Leadership and Management in Nursing

In this essay, the writer will analyse the philosophy, vision and mission statements of her organization, as well as the philosophy of the nursing department and discuss these values which are reflected in the nursing management and leadership that currently exist on your her specific unit/ward. The writer is working at SGH (Singapore General Hospital). SGH mission is ‘‘we deliver quality care to every patient through comprehensive integrated clinical practice, medical innovation and lifelong learning.’’ The vision is ‘‘to be a renowned organization at the leading edge of medicine, providing quality healthcare to meet our nation’s aspirations.’’ The philosophy is ‘‘service to mankind, professional excellence, profession development and team work.’’

Mission:

Nagelkerk (2000) stated that the mission of any organization is its function, purpose and reason why it exists. Innovation in healthcare includes technology-drugs, medical devices, diagnostic and therapeutic procedures which continues to be a driving force in the quest to balance cost containment and health care quality. (REFERENCES) Integrating technology advancements into our systems and processes enables efficient flow of information between carers and patients, and improve patient satisfaction. Quality care includes the quality of services provided to ensure that a consistently high level of care and best outcome is delivered to our patients. Actually I find that providing quality care doesn’t just stop when the patient is discharged. For example in the writer’s ward, as part of their initiative in discharge follow up, the nurses will call the patients and follow up with them the identified potential discharge problems or issues.

The nurses can continue their care for the patients even when they are discharged. This form of follow up methods will also reduce the risk of patient readmitting into the hospital. The writer’s rehabilitation department also have the annual rehabilitation party where the ex-patients will gather together with the rehab team which consist of nurses, physician, medical social worker, occupational, speech and physiotherapist to mingle around and build up rehab team cohesion. Through experience, the staffs can provide better and better quality care to the patients. who is able to think critically will give better patient care. Having continuing nursing education also enhances professional growth and job satisfaction of the staff. We need to upgrade ourselves where skill and knowledge are perishable commodities.

Learning is viewed as active, not passive, where one must be actively involved in one’s own learning. Self-directed learning is essential in assisting nurses to meet the challenges presented in today’s health care environment. Hill and Howlett concluded in their research that “basic ability to learn remains essentially unimpaired throughout the life span” (p. 49) (cited Barbara, M. 1999). In the writer’s rehabilitation department, there are multidisciplinary case conferences, weekly rehabilitation round table session where individual rehab team member will present and share with the team a topic relating to the rehab discipline and rehabilitation nursing programme for nurses.

The writer picks up bachelor course so as to increase her knowledge both theoretical and practical to provide better nursing care to her patients. The writer’s ward is divided into three stations which comprises of rehabilitation, renal and orthopaedic and general surgery department to create a ‘small ward concept’. The concept of small ward management allows a more focused delivery of care and ensures that the patients and the staffs are better managed. Small ward concept also promotes good working relationship among colleagues. The clear demarcation on the locus of control help staffs identifies their respective team-mates and supervisor. Greater performance is achieved through this small ward concept as evidence by the decrease in patient fall rates, medication incidents and complains. (REFERENCE)

Vision:

A vision statement is created for all the staffs in the organization. Vision statements are created to address the future of the organization and the most desirable state at some future point in time (Nagelkerk 2000). For example for clinical research, the drive towards building a strong research culture is motivated by our vision of development SGH into a national and regional clinical hub. SGH is the public sector’s flagship hospital, Singapore’s oldest and largest tertiary hospital and national referral centre. They hoped SGH will be nationally recognized healthcare leader in the future. SGH did it by obtaining the Magnet designation and it is the first hospital in Asia to vie for this prestigious award.

Earning the magnet accreditation will reaffirm SGH’s status as an organisation of excellence, committed to delivering superior patient care, demonstrate supportive leadership, innovation in professional practice, career development, professional education and providing our healthcare professionals with a distinctive value proposition. Our director of nursing verbalized that other hospital has already been approaching us on how to obtain the magnet designation. It demonstrates how SGH as an organisation continually make progress and challenges our paradigm to stay relevant and ahead of the changing healthcare environment.

The staffs in the writer’s ward interviewed are of the unanimous of their work, but even more significant than that is what they have discovered in the midst of the magnet fever. It is the power of team work, the importance of learning and re-learning, the need to communicate and clarify and the harnessing the strength of a multi-disciplinary team. Undergoing the designation process validates our existing strength and along the way, we also identify fresh opportunities. The writer have gone through it and see that the team spirit and unwavering commitment of the staffs and senior leadership have been the mainstay throughout this amazing journey of discovery. The hard work really pays off.

