FACULTY OF NURSING

ASSIGNMENT COVER PAGE

All details MUST BE COMPLETED or assignment may be

returned before acceptance

Student’s Name Tevaki Mathavan

Student’s ID 111160916492 Student’s NRIC 900704075670

Year/Semester 2016/Semester 3 Lecturer’s Name Pn.SajuChiam

Faculty Faculty of Nursing

Program Bachelor of Science (Hons) in Nursing (Post Registration)

Subject Name LBBS 3407 (Management 1) (summative)

Assignment Title Nurses as Agents for Changes

No. Page (excluding

12 pages
this page)

Required word 3000 words Actual # of words 4000

Date submitted 10th October 2017 Due Date 11 December 2017

Yes Y No
Soft copy included

DECLARATION BY STUDENTS:

I certify that this assignment is my own work in my own words. All resources have been
acknowledged and the content has not been previously submitted for assessment to LINCOLN or
elsewhere. I also confirm that I have kept a copy of this assignment.

Signed: Tevaki Mathavan. Date: 11 December 2017

Remarks: This assignment must be submitted in hard copy, either (1) in person to the college
office or by post, ensuring that either the assignment or envelope is date stamped. Also must
sign this sheet as proof of submission.
Nurses as a changing agent.
Nursing is profession within health care sector. They are assigned to take care of
individuals called patients. As a nurse we work with doctors as case mangers mainly and
with other health care workers as team manger to achieve ultimate outcome patient
care. We as a nurse work to keep our patient healthy, fit, and free from any medical
complications. This explanation may sound simple. But the real fact is we have to think
like a doctor and must do all other works in the hospital or health care setting including
maintenance work and sometime cleaner work. But we never complaint about that
because all what we want is our patient comfort. The nurse is the only person who is
able to help patients directly, by talking to them, full fill their needs, observe that nothing
is going wrong and of course seeing our patients getting better day by day. We as a
nurse have a high level of stress due to so much job Responsibilities.When nursing
began it had very little to do with formal medical training and everything to do with your
gender and willingness to do the job. In the early days of nursing, women learned
medical skills from their mothers or other women in the same profession. It was not
really seen as a respected trade, but women were not really seen as a respectable
gender, either. Women were caretakers, so nursing was just an extension of what their
roles at home were anyway. Today, the nursing profession has changed drastically.
There are extensive training programs, more diversified staff, and a level of prestige
associated with this area of the medical field that was not there before.Time has done a
lot for many career paths, but the nursing field has seen drastic changes to help the
efficiency of medical care. There are more training programs, better hospitals, more
responsibility, a sense of family, and a focus on patient care in the nursing industry that
has saved lives and created generations of dedicated medical professionals.When
nursing began it had very little to do with formal medical training and everything to do
with your gender and willingness to do the job. In the early days of nursing, women
learned medical skills from their mothers or other women in the same profession. It was
not really seen as a respected trade, but women were not really seen as a respectable
gender, either. Women were caretakers, so nursing was just an extension of what their
roles at home were anyway. Today, the nursing profession has changed drastically.
There are extensive training programs, more diversified staff, and a level of prestige
associated with this area of the medical field that was not there before.Time has done a
lot for many career paths, but the nursing field has seen drastic changes to help the
efficiency of medical care. There are more training programs, better hospitals, more
responsibility, a sense of family, and a focus on patient care in the nursing industry that
has saved lives and created generations of dedicated medical professionals.

