Nursing Practice Management.
Consider the Care Management Systems in a Care Setting.
The purpose of this report was to analyse the management systems on a Urology ward. The report explored four key areas, very briefly due to the word constraint. The four key areas were managing the service, managing people, managing resources and managing information. The ward staff were fully committed to the team nursing approach to care delivery and this facilitated efficient and organised care delivery. The report concluded that care was patient-centred and that teamwork was integral to providing this care.
The objective of this report was to consider and analyse the core management systems on a Urology Ward. This report has been written for the assessment of the author’s progress on the Diploma in Higher Education in Nursing course and has been requested by a lecturer at the University of Central Lancashire. The available resources utilised by the author for this report included the Urology ward where the author spent eight weeks on clinical placement, the staff on this ward, the internet, relevant managerial textbooks, journals and lecture notes. The main limitation was accessing the resources on the ward as it was a very busy surgical ward, with medical outliers, and it was difficult for the author to take time to access the resources. However the author managed to spend some valuable time with the ward manager and discuss some management issues and observe the different members of the team in carrying out their duties.
1.1 Management Theory (Literature Review).
Businessballs.com (2002) argues that Douglas McGregor was an American social psychologist that proposed the ‘X-Y’ theory of management and motivation (see appendix one). McGregor (cited by BOLA, 2002) describes the ‘X-Y’ concept as the theory that underpins the practices and attitudes of managers with regard to their employees. Huber (2000) states that theory ‘X’ managers assume that employees are lazy, that they dislike responsibility, would rather be directed, oppose change and desire safety. Theory ‘X’ implies that employees are rational and easily motivated (either by money or threat of punishment); therefore managers need to impose structure and control and be active managers (Huber, 2000).
Huber (2000) asserts that the opposing theory, (‘Y’) assumes that people are not lazy and unreliable by nature rather that they are self-directed and creative if well motivated in order to release their true potential. Businenessballs.com (2002) asserts that most managers are inclined towards the ‘X’ theory and usually obtain poor results whereas managers who implement the ‘Y’ theory produce better performance and results thus allowing people to grow and develop (Businessballs.com, 2002).
1.2 Care Delivery Approach. (Team Nursing).
Kemp and Richardson (1994) argue that organisation of care should reflect the needs of patients and the beliefs of the nurses and the commitment of the trust or unit to give a quality service. The RCN (1992, Kemp and Richardson, 1994) assert that team nursing is rooted in the principle that a small group of nurses can offer a higher quality of care than if they work in isolation. The RCN (1992, in Kemp and Richardson, 1994) go on to argue that team nursing utilises the skills of all the members of the team so that the patient receives the optimum care available.
The Urology ward implemented team nursing because they felt that that their patients received the best possible degree of care from many different members of staff at any one time, instead of restricting care to a smaller number of nurses. The ward also argues that all staff are aware every patients condition using the team nursing approach for the delivery of patient care and are therefore competent in the provision of consistent care for the duration of the patients stay on the ward.
2.0 Managing the Service.
Organisations exist for a purpose. Marquis and Huston (2003) argue that the purpose or mission statement is a declaration ascertaining the rationale that an organisation exists and its potential plan or purpose. This declaration establishes the organisations views, ethics, codes and standards of practice (Marquis and Huston, 2003). The corporate purpose of the Trust where the Urology ward was based was...
to ensure individual needs are met by caring staff, who continually strive to develop and deliver an efficiently managed, quality service.
According to Marquis and Huston (2003) the mission statement impacts on the development of organisational philosophies, aims, intentions, practices and regulations. The overall vision of the Urology ward’s Trust was to "be the leading provider of health care to local communities" and this influenced the lower levels of the trust such as the Urology ward. Following on from the Trust’s purpose statement and vision were three basic values that were fundamental to the success of achieving its purpose. The first value was that the trust recognises that their patients are individuals and have a right to respect, privacy, dignity and choice. The second was that everyone working as a team in the Trust is vital to its success.
