WEEK 1 : Registered Nurse
Nursing is a career that will never stop growing. When I graduate I plan on going to college and becoming a Registered Nurse specializing in Pediatrics. I have a heart for helping people and I absolutely love kids. That’s why I think this will be a great job for me. In order to fully understand the job of a registered nurse you need to know the type of work done, educational requirements, working conditions, and the job outlook.
Nurses have many different duties. They work to promote health, prevent disease, and help ill people. When assessing a patient they check vital signs, symptoms, and progress in patients. There are many different types of nurses, from surgical nurses to office nurses. They all have different duties. The largest group of nurses is hospital nurses. They are assigned to one department and work there, for example, maternity, surgery, and pediatrics.
To be a successful Nurse, they need to be compassionate, kind, gentle, and caring. Who wants a nurse who has no compassion? I know I sure don’t. Most nurses have a heart to help people and make them better. They need to be emotionally stable to be a nurse. Things aren’t always going to be happy and they need to be prepared for that. NURS 6053 Essay Discussions
Students must graduate from an approved nursing program and pass a national licensing exam in order to obtain a nursing license. There are 3 paths students can take to become a nurse they are, a bachelor’s of science degree in nursing, associate degree in nursing, and a diploma. The BSN program is offered by colleges and universities. It takes about 4 years to complete, sometimes 5.
The working conditions are normally comfortable and in a good environment. Nurses may spend a lot of time walking and standing. Many nurses in hospitals are on call a lot. Nursing also has its hazards; you may care for patients with infectious disease.
WEEK 2 : Nursing Informatics
Nursing Informatics is a specialized area of nursing and branch of the profession that is seeing much growth. This blog post’s purpose is to be an elementary introduction to this burgeoning specialty.
What is the Nursing Informatics Specialty?
According to the American Nursing Association, “Nursing informatics (NI) is the specialty that integrates nursing science with multiple information management and analytical sciences to identify, define, manage, and communicate data, information, knowledge, and wisdom in nursing practice. NI supports nurses, consumers, patients, the inter professional healthcare team, and other stakeholders in their decision-making in all roles and settings to achieve desired outcomes. This support is accomplished through the use of information structures, information processes, and information technology” (ANA, 2015)
What a Nursing Informatics Professional Does
Squarely focused on information, data, and communication, a nurse informatics career looks closely at how to use numbers to boost performance, both for patients and for an organization as a whole. This role’s goals are to “boost efficiency, cut costs, and boost patient care quality” (Nurse Journal, 2019). Nursing professionals within this specialty are positioned at the intersection of nursing science, computer science, and information science, where they are able to “better manage and communicate information, data and knowledge in the practice of nursing. Nursing informatics specialists facilitate data integration, information and knowledge so that they provide better support to patients, nurses and other health care providers” (Nurse Journal, 2019). One thing on which they spend a lot of their energy is documentation, because “high quality care is fully dependent upon strong communication among the wide variety of health care providers. As health care providers communicate via notes on a chart, a nurse informatics analyst wants to increase the speed and accuracy of the charting process. This means that health care workers have better access to patient notes, and can mean better decisions about care” (Nurse Journal, 2019).
Where Nurse Informatics Professionals Work
Typical employers for nursing informatics employees include facilities across the care continuum, from hospitals to medical practices, as well as a wide range of consulting firms, universities, and corporations. Job titles that match this professional competency include:
- Clinical analyst
- Informatics nurse specialist
- Director – clinical informatics
- Clinical informatics coordinator (Nurse Journal, 2019).
Nurse Informatics Job Opportunities & Salary Outlook
The demand for nursing informatics isn’t going to abate any time soon. Not only will the aging U.S. population require more caregivers, but we’ll need all the help we can get to control healthcare costs. That’ll require a growing number of nursing informatics analysts. Nurse Journal cites an American Medical Informatics Association finding that as many as 70,000 nursing informatics specialists or analysts may be needed in the next five years, with the surge in related to data gathering and analysis required by the Health Information Technology for Economic and Clinical Health Act (HITECH) of 2009 and the Patient Protection and Accountable Care Act (PPACA) of 2008.