Now the medical settings for nurses are hospitals, physicians’ offices, home health care
services, or assisted living facilities. Nurses are now medical professionals that are
needed in schools, correctional facilities, or the military. Nurses are even traveling to
fulfill nursing needs across the United States while gaining experience and pay. The
setting for nurses really started to change with the added training for nurses that made
them more respected medical personnel and not just women who focused on assisting
doctors and giving sponge baths. With the added responsibility came the need for
nurses all over the country, and many women flourished with this career path working in
hospitals more than just providing care in the home.Now the role of the nurse is not easy
to define for many medical professionals. They take on many more responsibilities than
they ever have before and are seen as respected medical professionals because of their
extensive schooling and real world application of skill. The medical world is always
changing and growing, which opens up a need for personnel in many hospitals
constantly. With the growing amount of patients in our hospitals it’s important that our
nurses know how to handle medical emergencies without asking a physician for aid, so
that is what our educators are focusing on. Nurses are not seen as a doctor’s assistant,
but rather as their own professional with the medical knowledge to back it up.Nursing
culture in the early 20th century was known as being mostly female with a rudimentary
amount of medical knowledge. There was a focus on being presentable, acting
respectfully, and acting as the obedient wife to every patient. In World War II, nurses
were badly needed but many women were starting to shy away from the profession
because they are not seen as professionals, endured demanding work schedules, and
were unable to keep up financially. When nurses started to be revered as heroes in order
to help raise the nursing numbers the numbers started to rise a little. Today, this culture
has changed a lot; nursing is about education and health care knowledge, has
diversified the gender norm, and nursing salaries are rising due, in part, to the nursing
shortage caused by retiring baby boomers.

