Nursing administration specialist roles and responsibilities

Nursing Administration Specialist

Dr. M's dilemma

Strengths

The hospital has a very strong reputation within the community and an over hundred-year history.

The hospital has just been purchased by a university hospital system with an equally stalwart reputation.

The new management seems committed to changing the hospital for the better and restoring it to its former glory.

There is a commitment to change amongst Dr. M.

Patients desire change.

Weaknesses

The hospital has rapidly grown in size from 50 to 300 beds and its standard operating procedures have not kept up with the current needs of patients.

It is losing money.

There are serious delays in transferring patients which could lead to a compromise of overall quality of patient health and also to inaccuracies in paperwork when patients are in a state of limbo. Not only do the transfers take place late at night, but the documentation is left to late night staff that has been working longer hours and is more apt to make errors.

4. Patient dissatisfaction is increasing overall.

5. The hospital is getting a great deal of negative press in the media.

6. There is a lack of cohesion on the unit amongst the nurses and upper-level staff members are continually being called in to 'put out fires.' The staff as a whole seems unable to come to agreement over minor issues. Assistant and head nurses are unionized and function on 8-hour shifts, which means that several nurses may take over the care of the same patient with 24 hours, increasing the risk of errors because of lack of knowledge of patient needs.

7. The emergency department is often used as a source of primary care by community residents without insurance. The emergency room is overbooked and overcrowded, making it difficult to handle real emergencies. Physicians do not complete their discharges until midafternoon, resulting in the ED being unnecessarily backed up and overcrowded.

Opportunities

1. The Board may provide funding for higher salaries.

2. Higher salaries will enable the hospital to raise educational standards for nurse managers to a master's level via supported education and hiring new staff.

3. Head nurses and assistant head nurses must be persuaded to leave the union in order to become members of management.

4. Even if there is resistance to change amongst staff, unavoidable change will occur because of leadership, budget, and public pressures.

5. A new medical chief of staff and a new CEO are assuming command.

Threats

1. At competitor hospitals, the units are led by nurse managers assuming 24-hour responsibility for patient care rather than head nurses, ensuring greater consistency of care for individual patients over the course of a 24-hour period.

2. There is likely to be profound resistance to the push to discontinuing unionization amongst the nursing staff, who are very loyal to their union ties.

3. Staff members are profoundly resistant to change, given that they have been working there for decades and are resent an outsider like Dr. M giving them advice.

4. Nurses have relatively low levels of education -- most have AAs and only a quarter have BSNs.

5. There is also tremendous friction between doctors and nurses, perhaps because of this educational discrepancy.

Conclusion

In terms of the hospital's strengths, there is profound community goodwill and a desire for it to succeed, as well as new-found institutional support from the university system that has acquired it. However, hospital has many weaknesses. Some of these are administrative, such as the inefficiencies of patient transport from the ED and the ways in which patients are overseen in terms of their care. This exacerbates the unavoidable societal problem of uninsured people using the ED as a site of primary care. There is also a great deal of animosity amongst the staff members on every level. There are opportunities to bring in new nurses and improve nurses' existing credentials as well as a change of leadership, which can be a harbinger of creative, out-of-the-box thinking. However threats remain -- it is uncertain if the hospital can remain solvent and compete with more efficient entities in the wake of the staff's change resistance. Also, introducing new staff will take time and may be resisted by the still-unionized nurses who may fear losing their jobs.