Critique 1

Impact of Nursing Leadership

By Bowers, Devin MSN, RN, NE-BC

This article discussed the significance of nursing leadership. Strong leadership is important in
any profession, but in the nursing field it's crucial to the well-being and recovery of patients.
Nurse leaders ensure that every member of the team provides the highest level of care, while also
encouraging employees to work together and put patient needs ahead of personal issues. They
also mentor fellow nurses, providing the advice and guidance they need to fulfill their job duties
with confidence.

While the definition of leadership in nursing often includes qualities such as encouraging,
inspirational, and supportive—truly successful nursing leadership must be equipped to evolve as
the nursing industry itself experiences ongoing change and shifts. This style of nursing
leadership has been linked to improved patient outcomes, reduced medical errors, and improved
staff retention, benefiting the healthcare workplace as whole.

As nurse leaders become increasingly aware of the correlation between a stronger team and
stronger achievements in patient quality and safety, understanding how to incorporate steps for
strategic, long-term success into day-to-day practice is key. In any given day, a nurse leader will
problem solve for issues related to bedside care, patient safety, budget constraints, and staffing
shortages. Being able to perform well under pressure and balance the myriad of daily challenges
is no small endeavor for even the most experienced nurse leader.

With the ever-evolving healthcare industry, one truth will always remain constant—leadership in
nursing practice directly impacts an organization’s drive, performance, and people (caregivers
and patients alike). As hospitals and health systems strive to improve patient care, an emphasis is
placed on adopting characteristics of a highly reliable organization (an organization that works to
create an environment in which potential problems are anticipated, detected early, and nearly
always addressed early enough to prevent catastrophic consequences).

In truly highly reliable organizations, leadership skills are encouraged throughout the
organization. While it’s often common to focus leadership efforts at the highest levels of a
hospital or health system, middle-management leaders (such as nurse leaders) are key to an
organization’s success and directly impact many front-line caregivers and healthcare workers.

References:

American Nurses Credentialing Center. ANCC Magnet Recognition Program.

Bowles JR, Adams JM, Batcheller J, Zimmermann D, Pappas S. The role of the nurse leader in
advancing the Quadruple Aim. Nurse Leader. 2018;16(4):244–248.
Critique 2

Developing Delegation Skills

By Alice Weydt, RN, MS

The article shows confidence in delegation of registered nurses. The ability to effectively
delegate is an essential skill for frontline clinicians, educators, and nursing leaders. Delegation is
a fundamental element of leadership and teamwork that lets individuals with various talents,
roles, and responsibilities come together, divvy up the workload, and make any job more
manageable. When done well, the work is accomplished successfully, generating a strong sense
of collaboration, pride, and esprit de corps within the team. When done poorly, well...there's
likely to be conflict, bitterness, and morale problems.

Delegation is hard for a lot of people. I've heard nurses’ comment that they just want to be
responsible for their own actions because it's too difficult to be accountable for what others do.
Newer nurses in particular may feel guilty about asking others to help them, even those
employees whose actual job it is to help. They may worry that staff will perceive them as being
unable to handle the workload, or that certain people on the unit won't accept or like them.

When effective delegation skills are used in a healthcare setting, patients, nurses, and employers
will benefit. These skills can be taught and sharpened over time to improve efficiency while
ensuring patients receive the best possible care. Consider training opportunities for teaching
delegation skills so nurses can practice them in a safe environment before confidently deploying
them in a healthcare setting.

Delegating to others creates manageable workloads, allowing qualified staff to fulfil the
professional responsibilities only their training and experience allows, while providing patients
with care and observations they need.
Delegating increases confidence in the individual taking on the higher responsibilities and
increases their status. It develops the skill set of the practitioner, offering new opportunities and
career progression. Delegation can free up time to develop the service and the staff. In this way,
delegation can be seen as an investment for the future of the service and staff.

However, it is important to plan for safe delegation and staff development. All too often support
workers are delegated responsibilities in an ad hoc fashion because services are short of staff,
and, consequently, short of time.

References:

American Nurses Association. (2001). Code of ethics for nurses with interpretive statements an
independent study module. Author: Washington DC.

