Essentials of Advanced Nursing Practice Field Experience

Essentials of Advanced Nursing Practice Field Experience

In the past, the nursing profession was well-defined. In today’s world, the profession has been specialized and modified to cater to different patient populations in various medical field settings. The nurse’s role in these settings may be limited based on the nurse’s authority and leadership influence, whether in formal or informal settings.

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Recommendations for Consultative Change

It was once simple to define the role of a nurse, but this is no longer the case due to the dynamism seen in the nursing arena. Nurses’ professional responsibilities have increased, so nurses must assume leadership roles in the healthcare sector (Sherwood & Bamsteiner, 2012).

Introduction

The goal of the consultation

This paper aims to assess nurses’ role in bringing about change in an organization. As a result, New Jewish Home was used as a model to identify the role of nurses in effecting change and improvement. The rationale for this endeavor is to use external measures such as community needs, patient metrics, and HCAHOS Scores as the model to consolidate a consultative change recommendation for the organization. As a nursing consultant, it is unavoidable to investigate nurses’ roles as custodians of change, innovation, and the advancement of organizational change for the sake of health care (Nolte & McKee, 2008).

A summary of the consultation process

A senior nursing executive from New Jewish Home was interviewed about equality improvement activities and her organization’s responsibilities to capture an aerial view of the consultation process. A one-on-one interview was conducted to identify pertinent information about the nursing profession and its responsibilities. Data on community health needs were gathered and analyzed. The health status and healthcare access indices were assessed. Finally, the organization’s most recent health assessments were evaluated (Sturmberg & Martin, 2013).

Organizational Description

The New Jewish Home has provided comprehensive care to aging New Yorkers for over a century and a half. The organization is a non-profit that primarily serves the elderly population. The organization serves terminally ill patients who require specialized ongoing care. The organization is managed through Manhattan, the Bronx, and Winchester County campuses, which are staffed by nurses, doctors, therapists, and compassionate caregivers. In Manhattan, the New Jewish Home manages three campuses, including a short-term rehab facility, a skilled nursing facility, and an Adult Day Program. The organization managed Kittay Senior Apartments and assisted living programs in Kingsbridge and an Adult Day Health Care in the Hutchinson River Parkway in the Bronx. The organization operates a Short-Stay Rehab facility and a Skilled Nursing Facility in Westchester County (Forni, 2017). These campuses have apartments for older people, where they can live independently or with some assistance. The organization’s services, including but not limited to post-senior living residences, long-term care nursing facilities, and innovative houses, are tailored to individual needs. The organization was founded to serve the Jewish community but later expanded to serve the entire city of New York.

A group of experienced administrators oversees the organization. President-CEO, Chief Operating Officer, Chief Medical Officer, Chief Development Officer, Vice President of Managed Care, Vice President and General Counsel, Senior Vice President of Business Development, Senior Vice President of External Affairs, Manhattan Administrator, Vice President of Information Technology, Senior Vice President of Human Resources, Vice President of Clinical Excellence (Sturmberg & Martin, 2013). The organization has 33 board members dedicated to empowering older people and improving their purpose and quality of life through a portfolio of innovative healthcare services. The knowledgeable board of directors provides guidance and oversight, ensuring the organization completes its mission with integrity. It was possible to obtain information on the organization’s leaders, but it was not possible to obtain employee data because it was not available on the website (Sturmberg & Martin, 2013).

This organization meets the basic needs of the people it serves.

It is empirical to assert that preexisting conditions determine a population’s fundamental needs. These conditions include but are not limited to, a population’s racial, socioeconomic, political, and economic status. As a result, the New Jewish Home is designed to address issues concerning the stated community’s health. New Jewish Home is surrounded by a population of over 7 million people, and as a result, the population of those over 65 is expected to rise further. It is worth noting that the organization serves a large portion of the region with higher poverty rates, including Manhattan, the Bronx, and Brooklyn. Escalating health disparities have been observed in this region, which is typically a low-income area; for example, the Bronx was discovered to have nine social, Economic, and health indicators due to poverty levels (Huston, 2014).

