NURS 6101 Discussion Essay

NURS 6101 Discussion Essay

To be influential, nurses must see themselves as professionals with the capacity and responsibility to influence current and future healthcare delivery systems. The nursing profession is based on the science of human health and the science of caring. It operates from a framework that values all people in a holistic way and seeks to foster and advance people’s health throughout their lifespans and across all levels of society.NURS 6101 Discussion Essay


Burke_Sheila_ID_embed_SFWTo achieve these objectives, it’s essential that policies exist that define and integrate appropriate standards for delivery of care and address conditions necessary for that care to occur. Through policy work, nurses can and should influence practice standards and processes to assure quality of care. Nurses who influence policy help shape the care that will be provided today and tomorrow. Policies also impact resource allocation to support delivery of healthcare.

More than ever, nurses are present in every healthcare setting and possess a unique role in formulating policy. The Institute of Medicine’s 2010 report The Future of Nursing: Leading Change, Advancing Health, recognized the importance of this role and called for nurses to take leadership in improving the quality of healthcare.NURS 6101 Discussion Essay

Many of the leading nursing organizations promote active participation by nurses in policy formulation. For example, the American Association of Colleges of Nursing emphasizes the role of nursing in policy and identifies, in its “Essentials” documents, the expected policy involvement that should be addressed in educational programs at the baccalaureate, master’s, and doctoral levels of professional nursing, including advanced practice. The National League for Nursing and the American Nurses Association also expect nurses to address policy as part of their professional role.

Collaborative policy work
One example of nurse leaders working together to address health policy issues at a national and global level involved collaboration between nursing leaders from Ireland and Singapore. In 2013, Swee Hia Lim, MN, RN, DSc (hon.), president of the Singapore Nurses Association, met with Liam Doran, MA, RGN, RMHN, leader of the Irish Nurses and Midwives Organization, to discuss issues affecting nursing and midwifery, both nationally and globally.NURS 6101 Discussion Essay

Together, Lim and Doran examined how the work of nurses and midwives impacts quality of care for individuals and families throughout the world. Both professions actively participate in health policy decision-making processes, ultimately benefiting patient outcomes. These two leaders recognized, however, it was necessary to have a strong and effective structure for effective change to occur and that the process also required clear definition and communication of practice issues involved—from direct delivery of nursing and midwifery care to the patient to the more operational, strategic delivery of healthcare and policy development at regional and national levels. By working together to influence policies, these nurse leaders increased contributions of both professions—nurses and midwives—thereby helping bridge disparities between political strategic direction and actual clinical practice.

STTI’s commitment to policy
STTI has long been a force for shaping policy and has worked with nursing and governmental organizations to advance policies that promote world health. The honor society also promotes member participation in policy work across local, regional, and global levels of healthcare. The organization makes its commitment to policy formulation clear on its website: “Since the work of Florence Nightingale, nurses have helped shape public, health and nursing policy. Visionary nurse leaders understood the consequences of the social, political and economic factors on the health and well being of the public. Today nurses continue to make an important contribution to planning and decision-making, and to the development of appropriate and effective public, health and nursing policy on all levels.”NURS 6101 Discussion Essay

Recently, STTI has taken important steps toward influencing healthcare policies through the newly established Global Advisory Panel on the Future of Nursing (GAPFON). GAPFON is bringing together stakeholders from across the world to design plans and metrics for addressing priority areas for policy, as well as nursing leadership, workforce development, and education.

The work nurses do in influencing policy affects decisions that impact quality of life and universal access to care. Becoming influential in policy work is a process that requires commitment to developing skills and acquiring knowledge about activities that lead to change. It involves making choices.NURS 6101 Discussion Essay

Why policy matters to me
Over the course of my career in nursing, my path has involved work in clinical settings that include acute care, hospice, home health care, and community-based programs. I’ve also administered direct care and support of thousands of patients and their loved ones. Today, I am responsible for overseeing educational standards and programs for pre-licensure nurses. For me, it’s essential that these individuals attain a level of knowledge and comfort with processes and activities related to healthcare policy and that, prior to graduation, they learn to value and appreciate opportunities to be active influencers of policy.

