The aim of this assignment is to describe and discuss a management activity and the issues that emerged from it in relation to the delivery of patient care in my practice area. This management issue was about a change in ordering menus for patients and how it affected the dynamics of the ward. The proposal was that menus were to be ordered electronically and emailed to the kitchen. For purposes of confidentiality, and to comply with Part 5 of the Nursing and Midwifery’s Code of Conduct (2004), the name of my practice area has been omitted and subsequently any other names or places have been changed/ omitted.
I will explore areas of development and then make recommendations for future practice. My practice area is a forensic inpatient low enhanced secure unit with ages ranging from 21 to 65 years. It is evident that nutrition is important for the recovery of patient’s physical and mental states. Within the staff team, there is mix of skill on the ward, which made this proposal difficult because most of the staff are not computer literate and they would find it difficult to use the computer. The patient’s food is meant to be ordered 48 hours prior to delivery. For example, menus for Friday were to be done before 1600 hours n Wednesday.
This posed a difficult task for three elderly women whom do find arduous to remember what they had ordered in the last two days. It was evident that this proposal was not inline with the Department of Health’s (DOD, 2009) initiative that nutrition of the elderly should be seen as priority by care providers. Reagan (2009) echoes the same notion, stating that ensuring patients had adequate nutritional intake is part of the nurse’s role and it is supposed to be an important part of holistic care. The NC (2008) also gives clear advice of the necessity of working with others to protect and promote the health and well eyeing of patients.
The proposed changes towards plan of care with regard to ordering of food emerged numerous issues as a result of the change. Most staff on the ward reported that they were not computer literate which meant that training had to be commenced as soon as possible, this led to issues of cost/fund to train staff members and it was not clear as how this was going to be possible. Time was also a factor due to staffing issues of flu outbreak. The matter was made worse for the reason that anyone with flu like symptoms were asked to stay at home, which left the ward struggling to cover shifts.
Staff felt that the sudden change would affect the quality of time spent with patients will be compromised by spending time on the computer. The issues of change regarding the menus increased the risk of being left out; creating a limitation to the elderly patient’s nutritional intakes on the ward because most of them were either asthmatic, diabetic or they were mentally unwell and adequate nutrition is essential for their well being. Leadership in Healthcare Developing future nurse leaders is one of the greatest challenges faced by the nursing profession (Mahoney, 2001).
Mahoney (2001) asserted that rueful leadership skills are required by nurses, from those providing direct care to those in top management positions. Anyone who is perceived as an authoritative figure (e. G. A nurse taking care of a patient) or who is responsible for giving assistance to others is considered a leader. A clinical nursing leader is a professional who is involved in direct patient care and whom continuously improves care by influencing others (Cook, 2001). An important leadership role in my practice area is that all nurses are responsible for enabling o to provide good nutritional care.
Leadership is not merely a series of skills or tasks, rather; it is an attitude that informs behavior (Cook, 2001). In addition to this, good leadership is consistent to superior performance with long term benefit to all involved. Leaders are not merely those who control others, but they act as visionaries who help employees to plan, lead, control, and organize their activities (Joist, 2004). Leadership has been defined in many ways in this literature. However, several features are common to most definitions of leadership.
For example, leadership is a process, involving influence, usually occurring in group settings, also involving the attainment of a goal, and leadership can exist at all bevels (Baggier & Woolworth, 2002). There are several recognized leadership styles such as autocratic leaders, whom set an end goal without allowing others to participate in the decision-making process (Baggier & Woolworth, 2002). Bureaucratic leadership occurs when a leader rigidly adheres to rules, regulations, and policies. Participative leaders allow staff to contribute towards decision-making and actively seek out the participation of those involved.
This type of leadership allows team members to feel more committed towards goals they were involved with formulating (Baggier & Woolworth, 2002) It is evident hat there is a difference between theory of leadership and styles of leadership. According to Maiden (2002), theory represents reality, while style of leadership involves various ways in which one can implement a theory of leadership? the way in which something is said or done. Organizations should aim for a leadership style that allows for high levels of work performance, with few disruptions, in a wide variety of situational circumstances, in an efficient manner (Maiden, 2002).
Similarly, there is a difference between management and leadership. Managers plan, organize and control, while leaders communicate he vision, motivate, inspire and empower in order to create organizational change (Baggier & Woolworth, 2002). Awaited (2003) quoted definitions of transactional and transformational leadership. Transactional leadership involves the skills required in the effective day to day running of a team. However, transformational leadership involves an integrated team working together and innovativeness of their approach towards work (Awaited, 2003).
