NURS 8100 Discussion Agenda Setting

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A work environment is made up of a range of factors, organizational culture, management styles, hierarchies, and human resources policies. Employee satisfaction refers to how satisfied employees are with their jobs on a personal level. Employee satisfaction in the workplace is an important part of any organization that wants to keep their employees and cut down on work-related costs (Miller-Jones, 2020). It has been three years since I’ve worked for the organization. I’m one of a few people who have kept their jobs. I have witnessed employees come and leave during this time. Prior employees have often said “this people don’t know what they are doing.” This has been a common reason for leaving the organization. This should be on the organization’s long-term plan because it is taking a lot of time and money to train, as well as costing the agency money.

Advanced practice nurses play a critical role in policy advocacy. They influence policy formation and implementation. They become part of the advocacy process in diverse ways. According to Hajizadeh et al. (2021), when elaborating on health policies, there must be a motivation for nurses to participate in health policy-making processes. For example, advanced practice nurses can influence their experiences on policies, laws, and regulations that govern the healthcare system. Thus, they know the critical procedures to utilize when pushing for some regulations and the techniques that fail to work. Advanced practice nurses are expected to identify the issues deliberately and work with other decision-makers to advance health care policies. They should understand the levels of power and resource allocation that impact policymaking procedures (Hajizadeh et al., 2021). Resource availability is a critical part of policymaking. Thus, advanced practice nurses need to advocate for the allocation of sufficient resources to support policy passage and implementation.

It comes as no surprise that poor leadership can result in higher employee turnover. Employees who aren’t motivated and are burned out from a poor culture begin looking for other jobs. Organizations struggle when they lose top performers and experienced employees and must replace them with new hires. The management of the organization lacks leadership skills and do not have a medical background, making it very difficult to communicate key issues that may arise. Dr. Kathleen discussed the importance of taking certain steps to get a policy adopted while taking into consideration feasibility, cost, and involvement of stakeholders prior to implementation (Executive Producer, 2011). Malik et al. (2017), found that engaging in leadership development, building organizational trust and commitment, and promoting job satisfaction are some of the modern human resource management functions in organizations.

A consequence of poor leadership is failing to inspire employees to deliver their best results and meet their potential. To achieve the best results, employees at every level need to be committed to the organization and to the accomplishment of goals, both financial and otherwise. Without a supportive culture or encouraging manager, financial goals are likely to be missed (Miller-Jones, 2020). Stakeholders include patients, caregivers, clinicians, employees, and healthcare facility representatives who are impacted by quality measures. Engaging stakeholders will involve identifying who the stakeholders are, and what my goals are for engaging with them. The more widely I spread my net at this stage, the more robust my plans will be bearing in mind how to influence each stakeholder to achieve the results I want.

References

Miller-Jones, G. (2020). Ineffective leadership and the devastating individual and organizational

consequences. Retrieved from

https://www.forbes.com/sites/forbescoachescouncil/2020/02/25/ineffective-leadership-and-the-devastating-individual-and-organizational-consequences/?sh=7d7c8fc51f2c

Malik, W. U., Javed, M., & Hassan, S. T. (2017). Influence of transformational leadership components on

job satisfaction and organizational commitment. Pakistan Journal of Commerce & Social Sciences, 11(1), 146–165.

Walden University, LLC. (Executive Producer). (2011). Healthcare policy and advocacy: Agenda setting and

the policy process. Baltimore: Author.

A key aspect of the policy process is agenda setting. How do topics get on that agenda? Agenda setting requires the support of stakeholders to move the issue forward. In this week’s media presentation, Dr. Kathleen White outlines the policy process and discusses how to move issues into the policy arena through agenda setting. The ultimate goal is to gain the attention of leadership whether at the organizational, local, state, national, or international level.

To prepare:Review this week’s media presentation, focusing on the insights shared by Dr. White and Dr. Stanley on agenda setting and identification of stakeholders.
Brainstorm clinical practice issues that you believe are worthy of being on your organization’s systematic agenda.
Who are the stakeholders who would be interested in this clinical practice issue?
By Day 3

Post a cohesive response that addresses the following:

In the first line of your posting, identify the clinical practice issue you would like to see on your organization’s systematic agenda.
What strategies would you use to inform stakeholders and persuade them of the importance of your identified clinical practice issue?

Read a selection of your colleagues’ postings.