What YOU can do
As a registered nurse and STTI member, you have education, experience, and perspectives that uniquely equip you to participate in policy formulation. Here are just a few ways you can be involved:
Learn how policy is developed. Seek out areas of policy you want to influence.
Learn who is participating in policy development and make contact with them. Nursing organizations and organizations such as AARP have multiple user-friendly internet sites that provide information about participating in policymaking activities.
Explore resources related to policy formulation.
Investigate health policy agendas that local legislators have established for their terms in office.
Volunteer to participate in policy meetings or related activities. Prepare a fact sheet, or assist in preparing a report to inform policy decision-makers. Inform stakeholders of activities that offer opportunities to address policymakers.NURS 6101 Discussion Essay

Political Ideology and Philosophy
The book provides the deeper understanding of the connection between the occupations of nurses and ideological and political concepts. Being aware of the philosophical and political themes, the nurses will be able to develop better work strategies and perspectives. The authors note the role of the political philosophy and ideology in the issues concerning gender and race.

The authors highlight the question of individuals and states and present the major ideas described by Thomas Hobbes, John Lock, and Jeremy Bentham. Hobbes focused his attention on the significance of the role of the government in the life of the society. As the matter of fact, the philosopher claims that the community would live in chaos without the governance.NURS 6101 Discussion Essay

The theory can also be applied to the nursing practice, as the government should intervene in the health care system to prevent unlicensed practices that harm the clients (Mason, Leavitt, & Chaffee, 2012, p. 53). In contrast, Lock is sure that the individual rights should receive the priority, and the community requires little governance from the state (Mason, Leavitt, & Chaffee, 2012, p.54). Bentham notes that sometimes right of the individuals contradict, and that is, the government should interfere.

For example, people have the right to smoke, whereas other ones have the right to fresh air. Then the authors focus on the different types of the political ideologies, namely liberalism, conservatism, and socialism. The accent is made on discovering of the major representatives of the philosophers and pivotal objectives that describe each type of the political ideology (Mason, Leavitt, & Chaffee, 2012, p. 55)

The Policy Process
The conceptual models of the presented policymaking provide the better involvement of the nurses into the changing of the system. First and foremost, it should be stated that the “health policy encompasses the political, economic, social, cultural, and social determinants of individuals and populations and attempts to address the broader issues in health care” (Mason, Leavitt, & Chaffee, 2012, p. 61).

The authors provide a bright example that shows how the theory should work in practice. In case that the medical setting lacks nurses and patients have to wait long for receiving the care, the nurses should react to the issue appropriately, namely to work more hours in order to improve the condition. The authors move on to the peculiarities of the policymaking in the United States. It should be stressed that the sphere of the health care faces challenges.

The system of the financial side is complicated as it is decentralized (Mason, Leavitt, & Chaffee, 2012, p. 63). The problems in the state and federal cooperation influence the health care delivery. It was informative to get the better understanding of two models of the policy process, namely the Longest’s Policy Cycle Model and Kingdon’s Policy Streams Model (Mason, Leavitt, & Chaffee, 2012, p. 66).NURS 6101 Discussion Essay

Nursing profession is one of the professions, where the professionals have to deal with diverse range of aspects including both the service users and other service providers’ issues. Thus, the nursing professionals have to be more focused upon maintaining the quality of care provided, in any circumstances and accountable for the health outcomes of the patients (Roberts et al. 2009). Thus, nurses should have the competence to handle contemporary situation in healthcare. Based on the skills and competencies the health care authorities recruit a nurse, but there are a number of factors in a microenvironment of the health care, which can motivate or demotivate a nursing professional to retain her job in this sector. The key issues that influence the nursing professional’s recruitment and retention in the health care organization include authority, autonomy and staffing issues. My sole focus in this essay would be to explore micro-politics environment in the hospital and how it influences the nursing practice with a greater focus on the “person centered care” (Wu et al. 2012). One key issue in this context is the gap between the expression of nurse’s adoption of the holistic patient care aspects and the reality of practice obtained through the research data. Thus, identifying and mitigating the micro political issues are essential for understanding the influences on nurse’s recruitment and retention in the health care settings. Some of the issues, which would be focused in this essay are, autonomy, horizontal violence, staffing issues, power relations and oppressed group behavior.NURS 6101 Discussion Essay

