NURS 6053 Organizational Policies and Practices to Support Healthcare Issues

NURS 6053 Organizational Policies and Practices to Support Healthcare Issues

Sample Answer for NURS 6053 Organizational Policies and Practices to Support Healthcare Issues Included After Question

Quite often, nurse leaders are faced with ethical dilemmas, such as those associated with choices between competing needs and limited resources. Resources are finite, and competition for those resources occurs daily in all organizations. 

For example, the use of 12-hour shifts has been a strategy to retain nurses. However, evidence suggests that as nurses work more hours in a shift, they commit more errors. How do effective leaders find a balance between the needs of the organization and the needs of ensuring quality, effective, and safe patient care? 

In this Discussion, you will reflect on a national healthcare issue and examine how competing needs may impact the development of polices to address that issue. 

To Prepare: 

  • Review the Resources and think about the national healthcare issue/stressor you previously selected for study in Module 1. 
  • Reflect on the competing needs in healthcare delivery as they pertain to the national healthcare issue/stressor you previously examined. 

By Day 3 of Week 3 

Post an explanation of how competing needs, such as the needs of the workforce, resources, and patients, may impact the development of policy. Then, describe any specific competing needs that may impact the national healthcare issue/stressor you selected. What are the impacts, and how might policy address these competing needs? Be specific and provide examples. 

By Day 6 of Week 3 

Respond to at least two of your colleagues on two different days by providing additional thoughts about competing needs that may impact your colleagues’ selected issues, or additional ideas for applying policy to address the impacts described. 

Click on the Reply button below to reveal the textbox for entering your message. Then click on the Submit button to post your message

A Sample Answer For the Assignment: NURS 6053 Organizational Policies and Practices to Support Healthcare Issues

Title: NURS 6053 Organizational Policies and Practices to Support Healthcare Issues

This discussion explores the competing needs of health policy that are challenged to coexist with improved patient outcomes. Change adaption is difficult, is often met with resistance, and is perceived as burdensome. Healthcare organizations routinely default to a transactional approach to meet governmental regulations through cutbacks and organizational strain resulting in cultural degradation and ethical concerns (Kelly & Porr, 2018). Nurses are immersed in the reality of these unintended consequences of change. Ethical principles governing nursing practice drive nurses to speak up to protect their practice landscape (Milliken, 2018).

Value-based healthcare (VBHC) aims to reduce healthcare spending through a collaborative model while improving patient outcomes. This model presents itself as a win-win on paper but needs to be more evidently self-aware. Collaboration is not an inherent skill of all healthcare-related professionals. Furthermore, collaboration takes time many do not have within their busy schedules afflicted by a national workforce shortage. Utilizing health information exchanges (HIEs) can assist in time management barriers. However, HIE proficiency requires training and is not a universal solution as it faces ongoing patient privacy issues for participation and consent (Vest & Gamm, 2010).

The VBHC model is an active reimbursement model in outpatient community mental health, but practices still need to be assimilated. In the video, Buttaro (Walden University, 2012) discusses a common dilemma in meeting the needs of the underserved in outpatient care when encountering complex individuals that require a higher level of care. Many clients lack natural and community supports. Homelessness, persistent mental illness, and substance use complicate patient care and require extensive intervention. A full nurse schedule that allows a 30-minute time slot to achieve patient care needs is a daily uphill battle. Nurses driven by their principles strive to advocate, refer patients for support, and connect with family members and professionals, which requires time and critical thinking (Milliken, 2018). The care pathway needed to provide necessary interventions is seldom commensurate with the time available within the nurse’s workday. Nurses must decide what aspect of their duties must receive less attention. Robust charting is an organizational requirement. Patient advance and care is an ethical requirement. Working overtime can lead to burnout and patient safety risks and deviates from the nurse’s personal responsibility to take care of themselves.

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Policy is the overarching force through which change happens. Rubino (Walden University, 2009) reminds us

NURS 6053 Organizational Policies and Practices to Support Healthcare Issues
NURS 6053 Organizational Policies and Practices to Support Healthcare Issues

that change is necessary for all healthcare environments to address competing needs and is not an inherently negative paradigm. Reconciliation of policy and the reality of practice can align with transformational leadership within an organization. Nurses must be a voice that innervates incremental change with the potential for meaningful impact (Kelly & Porr, 2018). Nurses on my unit have spoken out about high-risk clients and the need for complex case management and collaboration. Leaders respond to data and request that nurses bring specific cases for discussion at site-based meetings with stakeholders. Numerous cases illustrated and quantified that high-need patients were straining healthcare resources through frequent rehospitalization, and crisis interventions unveiling that outpatient care was not meeting their needs. A response was implemented as a universal synchronized one-hour weekly block of care coordination time for each clinician. This time can be used for team meetings, case management, extended patient care, or charting overflow. Collaborative care has genuinely benefited from this alignment in schedules by maximizing relationships on behalf of patients. This small change needs to be evolved and revisited as an iterative process.

Nurses have the power to influence policy. In the video, Freshman (Walden University, 2009) advises that the process begins with self-awareness and understanding the environment and why circumstances exist. Complaining is not the solution. Competencies in data collection, observation, and evidence-based knowledge must be leveraged to grab the attention of stakeholders.  Nurses with high-emotional intelligence are effective in unifying organizational values with personal values.

References

Kelly, P., & Porr, C. (2018). Ethical nursing care versus cost containment: Considerations to enhance RN practice. Online Journal of Issues in Nursing23(1). https://doi.org/10.3912/OJIN.Vol23No01Man06

Links to an external site.

