congruent leadership” is most effective when applied to the field of nursing. This means that rather tha  force top-down change from the management level, leadership roles are to be filled from among the nursing staff; the nurses who fill these leadership roles must work collaboratively for effective change to occur.

Effective leadership among nursing ranks certainly seems like a laudable goal, but if there are not enough nurses of any kind to go around, then there bwill likely not be enough nurses to fill leadership positions. Nursing shortages are at crisis levels in countries like Australia and the United States.  In order for leadership roles to be properly filled, it is imperative that the profession find ways to recruit and retain nurses, and to nurture the cultures and environments of these organizations to ensure that nurses reach their full potential, and that pateints receive the best of care. Time after time it is seen that adeaquately-staffed health care organizations have better patient outcomes; therefore maintaining an effective nursing staff is of primary importance.

Recent indications show that as nurses are retiring early or leaving thje profession for other work, younger nurses are not staying in the field as long as they used to. The ways in which older and more experienced  nurses are often driving younger and less experienced nurses out of the profession is referred to as “eating their own young” (Bally, 2007). There is a virtual laundry list of problems younger nurses are faced with from their older counterparts, such as “gossiping, scapegoating, undermining, intimidation, passive aggression, withholding information, and verbal and physical aggression” (Bally, 2007). These sorts of problems between nurses (as differentiated by problems subordinates might have with managers or other leaders) is referred to as “horizontal violence” (Bally, 2007). This term does not refer to actual physical violence, but rather to the sort of “psychological violence” experienced in a hostile workplace.

Given the fact that nurses have been seen to lead and be led by other nurses, and with the need for more experienced nurses to typically be called upon to fill leadership roles, it is important to find a way to avoid the horizontal violence that plagues the profession. One way in which some problems can be avoided, and where natural leaders can flourish, is by cultivationg a culture that fosters mentoring relationships.

In a transformational organization, the relationships between and among nurses can be redefined, and where there were once problems among nurses, leadership from within the nursing ranks can help to solve those problems.

One of the main safety issues that patients face is not “faulty people,” but “faulty systems, processes, (or) conditions” (Vogelsmeier,A and Scott-Cawiezell, J, 2007). In far too many organizations, those staffers who are most likely to be aware of faulty processes are the “front line staff” of nurses. These are the staffers who deal both with patients and with processes most frequently, and yet it is this group of staffers who are least heard from where problems exist. The reason that those on the front line are often unheard is because far too many organizations breed a culture where silence is rewarded and speaking up is punished.

One common error in care settings is incorrect dosage of medication. One study showed that in many nursing homes, the adminsitartion of an incorrect does of medication would be cause for disciplinary action, including a write-up in a staffer’s personnel file. This is clearly counterintuitive of a faulty process is leading to the improper administration of medication.  This study noted that frontline staffers fear “repercussion from both managers and peers when an error occurs” (Vogelsmeier,A and Scott-Cawiezell, J, 2007). In such an environment, it is no wonder that staffers would be hesitant to speak. In any case where a faulty process might be leading to a negative patient outcome, frontline staffers must weigh the needs of patients against the possible fallout from speaking up.

It was further determined that in organizations where mistakes could be freely and openly discussed without fear of reprisal, nurses and other frontline staffers were willing to speak up. Not all faulty processes will be “blamed” on the person or persons who speak up, but in an environment where a nurse may not be entirely sure whether or not it is safe to do so, it is not surprising that many nurses would opt to keep quiet.

It is exactly these kinds of tensions that can lead to the sort of hostility described earlier: in a situation where nurses cannot feel comfortable, collaborative efforts will naturally fail in the face of a culture that punishes open and direct communication. This lack of open communication will, in turn, lead to an environment where each staffer is more concerned with protecting his or her self-interests; in such an environment, it is the patients who will ultimately suffer.

In looking at various reports and studies that examine the raletionship between nursing and patient outcomes, it is clear that effective nursing and nursing leadership are critical components of positive patient outcomes. What is also clear are the ways in which different aspects of nursing and organizational leadership must work in step to achieve positive outcomes. Any one piece of the puzzle that goes missing will affect the entire situation: beginning with recruitment of nurses, it is clear that greater efforts must be made to bring more nurses into the field. If those nurses are to remain in the field, the problems of “horizontal violence” must be addressed. Many of the problems related to this horizontal violence are born out of a culture that punishes collaboration and open dialog and rewards silence. In order to address situations where dialog and collaboration are punished, effective leadership must be established. With clear evidence available that nursing leadership can be fostered in an environment where mentoring is allowed to flourish, it becomes more important than ever to recruit and retain effective and skilled nurses.

As I consider what I will find when I enter the field, I will admit that it seems I will face a daunting situation. It is difficult for me to imagine myself in a leadership position, yet at the same time, it is imperative that all nurses take the lead where patient outcome is concerned. I simply hope that I will find myself welcomed into an organization that espouses the kind of change –or willingness to change- that will lead to the best possible patient outcomes. Those organizations that nurture positive relationships among nurses, that provide ongoing quality training, and that value clinical nursing leadership, will be the organizations that best serve their patients. In the end, there is nothing more important than providing the best possible care to each and every patient, and I look forward to making my contribution to an organization that lives up to, or even exceeds, my ideals.