Royal College of Nursing survey (2013) have found nurses are into the high level of
stress through long working hours, heavy workload, unachievable deadlines and targets
are the main causes. This will generally affect the high standards of patient care due to
the work pressure the nurses are facing through. According to the American Holistic
Nurses Association, nurses are experiencing workplace stress at the higher level
comparing to other professions. McVicar (2003) identified the main causes of stress
among nurses are the workload, leadership and management style, professional conflict
and emotional cost of caring.
He also elaborates more on this issue and proposed changes and solutions are needed
to overcome these changes and proper patient care is being delivered. The author
identified this issue and suggestions to a better change in clinical practice will be
suggested. Change requires adding new forces for change or removal of some of the
existing factors that are at play in perpetuating the behavior (Ross A. Wirth, 2004).When
nurses are faced with higher patient loads; hospitals experience a higher patient
readmission which only increases the daily workload for the nurses. When the work load
increase nurse can’t really comply their duties accordingly to the standards which lead to
some issues. For instance, American Journal of Infection control (2012) it was stated
that when nurses had increased in patient load of just one patient, it was associated with
a greater risk of infection.
The nurses role has been regarded as stress filled based upon the physical labor,
human suffering, work hours, staffing issues and interpersonal relationships that are
central to the work nurses do. One of the major problems being identified is the shortage
of nurses in the organization. When there is lacking of nurses, the workload increases for
the remaining nurses. In looking after a higher acuity of patients, nurses are expected to
perform nonprofessional care and less attention is given towards them. High nursing
workloads at the unit level have a negative impact on patient outcomes. Nurses who
have a heavy workload may not have sufficient time to perform tasks safely, apply safe
practices or monitor patients and may reduce their communications with physicians and
other providers. It also will de-motivate them in achieving for high quality performances
and standards. Experiencing stress and burnout creates a negative image on their
performances. Contribution to errors and mistakes are mostly being faced by the nurses
and this makes the situation worst as they are being answerable for the patient’s
conditions. It is much more difficult for fellow nurses to follow the rules and guidelines in
compromising the quality and safety of the patient. Communication between the nurses
and patient are also affected and this makes the patient feeling insecure and frustrated if
there were questions needed to be asked for their illness. Examples such as several
members of the same family may call a nurse separately and ask similar questions
regarding patient’s condition. Answering all these different calls and repeating the same
information about the patient status to different family members increases the workload
of the nurse.
Nevertheless, work stress and burnout remains a big concern in nursing affecting the
individual nurse and the organizations. As for the nurse, it may contribute to illness. Most
hospitals are facing workforce crisis. According to Conner and Ulrich (1999), Human
Resources face the most important challenges which are managing the organizational
changes. There is no industry perhaps that needs rapid change other than healthcare
industry (Lowery 1197). In a toxic working environment, most nurses believe that
recruitment of more nurses will help to improve in job satisfaction for all health care staff
and patient outcomes as well will be positive most the time. Burnout is described as
emotional exhaustion which means feeling overextended and increasing in mental
distance from ones job that resulting impersonal response towards one care, treatment
or care. Nurses facing burnout may be found more likely to eat poorly, smoke cigarettes
and abuse alcohol and other drugs which lead a negative health conditions. Stress and
burnout are strongly linked to suboptimal patient care following a research being said.
Examples are such relationship between higher levels of emotional exhaustion in nursing
staff and lower patient satisfaction. Lack of mental alertness may due to medical errors.
Introducing a change to the clinical environment can be a big challenge in every
change situation, an individual or group must be designated to be the change agent to
make this change works (Gebrekidan, 2005). The author has identified the nurses as the
main change agents. It is because nurses are those who render most of the bed side
nursing care. Management of the hospital needs to play an important role in this issue.
Discussing with the management of the hospitals and having meetings with them with
evidence on how the nurses are going through their daily routine with the shortage of
nurses are also implement on changing for a better patient care. Management needs to
know the important of hiring adequate nurses for a better service to patient. A survey can
be showed to them on how the patients feel being treated and neglected by nurses as
they have a high ratio of patient per nurse. Healthcare organizations have reported
having to turn away patients to other healthcare facilities due to lacking of availability off
staff. This is particularly significant concern for the organization of management to
mandate minimum nurses to patient staffing ratios and not accepting cases to overflow
in the hospital settings. When nurses are forced to work with high nurse to patient ratios,
many errors such as Medication error, Failure to rescue patient & standards of patient
care are scarified as well as safety of nurses is compromised. Pressure ulcer
prevalence, High risk of falls can be prevented. When nurses have fewer patients, better
care can be implemented and examples such as patient can understand how to manage
their illness better. More nurses are graduating these days but due to the cost cutting of
most of the hospital is having this type of mentality of not hiring enough nurses. Nurses
often state that they do not feel empowered by the management when decisions need to
be made. Instead they feel that their expertise is compromised by poor leadership and
role confusion in general. Employers who establish measures which reduce stress
among nurses benefit by having increased staff retention and this will improved patient
outcomes.
Since financial reimbursement is becoming increasingly linked with patient satisfaction
and positive outcomes, it makes good financial sense for facilities to ensure that their
nurses are not overly stress up. Management should also allow having stress