The Career Path for Nursing Informatics Professionals
A typical route to becoming a nursing informatics expert starts with being a registered nurse. After a BSN, many get a master’s degree, either as a master of science in nursing (MSN) or a master’s in information or computer science. Nurse Journal advises those considering this direction that the “career is demanding in terms of project management, critical thinking and creativity. It is important to be able to work with a vast variety of people. You also must have skills to resolve demands that conflict, which can happen as you develop information systems to meet everyone’s needs” (Nurse Journal, 2019).
WEEK 3 : Hierarchy of Leadership in Nursing
Whenever we visit hospitals we see a lot of nurses who are working with different doctors and departments. Though all the nurses are important but there is a certain order and organizational structure that is followed to place nurses and to designate them with titles.
According to this structure, those with the maximum experience and the best qualifications are placed at the top followed by those with lesser experience and qualifications. If you wish to understand the hierarchical structure of nurses in hospitals, you can read the following given information. NURS 6053 Essay Discussions
Chief Nursing Officer
The chief nursing officer is placed at the top position of the pyramid and has mainly an administrative and supervisory role to play in a hospital. This is a position of decision making where the individual has to make major decisions regarding welfare of nursing staff career.
Director of Nursing
The position of director of nursing comes after the CNO and the person working at this position is mainly responsible for recruiting and placing nurses at various positions. This position is also of paramount importance.
Nurse Manager or Nurse Supervisor
Nurse Managers and nurse supervisors come at the next position and form a part of the leadership team. They are also referred to as nursing executives and are available 24 hours a day to direct and supervise the other nursing staff. They are not only responsible for Hospital management but also tending to the needs of patients and their family members
Advanced Practice Nurse or Clinical Nurse Specialist
Advanced practice nurses who are sometimes also referred to as clinical nurse specialists are those nurses who have already completed their advanced training beyond the basic Nursing education or criteria which all the registered nurses must fulfill. They are the ones who meet higher clinical and educational requirements than other nurses. Within this category, there are two subcategories which are given as follows:
- Nurse practitioners-these are those nurses who work closely with physicians and are qualified to diagnose and treat common illnesses. They can also work as the patient’s main healthcare provider.
- Clinical nurse specialist-they are experts of a specific area of nursing practice for example, they may specialize in surgery, pediatric, diabetic, geriatric, cardiovascular or psychiatric patients.
During each assigned shift, charge nurses are mainly responsible for directing and scheduling nursing care in a specific unit or ward. They are the first people in contact if there is any kind of a problem with the bedside nurse.
Staff Nurses or Bedside Nurses
These are registered nurses or RNs who make for the largest segment of healthcare workers. They have a bachelor’s degree, an associate degree or a diploma and are the ones who are in direct contact of the patients. They continuously monitor, observe and assess the patient’s progress and note down recordings.
Licensed Vocational Nurses or Licensed Practical Nurses
These are those nurses who perform basic patient duties like taking vital signs, monitoring medications and injections etc. They do not take patient related decisions.
WEEK 4 : Change in Medication
For many of us who have had bipolar disorder for several years, we may need to undergo a medication change for various reasons. When you are taking medications over the long term, they may stop working as well as they did initially. Or a new drug might come out with less side effects and a promise of higher quality of life.
I am currently undergoing the last steps of a major medication change. This scared me at first because a previous med change years ago triggered mania followed by depression to such a degree that I had to take 6 months off work. So when my psychiatrist suggested we switch meds again, I was very unsure of how this would affect me. But the promise of better control of my anxiety (which had not been controlled at all on the previous medication) seemed to be worth the risk of the disturbance in my mood that could happen with changing meds again. The new medication also has better control of insulin resistance, which had been exacerbating my other medical problems. I have Poly cystic Ovarian Syndrome which can cause infertility, all related to insulin levels. Getting pregnant for my daughter took 6 years of trying various fertility treatments and my husband and I wanted another child. I discussed the medication changes with my husband, who has been my best friend and partner in fighting my illness which kicked in right after we married. We decided that changing meds was best for my health and our family as a whole.
