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Practice By: Sarmika Ethirveerasingham, Farishta Ahmadzai, Brandon Tippin, Becky Mullholland, Ngawang Gelek Sang-Nga Lhabdra, Edgar Hipolito, Bob Mackay, & Jessica Hinkle Acknowledging Organizational & Personal Change Recommendations Moving Towards Improved Environments Initiating Change Thanks for listening! To understand the factors that shape a quality practice environment, and the outcomes of poor quality practice environments
To comprehend both personal and organizational changes, and the impact Lewin's theory can have on changing an environment
To assimilate what can be put into practice to initiate change lorrainerimando.files.wordpress.com/2010/11/stressed-nurse.jpg Leadership
Collaboration Leadership, communication, physical environment, and personal and professional self care, are the key principles in promoting high quality practice environments which can yield benefits such as improved patient care and safety, a decrease in avoidable adverse client outcomes and healthy workplaces for all. References Objectives Changing Environments "The quality of nurses’ professional practice environments has a direct impact on job satisfaction, work production, recruitment and retention (and therefore, the nursing shortage), the quality of care, and ultimately, client outcomes." -Canadian Nurses Association (2006) (O’Brien-Pallas & Baumann, 1992; Aiken et al., 2000; Baumann et al. 2001; O’Brien-Pallas et al., 2004) a Need for Change Personal Change Supporting each other
Supporting the team
Supporting the patient Supporting Each Other Have good relationships with co-workers
Provide recognition and reward for others
Help students develop a positive attitude
Engage in mentorship
Become active in peer support groups Supporting Team Share knowledge
Challenge unacceptable practices
Develop good conflict resolution skills
Work together to equalize power dynamics
Advocate to maximize quality practice environments
Develop and increase opportunity for organizational participation the Support the Patient Insist on ethical practice standards
Support others on the health care team
Watch for signs of burnout in other nurses Support = teamwork = supported clients Organizational Changes Make values and morals clear
Provide nursing leadership Morals Values and Does the organization's morals and values equal nursing morals and values?
Allow nurses to develop a moral community
Let nurses feel safe to question policies Nursing Leadership Have a flat versus a tall structure
Willingness to stand up for values
Evaluates the needs of the nurses Skilled in conflict management http://www.google.ca/search?q=everyone+happy&hl=en&client=safari&rls Three Steps Unfreezing Moving Re-freezing Assessment Unfreezing/Planning Uncomfortable
Disturbance of equilibrium
Creates disconfirmation of validity status quo Moving/Implementation The right direction
The right interventions
Energize the group
Overcome resistance Managing Change Lewin's Force Field Model http://www.im.org/Publications/Insight/Archives/2009/V7I3/PublishingImages/BRIGHAMfig1.jpg Re-Freezing/Evaluation Put your heart into it
Evaluate the plan
Stabilize the change
Terminate helping roles
Delegate responsibilities http://www.google.ca/search?q=frozen+Icecube&hl=en&client=safari&rls=en&source LEADERSHIP Promotion and development of plans that reduce stress and burnout
Dissemination of research and information that supports positive changes that are clinically sound
Inclusion of staff in decision-making
Quality leadership is the most successful way to improve the quality of nurses work life (Hayes et al., 2006) COMMUNICATION Develop team-building skills
Open dialogues between disciplines and departments Promote the benefits of a supportive workplace
Promote the development of professional practice Communication (Cont'd) Build in time for mentoring, support and debriefing
Increasing awareness of available resources http://tx.english-ch.com/teacher/alvi/goodcommunication.jpeg Take proactive actions in making management aware of the effects of stress and burnout. On unit health promotion programs result in a reduction of staff absence by over 25% (Lowe, 2006) Staying current in professional practice by being involved in formal and non-formal educational initiatives PHYSICAL ENVIRONMENT Increasing awareness and education related to environmental risks
Documenting and communicating safety and risk management concerns including 'near misses'
Promote a safe working environment that protects patients/clients and staff from physical harm. The overall level of nurse burnout on hospital units also affected patient satisfaction (Vahey, Aiken, Sloane, Clarke, & Vargas, 2004) SELF CARE Continuous self-evaluation Knowing personal capacity and limits Maintaining personal wellness Collaborative Nursing Practice Nurses must act in a manner that is consistent with their standards of practice, codes of ethics, scopes of practice and other relevant legislation
Nurses should practice within their own level of competence and seek direction and guidance from other health care professionals when aspects of the care required are beyond their individual competence (CNO, 2012) Nurses require access to supports and resources in order to provide safe and appropriate care. Including... Discussion Questions 1. How could you as a student nurse contribute to changing a poor quality environment? 2. As a new nurse, you arrive on a unit that has a poor quality practice environment. Due to this environment, there is a high number of poor patient outcomes. What would you recommend to initiate change for a better environment to this unit? Effective nursing leadership
Appropriate and sufficient staff
Adequate nurse-client ratios
Organizational support for collaborative practice
Sufficient time to discuss client care needs with colleagues (CNA, 2009) A quality practice environment is... “...a workplace that supports nursing practice, fosters professional development, and promotes the delivery of quality care.” CNO (2011, p.12) The Three Factors Shaping this Environment: Practice Supports
Environmental stability The Issue It has been known for years that there is a correlation between a negative work environment and employee stress. (Spence Laschinger et al., 2006)
Higher levels of nurse burnout has been related to poor quality practice environments, just as lower levels of burnout are associated with environments that are able to provide job autonomy, control over the practice environment, and nurse/physician relationships that are good. (Spence Laschinger et al., 2006)
Nurse burnout is a problem on a global scale (Aiken et al., 2011) Aiken, L. H., Sloane, D. M., Clarke, S., Poghosyan, L., Cho, E., You, L., Finlayson, M., Kanai-Pak, M., Aungsuroch, Y. (2011). Importance of work environments on hospital outcomes in nine countries. International Journal for Quality in Health Care, 23(4), 357-364. doi: 10.1093/intqhc/mzr022
Baulcomb, S. (2003). Management of Change Through Force Field Analysis. Journal of Nursing Management. 278-280
Burnes, B. (2004). Kurt Lewin and the Planned Appoach to Change: A Re-appraisal. Journal of Management studies 41:6
Canadian Nurses Association. (2006). Practice environments: Maximizing client, nurse and system outcomes. Ottawa: Author. Retrieved from http://www2.cna-aiic.ca/CNA/documents/pdf/publications/PS88-Practice-Environments-e.pdf
Canadian Nurses Association. (2009). Tested solutions for eliminating Canada’s registered nurse shortage. Ottawa: Author.