management programs available for healthcare members. Workshops help nurses to
open up and learn how to manage their stress well. This can help them to translate their
relationships with patients and colleagues. Communication is one of the best ways
nurses can decrease the stress in their day .Stress in hospitals are usually unavoidable
but it can be managed. When you foster a culture of purposeful communications, in
which people share information fully and openly, stress level can decrease. It is very
important for the patient as their trust level arise because they are fully informed about
their care and therefore can experience better outcomes. Management should also look
into rewarding the nurses more often and appreciate them by increasing compensation
and benefits and also by learning direct ways to promote nursing excellence, create
dynamic and supportive teams and encourage professional development. This will make
the nurses feel important and appreciated every day. “Human beings need to be
recognized and rewarded for special efforts. You don’t even have to give them much.
What they want is tangible proof that you really do care about the job they are doing. The
reward is really just a symbol of that” (Tom Cash, American Express, 2008)
Transformational leadership has been associated with positive traits such as
improvement in job satisfaction, enhancement of work group collaboration and
improvement in patient outcomes (Cummings et al, 2010). A nurse manager act of caring
builds trust and sets up an engaged work team that will ultimately move mountains for
the organization. Nurse Manager needs to help them to understand what they are doing
with the organizations overall goals and mission. It will generally have great satisfaction
when they engage in something eloquent. Nurse Manager needs to check on her own
stress and not put all her burden on her nurses. She needs to be aware of each nurse’s
workload and be fair to all. Helping them to shift their approach to their daily routine and
listening to their perspective and set deadlines and goals to get agreement together.
Another important part is that make sure your nurses get their breaks as well. It is good if
you can allow staff some autonomy over their time off and these will increases
satisfaction among the nurses. Nurse Manager also can play a role in helping her nurses
in the daily ward routine such as following doctors round, doing dressing which will help
in maintaining good flow in the ward. Giving assignment to nurses daily should be
rotating so that all nurses don’t feel burden on taking care of high acuity of patients all
the time. Having a fair acuity of patients is essential .Good team work and helping
around is another way to release the stress burden of nurses. Micromanaging increases
an employee’s stress from nursing. This may be a function of own sense of feeling out of
control as the demands increases. Nurse Manager should encourage, mentor, empower
and assign according to the nurses strengths and not on their ranks. Reinforcing your
nurses to help around when one of their partners is facing difficulty in managing her
patients. Senior nurses should be helping and guiding the junior nurses on how to
manage their patients and carry out target outcome. Nurses should start with most
important assignment first. Then they should tackle the assignment with medium priority
such as teaching of patient education might fall under this category, however preparing
the patient for a surgical procedure that is scheduled is immediate attention. Senior
nurses should play a role model of becoming a team leader and organizing the work
load in an equal and efficient method to demonstrate teamwork and this allows staff to
accomplish their goals in view of short staffing. Involving family in patient care activities
can reduce the work load and care givers are normally willing to learn and perform as
long the nurse is there to guide them. In this safe environment, families or friends will
have the opportunity to ask questions that they might have. Christina Orlovsky (2005)
encourages nurse manager to be an ally for their staff. When it is possible, nurse
managers could assist with patient-care on their unit. Nurse Manager should encourage
her nurses on supporting them to a better career development. Education, Leadership,
Program Management Responsibilities are one of the strategies can be implemented in
for nurses to become a better educator in future.
Violence towards health care workers appears to be on rise (Lipscomb and Love,
1992). Most of the violence acts involving threats, hitting, kicking, beating, biting,
stabbing, squeezing, pinching, and scratching nurses. Some of the factors that cause
patient to be violent towards staff are alcohol abuse, drug abuse, anger and high level of
stress. Other factors are such prolonged waiting time, gang related activities, increase
numbers of patient and neglects care to them. This makes patients inpatient and start
becoming violence. Nurses have to face this challenge and leads to physical attacks on
nursing staff. Hospital administrators and nurse manager must facilitate staff awareness
of potential violent situations and enhance the capabilities to deal with them effectively.
Nurse Manager should play an important role and teach her nurses on how to handle
such situations. Management should play a role and organize a training of violence
behavior such as containing and restraining assailant.
Conducting staff regular meetings is one of the changes can be made to solve
problems and share stress reduction techniques. Encouraged open discussion of their
everyday challenges with patient care, hospital environment, work schedules and any
other stressful nursing issues they are experiencing. This will be taken action by the
head nurse and finding a solution on these issues by regularly asking feedback from her
nurses. Motivating staff and support towards them are very important to retain qualified
nurses. Encouraging nurses to be part of the solution coming up with ideas to help solve
issues. Lending an ear on their issues and concerns also with a implementation on how
to solve issues also is a leadership skill which the head nurses needs to take attention
to. In a study conducted by AbuAlRub (2004), it was found out that social support system
is important at workplace as it enhances the level of job performances and decreases
the stress level being reported. The result also shows that nurses with moderate level of
job stress perform their jobs better rather than those with high or low level of stress.
Doctors doing their rounds in checking their patients need to be organized as well. Most
of them do their rounds not following the rounds schedules and this will create more
pressure for the nurses in always attending them and neglecting her work. Nurse
