Category Archives: Critical Thinking

The role of the professional nurse when implementing a change is to identify that there is a need for a change (Rubenfeld & Scheffer, 2014).  Once the need for a change is identified by the nurse, the next step is to implement a change in behaviors efficiently and with quality. When identifying the area specifically that needs the change, nurses need to be deliberate in stating the purpose for the change.  When speaking to the target group about making the change, it is important to keep their attention span with non-lecturing phrases.  As nurses we are not always in our comfort zone to explain why changes need to be implemented.  We should be prepared to explain why this change is needed and what improvements these changes will make.

Generally, people will always be resistant to change.  But as professional nurses, our focus is to build trust and credibility.  The goal is to acknowledge that the change is coming and that you empathize with the feelings of the upcoming change (Rubenfeld & Scheffer, 2014).

Where I used to work, they were very involved with ACHA (Agency for Healthcare Administration), because we held a state contract.  Evidenced based nursing was in a sense required as far as the patient care when our case managers were managing a case.  However on the same note, although our case managers were not performing hands on care, they were required to know about all their diagnoses and treatments.  We had social workers and nurses alike seeing the same types of members.  The issue with nurses and social workers seeing the same types of patients is that the social worker is not able to use his/her critical thinking skills in their area of expertise.   They were required to assist members who had complex medical issues for instance, on a ventilator or more complex medical problems.   A suggestion was made when I arrived at my work place to utilize the social workers in conjunction to the nurses to manage the social aspects of the patients, however the decision was denied.  It was noted that ACHA is not paying the company to rethink how cases were managed and by whom because it was not hands on care, it was case management.

There was very little nursing involved in my job role, it was primarily reports and meetings to talk about reports and how to fix these reports.  It was an ideal job for someone that had an interest in perfection of numbers and statistics.  Every other day, there was a new change that was being implemented. We often times questioned why there was a change, but what we were told was that the change was immediate and mandatory.  For the staff case managers, these changes were difficult because the staff was in the field.  They may receive an email about something that needed to be changed as soon as possible, however they may have just returned home at  5pm in the afternoon looking forward to the end of their day and they find  emails with deadlines on multiple items due.  These changes affect the staff because they have to work late hours to get the work completed timely. This kind of change caused many good nurses and social workers to resign.

As nurses or leaders we tend to fall in to the routine of lecturing due to the pressures that we are under.  However two of the six dimensions of dealing with complex dynamic changes are creativity and intuition.  As a leader we should not just teach our group something, we should implement a way to bring creativity in to the change and use intuition to know how to speak to your group.  The best way to implement a change is to get the group to commit to doing the new change and develop a smart goal with them that will allow them to measure their own goals.

The leadership theory that most resembles mine is the coaching leadership style.  The coaching leadership style allows me to work closely with the staff at different levels and  empower them to meet their goals and gain confidence of their strengths so that they can focus on them as they work on their weaknesses.  In my previous job, the leadership style could have been called a dictatorship, however for the purpose of the discussion here it will be stated as coercive.

My manager’s favorite phrase was, “I gave a directive and everyone needs to follow it, any questions (1 second wait) no, good.  It’s due by close of business.”  If questioned on how to juggle that with all the meetings and other directives, the reply was always as a manager makes it happen.  My manager always reminded me that she did not take lunch, breaks and basically had “no life” outside of work and she expected those under her to be like her. She was not a woman who read books as a matter of fact, she indicated that books were a waste of time, for fun she read the ACHA contract that was 350 plus pages because reading any other book was pointless (Barr & Dowding, 2012).

References

Barr, J., & Dowding, L. (2012). What makes a leader? In Leadership in healthcare (2nd ed., pp. 13-31). [Vital Source Bookshelf]. Retrieved from https://campus.capella.edu/web/library/home

 

Rubenfeld, M. G., & Scheffer, B. (2014). Critical thinking and patient-centered care. In Critical thinking tactics for nurses: achieving the IOM competencies (3rd ed., pp. 155-180). [Vital Source Bookshelf]. Retrieved from https://campus.capella.edu/web/library/home