Lack of primary and palliative care and health insurance was identified as a community health need (Nolte & McKee. 2008). These factors were viewed as fundamental barriers to healthcare, exacerbated by low literacy levels, low-income family support, inadequate infrastructure, and insurance coverage barriers. The environment was also discovered to contain mental stressors, which resulted in significant mental problems such as depression and anxiety, which were observed across the entire population (Kouzes & Posner, 2012). These social and economic factors have led to psychological complications such as autism, bipolar disorder, drug abuse, psychosis, substance abuse, and domestic violence. These issues are manifested physically in older people and adolescents. The population was also found to have chronic illnesses due to their lifestyle, which progressed to diabetes and obesity. Eventually, the community faces terminal diseases like hypertension, cancer, and cardiovascular complications (Sherwood & Barnsteiner, 2012). The population’s feeding habits further complicate the situation due to poor access to a balanced diet. Fast foods that are cheap and unhealthy abound in the environment. Asthma and other pulmonary complications are linked to poor housing and pollution. Finally, society’s social and economic status has fostered insecurity and promiscuity, which has culminated in sexually transmitted diseases such as AIDS and HIV.

Interview with a nurse supervisor

A nurse leader’s role

A one-on-one interview with a senior executive was critical for contextualizing this population’s health needs. Teresa Bellamy has extensive experience in nursing and is well-versed in nurse roles. She emphasized the importance of leadership in patient care coordination. The nurse leader’s role is to promote high quality and patient safety. We must emphasize ethical and critical decision-making as leaders. She saw her leadership role at the Jewish nursing home as propelling goal-oriented intervention to promote a patient’s well-being and comfort. Teresa reports that to be effective in a leadership role, you must demonstrate leadership by maintaining effective working relationships based on mutual respect and collaboration with interprofessional teams. To promote patient well-being, nurses must form associations, coordinate general healthcare operations, motivate team members, and integrate patients’ families with caregivers (Sturmberg & Martin, 2013).

To realize this, it is necessary to employ excellent communication skills to motivate others to achieve the defined goals. Teresa retorted that the nursing profession is holistically oriented to patient care when asked about the roles and scope of the nursing profession in the organization. The nurse’s responsible for assessing and monitoring the patient’s progress and implementing care plans, making nurses the primary custodians in healthcare delivery (Nolle & McKee, 2008). As a result, the scope and role of nurses within the Jewish health setting are entirely patronized by nurse leadership, which steers the strategic direction of the health systems and assists in enacting organizational changes. The nurse’s presence is felt across the entire healthcare spectrum, making nurses the most informed players in the healthcare fraternity. Their proximity to clients allows them to perfect the art of patient-centered care attitude. They are best positioned to explain the socioeconomic issues affecting their clients’ health. This holistic approach has enabled nurses to develop long-term strategies that directly impact the patient, thereby improving the health outcomes of the population they serve (Kouzes & Posner, 2012). As a result, nurses are best positioned to design and implement new models of care. Teresa acknowledged that as a senior nurse executive, she had successfully fostered communication among healthcare partners, including patients, families, and relevant governmental bodies (Sherwood & Bamsteiner, 2012). She retaliated by stating that embracing partnership was the surest way to enable the organization to identify and implement workable models of care. She concluded her interview by admitting that allocating resources to the nursing unit was critical to ensuring change. She was adamant that adequate human resources resulted in high-quality care and that a well-coordinated workplace culture was ultimately required to achieve positive quality care.

Organizational Characteristics

Strengths

Nurses have been involved in every aspect of the organization’s healthcare system. They are at the heart of most healthcare delivery systems, including long-term care home care, post-acute rehabilitation, and managing senior living options. They also work in management, research, education, quality control, and clinical care (Sturmberg & Martin, 2013).

Weaknesses

According to the organization, patients have reported that they do not receive “help” as quickly as they would like, implying that call lights are not being answered promptly.

Activities involving evidence-based practice

The organization has tailored strategies to meet its clients’ health needs. The organization provides a well-designed environment where patients can improve their quality of life. All the facilities are designed to have a welcoming atmosphere reminiscent of Home. The involvement of nurses in ensuring comfort allows the organization to continue to improve. This is accomplished by encouraging nurse-patient collaboration and client intimacy (Nolte & McKee. 2008). These welcoming environments have been shown to improve the client’s health. For example, this intervention resulted in poor sleep quality and mood swings. RNs at the new Jewish Home are always eager to assist CNAs in interpreting research-based knowledge. This is accomplished by using feedback, clinical reminders, audits, and practice prompts. Other strategies used include, but are not limited to, educational outreach, change agents, academic detailing, questioning and teaching leadership, and so on (Swansburg & Swansbury, 2002).