Canadian Nurses Association. (2010). Ethics in practice for registered nurses: ethics, relationships and quality practice environments. Ottawa: Author. Retrieved March 13. 2013, from http://www2.cna-aiic.ca/CNA/documents/pdf/publications/Ethics_in_Practice_Jan_2010_e.pdf
College of Nurse of Ontario (CNO). (2011). RN and RPN practice: The client, the nurse and the environment. Retrieved from http://www.cno.org/Global/docs/prac/41062.pdfFlynn,
L., Liang, Y., Dickson, G. L., & Aiken, L. H. (2010). Effects of nursing practice environments on quality outcomes in nursing homes. Journal Of The American Geriatrics Society, 58(12), 2401-2406. doi:http://dx.doi.org.ezproxy.library.yorku.ca/10.1111/j.1532-5415.2010.03162.x
Garrett, C. (2008). The effect of nurse staffing patterns on medical errors and nurse burnout. AORN Journal, 87(6), 1191-1191-2, 1194, 1196-200 passim. doi:http://dx.doi.org.ezproxy.library.yorku.ca/10.1016/j.aorn.2008.01.022
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Lowe, G., Schellenberg, G., & Shannon, H. S. (2003). Correlates of employees’ perceptions of a healthy work environment. American Journal of Health Promotion, 17(6), 390.
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Mahony, N. (2011). Nurse burnout and the working environment. Emergency Nurse, 19(5), 30-37.
Registered Nurses Association of Ontario (2008). Best practice guidelines: Healthy Work Environments Best Practice Guidelines retrieved from http://rnao.ca/sites/rnao ca/files/Workplace_ Health_ Safety_and_Well-being_of_the_Nurse.pdf
Registered Nurses’ Association of Ontario. (2008). Workplace Health, Safety and Well-being of the Nurse Healthy Work Environments Best Practice Guidelines, Ontario RNs. Toronto: Author.
Spence Laschinger, H., Leiter, M. (2006). The impact of nursing work environments on patient safety outcomes: The mediating role of burnout engagement. JONA: The Journal of Nursing Administration, 36(5), 259-267. Retrieved from http://ovidsp.tx.ovid.com.ezproxy.library.yorku.ca/
Statistics Canada (2005). National Survey of the Work and Health of Nurses 2005: Provincial Profiles retrived from http://www23.statcan.gc.ca/imdb/ p2SV.pl?Function= getSurvey&SDDS= 5080&Item_ Id=13648
Sullivan, J.E. (2013). Development of Self as Nurse: Nurse as Leader and Agent of Change. Pearson, Boston MA 02116
Vahey, D. C., Aiken, L. H., Sloane, D. M., Clarke, S. P., & Vargas, D. (2004). Nurse burnout and patient satisfaction. Medical Care, 42(2), 57-66.
Van Bogaert, P., Clarke, S., Wouters, K., Franck, E., Willems, R., & Mondelaers, M. (2013). Impacts of unit-level nurse practice environment, workload and burnout on nurse-reported outcomes in psychiatric hospitals: A multilevel modeling approach. International Journal of Nursing Studies, 50(2013), 357-365. Retrieved from http://dx.doi.org/10.1016/j.ijnurstu.2012.05.006 http://sweetwaterhrv.com/blog/wp-content/uploads/2012/03/heart-with-stethoscope.jpg http://www.ona.org/documents/Image/campaigns/NursesHaveRightsTooBorder.jpg http://www.wallpaper4me.com/images/wallpapers/icecubemelting-554169.jpeg http://www.wallpaper4me.com/images/wallpapers/icecubemelting-554169.jpeg http://static3.depositphotos.com/1006031/209/i/950/depositphotos_2093433-Red-heart-frozen-in-ice-cube.jpg http://fourthirds-user.com/galleries/data/549/medium/Moving_water.jpg http://fourthirds-user.com/galleries/data/549/medium/Moving_water.jpg