Like with any big change in the life of a person with bipolar disorder, planning in advance can really make a difference. For myself, with every big life change I have experienced, such as having my first child, planning ahead and making a commitment to stick to my plan got me through the change without a major relapse of my bipolar symptoms. So I knew that if I planned ahead and committed to doing what I have learned works for me in times of stress and change, that I could handle what was coming. NURS 6053 Essay Discussions
My psychiatrist knew that previously when changing meds, doing it quickly did not work for me. So we set out a plan to adjust the medication over the course of 4 months by changing from the old one to the new one in small increments. In fact, I am still going through the last few changes and hope to soon be on only the new medication. I would suggest taking this approach if you and your doctor are considering a medication change. Slow and steady seems to be the best way for myself to manage these changes. Although we are all different, I feel that major changes in our lives that happen quickly can trigger relapse for many of us.
The biggest problem I encountered is that this new medication does not have the same sedative effects as the old medication. So I have had to work hard to maintain my sleep schedule. Going to bed at roughly the same time every night has helped, although life gets in the way and sometimes you stay up later than you know you should. Keeping a consistent routine at bedtime can help. Doing the same bedtime ritual each night helps your body and brain shut down for the night. I try to do my best to stick to my tried and tested routine.
Almost four months later, I have already seen major results in making this change. The change came at a risk, to be sure, but in the long term I have seen that this was the right choice. I went from having severe social anxiety to almost none, and I have already noticed better control of my insulin levels. I lost weight, and recently became pregnant with our second baby. I am still working out what to do about losing the sedative effects of the previous medication, but overall this change impacted me in such a positive way that I know it was worth it.
If you are considering making a major medication change, make sure that you plan it out thoroughly with your doctor, and involve that person in your life that you rely on. Take it slow and remember that if you start to relapse, your doctor can help but only if you are honest with your doctor about your symptoms and how you really feel. Remember that what has worked for you in the past to control your symptoms such as a good sleep routine, proper nutrition, and using the supports you have in your community will help you get through this change. Sometimes we cannot control major changes in our lives but this kind of change, if well thought out and taken on slowly, can be a positive one.
WEEK 5 : Working With Groups
Since the early 20th century social workers have played an important role in the coordination and provision of services in various health care settings, including primary care facilities, hospitals, specialty clinics, schools, home health care settings, hospice care settings, continuing care settings, private physician groups, and research settings. While historically social casework and social diagnosis have been the predominant model of social work practice in health care coordination and provision, group work has played an important role in health promotion and the assessment and treatment of diseases and disorders within health care settings. Today, several types of groups are used in health care settings to address many different issues, including but not limited to treating cancer and its related effects for patients and their families, addressing chronic illnesses and their related effects, substance use treatment and recovery, and parenting. Group workers in health care settings incorporate a bio-psycho-social perspective in their practice, which seeks to recognize the whole person, as she or he exists within her or his environment.
What theory supports this topic in group work?
Mutual aid groups are described as “an alliance of individuals who need each other, in varying degrees, to work on certain common problems” (Schwartz, 1994, p.18). Mutual aid is also seen as a process whereby group members help themselves through helping one another and derive empowerment through the process (Gitterman & Shulman, 2005; Steinberg, 2014). The processes of mutual aid help group members experience the universal nature of their problems, reduce isolation and stigma associated with these struggles, and hear perspectives, challenges, and solutions from other members (Gitterman & Shulman, 2005). NURS 6053 Essay Discussions
The biopsychosocial model of health recognizes that an individual’s health and well-being are impacted by the interaction among a number of factors. These include biological factors, psychological factors (i.e. emotions, mental health status), social factors (i.e. support from family/ friends) and environmental factors (i.e. the social determinants of health–i.e. finances/housing,). Group work hospital care settings is an ideal approach to incorporate these factors into a program of support.
What are a few examples of how to implement this topic in group work practice?
