Critical Thinking – Page 3 – JRM Nurse Consultants

January 01 2017

Working Your Staff Unsafely

This week has been the week of speaking with different professionals on training and how companies place employees in jobs that are not properly trained in their skill set to pay them less and get more out of them. I used to work for a large insurance company that employed over 80,000 people. I worked in the long-term care department which had about 400 staff from administrative assistants to presidents. I was the manager of case managers which consisted of RN’s, LPN’s and Social Workers. They all did the same job and got paid different salaries to do it, however the job description and responsibility was the same.

I felt that this policy of having nurses and social workers working on the same cases needed to be changed. Having all the staff doing the same exact work and paying them differently based on their degree and expecting the same level of skill, was inappropriate. Nurses have a different skill set than social workers. If a patient has a medical issue, the social worker that is visiting that member in the home completing an assessment may not be able to capture that the member has been retaining water in their ankles and think to ask if they are on a diuretic. Much like the nurse that goes in the home setting and sees a patient that has issues paying their light bill won’t know where to call to find a resource for them. The patient may be concerned because they are on oxygen at home; they wonder how they will pay their light bill and what they will do if the power is turned off. This can be a liability to any staff member but also a disservice to the patient.

In contrast, I worked for another company that did case management. I loved that job, until federal cutbacks came along for the program during the new Obama administration. The company employed RN’s, MSW’s, CHW’s, Nutritionists and Behavioral Health Specialists. The cases were assigned only to nurses and there were two tiers of nurses, regular case managers and those that were more experienced received complex care patients. The other staff MSW’s, CHW’s , Nutritionists and Behavioral Health Specialists were consulting on the files that the nurses referred to them. They would work as a team with the nurses. This team work gave the patient a more well-rounded form of care.

There are several leadership styles in companies, autocratic, democratic and laissez-faire. In the large insurance company that had all the workers regardless of skill set do the same job, the leadership was autocratic. The department maintained total control in all decisions and no opinions or suggestions were accepted from others. There was no opportunity to make a change due to the leadership style. In my prior job, where everyone worked on a tiered team, there was a democracy; decisions were made after consideration of input from the staff (Mitchell, 2013).

There are some days that as a professional you want to see changes implemented or at least considered, however the leadership does not support that. If you are the type of person that works for the better of seeing changes in a situation, get involved in the departments or committees that have a say in policy writing, this will be the only way to see changes that can be discussed for the betterment of the company.

References

Mitchell, G. (2013, April). Selecting the Best Theory to Implement Planned Change. Nursing Management, 20(1), 32-37. Retrieved from http://web.a.ebscohost.com.library.capella.edu/ehost/pdfviewer/pdfviewer?sid=4ba42c53-9a6d-4ec5-b6bb-2f078e04b7c7%40sessionmgr4001&vid=1&hid=4204

January 01 2017

Using Evidence to Change Policies

Rules are sometimes implemented by people who may not actually be a staff nurse to observe and see what a family’s needs are. In most hospitals these days there are more times that can be spent with families in intensive care units, however they are probably limited to 1-2 people. As a staff nurse, changing a policy that is not implemented is not a good thing, because if something were to happen while the family is there, the nurse may be reprimanded for not following protocol. What the staff nurse can do is collect information by asking a foreground question that is more specific (Rubenfeld & Schaeffer, 2014).

An example of a foreground question can be which visiting hours work best for families that have patients in the hospital? The nurse should look for the answers by recording the hours that the families are able to come in to see their loved one. Once this is determined, then the nurse can speak with the manager and bring the evidence that was collected, specifically how many families were questioned, what hours they were visiting, what is the majority of the time that families selected. Once the manager has had a chance to review the statistics provided, then this information can be taken to the decision makers of policies to review and come up with a better outcome. Making changes in the workplace can only take place when the staff genuinely cares about work place practices that will benefit their patient and the staff (Mitchell, 2013).

References

Rubenfeld, M. G., & Scheffer, B. (2014). Critical Thinking Tactics for Nursing Achieving the IOM Competencies (3rd ed.). [P2BS-11]. Retrieved from http://online.vitalsource.com/books/9781284059571

January 01 2017

Empowering Patients with Chronic Conditions

Many patients that are diagnosed with chronic conditions have a hard time understanding how to take care of themselves at home, especially if there is a language barrier. Community Health Workers (CHW’s) work in the community and empower people to take care of their chronic conditions. One of the chronic conditions that drives the bills up for Medicaid is Diabetes. Many of the people who were being seen in the clinic were Hispanic and had trouble understanding how to take care of their Diabetes.

Some of these clinics started to take charge and work with Medicaid to decrease the cost of hospital admissions and frequent clinic visits. What ended up happening was that once per week, a Diabetic Educator would teach classes in Spanish about managing their Diabetes. The educator went over checking their blood sugar with the blood glucose monitor, exercise, insulin administration, diet, skin and foot care as well as regular follow up with their primary care physician. This population was very non-compliant and would prefer to use the emergency room instead of the doctor to manage their chronic condition.

The CHW’s made visits to the patient’s homes and reinforced the teaching that the Diabetic Educator taught the week prior at the center. Some patients would not be able to get out to the community center, so the teaching would be brought to them by the CHW. When I read about comparing old thinking and new thinking, one of the things that is mentioned is the difference between a background question and a foreground question. The foreground questions are more specific and probably a better fit for the studies that need to be done on the Hispanic population suffering from Diabetes. With the foreground question one can ask which works best for reducing hospitalizations for Diabetic patients instead of how can we manage someone’s Diabetes which is a background question (Rubenfeld & Scheffer, 2005).

