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Management is an important aspect to any organization and in healthcare, it serves as a way of structure to maintain and accomplish the overall goal of proper patient care and satisfaction within the patient population as well as the healthcare team. There are many levels of management which can be correlated with a chain of command pertaining to the specific organizational system that the hospital uses. To begin with, a leader pertains to those who works with others in order to develop visions and obtain accomplishments pertaining to those visions. Management is defined as the role while leadership is defined as the ability. Leaders are said to be created through experience and management to be taught and learned. A health care facility that we tap into is the Veterans Affair and a current employee who works as a nursing informatics coordinator. As a nursing informatics coordinator her superior is the director of the hospital and she oversees the hospitals units collaborating with managers and staff members in order to preform her duties.
The Veterans Health Administration has as many as 1, 243 facilities including 172 Veterans Affair Centers and 1, 062 outpatient sites that caters to millions of veterans across the country. According to the Pee Research Center there were a reported 20. 4 million United States veterans in 2016 consisting of 6. 8 million from the Vietnam era, 7. 1 in the Gulf War era, 1. 6 through the Korean war, and 771, 000 from the World War II era. The Veterans Affairs across the country serve to follow a promise created by President Abraham Lincoln which is to “To care for him who shall have bome the battle, and for his widow, and his orphan” by serving and honoring those who are considered to be categorized as veterans of America. VA’s across the nation follow 5 core values which consists of integrity, commitment, advocacy, respect and excellence in order to provide satisfactory care to patients all over the country. The VA is reported to have above 9 million veterans enrolled in health care and has an estimated 320, 000 employees. According to the interviewee she stated that the VA nursing care delivery system focuses on the patient and families care where they are included in the decision-making process where the nurses are to provide reliable, efficient and constant care.
The structure of the Veterans Affair reflects a basic management approach of shared governance. “There are 128 VA acute care hospitals designed with similar foundational organizational structures and numerous shared governance implementations that provide an ideal sample for examining the impact of organizational context on shared governance structure and patient outcomes”. A shared governance allows for a strict focus on responsibility and accountability within the nursing staff. In this structure management and administration utilize their leadership skills in coordinating and facilitating work to the practicing nurses in the facility. Also, all staff must present an understanding in an educational aspect, experience in group collaborations, and conflict management in order to be successful. Being in a shared governance organizational structured facility allows for the nursing coordintator interviewee to promote participation by the patients, maintainence of patient care and safety through educatuion, training and communication techniques as well as one of the main goals of promoting innovation.
Nursing informatics (NI) is a field specialty that takes the components of analytical science in integration of nursing science to cover “the design, administration and support of computer and telecommunication system”. This position works on the evolution of electronic health records in order to enhance the coordination of care as well as increasing both the participation of patients and quality of care, improving the accuracy of diagnoses, health outcomes, financial savings and practice productivity (Benefits of EHRs, n. d. ). The goal of utilizing electronic patient classification systems allows managers to not only collect data but to have a proper budget planning as well as maintaining patient needs with proper amounts of resources. The art of being a nursing informatics coordinator is being able to utilize these tools, gather data, communicate the issues at hand and teach. As there are groups of age groups the two specific ones are baby boomers and millennials. The difference in these two groups in this scenario relies on the knowledge based on technology. With the evolution of technology, it is important for aged nurses to learn about updates and the way devices works in order to provide proper patient care. Nursing informaticists are able to provide that education and help in order to restore balance in their hospitals.
There are many factors needed to get the position of nursing informatics coordinator as you must have the educational degree as well as the clinical experience. Technology is a major aspect of the job as a lot of the devices used are needed to collect and communicate data. The interviewee was a graduate in the Philippines holding her bachelor’s in nursing and attended New York University with the intent of Master’s in Informatics. During her educational status in NYU she was part of a nursing staff in the medical-surgical unit for 10 years before pursuing a job with her attained master’s degree in informatics. She was considered for the position due to her outstanding experience with technology in the healthcare setting, graduating from a prestigious school, and her management experience as well. A big factor is the experience in the healthcare setting due to the constant understanding of nursing struggles revolving around errors in all aspects regarding technology and problems that may been faced in past experiences.
