External Environment: Technological Trends Affecting Health Care and Nursing Leadership

Technology and Data Management

The push to transition from paper charting and data collection to Electronic Medical Records (EMR) is an external environmental factor that affected healthcare.  Electronic Medical Records (EMR) must be monitored and managed.  Data collected from many individuals practicing must be integrated, coordinated, managed, and linked with patient outcome measures.  By linking the EMR with patient outcome measures, data is provided for reimbursement for health care services.  The technological trends forced health care systems to become compliant with the advances being made, as it affected reimbursement dollars.  As taught in nursing school, if it wasn’t charted, it wasn’t done.  The data reviewed in the EMR can cause increased, decreased, or denied reimbursement (Huber, 2010, p.781). 

New departments such as data management offices were developed to monitor and implement upgrades and training for documentation programs.  Data management offices must also review documentation for accuracy per guideline expectations (most frequently Medicare requirements).  Health care organizations had to follow the trend and adapt by the implementation of EMR and the development of departments and personnel to support the software.

My organization’s main management information systems used are Healthwise and hCAR (Humana Cares Reports).  The hCAR offers reporting features to assist in managing a team, individual caseload, and monitor productivity.  The purpose of the management information system is to provide useful information to be used in decision making.  According the Huber (2010), the 10 criteria of a management information system include:  informative, relevant, sensitive, unbiased, comprehensive, timely, action oriented, uniform, performance targeted, and cost effective (p.782).

Data base systems are used for physician order entry, view/retrieve lab results, and support the documentation of nursing care.  The goal of data base systems and EMR is to provide a unified electronic record that is able to link clinical and business processes, decrease data replication, and increase the availability and accessibility of information (Huber, 2010, p.781).  The systems used within my organization are Humana Cares Action Tracker (hCAT) and Clinical Guidance Exchange (CGX).  hCAT is a system for tracking actions, intervention, and data for each member.  CGX is a system for documentation of member information, nursing and ancillary service notes, call outcomes, care plans, medical history, etc.  The goal of the organization is to merge the two data base systems into one system to increase efficiency and accuracy of documentation.

I experienced the implementation of EMR in my previous position.  Management was responsible for being complaint with training and knowledgeable of technology.  As I switched organizations this fall, I have been able to newly experience the affect of technology with a different company.  External factors will always affect health care organizations and the expectations of management.  It is important that management stay supportive and knowledgeable of change and promote compliance by their employees. 

Huber D L 2010 Leadership and nursing care managementHuber, D. L. (Ed.). (2010). Leadership and nursing care management (4th ed.). Maryland Heights, MO: Saunders Elsevier.  

Ethical Dilemma: The Impaired Nurse. What is a manager to do?

Substance Use Disorder of Nurses:  Ethical Dilemma or Disease Process?

According to DeClerk (2008) “Substance use disorder is a progressive disease which untreated continues to worsen leading to the addict’s decline physically, psychologically, emotionally, and eventually their death” (p. 22).  Substance abuse is considered an occupational hazard of nursing affecting 10% of nursing professionals.  6% of nursing professionals with substance use disorder experience interference with their ability to practice (Michigan Nurse, 2008).  Impaired nurses are a danger to not only themselves, but coworkers and patients in their care. 

Behaviors indicative of substance use disorder must be identified in order to confront a nurse believed to be impaired.  Fleck (2012) recognized behaviors suggestive of impairment as follows:

Unkempt appearance, shakiness, tremors, pinpoint pupils, slurred speech, flushed face, bloodshot eyes, smell of alcohol on breath, injuries such as bruises/burns/wounds, increased physical complaints, increased reliance on prescription medications, impaired motor coordination, personality changes, overreaction to criticism, professional and social isolation, medication errors, illogical or absent documentation related to controlled substances, discrepancies in documentation related to controlled substances, excessive absences or tardiness, difficulty focusing on task and forgetfulness, absent from unit without explanation, and patient complaints of ineffective pain relief after being medicated. (p.22).