Philosophy:

‘‘Philosophy is a belief about life, human beings, values, and ideals. Nurses need to understand philosophies, theories, concepts and process because nursing is a discipline based on using and integrating bodies of knowledge so as to be able to assess what is needed to deliver health care.’’ (Flynn, J.M. & Heffron, P.B. 1998) We need to study nursing philosophy to give us a meaning to the profession by providing the values and beliefs and to give a direction for achieving our goals, and these indirectly affect the delivery of nursing care (Potter & Perry 2001). SGH has three nursing division philosophy. Firstly is service to mankind. The writer’s organization believes that nurses should be committed to the care of patients, without racial, religious or social discrimination, and strives to meet their physical, emotional and spiritual needs. The writer felt that every patient should be treated as a holistic individual. However the writer saw that some nurses simply doesn’t attend to the patient’s call bell just because the nurses do not understand the patient’s language. Secondly is professional excellence.

The writer’s organization believes that nurses should aim to provide the highest quality of professional nursing service to all patients. Nurses deliver care in accordance with the standards of nursing practice. Unfortunately this is not always the case. For example is the hand hygiene. There are still a lot nurses caught not performing hand washing after patient contact. Sometimes there will be auditors around to check and competencies are carried out to ensure that the nurses demonstrate the required knowledge and skills to achieve safe, effective, efficient and quality patient-centered care. It also serves as a mechanism for maintaining and updating the knowledge and skills of nurses. Hence, enhancing the professional development of nurses can attain excellence in nursing practice. Thirdly is profession development. The writer’s organization believes that nurses should achieve personal and professional goals that also contribute to the overall goals of the nursing service.

The various opportunities that were available in SGH for professional development are local and overseas seminars, education tours, scholarships for professional development and career growth like degree and master courses, health manpower development program fellowships, career counselling, in-service talks, clinical teaching rounds, continuing nursing education which includes upgrading. Education tours were organised to keep nurses updated with the professional practices and technology during the exchange of nursing knowledge and to identify their nursing practice that can be implemented in our institution. Clinical teaching improves patient care, involve patients and improve communication. It is also useful in development clinical practice, evidence-based care, understanding patients and the conditions they experience, while linking theory and practice. Nurses are taking a greater role today as part of healthcare team to recognize and develop our nursing pool.

SGH not only provides local nurses but also the foreign nurses for upgrading. It provides the opportunity for outstanding talent to develop their fullest potential and achieve nursing excellence. Nurses participate in continuing education activities and research to ensure that nursing practice remains current and relevant to the changing needs of clients. They have a professional responsibility to assist in the education and development of other nurses. (SNB) The writer herself has been a preceptor before. Preceptor helps guide the transition and integration of nursing students and new graduates into the nursing workforce.

They support the development of clinical competence and confidence in a way that allows the junior nurse to grow professionally. By sharing their knowledge with the junior nurses, preceptors help improve job satisfaction, decrease orientation time and have a direct impact on how well the nurse will perform. This displayed strong leadership abilities and demonstrated systematic thought and industry when she helped her preceptee iron out the challenges encountered. Another one is mentoring program. Mentors will share their own experiences. They nurture their mentees by providing guidance, direction and support, including being a role model and inspire them.

Job rotation facilitates learning of new skills to be more valuable and can also combat worker boredom and helps in professional development of a nurse. However as verbalized by my colleague working in the same ward, the nursing department took nearly one year before approving her to rotate to another ward. From here the writer finds that the nursing management should improve in it. Every year, SGH sets aside funds for the upgrading and professional development of our nurses to promote the advancement of nursing manpower pipeline. This is aligned with management’s commitment to nurturing the future generation of nurses through investment in nursing education. Nurses need to constantly upgrade and keep themselves abreast of clinical developments and leverage on technology to enhance their work process and efficiency. The management is good in ensuring that communication has taken place.

Communication channels are important avenues for nurses to disseminate or receive information. Communication channels are designed for nurses to voice out their concern with regards to professional development or patient care. It allows nurse leaders to understand ground issues and nurse managers to disseminate policy changes and discuss on action plans to improve nursing care. It allows organization to maintain a two-way communication between nurses and nursing leaders in clarifying policies changes relating to professional and operation matters.

The various type of nursing communication channels are ward staff meeting, nurse voice and facebook, intranet, feedback or communications sessions, daily ward roll call e.g. The voices of patients shape the way we deliver care. Ongoing feedback tells us that good communication between the patients and the healthcare professionals forms the basis for future healthcare transactions. It sets the tone not just between the patient and the doctor, the nurse or the allied health professional but defines the future relationship with the hospital too.

