Ethical issues play a significant role in the daily work of a nurse. Thus, experience of a preceptor showed that sometimes, work of a medical employee demands making a crucial decision. The preceptor cared for end-of-life patients who required specific care and support. Principles that she applied included efficient care for a patient, autonomy, harm avoidance, and fidelity (Herbert, Moore, & Rooney, 2011). In situation under discussion, a patient needed special care due to constant anxiety. Thus, the nurse used the principle of efficient care that helped to make a right decision and calm down the ill person. The nurse also used American Nurses Association’s code of ethics that supported making effective ethical decision. According to the ANA, nurses should provide compassionate and comprehensive care to end-of-life patients either individually or collectively (Herbert, Moore, & Rooney, 2011). The code describes ethical standards applicable in various settings, which have been effectively followed by the preceptor. Problematic issue faced by the nurse was to find a balance between compassion and support (Herbert, Moore, & Rooney, 2011). The patient’s case was specific that is why, it was important to demonstrate respect to his view and provide comfort and care. Nurse’s work required specific moral stability and responsibility (Herbert, Moore, & Rooney, 2011). Therefore, after several months of work, the nurse decided to undergo additional trainings, which further helped to cope with non-standard situations and gain required skills of reacting fast in case of problematic situation (Herbert, Moore, & Rooney, 2011).
Process of new staff acquiring, orientation, and socialization is considerably important for a manager of unit because it enables finding the most eligible candidates. Socialization plays a significant role because productive work of medical employee is based on effective collaboration with colleagues as well as development and adoption of new performance strategies (Leineweber et al., 2016). One of the specific socialization factors is ensuring open and clear communication that supports sharing necessary knowledge and important information. Managers of an unit support new staff and help them to get acquainted with other employees (Leineweber et al., 2016). They also strongly focus on providing efficient orientation of the staff that begins with explanation of a medical organization structure, overview of performance strategy, and description of responsibilities. Before the work starts, the new staff visits two-week session to acquire necessary skills that facilitate their further performance (Leineweber et al., 2016).
Process of new staff acquiring is based on open enrollment that presupposes providing employees with plan materials and ability to ask questions about plan choice. Such strategy allows effective adoption of the plan and appropriate medical schedule (Leineweber et al., 2016).
Direct care staff scheduling is necessary to ensure that the staff makes enough contribution to arrangement of the schedule. It includes an adequate number of direct care workers to meet patients’ needs. Therefore, nurse’s responsibility involves submitting desired work schedule that also includes off-shift rotation, weekends, and holidays (Leineweber et al., 2016). Unit managers assign responsible nurse who has to control adequate coverage on shift-to-shift and day-to-day basis.
Sometimes, principle of practice transition raises such problems as formation of reasonable schedule that would be effective and eligible for all personnel members and would exclude work overload. The transition also should focus on the right distribution of shift time, spacing of shifts, and scheduled hours. Thus, responsible nurse has to keep record of shifts in order to eliminate 12-hour shifts that can lead to fatigue of nursing workforce (Leineweber et al., 2016). It appears to be the most difficult adjustment because nurses’ work overload is a common practice. Analysis has showed that fatigue results in frequent procedural errors (Leineweber et al., 2016). Besides, the study reports that such situation causes greater chances of ED visits (Leineweber et al., 2016). Thus, one of the most valuable recommendations that will help to cope with possible problems is elimination of 12-hour shifts. It would be rational for management team to set rules regulating working hours available for the staff. It would be effective to control overload of nurses with chronic medical conditions, older workers, and pregnant employees (Leineweber et al., 2016). Moreover, there is a need for evaluation of adequate rest time between the shifts.
Analysis of current and previous practices showed that there were motivation barriers in both of them. However, some managers work hard on elimination of such barriers, while others leave the issue unattended. Considering personal experience in the unit, there were such barriers as lack of support for nurses, centralized management, and problems with work organization. In contrast to the previous work place, current unit managers work hard to eliminate the barriers. Supervisor asks for nurses’ feedback on a daily basis and encourages discussion of everyday challenges regarding patients, work schedule, and working environment with the aim of providing employees with support. An efficient approach to work requires requesting feedback in a positive way asking not only about opinions and feelings of employees but also possible solutions to the existing issues (Oshvandi et al., 2008). The problem of centralized management can be solved through exercising nurses’ leadership and encouraging their participation in decision-making process.
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In addition, managers of the unit solve the problem of work organization through involving the staff into active communication with the aim of creating supportive and friendly atmosphere. Such approach provides employees with an opportunity to ask for advice and better understand the structure of organization (Oshvandi et al., 2008).
Regarding personal experience, one of the most significant conflicts concerned the absence of medical staff representative in executive committee that led to discords between two groups. Such approach formed a gap in understanding of actual problem and caused misunderstanding. According to the Joint Commission Standard 01.01.01, an effective solution is adopting the rule, policy, regulation, or amendment that can help to settle the conflict, come to understanding, and make a right decision (Brown et al., 2011).
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