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Nursing: Case Scenarios

Nurse Resignation Scenario

The nursing profession in the health care industry is facing a continued decline, and this poses a major problem in the years to come. Many nurses, both new and seasoned professionals, are leaving the nursing profession to seek new careers elsewhere. From the case of Nancy, who is an emergency department nurse manager, many nurses in her department state that the reason for resigning their position is in “feeling some level of powerlessness”. It is combined with a tendency towards poor morale in their work as well as high turnover of nurses. In fact, nurses are expected to be caregivers in health care institutions. However, lack of good care for nurses has also caused the increased decline in the number of nurses in the nursing industry. The dire situation of nurse resignations could be approached through understanding the causes of the trend, thereby finding the best solutions to ensure increased nurse retention.

There are various issues in Nancy’s emergency department that lead to the creating of feelings of powerlessness among the staff. For instance, poor management is a major problem that demotivates nurses in their workplaces. Many health care institutions in the US, for example, are inadequately staffed. Although assigning nurses more tasks is common, giving them other duties outside their profession often affects nurses emotionally. Another issue concerns the ability to move up the hierarchy. The nursing profession does not offer chances for individuals to be promoted to higher ranks due to the high qualification needs for promotions, i.e. having a master’s degree. For nurses who have worked for over 10 to 20 years, it may be hard to return to class, thereby leading to the creation of feelings of powerlessness and poor staff morale. The issue of having a reduced number of nurses in the profession may also lead to nurses having to work for longer hours with the promise of overtime remuneration. However, financial reimbursement for nurses does not improve the situation as they may suffer from fatigue and work burnout. Burnout in the emergency department may be the reason why many nurses are resigning or having a poor attitude towards work.

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The emergency department unit where Nancy works as a nurse supervisor may be affected by various group issues, leading to the increased rates of nurse resignation or lack of morale in their job activities. Thus, the facility needs to ensure it institutes policies that will empower nurses. Nancy, for instance, should facilitate change in the emergency department unit to ensure nurses do not resign or feel demotivated. Hereby, some of the sources of power will include structural and psychological empowerment. Structural empowerment involves the provision of opportunity to nurses to advance in their careers. The emergency department unit manager should spearhead the changes to ensure equal chances are given to all nurses to develop in their careers. Structural empowerment also includes access to resources needed in their practice. If nurses are assigned to lesser shift hours, the rate of care given would be increased compared to longer hours that put nurses under pressure. Psychological empowerment involves the provision of an environment that will ensure the emotional status of nurses is kept stable. For instance, many nurses are stressed after being assigned many tasks outside their nursing profession such as cleaning rooms and paperwork. Thus, the reduction in endless tasks can provide a healthy work environment to ensure stable emotions.

Most of the issues leading to nurse resignation or lack of workplace morale are considered psychological. Hereby, the issues can be improved by nurse behavior change as well as the management’s provision of favorable working conditions to ensure nurses are empowered. In the case of Nancy, working in the emergency department unit as a nurse manager, there are various methods she may use to empower the staff. For instance, she should spearhead stress management programs for nurses to ensure they do not become exhausted from the job pressure. Most nurses who work overtime are motivated by pay. However, they overlook the fact that working for longer hours in shifts could have adverse effects on their performance and morale. Nancy should, thus, encourage the staff to take a rest during vacations and not engage in overtime work. Nancy could also institute various control measures to retain their workforce. Some of the effective monitoring measures would include the reduction in the shift hours by employing more nurses to the emergency department unit. Thereafter, more nurses will reduce the strain in the emergency department, hence less shift hours. Another control strategy will include the reduction in the qualification standards for promotions to ensure upward mobility. Hereby, this will encourage nurses to have hopes of getting promotions to higher levels in the management hierarchy.

In all, there has been an increase in nurse resignation trends in the recent past. Research in the US indicates that the decline in registered nurses due to quitting and other reasons will translate to a shortage of over 500,000 nurses by the year 2025. Various reasons make nurses feel powerless, as demonstrated by the case from Nancy’s department. Some of the reasons, however, can be controlled. For instance, lack of opportunities to be promoted in the management hierarchy can be controlled by reducing the qualifications for promotions. Also, on the issue of loss of morale by nurses, the improvement of the working environment for nurses could help reduce the work stress, thereby motivating workers. Reduced shift hours can also be used as a control measure to lower staff stress.