Milliken, A. (2018). Ethical awareness: What it is and why it matters. Online Journal of Issues in Nursing23(1). https://doi.org/10.3912/OJIN.Vol23No01Man0

Links to an external site.

Vest, J. R., & Gamm, L. D. (2010). Health information exchange: persistent challenges and new strategies. Journal of the American Medical Informatics Association17(3), 288-294. https://doi.org/10.1136/jamia.2010.003673

Links to an external site.

Walden University. (2012). Ethical, moral, and legal leadership [Video file]. Walden University Canvas. https://waldenu.instructure.com

Links to an external site.

Walden University. (2009). Working with individuals [Video file]. Walden University Canvas. https://waldenu.instructure.com

, I enjoyed reading your post. Resistance to change can be a powerful barrier to policy adoption. In my work setting, we have

experienced multiple policy or procedural changes that staff is resistant to accept. Within a few months, most staff reverts to the original way of

doing things. One of the most significant barriers an organization faces when initiating change is resistance from staff, and how behavior toward

change is approached will determine long-term success (Redman et al., 2021). Competing needs add another layer of complexity to the problem.

Self-awareness and high emotional intelligence are essential characteristics to cultivate to be a positive change agent. The purpose of this post is

to take a deeper look at resistance to change in efforts to support policy change leading to positive patient outcomes.

Although resistance is identified as a barrier, resistance should not be viewed as unfavorable. When nurse leaders understand resistance as

fear of the unknown and a sense of loss from the change, leaders can be more equipped to successfully navigate their team through the change

process (Dubose & Mayo, 2020). Although this response to change is considered normal and pliable, a more rigid reaction to change can be

explored through early childhood trauma. Through an attachment lens, individuals who establish a secure attachment with a parental figure in

early childhood are less resistant to change in adulthood. Those who developed an insecure attachment during childhood with a parental figure

are more resistant to change in adulthood (Forsell & Åström, 2012).

When nurse leaders understand, acknowledge, and communicate with their staff why resistance is present during policymaking, leaders can

be more successful at creating long-term change. Self-awareness and emotional intelligence skills enhance when individuals become aware of

and can differentiate between average levels of resistance and an altered reaction to change due to their personal history. Working together as a

team creates an environment capable of effective policymaking for competing needs.

References

Dubose, B. M., & Mayo, A. M. (2020). Resistance to change: A concept analysis. Nurs Forum, 55, 631-636.

https://doi.org10.1111/nuf.12479

Forsell, L. M., & Åström, J. A. (2012). An analysis of resistance to change exposed in Individuals’ thoughts and behaviors. Comprehensive

      Psychology1https://doi.org/10.2466/09.02.10.CP.1.17

Rehman, N., Mahmood, A., Ibtasam, M., Shah Ali, M., Naveed, I., & Edina, M. (2021). The psychology of resistance to change: The antidotal effect

of organizational justice, support and leader-member exchange. Frontiers in Psychology, 12, 678952, 1-15.

https://www.frontiersin.org/articles/10.3389/fpsyg.2021.678952

 

A block of time for care coordination sounds like a great intervention for these complicated patients that get stuck in hospitals.  This approach also assists with value-based healthcare (VBHC), since it could help with finding solutions and improving outcomes for these difficult patients (NEJM Catalyst, 2017). Unfortunately, my experience with VBHC is that since payers (Medicare in particular) reimburse based on outcomes, they are more focused on undesired outcomes than positive ones so they can avoid payments.  This has trickled down to organizations that base any new policies around the negative outcomes associated with not being paid back.  Instead of focusing on positive outcomes with policies like increased time for collaborative care coordination, the old business model of healthcare is just manifesting itself in a new way (Kelly & Porr, 2018). Healthcare systems and payers using VBHC need to integrate inevitable negative outcomes in a way that is not punitive and find ways to reward desired outcomes.   For example, fall prevention is an even bigger priority in hospitals since the implementation of VBHC by Medicare means falls impact hospital reimbursement.  This priority conflicts with the evidence-based health benefit of early mobilization of patients since nurses are trained to over-use bed alarms and patients end up feeling like they are bothersome when alarms are involved. This newer policy-based barrier to mobilizing patients combines with inappropriate activity orders, staff not having time, patients refusing, and patients only moving with physical and occupational services. (Young et al., 2022).  Ironically, an attempt to improve outcomes through VBHC can do the exact opposite.  Bed alarms are, of course, appropriate and preventative intervention for falls in many cases, but nurses being scared to move patients and patients being afraid to set off bed alarms leads to deconditioning, longer hospital stays, and other health complications.  Financial prioritization by hospitals often leads to trading off patient-centered care like this example with fall prevention grossly outweighing mobility.

References

NEJM Catalyst (2017, January 1). What is Value Based Healthcare? https://catalyst.nejm.org/doi/full/10.1056/CAT.17.0558

Kelly, P., & Porr, C. (2018). Ethical Nursing Care Versus Cost Containment: Considerations to Enhance RN Practice. OJIN: Online Journal of Issues          in Nursing, 23(1), Manuscript 6. doi:10.3912/OJIN.Vol23No01Man06.

Young, D., Kudchadkar, S., Friedman, M., Lavezza, A., Kumble, S., Daley, K., … & Hoyer, E. (2022). Using systematic functional measurements in           the acute hospital setting to combat the immobility harm. Archives of physical medicine and rehabilitation103(5), S162-S167.