Case Study: Empowerment of Nurses
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1a. Issues Creating Feelings of Powerlessness among Staff
Moral distress is one of the issues that can cause a nurse to experience feelings of powerlessness. In such situations, the nurse knows what the ethically right action is but feels immobilized to do it (Manoljovich, 2007). An example of this is a nurse placing a patient on life support for a long time, even though it is not ethical and it does not benefit the patient. Another instance is a nurse giving false hopes to patients and their families. If the moral distress is unresolved even after explaining the situation to the head of the emergency department or administrators, it can cause staff turnover. Another issue that can create feelings of powerlessness among the staff is the nurses feeling belittled by emergency doctors who are experts in their fields. Typically, nurses experience a low level of nursing training. They, therefore, lack the expertise that doctors have. Being less educated than other emergency staff members tends to place nurses at a grave disadvantage in organizational politics (Manoljovich, 2007).
Nurses can also feel powerless in cases where they handle bedside emergencies. These nurses are best placed to deal with emergencies of the patients they are handling, as they are in proximity to them (Manoljovich, 2007). However, any decisions they make that they consider appropriate in a given situation can be changed by hospital administrators and heads of the emergency department. It ends up making them feel powerless. Another issue that can create feelings of powerlessness in nurses in the emergency department is workplace bullying. The nurses may experience aggressive and deliberate bullying from doctors and head nurses. These include the doctors making sarcastic comments about them and insulting them in public. Head nurses can at times be so mean as to give the nurses, especially newly employed or student nurses, the wrong patient charts. These situations end up draining the professional well-being of the nurses (Gaffney et. al., 2012). Other forms of bullying includ doctors blaming them for mistakes of other nurses or punishing them with the most challenging assignments in case they report the doctors' ethical violations to senior administrators. There are times when the nurses' opinions, no matter how valid they are, end up rejected by the head nurses. All these issues create feelings of powerlessness among nurses.
1b. Sources of Power
The first source of power available in the emergency department is expert power. It arises when a surgeon or head nurse has the necessary expertise in the emergency healthcare field (Manoljovich, 2007). Such doctors maintain this power with knowledge acquired through education and experience. The second source of power available is legitimate control. It occurs due to a person’s involvement in the running of the emergency care department and the hospital in general. Nurse managers and heads of departments usually hold this source of power. They control the context of the nursing practice (Manoljovich, 2007). The last source of authority in the emergency department is power over the content of the practice of nursing. It is also identified as autonomy. A nurse creates this source of power when he or she uses his judgment to act on what he knows. Most emergency bedside nurses have this source of power. Their proximity to the patients gives them the power to make decisions in case of emergency (Manoljovich, 2007).
1c. Staff Empowerment
Empowerment of nurses will not only help retain the emergency care staff but will lead to improved quality patient care. One way in which Nancy being the department nurse manager can help with the empowerment mission is through embracing the shared governance model. There has always been a constructive connection between a nurse's insight of collective management and empowerment. Through this, nurses are given control over their practice. The model promotes the nurses’ independence in their work and ensures their participation in decision making of the department. It enables them to feeel empowered and equal to other members of the faculty (Barden et. al., 2011). Nancy can also help empower the nurses using Lazarus and Folkman's transaction model of stress. It identifies strategies for dealing with bullying in the workplace. It uses a problem-focused approach. The method consists of three procedures. The first involves the bullied nurses taking action by getting support. Nancy should provide the nurses with the necessary emotional support that will help them with the next stage. The second strategy involves the nurses speaking up on the persons responsible for bullying them. It will lead to disciplinary actions being taken against the bullies. The third category is moving out of the poisonous surrounding. In case the first two methods are unsuccessful, the nurses can be reassigned to another division for the sake of their professional welfare (Gaffney at. al., 2012).
Nancy can also assist the nurses by speaking to the hospital administration about providing them with educational opportunities. The scholarships for advanced nursing will help the nurses feel empowered as they become experts. In her capacity as the head of the emergency department, Nancy can also assist the nurses in accessing the resources they need. She can also involve them in activities beyond their job descriptions as a test for them to challenge themselves. It will make the nurses more efficient and reduce the employee turnover, as they will feel like part of the staff (Manoljovich, 2007).
2a. Information Prior to Attending the Meeting
It is important for a representative of the staff unit to get the views of other staff members. Information on what the team thinks about the possibility of nurses returning to 8-hour shifts is necessary because this particular topic affects them directly. Another type of information essential before attending the meeting is the staff's views on the process of passing the 8-hour shifts policy. If the team wants the regulation implemented immediately or gradually, then these views are to be voiced during the meeting.
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