The study described in the Research Perspective (Hauck, Winsett, & Kuric, 2012) was about the introduction of evidence-based practice for a hospital. Rogers’s theory of diffusion of innovation served as the theoretical framework for that study. However, other theoretical perspectives are present. Based on situational-contingency theory, describe factors that the nurse researcher, as the leader of the implementation team, would need to consider. Consider the following:
Question 1
What considerations come into play that are outside of the group targeted for the change initiative? Are there any external stakeholders? What are the internal factors that would drive or limit change from being successful?
Question 2
How do people behave individually and in groups when it comes to adopting a practice-based change? Is there a difference between individual and group behaviors? If so, why does this occur?
Question 3
What should the nurse leader do to plan for and address potentially negative attitudes of staff regarding the implementation of evidence-based practice? How should the nurse leader use nurses with positive attitudes toward the implementation of evidence-based practice?
Question 4
How can previous interactions with the nurse leader impact the success or failure of implementing evidence-based practice?
Question 5
What are the resource requirements? What are the regulatory requirements?
Influence and Diplomacy Case Study 2
Ryan graduated from his BSN program about 18 months ago and has been working on a surgical unit in a large Magnet™ hospital. He belongs to his state nurses association and the Academy of Medical-Surgical Nurses (AMSN).
He recently moved to another town for graduate school and took a job in a small community hospital. The new chief nursing officer is trying to create a shared governance structure. The nursing staff seems disinterested in participating in such a governance structure. Some of them complain that they do not want to “think” about nursing beyond what they have to do at the bedside.
Ryan served on the practice council at the hospital where he worked after graduation. The nurses he works with now are discouraging him from volunteering to serve on one of the new councils being formed to implement shared governance. He is frustrated by his colleagues’ lack of interest in participating in decision making about nursing care. He wonders if this is the right place for him to work while in his graduate program. Although this hospital is closely affiliated with the school of nursing where he is a graduate student, the nurses on his unit openly challenge the wisdom of his decision to pursue a graduate degree.
Question 1
What resources should Ryan use to gain support for his desire to participate in the new shared governance structure?
Question 2
If Ryan wants to test the job market to find a position in a more positive nursing work environment, what resources can he use?
Question 3
Ryan has been subjected to a lot of questions and negative comments by some of the senior staff nurses about his graduate studies. They tend to negate the importance of advancing one’s nursing education. How can he redirect their comments?
Evolution of the Nurse Leader Case Study 3
Margaret Compton, RN, is 52 years old and recently widowed. Her husband died a week after traumatic injuries from a serious fall on a hiking expedition.
Margaret has been out of the work force for 23 years, electing to stay at home and take care of her three children while her husband worked. Her youngest is in his third year of college, and Margaret has realized that she needs to return to the workforce.
During her husband’s hospitalization, Margaret realized that she missed nursing and eagerly looks forward to returning to active practice. She kept her license active all these years, but during her husband’s hospitalization, Margaret saw that much has changed since she left her last nursing position.
Question 1
What specific challenges does Margaret face in returning to the nursing workforce after 23 years?
Question 2
What has changed in health care that will make her work different now?
Question 3
What do you think is the same in nursing over time?
Professional Standards for Nursing Leadership Case Study 4
You are the nurse manager of a busy operating room in a large metropolitan hospital, serving both adult and pediatric clients. A case is scheduled involving a child who will have a hip arthroplasty. The surgical technician usually scheduled for the pediatric cases is unavailable to assist with this case, so you schedule a surgical technician who has assisted with multiple hip arthroplasties but has never performed one on a younger child. After the procedure, the child has permanent damage to his sciatic nerve, and his parents have filed a lawsuit against the surgical technician, you as the nurse manager, and the hospital.
Question 1
How do you suspect that the court will react to such a case?
Question 2
What would their findings likely be in such an instance and why?
Question 3
What could you have done to prevent this outcome?
Professional Standards for Nursing Leadership Case Study 5
Joe Rodriquez, 19, presents to the hospital Emergency Department with a diagnosis of West Nile virus. He has a fever of 102° F, chills, and generalized aching in all his muscles. He reports that he was recently hiking in a wooded portion of the state and was bitten repeatedly by mosquitoes, despite the fact that he used an insect repellent. He and his parents are informed about this condition, including the need for immediate hospitalization and the treatment plan. Joe refuses to be hospitalized, stating that he will follow all medical recommendations at home. He asks to be assigned a home healthcare nurse to assist with his medical treatment. His parents are totally torn between honoring their son’s wishes and forcing the admission of their son, so that he can receive the needed medical and nursing care.
Question 1
You are the nurse manager for the emergency department, and staff members approach you about this patient. How would you begin to resolve this dilemma?
Question 2
What type of direction would you give staff members to allow them to come to a satisfactory conclusion?
Question 3
How does the Code of Ethics for Nurses (ANA, 2001) provide guidance in reaching needed decisions?
