Module Title
Small Storm in my Unit
CONTENTS
Introduction………………………………………………………………………………………….2
Description……………………………………………………………………3-4
Feelings……………………………………………………………………….4-5
Evaluation……………………………………………………………………………………………5-6
Situational Analysis……………………………………………………………………………….7-10
Conclusion…………………………………………………………………………………………….10-11
Action Plan…………………………………………………………………….11-13
References………………………………………………………………………14
Introduction
Collaborative means a team of people work together as well cooperating with each other for the target. ( 2000) As (2002), comment teamwork is delegation and empowerment gives people a sense of being valued, feeling that their efforts are being acceptable. It seems an ideal picture, instead there are many barrier in command good collaboration among a team such as role and culture different, knowledge base and training are different, decrease of manpower , value of view are different or communication breakdown in the organization. (2002) All these reason might cause conflict between the team therefore; we need a strong leader as a head of the ship to guide the team cooperation. ( 1985) In organization, there is no individual work; especially in health care worker, we must work together as a team to provide safety services to our patients. Therefore, in the assignment I will use an issue as an example apply on Reflection cycle (1988) to explorer why we have conflict in the team and cause of working inefficiency in my working area (medical unit). Nurse are the largest group of professional in health services, team work between nurse to provide appropriate care and avoid harming to patient are the main concern. Thus, I will analyse my unit situation and find out if we have room to improve in team building and reduce cause of conflict, so that we have smooth shift work closely with patients 24 hours a day
Description
In the past, our unit cares the patient by use of team nursing system (functional nurse). It means one Registered Nurse (RN) in-charge the ward, one RN /one enrolled nurse (EN) as a partner to deliver medication for all patients in the unit and the rest of the nurse will care of the patient as a team. Most of the time, each nurse have to takes care about 8 to 9 case and we have one to two health care assistant in each shift. Usually we have seven nurses in morning shift, six nurses in evening shift and three nurses in night shift on 37-bed unit. The ratio of staff depended on the high-risk case ratio in the ward.
Few month ago, follow the change of the nursing administer we change the team nursing system to total patient care system. Which was one nurse (RN or EN) take care about 8-9 case from admission to offer medication, set up the infusion drip, dressing, make round with doctor, answering the call bell… One day, my colleagues was crying after duty and complains of too busy without support as she need to take care of two high dependency case. On top of that, she have another six case need to care, she just cannot manage and even do not have time for lunch. It make her feeling of lonely in the unit without support, she comment on that incident was that if condition no change than she will plan for resign. In this issue, I have the same feeling about that new system, it seems working in the factory without team spirit; each staff was busy to complete their own work without other support; after a long period, it becomes a routine and monotonous job without any challenge. Hence, I will explorer our unit situation and the poor team working among the staffs.
Feelings
On this issue, health care providers should maintain the level of competence and deliver safe quality care to our patients. Therefore, a good team work in the unit must well establish by collaboration between staff and manager so as the top leader. According to (1985), change cannot be too rapid and must be well inform to the staff about the new system because staff need time to adjust. At the beginning of the system start, everything seems out of control and feeling of mess. Such as we only have one medication trolley and 4-5 nurses get the medicine from one trolley. Even we have feedback to the manager and the answer was you just not familiar to the new system. The other point that I concern which is RN and EN role seems not clear and I feel not comfort and it is not fair to EN. Just (2002) pointed out that team members should understand each other’s role and specialize for the task in the organization. (1999) suggests that leader should try to co-exist in harmony with two groups of people. About team nursing and total patient care system, each system has their weakness and strength part. After a new system start, manager should ask for feed back and have adjustment to help team work smooth, this way can show administer were concern their staffs. As (2000) ask for feedback should have active listening and being open in encouragement but not criticism to staff, the last was argue to convince and not to win . I have an experience was some nurse are very busy but some of the nurse seems always busy in her job without help each other. The result will be fatigue and frustrated among the team members and feeling of unfair in job allocation, the outcome will be conflict among team can easily arise.
Evaluation
The system itself might create different kinds of problem, I am try to evaluate their strength and weakness parts between team nursing system and total patient care system.
