Transitioning From Closed to Open Systems: How

Transitioning From Closed to Open Systems: How Effective Nurse Leaders Approach Problem Solving and Decision Making in Organizations

The objective of this study is to examine transitioning from closed to open systems and how effective nurse leaders approach problem solving and decision making in organizations. This study will utilize systems theory in identifying an issue or process that could be improved and apply knowledge and strategies related to systems theory.

The problem addressed in this study is the excessive trust vested in unlicensed personnel resulting in some to make decisions reserved to licensed health professionals.

Responsibilities of the Nurse Manager

It is reported that the licensed nurse manager or supervising nurse has the responsibility to "delegate professional responsibilities only to persons who are qualified by education, experience or licensure to carry out the responsibility." (New York Office of the Professions, Division of Professional Licensing Services, 2009, p.27) It is additionally reported that it is the responsibility of the State Education Department to investigate any charges relating to whether "administrative and supervisory personnel have made adequate provision for staffing…to ensure necessary patient care in all situations." (New York Office of the Professions, Division of Professional Licensing Services, 2009, p. 27)

II. Specific Nurse-Administrator Duties

Included in the responsibilities and duties of the nurse manager or administrator in patient care are the following: (1) making sure that the personnel's qualifications and capabilities are appropriate to the needs of the patient; (2) accepting the reasonable notice of a nurse to terminate the nurse-patient relationship and locate a qualified replacement; (3) addressing any known vacancies in a timely manner; (4) ensuring that every effort is taken to acquire additional staff that is qualified; (5) assign assistance periodically from another area for the delivery of specific services; (6) prioritize the activities of care that will be given during the tour of duty; and (7) notify administration of any limitations in the provision of optimal care during periods when the organization is understaffed. (New York Office of the Professions, Division of Professional Licensing Services, 2009, pp. 27-8)

III. Licensed Professionals and Duties

It is reported that licensed professionals should "in general…must provide only services that they are competent to perform." (New York Office of the Professions, Division of Professional Licensing Services, 2009, p. 28) It is reported that Registered Professional Nurses are authorized to execute medical orders "from select authorized health providers." (New York Office of the Professions, Division of Professional Licensing Services, 2009, p. 30) Additionally, Registered Nurses may functioning independently in the provision of nursing care in the following areas: (1) Case finding: this includes but is not limited to: (a) identification of epidemiological trends; (b) client abuse assessment; and (c) early identification of emergent complications; (2) Health teaching: this includes but is not limited to: (a) patient teaching; (b) patient teaching in relation to disease process and management regarding life factors including health and ethnicity; and (3) Health care promotion: this includes disease and accident preventing as well as teaching normal child growth and development; (4) Health counseling: this includes but is not limited to: (a) mental health counseling; (b) Addiction counseling; and (c) health counseling related to management of chronic diseases; (5) Care Restorative of Life and Well-Being: this includes: (a) rehabilitation services; (b) triage and ongoing assessment; (c) and ongoing surveillance and nursing intervention; (6) Care that is supportive of life and well being including: (a) hospice and palliative care; (b) management of chronic pain through non-pharmacological measures of nursing; and (c) public health care. (New York Office of the Professions, Division of Professional Licensing Services, 2009, pp. 30-1)

IV. Systems Theory

A system is defined as "a group of interacting units or elements that have a common purpose." (Arizona State University, nd, p. 1) In the field of healthcare this system is characterized by a group of health care professionals with the common purpose of providing optimal patient care. In an open system, the system interact with other systems outside the environment as compared to closed systems that generally have no interaction with other systems or the environment outside of the system. The field of health care is presently characterized by a shift from the historically closed system to the present open system in health care provision. It is critical that nurse leaders understand the implications of the open system and the important role that those outside of the organization or system play in affecting the health care of patients. The provision of home health care or hospice is one example of the open system interactions. The nursing leader has a responsibility to ensure that hospice care is making the provision of the best possible care to the patient and that this care supports the patient's needs and the provision of care that is characterized by the industry's 'best practice' methods of health care provision. The nursing leaders of today play an important role and are responsible for ensuring that their patients are on the receiving end of effective health care whether that care is restorative or palliative health care. The organization that functions as a closed system places an emphasis on the interrelationships that exist between the internal components of the system solely and thereby ignores the interaction with the external environment. The emphasis of the closed system is on "procedures for monitoring outputs, comparison of outputs with preset standards, evaluation of discrepancies between actual ouputs and preset standards, and mechanisms for taking action to rectify negative variances between actual outputs and preset standards." (Singh, n.d., p.3) Closed systems management is focused primarily on such as "organizational structures, productivity, effectiveness, cost control, profitability, and quality." ( ) The closed system functions as an entity that is "self-contained…isolated from its environment." (Singh, n.d., p.3) It is reported that regardless of the efficiency of the organization's internal system that the lack of the open system approach will result in stagnation and a loss of a competitive edge. (Singh, n.d., paraphrased)