By Day 6

Respond to at least two of your colleagues providing additional strategies for informing and persuading stakeholders. Include additional research evidence that supports the importance of their identified clinical practice issue.

Note: Please see the Syllabus and Discussion Rubric for formal Discussion question posting and response evaluation criteria.

Return to this Discussion in a few days to read the responses to your initial posting. Note what you learned and/or any insights you gained as a result of the comments made by your colleagues.

Be sure to support your work with specific citations from this week’s Learning Resources and any additional sources.

Submission and Grading Information
Grading Criteria

To access your rubric:

Week 3 Discussion Rubric

Post by Day 3 and Respond by Day 6

To participate in this Discussion:

Week 3 Discussion

Name: NURS_8100_Week3_Discussion_Rubric
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RESPONSIVENESS TO DISCUSSION QUESTION

Discussion post minimum requirements:

*The original posting must be completed by Wednesday, Day 3, at 11:59pm MST. Two response postings to two different peer original posts, on two different days, are required by Saturday, Day 6, at 11:59pm MST. Faculty member inquiries require responses, which are not included in the minimum number of posts. Your Discussion Board postings should be written in standard edited English and follow APA style for format and grammar as closely as possible given the constraints of the online platform. Be sure to support the postings with specific citations from this week’s Learning Resources as well as resources available through the Walden University online databases. Refer to the Essential Guide to APA Style for Walden Students to ensure your in-text citations and reference list are correct.

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Points Range: 8 (26.67%) – 8 (26.67%)
Discussion postings and responses exceed the requirements of the Discussion instructions. They: Respond to the question being asked or the prompt provided; – Go beyond what is required in some meaningful way (e.g., the post contributes a new dimension, unearths something unanticipated); -Are substantive, reflective, with critical analysis and synthesis representative of knowledge gained from the course readings and current credible evidence. – Demonstrate significant ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Demonstrate that the student has read, viewed, and considered the Learning -Resources as well as additional resources and has read, viewed, or considered a sampling of colleagues’ postings; -Exceed the minimum requirements for discussion posts*.

Points Range: 7 (23.33%) – 7 (23.33%)
Discussion postings and responses meet the requirements of the Discussion instructions. They: -Respond to the question being asked or the prompt provided; -Are substantive, reflective, with critical analysis and synthesis representative of knowledge gained from the course readings and current credible evidence.re -Demonstrate ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Demonstrate that the student has read, viewed, and considered the Learning Resources and has read, viewed, or considered a sampling of colleagues’ postings -Meet the minimum requirements for discussion posts*.

Points Range: 6 (20%) – 6 (20%)
Discussion postings and responses are minimally responsive to the requirements of the Discussion instructions. They: – do not clearly address the objectives of the discussion or the question or prompt; and/or -May (lack) lack in depth, reflection, analysis, or synthesis but rely more on anecdotal than scholarly evidence; and/or -Do not adequately demonstrate that the student has read, viewed, and considered the Learning -Resources and/or a sampling of colleagues’ postings; and/or has posted by the due date at least in part. – Lack ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Do not meet the minimum requirements for discussion posts*.

Points Range: 0 (0%) – 5 (16.67%)
Discussion postings and responses are unresponsive to the requirements of the Discussion instructions. They: – do not clearly address the objectives of the discussion or the question or prompt; and/or – Lack in substance, reflection, analysis, or synthesis but rely more on anecdotal than scholarly evidence. – Lack ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Do not demonstrate that the student has read, viewed, and considered the Learning Resources and/or a sampling of colleagues’ postings; and/or does not meet the minimum requirements for discussion posts*.

CONTENT KNOWLEDGE

Points Range: 8 (26.67%) – 8 (26.67%)
Discussion postings and responses: -demonstrate in-depth understanding and application of concepts and issues presented in the course (e.g., insightful interpretations including analysis, synthesis and/or evaluation of topic; – are well supported by pertinent research/evidence from a variety of and multiple peer- reviewed books and journals, where appropriate; -Demonstrate significant mastery and thoughtful/accurate application of content, applicable skills or strategies presented in the course.

Points Range: 7 (23.33%) – 7 (23.33%)
Discussion postings and responses: -demonstrate understanding and application of the concepts and issues presented in the course, presented with some understanding and application of concepts and issues presented in the course (e.g., insightful interpretations including analysis, synthesis and/or evaluation of topic; -are supported by research/evidence from peer-reviewed books and journals, where appropriate; and · demonstrate some mastery and application of content, applicable skills, or strategies presented in the course.