Psycho educational groups
In health-care settings, which operate under a medical model of care, patients may struggle with the sequel of their medical conditions, such as anxiety, depression and difficulties adhering to treatment. As well, patients also may need support understanding their medical conditions and the lifestyle changes needed to manage them. Psycho educational groups are often delivered to individuals with medical needs, to educate patients and/or their families about medical conditions and to teach skills required to help manage the conditions and the stress that often accompanies them. The psycho educational offered in the groups may be informed by already developed treatment manuals or by materials developed by facilitators specifically for the group.
Groups are generally facilitated in a structured manner, such that material is presented by the leaders, skills are taught and practiced and members are encouraged to talk about what they have learned and how they will apply it outside the group. Leaders must be well-prepared ahead of time with content developed in advance, and also be skilled in facilitating group processes. Typically skill building groups have 10-12 sessions and educational groups tend to be shorter-from 3-5 sessions. Evaluation in these groups tends to examine acquisition of knowledge and/or skills.
Therapy and support groups
Therapy and support groups provide members with opportunities to address behavior change through cognitive behavioral techniques. For example, a facilitator might work with a group in early recovery from heroin on challenging negative and faulty thinking around methadone maintenance treatment. Therapy groups also provide members with opportunities to explore personal issues through process-oriented techniques, such as working with trans youth as they navigate negative family reactions to their decision to begin hormone treatment. Support groups help members identify coping strategies for dealing with stressful life events, often in a caring and empathetic environment, such as a support group for people living with a chronic illness.
Self-help groups offer a similarly supportive environment without formally trained facilitators. Examples of this include Alcoholics Anonymous, Narcotics Anonymous, and several other 12-step fellowships. These various types of treatment groups offer members important opportunities to experience all the benefits groups have to offer, including empathy, feedback, mutual aid, and support.
Single session groups
Single-session group practice has been seen as a source of significant benefits, both for participants and for the delivery of social work services (Ebenstein, 1999; Holmes-Garrett, 1990; Kosoff, 2003; Rotholz, 1985). These groups are a venue for the provision of information, connection, social support and the sharing of experience. They create a feeling of inclusion in a community of people who are “in the same boat” (Steinberg, 2004). Single-session groups can also be models of anti-oppressive practice based on social justice, social action, advocacy, community and diversity. As a strengths-based practice that utilizes purposeful activity and mutual aid, single-session groups are particularly useful in healthcare and can fulfill important needs for patients, families, staff and the organization. Single-session groups are suited to today’s fast-paced hospital environments and are commonly delivered in hospital settings. They include groups operated in clinics, in hospital units and in weekend family days. These groups are either newly formed each session or have an open format, with new members joining and/or attending each session. They tend to maintain an agenda and include all stages of groups within a single session, with the exception of the conflict stage. They are often used to impart information related to the health issue, or to bring people together who share a health issue to offer one another support, insights into coping strategies, and resources available outside the hospital. They require organized facilitators who must engage with members quickly, allow for maximal participation, keep the agenda moving, and terminate the group with the minimal unresolved matters. Evaluation of these groups is rare, but quick feedback surveys after each session are recommended. NURS 6053 Essay Discussions
WEEK 7 : Communication in Nursing
Having good communication with patients/clients helps them in three main ways.
Good communication helps patients/clients feel at ease
It’s common for people who need health care services to feel anxious about their health, about what tests and treatment they might have to undergo and about what the future holds for them. This can sometimes lead them to speak out of character, perhaps being a bit rude or aggressive. Having good communication with health care workers will reduce their anxiety and build their confidence.
Good communication helps patients/clients to feel in control
It’s easy for people to feel that they give up all control of their lives once they enter the health system. If they’re in hospital, for instance, even simple everyday things they normally control, like when they get out of bed, when they wash and when they eat, might be dictated by someone else. Losing control can make people feel helpless and hopeless, which isn’t good for boosting their chances of recovery from illness. But good communication can avoid these feelings – it can help people to see that they still have a say and are still in charge of their own lives.
Good communication makes patients/clients feel valued
The most precious thing we can give to another person is our time. When we show we’re prepared to lay aside all the other things we need to do to spend time with someone, to listen to them, get to know them and understand how they are feeling, we’re showing that we really value that person. Being able to communicate well helps us achieve this with patients/clients.
