Discussion: Organizational Policies and Practices to Support Healthcare Issues

Discussion: Organizational Policies and Practices to Support Healthcare Issues
Discussion: Organizational Policies and Practices to Support Healthcare Issues
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Discussion: Organizational Policies and
Practices to Support Healthcare Issues
Quite often, nurse leaders are faced with ethical dilemmas, such as those associated with choices
between competing needs and limited resources. Resources are finite, and competition for those
resources occurs daily in all organizations.
For example, the use of 12-hour shifts has been a strategy to retain nurses. However, evidence
suggests that as nurses work more hours in a shift, they commit more errors. How do effective
leaders find a balance between the needs of the organization and the needs of ensuring quality,
effective, and safe patient care?
In this Discussion, you will reflect on a national healthcare issue and examine how competing
needs may impact the development of polices to address that issue.
To Prepare:
 Review the Resources and think about the national healthcare issue/stressor you
previously selected for study in Module 1.
 Reflect on the competing needs in healthcare delivery as they pertain to the national
healthcare issue/stressor you previously examined.
By Day 3 of Week 3
Post an explanation of how competing needs, such as the needs of the workforce, resources, and
patients, may impact the development of policy. Then, describe any specific competing needs
that may impact the national healthcare issue/stressor you selected. What are the impacts, and
how might policy address these competing needs? Be specific and provide examples.
By Day 6 of Week 3
Respond to at least two of your colleagues on two different days by providing additional
thoughts about competing needs that may impact your colleagues’ selected issues, or additional
ideas for applying policy to address the impacts described.
Submission and Grading Information
Grading Criteria
To access your rubric:
Week 3 Discussion Rubric
Post by Day 3 and Respond by Day 6 of Week 3
To participate in this Discussion:
Week 3
Learning Resources
Required Readings
American Nurses Association. (2015). Code of ethics for nurses with interpretive statements.
Silver Spring, MD: Author. Retrieved from https://www.nursingworld.org/coe-view-only
Note: Review all, with special attention to “Provision 6” (pp. 23–26).
Kelly, P., & Porr, C. (2018). Ethical nursing care versus cost containment: Considerations to
enhance RN practice. OJIN: Online Journal of Issues in Nursing, 23(1), Manuscript 6.
doi:10.3912/OJIN.Vol23No01Man06. Retrieved from
http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/Tabl
eofContents/Vol-23-2018/No1-Jan-2018/Ethical-Nursing-Cost-Containment.html
Milliken, A. (2018). Ethical awareness: What it is and why it matters. OJIN: Online Journal of
Issues in Nursing, 23(1), Manuscript 1. doi:10.3912/OJIN.Vol23No01Man01. Retrieved from
http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/Tabl
eofContents/Vol-23-2018/No1-Jan-2018/Ethical-Awareness.html
Required Media
Laureate Education (Producer). (2012). Ethical, Moral, and Legal Leadership [Video file].
Baltimore, MD: Author.
Laureate Education (Producer). (2009b). Working with Individuals [Video file]. Baltimore, MD:
Author.