Nowadays, recruiting a skilled nurse and retaining the staff for longer period is one of the key challenges for the hospital or other health care programs. The health care organizations are undertaking a number of strategies for retaining the nurses for longer period. Nursing shortage is one of the common issues in the health care sector. In spite of implementing diverse range of effective strategies, due to the influence of some micro politics related factors, nurses have to undergo unpleasant environment, sometimes, which is related to lack of support, lack of management or dominance of higher authority people. In this context, I will discuss some particular micro political issues, which are most common reasons behind the poor recruitment and retention of the nursing staffs in the organization.

According to Laschinger (2012) understanding nurse’s perceptions about their workplaces supports the effective recruitment and retention strategies. American Nurses Association (ANA) and American Academy of Nursing recognized the “magnet characteristics”, which are characterized as the organizational factors, supporting the effective nursing practice and working conditions in health care environment. I have revealed from the study that, with the use of these magnet characteristics, we would be able to understand the micro-political environment, which is accountable for poor nursing recruitment and retention strategies. During my personal experience as a nurse, I have encountered some of the common micro-politics issues in the health care settings. One of the common issues is horizontal violence (Sawatzky and Enns 2012). Horizontal violence is the practice, which is being practiced within nurse professionals. It promotes a negative work environment, decreasing the efficiency of teamwork and reducing the quality of patient care. While reviewing the previous articles, I have revealed that horizontal violence has a significant negative impact upon the management and retention of a nurse for longer period in the nursing care settings.NURS 6101 Discussion Essay  If we try to find the evidence on horizontal violence, we might not get enough information, because, in most cases, the incidences are not reported. However, recent reports have highlighted 65 to 80% cases of horizontal violence in health care settings (Ceravolo et al. 2012). Strengthening. Bullying is the most common form of horizontal violence in nursing domain. In Australia, approx 50% nursing student experiences horizontal violence and humiliation (King-Jones 2011).

I have revealed from the report of Dumont et al. (2012) that the newly graduate nurses experiences a higher level of horizontal violence, which results in extended absenteeism, sometimes this situation leads to absenteeism. The resulting effects of horizontal violence include detrimental effects to the professionals. As a newly graduate nurse, I have also gone through a phase, when horizontal violence affected my self-esteem and promoted my burnout. In this context, I have critically evaluated the effects of horizontal violence and found that these kinds of situation can hamper the work of entire health team. I have observed the effects of horizontal violence from very close proximity (Sorensen et al. 2008). One of my colleague experienced anxiety and sleeping disorder. Other health effects of HV include depression, low self-esteem and agitation. The rate of leaving the job after experiencing horizontal violence is not rare. Due to the poor teamwork as a result of horizontal violence, essential information related to patient care is eliminated and the victimized nurse become in a poor position from where she might not be able to deliver promising nursing care to assigned patient, which in turn results in compromised health outcomes of the patient (Hayes et al. 2012). It also causes enhanced cost to patient, their families as well as organization. In contrast, a good management system, that can resist any kinds of practices related to horizontal violence, in the organization, can effectively enhance the nurse’s satisfaction level as well as can influence nurse’s retention for longer period.NURS 6101 Discussion Essay


The second theme in my unit outcome is related to the topic discussed above, as horizontal violence is one of the key issues in micro-political environment in health care settings. Another key issue in this context is autonomy. Autonomy is a common issue in health care context, which influences nursing staff’s dissatisfaction in teamwork, resulting in enhanced nursing turn over. Autonomy refers to such practice, when the nursing staff acts according to his or her knowledge in team, instead of taking other’s opinion (Twigg and McCullough 2014). From my perspectives, the person who is applying autonomy in a team wants to direct or control the other members of the team, which might not be satisfactory to the other members in the team. As a result, the dissatisfaction leads to nursing burnouts, less participation in the decision-making processes, which in turn promotes the thoughts of leaving the job. Thus, it should be treated as a critical cause of nursing turn over. As health care practices can be enhanced through teamwork, autonomy is usually not preferred, instead of that; a democratic leadership is usually preferred for prioritizing the thoughts of all the members in the health care team and considering the best parts in their concepts.

