Critical Thinking – Page 5 – JRM Nurse Consultants

October 10 2016

Nursing Shortage

It seems that the nursing shortage has been an issue since I was going to school. I remember at one point I received a one year full scholarship to go to nursing school my first year; then the 2^nd year I received a letter that stated the President decided the nursing shortage was over and cut my full scholarship for the second year, forcing me to get student loans. That is enough to make you mad! But now as I practice in a non clinical job as a legal nurse, I do see that there is a shortage of nurses in many fields (Moore, 2015). For instance in the hospital what I see is that they do not hire too many nurses because if they have too many on the unit and they don’t float them to another unit, they will send them home without pay because there is not sufficient work.

When my son was in the Neonatal Intensive Care Unit, I had to walk past high risk antepartum, one day the lights were dim, and there was no one around. I got a bit concerned that something had happened. There was a sign that said “unit closed.” When I inquired, someone stated that there weren’t any patients so they closed the unit for that day. Of course two days later, it reopened.

I see that nurses are overworked because of the shortage as well. I have also been reading articles that speak of the shortage getting worse because of the baby boomers retiring and there aren’t any new nurses to take their place (“Focus on Education,” 2010).There are also articles that speak about new nurses graduating, but their minimal level of education required, will be the bachelor’s level plus all the clinical involved with that level. There are entrance exams to some nursing schools, making it difficult for the student to pass. Of course education should be taken to the next level due to the more complex illnesses and family dynamics we have today.

In order to not continuously have a shortage, employers of nurses need to realize that yes they understand that there is a shortage and hire more staff to help the current nurses and not over tap them. The medical cases are getting more complex these days for patients in the hospital, therefore making it important for nurses to have a higher level of education. The colleges have to start sending representatives to the high schools to start recruiting future nurses so that when they graduate, we can add more nurses to the profession. Recruiters need to present the pros and cons of being a nurse and look for candidates that will be a good fit to the nursing profession.

References

Moore, M. (2015). The nursing shortage and the doctor shortage are two very different things. Retrieved from http://www.washingtonpost.com/news/to-your-health/wp/2015/06/05/the-nursing-shortage-and-the-doctor-shortage-are-two-very-different-things/

The future of nursing: Focus on education. (2010). Retrieved from http://nursejournal.org/articles/the-future-of-nursing-infographic/

October 10 2016

Identifying a Health Care Issue

There is concern among parents of premature babies when they are told that that they will be discharged home from the neonatal intensive care unit (NICU), because there is not a discharge process in place that helps to decrease stress when the parents are at home with a sick baby. The parents of the premature babies are the ones that are affected by not having a transition program that helps them get back in the community to function with a baby that may require more care had the baby been born full term.

The implication of the current practice is seeing parents of premature babies suffer from depression and anxiety because of the level of stress that they encounter. When parents are in the NICU, there is stress from the roller coaster of whether the baby will survive. Once the baby gets to a point of survival, then the planning phase of going home starts. If the baby goes home with tube feedings, oxygen or a tracheostomy and monitors, this causes a lot of family changes. One parent leaves their job to care for the baby, there is concerns when home care nurses are supposed to make a visit and they do not show up; this causes an unsafe environment because the only parent than can take care of them as a relief is at work. This will cause the parent that is not working to have the greater bulk of the care and have an all-night watch which is both dangerous to the parent and the baby.

The nurse, doctor, occupational therapist, child life specialist and a nurse educator or consultant should be a part of the multidisciplinary team that should be working with the families in the neonatal intensive care unit (NICU). The key supporter should be the nurse that sees the baby daily because she will be the one that sees the family and gets to know them and the baby.

The parents of premature babies want a step by step explanation with demonstrations and written instructions this way they could pick up the brochure anytime for reference (Ronan et al., 2015). In one study, the downfall was that they used full term infants without medical problems, this may be good for a DVD purpose for filming, however to be realistic in how an infant would react at home, the researcher should have used premature babies at different gestational ages. It would be beneficial to have had the researcher use premature babies with different medical conditions and equipment such as oxygen, tracheostomy, tube feedings, and monitors to determine if the provided material would be beneficial. More research is needed to be able to determine the best care for NICU families transitioning back to the community.

References

Ronan, S., Liberatos, P., Weingarten, S., Wells, P., Garry, J., O’Brien, K., … Nevid, T. (2015, March/April). . Neonatal Network, 34(2), . http://dx.doi.org/10.1891/0730-0832.34.2.102

April 04 2015

Multiple Factors Can Interfere With Teamwork

In every organization there are communication barriers, but overcoming them is part of being professional and respectful of others’ opinion. In some organizations the leadership structure has a medical director, senior health service director, a health service director, a manager and the case manager. The case manager manages the file, develops the plan of care with the assistance of the member or the family. The nurse is responsible to ensure that the member is attending their doctor’s appointments, taking their medications and maintaining their insurance eligibility monthly. This should be done by the social worker however in some organizations, the social workers manage the same types of patients that the nurses manage.