Points Range: 6 (20%) – 6 (20%)
Discussion postings and responses: – demonstrate minimal understanding of concepts and issues presented in the course, and, although generally accurate, display some omissions and/or errors; –lack support by research/evidence and/or the research/evidence is inappropriate or marginal in quality; and/or lack of analysis, synthesis or evaluation of topic – demonstrate minimal content, skills or strategies presented in the course. ——-Contain numerous errors when using the skills or strategies presented in the course

Points Range: 0 (0%) – 5 (16.67%)
Discussion postings and responses demonstrate: -A lack of understanding of the concepts and issues presented in the course; and/or are inaccurate, contain many omissions and/or errors; and/or are not supported by research/evidence; and/or lack of analysis, synthesis or evaluation of topic -Many critical errors when discussing content, applicable skills or strategies presented in the course.

CONTRIBUTION TO THE DISCUSSION

Points Range: 8 (26.67%) – 8 (26.67%)
Discussion postings and responses significantly contribute to the quality of the discussion/interaction and thinking and learning by: -providing Rich and relevant examples; discerning and thought-provoking ideas; and stimulating thoughts and probes; – -demonstrating original thinking, new perspectives, and extensive synthesis of ideas supported by the literature.

Points Range: 7 (23.33%) – 7 (23.33%)
Discussion postings and responses contribute to the quality of the discussion/interaction and thinking and learning by -providing relevant examples; thought-provoking ideas – Demonstrating synthesis of ideas supported by the literature

Points Range: 6 (20%) – 6 (20%)
Discussion postings and responses minimally contribute to the quality of discussion/interaction and thinking and learning by: – providing few and/or irrelevant examples; and/or – providing few if any thought- provoking ideas; and/or -. Information that is restated from the literature with no/little demonstration of critical thinking or synthesis of ideas.

Points Range: 0 (0%) – 5 (16.67%)
Discussion postings and responses do not contribute to the quality of interaction/discussion and thinking and learning as they do not: -Provide examples (or examples are irrelevant); and/or -Include interesting thoughts or ideas; and/or – Demonstrate of critical thinking or synthesis of ideas

QUALITY OF WRITING

Points Range: 6 (20%) – 6 (20%)
Discussion postings and responses exceed doctoral -level writing expectations. They: · Use grammar and syntax that is clear, concise, and appropriate to doctoral level writing; · Make few if any errors in spelling, grammar, and syntax; · Use original language and refrain from directly quoting original source materials; -provide correct APA · Are positive, courteous, and respectful when offering suggestions, constructive feedback, or opposing viewpoints.

Points Range: 5 (16.67%) – 5 (16.67%)
Discussion postings and responses meet doctoral -level writing expectations. They: ·Use grammar and syntax that is clear and appropriate to doctoral level writing; ; · Make a few errors in spelling, grammar, and syntax; · paraphrase but refrain from directly quoting original source materials; Provide correct APA format · Are courteous and respectful when offering suggestions, constructive feedback, or opposing viewpoints;.

Points Range: 4 (13.33%) – 4 (13.33%)
Discussion postings and responses are minimally below doctoral-level writing expectations. They: · Make more than occasional errors in spelling, grammar, and syntax; · Directly quote from original source materials and/or paraphrase rather than use original language; lack correct APA format; and/or · Are less than courteous and respectful when offering suggestions, feedback, or opposing viewpoints.

Hello Dominique,

This is an outstanding post on the issue of frequent admissions due to poor discharge nursing education. Minimization of hospital readmission is currently a national focus for the health care system. Many hospital readmissions are preventable and emanate directly from uncoordinated care. As such, patient discharge education is essential in enhancing clinical outcomes and lowering hospital costs (Oh et al., 2021). Patient education during discharge matters because the current discharge process is intricate, inefficient, and time-consuming (Gülşen & Akansel, 2020). Patients are often overwhelmed and rushed at discharge. The discharge information they are given through verbal instructions or a pile of aftercare guidelines they are handed on discharge are often infective. Ideally, the weakest link to hospital readmissions entails discharge procedures including inadequate post-discharge support, failed handoffs, premature discharge, and poor follow-up (Sharma & Rani, 2020). Therefore, proper education of patients both after discharge and at home and providing them with the appropriate tools they deserve to care for themselves or their families is essential in a significant reduction of the readmission rates in hospitals.