To meet the objectives of the person centered care, the teamwork is mostly preferred. On the other hand, providing autonomy to every person is necessary in all conditions. In some cases, it has been seen that the higher authorities are using autonomy as a tool of controlling the other nursing staffs. I have seen that, nurses, who prioritize their autonomy more than the values of being a member of multidisciplinary health care team, are mostly seen to misinterpret patient medication or reports. I have also revealed that many physicians declare them as care giver of a patient, playing the role of a registered nurse autonomously. These members may not have good training, thereby lowering the quality of health care practice. According to Van den Heede et al. (2013), “Not even all nurses agree that they are members of an autonomous profession, in our view mistaking a lower level of practical power for a conceptually subordinate practice role, and maintaining that physicians have final authority over all patient care decisions”.NURS 6101 Discussion Essay

I have experienced power relation related issues, while working in a health care setting as a registered nurse. The relationship between nurses, doctors and patients affects the experience of patient as well as nurses. A well managed power relation can promote the long-term retention of a nurse in a health care organization; in contrast, inappropriate relationships or power relation issues can lower the satisfaction of nurses, doctors or patients. I have seen that it is a common issue in multidisciplinary team, which promotes inappropriate behavior of nurses with patient, thereby deteriorating nurse-patient relationship. Usually problem arises when there is a lack of means through which the nurse’s perception can be adequately communicated (Knudson 2013). I have evaluated the reason behind moral suffering of nurses in a nursing care team, which includes such situations, when the nurses are able to make their moral judgments for the team or for the patients, but the decision-making is hindered due to lack of power issues. Thus, the nurse managers or leaders should consider power relation issues during the decision-making and related practices. It can significantly affect the patient-centered care, due to the hindrance in nurse-patient relationship as a result of “lack of power” issues of nurses, which in turn dissatisfies nurses, thereby enhancing the chance of increased nurse turn over.NURS 6101 Discussion Essay

Oppressed group behavior has been recognized in nursing practice over more than 2 decades, which has been considered as one of the common and pivotal issue in nursing care. According to my knowledge, oppressed group behavior is the kind of behavior of the group members, which might hurt a team member, affecting the person’s thought process. In nursing, while working in a multidisciplinary team, I have experienced oppressed behaviors from my team mates. From my experience, I have seen that, due to lack or leadership and management skills of the team leaders, these kinds of behaviors are prioritized and performed. However, these kinds of behaviors are not needed in the health care settings, as it can indirectly affect the patient’s outcomes.

In a team, oppressed behavior of the group member usually highly demotivates the staff and influence staff turnover. Murata (2014) stated that, the presence of oppressed group behavior in a health care team results into lowered nurse self-advocacy, burnout and negative aspects of the organization. The final outcome is nurse’s dissatisfaction, which in turn leads to leaving the job.NURS 6101 Discussion Essay  With oppressed group behavior, person centered care service provision is usually not possible, as these kinds of decision enhances stress, anxiety or depression, thereby lowering the nursing staff’s participation in the team decisions, leading to the poor group performance, satisfaction and retention of nurses in the organization. It has been argued by Carrigan (2009) that nursing is an oppressed group, as it lacks power and control in the organization. I have revealed that the presence of oppressed behavior has been enhanced. From my perspective, the key reason behind these behaviors is that where the powerful people promote their own features as more valued, the dominated people feels devalued and thereby developing a distain for themselves and low self-esteem. I have experienced two behaviors “silencing” and “horizontal violence” described as oppressive group behavior, which can lead to increased nursing turnover (Tillott et al. 2013).

