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Behavioral hallmarks such as honesty, high ethical standards, and maintained moral principles define workforce integrity. Here, learn methods for integrating them into management practices.
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Physicians must learn new skills in a manner consistent with their ethical obligations to benefit the patient, to do no harm, and to respect a patient's right to make informed decisions. Patients should be given the opportunity to consent to or refuse treatment by students. Students must hold in confidence any information they learn about patients. The relationship between teacher and student involves an imbalance of power and the risk of exploitation of a student for the benefit of the teacher. Students should not be placed in situations where they must provide care or perform procedures for which they are not qualified and not adequately supervised. Students have the obligation to be honest, conscientious, and respectful in their relationships with their teachers. They should act in ways that preserve the dignity of patients and do not undermine relationships between patients and their physicians. If a student observes unethical behavior or incompetent conduct by a teacher, the appropriate institutional authority should be informed. Institutions have an obligation to provide a work environment that enhances professional competence by ensuring that students and residents work reasonable hours, helping them balance education and patient care responsibilities; providing adequate support services; and, in the case of residents, providing reasonable salaries and benefits. With increasing numbers of women in education programs, special attention must be given to the parallel demands of pregnancy and career goals.
It is time for a change in mindset in how nurses operationalize system implementations and manage projects. Computers and systems have evolved over time from unwieldy mysterious machines of the past to ubiquitous computer use in every aspect of daily lives and work sites. Yet, disconcertingly, the process used to implement these systems has not evolved. Technology implementation does not need to be a struggle. It is time to adapt traditional plan-driven implementation methods to incorporate agile techniques. Agility is a concept borrowed from software development and is presented here because it encourages flexibility, adaptation, and continuous learning as part of the implementation process. Agility values communication and harnesses change to an advantage, which facilitates the natural evolution of an adaptable implementation process. Specific examples of agility in an implementation are described, and plan-driven implementation stages are adapted to incorporate relevant agile techniques. This comparison demonstrates how an agile approach enhances traditional implementation techniques to meet the demands of today's complex healthcare environments.
Change is common and important in improving patient outcomes in the current healthcare market. Because of the tremendous increase in credible research and publication of research findings, clinicians now use evidence-based findings to guide their practice. The rapid changes in the healthcare environment require effective leaders that can implement change strategies to improve patient outcomes. Evidence has shown that clinicians may have difficulty integrating new knowledge into clinical practice. The advanced practice nurse (APN) equipped with advanced clinical knowledge and knowledge of the change process is perfectly situated in the healthcare setting to be an agent of change. This article focuses on the specific steps of the change process APNs can use to effect change in practice in their institutions. An example from the author's own clinical practice in implementing an intensive insulin drip protocol is outlined. The key elements important in successful development and implementation of a change in practice are presented. By improving the understanding of the change process, APNs as change agents can meet the challenge of leading the way to change in their clinical setting.
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The health care professional who assumes a management role must recognize that he or she is adopting a second and concurrent career of equal importance to his or her primary occupation. Many such managers have considerable difficulty balancing the two sides of the role because most are well trained in their specialties but enter management with little or no preparation for management. Lack of preparation and inadequate understanding of the requirements of the management side of the role lead to discomfort in management matters and in turn frequently cause a manager to seek refuge in being more of a specialist than manager. The most successful managers will be those who develop the ability to appropriately balance the sides of the dual role.
An administrator who is able to delegate to subordinates without feeling the need to "micromanage" gains power by "letting go." Power is the ability to influence others by persuasion in coercion. The administrator who is able to "let go" can enjoy the role of facilitator and mentor to subordinates. Details that were formerly obsessed about can be left to others. The administrator who has accomplished the art of "letting go" can say of a subordinate manager, "I trust the manager as a competent professional. I don't 'supervise' constantly. That would be 'micromanaging.' If that person needs some assistance, I will encourage the request."
This study identifies the most essential skills and roles of senior-level health care managers. The study first reviews the literature to describe major forces in the healthcare environment that impact management and then discusses the skills and roles of managers. From this, a descriptive list of skills and roles is created. Ten senior-level managers were interviewed to reveal six roles and associated skills necessary for managing in the current health care environment.