Quality-improvement initiatives

The formidable nurse leadership demonstrated at the new Jewish care home has transformed many workplace features, most notably the organizational culture, by encouraging professional development and inter-professional collaboration. The nurse leadership has successfully reduced lateral violence between the organization and the nursing practice. This has improved patient outcomes, increased productivity, and high retention rates. Implementing research-oriented principles has enabled the organization to improve the quality of donor-funded or government-funded research based on the quality of nursing focuses on its patients to disseminate the most appropriate interventions (Nolte & McKee, 2008). Maximum effort has been spent in improving the patient’s lifestyle habits and ensuring their comfort target is met (Swansburyg & Swansburg, 2002).

Organizational Change Recommendation

Recommendation

The New Jewish Home should adopt a policy and procedure for call lights and an hourly rounding system to improve nursing to patient-initiated call lights. The nursing staff will have a no-pass zone; this is a collaborative approach to answering call lights. This also provides the nurse with a monitoring mechanism to keep patients safe and comfortable by anticipating their needs. The New Jewish Home will conduct a 60-day trial test in which CNAs and floor nurses complete the hourly rounding with the no-pass zone. Before the start of the 60-day trial, all staff will attend an in-service meeting. HCAHP scores will rise over 60 days, proving that hourly rounding and the no-pass zone are practical tools. During the trial, nurse leaders will make weekly rounds to complete audits.

Rationale

The rationale for this implementation is to ensure that patients are satisfied with their nursing care and are safe. A patient’s assessment of how well the nursing staff met their needs during their stay. The New Jewish Home will run a 60-day trial during which CNAs and floor nurses complete the hourly rounding with the no-pass zone. The nurse leaders will conduct weekly audits, and the team will reconvene after 60 days to compare HCAHP scores. Patient satisfaction is essential regarding reimbursements; HCAHPS accounts for up to 30% of the government’s value-based purchasing. In short, the rationale is that the hospital may lose funding and be forced to close its doors, affecting the community. If the government does not provide funding, the community surrounding the hospital may have to travel long distances to be seen. Due to a lack of funds, the community may lose the New Jewish Home.

Effectiveness evaluation

The Hospital Consumer Assessment of Healthcare Providers and Systems-HCAHP survey can be used to assess effectiveness. The survey data will be used to understand better the patient’s feelings and concerns about the organization. This standardization is geared toward organizational practice as well as management structure. This standard will bring balance to the organization’s quality assurance. Management can modify systems to reflect changes in HCAHPS scores that will be seen over time by evaluating HCAHP scores. One modification that can be made is to use patient rounding. By rounding on a patient hourly and asking three simple questions, such as Are you in pain? Do you need anything, or can I help you to the restroom? You can raise your HCAHP scores and be an effective measurement in the organization. It is also recommended that nurse leaders audit hourly rounding with unit supervisors at least once a week.

Conclusion

Finally, nursing leadership is unavoidably essential in the smooth and efficient management of a nursing unit attempting to balance quality, patient care, and financial stability (Huston, 2014). In a nutshell, nursing leadership directly impacts the quality of care provided in a given health institution because it has the potential to provide clients with safety and quality while also influencing workplace culture. Strategic nurse leadership is the surest way to achieve this (Kouzes & Posner, 2001).

Similar Post: Project Evaluation and Control

References

Forni, Aleesia (2017). “The New Jewish Home names Farber CEO.” Westfair Communications. Retrieved 17 November 2018.

Huston, C. (2014). Professional issues in nursing: Challenges & opportunities. (3° ed). Philadelphia: Wolters Kluwer Health’Lippincott Williams & Wilkins.

Kouzes, J. M., & Posner. B. Z. (2012). The leadership challenge: How to make extraordinary things happen in organizations. San Francisco, CA: Jossey-Bass.

Nolte. E., & McKee, M. (2008). Caring for people with chronic conditions: A health system perspective. Maidenhead: Open University Press.

Sturmbery, J. P., & Martin, C. M. (2013). Handbook of systems and complexity in health. New York: Springer.

Sherwood, G., & Bamsteiner, J. H. (2012). Quali. And safety in nursing: A competency approach to improving outcomes. Chichester: Wiley-Blackwell,

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Often, on a “Clinical Practice Nursing Committee,” we use previously established evidence-based practice guidelines for standards of care. This is a process whereby the generation of data and topics has been well-researched and established. Events or practice issues also need to be evaluated/researched in your institution. Answer both questions below:

1. Identify one nursing practice issue in your current or prior healthcare setting that resulted in research, data collection, and a change in nursing practice.
2. Discuss a current nursing practice issue for which evidence-based guidelines must be developed. Once completed, speculate on the relevance of the evidence-based practice guideline for nursing care and patient outcomes.