Discussion: 2 responses

Apa format. 1 paragraph for each discussion. 2 references are needed. scholar authors only.

Discussion 1:

The staff nurse is the final stop between an error and the patient. The staff nurse implements care plans to promote patient safety and it is their responsibility to educate that patient and their family to ensure a safe stay. For this to happen a culture must be in place that promotes safety and quality of care. The three levels of organizational culture can be implemented at each individual unit as well as the hospital level. These three levels of culture include: Observed culture (that what we see to imitate), shared values (individual awareness of the organizational values and their value to practice), common assumptions (shared experiences that cause groups to take knowledge for granted) (Spath, 2018, Chapter 12). My organization is very passionate about their “pillars” (shared values) that the organization are founded on. They incorporate them into all training sessions and do a reflection on what pillar best suits the training happening that day. Given that training is a big part of our culture the pillars are strongly a part of the culture and why we are not running into the common barrier of EBP use in our facility. I had not considered that the culture of shared values leads to increased use of EBP, but I am finding that not all facilities are strong at using EBP (Ost et al., 2020). This culture has been beneficial to pushing me to further my education and always look for changes to benefit patient safety.

          Leadership in my hospital has changed hands about three times in four years. I have not heard much from our current CNO as she just took over about the time covid-19 hit our area. I can say she has worked hard to ensure our safety at bedside by getting funds to acquire new PAPR’s as ours were so outdated there were no parts available any longer, including the HEPA filters. Finkelman describes the style of leadership I have been seeing during the pandemic as “team leadership” (2016, Chapter 1). This type of leadership is both concerned about productivity and morale. The willingness to understand that the two are intertwined in stressful situations is essential at this point. It was brought up to the prior CNO that we had outdated equipment and were met with resistance to replace it since, “it still worked” even though we could no longer prove it was providing protection. This caused several people to leave once the pandemic hit as they felt their lives were not worth risking. The current CNO looked at the equipment and authorized emergency funds to provide the ICU with current equipment, albeit not top of the line it can be tested and parts replaced.

          I never want to personally be in a situation that requires me to be responsible for an entire unit nor an entire hospital. I am grateful for those that wish to pursue management and have the minds that can do the thought processes to weigh benefits, risks, and financial responsibility. The only thing I can think of doing to increase our facility to a higher performance is looking at management and who covers whom. The director of ICU also is the director for ED and we often get overlooked in the ICU for budget and required gear when the ED gets first pick at new procedure items and gear. This leaves the ICU feeling left out of the loop, and we often are. This happens at other levels in the hospital as well and it is bad for retention as well as staff morale.

Discussion 2:

The role of the staff nurse is endless, staff nurses are med passers, house keepers, patient advocates. Nurses assess a patient and sometimes are the first ones to rise a red flag to the providers when something is not ok with the patient. Nurses are social workers; we examine the need for services in the community to support the patient and the family after discharge. Nurses are educators, we explain medications, treatment, and disease processes. And the list goes on and on.

The role of the staff nurse for promoting quality in a high-performing healthcare organization is broad. Staff nurses are the base of any healthcare organization functioning. The Joint Commission’s defines a high-reliable organization as an organization that achieves high quality and safety standards (Yoder-Wise, 2019). Nurses have an important role in the quality management process because they provide direct care to the patients, nurses are in charge of the day to day monitoring of patients changes and they are the base for safe delivery of care (Yoder-Wise, 2019).

The healthcare organization I work for is Denver Springs Behavioral Hospital, I am please to say that this organization promotes a Just Culture. The Just Culture concept promotes transparency, collaboration, and accountability within staff (Bashaw & Lounabury, 2012). This blame free reporting system, promotes honesty between staff members and management, early coming forward with an error decreases the chances of negative outcomes and promotes a safe work environment. Our managers consider an error as a teaching moment and not a punishment situation.

We experienced an upper management change at the beginning of this year, our DON and CEO are new to the facility. They started several positive changes in our hospital new computer to every unit because ours were old, implementation of charge nurses in each unit to increase organization, and self-scheduling to increase flexibility and decrease call-offs. Looking in retrospective, I can affirm that our upper management is not afraid of changes that require financing support.

There is always something we can do to improve our organization performance. I am one of the unit charge nurses and some of the strategies I have been implementing to promote higher quality of care are:

- Help other units with admissions when they are getting more than one at the same time, to decrease the waiting time of the patients in the intake hallway.

- Train new nurses on the medical detox protocols to promote safe assessments and interventions for our chemical dependency unit patients.

- Keep all forms organized and stocked to increase staff compliance with documentation.

- Go to the intake hallway and assess at risk detoxing patients (like benzodiazepine and alcohol detox patients) and medicate during the intake process to decrease the rate of seizures within the facility.