In addition to the list of behaviors offered by Fleck (2012), DeClerk (2008) offered the following signs and symptoms of substance use disorder:

Long trips to the bathroom after being in medication/narcotic cabinet, volunteering for overtime or showing up at work when not scheduled, unreliability with appointments and deadlines, mistakes due to inattention and poor judgment, heavy wastage of drugs, frequently breaks and spills drugs, usage of maximum PRN dose when other RNs have used less, wears long sleeves when inappropriate, irritable with patients, sleepy or dozing off while on duty, and defensive when questioned about medication errors. (p.12-13).

So I recognize it, now what?

The American Nurses Association (2013) believes that the nurse’s duty of compassion and caring extends to self and colleagues as well as patients.  It is an ethical responsibility to provide care to the impaired nurse.  A substance abuse problem displays neglect of self.  The ANA supports peer assistance programs, such as the Kentucky KARE program.  The Kentucky Board of Nursing has a program to identify, assist, and monitor nurses whose ability to practice is impaired by substance use disorder (Kentucky Board of Nursing, 2013). 

It is the ethical obligation of a coworker to report an impaired nurse as much as it is an ethical responsibility to not abuse substances.  Nurses have an obligation to report impaired colleagues.  Friendship, concern for colleague’s reputation, and stigma associated with reporting can cause hesitance to report.  While many factors dissuade nurses from reporting questionable behavior of a colleague, legal and ethical duty require the nurse to uphold state and federal laws pertaining to nursing practice.  “The nurse has a legal, as well as professional, responsibility to report an impaired colleague, or any nurse to the Board that is suspected of misusing or misappropriating drugs placed in the custody of the nurse for administration or for use of others” (Fleck, 2012, p. 23).    

Reporting an impaired nurse should be done following the facility’s policies and procedure.  The staff must report findings objectively to the immediate supervisor (Fleck, 2012).  Key factors to remember while confronting and reporting an impaired nurse include remaining objective, non-accusatory, non-threatening, non-confrontational, and maintain confidentiality (Michigan Nurse, 2008).  Substance use disorder is dangerous and can lead to death if untreated.  According to DeClerk, drug addiction is often discovered in the workplace last and has already affected other aspects of the individual’s life (2008).  Identifying and reporting an impaired nurse is necessary to protect the health and well-being of the nurse and patients in their care.    

References

American Nurses Association 2013 Impaired nurse resource centerAmerican Nurses Association (2013). Impaired nurse resource center. Retrieved from http://www.nursingworld.org/MainMenuCategories/WorkplaceSafety/Healthy-Work-Environment/Work-Environment/ImpairedNurse 201307101146231206593633

DeClerk P 2008 Recognizing the chemically impaired nurse.DeClerk, P. (2008). Recognizing the chemically impaired nurse. ASBN Update, 12(4), 12-13.  201307101058261772331715

Fleck P L 2012 HELP! I think I know a nurse who may be impaired!Fleck, P. L. (2012). HELP! I think I know a nurse who may be impaired! KBN Connection, (31), 22-23.  20130710104723225020647

Kentucky Board Of Nursing 2013 KARE for nurses programKentucky Board of Nursing (2013, May 8). KARE for nurses program. Retrieved June 10, 2013, from http://kbn.ky.gov/kare/ 20130710105221110514283

Michigan Nurse 2008 do's and don'ts of helping the impaired nurse.Michigan Nurse (2008). The do's and don'ts of helping the impaired nurse. Michigan Nurse, 81(6), 15.  

Personality Types: What makes a good nurse?

A nurse must be kind, gentle, patient, able to multitask, have strong critical thinking skills, and confident to make decisions and act quickly under pressure.  Much is required of nurses.  It is not a job meant for everyone.  Personalities and characteristics must support the skills necessary to thrive in the field of nursing.

 

Our personalities shape our behavior and interpersonal relationships.  The MBTI personality test is a tool for self evaluation and awareness of one’s strengths and weaknesses.  It can help us understand why we think, act, and react the way we do.  The psychological types evaluated in the MBTI personality test include:  extraversion versus introversion, sensing versus intuition, thinking versus feeling, and judging versus perceiving.  The test indicates the differences in personality for gaining energy, becoming aware of information, making decisions, and dealing with the world (Roussel, 2013, p.486).  These differences can lead to strengths in weaknesses in providing patient care and functioning as a nurse. 