Creative Health Care Management. (2007). Leading an empowered organization manual.

Minneapolis: Author.
Critique 3

Ethical Awareness: What It Is and Why It Matters’

By Aimee Milliken, PhD, RN

Much attention has been paid to the role of the nurse in recognizing and addressing ethical
dilemmas. There has been less emphasis, however, on the issue of whether or not nurses
understand the ethical nature of everyday practice. Awareness of the inherently ethical nature of
practice is a component of nurse ethical sensitivity, which has been identified as a component of
ethical decision-making. According to the non-maleficence principle of medical ethics, ensuring
patients’ safety and preventing any injury or damage to them is a major priority for healthcare
providers. Thus, it has been the most emphasized component of the quality of health care
services all around the world.

Despite various patient safety guidelines and standards, less attention is paid to the ethical and
legal aspects of this issue. From a moral perspective, the main goal of patient safety in the health
system can be studied from two aspects. It can be studied as a practical value, in the sense that
the main focus is its positive outcomes and benefits. It can also be studied as a moral value by
focusing on the protection and promotion of humanity and human dignity.

It should be emphasized that both aspects are important in the health system. From a professional
point of view, moral values in patient safety are not separated from basic medical obligations,
but are so central that they may be the source of other moral values emphasized in medicine.
This means that patient safety is closely related to the concept of human dignity and all patient
safety measures taken must insure the protection of human’s dignity. In other words, the
responsibility of the health care staffs and professional commitment, in general, are closely
related to human dignity.
Despite increased attention toward the quality of health care services, there are still numerous
threats to patient safety in healthcare settings. Since patient safety is multidimensional and
grounded in ethical and legal imperatives, both ethical and legal challenges should be taken into
account.

Reaching the ultimate goal of the healthcare system, which is to ensure quality and safety of the
services, requires structured policies and processes to foster the safety settings based on mutual
trust. This can be facilitated by encouraging multidisciplinary collaboration for the transparent
reporting of medical errors and also active participation of the patients and their families in
detecting medical errors. Furthermore, the provision of emotional support and legal protection of
the staffs by the organization is essential to encourage voluntary reporting of incidents.

Moreover, training and emphasizing on the professional code of ethics can be effective on
deepening the understanding of and belief in the moral foundations of patient safety.

References:

Durgun H, Kaya H. The attitudes of emergency department nurses towards patient safety. Int
Emerg Nurs. 30113-6. [PubMed] [Google Scholar]

American Nurses Association. (2015). Code of ethics for nurses with interpretive statements.
Silver Spring, MD: Nursebooks.org.
Critique 4

Staffing Ratios and Burnout

By Vuong, Linda BSN, RN, CCRN

Nurses' vigilance at the bedside is essential to their ability to ensure patient safety. It is logical,
therefore, that assigning increasing numbers of patients eventually compromises a nurse’s ability
to provide safe care. There are many key factors that influence nurse staffing such as patient
acuity, admissions numbers, transfers, discharges, staff skill mix and expertise, physical layout
of the nursing unit, and availability of technology and other resources.

The nurse-to-patient ratio is only one aspect of the relationship between the nursing workload
and patient safety. Overall nursing workload is likely linked to patient outcomes as well. A
PSNet Classic 2011 study showed that increased patient turnover was also associated with
increased mortality risk, even when overall nurse staffing was considered adequate. Determining
adequate nurse staffing is a very complex process that changes on a shift-by-shift basis. It
requires close coordination between management and nursing and is based on patient acuity and
turnover, availability of support staff and skill mix, and settings of care.

Longer shifts and working overtime have also been linked to increased risk of error, including in
one high-profile case where an error committed by a nurse working a double shift resulted in the
nurse being criminally prosecuted. Studies show that medication errors are three times more
likely to be committed by a nurse working shifts longer than 12.5 hours each on more than two
consecutive days. Fatigue results in inattention, a decline in vigilance, poor judgment, and lack
of concentration.

High patient-to-nurse ratios are strongly associated with emotional exhaustion, job
dissatisfaction and fatigue. Nurse fatigue (sometimes called burnout) can be described by a
number of symptoms, including irritability, insomnia, headaches, back pain, weight gain,
depression, and high blood pressure.