References

Rubenfeld, M. G., & Scheffer, B. K. (2005). Critical Thinking TACTICS for Nurses:Achieving the IOM Competencies (3rd ed.). [Vital Source BookShelf]. Retrieved from http://online.vitalsource.com/books/9781284059571

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January 01 2017

How Nursing Has Evolved Through the Years

Nursing has evolved throughout the years thank goodness to a different level of respect. Although I do believe that some doctors and even nurses still carry the old way of practicing where the doctor is the lead and nothing else matters. This is I believe even differs from the North to the South. I remember graduating from nursing school and working with the doctors in labor and delivery who are now looking at me not as the kid in school, but as the professional on their team. The doctors would say call me Mike, or John when we were not around the patients and it was a comfortable working relationship (not to the extent of the TV show dramas, that is not realistic!) making everyone’s job easier, especially for a new grad that had questions.

When I moved to Florida I noticed that the nurses and staff would say Dr. Smith or Dr. Jones and he would say whatever it is he needed and the nurse would say yes sir, is there anything else that I can do for you. It was the politeness of the South or the servant of the South one or the other. I thought to myself, okay this is certainly going to take some getting used to if I am going to live in Florida. In no time at all, I had to conform since I wanted to be gainfully employed.

When I think of being on an interprofessional team, I think of the team that I was in up North, where it was a comfortable open ended relationship between nurses and doctors to discuss what was happening with the patient and come up with a plan. When I think of being on the interprofessioal team in Florida when I first moved here, that to me was not a team. It was a nurse and a doctor, with the doctor stating what needed to be done, the nurse saying yes sir and doing what she was asked. It should be a partnership collaborating together (Sommerfeldt, 2013).

Many years have evolved since I first moved to Florida and I have seen the change happen where nurses can have a more involved relationship with doctors as a team player and include nutritionists, therapists and discharge planners. There are still some rigid single minded doctors out there that will not work on an interprofessional team; however our job is not to change them. We can spend a long time trying to make changes and getting our point of views heard, but if we can make an impact with what we can control in our scope of practice, this will go a long way to improving healthcare.

Sommerfeldt, S. C. (2013, February 25 2013). Articulating Nursing in an Interpersonal World. Nurse Education in Practice, (13), 519. http://dx.doi.org/http://dx.doi.org/10.1016/j.nepr.2013.02.014

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January 01 2017

The Nurse Leader of a Healthcare Team

A nurse can play three different roles as part of an interprofessional team. The three roles consist of a nurse, nurse leader and nurse educator. The interprofessionalism team consists of other healthcare workers as well, not just nurses (Sommerfeldt, 2013). However as nurses the roles can be at different levels depending on the patient’s condition. At my previous job, I worked as a complex case manager. The team consisted of registered nurses, social workers (masters prepared) behavioral health specialists, community health workers and nutritionists. The nurse case manager managed the patient, however if there was an issue with the patient in the home setting that required community resources, the community health worker would be consulted to assist in those needs. If the member had psychological issue or other financial issues that required the need of a social worker or behavioral health specialist this referral would be added as well. There was collaboration on the plan of care and all participated because we all were looking at the patient as a whole, not just as the part that each discipline took care of. If the member cannot pay his light bill or water bill due to financial difficulties, until we take care of those needs through resources, any teaching that the nurse would do would be in vain. A person cannot focus on teaching for their health or anything else if their mind is on their current financial strain, not their medical condition. In this instance the nurse is playing the role of the nurse leader.

When a patient is in the hospital a nurse can also play the role of a nurse that is doing dressing changes, medication administration and other treatments. The nurse’s role in the interprofessional team that may consist of the doctor, physical therapist and dietician, would be more medically involved because maybe the patient is recuperating from heart surgery and requires a lot of care initially. The patient is on a special cardiac diet, which can also be explained by the treating nurse, however in this instance, the member is starting something new, so a consult from the dietician can help the patient understand the diet and the nurse can reinforce the teaching.

The nurse educator as part of the interdisciplinary team can be seen for example in a disease management setting. This type of setting also has multiple specialties that can follow the patient. In this instance the nurse educator is educating the member on how to empower themselves and learn about managing their chronic disease by learning about taking their medications, following a diet and exercise program, learning to check their blood sugar or blood pressure. The nurse educator measures the members learning based on return demonstration through development of a plan of care.

All three roles bring value to the scenario that they are in, because the nurse is the one that will be around the patient most of the time. In each role the nurses is responsible for all aspects of the patient’s care. In reading through the assigned readings for this week, I am able to see that although you have one nurse, that one nurse can play one of three roles depending on what scenario the nurse is in. Regardless of which role the nurse is playing, working on an interprofessional teams is a style of partnership that allows decision making to be collaborative (Sommerfeldt, 2013). It takes many people to work together in getting a patient discharged to his home.

References

Sommerfeldt, S. C. (2013, February 25 2013). Articulating Nursing in an Interpersonal World. Nurse Education in Practice, (13), 519. http://dx.doi.org/http://dx.doi.org/10.1016/j.nepr.2013.02.014

Follow Rosie Moore https://www.facebook.com/rosiesnursecorner/

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Years of experience in Work Comp, Case Management, Disease Management, Utilization Review and Prior Authorization.

Category Archives: Critical Thinking

Using Evidence to Change Policies

Empowering Patients with Chronic Conditions

How Nursing Has Evolved Through the Years

The Nurse Leader of a Healthcare Team