Transactional leadership focuses on providing day-to-day care, whilst transformational leadership is more focused on processes that motivate followers towards reforming to their full potential by influencing change and providing a sense of direction (Cook, 2001). The ability of a leader is to articulate a shared vision; this is an important aspect of transformational leadership (Baggier & Woolworth, 2002). Transactional leadership is most concerned with managing predictability and order, while transformational leaders recognize the importance of challenging the status quo (Baggier & Woolworth, 2002).
Change The health care environment is constantly changing and producing new challenges that the nurse leaders must work within (Joist, 2004). Leadership involves enabling people to produce extraordinary things while being faced with challenge and change (Joist, 2004). While management in the past took a direct, hierarchical approach to leadership, the time has come for a better leadership style that includes encouragement, listening, and facilitating (Hyatt, 2003). Hyatt (2003, p. 31) cited Yoder-Wise (1999) as defining leadership as “the ability to create new systems and methods to accomplish a desired vision”. Today, the belief is that anyone can be a leader? as leadership is a learnable set of skills and practices (Hyatt, 2003). All nurses must display leadership skills such as adaptability, self-confidence, and judgment in the provision of a health care setting (Hyatt, 2003). The expectation is that nurses lead care, and that they be able to move between leading and following frequently (Hyatt, 2003).
Clinical governance is a new way of working in which National Health Service (NASH) organizations are accountable for continuous quality improvement, safeguarding standards of care, and creating an environment for clinical excellence (Maiden, 2002). Requirements of several recent UK government policies require that new forms of leadership should reflect the diversity of the workforce and the immunity (Scott & Caress, 2005). Leadership requires to be strengthened and needs to involve all staff in clinical leadership. Shared governance is one method of allowing for this to take place.
This form of leadership empowers all staff to contribute towards decision making processes, and allows staff to work together to develop multi-professional care (Scott & Caress, 2005). Scott and Caress (2005) contend that this type of leadership will lead to increased morale and job satisfaction, increased motivation and staff contribution, encouragement of creativity, and increased sense of worth. The National Institute for Clinical Excellence (NICE 2007) states that change in health care settings can be difficult and they are barriers that can hinder the successful implementation of change.
Bennett (2003) recognized the potential barriers towards implementing change in a clinical setting includes; inadequate access to information, lack of resources, resistance to change due to ward cultures, insufficient time due to work commitments and lack of confidence in what is being implemented. At the time of the change (of the previously mentioned scenario) it was obvious that staff were a bit apprehensive about the change and were not sure of why it was accessory. Right from the start there were barriers in the process of this change being implemented.
Bert (2007) supported this view that change in healthcare setting is resisted by employees because they fail to “get on board” and instead adopt apathy and an aggressive attitude towards change. This may be caused by staff feeling they are happy with what they already have and most importantly staff may feel that they find no reason for change. Staff may also feel threatened by the change and fear that it will adversely affect them in a certain way. For instance staff on the ward may have felt they lacked appropriate skills ND felt they would be vulnerable.
Methods to minimize these issues may include pilot schemes, meetings with staff before a change is implemented and understanding the view points of staff members; through the use of questionnaires and try to get feedback from staff. This may also include identifying possible opposing elements such as values, financial constraints and the technologies involved (i. E. Computers). However, Price (2008) states that while healthcare settings has always involved change, it is the pace, direction and intensity of change that challenges nurses to adapt and cope.
Allan (2007) states that if change was to happen evenly, gradually and with early warning, there would be less need for advice and counseling. Robert et al (2008) also of the point of view that resistance to change can be reduced through creative organizational design and development, however can not be eradicated. Although change may seem painful, Price (2008) states that undergoing a major change provides healthcare professionals with the opportunity to develop a more thoughtful attitude towards the future and they can understand their experience, skills and knowledge better and be in a position to present homeless to others.
Despite the fact that this was an opportunity for staff to develop new skills in computer literacy, most of them felt uncomfortable to leave their comfort zone and indulge into something new for fear of the unknown. Research by Robert et al (2008) reveals that staff members are comforted by familiarity and they would not risk losing position, control and their reputation. During the introduction of the change, staff perceived the planning and processes were too complex as there was much to consider in terms of the change agents, restraining forces and driving forces (Lenin, 1951).
The reasons being, choosing the right approach to change involves others, maintaining safety, as well as the availability and use of resources therefore ensuring that the change is sustainable. Hellhole (2006) stipulated that change is an emotional journey in which we are manifestly not in control. Consequently, Apical (2000) suggests that employees expect effective planning and a leader who can lead a team through change processes. The leader goes through phases that will make implementation of change less stressful.