A nurse leader must understand their personality types as well as those of the team.  This allows for a nurse leader to be a more effective leader, especially in high stress situations, based on the combination of specific personality traits.  So the question remains, do certain personality types make better nurses?  The following personality types (based on results using the MBTI tool) are thought to be compatible with the nursing career:

ESFJ (Extrovert, Sensing, Feeling, Judgement) = “the Supporter”

ISFJ (Introvert, Sensing, Feeling, Judgement) = “the Defender”

ISFP (Introvert, Sensing, Feeling, Perception) = “the Artist”

ENFJ (Extrovert, Intuition, Feeling, Judgement) = “the Mentor”

ENFP (Extrovert, Intuition, Feeling, Perception) = “the Advocate.” (My Personality Info, 2013).

The personality type ESTJ (Extrovert, Sensing, Thinking, Judgment) is typically good for nurse administration career paths (My Personality Info, 2013).  Introvert versus extrovert, sensing versus intuition, and judgment versus perception are equally represented as personality traits recommended for nurses.  While different combinations of these characteristics comprise a personality type recommended for nurses, thinking versus feeling were not equally represented.  Nurses (aside from the nurse administrator personality) rate higher for feeling than thinking. 

The thinking versus feeling component affects decision making.  Thinking versus feeling represents whether logic and consistency or people and circumstances affect decision making.  Nursing is a job of providing care for people and their circumstances.  Care must be provided logically, but is individualized based on the patient.  Personal care is a factor in decision making more often than logical care.  The personality career recommendation results of My Personality Info (2013) suggests that feeling plays a stronger role than thinking on the personality and decision making of a nurse.

The relationship between personality trends and career paths offers an interesting opportunity for us to explore what brought us to the career path we chose.  While nurses come in all shapes, sizes, and personalities, there may be reoccurring trends in personality.  Understanding self and others provides leaders with tools to effectively lead by building strong working relationships.  By better understanding what drives nurses to do the job they do, nurse managers and leaders are able to better understand how to support their staff to thrive in their environment.  The success of the manager to develop and lead the team can translate into greater success for the organization.      

References

My Personality Info 2013 My Personality InfoMy Personality Info (2013). My Personality Info. Retrieved September 12, 2013, from http://www.mypersonality.info/personality-types/careers/

Roussel L 2013 Management and leadership for nurse administratorsRoussel, L. (Ed.). (2013). Management and leadership for nurse administrators (6th ed.). Burlington, MA: Jones & Bartlett Learning.  20130914130953335672974

Stress management and nurse burnout: The role of management

Stress is a physical, mental, physiological, or spiritual response to a stressor.  A stressor is an experience in a person-environment relationship evaluated by a person as taxing or threatening the sense of wellbeing (Huber, 2010, p.131).  Stress is a subjective experience of an individual in response to their environment.  Work overload or underload can lead to physical exhaustion, emotional exhaustion, attitudinal exhaustion, and feelings of decreased accomplishments.  This experience is recognized as burnout.  Burnout is a term used to describe a response to chronic emotional stress.  Huber (2010) characterized burnout by three components:

1.       Emotional and/or physical exhaustion

2.      Lower job productivity

3.      Over depersonalization. (p.132).

“Nursing burnout is the terminal phase of the individual’s failure to resolve work stress or accumulated inability to cope with day to day job stress.”(Huber, 2010, p.132).  The high stress/emotional work environment, real or perceived short staffing, increased workload, increased concerns about client safety and the nurses' ability to cope and deliver adequate services can contribute to stress and burnout (Huber, 2010).    

So we understand burnout…how does that affect the manager or the institution?  Both the nurse and the employer have a stake in the management of stress and stressful environments.  High levels of job stress/burnout can affect the following:

§  Individual nurse health (a healthy nurse is an effective and reliable nurse)

§  Job satisfaction (a satisfied employee is more productive)

§  Absenteeism (adequate hospital staffing is vital to the institution to be able to provide patient care)

§  Turnover (hiring and training new nurses is timely and expensive $$)

§  Client welfare (the goal of healthcare organizations is often to provide quality patient care maintaining the client welfare as the top priority) (Huber, 2010).