Professional Standards for Nursing Leadership Case Study 6
The community has been suffering from a severe nursing shortage made worse by a particularly virulent flu that has affected many of the staff members. Upper management is aware of the severity of the shortage and has decreased the bed census by 20%; only emergency surgery is being performed until the crisis abates. You are considering reassigning a portion of your critical care staff, including dialysis and emergency care nurses, to the general medical and surgical floors because the crisis is most severe on the general units. None of the staff has been cross-trained specifically for the general units.
Question 1
From an ethical standpoint, how would you begin to achieve this task, and what are the ethical principles involved?
Question 2
How would you select which nurses to reassign and which nurses to retain in the unit?
Question 3
Would you involve the nurses themselves in the decision-making process? Why or why not?
The Health Care Delivery Workforce Case Study 7
Ms. Clark, a registered nurse, arrives at work at 6:30 AM so she has plenty of time to make out her assignment and decide who will be working with her before the report begins. As she walks onto the unit, she hears the night charge nurse speaking on the telephone in a rather loud and firm voice. Based on this conversation, it is clear that the charge nurse does not believe that the unit is adequately staffed to meet the patient care needs. The charge nurse, Ms. Viola, turns to Ms. Clark and says, “Your assistant called in sick and we are trying to get a CNA (certified nursing assistant) from another unit as a replacement; however, that may not happen until after the shift begins. As usual, we are trying to get someone from our sister unit, so whoever comes will be late. Sorry, that’s how it is today.” Ms. Clark has worked on this unit for approximately 6 months and is anxious about working with someone she never met before and for whom she has not observed provide patient care.
Ms. Clark, using various flowcharts, quickly assesses the patients’ immediate care needs and determines what questions to ask during report. She circles tasks/activities that normally can be completed by a CNA and that must be done before 8 AM—the earliest she might anticipate getting some assistance. Ms. Clark is overwhelmed with her responsibilities and what she needs to keep track of and hasn’t even learned the status of the patients since she last worked with them.
Question 1
What could the day charge nurse do to assist Ms. Clark?
Question 2
What should Ms. Clark do as soon as the replacement CNA arrives on the unit?
Question 3
Is Ms. Clark making appropriate use of her time by arriving early?
Case Study: Quality Improvement – Six Sigma 8
Tiffany has worked in the Emergency Department (ED) of a regional medical center for the past year. The average length of stay (LOS) is over 4 hours, the number of patients who leave without being seen (LWBS) has climbed to 180 patients/month, and patient satisfaction scores have fallen to 80%. A Six Sigma team, including ED nurses, ancillary department staff, and physicians, has been established to identify opportunities to decrease average LOS and the number of patients that LWBS. Tiffany, a new member of her department’s Practice Council, has been asked to participate. The Six Sigma team will apply the six steps of the QI process to determine an approach to reduce excessive wait times and improve patient satisfaction. The Practice Council completed the first two steps of the process (identify needs most important to the consumer of healthcare service, and assemble an interprofessional team to review identified consumer needs and services) before Tiffany was asked to join.
Question 1
Identify the next step (step 3) in the QI process and an approach the Six Sigma team might take.
Question 2
The Six Sigma Team then moves to the fourth step and identifies the following goals: to decrease average LOS to less than 180 minutes, to reduce the number of patients that LWBS to less than 1% of the monthly volume, and to raise patient satisfaction scores to 97%. What is the next step of the QI process? Identify an effective approach the team might take.
Question 3
Describe the sixth step in the QI process. Speculate on how communication rounds affected wait times, reduced the number of patients who LWBS, and improved patient satisfaction.
Case Study 9: Quality Improvement – Nursing Indicators
Maria, a new professional nurse graduate, has been asked to participate in her unit’s quality improvement council. Each unit in the hospital has been directed to focus on nursing-sensitive indicators and report the following results to the National Database of Quality Indicators (NDQI) database: hours per patient-day, falls with injury, pressure ulcers, and RN satisfaction. Maria has been informed that over the past year, the hospital has used the results to implement several changes, including decreasing the nurse-to-patient ratio on select units, developing a clinical ladders program, and increasing orientation services for new professional hires.
Question 1
Where can Maria find more information about nursing-sensitive indicators and about best practices in other hospitals?
Question 2
As a new graduate, how can Maria possibly contribute something unique?
Question 3
How can Maria approach this challenge in a way that she can learn something from her co-workers and her co-workers can learn something from her?
Overview of Precepting and Mentoring Case Study 10
Thomas is a baccalaureate-prepared registered nurse in an ambulatory care clinic associated with a community hospital. He has been in a staff nurse role in the congestive heart failure clinic for 5 years and is interested in furthering his career with additional education. He approaches his mentor, David, for advice about how he might build on his experience in the ambulatory setting.
Question 1
Before meeting with David, what demographics should Thomas investigate that might have an impact on his career choices?
Question 2
What career opportunities might Thomas consider?
Question 3
What advice might his mentor, David, provide?