Critical Thinking – Page 6 – JRM Nurse Consultants

March 03 2015

Organizational Culture and Critical Thinking

In some managed care organizations, there are several factors that inhibit critical thinking skills to be utilized. Some of these factors are contract led and others are management style. Long term care programs are mandated by the state to follow a certain protocol on managing their cases for the members that are seen. The care part for the member is not an issue, however the reports and assessments that are required to be filled out, keep the case manager from adequately spending appropriate time with the member. If there is one item not completely filled out, the assessment will be returned by the state. The assessment is at times sent back late from the state, forcing the case manager to redo the entire assessment that can easily take two hours. This in turn causes a high turnover of staff because the demands on their time as salaried employees working 12 plus hours and 6-7 days per week are not what they want to do.

These company cultures do not lend themselves for new implementations for a better way to manage the staff and their time. The industry has seen some of the staff say that they have PTO (it should be paid time off) but at times they are still checking emails and phone messages for fear of getting behind, so one has to ask themselves are they on paid time off or pretend time off? One manager cannot implement changes in the entire company, but with their own team they can apply evidence based nursing and critical thinking skills to make a difference internally.

Some ideas that a manager can work on with their team can be, discussing best practices for different aspects of the job. It seems that all team members and managers have to address emails, projects and reports, these will always interrupt the flow of the day. The team however, can control when they see their patients, make phone calls and when notes are entered in the system. When a manager is preparing to discuss the best practices, some things to consider can be based on the issues that the staff come up with ahead of time during the week or audits on their files. This can help the morale of the staff as well as their performance, decreasing the amount of turnover. (Marchionni & Ritchie, 2007)

In conclusion, every manager has their own style of managing. The best style of management is always going to be one that empowers employees to do their job based on examples and positive reinforcement. If all the employee ever hears is what they did wrong and never a word of praise, the employee will not strive after a while to grow and better themselves.

” A word aptly spoken is like apples of gold in settings of silver.” Proverbs 25:11

Written by Rosie Moore, RN, BSN , LNC

February 02 2015

Role of Professional Nurse

The role of the professional nurse when implementing a change is to identify that there is a need for a change. (Rubenfeld & Scheffer, 2014, p. 321) 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, p. 324)

Some companies are very involved with AHCA (Agency for Healthcare Administration) because they hold a state contract. Evidenced based nursing is in a sense required as far as the patient care when case managers are managing a case. However on the same note, although case managers are not performing hands on care, they are required to know about all their patients’ diagnoses and treatments. These companies have social workers and nurses alike seeing the same types of patients. The issue that comes up with nurses and social workers seeing the same types of patients is when the social worker is not able to use his/her critical thinking skills in their area of expertise. The social workers are required to case manage a patient having medical issues that can possibly be on a ventilator or have more complex medical problems. Some companies, utilize social workers to assist patients with the community resources that they are all too familiar with. While other companies, say ACHA is not paying the company to rethink how cases are managed and by whom because it is not hands on care, it is case management.

These days nurses can work in many diversified places, even in corporations such as insurance companies. The problem for some places that employ nurses in a corporate role, is that there is very little nursing involved in their job role. Sometimes it is primarily reports, meetings to talk about reports and how to fix these reports. It is an ideal job for someone that has an interest in perfection of numbers and statistics. Most nurses are not geared this way, they are geared to use their critical thinking skills. As a nurse seeing that every other day there is a new change that is being implemented, will often make the nurse question why there is a change, but only too often to be told that the change is immediate and mandatory.

Nurses who are managers and supervise case managers have to explain new changes to them. For the case managers, these changes are difficult because the staff is in the field. They may receive an email about something needed to be changed as soon as possible, however they may have just returned home at 4:30 or 5pm in the afternoon looking forward to the end of their day. They check their emails and find deadlines on multiple items due. These changes affect the staff because they have to stay late after hours to get the work completed timely. This kind of change can cause many good nurses and social workers to resign.

As nurses or leaders we can 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.

Change is inevitable and we all have to change, but the way we implement those changes can be the success of the process being changed.

Author John Maxwell states, ” If you want to change your life, you must first change the way you think..”

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

(Rubenfeld & Scheffer, 2014, Chapter 11)

Written By Rosie Moore, RN, BSN, LNC

February 02 2015

How Do You Use Your Critical Thinking Skills

Professionals use critical thinking and problem solving strategies daily in their work environment. Take for instance a health plan managing their member’s health, consisting of a staff of social workers, RN’s and LPN’s they will manage all kinds of medical conditions. The case manager is expected to apply critical thinking skills to each case and prioritize what that individual member needs. As an organization in healthcare they are to effectively encourage behavior change in members towards a healthier life that will avoid gaps in their healthcare treatment. The case manages are also required to achieve the business goals of the company by submitting state required forms timely to AHCA (Agency for Healthcare Administration). With each member that the case manager interacts with, they will be advising them of what care is covered under their plan, how they can best utilize the health plan to empower them to live a healthier lifestyle by complying with such things as attending their doctor’s appointments, taking their medications and reporting changes in their health, socioeconomic status or if their living arrangements are no longer safe for them.

Every organization can improve the critical thinking of their staff, but the reality is that it is the staff member that needs to utilize their critical thinking skills to make that change. One thing I learned is that “To provide quality care in this environment, nurses need to develop critical thinking (CT) skills that will provide them with expertise in flexible, individualized, situation-specific problem-solving.” (Brunt, 2005, p.60) When I think of how some case managers use critical thinking skills, I become concerned. For example, I will share a story of a time that a social worker went out on a field visit with a nurse to a nursing home. The social worker had already informed the accompanying nurse that the member was non responsive and she will either sleep through the visit or have a blank stare. One of the first things the nurse noticed when she came in the room was that she had slipped in her hospital bed to the side. It is noted that the insurance company case managers do not do hands on care, so the social worker will have to let the nursing home staff know to readjust her.

Second the nurse accompanying the social worker noticed that she had a big bump on her forehead, she questioned the case manager but she did not know where that came from. The nurse quickly used her critical thinking skills to scan the situation and see that the member probably had slipped. During the nurse’s visit, she noticed that the member had too many pillows behind her back; she was a light weight and was slipping to the side about ready anytime to hit her head on the same spot with side rail. This led the nurse to believe that this was not the first time this had happened to this member. The nurse and social worker let the staff know on the way out of the member’s room.

However, in thinking about the list of 17 Dimensions of Critical Thinking in Nursing, a few critical thinking skills stand out in my mind for this situation that I was hearing about. When analyzing a situation, if the case manager is not a nurse who is used to doing head to toe assessments, would she have known that bump on her head was the result of the member falling sideways and hitting it on the side rail in the very same position that she was found in? If the social worker did not seek information from the nursing staff to ask about the bump on the member’s forehead and was only concerned for what is in the member’s chart, then she would not have the correct information to formulate a plan of care that will benefit that member. If the social worker could predict what would happen if the member continued sleeping sideways on the bed propped by pillows, then she would be using her critical thinking skills to avoid an incident. Transforming knowledge can only happen when you have a working knowledge on any subject. If you have not been taught how to do a physical assessment on someone, then you are not able to transfer what you were taught in a book to a real life situation that will require critical skills thinking to resolve a problem. (Rubenfeld & Scheffer, 2005, p. 2)

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

Written by Rosie Moore, RN, BSN, LNC

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Category Archives: Critical Thinking

Organizational Culture and Critical Thinking