So let’s look at some of the methods of communication we can use to help patients/clients in these important ways. We’ll look at communication issues with colleagues later in the program me, in teamwork.
WEEK 8 : Qualities of A Leader
A leader has got multidimensional traits in him which makes him appealing and effective in behavior. The following are the requisites to be present in a good leader:
- Physical appearance- A leader must have a pleasing appearance. Physique and health are very important for a good leader.
- Vision and foresight- A leader cannot maintain influence unless he exhibits that he is forward looking. He has to visualize situations and thereby has to frame logical program mes.
- Intelligence- A leader should be intelligent enough to examine problems and difficult situations. He should be analytical who weighs pros and cons and then summarizes the situation. Therefore, a positive bent of mind and mature outlook is very important.
- Communicative skills- A leader must be able to communicate the policies and procedures clearly, precisely and effectively. This can be helpful in persuasion and stimulation.
- Objective- A leader has to be having a fair outlook which is free from bias and which does not reflects his willingness towards a particular individual. He should develop his own opinion and should base his judgement on facts and logic.
- Knowledge of work- A leader should be very precisely knowing the nature of work of his subordinates because it is then he can win the trust and confidence of his subordinates.
- Sense of responsibility- Responsibility and accountability towards an individual’s work is very important to bring a sense of influence. A leader must have a sense of responsibility towards organizational goals because only then he can get maximum of capabilities exploited in a real sense. For this, he has to motivate himself and arouse and urge to give best of his abilities. Only then he can motivate the subordinates to the best.
- Self-confidence and will-power- Confidence in himself is important to earn the confidence of the subordinates. He should be trustworthy and should handle the situations with full will power. (You can read more about Self-Confidence at : Self Confidence – Tips to be Confident and Eliminate Your Apprehensions).
- Humanist-This trait to be present in a leader is essential because he deals with human beings and is in personal contact with them. He has to handle the personal problems of his subordinates with great care and attention. Therefore, treating the human beings on humanitarian grounds is essential for building a congenial environment.
- Empathy- It is an old adage “Stepping into the shoes of others”. This is very important because fair judgement and objectivity comes only then. A leader should understand the problems and complaints of employees and should also have a complete view of the needs and aspirations of the employees. This helps in improving human relations and personal contacts with the employees.
From the above qualities present in a leader, one can understand the scope of leadership and it’s importance for scope of business. A leader cannot have all traits at one time. But a few of them helps in achieving effective results.
WEEK 9 : Nurse Leaders
Leadership is a process of social influence in which an individual enlist the aid and support of others towards accomplishment of a common goal (Lorber & Skela-Savič, 2011). However, achievement of such common goal is done by leaders using varied strategies that include cohesive behavior and teamwork. In healthcare setting, leadership plays a critical role in imparting a sense of positivity in delivery of healthcare services in order to attain specific health-related objectives (Casida & Parker, 2011). As a result, the leaders in healthcare settings normally embrace and integrate different leadership styles, approaches and models in order to ensure effective healthcare services delivery. In this paper, an interview with nurse leader in the med surg unit will be analyzed. The paper will describe in depth the leadership styles the practitioner has utilized to ensure proper delivery of healthcare services in the patient care unit. NURS 6053 Essay Discussions
Summary of the Nurse Leader Interview
As a nurse student, I was interviewing nursing leaders in order to find out their perspective in regard to leadership and management in the nursing context. As a young nurse student, understanding leadership perspective of professionals with well-rounded leadership experience is crucial towards my professional development. With this aim, an exhaustive interview was held with X, a professional nurse with 5 years’ experience as a medical surgery floor nurse in Miami. X has a triple master’s degree and is planning to finish her doctorate in strategic planning and development career path. X has been working as a nurse since 2009, when she started as a nurse aide.
The nurse manager acknowledged management as a formal leader. On the other hand, patients and her staff were recognized as informal leaders. Before becoming a director, the interviewee held an informal position as a nurse aide within the hospital. X worked as a nurse aide for two years before assuming the managerial role, which she had held for 4 years. Maintaining an open relationship with both informal and formal leaders is necessary toward achievement of the organization mission. Apparently, this has enabled her to gain great skills in leading a team within the nursing setting and in the hospital. However, before acquiring the current position, the organization offered her numerous training sessions that aimed to develop her leadership skills. With regard to a team in the hospital, X managed to affect organization changes within the hospital in order to enhance efficiency in the delivery of healthcare services.