The leader should plan the changes and include the team in the planning process. The leader must be a good decision maker, and this will include the promotion of trusting relationships among employees and thus staff will feel empowered in the leadership decision making process. Garage & Smith (2005) postulated that the leader must ensure enhanced communication in times of change and this is essential for a sustainable change. Robert et al (2008) was of the opinion that communication often holds the key to successfully unlocking the door to change.
Wang and Aimed (2003) states that an open minded approach towards discussion facilitates an opportunity in which underlying assumptions re challenged; thereby eradicating limitations and pioneering a new set of ideas. Imperatively I recommend that the manager should give regular feedback, and this must be maintained to ensure that staff are kept informed of the impending change. The manager must show leadership skills by taking on the responsibility to lead, however as an employee one must also deal with the change that affects an individual basis and seek support from their superiors if need be.
It is of significant importance that leadership and management support change Allan (2007). Robert et al (2008) stated that managers must be aware of the impact of their actions as negative behaviors in leadership can lead to loss of trust and respect within the workplace while positive leaders have the ability to create an infectious ‘can do’ culture for service transformation. The managers must adopt a leadership style that suits the current atmosphere. Leadership styles can be affected by the type of organizations in which leaders work.
An authoritative style of leadership has been seen to be more effective and has more positive outcomes (Allan 2007). According to Welfare (2002) successful adoption of transformational leadership depends on how the leader uses the power she/he has. If the power is abused this can be detrimental to nursing morale and patient care delivery. Pearce (2007) suggests that there are ten steps the nurse can use as a guide to help managers improve their team leadership skills.
He suggests that a good team must have a clear vision of the present and the future, set clear goals and ensure that there are processes in place to support individuals in achieving those goals. There must be a two way communication both formally and informally, teams must be encouraged to constantly innovate their work and be ready for any change, teams must also be prepared to take risks, make mistakes and earn from them, step aside and learn from teams, treat people with respect and dignity (NC 2008), making sure the work is done.
At the time of change the approach adopted on the ward when change was being implemented was a top down approach. Alexis (2002) states that it is often assumed that the top down approach should be taken to develop staff. This means that some members of the top management side should envision strategies and tactics first. Kessler and Bailey (2007) are of the view that when change is implemented the top management is capable of infecting energy and passion necessary for the change.
Bailey goes on to say for change to be successful; the efforts should emphasize the human side of change and focus on relationship management. For this reason, it is necessary for change to trickle down from the top, down through to all levels. Although the change on patient menus was a top down approach, I feel this was well handled because the manager of the ward communicated well with all junior staff members. Although staff morale was low due to lack of computer skills, the manager asked all the staff who had computer skills to take a leadership role.
This is supported by Alexis (2002) when he states that top level management would focus on spreading enthusiasm, engaging lower level management and for staff members, helping them change their attitudes and activities on their own accord. The manager used transformational leadership where all staff felt empowered and they were involved in the decision making process. Recommendations For change to be successful staff must be involved and there should be a clear plan (Robert et al, 2008 & Price, 2008).
Although the manager tried to involve staff in the implementation of the change, staff felt they should have been more involved in the planning stages of the change. Patients were dissatisfied with heir menus and on several occasions, the top management was informed of this. The manager then took the ownership of the problem and this seemed to lift the morale of the staff. This is supported by Robert et al (2008) when they state that ownership of change tends to increase the probability of a change being seen in an opportunistic manner and therefore possibly being considered to be less threatening.
During the change on the ward, I felt that the negatives outweighed the positives. While change is of the benefit to the patient and the running of the ward in general, the junior members of staff are the ones who deal with the active consequences. Therefore it is paramount to ensure that effective communication is maintained while the top down approach of change takes place. As senior nurse on the ward I felt there could have been other channels explored to make this change less stressful and manageable.
For example, involving housekeepers, occupational therapist, staff nurses and support workers in the planning stages could have produced positive outcomes. With regards to the elderly patients, it desirable to allocate the task of ordering their meals, member’s of their nursing team to make sure that this is done. Change is an inevitable part of life yet it frequently causes problems. For change to succeed, it must be seen through a multidimensional focus that incorporates the staff, their feelings, the impact of change and the barriers that could be encountered when change is being implemented.
Change should attract widespread negotiations and ensure co-operation between staff, patients and the management team, taking into account differing views. Nurses should be able to realize the benefits of contemporary nursing and be able to deal with change in a positive way. The most fundamental steps in achieving the successful implementation of change is that of obtaining a shared perception amongst those affected. The management should reach a point where all parties reach a common objective with a vested energy in the change.
The management team must feel that they are responsible for the successful implementation of change. This responsibility is best possible through a desire to succeed rather than to survive. Resistance to change can be reduced by creative organizational development, but it can not be eradicated.