Chapter 14: The Nursing Work Environment Flashcards
Finkelman Textbook, pg 483-492
Key Issues in the Work Environment
- Staff safety
- Communication
- Collaborative, positive work relationships
- Work design (space/facility)
- Work processes
- Infrastructure that support staff participation in decision making
- emphasis on positive work environments that support staff and reduce staff stress/burnout and high turnover rates and seek to develop staff
What Kind of Environment does A nurse Manager need to Maintain?
develop and maintain a work environment that engages staff in work processes, decision making, and continuous quality improvement (CQI)
-quality care is best provided in a healthy, functional work environment
What Influences the Work Environment?
- Job resources
- Interpersonal relationships
- Job performance
- Proactive work behaviors
Staffing has an impact on what?
- staff morale
- staff retention
- budget
- quality care
How does Scheduling affect staff?
affects staff directly and their ability to engage in decision making
-fairness in patient assignments and staff scheduling has a positive impact on the manager-staff relationship
Factors that need to be considered w/ Staffing
- patient acuity and changes in status
- staff expertise
- mix of staff
- supervision
- budget
- staff fatigue and stress
- staff behaviors that may lead negativity such as incivility
- physical environment
- admissions and discharges
- presence of students
- presence and quality of medical staff
- access to resources such as a pharmacist
- need and methods used to transport patients
- use of electronic documentation
- position descriptions
- standards
- policies and procedures
- access to EBP resources
- presence of family members or significant others
- leadership within the HCO
- budget
- staff orientation and education
Nursing Shortages May be Due to What?
-budget cuts
-recruitment problems
-poor HCO ratings
>thus reducing applications for positions and/or leading to staff retention problems
-nursing shortage is expected as more nurses retire due to the number of nurses approaching retirement age
Staffing and Related Workforce Issues r/t Education
- to meet demands, there must be sufficient graduates from nursing programs, and this means there must be sufficient qualified applicants in nursing program admission pools
- shortage of nursing faculty has led to nursing programs turning away qualified students; efforts have been made to provide funding for graduate education to increase the faculty pool
- will need more nurses who are competent to care for the growing aging population; will require clinical content and experiences with this population in nursing programs and staff education to increase staff competencies in this area
The Work Environments Impact on Nursing
- work environment is an important factor in recruiting and retaining nurses
- the environment is high stress; some HCOs have more problems in this area leading to staff dissatisfaction, burnout, turnover, and a decrease in productivity; all of this may lead to a reputation of a poor work place, and this drives employee applicants away
- HCOs need to continually assess these issues and institute changes to reduce stress in the workplace, and staffing is one of these factors
Ensuring Adequate Staffing levels Has been shown to:
- reduce medical and medication errors
- decrease patient complications
- decrease mortality
- improve patient satisfaction
- reduce nurse fatigue
- decrease nurse burnout
- improve nurse retention and job satisfaction
Staff Scheduling Approaches Should Consider What?
-patient acuity
-strategies for using unlicensed assistive personnel
-staff skills and competencies (skill mix)
-education
-training required for specific settings
-effective use of delegation
>staffing levels are r/t quality care and to meeting patient outcomes, as well as staff satisfaction and a healthy work environment
The Level of Staffing Impacts What?
staff safety
- if there are too few staff, this may lead to more staff stress and staff injuries
- ex: when lifting patients w/o considering the most effective interventions and/or asking for help
Interprofessional Teams and the Work Environment
- one of the healthcare core competencies is the ability to use interprofessional teams effectively as teams have a major impact on the work environment
- improving teamwork can have a positive impact on reducing the occurrence of preventable adverse outcomes
- if a nurse leader can improve teamwork, this may have a direct impact on performance, improving care
Key Points r/t nurse-physician relationships that are important in the development of effective interprofessional teams:
- all teams are not created equal, but careful development of working relationships and clear goals can make all the difference
- successful teams are composed of competent team members with the necessary skills, abilities, and personalities to achieve the desired objectives
- teams composed of many professions/disciplines are able to expand the number and quality of actions to improve healthcare systems
- interprofessional teams work collaboratively to set and achieve goals directed toward innovative and effective care and efficient organizational systems
- nurses on the team represent the voice of nursing as a discipline responsible for the holistic care of patients
- positive relationships with physicians benefit the patient and enhance the work environment for nurses
- nurses must develop the skills to work collaboratively as professional members of the interprofessional team
Nurses and Improving the work Environment
nurses need to take the lead in HCOs to improve the work environment
- identifying concerns
- helping to identify supporting data and analyzing the data
- understanding retention of staff
- assisting in the development of strategies to resolve problems
- tracking outcomes to to improve the work environment and level of care
Workaround
an effort to get something done w/o following the expected process, standards, policy, or procedure
-this situation means staff do not recognize or understand a potential risk for error so that it is difficult to correct and improve
Charting Nursing’s Future Newsletter describes an emerging blueprint to transform nurses work environment that recommends providers, policy makers, and educators to use the following strategies:
- monitor nurse staffing and ensure that all healthcare settings are adequately staffed with appropriately educated, licensed, and certified personnel
- create institutional cultures that foster professionalism and curb disruptions
- harness nurse leadership at all levels of administration and governance
- educate the current an future workforce to work in teams and communicate better across the health profession
Goal for Transition Policy and Strategies
anticipate and prepare the nurse labor market for impending shortages, thereby reducing their duration and impact and lowering the economic ad noneconomic costs to patients, nurses, and hospitals
>demand strategies
>supply strategies
>wage strategies
Demand Strategies: Transition Policy
- speed up development and adoption of technology and use nonprofessional nursing personnel more effectively
- remove barriers to efficiency and redesign the work content and organization of nursing care
- strengthen management decision making
- avoid regulating nurse staffing
Supply Strategies: Transition Policy
- accommodate an older RN workforce
- accelerate improvements in working conditions
- expand the capacity of nursing education programs
- continue to inform the public about opportunities in nursing
Wage Strategies: Transition Policy
- assist hospitals and other healthcare employers in financing needed RN wage increases
- avoid imposing controls on RN wages
Long-Run Policy and Strategies Goal
expand employment of RNs in the long run by eliminating barriers that lead to an inadequate supply of RNs and by appropriately valuing the contributions of RNs
Supply Strategies: Long-Run Policy
- remove barriers to hiring foreign-educated RNs
- remove stigmas and barriers facing men and hispanics
Demand Strategies: Long-run policy
- reinforce development of pay-for-performance systems
- increase the number of nursing-sensitive outcomes included in pay-for-performance systems