I have reviewed the surveys where nurses have discussed about their work life in hospital as a nurse. In most cases, I have seen that the question is unresolved. Sometimes results revealed the nature of their job, however, in most cases, nurses were not willing to express their actual feelings about their job. It indicates the dominance of power relationships. The other higher designation authorities usually control nurses in a multidisciplinary team (Duffield et al. 2011). Thus, to work peacefully, nurses have to follow all the instruction in the power relationship, which hampers her dignity as well as autonomy.

Staffing issue is another significant issue in contemporary health care context. Effective nurse staffing can help to keep nurses satisfied and patients safe. Improved nurse staffing is a good retention strategy, on the other hand a poor nurse staffing, for instance, if the staffing level is not appropriate, the nurses tend to leave their positions. I have revealed that to retain a specialty nurse, hospital authority has to bare $80, 000 (Dotson et al. 2014). Through the analysis of government reports of health care sectors, I have found that quality of nursing care saves lives. If nurses are forced to work in a high pressure, due to short supply of staffs, nurse’s burnout becomes higher, with negative patient outcomes. Due to short supply of staff, the remaining nurses become accountable for more complex care of more than one patient. It affects the mental stability and self-confidence of the nurse and get irritated due to huge pressure. From my personal experience,

I can say that, when a nurse has to work 24X7, the normal work-life balance is hampered, which can also affect the patient’s outcomes. This micro political issue can hamper the person-centered care and the perception of a patient about the nursing practices. Evidences say that more nurse burnout enhances the chance of patient infection and an unsafe environment, in contrast, appropriate staffing causes less death. When there is adequate staffs in a hospital, nurses can balance their work through the equal distribution of patient’s accountability within the existing staff, which helps the nurses to focus on the patient’s issues precisely. It reduces the chance of errors and nurse’s burnout. As a result nurse-patient relationship also gets strong, which is an important part in holistic and patient-centered nursing (Buffington 2012). In this context, nurse would be able to balance their work and life and would be satisfied. Finally, it would promote retention of a skilled nurse for longer period.NURS 6101 Discussion Essay

From the above discussion, I have gained an in-depth knowledge about several significant micro-political issues related to nursing care. I have modified my perception about the micro-political environment in the nursing. I have revealed that proper management and monitoring is required for recruiting and retaining nurses in the health care settings. From my perspective, as I have discussed above, to retain a specialty nurse, the organization has to spend adequate amount of money, sometimes, management does not implement a retention strategy, rather recruit newly graduate nurses in low payment with a thought that it would be better to recruit more new staffs than investing money for retaining a single specialty nurse. However from my perspective, this micro-political viewpoint is not right, because, the newly recruited nurses might not be as skilled as the experienced one; thus, either the organization have to invest for providing them a good training session, or the quality of health care would be lowered, affecting the health outcomes of a patient (Kean and Haycock-Stuart 2011).

In my future practice, I would always try to be responsible for all the aspects of my patients and would try to meet my professional standards and ethical codes. In a managerial post, I would attempt to implement effective strategy for retaining nurses and explore their expertise in emergency, instead of recruiting unskilled nursing staffs, thereby enhancing the quality of nursing practice (Leiter et al. 2009). Finally, as I know that health care provision following a holistic perception is only possible through effective teamwork, I would prefer democratic leadership and would try to discuss my perception with my teammates, for giving value to their perceptions. From my perspective, it is the only way to meet holistic needs of patients as well as to satisfy nursing staffs.NURS 6101 Discussion Essay

In conclusion, I would say that, the micro politics and related environment has a great influence upon the recruitment, retention as well as satisfaction of the nursing staffs. To deal with nursing retention strategies, the initial requirement would be to ensure a healthy and safe environment, where nurses can effectively work and become satisfied with high quality work and cooperation from their colleagues as well as higher authorities. In this context, i have revealed essential knowledge about relevant political issues that I would experience during my nursing carrier, which would promote my critical thinking skills to deal with these issues.NURS 6101 Discussion Essay NURS 6101 Discussion Essay

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