This paper provides a plan of action for utilizing resources to pursue two SMART goals in nursing leadership and communication. Emphasis is placed on holistic, systematic solutions to the work-life balance with strategies that are derived from the lean movement that Toyota has led for decades. The communication goal is focused on informatics competencies and the pursuit of self-guided studies to develop these skills.
Evidence and Expert Interview
SMART Goals - Evidence and Expert Interview
I chose goals in the areas of leadership development and organizational planning because I believe these are pivotal skills for a nurse to have in order to be an effective member of a healthcare team. My SMART goals are as follows:
SMART Goal 1: Leadership Development
To implement a process of increasing communication between field staff and case managers to increase patient meeting nursing goals to 80% by July 2014.
SMART Goal 2: Organizational Planning
As a nurse administrator of a home health agency, it is my goal to incorporate a time management-mentoring project for all nurses to balance a healthy work-life balance by March 1, 2015.
Peer-Reviewed Articles
SMART Goal 1: Leadership Development
Staggers, N., Gassert, C.A., and Curran, C. (2002). Results of a Delphi study to determine informatics competencies for nurses at four levels of practice. Nursing Research, Nov/Dec. Retrieved http://nursing-informatics.com/niassess/NIcompetencies_Staggers.pdf
Retrieved http://www.ncbi.nlm.nih.gov/pubmed/12464758
This research yielded a research-based master list of informatics competencies for nurses that is differentiated according to conventional levels in nursing practice, and thereby filled a gap in the literature. Since the study spans nursing levels -- form entry level to experienced informatics nurse specialists -- it provides me with a comprehensive, valid list of informatics competencies to which I can refer as I progress through my studies in this area. The Delphi process used to construct the informatics competencies master list was rigorous, entailing a comprehensive review of the literature, item consolidation, and an expert panel (members of the panel were U.S.-based expert informatics nurse specialists) participating in three rounds of the survey in order to validate the items.
SMART Goal 2: Organizational Planning
Spear, S.J. (2005). Fixing Health Care from the Inside, Harvard Business Review. Retrieved http://hbr.org/2005/09/fixing-health-care-from-the-inside-today/ar/1
The tools that I plan to employ to address work-life balance challenges with the nurses in my facility are derived from the lean organization movement that Toyota has led for decades. Specifically, I will use the 5S Program Audit Scorecard
This article illustrates the importance of addressing the root of problems that occur in healthcare settings, including some that appear to be simple and relatively innocuous -- like interruptions or chronic multitasking. I believe the article could be useful in-service reading as it gives the big picture perspective of small ambiguities, irritations, interruptions that occur many times throughout the day of a clinician.
Spear (2005) aptly summarizes the issue: The problem also stems from the way health care workers react to ambiguities when they encounter them. Like people in many other industries, they tend to work around problems, meeting patients' immediate needs but not resolving the ambiguities themselves. As a result, people confront "the same problem, every day, for years" (as one nurse framed it for me) regularly manifested as inefficiencies and irritations -- and, occasionally, as catastrophes. (webpage 1)
Credible Websites
SMART Goal 1: Leadership Development
Tools for Competency Self-Assessment. (2012). [Website]. Retrieved
http://nursing-informatics.com/NILC_niassess.html
Under the Obama Administration, new legislation has passed to further the development of digital medical records. This trend in medical recordkeeping will have substantive impact on nursing practice. To promote preparation by nursing staff to be competent users of informatics, I can use the master list of informatics competencies for my own edification and encourage field staff and case managers to incorporate the technology in their efforts to meet patient goals. This website includes a range of resources associated with the technical, utilitarian, and leadership aspects of informatics competencies for nurses. Different user levels and tutorials are addressed, and resources for continued self-guided study are provided.
SMART Goal 2: Organizational Planning
(2009, February 10). Nurses waste 'an hour a shift' finding equipment. Nursing Times.net [Website]. Retreived http://www.nursingtimes.net/nurses-waste-an-hour-a-shift-finding-equipment/1987381.article#
This website is a product of Nursing Times periodical and requires registration -- restricted access may result in higher quality content, including peer reviewed articles. For instance, a recent article discusses how hands-free communication devices may save nurses time during their time on the floor. The webpage content cited above corresponds with a line of inquiry about systematic inefficiencies in hospitals and healthcare facilities.
There is evidence in the nursing literature that roughly 25% of practitioners' time is wasted because of systematic inefficiencies. Nurses report having to look for missing equipment or medication, having difficulties deciphering the handwriting of doctors, being asked by doctors and others to find charts, being distracted while administering medications, and putting up with numerous, unnecessary interruptions during their shift. Informed by this body of research, my initiative to improve the work-life balance of nurses will include efforts increase efficiencies in the workplace. This is counterpoint to examining timesheets and looking for time management issues with individual practicing nurses -- that would be treating the symptoms instead of causes. It is critical to my efforts to ensure that systematic issues do not pull down the performance and efficiency of nursing staff.
Informational Expert
I conducted an email (telephone) interview with Steven Spear, a senior fellow at the Institute for Healthcare Improvement in Cambridge, Massachusetts. Spear is the co-author (with H. Kent Bowen) of "Decoding the DNA of the Toyota Production System" (Harvard Business Review, 1999, September -- October), and the author of "Learning to Lead at Toyota" (Harvard Business Review, 2004, May). Spears served as my informational expert for both of my SMART goals since his work on lean healthcare organizations encompasses communication (SMART Goal 1) and leadership (SMART Goal 2). I believe that Spears approach to improving efficiency, effectiveness, and safety in hospitals has direct application on my initiative to secure a reasonable work-life balance for nurses at my facility.
Spears (2005) asserts that reform is within the sphere of control of nurses and other practitioners: What I'm talking about here are opportunities that will not require any legislation or market reconfiguration, that will need little or no capital investment in most cases, and -- perhaps most important -- that can be started today and realized in the near-term by the nurses, doctors, administrators, and technicians who are already at work. (webpage 1)
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