Finally the third value was the Trust’s services were the end result of their efforts and they should be focused on meeting patient requirements. At the time that the author was working on the Urology ward there was no ward philosophy available as the ward manager was updating it, however it was observed daily that the core values of the Trust were implemented. Teamwork was at the heart of the ward and was important to all of the staff on the ward. It was also evident that patients were treated as individuals and patients privacy, dignity and choices were always treated with respect and nursing care largely focussed on the patients need and requirements.
According to Kemp and Richardson (1994) one of the disadvantages of the team nursing approach to care delivery is that task allocation may occur. Tappen (1995) argues that task allocation is a means of delivering nursing care, which is based on the distribution of work like a factory assembly line. Tappen (1995) argues that care can be fragmented and detached, impersonal and technical. On the Urology ward the staff did implement task allocation, however the nursing care that the patients received was not detached or impersonal. The nursing care was skilfully organized, individualised and holistic.
3.0 Managing People.
According to Marquis and Huston (2003) it is the manager’s responsibility to ensure that staff are properly socialised and trained to facilitate a united and effective team.
3.1 Leadership and Supervision.
Marquis and Huston (2003) argue that there is a lack of consensus regarding the definition of leadership therefore attention should be on the roles that are intrinsic to leadership such as decision maker, communicator, facilitator, mentor, advocate, diplomat, role model and so on. One of the components of team nursing is that there should be a team leader. According to Kemp and Richardson (1994) this a nurse who is responsible and accountable to the ward Sister for the care given to a group of patients and who has leadership and some managerial skills. The team leader takes advantage of the particular skills of the individual nurses in the team, ensures junior members of the team are supervised and given learning opportunities (Kemp and Richardson, 1994).
The team leader on the Urology ward was identified at the start of the shift and this was usually an E grade nurse or above. Sometimes, it was not always possible for a senior nurse to be allocated team leader therefore an experienced D grade nurse was allocated team leader. This could be done as long as it is not for more than eight hours a month, anymore than this and the nurse should be paid as an E grade staff nurse. As argued by Kemp and Richardson (1994) it is the team leader’s responsibility to ensure that junior members of the team are supervised. On the Urology ward it was the team leader’s responsibility to supervise the staff in their team, delegate patients and tasks to team members and ensure that the team carries out their duties safely and competently and provided optimum nursing care.
3.2 Staff Development.
Marquis and Huston (2003) argue that it is the manager’s responsibility to maintain competent staff and assess staff learning needs. Marquis and Huston (2003) also argue that the degree of knowledge and abilities of staff are fundamental issues in influencing the number of staff required to implement the goals of the ward. The availability of further training on the Urology ward was dependent upon what the training was. There were mandatory courses available to all members of the team such as manual handling. Funding was also available for courses, which would benefit the ward; for example if there was a course about breast cancer it was unlikely funding would be granted, as it was a Urology ward. The ward manager held annual staff appraisals for all members of the staff whereby learning requirements could be discussed and development plans could be devised.
4.0 Managing Resources.
Marquis and Huston (2003) argue that limited resources and increasing healthcare costs have pressurised all healthcare delivery systems and they need to function more cost effectively.
The ward manager on the Urology ward did not control the ward budget, however it was a major part of her role to ensure the ward ran cost effectively with the highest quality of patient care and only had a limited input into the financial planning. Marquis and Huston (2003) argue that ward managers should have the knowledge to manage expenditure.
4.2 Skill Mix.
Marquis and Huston (2003) argue that staffing tasks start with planning because the philosophy and financial resources of the organization impacts on the mix and numbers of staff. Another advantage of team nursing according to Kemp and Richardson (1994) is that it is an efficient method of organizing the qualified that are available. Whilst working on the Urology ward the ward sister gave the author the task of compiling a duty rota for one week. The sister gave the author one G grade, working full time, (Monday to Friday only), one full time F grade, one full time E grade, one full time D grade, one D grade working a thirty-two hour week and two full time A grade auxiliary nurses. The author had to take into account skill mix, continuity of care and three theatre days. Skill mix is important.
