These skills are vital for them to make an impact, considering the powerful relationship between leadership strength and influence. (...)
In Australia the following study has noted a change in skill mix may be necessary:
Rising demand for health services, cost containment and shortages of nurses, midwives and other health workers were cited as the major catalyst for skill mix changes by ICN (2005d in ICN 2006). ICN (2004 in ICN 2006) noted that the evidence base in the area of skill mix was limited, but growing, with examples of studies that reported cost and quality improvements. (Fox-Young, 2007, p.17)
Regarding education, these nurses should have been exposed to training even in the classroom the would make them better prepared for these circumstances by,...using real life case studies in the classroom and clinical set- tings This complex and progressive learning is a continuous process that occurs throughout one's (Feldman & Greenberg, 2005, p. 6)
Perception of workload problems by the staff is also an issue. In this 30 bed unit some may feel they are being overly worked. This is often the case when newer nurses who need more experience, are assigned to more shifts. Newer nurses are also cheaper to utilize than nurses who have been with the hospital for some time, which is the case here where an inexperienced nurse is assigned the medication cart. Seniority and overtime is also an issue. While overtime and patient care is another issue, some limits that need to be set about overtime during a given period by one individual in an attempt to uphold that standard of patient care. (Continuing Competence, 2006)
Not only is call bell response time a concern, it is also trouble that nurses did not notice a change in the patients condition until she brought it toothier attention. While a call bell is required to protect the patient, vigilant staff should not rely on it as the only course of identifying a problem. (Schroder, 2003) in this case, nurses on round the entire day should have been more aware of the patient a's demeanor and possibly signaled an earlier response to her distress. Current research suggests further studies attempt to replicate and improve upon these results. That a more systematic assessments of both patients' and staff's overall satisfaction be made to determine further improvement. Also, that more studies research the influence of other factors that may not be as obvious such as patient, age, gender, race, etc. As wel as other nursing attributes Nursing must constantly adapt to health care changes and better protocols in order to return the utmost in patient care. (Coombs, 2004, p. 5) the Australian Nursing and Midwifery Council (ANMC) which is "...the peak body established to bring a national approach to the regulation of nursing and midwifery in Australia." (a national framework, 2007, p. 3) provides a set of the national principles, one of which is to "Enhance safety and quality when integrated with a comprehensive approach to managing risk." (a national framework, 2007, p. 5)
Finally there are several tools already in place which, if in use in the current situation would have helped to prevent this problem. For instance in section five of the National Competency Standards for the Registered Nurse points out:
5.2 Uses a range of assessment techniques to collect relevant and accurate data uses a range of data gathering techniques, including observation,...
These coupled with the proper training and supervisory techniques may have prevented this problem from occurring by reevaluating the performance of the staff prior to the incident.
The levels of competency standards provided by the ANMC are as follows:
Competence is the combination of skills, knowledge, attitudes, values and abilities that underpin effective and/or superior performance in a profession/occupational area1. Continuing competence is the ability of nurses and midwives to demonstrate that they have maintained their competence in their current area of practice. (National Competency Standards, 2008
Certainly the nurse in charge of the medication chart appears to be the primary target of the critical incident. However, in reality the team and the supervisor is ultimately to blame for not having better prepared the staff overall. The assessment from the beginning that the patient a's depression was being controlled by St. John's Wort should have signaled more vigilance and the level of care simply did not meet the competency standards right from that point and then onward. There is also the matter that this small staff was in charge of a 30 bed unit, and that the workload may have been to great as well. But in an era of cost cutting, more vigilance and improvements in training for smaller staffs working as a team must come into play,.
Continuing Competence in Nursing and Midwifery. (2006) Australian Nursing and Midwifery Council Retrieved on March, 12, 2009 at http://www.anmc.org.au
Coombs, M.A. (2004). Power & Conflict between Doctors and Nurses: Breaking through the Inner Circle in Clinical Care. New York: Routledge.
Feldman, H.R. & Greenberg, M.J. (Eds.). (2005). Educating Nurses for Leadership. New York: Springer.
