NR 501 Week 6: Impact of Nursing Theory Upon Healthcare Organization

Dr. Imogene King developed the Goal Attainment Theory to explain the interpersonal relationship systems in which people develop and progress through life to achieve personal life goals (Schub, 2016). King’s Theory of Goal Attainment is a dynamic notion that nursing interactions lead to actions that result in accomplishing a goal (Schub, 2016). According to King, goal attainment fosters successful nursing care as well as growth and development (Schub, 2016).

King’s Theory of Goal Attainment is used as a framework for nurse leadership and the director of nursing position. King’s theory is based on accomplishing goals, which is the duty of a director of nursing. As a director of nursing an issue that may arrive is staff performance issues. This could be due to many factors for nurses. Long hours and high acuity patients lead to unhappy nurses. They feel over worked and underappreciated. As a director of nursing, it is imperative to be aware of these issues and find ways to address them to improve nurse satisfaction and performance. King’s Theory of Goal Attainment is a method that directors of nursing can use to address these issues.

As a nurse leader, goal attainment is a necessary aspect of the job. A director of nursing is in charge of the nurses in a health care setting. Nurses who have an optimistic attitude in reaching work related goals show a stronger ability to acquire nursing competencies and skills (Korunsky & Wiemer, 2016). As a director of nursing, it is important to support nurses in continuing professional development and growth to increase performance in the workplace (Korunsky & Wiemer, 2016).

As an example, director’s use King’s Theory of Goal Attainment to assist nurses in accomplishing professional development by supporting beliefs, listening to fellow nurses, and organizing programs that support nurse’s skills. This could be by simply speaking with nurses and listening to their concerns, or by facilitating continuing education for nurses to expand their nursing knowledge to enhance nurse performance. By doing this, director of nursing and nurses alike, are able to accomplish goals, address performance issues, and provide competent care to patients through King’s theory.

Korunsky, J., & Wiemer, H., (2016). Goal attainment. CINAHL Nursing Guide.

Schub, T. (2016). King’s theory of goal attainment. CINAHL Nursing Guide.

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As advanced practice nurses we have to have an understanding of how to be a leader. To be a leader takes many different types of skills. All of which we gain over time from learned experiences. Maintaining staff retention is a big problem in every nursing unit. Many nurses leave before they have had time to fully understand the area of expertise. Patricia Benner’s theory from novice to expert outlines the milestones we overcome throughout our nursing experiences. As we advance through our careers we develop more complex knowledge and application of nursing interventions as we care for patients in the same nursing specialty. Benner’s theory can be “applied to support the principles of nursing practice, education, evaluation, and professional development and leadership” (Mennella, 2016). During the time we will transition “from relying on abstract nursing principles to incorporating past nursing experiences that facilitate nursing actions” (Mennella, 2016). For example, how to take a blood pressure or how to insert an indwelling urinary catheter. These are first taught to us during our fundamentals class in nursing school. As we begin to advance through the five different stages we begin to take real life experiences and turn them into learning experience that will help to guide us in the directions of what is positive and negative in our nursing experiences. As an advanced practice nurse we will start at a lower level than we may have previously been. Reason being is that we are learning a whole new aspect of nursing. We are still nurses, but we have more responsibilities to take care of when it comes to managing a patient load and managing other nurses or aids who are caring for our patients. As we begin to gain experience and reach the expert level we will start to achieve more of a management role where we are the subject matter experts who can help to educate the nurses that are below us. The expert nurse is able to understand all situations and anticipate changes. Mennella describes an expert nurse as one who performs their job in a fluid, flexible, and highly proficient manner (2016).

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References

Mennella, H. A. (2016). Benner’s Professional Advancement Model. CINAHL Nursing Guide,

I am sure that nurse managers struggle when it comes to making assignments. They must have an equal balance that promotes quality care without leading to nursing fatigue or poor patient care. I have chosen the Synergy Model to further explain this.

The Synergy Model was made by the AACN and is applied everyday to clinical settings. This model is the relationship nurses and patients share while optimizing patient and family outcomes. It is a phenomenon that occurs when individuals work together towards a common goal. This applies to nurses because we as nurses have one common goal: caring for our patient. This model recognizes the actions of the nurse and the actions of the patient (Sechrist et al., 2010).

Nurse managers utilize the Synergy model when it comes to staffing assignments because they must consider the acuity of their patients. Does the patient need to be one-on-one? Does the patient need any particular care for any reason? What is the patient’s diagnosis? Nurse managers also must consider the nurse. Can this nurse handle this assignment? Can this nurse be diligent with this patient’s care? There are a lot of considerations that fall into play with nursing assignments and the Synergy Model is the best way this is applied today.

I no longer work as a floor nurse. I am in the Operating Room, but if the floor I previously worked on utilized the Synergy Model, I think I wouldn’t be so veered away from floor nursing.