Lastly is team work. The writer’s organization believes that patient care depends on an effective working relationship between nurses, doctors and all other hospital staffs and achieving an empathetic and co-operative relationship with the patient and family. Nurses collaborate with other health care professionals and the community is essential to achieve an effective and continuity delivery of care and integration of disciplines for optimal client outcomes. The purpose of team building is to increase cohesiveness, mutual cooperation, and identification with the group. Mutual respect and having the same interest in the welfare of the patient is a crucial foundation in building a strong working relationship. Nurses give feedback on clients’ needs and progress to professionals involved and maintain constant communication with all the members of the healthcare team to achieve quality care for the clients (Singapore Nursing Board).

The writer felt that collaborative style encourages each team member to help each other work democratically and requires team spirit. However, Kay Kittrell Chity (2005) stated that this success depends a lot on effective skills in communication and leadership of the team leader. In the writer’s department, there is a rehab (APN) advance practice nurse where she is responsible for the care of the rehabilitation patients. She is a clinical expert, collaborator, educator, researcher and manager to lead, perform, promote and maintain clinical nursing excellence, quality and cost effectiveness in specific clinical speciality through assessment and application, collaboration and utilization of advance knowledge and skills. The writer finds that rehabilitation nursing is not just about basic care. There is something more unique and special. Having an APN help the writer unfold this journey to realise her identity as a rehabilitation nurse.

Communication is and must be a two-way process (Joy Buxbury 2000). Miscommunication will break the team work. In this continuum of care, nurses play an integral an important role. Interactions between clinical departments and nursing are of utmost importance to ensure seamless coordination in the provision of care for patients. The writer who works in the rehabilitation department, for instance, works closely with the physicians and other health care professionals as a multi-disciplinary team which brings out the collegiality, team spirit and professionalism. The rehab team consist of nurses, physician, medical social worker, occupational, speech and physiotherapist. The multidisciplinary team approach of the rehabilitation services provides comprehensive and interdisciplinary rehabilitative care for patients. (PUT AT WHICH SIDE??) In the writer’s ward, there are a few rehab collaboration.

Firstly is the functional instrument measurement (FIM) training. Nurses, with the rehab team are brought together to discuss and be trained in using the FIM tool, in assessing patient’s daily activity living. Secondly is the multidisciplinary meeting (MDM). The rehab team conducts weekly multidisciplinary team meetings for all the inpatients which discuss about patient’s rehab progress, treatment and discharge plan. This meeting consist of all the rehab team members. This enhances the collaboration between nurses, and other health professionals. However sometimes there may be disagreement between the health professionals. Consensus of decision is achieved through discussion and negotiation. Thirdly is the rehab weekly round table talk and fourthly is the annual rehab round table which the writer has mentioned above. Therefore positive clients’ outcomes are achieved through teamwork between members of the health care professions.

Conclusion:

In conclusion, all the healthcare workers are working together as a team to provide the best quality care to our patients. Nursing is dynamic, evolving from changes in health care, and advances in medical science and technology. Professional nursing practice is achieved through continuing nursing education and research. The organization in the hospital includes all the healthcare workers to work together to provide the best quality patients care to the patients.

Factors that distinguish self-directed learners are the ability to take charge, accept responsibility, and not be stopped by problems (Zemke, R. 1982).

http://www.sgh.com.sg/about-us/More-About-SGH/Pages/MissionCoreValues.aspx http://www3.interscience.wiley.com/journal/119155749/abstract?CRETRY=1&SRETRY=0 http://www.oppapers.com/essays/Philosophy-Nursing/71172

Medical innovation:
http://www.innovation.cc/scholarly-style/omachonu_healthcare_3innovate2.pdf

References:
1) Flynn, J.M. & Heffron, P.B. (1998). Nursing from concept to practice. (2nd ed.). Normalk: Appleton and Lange

2) Joy Buxbury (2000) Different Patients (1st ed.). Oxford: Reed Elsevier plc group

3) Nagelkerk J. (2002) Leadership and Nursing Care Management (3rd.). Missouri: Saunders

4) Kay Kittrell Chitty. (2005). Professional Nursing: Concepts and Challenges. (4th ed.). St. Louis: Elsevier Saunders

5) Potter, P.A., and Perry, A.G. (2001). Fundamentals of nursing concepts process and practice (5th ed). St. Louis: Mosby