Manager should raise this issue and look in to it. Changes can be made such as doctors
doing their rounds after medications are commonly served to patient. This will make time
for the nurse to assist doctor’s rounds. Communication between doctors and nurses
should be good as to prevent any errors and keeping patients safe.
Long working hours for nurses also is a main factor that leads them being stressful. It
increases the risk for short sleep duration and sleep disturbances. When one does not
have adequate of sleep, it impacts on the patient care such as showing faces to patients,
answering in angry tones to them as you are sleepy. These all factors are important to
change in order to be fair to the patients as well. Most of the nurses brought up that they
are lacking of sleep. Twelve hours shift are common in hospitals but it can have adverse
effects on nurses. Most nurses can work twelve hour shift if they got the right support
and right level of staffing. A research reported working twelve hours shift can lead to
severe depression than those who are working eight hours a day. Most nurses will stay
back after their duty in order to complete their paperwork and all other pending work
after handing over to the next shift. This will results in them going back late. This is why
enough of staff is important in order to divide the work equally and not stressing on that
particular nurse. Nurses work schedules are based on the needs of the patient
population. A twelve hours shift means a fewer shifts to schedule in a week and the
nurses may have their off days but instead even their off days they are called to work as
lacking off staff. When long shifts are combined with overtime, shifts, this causes the
nurses high risk of fatigue which may compromise in patient care. This leads in to nurses
battling into fatigue. Fatigue and sleep deprivation are linked in to decrease in vigilance,
memory, informational processing, reaction time and decision making. Fatigue is a factor
that has been linked to stress, safety, and performance decrements in numerous work
environments (Leung, Chan, Ng, &Wong, 2006)
At the same time healthcare managements should follow certain management theories.
In the list the first one that im going to explain is system management which is Viewing
the company or organization as a system by managers are the requirement for the
systems management theory rather than viewing it as a monolithic structure. Managers
will be forced to reflect on the decision made on one aspect affecting others such as how
laying off workers will affect other company division. Company is divided into
departments, sections and subsections by business leaders as part of an overall
framework to implement this. Second one is Chaos theory which mean Large
businesses are viewed by theorists as live creatures which is part of a complex and
erratic world. This view suggests that specific events are rarely ever controlled, and the
energy expended to manage the company must grow as the business grows.According
to the chaos theory, much like humans the trends continue growing until the system
becomes overly complex, joins another complex structure and continues to grow. In the
other hand, freedom based management theory. This theory is about There is no reason
why a management system should be organized in a hierarchical structure where
employees are controlled and restricted by management is suggested by The freedom-
based management theory. Fully empowered employees that are more like
entrepreneurs and act in full freedom while still functioning with accountability and
responsibility is supported by this theory. Another theory that i would like to explain is
Contingency Management Theory. This theory is all about The best choices in a given
situation depend on numerous factors, which must be considered as there is no single
right answer suggested bybthe contingency theory. A company, also hould take into
account all aspects of a situation when making a decision. This including which type of
management system it chooses, as example a leader using contingency theory may
decide an autocratic and hierarchical management system is the best when leading
soldiers into battle, but not necessarily the best if managing a group of scientists. The
purpose of explaining all these theories is to emphasize that if certain management
follow any of these theories I'm sure they can overcome all the problems facing in
nursing to improve.
Last but not least, Patient care is now an extremely important factor in the medical field
for all medical professionals. The advancements in technology have created an
environment that makes patient care more efficient and helpful for the patient.
Technological advancements have changed almost every industry in the US and the
medical field is no different. This has helped save more lives, made certain jobs easier
for nurses, and created a better experience for patients. The culture for patient care used
to be a very demoralizing experience for many patients where medical professionals
weren’t as concerned for their dignity or enduring painful medical procedures. Luckily,
patient care has become the number one priority for medical professionals and has
flourished in recent years with nurses on the front lines of patient care.The nursing
profession has come leaps and bounds and continues to be a growing field. Historically,
it has proven its ability to adapt to the culture around it. For nurses and patients alike,
the advances made have helped the nursing field to go from being one that is not
revered as being one that deserves respect. The changes in training, health care setting,
growing responsibilities, nursing culture, and patient care have saved countless lives and
helped it become the respected field that it is today.
References
1. Aiken, L.H. (2002). “Superior outcomes for magnet hospitals: The evidence
base.” In M.L. McClure & A.S. Hinshaw (Eds.), Magnet Hospitals Revisited:
Attraction and Retention of Professional Nurses. Washington, DC: American
Nurses Publishing.
2. https://archive.ahrq.gov/research/findings/factsheets/services/nursestaffing/
nursestaff.html
3. https://www2.rcn.org.uk/__data/assets/pdf_file/0003/643476/Stress-long.pdf
4. https://www.ausmed.com/articles/stress-in-nursing/
5. https://www.ukessays.com/essays/nursing/impact-of-work-stress-on-nurses-
nursing-essay.php
6. 1997 -- Knauf RA, Lichtig LK, Risen-McCoy R, Singer AD, Wozniak
L. Implementing nursing's report card: a study of RN staffing, length of stay and
patient outcomes.
7. https://hcmarketplace.com/media/browse/6551_browse.pdf
8. http://www.nursingworld.org/fatigue
9. http://www.netscc.ac.uk/hsdr/files/project/SDO_FR_08-1819-213_V01.pdf
10. https://archive.ahrq.gov/downloads/pub/evidence/pdf/nursestaff/nursestaff.pdf
11. https://scholar.google.com/scholar?
hl=en&as_sdt=0%2C5&as_vis=1&q=system+theory&btnG=
12. https://bizfluent.com/info-8375509-four-types-management-theory.html