An organization needs satisfied customers to remain competitive.  Nursing personnel

constitutes the largest group of healthcare providers in the United States (Huber, 2010,

p.319).  With nursing personnel making up the largest part of the healthcare workforce,

healthcare organizations cannot thrive without healthy, happy, and high functioning

nursing staff.  

Empowerment of staff nurses has been related to increased work satisfaction and lower burnout rates (Huber, 2010, p.130).  Stress reduction techniques and promotion of autonomy is important for a nurse manager to understand.  It is the responsibility of the management and institution to promote stress reduction for the nursing staff and hospital employees.      

 Huber, D. L. (Ed.). (2010). Leadership and nursing care management (4th ed.). Maryland Heights, MO: Saunders Elsevier.  

Human Relations Movement Impact on Nursing/Healthcare Management

The Human Relations Movement, beginning in the 1930s, sparked a change in focus for management.  Organizational management realized that the satisfactions and dissatisfaction of employees affected productivity.  Management focused on the needs of employees.  Through the satisfaction and retention of employees, an organization is able to increase productivity and decrease costs.  An organization saves money by retaining employees and not having to spend resources on training/orienting new staff.  Experienced, satisfied staff tend to work harder and better!  Change in the workplace and attention paid to satisfaction/dissatisfaction of employees makes employees feel appreciated.  It was in the organization's best interest to manage employees while focusing on their needs.  

Drucker (2001) displays the importance of the Human Relations Movement in his writings.  He wrote, while the manager represents power, management is also about human beings.  A manager should focus on the needs of the employee.  As a result, management is able to make "strengths effective and weaknesses irrelevant"(p.10).  How has the Human Relations Movement impacted the current role of nursing management?

The satisfaction and dissatisfaction of staff within a healthcare system is a reflection of the management in place.  Surveys are taken regularly of nursing staff to evaluate their job satisfaction.  Surveys measure areas of satisfaction such as opportunities for advancement, satisfaction and support with management, opinions being heard and respected, satisfaction with pay, etc.  The Human Relations Movement set the stage for healthcare workers/nurses to voice satisfactions/dissatisfactions. 

In order to be able to offer satisfying management, a nurse manager must understand what is valued by the employee.  Roussell (2013) offered characteristics of best bosses and worst bosses from the viewpoint of nurses:

BEST BOSS

-understands by strengths and weaknesses

-available and accessible

-open to feedback

-expects effort and conscientiousness, not perfection

-open to input from the group

-positive and upbeat

-'walks the talk'

-keeps department's best interest at heart

-cares about how the patients are treated

-high standards, sticks to values

-creative, willing to take risks

WORST BOSS

-poor listener

-only offers negative feedback

-doesn't want my opinion

-wants to look good to his boss at all costs

-unavailable, inaccessible

-negative, always in a bad mood

-rigid and defensive

-unaware of the feelings of others

-listens to gossip

-has favorites

-has no vision

(p.71).

The Human Relations Movement gave power to the employee experience.  A satisfied employee is a productive employee.  Nursing management must offer attention and focus to the feelings of satisfaction/dissatisfaction of their employees.  A nurse manager who is positive, upbeat, leads by example, a patient and employee advocate, trustworthy, and open to feedback will improve nurse satisfaction.  The satisfaction of nurses with their workplace and management is important as a result of the Human Relations Movement of the 1930s.  The values and priorities identified through the movement laid the ground for an effective nurse manager to lead efficiently by retaining staff.  Happy and experienced staff provide higher quality of care to the patient, who is the customer of healthcare organizations. 

 "A result of business is a satisfied customer"(Drucker, 2001, p.12).   

     

Drucker, P. F. (2001). The essential Drucker. New York, NY: HarperCollins Publishers. 

Roussel, L. (Ed.). Management and leadership for nurse administrators (6th ed.).  Burlington, MA: Jones & Bartlett Learning.