RE: Discussion – Week 3

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In my memories, when I go back to the years of nursing school, I recall teachers continuously telling us how ethics, morals, values, and respect pay an integral role in the nursing profession. I used to share a vision that nursing is one of the most heroic jobs, and with a strong foundation of leaders, it will be more like a part of my life, my passion, not just a job that guarantees to pay my bills. However, over the years, my experience has become weary. I met nurses who just wanted to get through their day, managers who did not respond to their staff needs, CNOs who cared more about their budgets than their employees. Nurses have become undermined and overloaded with tasks that have caused burnout, anger, tears, fear, and tension (Kelly & Porr, 2018). Poor leadership and increasing demands have caused many nurses to look for new jobs or consider quitting the nursing profession for good. Competing needs of the workforce, patients, and resources impact the development of every healthcare policy, but most of all, it affects its employees.
Competing Needs of the Workforce, Resources and Patients and Their Impact on Development of Policy
Over the last couple of decades, we all have experienced healthcare professionals’ shortage. The units are understaffed, sometimes charge and break nurses are requested to take patients. Outdated electronic resources cause more headaches than help, and lack of authentic leadership leaves us alone helpless. Since hospitals are being paid based on a value-based system, clients and their families have become more demanding and aggressive. Nurses are not protected by law, and there are many cases nationwide of healthcare professionals being attacked, hurt, or even murdered.  Some employers say their hands are tied and such situations are “a part of a job”. It almost appears that something tragic must arise to shake our leaders’ heads and prevent it from happening again. Although OSHA does not require employers to establish violence prevention programs, it does fine those who do not provide a workplace free from serious hazards (ANA, n.d.).
Competing Needs and Poor Leadership
The strength of any business lies in the hands of a strong leader. Effective communication, integrity, sharing the same values, professional and personal ethics, always build loyalty supported by honesty and sacrifice (AACRAO, n.d.). Our healthcare nation needs leaders who do not only promise a safe working environment but also deliver resources that make this promise realistic (Kelly & Porr, 2018).
In my organization, during the COVID-19 pandemic, the administration offered a $5.00 per hour increase to attract nurses to take extra shifts during a shortage. However, when it came to the payout day, each nurse’s paycheck showed variation between $0.75-2.50 based on which unit they worked. When the administration was contacted for an explanation, they said that although they offered this, it was never approved by the higher management. However, knowing that nurses would expect the $5.00 increase, they decided to pay “something” to let them know they had the best intentions.
Such a maneuver cost the organization a high turnover of nurses who either already quit or are desperately looking for new positions.
Policy Needs and Impact of Competing Needs
Working for an institution that keeps bending rules and adhering to policies when it is convenient is like being a Sunday churchgoer and abusing their family daily. I understand that my comparison may seem keen to some. Still, I feel that many healthcare organizations write policies to meet institutional and legal needs, but are nearly impossible to meet by their employees. Hence, burnout has emerged as a significant problem of the 21st century in the healthcare industry (Reith, 2018).
I remember when I was a new nurse, I received six months’ orientation to precept me into the ICU floor. Over the years, the high nurses’ turnover added to a personnel shortage, so the management cut the orientation days to 12 weeks. Last year I precepted a few new nurses who were given four to six weeks. Needless to say, the covering material has not changed in years. Recently, during the COVID-19 pandemic, due to severe staff shortage, and lack of travelers and registry nurses, the administration started bringing M/S and Telemetry nurses to the ICU, giving them only two days of orientation. Most people are lost, and charge nurses are overwhelmed. The safety of the patients is hanging on a thread. More nurses are looking for new positions while taking stress leave from the current organization. Leadership is pretty much nonexistent.
 Conclusion
Many of us decided to be nurses because of the great desire to help others. We believed that the healthcare industry has our backs and will provide us resources and policies needed to keep us safe while practicing holistic care. Yet over the years, it seems that there is an incredible number of increasing tasks, while resources are diminishing. Our leaders are failing us. It is time they step up and show us their loyalty, support, and integrity, otherwise, the burnout and high turnover will progress, and our healthcare industry will crumble.
Reference:
AACRAO (n.d.). Core competencies: leadership and management. American Association of Collegiate Registrars and Admission Officers.
 https://www.aacrao.org/resources/core-competencies/leadership-and-management
ANA (n.d.). Workplace violence. American Nurses Association. https://www.nursingworld.org/practice-policy/advocacy/state/workplace-violence2/
Kelly, P., & Porr, C. (2018). Ethical nursing care versus cost containment: Considerations to
enhance RN practice. OJIN: Online Journal of Issues in Nursing, 23(1), Manuscript 6. https://doi.org/10.3912/OJIN.Vol23No01Man06. http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Nursing-Cost-Containment.html
Reith T. P. (2018). Burnout in United States Healthcare Professionals: A Narrative Review.
Cureus, 10(12), e3681. https://doi.org/10.7759/cureus.3681

