Tag Archives: Rosie Moore

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.

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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.

nurse-leader team

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.

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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

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.

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Stressed Businesswoman Working In Office

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.  Time-Mgt-shutterstock_104666783

 

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)

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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.

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

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Written by Rosie Moore, RN, BSN , LNC

 

 

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)

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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.

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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..”

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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

Why Do Nurses Become Complacent

A question arose from the Article called ” Challenges That Parents of a Preemie Face”

Question from Reader:

Why do you think that some nurses even myself become complacent to what is happening in our work environments and that we do not always critically think outside of the medical treatments we provide?

Answer to Reader:

Thank you for reading the article “Challenges That Parents of Preemie Face.” In answer to your question, nurses and healthcare staff become complacent in their environments because it is a job and the passion is lost allowing the nurse to move through the motions.  We are all guilty in many professions, not just nursing, of treating people matter of fact and we forget it may be our hundredth experience, but it is their first experience, no matter what the experience is. When we approach any person, especially in our nursing experience, we have to approach them with kindness and passion. We as nurses cannot continue to eat our young and continue to treat our patients as if we need to move on to our next task. Our body language, tone of voice and facial expressions, give away our genuineness.  We are all busy, but we have to put that aside and go back to compassion and empathy, thinking about how we want to be treated in this situation if we were in it.  We have to utilize our critical thinking to see what level of care that parent needs to get through this situation at hand.

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Written by Rosie Moore, RN, BSN, LNC

Challenges that Parents of a Preemie Face

In the Neonatal Intensive Care Unit (NICU) there are challenges that parents face when they are getting ready to be discharged to the home.  The parents are asked to bring a car seat to the hospital to test if the baby is able to sit in the seat and travel safely home without complications.  The parent is then asked to room in one night in a different room, with equipment that they will be using in their home, for example pumps for tube feeding, oxygen monitors as well as the medications that the baby is to receive.  The parents are given a brief lesson on how the equipment works, as it will be what they use at home. The nurses let the parents know that they are a call bell away and they are left there to run the NICU for their baby for one night.

People - Baby Sierra

The underlying assumptions of these issues are lack of confidence to be able to take care of the baby, not enough information to really understand what all the machines do and a lack of practice time. Regarding this population, parents of premature babies, the argument that is most often heard is the parents have been in the NICU watching the nurses for the last 5-7 months as they take care of their infant.   The reality of the argument is that yes, the parents have been there for 5-7 months however, they have been focusing on bonding and healing from their own wounds both physically and emotionally.  When they go see the baby, they only want to bond and see their baby get well so that the baby can go home.  They are not focused so much on how they are going to take care of the baby when they go home because in their hopeful minds, they are hoping for the best that the baby will go home without any equipment.  These arguments that the hospitals state are factual when they state that they give parents the opportunity to learn and this is enough for them, in my opinion are not factual.  The truth be stated, more education is needed geared towards the parents and the home life.

An alternative to sending the parents of premature babies with pamphlets on the care of each equipment and to call the pediatrician if they have any questions, would be a personalized discharge plan that starts during the stay of the baby.  A discharge teaching planner that only works with the families when they are going home would be beneficial.  Every parent should receive a binder when discharge planning is being talked about.  This usually happens about a month before the baby is even ready to go home.  This is the time when neonatologists are deciding if the babies are ready to go home and what they will go home with.  Instructions with pictures in easy to understand language should be placed in the binder with one instruction tabbed for each piece of equipment, for each treatment and for the medications.  This will allow the discharge planner to start preparing the parent of the possibilities of what to expect in the home.  The next step is to get the parents to practice with the NICU nurse and respiratory therapist on how to do the various treatments and care for that baby.  Allowing the parents to watch the nurse and return demonstrate the treatment as they will be doing at home, referencing the instructions from the binder and allowing them to ask questions and write down notes that will help them remember something would be helpful.

There are many types of learners and we as a population of nurses have to allow people to learn in a style that they feel comfortable in order for then to be successful parents taking care of their baby.  The personal connection that I have to this population is that I am one of those parents that had a premature baby.  My son was born at 27 weeks, 1lb 10oz.  He stayed in the NICU for 5 months.  I was very involved in my son’s care and status as a nurse, but there were many times that I was a mom first.  The night that my husband and I roomed in, we were overwhelmed, we did not sleep with all the monitors beeping, alarms sounding for feeding and treatments needed.  I thought to myself, this is very stressful even for an experienced nurse like myself.  During my NICU stay as a parent I mostly cared about bonding with my baby and having him discharged to home as soon as possible. This is one of the reasons that my husband and I started a 501c3 charity organization called The Gift of Life.  “The Gift of Life offers hope, encouragement and support to parents of premature babies and neonatal intensive care units.”(The Gift of Life, n.d., p. 1)

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“Knowledge is followed by comprehension, the ability to grasp the meaning of material and exceeds the knowledge level. Comprehension is the lowest level of understanding. Application is the next area in the hierarchy and refers to the ability to use learned material in new and concrete principles and theories. Application requires a higher level of understanding than comprehension.” (Robert & Petersen, 2013, p. 85)

 

 

Robert, R. R., & Petersen, S. (2013). Critical Thinking at the Bedside: Providing Safe Passage to Patients . Med Surg Nursing, 22(2), 85–93. Retrieved from http://search.proquest.com.library.capella.edu/docview/1350295511?accountid=27965

The Gift of Life. (n.d.). http://www.thegiftoflife27.org/

Facbook page  https://www.facebook.com/rosiesnursecorner/timeline

 

Written by Rosie Moore, RN, BSN, LNC