WEEK 10 : Leadership Roles and Management Functions in Nursing
In every organization, leadership and management play a pivotal role in achieving the set goals and targets. Both the mangers and leaders in an organization strive to fulfill organization’s mission and vision. In this paper, we will critically compare and contrast two different leadership and management theories and their application with special reference to nursing.
Role of management and leadership
The basic function of management encompasses planning, staffing, organizing, directing and controlling.(Marquis & Huston, 2009) It is important to note that the role of management and leadership goes hand in hand and cannot be analyzed in isolation. For instance, scarcity of staffing in nursing will naturally lead to a dearth of leadership. With the absence of proper and effective management, new nurses find themselves directionless which subsequently creates a vacuum of leadership.
The decisions in this respect are made to ensure optimum level of care provided to patients. On the other hand, the role of leadership may be associated with those of mentors, coaches, advocates and role models.(Kerfoot, 2001) The amalgam of management and leadership can guarantee the growth and development of different professions in general and nursing in particular. A leader always lays emphasis on interpersonal relationships necessary to create an amicable, competitive and result-oriented environment in a workplace setting. NURS 6053 Essay Discussions
As a matter of fact, management theories focus mainly on the role of supervision, organization and group performance. Developed and proposed by Douglas McGregor in his book “The Side of Human Enterprise” both Theory X and Theory Y are contrasting management theories that aim to discuss human motivation at work place. As opposed to Theory X according to which human beings inherently shirk work and must be controlled by the management, Theory Y assumes that people treat their work as natural and play therefore management should focus on exploring the unrealized potential and creativity of the workers. The followers of Y Theory contend that if workers are provided with favorable environment, most of them will naturally seek to offer the best they have in them at workplace. In other words, Theory X stresses the need for control of human behavior while Theory Y places a lot of emphasis on the need of self-direction and responsibility on the part of workers. In my opinion, Theory Y coupled with strong leadership will prove more rewarding in terms of nursing. It must also be pointed out that nursing management and leadership was carved out on the principle that all nurses are leaders who use their acumen and decision-making skills to pave the way for a work environment dedicated to providing quality care to its patients. This style of management is more suitable to nurses.
Though there are many theories of nursing leadership but we will place our focus on only some of them. Transformational leadership is a leadership style that breeds positive changes in those who follow it. Such leaders are usually dynamic, vigorous, enthusiastic and robust. They not only full participate in the process but also lend a helping hand to every member involved in order to reap successful results.(Laurent, 2000)
Transformational leadership merges ideals of leaders and followers. Its focus is to unite both manager and employee to pursue a greater good and encourages others to exercise leadership (Sullivan & Decker, 2001). The chief characteristic of transformational leaders is that they defy the status quo infusing creativity among the follower. They allow for their followers to embrace new ways and learning opportunities.
In order to foster and maintain supportive and friendly relationships with others, transformational leaders never lose sight of rapport among followers and also allow them to exchange and communicate novel ideas. They also never have any qualms in recognizing the contribution of each follower. They have a clear vision and an ability to articulate it for their followers. All in all, they serve as role models for their followers. They inspire motivation on the part of followers and also the tendency to trust and respect the leader.(Perra, 2000)
Transactional leadership first defined by sociologist Max Weber assumes that people yield best results when the goal of a leader is clearly chalked out. Workers are motivated by rewards and punishment and they accept and obey the instructions of the leader. This theory suggests that followers should be monitored closely so that they meet the expectations of the leader. This leadership style can be effective in some situations but it is generally considered as a theory that can impede both leaders and followers from achieving their full potential.
The leadership and management style that a nurse chooses should be consistent with her ideals. She can adopt any style that fits her personality best. In my opinion, the Y management and transformational leadership style is most likely to reap greater results. Nurses, be she new or old, must be encourage to participate and interact in the decision-making of the hospital. The nurses must put in all their efforts to nurture abilities by internalizing this kind of management and leadership style. The dearth of leaders in the nursing profession will automatically become a redundant expression.