Workplace Scenario Policy Changes

Workplace policy changes are common for the better management of organizational activities. In fact, the establishment of policy changes takes into consideration various issues in an organization. Some of the issues include employee reaction to new changes, the impact of changes on the administration and the legality of the policy change on the basis of the regulations governing the activities of an organization. Taking into account the case scenario of the magnet facility governance model, the organization plans to implement the eight-hour shift policy. As a representative to the council meeting, there are various information issues that I will need to obtain from the employees, the management, and the legal councils concerning the planned changes.

Before the policy-making meeting, there are various information issues that I could obtain from the staff to ensure proper representation. For instance, there is a need to consider the effect of the new policy on the nursing staff. The effects could be measured regarding individual effectiveness after working for more than eight hours. Due to the fact that longer hours impact on the performance of nurses, it would be reasonable to consider changing the policy. The other issue is to consider the cost-benefit analysis of the policy change to the nursing staff from the magnet facility unit. Often, working for longer hours earns nurses overtime pay, and this acts as a motivation since most individuals in the profession consider themselves as being underpaid. The employees who will be eager to work for longer hours motivated by the overtime pay will need other motivations such as increased pay to ensure better patient satisfaction and reduced medication errors. Employees’ expectations of the policy change are also critical information that needs to be considered before implementing policy changes. It is common to experience fatigue and boredom after working for longer hours; thus, the reduction of working hours should be a motivation for the staff leading to improved patient satisfaction. Thereafter, if the team is excited by the new policy changes, then the plan would succeed in its objectives. However, if patient de-satisfaction and medication errors are not as a result of staff working for longer hours, the team expectations of improvements will be low, hence no need to change working hours policy.

Apart from staff information, I would also need to acquire information on the impact of the proposed change on the administration. The managers of the facility will be responsible for the implementation of the new policy. Thus, there is a need to understand concerns that the policy will have among the staff and the stakeholders, i.e. patients. Since the proposals for policy change are grounded on patient satisfaction, information on the management’s expectation of improved experiences will help support speedy implementation of the plan. The management is also responsible for ensuring staff satisfaction which in turn will lead to patient satisfaction. It would, thus, be important to consider managerial expectations of the new changes’ effects on staff satisfaction. The new policies should not be biased against a particular group of staff, i.e. due to gender, age or presence of disability. Lastly, I would also need to seek information on the legality of the new policy with regard to employment standards and the collective agreements within the facility. Eight-hour shifts are legal due to the employment standards; however, if there is collective agreement within the facility that allows staff to work overtime for additional payments, then it would be necessary to explain the need for the change to the staff.

Shared governance is a form of management when the role of decision-making is shared among the members of a unit. Shared governance in the nursing profession is instrumental in ensuring equity, accountability, partnership and ownership of work within a unit. Shared governance plays a significant role in facilitating policy change within a health care institution. For instance, the inclusion of staff nurses in the process of decision-making eliminates the managerial role of the administration giving each nurse responsibility to ensure patient satisfaction. Being included in decision-making will help in reducing the chances of feeling powerless or loss of morale. The need to change workplace policies is to ensure patient satisfaction in a health facility. Apparently, using shared governance helps change the staff behavior and attitudes towards particular activities and patient care operations. It becomes the responsibility of staff nurses to ensure patient satisfaction, as opposed to management which makes the staff feel powerless and often overworked. Shared governance improves the relationship between the staff and the management, while promoting workplace changes that are favorable for both parties. Regular discussions through meetings help remove communication barriers that might be between the staff and the administration, paving the way for respective agendas.

In all, policy change in an organization is necessary to provide improved care. However, it is vital to consider other issues such as the effect of the policy changes on employees, managers, and stakeholders. Shared governance is important to improve nursing working conditions. It involves including the employee staff in the process of decision-making. Shared governance is effective in precipitating policy change as it takes into consideration various changes in both parties, i.e. the staff and the management. Shared governance challenges the management through improved communication and form of management strategies used, thereby fostering policy change.

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