The Nursing Management Research Paper

Managers play a crucial role in ensuring the achievement of organizational goals. Nurse Managers assume the responsibility of ensuring the provision of health care services. However, such managers undergo a number of challenges that they have to solve discreetly. This paper presents a hypothetical case involving violation of the HPPA stipulations and quality assurance/performance. This paper will develop a plan to solve the highlighted problem by considering various leadership theories coupled with giving tools for evaluation of the stipulated strategies.

Managers shape the image of institutions and it is evident that most growth and development seen in various sectors is due to good management. The task of a manager is to lead an organization towards achieving its goals whilst adhering to the set rules and regulations. Nursing management ensures that services are rendered to patients effectively. It entails the creation of strategies, rules, and regulations that facilitate the delivery of services and achievement of goals by working in unity with employees and other departments in an institution. In addition to these tasks, nursing managers should identify shortfalls in an organization, particularly those related to management, and resolve them. This paper explains how nursing managers can resolve some nursing managerial challenges that might occur during service delivery. The paper will define a problem, develop an action plan, suggest possible solutions, and explain the means of implementing the most pertinent strategy. Moreover, the paper will develop a tool for evaluating whether the expected outcomes have been met or not.

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Hypotheses Case and Report
The cases to be tackled in this paper involve two observations that I made at a clinical site showing managerial weakness of the organization. I work for Maxim Health Services, which conducts wellness clinics with the help of registered nurses for corporate or private companies in various locations in Manhattan and Brooklyn.

In the first case, Maxim Health had tasked nurses to attend to about 300 participants who were to be screened for blood pressures, glucose, and lipids. Normally, each nurse is in a private room with each patient to protect the HPPA rights, but on this day, the hosting company gave the nurses a small conference room where they were set up in various sides of a long table, which was the only available room. Once the clinic commenced, each nurse engaged his/her own patient in a different way by striking up conversation or getting straight to the task. Once the tests were done, it was evident that everyone in the room could hear the others conversation and what their results of the screening were for the room was so small and thus even if someone whispered it echoed throughout the room. Additionally, we were backed up and patients were lined up against the wall in the room sitting on chairs waiting for their turn, in which they could clearly hear what the other participants results were.

In the second scenario, a nurse neglected to engage her patient thoroughly in conversation to find out if he were comfortable with a small needle stick and the sight of blood and she proceeded to gather the sample unknowingly that this patient usually passes out when either the needle stick is done or at the site of blood. This patient then suddenly passed out in the small room that is full of other participants at the clinic. The nurse responded correctly with the help of a colleague in propping up the patients legs, taking his vitals, and keeping him injury free until he woke up. The home office should have sent an emergency kit with supplies, which contains smelling salts and other medication, but it only send it after the nurses carried out immunizations as the kit contained an epinephrine injector incase of allergic reactions. The only directive from management was to make the best of the situation and document the incident of one patient passing out and what was done, but no other follow up was pursued or action taken afterwards in regards to each incident.

Analysis of the Hypotheses Cases
The nursing profession is often guided by several ethical and legal responsibilities. One of those legal duties is to maintain patients privacy and confidentiality. As early as 1890s, nurses vowed to raise their professional standards and act in a way that conceals personal information of their clients. The latter was done using the Nightingale Pledge; however, after a number of years, a new law was adopted to provide clear guidelines on how to ensure client confidentiality. The Health Insurance Portability and Accountability Act (HIPAA) was enacted in 1996 to raise the standard of health insurance, discourage healthcare abuse and corruption, as well as removing bottlenecks encounters when giving health insurance (Yurumezoglu & Kocaman, 2013). The Act was amended in 2003 to contain the privacy rule, which is the most relevant in the current instance.

The privacy rule was introduced with a core purpose of ensuring that confidential information of patients is the transfer of the required data for the provision of high quality health services. It protects information retrieved from the person such as ones background, psychological condition, process of offering medication, and the nature in which the patient is paying for the treatment. It also stipulates that any information that can be used to recognize the patient such as contacts should be concealed. Considering the ambiguity of the privacy rule, one would infer that the law allows very little information to be shared among medical practitioners and patients (Yurumezoglu & Kocaman, 2013). Nonetheless, the privacy rule provides exemptions, thus allowing medical practitioners to ignore the patients right to privacy. For instance, if a patient is incapacitated and there is a need for urgent attention or if the disclosure of the patient information will prevent a potential threat of harm to the public. Moreover, the rule permits instances of incidental disclosure. For instance, a waiting client may eavesdrop on the conversation between nurses and their patients. However, incidental disclosure is allowed if a medical center has taken every step to protect the clients information, but disclosure still remain inevitable (OBrien, 2010). Such steps may include speaking to the patient quietly and shinning from mentioning the clients name particularly in public. Therefore, it is evident that Maxim Health failed to protect patients right to confidentiality. Allowing nurses to set up their workstation in a single room where every participant could see and hear what was going on was an utter mistake by the management. Therefore, it is vital for the nursing administration to consider the strategies that will be discussed in this paper.