WEEK 11 : Conflict Management in Healthcare
The health care professional’s typical day involves a frenetic race to coordinate resources, provide care, perform procedures, gather data, integrate information, respond to emergencies, solve problems and interact with diverse groups of people. Regardless of the role of the professional; physician, nurse, administrator, manager, social worker or technician, as a group, health care professionals face more conflict and greater complexity than any other profession. Despite the challenges of balancing competing interests, philosophies, training backgrounds, the endless quest for adequate resources, and the emotional quality of the work that they do, very few health care professionals have had the opportunity to learn the skills and processes necessary for negotiating their environments. There is little formal training available to them in this area and role models for collaboration and good negotiation are far and few between. As a result, the clinical environment is one of competition, quick fixes, hot tempers, avoidance tactics and at times, hopelessness.
The field of dispute resolution has a unique opportunity to inject hope into our hospitals and clinics. By providing education, professional development, and strategies for conflict management and dispute resolution, the ADR field can create synergy by merging solid conflict resolution processes with an environment rife with complex problems and motivated problem solvers. By creating shared meaning between ADR and health care, clinicians can begin to integrate interest-based processes into their existing activities. Through development of conflict management skills of experienced clinicians and administrators, health care organizations can begin to raise the level of dialogue from that of survival-of -the-fittest to that of collaboration and synergy.
Where to Provide Training/ Professional Development
Providing training and education for health care professionals can take various forms. For licensed providers, creating continuing education courses can provide an educational forum that takes advantage of their licensure requirements and creates an opportunity for more intense learning outside of the clinical environment. Continuing education can take place at conferences and workshops, or through CE centers. Additionally, education can take place within the clinical setting through grand rounds, staff meetings, retreats, HR development programs, brown bag discussions, leadership development courses, and internal newsletters, websites and journals. From within the health care organization, education in conflict management can occur through integration of facilitation and mediation techniques into patient safety processes such as root cause analysis, process reviews, failure modes and effects analysis, disclosure conversations with patients, and team care conferences. Finding multiple ways to integrate skill development and process understanding into currently existing health care activities is essential to the successful development of the field of health care alternative dispute resolution. NURS 6053 Essay Discussions
Training Strategies That Work
To provide a framework for teaching conflict resolution to health care professionals, it helps to tie the principles of dispute resolution to their clinical experience. Simple analogies during a facilitated session can help them see how something they are doing to resolve the conflict is similar to something they do clinically. For example, a group of obstetrical physicians who are developing an important guidelines document and who are having difficulty understanding the importance of the process necessary for the creation of the document, by focusing on content alone, can be given insight with an analogy to the birth of a baby. As obstetricians, their focus for 42 weeks is on the process for development of a healthy baby. Analogizing how lack of attention to the process can affect the health of the “baby” (the document) helps them understand the collaboration and process issues and recognize the need to work together at a different level.