Before I graduated nursing school with my Bachelors, I was a Certified Nursing Assistant on a Neuroscience Floor. Working as a CNA ruined floor nursing for me. My assignments every time I worked consisted of 18-22 patients at a time. If anybody has ever worked on a neuro floor, then you know this is not feasible. As a CNA, I was responsible for bathing every patient, taking them to the restroom, doing their vitals (sometimes every 15 minutes), etc. Most of our patients were either brain dead or had strokes. Stroke patients, as we know, can only utilize one half of their body. They were heavy patients. This whole floor was a total care floor, and nobody could just get up and walk themselves. They needed several staff members to assist with their moving. I would drown in my assignment, not because I could not handle it, but because the nurse managers did not realize how hard it was to take care of patients like this when it came to making the assignments. 18-22 patients were just far too much.

I grew a fatigue when it came to floor nursing. I wish this was not the case because often I feel I am missing out on a lot of the floor nursing hands on experience.

Reference:

Sechrist, K., Berlin, L., & Biel, M. (2010). The synergy model: overview of the theoretical review process. Critical Care Nurse, 20(1).

The application of Hildegard Peplau’s theory of interpersonal relations relates to staffing. The staffing of a facility has one of the most significant roles in the operation to function. Nursing staff is usually the largest discipline that is employed and provides the most contact with patients and families. Currently, over 300 nursing staff work under my direction and supervision. There are many factors that affect staffing. A competent staffing coordinator, an adequate nursing schedule program, staffing the units according to needs and acuity, most of all the relation between staff and management. Staffing is also incorporated into healthcare and financial management. Budgeting overtime and allotted use of staffing. The model of nursing schedule that was utilized in my facility was fragmented , inaccurate and confusing. The schedule caused many errors in staffing, over budget costs, poor relationships between the nursing coordinator and the nursing staff. Poor attitude dealing with the staff escalated situations that could have been avoided. A new model of staffing was developed with a six week core schedule with a daily schedule to capture all of the daily changes. Email communication was now in use for any updates and changes to agencies that supply additional staffing, to payroll and administration. A review of the staffing matrix was completed to assess staffing needs without over use and over budgeting. The hypothetical model was incorporated into the current payroll system to financially mange the new system. There has been a performance improvement plan for the scheduling coordinator and communication with the nursing staff has improved. Lees scheduling errors and payroll issues occur. The new model will be reviewed quarterly, to continue to assess the new implementation.

Maria Joao,F. (2015) . Grounded theory in nursing: building a middle range theory in nursing . Journal Biomedical and Biopharmaceutical Research, Vol 12 pp 11-20 (2015), (1), 11.

There are many theories in nursing that can relate to issues in nursing leadership. One such theory is Patricia Benner’s model of skill acquisition in nursing. Benner’s model is a middle range theory that focuses on five stages of skill acquisition. The five stages are novice, advanced beginner, competent, proficient, and expert (Bennett, Grimsley, Grimsley, & Rodd, 2017). Benner also sited seven domains of the nursing practice, which are the helping role, teaching or coaching function, diagnostic client-monitoring function, effective management of rapidly changing situations, administering and monitoring therapeutic interventions and regimens, monitoring and ensuring quality of health practices, and organizational and work role competencies (Bennett et al., 2017).

One administrative issue for nurse leaders is the ability to retain skilled staff and bring up new nurses who become skilled staff. I have worked at three different hospitals and the satisfaction and retainment of staff seems to be related to the ability of the leadership to provide adequate support and role modeling along with career advancement opportunities like clinical ladders. Benner’s model of skill acquisition can be applied to this issue. The units that I have worked on that had the best staff morale and retainment offered a large amount of training that was easily accessible. They also had a well hashed out orientation process that included a buddy system, hands on training, and frequent check ins to gauge progress. They placed novice nurses with expert nurses so that they might receive the training that they need. Once you progressed from novice to advanced beginner nurse leaders would constantly check up on your progress and ask if there was anything that you felt you needed more training in or anything that you were interested in learning. Once you progressed from competent to proficient they would encourage you to offer input on unit improvement programs and pursue additional classes like getting trauma neuro critical care certified. Finally, once you reached expert level, they began encouraging you to pursue things like clinical ladder, charge, or management.

References

Bennett, L. L., Grimsley, A., Grimsley, L., & Rodd, J. (2017). The gap between nursing education and clinical skills. ABNF Journal, 28(4), 96-102. Retrieved from http://web.a.ebscohost.com.chamberlainuniversity.idm.oclc.org/ehost/detail/detail?vid=49&sid=6cfd5f17-39ee-480c-af74-2ba033c850cc%40sessionmgr4006&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRl#db=ccm&AN=125885622