Recently, there has been much written about professional ethics in health care, but the literature has tended to focus on the ethical care and treatment of patients and protection of their privacy and confidential information. This article focuses on the ethical behavior of health care professionals and how they treat each other in the workplace. Examples of unethical behavior are described ranging from subtle favoritism by managers and bullying to crossing the legal line. Two specific cases demonstrate serious situations where it was necessary for colleagues to "blow the whistle" even at the risk of their own careers.
Within the present context of a shortage of nursing personnel, it seems crucial for organizations to find strategies that facilitate the transition from the student to the nurse role in order to recruit and retain caring and competent professionals. Early exposure to clinical nursing practice can (1) promote an appreciation of the organization and functioning of the clinical unit, (2) facilitate the application of knowledge and acquisition of nursing interventions, and (3) engage motivated nursing students in the learning process. L'Ordre des Infirmières et Infirmiers du Québec initiated the Nursing Extern Program (the Program) to ease the severe nursing shortage, which was expected to worsen over the summer. The Program was seen as a way for students to consolidate the learning acquired during clinical rotations. Nursing students were employed as externs over the summer period. Within the confines of the Program, nursing students had the opportunity to practice 21 nursing care activities while under the direct supervision of an expert nurse. This article describes the L'Ordre des Infirmières et Infirmiers du Québec Program and identifies the key elements of a hospital-based program. In the first 2 years of implementation, the Program retained 62% of the externs as graduates.
The purpose of this descriptive study was to explore the concept of moral turpitude and related terms as they are used in the process of licensing professional nurses. The researchers reviewed applications for licensure and nurse practice acts or rules and regulations for nursing for the 50 states and Washington, DC. Terms such as moral turpitude, moral character, and morality are used by approximately half of the states and, when used, are not usually defined. Agreement among states on uniform definitions and standards of nursing practice can be a step toward aligning practice acts, bringing consistency to disciplinary actions, and informing the public about the profession's standards for practice.
As in any other industry, laws and regulations significantly impact the functioning of the healthcare industry. Some laws, such as those relating to malpractice and social insurance systems, affect the manner in which the industry operates. Other laws, such as those regulating antitrust and employment practices, affect the organization and the environment in which the industry operates. It is increasingly important that practitioners and managers be cognizant of this complex and dynamic legal minefield. This study examined healthcare managers and executives' knowledge of 9 key issues in the legal and regulatory environment of the healthcare industry. Specifically, the study focused on knowledge concerning tort and contract liability, insurance law, labor and employment regulation, criminal and ethical responsibility, antitrust regulation, the law governing business associations and recent developments. Findings suggest that the levels of knowledge required to manage legal and regulatory issues are much greater than the existing levels of knowledge.
Defining the roles and functions of case managers is crucial in today's healthcare environment and necessary for the case management field. One way to address this issue is through the examination of case managers' job descriptions used in various healthcare organizations. The study reported herein used qualitative analysis procedures and the latent class cluster analysis method to examine a national sample of 1028 job descriptions of case managers. The study identified the activities, role relationships, knowledge, skills, and abilities of case managers working in varied settings. It also described the changes that occurred in the practice of case management, based on these job descriptions, over 5 years: from the mid-1990s until the early 2000s. One benefit of this study was a change in one eligibility criterion of the CCM credential. Another was the development of a taxonomy of case managers' roles and functions that can be used as a step toward standardization of case managers' job descriptions.
Since the introduction of the National Patient Safety Goals (Joint Commission International Center for Patient Safety, 2005) into the Joint Commission on Accreditation of Healthcare Organizations standards, there appears to be a positive movement toward improvement in patient care outcomes and safety. Case management has been an integral part of the care team, and has emphasized standards of performance in quality of care, collaboration and resource utilization since 1995. When Leapfrog defined hospitalist intensivists as one of the three requirements necessary to be a safe hospital, an opportunity was borne to create a professional partnership. With the patient and the safety as the central focus of care, case managers and hospitalists are beginning to exponentially change the face of healthcare. This article will demonstrate the value of this partnership.
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