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Thanks for sharing Annette.
You are entirely right with all you shared in your post. Much more is expected from nurses, but with limited resources. It does seem policies are made to protect organizations, and when it comes down to practicing what they have preached, they always fall short.
Training a new nurse into the ICU setting should be more than 12 weeks. A minimum of six months’ preceptorship should be adopted “to manage the intellectual, physical, psychosocial, cultural, and ethical challenges inherent in the provision of critical care. The rule of an appropriate critical care nursing workforce requires careful planning and execution to ensure a balance of skills and expertise to ensure safe and high-quality patient care (Bloomer et al., 2019, p. 2).
Burnout is also a big issue amongst nurses, and little compensation could motivate and re-energize a nurse. The promised $5.00 pay increase would have motivated staff. This promise was never honored, and none of the management team communicated this until nurses woke up and found the pay raise was between $0.75-$2.50. This is a precursor to burnout in such a critical time.
Burnout is associated with feelings of work overload, a non-supportive, and low resource working environment (da Silva Batalha., Melleiro, & das Neves Borges, 2019).
In conclusion, a day of reckoning is at hand when nurses rise and stand up and say enough. Nurses have been silenced for far too long, with policies and politics.
 
Reference
Bloomer, M. J., Fulbrook, P., Goldsworthy, S., Livesay, S. L., Mitchell, M. L., Williams, G., & Friganovic, A. (2019). World Federation of critical care nurses 2019 position statement: Provision of a critical care nursing workforce. Connect: The World of Critical Care Nursing, 13(1), 3-7. https://doi.org/10.1891/1748-6254.13.1.3
da Silva Batalha, E. M. S., Melleiro, M. M., & das Neves Borges, E. M. (2019). Burnout and Its Interface with Patient Safety. Journal of Nursing UFPE / Revista de Enfermagem UFPE, 13, 349–358. https://doi-org.ezp.waldenulibrary.org/10.5205/1981-8963.2019.239641

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Hello Osaze,
Thank you for a great post. I think that the nationwide competing needs in regards to nursing staff unemployment of other than ICU units as well as lack of proper PPE are essential. When it comes to elective procedures and adequate functioning of other departments, such as cath-labs or transplant units, they have already returned to normal in most organizations. However, the PPE problem still exists in many acute and non-acute facilities. What it comes down to is a lack of effective leadership.
Let us look closer to other pandemics or epidemics that were recognized nationally or globally, such as the flu pandemic in 1918 or 1957, or 1967 and 2009. Based on historical events, our health organizations should have planned better. It was predictable that in the future we can face another pandemic which could be even worse than the previous ones. Yet, instead of foreseeing and anticipating problems, our leaders’ attention went elsewhere. So, when the COVID-19 pandemic happened, thousands of hundreds of people died globally. Based on recent CDC reports, over 80,249 healthcare personnel were infected with Coronavirus in the United States only, and 446 of them died (CDC, 2020).
Considering 80% of healthcare workers are not being tested, I presume the actual numbers of infected HWs are much higher, but not being reported. Some nurses and other healthcare providers contract the virus at work, and their leaders try to sweep it under the carpet, suggesting it cannot be proven. Perhaps they contracted the illness somewhere else. Instead of helping their staff and supporting them with every ounce of their loyalty, they turn their backs and blame someone else. Is a lack of integrity and loyalty traits of a good leader? Absolutely not.
Based on research, the most effective leaders are those who pursue excellence through core competencies such as emotional intelligence, selfless service, critical thinking, integrity, and teamwork (Hargett et al., 2017). I find all these qualities essential, but the most important is integrity. It sums up everything else. Without moral principles, a person cannot be a whole and undivided.
Reference:
CDC (2020). Coronavirus disease 2020: Cases in the US. Centers for Disease Control and Prevention.
https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html
Hargett, C. W., Doty, J. P., Hauck, J. N., Webb, A. M., Cook, S. H., Tsipis, N. E., Neumann, J. A., Andolsek, K. M., & Taylor, D. C. (2017). Developing a model for
effective leadership in healthcare: a concept mapping approach. Journal of Healthcare Leadership, 9, 69–78. https://doi.org/10.2147/JHL.S141664

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