The author tried to work the rota so that there was at least an E grade staff nurse left in charge of the ward. The author also tried to ensure that at least one staff nurse who was on a late shift was on an early shift the following day to ensure continuity of care and ensure sufficient staff for the theatre days. The author also avoided the use of the F grade on the weekend shifts in order to save money. The author found that devising a duty rota was an extremely difficult task.
At the time that the author was working on the Urology ward the trust was piloting a Housekeepers role on the ward. The Housekeeper was a full time post, Monday to Friday, working alongside the early shift. The Housekeeper, among her many duties gave breakfasts to patients, assisted with bed making, made and distributed patient drinks, assisted staff to distribute lunches, order supplies for the ward, and so on. The Housekeepers role was priceless as it freed up a lot time for the nurses and health care assistants to give total, hands on, patient care.
5.0 Managing Information.
The management of information on the Urology ward was by either verbal or written communication. Marquis and Huston (2003) argue that communication is vital for flourishing management.
5.1 Written Documentation.
Marquis and Huston (2003) argue that written communication is employed most frequently in big organisations and can include policies, procedures, events and changes. On the Urology ward there were numerous pieces of everyday information that were vital to the management of the ward, such as Kardexes, care plans, waterlow scores, fluid balance charts and so on.
5.2 Verbal Communication.
Marquis and Huston (2003) argue that good verbal communication skills are vital for management. Verbal communication was very good on the ward, not only with the manager and team leader communicating with staff, but communication between staff and staff and patients and their families. Not only was there a patient handover at the start of the shift but also frequent feedbacks and updates regarding patients throughout the shift, which the author found very useful.
In conclusion the management systems in place on the Urology ward were very efficient. Care was always patient-centred and the team worked as a team. The ward manager appeared to be a Theory ‘Y’ manager and produced good performance and results from the staff and allowed staff to grow and develop. The team nursing approach worked very well and all staff were committed to it. The team nursing approach facilitated very good communication with the team.
BOLA, (2002) Douglas McGregor – Theory X and Y. http: www.sol.brunnel.ac.uk/~jarvis/bola/motivation/mcgregor.html.
Businessballs.com, (2002). Douglas McGregor – Theory X and Theory Y. http: www.businessball.com/mcgregor.html.
Huber, D. (2000). Leadership and Nursing Care Management. 2nd Edition. Pennsylvania: W.B. Saunders Company, pp. 152-153.
Kemp, N. and Richardson, E. (1994). The Nursing Process and Quality Care. London: Edward Arnold.
Marquis, B.L. and Huston, C.J. (2000). Leadership Roles and Management Functions in Nursing. Theory and Application. 3rd Edition. Philadelphia: Lippincott Williams and Wilkins, p. 12.
Marquis, B.L. and Huston, C.J. (2003). Leadership Roles and Management Functions in Nursing. Theory and Application. 4th Edition. London: Lippincott Williams and Wilkins.
Tappen, R. M. (1995). Nursing Leadership and Management. Concepts and Practice. (4th Edition). Philadelphia: F.A. Davis Company.
Waters, A. (2003). It’s All In The Mix. Nursing Standard. 17, (23), 14-17.
Furlong, S. and Ward, M. (1997). Assessing Patient Dependency and Staff Skill Mix. Nursing Standard. 11, (25), 33-38.
Jones, A. (2001). The Influence of Professional Roles on Clinical Supervision. Nursing Standard. 15, (33), 42-45.
Martin, V. (2000). Effective Team Leadership. Nursing Management. 10, (5), 26-29.
Martin, V. (2001). Managing an Information Flow. Nursing Management. 8, (5), 34-37.
Martin, V. (2001). Managing an Information Flow. Nursing Management. 8, (6), 28-31.
LMcGibbon, G. (1997). The Ward Sister/Charge Nurse as ‘On-Site’ Manager. Nursing Standard. 11, (36), 34-37.
Moiden, N. (2003). A Framework for Leadership. Nursing Management. 9, (10), 19-22.
Webster, J. (2002). Teamwork: Understanding Multi-Professional Working. Nursing Older People. 14, (3), 14-19.
Source: Essay UK - http://www.essay.uk.com/coursework/nursing-practice-management.php