Healthcare is one of the most important topics of discussion in the 21st century. Part of the reason is that a great percentage of the population – especially in the Western world – is aging. There are now many elderly people needing care. On top of that, breakthroughs in science and medicine allowed people to live longer than ever before. Thus, the increase in population, the high birth rates, and low mortality rates add up making healthcare one of the most important issues within the United States of America. At the center of the storm is the cost of healthcare as well as the level of professionalism of health workers. Doctors and nurses are always under intense scrutiny. The slightest mistake will bring malpractice lawsuits for the doctor and nurses are forced to quit due to frustrations and unmet expectations.
In the field of nursing, there are also many issues that have to be dealt with in order for the profession to adapt and thrive in the 21st century. One of the major issues concerns the role of the nurse, his or her value as a health care provider, and how to behave in an extremely complex world where one can find diversity in culture and ideas that can easily make the job difficult and unmanageable. The modern-day nurse is not only an assistant but must also learn to understand the principles of leadership and management. But in order for nurses to walk in confidence, he or she must first understand her value in the world of health care and at the same time master not only the technical skills requires to become a highly proficient nurse but also the principles that will guide him/her to perform “right action” under pressure.
The nurse as leader and manager must be guided by a set of principles. The experts require no rule book as they seem to have mastered the science and art of nursing by doing the same thing over and over again. The experts also have a storehouse of experience that they can draw from to make decisions. And yet even the masters are guided by ethical principles and values that guide them in making the right decisions. The proponent of this paper will reflect on nursing theories and concepts making sense of what was learned by doing evidence-based research and nursing practicum.
Evidence-based research was conducted by choosing two peer-reviewed journals. The focus was on the ethical aspect of the nursing profession. It is important to understand that without the correct core values and proper ethical standards a nurse can be technically proficient and yet ineffective when it comes to dealing with people. Thus, a closer examination of what has been written regarding nursing ethics as well as the ideas and opinions of researchers focused on this field will help provide an overview and a consensus of what other nurses from all over the world are saying about the nursing profession (Horton et al., 2007). The concepts and theories that will be uncovered from this study will be applied specifically to the leadership and managerial role of nurses. This evidence-based research is complemented by doing practicum work, specifically shadowing a senior nurse acting in a managerial capacity.
The said nurse was already a veteran in the field of nursing having served many years in various capacities as a nurse. Mrs. Joan Harriott is a nurse-manager, in-charge of several floors at the Mt. Sinai Medical Center. Mrs. Harriott’s area of responsibility includes the cardiac and surgical critical care units. She is responsible for the nursing staff that works on those floors and for keeping the units compliant with all the requirements of the Joint Commission. She has to be in constant communication with the hospital’s administrative staff. Part of her job is to deal with payroll. Aside from that, she is also tasked to handle minor expenses that the surgical and cardiac units will incur in the day-to-day operations of the hospital. From time to time Mrs. Harriot will also have to contend with legal issues arising from conflicts and misunderstandings in the workplace. This is the reason why Mrs. Harriot should not be only an expert when it comes to the technical aspect of nursing but she must also have a nuanced understanding of human nature and how to deal with people of different temperaments and socio-economic backgrounds. In her capacity as nurse-manager, she is not only dealing with the nurses under her care but also the support staff that has to keep the hospital running in a very efficient manner.
The focus of the practicum is not only to observe nurses in a real-world setting but also to observe an expert working outside the clinical sphere of nursing. Nurses are always seen as assisting a doctor in a clinical setting but this is an incomplete understanding of what nursing requires. By observing Mrs. Harriot in action, the proponent of this study will be able to gain insight into the skills and core values required for a nurse to act as a leader and manager. The leadership practicum will be a total of ninety hours. The practicum started last May 27, 2009, and was completed Wednesday, June 24, 2009. The basic requirement of the practicum was to shadow Mrs. Harriott in her day-to-day routine at Mount Sinai Medical Center every Wednesday starting on the date indicated above.
The purpose of this internship is to observe, learn and understand the nursing process by shadowing a nurse manager. The managerial role of a nurse is different from the clinical role learned at an associate level. This experience will provide a deeper understanding of what the nursing profession encompasses. It will open the perspective of the nursing profession from an administrative role where a new personal philosophy might be established. Furthermore, the purpose of the rotation and doing the rounds with Mrs. Harriot is to understand the skills and core values required to be in a managerial role and to learn how to work in a hospital setting.
Using the standard principles on how to conduct a practicum, the proponent of this study completed the necessary requirements to be given the chance to work with Mrs. Harriot. After being given the go signal to do the rounds with her, the next thing to do is to maintain a journal. In this journal, the observer will jot down notes and make necessary comments on what was observed and the insights gained from doing the task. In order to fully understand the principles behind certain actions performed by Mrs. Harriot, it is necessary to ask questions and to clarify things with her.
The leadership practicum was complemented by doing evidence-based research. Two peer-reviewed journals were chosen and the common theme between the two studies was the focus on ethics and how a nurse in the 21st century tried to cope with various challenges such as globalization and the impact of cultural diversity in the nursing profession. All the knowledge and experience gained from these two activities will be consolidated at the end of the practicum and the review of related literature to help the proponent of this study reflect and make assessments and predictions with regards to the possible future implications to the nursing profession.