References

Gülşen, M., & Akansel, N. (2020). Effects of discharge education and telephone follow-up on cataract Patients’ activities according to the model of living. Journal of perianesthesia nursing, 35(1), 67-74. https://doi.org/10.1016/j.jopan.2019.04.010

Oh, E. G., Lee, H. J., Yang, Y. L., & Kim, Y. M. (2021). Effectiveness of discharge education with the teach-back method on 30-day readmission: a systematic review. Journal of patient safety, 17(4), 305-310. doi: 10.1097/PTS.0000000000000596

Sharma, S. K., & Rani, R. (2020). Nurse-to-patient ratio and nurse staffing norms for hospitals in India: a critical analysis of national benchmarks. Journal of family medicine and primary care, 9(6), 2631. Doi: 10.4103/jfmpc.jfmpc_248_20

As the chair of the Nurse Peer Review Council at my institution, we review many problems that arise from clinical practice issues that are unresolved. In the first two months of 2022, we have reviewed clinical practice issues with the nurse-to-nurse handoff, staffing shortages, and failures to escalate the chain of command.

I have been a perinatal services director for over 10 years and in my time as a leader, I have often felt that the patient ratios in the perinatal services arena are not in alignment with the Association of Women’s Health and Neonatal Nursing (AWHONN) staffing acuity guidelines. Although these guidelines were created in 2010 to promote caring for patients in the perinatal period in a safe manner based on the acuity of the patient (Simpson et al., 2019) hospital financial colleagues do not understand the importance, and frequently these guidelines have to be overlooked to maintain compliance financially. The guidelines break down different types of diagnosis and acuity of specific clinical care scenarios and rank them into categories. This information is further broken down into the number of FTEs that would be appropriate to care for this type of patient. An example would be that any patient that is pushing while in labor would require a 1:1 patient ratio whereas three patients in triage could be cared for by one nurse. The problem with this is that patients can move in and out of different levels of acuity based on their course of labor up to and after delivery. From a financial and productivity perspective this does not make sense. Staffing for a patient that begins at the lowest level of acuity then turns into the highest level of acuity, and then back to a moderate level of acuity after delivery is hard to measure from a productivity standpoint. This is even harder to maintain if departments are held to a productivity standard that is not in alignment with the patient ratios that mirror actual care a patient needs to receive during their hospital stay. The result is less safe care for patients, poor outcomes for mothers and infants, and staff dissatisfaction and burnout (Simpson, 2016).

I am currently working with an internal PI specialist piloting a program for the health care system that involves assessing the AWHONN staffing acuity guidelines and how often my labor and delivery unit is overstaffed or understaffed based on the AWHONN staffing acuity guidelines. We have collected eight months of data and have now created a presentation for the senior leadership team to help inform them of the need to deploy additional resources at a certain time of the day and on certain days of the week. This additional resource would increase the safety of care being provided to mothers and infants.

Some of the strategies I have used up to this point are in an agency for healthcare and research quality toolkit (AHRQ). The strategies include having a well-outlined plan that involves getting the right people on the team for the project, identifying a champion, communicating regularly with the stakeholders, and moving systematically through the stages of a project (www.ahrq.gov). By doing this the end-user has a well-developed objective presentation to support the need for a change. The importance of presenting a proposal that not only includes the need for change based on safety, but needs to include the financial, and operational impacts also.

References:

Agency for Healthcare Research and Quality. (October, 2014). Designing and Implementing Medicaid Disease and Care Management Programs. Retrieved from https://www.ahrq.gov/patient-safety/settings/long-term-care/resource/hcbs/medicaidmgmt/mm2.html

Simpson, K. R., Lyndon, A., Spetz, J., Gay, C. L., & Landstrom, G. L. (2019). Incorporation of the AWHONN Nurse Staffing Guidelines into Clinical Practice. Nurse Women’s Health, 23(3), 217–233. https://doi.org/10.1016/j.nwh.2019.03.003

Simpson, K. R., Lyndon, A., & Ruhl, C. (2016). Consequences of inadequate staffing include missed care, potential failure to rescue, and job stress and dissatisfaction. Journal of Obstetric, Gynecologic & Neonatal Nursing, 45(4), 481–490. https://doi.org/10.1016/j.jogn.2016.02.011