The Organizational Unit
This paper examines the provision of nursing care in the Recovery room of the Doctors Hospital at Renaissance in McAllen, Texas. First, a description of this unit based on the Systems theory model will consist of a description of its input, throughput, output, cycles of events, and negative feedback (Meyer & O’brien-Pallas, 2010).
In this regard, the inputs in the recovery room include the nurses who monitor the patients’ vital signs and conditions; the patients who have come from surgery; the devices and equipment used for monitoring the patient’s condition (e.g. a pulse oximeter; a sphygmomanometer; a stethoscope; and others); the supplemental oxygen that may be administered to the patient if their oxygen saturation level is too low; and the intravenous fluids that may also be administered to the patients. In addition, the budget or funds that are allocated to the recovery room would be considered among the inputs, as well as any information (e.g. technological advances or new evidence) that may be used to improve the quality of care provided in the recovery room.
On the other hand, the throughput involves the patient monitoring activities conducted by the nurses as well as any interventions they may perform in the event that the patient’s condition or vital signs become unstable while in the recovery room. The output includes the stabilization of the patients’ vital signs, which enables them to return to their rooms (i.e. for inpatients) or to go home (i.e. for outpatients).
The cycles of events include the revenue gained from the services offered and the achievement of criteria for accreditation. The hospital is currently at trauma level 1 and aims to become a magnet hospital. As for the negative feedback, this includes the declining performance levels in some of the nurses as evidenced by increased absenteeism, reduced quality of care, and the failure to strictly comply to procedures. Examples include the failure to conduct a thorough assessment of the patient’s condition, a failure to communicate some important information to fellow nurses and to other pertinent healthcare professionals, a failure to document all of the information that requires documenting; and a failure to act as patient advocate
A description of the problem in the recovery room of the Doctors Hospital at Renaissance using the Systems Theory model indicates that the input involves a shortage of nursing staff. The throughput includes uncertainties when the number of patients outnumbers the nurses; the coordination mechanisms that may become ineffective during times of nursing staff shortage; a stressful environment that results from the nursing staff shortage; and the disempowerment that nurses may feel when they have too much workload, which prevents them from delivering quality care. The output may include customer dissatisfaction, reduced revenues, reduced quality of care, decreased level of job performance, and reduced employee satisfaction.
The desired outcome for the proposed solution is to have a lower nurse-to-patient ratio in the recovery room, which ensures that the patients receive quality care. This also ensures that the nurses are assigned a manageable workload, which increases job satisfaction and decreases the employee turnover rate.
Goals and Objectives
The following are the goals and objectives that would lead to the desired outcome:
- Ensure that the recovery room has an adequate number of nurses at all times.
- Ensure that the nursing staff consists of healthcare professionals with the appropriate skill mix.
- Ensure that the nurses hired meet the educational requirements for the role and have received clinical training.
- Ensure that the nurses are given a manageable workload.
- Ensure that the nurses are provided with sufficient resources to enable them to deliver the best possible care.
- Promote job satisfaction through improved work conditions and employee benefits.
Policies and Procedures
As asserted by Hill (2010), nursing expertise is associated to quality outcomes, which makes it important for organizations to retain such expertise. A key strategy for achieving this is by providing nurses with improved nursing work environments (Van den Heede, Florguin, Bryneel et al., 2013). As shown by the findings of Van den Heede, Florguin, Bryneel et al. (2013), higher employee retention rates result when an organization has a flat organizational structure, has a participative management style, and provides their nurses with structured education programs and career opportunities.
Similarly, Hill (2010) suggested that to retain nurses, it is important for the organization to cultivate a climate of continuous, career long learning, that is, nurses should be provided with opportunities to develop skills through advanced education and new technologies. In the same manner, the organization should enable their nurses to develop a career portfolio in order to maintain financial security. As well, the organization should structure ergonomic accommodations, that is, it should provide work environment accommodations for nurses aged 45 and above (Hill, 2010). Examples include the use of communication systems, computer stations, ergonomically correct chairs, decreased distances walked, the development of lift teams, and the installation of overhead lifts (Hill, 2010). The organization should also develop strategies to support succession planning. This ensures that leaders with the necessary skills and abilities are available when personnel transitions occur. It should also implement phased retirement (Hill, 2010).
As well, the organization should provide the nurses with more incentives and benefits such as bonuses, hospital discounts, and gym memberships for them and their families. These rewards can serve as extrinsic motivations for them to stay in the organization and to improve their performance.
The proposed policies and procedures support the organization’s mission and vision in that the retention of nurses enables the organization to always provide its patients with a high quality of service. As indicated by the Australian Nursing Federation (2009), nursing care makes substantial contributions in the reductions in mortality and morbidity. In addition, it is important for the organization to provide postoperative patients with 24-hour postoperative care and thus, provide 24-hour cover at the staffing level, as this reduces the poorer “out-of-hours” care. This is the period when the patient is most vulnerable and where the provision of quality round-the-clock care reduces the risk of complications and enables their prompt identification if they occur (Simpson & Moonesinghe, 2013). The proposed solution will also enable the organization to provide cost-effective care because as shown by the Australian Nursing Federation (2009), nursing interventions are cost-effective such that investment in more nurses pays for itself. In particular, nursing care leads to better care outcomes and to the reduced use of expensive healthcare resources (Australian Nursing Federation, 2009). In addition, the patient’s reduced length of stay and the improved surgical outcomes lead to cost savings (Simpson & Moonesinghe, 2013).
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