Fox-Young, Stephanie. (2007) Report to the Australian Nursing and Midwifery Council. Australian Nursing and Midwifery Council. Retrieved on march, 10, 2009 at http://www.anmc.org.au
Greathouse, J. (1997). Kurt Lewin. Muskingum College Psychology Department, New Concord, OH Retrieved on march 9,2009 at http://www.muskingum.edu/~psych/psycweb/history/lewin.htm
Janiszewski Goodin, H. (2003) the nursing shortage in the United States of America: an integrative review of the literature. Journal of Advanced Nursing, 43(4), 335-350
Joynt, J. & Kimball, B. (2008) Blowing Open the Bottleneck: Designing New Approaches to Increase Nurse Education Capacity. Texas Board of Nursing. 1-39 Retrieved on Mach 11, 2009 at http://www.bne.state.tx.us/about/July08/7-7.pdf
Mccabe, S. (2005). I Don't See No Line. Perspectives in Psychiatric Care, 41(2), 79-88
National Competency Standards for the Registered Nurse (2006) Australian Nursing and Midwifery Council Retrieved on march, 10, 2009 at http://www.anmc.org.au
National Framework for the Development of Nursing and Midwifery Practice. (2007). Australian Nursing and Midwifery Council. Retrieved on march, 10, 2009 at http://www.anmc.org.au
Nelson, R. (2005)T he Clinical Nurse Leader -- Needed or Not? American Journal of Nursing, 105 (12) 24-25,
Nursing Practice Decision Flowchart. (2008) Australian Nursing and Midwifery Council Retrieved on march, 10, 2009 at http://www.anmc.org.au
Nursing Practice Decisions Summary Guide. (2008) Australian Nursing and Midwifery Council Retrieved on march, 10, 2009 at http://www.anmc.org.au
Outshoorn, J. (2002). Gendering the "Graying" of Society: A Discourse Analysis of the Care Gap. Public Administration Review, 62(2), 185-197.
Schroder, Jack. (2003) Identifying medical malpractice. (2nd Ed.) Oakland, CA: Catalpa Press
Staff Nurses. (2007). American Nurse Association. Retrieved…
• •the marketplace lacks competition. Thus the consumer may have limited choice, and some sellers or manufacturers may not care if the consumer is dissatisfied. (Zelman, 1999, pp. 5-6) Managed care, then becomes an institution that is highly in need of regulation, according to those who make such decisions, as the need to be a consumer advocate (including those who are profiting from health care) has always driven the government to
Likewise, the therapist in front of the mirror is expecting a credible "performance" that illuminates and furthers the therapeutic process (Johnson et al., 1997). Solution-focused therapy encourages all participants to attend to their own wants and needs, not just those of their partners. Depending on the goal, therapists recommend that each participant take charge of caring for oneself as well as appreciating how his or her own actions influence others
Hayes, E. (2007). Nurse Practitioners and Managed Care: Patient Satisfaction and Intention to Adhere to Nurse Practitioner Plan of Care. Journal of the American Academy of Nurse Practitioners. 19 (2): 418-26. Personal Response: At the heart of healthcare as an institution is, of course, the need to care for the sick and the injured. However, in the contemporary model of healthcare, effective communication during a crisis is not only important, but
managed care in modern health care. Specifically it will include a brief history of managed care, along with some pros and cons about the process. Managed care is an arrangement where an insuring organization accepts the risk for providing a defined set of health services, using a defined set of providers, for a defined population, in return for a fixed or regular per capita payment" (Lammers and Geist, 1997, p.
, income is quite often decreased and patient care sometimes adversely impacted due to time constraints, the need to hire a dedicated insurance person for the office, and the innumerable and sometimes counter-productive, forms and questions the HMOs ask of their medical professionals (See: Zimet, 1989, 2002). The survey instruments were both quantitative and qualitative in nature, and included four to six sections: basic demographics; general information about the practice (theoretical
Cox, T. (2010). Legal and ethical implications of health care provider insurance risk assumption. JONAS Healthcare Law, Ethics and Regulation. 12(4):106-116. How healthcare providers really feel about managed care and other forms of insurance is very important. If doctors and hospitals do not feel good about the payments they receive from specific managed care organizations, they may choose not to work with those organizations. That can leave a large number of