Hospitals are facing multiple challenges. Governments have increasingly mandated containment
of rising hospital costs. Advances in technology, including less invasive surgical procedures,
have reduced the need for inpatient care on the one hand, resulting in excess inpatient capacity.
On the other hand, the complexity of medical and surgical interventions undertaken in hospitals
requires an ever bigger and more sophisticated clinical workforce.

References:

National Academies of Sciences, Engineering, and Medicine. Taking action against clinician
burnout: a systems approach to professional well-being. Washington, DC: National Academies
Press; 2019. Consensus study report;
Critique 5

Decision- Making in Nursing Practice: An Integrative Literature Review

By Christine W. Nibbelink, PhD, RN and Barbara B. Brewer, PhD, RN, MALS, MBA, FAAN

We are all involved in decisions in life from the simple to the complex, those that deal with
patients and clients to those that deal with our life outside work. Decision making can range from
fast, intuitive, or heuristic decisions through to well- reasoned, analytical, evidence-based
decisions that drive patient and client care.

There are many factors involved in clinical decision making and each of the core skills has the
potential to impact effective decision making. In an ideal world decision- making would be made
objectively, with a full set of evidence, an endless bank of resources, no time pressures, minimal
interruptions, decision support tools to hand and plenty of energy to handle any decision- making
situation at any time of the day.

However, this is not always the reality. Clinical decision making is a balance of known best
practice (the evidence, the research), awareness of the current situation and environment, and
knowledge of the patient. It is about 'joining the dots' to make an informed decision. Informed
clinical decision making should include a variety of information and knowledge sources.

Patients, clients and their families expect to be given information on their condition and
treatment options with the practitioner and broader clinical team taking their individual
preferences into account. However, many patients and clients may wish to be actively involved
in the decision making, making the decisions themselves.

This concept of shared or negotiated decision-making, with the patient/client as an active partner,
brings with it issues of informed consent and comprehensible risk communication. It is important
to hear the patient and enable them to build knowledge to support their self-care and self-
management strategies.

References:

Rana Alaseeri."Factors Influencing Nurses’ Decision-Making Process: An Integrative

Literature Review”. IOSR Journal of Nursing and Health Science (IOSR-JNHS), vol. 8, no.04,
Critique 6

The Effect of Budgetary Controls on the Performance of an Organization

By Anthony Tapiwa Mazikana

This article gives you a breakdown of the “what” and “why” behind budgeting reports, an action
plan to get budgets under control, and our number one recommendation if you struggle to control
spending. Budgetary control is financial jargon for managing income and expenditure. In
practice it means regularly comparing actual income or expenditure to planned income or
expenditure to identify whether or not corrective action is required.

Budgets are an important element of organizational management and serve multiple purposes.
What is clear from the authors noted and other authors is that budgets are an inherent part of
most organizations and support the primary management functions of planning, directing,
controlling, and decision-making (Sponem & Lambert, 2016).

Poor financial management, including the lack of budget use for planning and control, often
leads to poor financial performance and eventual business failure.

A budget is an accounting plan. It is a formal plan of action expressed in monetary terms. It

could be seen as a statement of expected income and expenses under certain anticipated
operating conditions. It is a quantified plan for future activities –quantitative blue print for
action. Every organization achieves its purposes by coordinating different activities. For the
execution of goals efficient planning of these activities is very important and that is why the
management has a crucial role to play in drawing out the plans for its business. Various activities
within a company should be synchronized by the preparation of plans of actions for future
periods.
Budgeting and Budgeting Control are tasks that every organization has to undertake to
successfully manage the operation of the entity. These tasks are very important organizational
activities which need time to prepare, operationalize and implement successfully. It is the
objective of every organization to be successful by achieving its goals and attain competitive
advantage.

References:

AL Mahroqi, R. M. (2021). Examining the Effect of Budgetary Controls on the Financial

Performance of Oman Telecommunication Company. Advances in Social Sciences Research
Journal, 8(6), 83–95.

Prepared By:

Mechelle V. Mendevil

Foundation of Nursing Management