Nursing informaticist need to be able to utilize their clinical nursing expertise while integrating software applications in order to factor in electronic documentation issues that have a direct impact with patient care delivery. As the coordinator, the interviewee states that she must be able to encourage her staff to be involved with the evolution of the hospitals electronic documentation in means of allowing their ideas to be heard. An issue that she has been working for years is the use of barcode administration and how her staff nurses have been able to express problems revolving around the very tool that is used to eliminate medication administration errors. She allows for staff involvement due to their constant experience while she is able to gather data and notify her director. Currently, they are working on making all medication barcodes compatible to the barcode scanner. The problem that her nursing staff seem to face is the time being consumed by the compatibility issues of the scanners. Nurses have seemed to spend more time in the medication administration process at times when entering label numbers into the application due to some medications barcodes not being scannable. The other duty that she elaborates on pertains to the fiscal duty such as budgeting on what units may need as far as technology-based expenses and utilizations to improve care hospital wide catering to all units. Some devices may fail, some pieces of technology may have a space in the hospital she reiterates. Her duty includes having is to improve the hospital in a manner while staying within the budget and reporting off to her director of the possible implementation.
The main technology being used is the electronic medical records and devices that collect information in order to manage, interpret and communicate data that is acquired through the nursing procedural aspects. One of the main pieces of technology that the interviewee touched upon was the use of barcode scanners. The function of the barcode scanners in the unit is to one ensure the assigned patient’s identity is correct and that medication administration errors are reduced. Methods of patient identifiers, administering the right medication, and reviewing of laboratory results prior to administration is evaluated on the spot when scanning the patient’s wristband. According to research collected by the interviewee, there are even scoring methods pertaining to each nurse on their documentation of if medications are given within the allotted time of the hour before and after time frame. The data collected from the various pieces of technology allows for analysis, assessment, problem solving and implementation of ideas from the nursing informaticists.
According to the interviewee, as a nursing informatics coordinator she works directly under the director of the hospital. Any changes or implementation of new technology or ways of performing practice are to be reported to the director weekly along with other managers and coordinators in different departments. She uses the transformational leadership rather than the approach of a transactional leadership style. The transactional leadership style is defined as the superior figure in the organizational department is understood by employees to make the decisions without any input or ideas. As a nursing informatics coordinator, the interviewee believes that through the transformational leadership style, more input is given by her nursing staff team due to the ability of letting them voice out ideas and concerns. This is especially important due to the staff members utilizing most of their time around the technological aspects of the unit such as documentation or procedural aspects regarding patient care. The transformational leadership allows the leader to “enables others to act, which includes empowering people to believe that their extra effort will have rewards and will make a difference. A way that she was able to elaborate on a specific time that staff concerns led to a change in documentation was during the topic of pain management regarding the one hour time frame within giving a pain medication and the reevaluation of the pain intensity/the effects of that specific medication. Due to a poor result on staff feedback on pain reassessment, her and the nursing staff team waere able to discuss the problem in which pain reassessment was not being completed within the time frame of one hour after giving the pain medication or not documented at all. She hosts meetings, assembling the team in order to solve conflicts within the workplace by assessing the problem with the team, conjuring ideas as well as serve her opinions/ideas and implement those ideas while collecting data to see if improvement is made. An example of her implementing a team idea, was unit timers that went off with a log chart of pain medication given which would remind the nurse who preformed the medication administration to log on the time given and alert her when to check the reassessed pain intensity. This allowed for better staff preformace regarding this situation as their ideas were heard which makes them a part of the change.
Another conflict and resolution scenario she faced was the lack of nurses utilizing the barcode scanning methods during medication administration. In this case, she collaborated with all the managers of each unit in the hospital explaining the purpose of the use of barcode scanners and the benefits. She explained the lack of use of the barcode scanners by the nursing staff must be explained rather than abandoned. This led to unit managers exploring nurses insights on why procedural methods were being abandoned and afterwards ways that the nursing informaticists, managers and nurses can overcome concerns.