Strength in team nursing can have good task orientate with arrangement that is more flexible such as when staff got sick, manager could easy to delegate job to other team members. As (2002) suggests teams working encourage flexibility, involvement and efficiency. Teamwork usually has good team spirit as a group of people working as well as a cooperating with each other in the task. In addition, teamwork can achieve cost-effectiveness especially in the private-health sectors. (2004) also mention consumers want the latest technology and highest- quality care at the lowest possible cost from their caregivers.
Weakness in team nursing were the responsibilities sometime may be not clear, as I mention above (RN/EN) role are not clear. For example, the new experience RN cannot manage some of the job than the old experience EN need to take over the job. Team nurse play a functional role in a group might have a limited understanding of patients’ needs. Furthermore, team nursing might limitation in staff development in management aspect as decision-making usually put on few nurse (2004) share decision making, empowerment is an essential element of the work.
Strength in total nursing care, patient will have good nursing care as nurse are full understanding of the patient’s needs therefore nurse can provide prompt service as patient required. This system also can establish a good relationship between nursing staff and patient so as their family. It contributes the communication skill and decision-making skill while caring of the patient. According (1999), job satisfaction is one of the intrinsic factor. As nurse understand patient‘s condition thus can give a clear handover report to the next shift in provide an effective continuity care.
Weakness in total patient care were time consuming if inadequate staff might leading to burnout, therefore my colleague crying after shift for the heavy workload. This system benefit on train the nurse about technique in solves problem independency. On the other hand, this system will limit in development of the relationship between colleagues because nurse handle patient all by her own. As a result, staff will lose the team spirit in the organization. Furthermore, nurse unresponsive to other patient’s needs might influence our customer services. For example, while that patient seeks for help, nurse might not handle what patient ask for, as she does not know the whole picture.
Situational Analysis
analysis (1999)
Political-In Hong Kong nurse training before 1997were base on academic and practical in few hospital with recognized by nursing broad for (RN and EN). After 1997, all EN training was suspended and RN training is back to University. Thus different nursing work together with different levels of knowledge or skills and the clinical experience background might have different value/view, as the result, it become a barrier in collaboration.
Economic- hospital was try to cut budget that staffs salary expend not over 47% therefore the shortage staff and over workload brings nurses are stress and fatigue. As (1999) economic is one of the 12 human needs, its will influence staff moral and lost the enthusiasm so as the sense of belonging. According to (2004), point out that health budget cuts will result in lower standard of service and poorer patient outcomes thus a threat to patient safety.
Social- personal differences when engaged in interacting with others require having different skill and talents indifferent situations. Usually, nurse has different cultural background, training, age, religions and educational background; hence influence the team working performance (2000) mention different culture might speak different ‘languages’ and it find hard to understand each other.
Technical-Due to our hospital expand its services in the procurement of new equipments in our unit and computerization system. Nurse should collaborate with other in operate the new equipments such as use the hoist to lift the over weight patient from one place to the other place. On nurse cannot manage some of the job and we should work with other to achieve that target. According (2004), mention consumers want the last technology and highest-quality care at the lowest possible need kindness and compassion from their caregivers.
Ethical- Each person have their value and point of view; once they work together, conflict might arise. We should respect other decision even I am not agree with other, therefore, collaboration might have barrier. There is no single formula for health care worker in caring of the patient; both patient and nurse have their right but respect each other can reduce conflict.
Legal- as a health organization, patient safety must put in first priority. Hong Kong is a city under legislation; hospital and health care worker have responsibility to ensure all actions have taken to prevent or minimize harm to patient. (2004) In the collaboration issue, legal aspect seems cannot total apply on it, only if under the reason of patient safety.
According to the (1981) nine types of personality, which include people with plant, resource investigator, coordinator, shapers, monitor-evaluator, team worker, implementer, completer, . As I know my colleague was a typical team worker, she need support and power but cannot take too much responsibility. Therefore, she was crying under stress in taking care of heavy workload. Each type of personality has its strengths and weaknesses, thus different situations will have different outcomes. In team nursing system and total patient care system, if manger knows the staffs strengths and weaknesses than delegate different task that leads to satisfactory outcomes. It was because both system cases was delegates by unit manager, the problem is manager assign case to staff sometime was not even and do not follow the team role, once the staffs have error occur our manager will blame the staff for any of the incident happen. Just like (2000), mention people want the praise for success, but not the blame for the failure.