Review of Literature
According to Horton et al., nursing is often viewed as having a low value in the field of healthcare (2007). It is the doctors and the various specialists who receive the accolades and are given importance by the public. Nurses are considered as mere assistants and thus the erroneous perception that their job is easy and not as critical as the other professions in the medical field. It is important to first establish the value of nurses because if this is neglected then the nursing profession cannot be elevated to tackle the challenges of the 21st century. More and more articles and studies are being released refuting the misconception that nurses are nothing more than assistants in the field of healthcare (Vanlaere & Gastmans, 2007). This change of mindset will allow nurses to break out from this image and began to actively participate in providing quality healthcare. For instance, in the surgical unit, surgeons are seen to be doing the bulk of the critical work but without the support of the nursing staff, the pre-surgery phase, as well as the recovery phase, may not be as successful.
Aside from re-examining the value of nurses they must also have to redefine how they come to perceive their self-worth. The medical community must actively participate in this task because a nurse with low self-esteem will find it difficult to continue working in a high-pressure working environment. It was also pointed out by researchers that nurses are not really particular about a high-paying job, just as long as he or she can find satisfaction in his/her work (Horton, et al., 2007). Aside from building up the self-image of nurses another way to increase his/her proficiency is to be knowledgeable about the ethical aspect of nursing.
Ethics play a major role in the decision-making process (Vanlaere & Gastmans, 2007). For instance, nurses must fully understand the principles behind confidentiality. Nurses are on the frontline in the battle against sickness and diseases and they are witnesses to the vulnerable state of the patient. They cannot share sensitive information beyond the four walls of the hospital and they could not discuss beyond their immediate supervisors regarding the welfare and status of the patients (Vanlaere & Gastmans, 2007). Nurses must also come to understand the principle behind informed consent. This will establish trust between patient and healthcare provider and can create a smooth pathway to recovery (Vanlaere & Gastmans, 2007). Furthermore, in a multicultural society like the United States nurse must learn not to discriminate (Vanlaere & Gastmans, 2007). These are just some of the ethical principles that must be observed by nurses.
Implications for Practice
In the leadership practicum, the first thing that was very obvious to the proponent is the major difference between a nurse working as an administrator to a nurse working in a clinical setting. In a clinical setting, nurses are only focused on the task at hand but oblivious to the other aspects of a medical facility. A nurse manager like Mrs. Harriot requires the use of multiple skills and to be attentive to details not only on her own conduct but also that of the other nurses under her care. Mrs. Harriot is also under great pressure from those who continually check standards of excellence at Mt. Sinai Medical Center. In her case, it was the Joint Commission. Thus, Mrs. Harriot had to be mindful of agreed-upon protocols in order to satisfy whatever committee was going to visit and check up on the performance of the staff. On the other hand, she is also bound by nursing ethics not to be merely mechanical about her work but to show compassion to the patients and to maintain healthy working relationships with the staff. This is a Herculean task knowing that the heavy workload can be overwhelming at times.
This was made evident when observing part of her routine which is to perform tracers for the charts. This means that Mrs.Harriot and her staff had to evaluate the charts and determine that they were able to follow the guidelines for several protocols. For instance, the chart had a pain assessment at the time of admission, and then every four hours the same protocol must be observed depending on the condition of the patient and the unit he or she is assigned to. If the patient is in pain, then pain medication must be administered on a regular basis or as prescribed by the attending physician. This is a routine procedure but it is also tedious and it would be very easy for the nursing staff to overlook the protocols. This job requires focus and dedication. Nurses can grow weary in performing these actions on a daily basis. It is the job of the administrator to keep them on their toes, boost morale, and keep them satisfied. This ability is more than technical. The nurse manager will have to learn people skills along the way in order to succeed in this level of leadership and management.
After consolidating what was learned during the leadership practicum and the evidence-based research the proponent of this study made the discovery that nurses must go through a paradigm shift in order to become more successful in their profession. The first thing that they have to do is to realize that they are not merely assistants to doctors. In fact, they play a critical role in the various phases of medical care. Without the doctors and specialists will not be able to perform their duties.
In recent years, according to the review of literature, the medical profession has come to realize that nurses are not only serving in the clinical sphere but are also needed in the managerial aspect of healthcare. This is very much evident when it comes to large facilities like the Mt. Sinai Medical Center. Nurses help maintain operational flow by attending to the business side of healthcare. On the other hand, they need to be proficient not only in managing the day-to-day operation of hospital nurses must not neglect their primary duty which is attending to the needs of the patients and double-checking on protocols ensuring that patients are getting the quality of healthcare that they deserve.
Future implications to nursing can be seen in how nursing schools will adapt to these changes. It will come as no surprise if nursing schools will allow nursing students to be exposed to the business side of running a hospital. In the future, nursing schools will provide resources to develop the leadership skills of nurses in preparation for other job requirements. More resources will also be provided to understand the ethical aspect of nursing and how to perform well in a multicultural society.
There is a need to re-examine the role of nursing not only to change the wrong perception about nursing but also to prepare nursing students for the real world. They are not merely assistants and therefore they will need to learn other skills such as those related to leadership and how to deal with people from different cultural backgrounds. It is becoming clearer that technical knowledge is not enough to succeed in the field of nursing. If enough effort is geared towards changing the old mindset then healthcare will dramatically improve.
- Horton, K. (2007). The Value of Nursing: A Literature Review. Nursing Ethics, 14(6): 716-740.
- Vanlaere, L. & C. Gastmans. (2007). Ethics in Nursing Education: Learning to Reflect on Care Practices. Nursing Ethics, 14(6): 758-766.