The American Nursing Association (ANA) provides rules and regulations that are binding to all nurses as they perform their duties. Kelly (2012) notes that one of the principles of nursing is beneficence, which states that nurses should provide their services with compassion and take every necessary action to assist others with the aspiration of doing good. Moreover, nurses should be dependable and liable for personal nursing performance, and thus they should make a decision in line with the duty to offer best client care. Nurses should also aspire to safeguard the health and interest of their patients. In tandem with the latter, nursing administrators should review methods to ensure that their staff team entails qualified nurses to offer optimum patient care. In the second case, it seems that some of the nurses were unqualified. Failing to converse with patients and treating them without knowing if they are fine with a particular treatment is a breach of code of ethics, and in particular the right to self determination (Yurumezoglu & Kocaman, 2013). Furthermore, the failure to have sufficient emergency kit with supplies for the program contradicted the duties of nursing administrators. Managers have the duty to organize, direct, supervise, staff, and control operations in health institutions to ensure that clients are satisfied. Considering the above analysis, it is apparent that some managerial problems should be solved, especially pertaining to confidentiality, professionalism, and adequate of emergency resources.

Approaches to solving the problem
One of the basic roles of nursing administrators is decision making. This role entails detecting a problem, looking for possible solutions, and picking the option that fits the particular problem. Decision-making is divided into three types, viz. administrative, operational, and . Decisions are made to achieve personal or organizational results. when top management team makes decisions that affect the entire institutions such as policies and resource provision and distribution. when mid-level administrators make decisions to tackle the daily operations. Programmed decisions refer to decisions that are made recurrently and habitually, while non-programmed decisions occur recurrently. This paper will consider the above aspect of decision making in nursing administration as it devises ways to solve the current issue of managerial problems.

First, the nursing administrator should ask the private company to provide an alternative room that can facilitate the provision of clinical services whilst protecting the patients confidentiality. The room should be conducive for both the nursing staff and participants. The room should be furnished with all the screening and examination requirements. Moreover, the room should have clear spaces and safe areas for providing clinical services. In addition, the room set up for conducting the screening should be designed to fit with the domestic climatic features and contain environmentally sustainable design (ESD). There should be modular planning that can abridge the filing, construction, and increase flexibility. Though it was not mentioned whether any of the participants was disabled, it would be necessary for the private company to set up a room that can enable access for the disabled.

Another possible solution is to reduce the number of patients being handled at a particular time. If there is only one available room, the nursing administrators can opt to serve a reduced number of clients at a given time so that the noise is minimized and every nurse can communicate to his/her client without disrupting another client. The main setback in this proposal is that it may take a prolonged time before serving all the participants. Furthermore, the nurses can decide to build clinical sites outside the private company to accommodate the excess patients. The clinical sites should be made of enclosed tents to avoid incidental disclosure. Moreover, every tent should be equipped with the necessary equipments needed for the examination. This option will depend on the availability of the tents or cash to buy to the tents. It will only be applicable if the company has an extra space for setting up a clinical site.

If no other room is available, then nurse managers can opt to reorganize the room and set up in such a manner that every nurse is in enclosed cubicle with his/her patient. Moreover, the nurses should be monitored to ensure that they speak in low tones and avoid mentioning the clients names in a bid to maintain privacy. The administration should appoint a program coordinator whose primary duty should be to ensure smooth progress of the screening program.

The administration can use program coordination to report all challenges that nurses meet even as they serve the patients. For instance, in the case of inadequate emergency supplies, the presence of a program coordinator will help in detecting the problem in time and correct it before any complications emerge. Moreover, management can buy more emergency kits to serve clients that develop complications and are in a dire need for a first aid.

The nurses failure to communicate with the patient was a gross mistake against the code of ethics that govern how nurses operate. As an administration, nurse managers have a duty to ensure that their personnel are qualified and work professionally. One of the actions that should be taken against this nurse includes disciplining her through demotion because failure to punish such acts is likely to taint the image of the institution. Furthermore, having a program coordinator to monitor the actions of the nurse will ensure that workers act in the most professional way (Yurumezoglu & Kocaman, 2013). Conceivably, Maxim Health can also decide to train its nurses on professionalism. Nurses should maintain a client relationship knowing that their loyalty is to the clients that they serve and their sole purpose as nurses is to promote the welfare of their patients. They should also know that patients have a right to self-determination, which the nurse denied the patient who passed out. This exercise may take time, and thus it may not be considered as the best solution to solve the current case.

Course of action selected with rationale
When a nurse makes a decision, it should be logical the final idea must be coherent, intelligent, and ordered. Hence, a nurse manager should weigh between the necessity for applying a long-term and interim solution. It is important to consider that the manner in which a nurse administrator manages his/her staff can influence the staffs morale as well as output, which may further influence the quality of services given to patients. The nature of the cases given here is an urgent situation that requires an interim as well as a long-term solution to solve the issue satisfactorily. Therefore, the best option for the cases would be partitioning the hall to create enclosed cubicles accompanied with a program coordinator to monitor the acts of nurses. In the second instance, the nursing management should organize refresher courses to help in improving professionalism amongst the nurses.

In implementing these strategies, I would adopt a transformational model of leadership where the object of management is to motivate and create good rapports among staff members. The transformational leadership model motivates employees to be loyal and work as a team. Moreover, I would apply a visionary and directive style of leadership. Visionary leadership in this instance refers to making decisions, which have a long-term effect on the employees and the institution. Directive style of leadership on the hand focuses on achieving immediate compliance (Kangasniemi et al. 2013).

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