There are other professionals on the team that help maintain the members with their eligibility for their Medicaid insurance. Part of the team is the operations team. This is where things in an organization get blurred due to communication gaps, lack of resources, support and professionalism. The team in operations are not nurses. The operations team will email the nurse and copy the manager to let them know that the member is going to lose eligibility if they do not send in their paperwork timely to the state. When the nurse receives this email, the nurse is to drop all that they are doing to attend to the member’s eligibility. This will involve contacting the state to see what is happening with their eligibility. This is something operations can handle but they state their function is just to advise the case managers of the discrepancy.

Another barrier that is seen in management of cases is the inability to show respect to other team members and allow a learning environment. One agency case manager stated that every two weeks the team of case managers reviews case files on a conference call with the medical director. These cases are reviewed in their team meetings weekly before submitting to the medical director and as a team they discuss what has been done and make suggestions. The cases are emailed to the medical director and his assistant selects the cases. Recently, a case manager stated that two cases were selected for review from her team. The case managers present them to about one hundred and eighty people or more on the call from directors to managers and case managers. As the doctor asks his questions and makes his recommendations, the case manager indicated that her director, who is her manager’s superior, made a statement on both cases stating to the team that their manager should have known this and taken a different approach before sending this to review. The case manager did not know what to say, but this was stated over and over about five or six times throughout the presentation of both cases. At the end, what was stated by that director was if your manager does not know what to do, then call her. This is a prime example of a barrier in trying to be in a learning environment that will help the case manager grow and benefit the patient. (Rubenfeld & Schaeffer, 2014)

Collaboration can only exist in a team when the leader uses critical thinking, an interdisciplinary team approach and collaborate on cases together. But in the big picture of corporate America under some managers this is not acceptable, it is more along the lines of a multidisciplinary team. In this type of team, you only have individual thinking in the group, meaning their way and no other opinions. The focus will be on tasks and check off systems regardless if it is feasible to do. (Rubenfeld & Schaeffer, 2014)

In conclusion, nurses do have the ability to be leaders, educators and changers of a system, if assertive enough to make that change, but in order to do so a good team of interprofessional people are needed. Because at the end of the day, the patient is who counts and why changes are necessary.

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

Written by Rosie Moore, RN, BSN, LNC

April 04 2015

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. In speaking with a complex case manager working for a managed care company, 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 they were all 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 they take care of those needs through resources, any teaching that the nurse does 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. 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

Written by Rosie Moore, RN, BSN , LNC

March 03 2015

Corporate America Nurse …What Changes Can You Expect

When a nurse is working in corporate America, changes are bound to be evident, from what the nurse was used to at the hospital. When nurses take on the this role, they have higher skill sets in the business world than in the clinical world since they do not practice and they may not feel confident providing care. The role of a nurse manager in the clinical setting when she is managing the business aspect can be very confusing for nurses. This is because their training is that of a nurse and possibly they received their MBA to manage an office, however when put in a clinical situation, due to less involvement clinically, they lose their clinical awareness.

In some places, there are many nurse managers that are in this manager role and there is very little clinical involvement. The clinical they may get to do as a manager is when they go out in the field quarterly with staff or when they do chart audits. Some nurses maintain their clinical skills because they choose to be more involved in their staff’s patients, looking at their diagnosis and medications right along with the staff to be able to keep up with what is changing medically. Some managers are quite content with the non-nursing role.

This makes it very difficult at times dealing with a manager that is a transactional leader. Transactional leadership is a style of management when the leader promotes compliance from their staff through rewards and punishments. it is an antiquated method of management, where mostly punishments are used. After awhile the leader loses their staff due the rigidity of management. A transactional leader will not allow the status quo to change and when a nurse brings up evidenced based nursing approaches to help the staff, they may be quickly dismissed as this is not part of what a manager does. Some managers are told constantly that they are a manager and have to think like one, not like a nurse that is doing clinical. It sounds like a power struggle of the titles.

Marchionni, C., & Ritchie, J. (2007, January 25). Organizational Factors that Support the Implementation of a Nursing Best Practice Guideline. Journal of Nursing Management, 16(), 266-274. http://dx.doi.org/10.1111/j.1365-2834.2007.00775.x

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

Rosie Moore, RN BSN, LNC

Previous page 1 … 3 4 5 6 Next page

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

Category Archives: Critical Thinking

Nursing Shortage

Identifying a Health Care Issue

Multiple Factors Can Interfere With Teamwork

The Nurse Leader of a Healthcare Team

Corporate America Nurse …What Changes Can You Expect