Health care professionals are excellent problem solvers. They are expert at analyzing a problem, developing a strategy, locating resources and implementing the plan. This is how they are trained to care for patients. Using the analogy to patient care enables clinicians to grasp quickly the concepts associated with conflict management. The skills used to take care of patients can be honed to resolve conflicts and negotiate effectively. A useful strategy for integrating skill development into a training session is to identify the steps in caring for a patient. The first step is assessment, then diagnosis of the disease or illness, then creation of a treatment plan, followed by evaluation of the treatment and modification of the plan if necessary. Given a clinical scenario, health care providers easily identify these steps in the process. They have difficulty applying the same process to conflict situations. If given a conflict scenario, for example a dispute regarding visiting hours on the unit, most of the clinicians will jump straight to diagnosis or treatment. They will describe the problem as, “inconsistency in the enforcement of visiting hours” and therefore there must be a stricter policy and re-education about the policy. Diagnosis- Inconsistent practice. Treatment- Tighter policy and re-education. Assessment of what is leading to the inconsistent practice is not done. Analogizing the situation to one of treating a patient without taking vital signs, listening to their lungs or looking at their lab work helps clinicians grasp the importance of assessing the interests and needs at stake in a conflict situation. ADR professionals are expert at assessing needs and interests and can provide skill development for clinicians in this regard. NURS 6053 Essay Discussions
Conflict Resolution Skill Development
Despite an abundance of years in schools, most physicians and nurses are lacking in basic skills necessary for resolving conflicts. Some of the skills that must be developed for effective conflict management in the clinical setting include, being present in the moment, listening for understanding, mutuality, openness, and reflection. Due to the chaos and complexity that exists in most health care environments, a majority of health care professionals are busy thinking about the next patient, how to get the next resource, when to fit in a test or procedure, when to eat or sleep, and responding to multiple distractions and interruptions. It is difficult to truly be present in the environment and listen to what others are saying at a deeper level. Listening is typically restricted to information needed to move through the day and is rarely done at a level that enables understanding of a situation where there may be collaboration barriers resulting from fear, need for control, fatigue, a need to be right, or shame. Creating the ability to listen at a deeper level within a chaotic clinical environment is an essential skill for developing conflict resolution abilities in clinicians.
Despite the descriptor, “health care team”, there are relatively few times throughout the day when members of the interdisciplinary team function as a team. Most often, they are working as individual advocates for the patient through their role and only in rare instances, such as clinical emergencies, do they step out of the role and truly work together as a synergistic team. Turf battles, differences of knowledge level and experience, and rare opportunities for group conversation lead to a competitive atmosphere where everyone is struggling to do the right thing. Development of the skill of mutuality is essential for managing disputes and for preventing the shame/blame game that so frequently arises in the clinical setting. Fear of doing harm to the patient creates a great need for control of the patient and the environment and can cause harm to the development of true teams. Demonstrating ways for developing mutuality through exercises and role-playing is a great method for advancing the professional development of skilled clinicians.
Openness to alternative solutions is key to resolving complex problems. Developing this skill in clinicians enables them to consider creative alternatives to a conflict situation. It is what enables them to think beyond “a policy”, “a guideline”, or “re-education” as the solution to their current conflict. Openness is necessitated by a trusting and supportive environment. ADR professionals may be required to come into a toxic environment to recreate trust and establish support structures before openness can be fostered. In a competitive environment where mistakes can be lethal, it is difficult for health care professionals to be open to the fact that their idea or answer could be wrong. There is a need to be right so as not to hurt the patient. This trait carries over into conflict situations where everyone has the right answer to the problem and has difficulty hearing conflicting solutions. On a broader level, with varied levels of training, there is a built in tendency to believe that you know more than someone else because of specialty training, certification, more experience or position within the organization. Developing openness across professions and across hierarchical levels is difficult but necessary to foster just agreements and lasting solutions. NURS 6053 Essay Discussions
Training in methods of reflection is also key for health care professionals. As a result of the need to be right, there is a difficulty managing situations where it appears that the wrong choice was made or a system design flaw lead to a bad outcome for the patient. Many conflicts in health care flare up around adverse outcomes or near misses with a patient’s care. The quick jump to diagnosis usually results in a search for who to blame for the bad outcome. The blame environment exacerbates the conflict by creating secrecy and shame. Individual reflection is a necessary skill for resolving these types of conflicts by enabling clinicians to learn from the event and identify what they would do differently the next time. Organizationally, hospitals and health care organizations must also find a way to reflect on how to improve their processes rather than foster a punitive environment that adds fuel to conflicts or drives them underground until the next adverse event occurs.
Skill development in conflict management can enhance the role of the clinician in their current role and can assist managers and administrators in negotiating the complexity of their environments. In addition, skill training programs can be designed specifically to develop health care professionals who are interested in becoming health care mediators or internal neutrals within health care organizations. Expanding the role of the mediator to include work within health care organizations will require training a core group of health care professionals who can integrate their clinical expertise with the practice of dispute resolution. Programs with this purpose are relatively new and are developing momentum as more health care professionals become interested in the field of dispute resolution. NURS 6053 Essay Discussions