The American Nurses Association created standards which the hospitals’ staff much abide by to provide competent patient care. According to a journal published on American Nurse today, “The scope and standards of practice are authoritative statements on how the professional nurse should practice. They aren’t prescriptive; they don’t state exactly how to perform specific job tasks or functions. But they do serve as a guide on how to perform those tasks and functions competently”. There are a total of 9 provisions that are provided and are guidelines allowing staff members to identify what type of role they will play according to their occupation. The first provision focuses on the nurses compassion and respect in means of dignity and worth pertaining to unique persons. The second provison pertains to the intrests revolving around the patient, family groups and nurses, The third provision takes a look into the nurses duty of promoting, advocating, protecting the patient’s rights, health and safety. The fourth provision establishes that of the nurses authority, accountability and resonsibility while making decision and performing with the motive of providing optimal care. The fifth provision looks into the maintainence of competence of personal and professional growth as well as owing the responsibility of health/safety promotion not only to other but themselves as well. Provision six tells that follwing the specific guideline allows for staff individually and through collective efforts can improve the working place environement ethically. The seventh provision takes plays a role in the development, maintainece and implementation of professional practice through scholary research. The eight provision focuses on the collaboration of the healthcare team professionals in order to protect human rights and the protion of health diplomacy with the reuduction of health disparities.
Last but not least the ninth provision is the integration of values, integrity, and the principals of social jutice in nursing and health policies. According to the ANA Code of Ethics for Nurses, Provision 3 focuses on the promotion, advocacy, protection of rights, safety and health of the patient. A subtopic according to the ANA standard of nursing provision 3 is the 3. 4 Professional Competence in Nursing Practice which states, “Nurses must lead in the development of policies and review mechanisms to promote patient health and safety, reduce errors, and create a culture of excellence… Nurses must use the chain of authority when a problem or issue has escalated beyond their problem-solving ability and/or scope of responsibility or authority”. In this case the interviewee explained her role and the way this provision is implemented in her practice with the example of barcode scanning and the overall analysis of data in order to implement new policies to change the outcomes in patient care as well as the reduction of errors. The overall picutre is being covered where reduction of errors is achieved as patient is not only identifiable but laboratory results, vital signs and conditions are reviewed by the application prior to allowing the nurse to document medication given and actually giving medication. The overall job duty of analyzing data and the promotion of new policies favors the patients in protecting them from any harm as well as providing reassurance.
The nursing informatics coordinator is an important position for analysis of data collection and the change in policies supplemental to providing efficient patient care and the change in practice tailored to assisting the fellow nursing staff regarding the changes around technology. She must have the proper experience as a clinical nurse and the education to perform the tasks at hand efficiently and be considered for the position. This position requires the role of a manager and the leadership quality. Under the leadership and management aspect of the coordinator, they ensure all procedural aspects are followed correctly by the nurses to collect the most accurate data possible, teaching staff the uses of the technology, obtaining an analyzing data, while keeping in mind budgeting. They are able to train nurses hospital wide on the uses of applications and new devices being implemented to the unit as well as gain any insight on concerns staff members may have. The example provided by the interviewee was the medication barcode administration data collection and procedural outlook as well as well as any applications being utilized to improve work essentials such as communication. The informatics coordinator reiterates commands by the superior otherwise known as hospital director on timelines and goals that need to be met along with application changes to improve staff work efficacy and patient satisfaction.
Using her leadership style of transformational leadership theory, she is able to gain more insight and ideas while motivating her staff to contribute for the cause of improving communications, data collection and design regarding telecommunication systems. She was able to overcome conflicts within the units of the hospitals by tackling the problems with her staff team and implementing their collaborated ideas. Although all ANA provisions one through nine are considered a main one that she seemed to elaborate on was ANA provision 3. Through her leadership style she implements ways of promoting a better care of health needs in different aspects as well as her collaboration with managers of units and staff members. She works towards the development of policies and means of reviewing in order to promote patient health and safety while reducing errors. By creating a reviewing information and collaborating with team members, she is able to focus on the problems at hand and create new changes to improve the quality of care provided to the patient.
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