Step 1 Read the scenario.
You are one year into your first nurse manager position, and you have noticed that your staffing is way below average. Your turnover rate is 13%, and you have noticed that new RNs stay only about six to nine months after orientation. You are hearing complaints from staff about constantly orienting new RNs. You also hear patient complaints that staff members are not anticipating their needs. This is affecting your budget, staff morale, and patient outcomes. Additionally, a number of documentation and medication errors have occurred over the last three months, and these mistakes are contributing to poor patient outcomes.
Step 2 Post your response to the discussion board.
Discuss short- and long-term decisions to help alleviate problems on your unit. Respond to the following questions and, if it’s relevant, include your own personal experience:
- Discuss the concerns of this unit and any priorities that will need to be analyzed immediately.
- Explain your short-term (zero- to six-month) decisions and plan.
- Describe your long-term decisions and your rationale for making these decisions.
Step 3 Read other students’ posts and respond to at least two of them and cite your reference(s) using APA 7th edition.
Use your personal experience, if it’s relevant, to support or debate other students’ posts. If differences of opinion occur, debate the issues professionally and provide examples to support opinions.
NUR435 Student Posts:
Student #1:The concerns on the unit are the staffing, the turnover rate of 13%, and the documentation and med errors. There is also a major problem that needs to be addressed with the med errors and documentation. The med errors in my opinion are the worst because making med errors can kill people. Understaffing can definitely play a part in that too because if the staff that are passing the pills are tired all the time, it is easy for them to make errors. “Unintentional medical error will likely always be a part of the medical system. However, by focusing on provider as well as patient health, we may be able to foster resilience in providers and improve care for patients in healthy, safe, and constructive environments.” (Muzafarovich, 2021)
Short term decisions may include working on why medication errors are being made or if a particular person is making them. The safety of the patient is first and foremost. In-services could be done on proper documentation or have an open door policy for anyone needing help with documentation. Perhaps a floor survey could be done to see why they think the nurses are not staying very long after orientation. Put incentive programs in place to help out with morale on the floor. Let the staff know that they are appreciated.
“Healthcare leaders are pushed to think outside the box and must consider innovative nurse retention strategies to retain nurses. New graduate nurse retention statistics suggest that as many as 30% of new graduate nurses will leave during their first year of practice, increasing to as many as 57% within the second year. With the average cost of turnover per nurse between $37,700-$58,400, healthcare organizations can’t afford to continue to lose the nurses they have. Organizations can quickly focus their retention efforts, starting with these five nurse retention strategies: (1)Be Strategic During Recruitment, (2)Establish a Nurse Residency Program, (3)Make Career Development a Top Priority, (4)Promote a Culture of Learning, and (5)Offer a Flexible Work Schedule. Also, it may be helpful to offer bonus incentives to help keep the current staff and, perhaps, attract new employees. (Colwell, 2019)
I think that if you give the staff a reason to stay and make things better for them that word of mouth travels fast and it will help encourage new employees to want to work on your floor as part of your nursing team.
Student #2: There are several issues to be addressed with immediate effect. For instance, there is the issue of under-staffing, which is very key to service delivery. Under-staffing leads to problems such as overworking and loss of morale which lowers production through poor records and medication errors. The decision by RNs to quit after a short while shows the existence of an internal problem in the facility. Patient satisfaction also needs to be prioritized and well analyzed. There are several complaints from patients that they are receiving poor services.
I would make several short-term plans and decisions to improve the conditions in the facility. The very first short-term plan would be to introduce effective communication. Timely and accurate information from all parties makes work easier through promoting accountability and creating a good rapport (Schiavo, 2016). I would then call for teamwork from all involved stakeholders to identify the problems and their key solutions. For instance, I would request more staff from the board as understaffing is among the caregivers’ problems. This will improve patient service delivery.
The long-term decision and plans will be based on employee motivation and fixing the facility’s image in the eye of the patient. I will organize career development plans for staff to improve their service delivery skills and as a motivational factor to give their all. I will also request the board to consider giving rewards to employees such as gift hampers and promotions for their work well done. I will also organize community-based services such as free blood pressure checkups for societal members to rebuild the lost reputation. This will significantly work on the mentioned problems.
Discussion Post:
Step 1 In your initial post of approximately 150 words, identify an ethical or legal issues or dilemmas that you have encountered in your practice. Use defining ethical terms in your post (for example, fidelity, beneficence, nonmaleficence, and so on).How was the situation resolved? Did the resolution follow ethical principles? Cite your reference(s) using APA 7th edition.
Step 2 Read other students’ posts and respond to at least two of them and cite your reference(s) using APA 7th edition.
Use one creditable source to support each response post.
Student Posts:
Student#1:
One of the most common ethical issues I see arise on my unit is informed consent. Working on a critical care unit majority of our patients are “rushed” to surgery upon arrival or immediately after a CT is done. To expedite optimal care, our team of surgeons have to obtain patient consent. For the patients who are not fully intact with a GCS of 7 and lower, we’re retrieving consent over the phone from a health care proxy and or next of kin. Mind you, it’s not just one consent, its consent for procedures, anesthesia, blood administration etc. As a nurse I am a witness to these consents. Which can lead to concerned families who are not being fully informed about their clinical prognosis. This becomes an ethical issue about how much information nurses can convey. Although, informed consent process is the legal responsibility of the physician, my role as a nurse is to be a patient advocate as well as including health care surrogates in patient autonomy. Autonomy and patient self-determination are upheld when the nurse accepts the client as a unique person who has the innate right to have their own opinions, perspectives, values and beliefs. Nurses encourage patients to make their own decision without any judgments or coercion from the nurse and physicians (“Ethical”, 2021). I do this by making sure the consent is valid, families or patients understand their right to refuse and the information provided to them is accurate.
Student #2: Despite being a fast-paced occupation with numerous challenges, nurse managers report different dilemmas in their jobs. A common ethical dilemma in nursing involves honesty and withholding a patient’s information. Family members often want to withhold medical information to protect sick patient’s emotions. However, patients have the right to know their medical conditions. Decision-making on how to handle the situation and whether to share the information raises an ethical issue, especially when it goes against a family’s cultural beliefs. I once encountered the ethical dilemma whereby patient’s relatives urged me not to inform the patient about their condition. However, the situation was easily resolved because, based on the American Nursing Association, a nurse is required to advocate for the truth or veracity, which is a significant and crucial factor in nurse-to-patient relationships (Rainer, Schneider & Lorenz, 2018). Nondisclosure results from embarrassment, not wanting to feel judged, or not wanting to hurt the patient’s feelings or make their condition worse. Therefore, creating ambiguity and offering selective information in nursing is considered unethical.
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