In my unit, experience EN take care of high dependency case and new experience RN take care simple case were always happen. As the result, experience staff will be felling of exhaust to deal with heavy workload and new experience nurse will lost of chance in learning without job satisfactory thus destroy the relationship between staff (RN/EN). According to the (2005) mention four main type of barrier that include distrust to staff, unfamiliarity with staff’s contributions, aversion and attraction to staying busy. However, (2000) mention that delegating task to the staff must include delegate with authority, identify skill, evaluate and recognize the achievement, set up the objectives, ensure it is really necessary, monitor set the time frame and communicate with the colleagues……….. My manager did not empower the staff and not trust the staff might decrease team spirit so as the morale in the unit
In (1965) who identified the four main successive stages of group development and relationships, which are forming, storming, norming and performing . My suggestion was that good orientation program is an important step on develops team building as new staff would able to adapt to the new environment, have sense of belonging and feel familiar with staffs. Just like (2000) mention we must aware different languages and different interpretations and emphases in similar languages. Therefore, manager should help the new staff in go through each step until created structure and cohesiveness to work effectively as a team.
Conclusion
As one of the team member in the unit, I would like to work in the pleasure environment with my colleagues in well co-operated with other. Health care worker always work under stress, as we have to face live and death every days. To reduce stress among staff, nurse manger can play an important role in helping frontline staff by provide effective learning environment, establish the strategy of two-way communication between team members and the rest of organization, promote an open and fair culture, listen for the staff’s feedback and empower the staff in create job satisfaction. Each human need to and to be respect, manager knowing the staff strengths and weaknesses and able to empower the staff wound gain support and raise motivation in work. Just like my colleagues, once she make error than she will lost the chance to improve as my manager not delegate job to her; this way will contribute lost of self-esteem and sense of belong to the team. (2002) comment on success team, require empowerment, providing, autonomy in decision-making, establishing opportunities for training, resourcing the team, support and respect. On the other hand, team members should establish social relationship hence to keep humorous working environment. (2000) suggests five areas should improve in organization that includes affiliation, security, competence, achievement and power. These can help staff to build up the enthusiasm through success and create work that is more efficient. The aim of collaboration between health care worker was benefit to the patient and their family in provide the safety and efficiency service.
Action Plan
As we know that, no system is perfect and we can try to modify these two-system in helping staffs collaboration. My suggestion was that, if we have seven nurse on duty that include one unit manager to over see the unit situation; three nurse in each team that include one RN, one EN and one nurse assistant. Each nurse can still take care of their patient but they can help each other such as checking medication, answer the call bell while her partner was busy in other job. On the other hand, old experience nurse can assist or teach the new experience nurse to reduce the role delegate not fair in duty. Increase equipments as staffs request for user know what they needs and convenient to both staff and the patient.
Moreover, our organization needs to support the staffs by provide chance of training and continued education. According to (2000), providing staff education can achieve valuable benefits in improving staffs insight and ensure individuals value in their professional. (2005) pointes out that lack of professional development and training opportunities will lead staffs sense of job dissatisfaction and frustration, thus influencing the quality care to patient. In other author (2005) mention, that knowledge will provide varying goals for the professional’s value and the foundation in role of change. Continue education can improve our knowledge base while apply on our nursing practice we can gain experience thus increase our confidence in work so as self-esteem and job satisfaction.
(2000) mention about shortage of nursing staff and increase of workload could cause miscommunication among team working. Both (2002) and (2000) have mention about effective communication mechanisms is an essential for team building. (2000) suggests four communication skills including encouragement and criticism, active listening, being open and argue to convince, not to win. Using the issue of my colleague, if she cannot manage the heavy workload, she should inform the manager to make better arrangement and the manager should listen to the staff and give support hence to collaboration each other in run the smooth teamwork. Therefore, no matter formal or informal communication between team members and manager so as the organization should well establish.
The last, (2000), points out that people are able to feel proud of belonging to the team; the most important principle of all in successful team is through respect. We can support by team empowerment, providing autonomy in decision-making, establishing opportunities for training, listen for the staff feedback, and try to make change if possible to gain a win-win outcome. (2000) also mention trust and respect will make the team grow. Just like the change of team nursing to total patient care system, manager should listen to the staffs’ feedback regularly to make plan in adjust the system so that we could work together in harmony environment.
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