NR 506 Week 8 Assignment: Organizational Change
NR 506 Week 8 Assignment: Organizational Change
Background
We have learned that the advanced practice nurse is focused on planning for the restoration, maintenance, and promotion of health across a variety of populations and the importance of considering legal influences on APN practice. However, many nursing interventions, such as the promotion of health and wellness, sometimes generate concerns about what is good for one person over another, and the resulting moral conflict that may emerge from such questions. In this lesson, we will first focus on organizational change, and how nurse leaders can create an environment for innovation within an organization, and then we will examine ethical dilemmas and how good intentions on the part of the nurse may result in unintended consequences.
Organizational change is frequently described within the framework of three phases in which there is a period of unfreezing the existing practice, implementation of the innovation (change), and refreezing of the practice change. Along with innovation, it is also important for the nurse leader to ensure that routine work is completed. For this to occur, the nurse leader must see that all staff members understand their roles in completing the tasks and that the optimal structures and processes are in place to support the work. Who Is often called the guru of quality care, optimal structures and processes foster optimal outcomes, whether in educational or clinical settings. Attending to structure, process, and outcomes leads to higher quality-driven care in health organizations.
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Structure refers to the physical facilities of the organization. In addition, structure includes the tangible resources within the organization. These include money, equipment, and skilled personnel. The leader is responsible for appropriate policies that guide the work. Polices should be enforced and updated appropriately. When structure and processes are both appropriate to the mission of the organization, whether in an educational or clinical setting, then positive outcomes are more likely to occur.
Let’s consider some key variables that affect adoption of innovations.
Environmental Competition
Innovations are adopted more quickly in a highly competitive environment due to the pressure of competition.
Functional differentiation:
Vertical differentiation:
Centralized versus decentralized decision-making:
External/cosmopolitan communication:
Internal/local communication:
Organizational Attitude Toward Innovation and Change
To thrive versus survive in today’s environment, organizations must change as necessary and continue to examine the relevance of their mission. The decision-makers in some organizations prefer stability. Change happens only when an outside force requires it. Other organizations believe that change is essential to adapt to the ever-evolving environment.
Org Attitude toward Change
Innovation Model Description
Propose a model explaining how innovations are disseminated. In this model, organizations or individuals can be classified in terms of how readily and early they adopt innovations. Innovators are the first adopters of an innovation in a local market. Innovative leaders face a high level of uncertainty concerning the outcome of their decisions. These nurse leaders cannot be risk averse, and they cannot wait for consensus in support of a new aspect of structure or a new process. Nurse leaders who want to be innovators must have the support of the decision-makers in their organizations. These decision-makers may be the board of directors of the organization or other key stakeholders. Early adopters are forward thinkers who want to stay ahead of the curve of innovation. Early adopters are often leaders in their profession. Since they do not want to jeopardize their reputations, they are careful in selecting innovations. The early majority adopt those innovations that have already been tested by the innovators and the early adopters. They make up the largest group of the first 50% of those who adopt an innovation. The late majority are skeptics who will only adopt an innovation when there is persuasive evidence that has value in furthering the mission of the organization. Finally, laggards are those who like the tried and true methods for fulfilling the mission of the organization. Laggards wait to adopt an innovation only when required to by external forces such as changes in accreditation policies.
How does a leader go about creating and sustaining innovation? As noted above, innovators often have a high level of uncertainty about the outcome of their innovation, but there are a few steps that one can take to help develop acceptance of innovations. Research has shown that the best leaders assess the social identity of the group, formulate their innovations and goals to lead based on this identity, and guide groups from within the social group. This research shows that the best leaders not only appear to belong to the group but have many of the characteristics that make their group distinct from others. Moreover, leaders who separate themselves and hold very different social identities than the group are less effective. Second, find the basic beliefs of the group through this assessment. Third, learn what you and the group share as common beliefs and visions for the group. A common, shared vision for the group is the best place to start. Finally, remember that the leader must be recognized as someone who can fit into the group AND who can help the group see that the leader’s agenda for innovation and change is the group agenda and fits in with the group’s social identity.
Creating and sustain innovation
Creating and Sustaining Innovation Image Description
How does one create creativity in others? Building an environment of acceptance is the first place to start. Encourage staff to bring any and all ideas to you, assuring them that you love new and creative ideas and no idea is too small to consider. Then make time to listen to these ideas. Answering with a “put it on my desk” approach will quash the bravest innovator. Finally, praise the idea and make an effort to use it, if possible. This is the most sincere form of flattery and will encourage your staff to bring more ideas to you.
An interesting consideration in the adoption of new innovation is the time frame needed for the innovation to either take hold or to fail. How do we know when an idea, innovation, or change is not progressing? A curve was developed to illustrate the pace of innovation adoption. It demonstrates that innovation is no longer accepted when the adoption rate slows. If the adoption rate has slowed, but you do not see the late majority or laggards adopting it, it is very likely that the innovation will not be adopted and should be discarded or a new strategy initiated.
NR506NP-11157
Week 2: Frameworks to Approach Dilemma
Week 2: Frameworks to Approach Dilemmas
Week 2
Frameworks to Approach Dilemmas
Background
Two frameworks often used when approaching dilemmas are an ethic of care or an ethic of justice. The APN must also appreciate how an ethic of justice can be differentiated from an ethic of care in considering best practices in ethical decision-making. An ethic of care is compassionate, while an ethic of justice is judicial.
Ethic of Care
An ethic of care is often associated with the caring theoretical paradigm. It involves a commitment to holistic care that is always sensitive to the needs of others and is considerate of context. For example, within the patient safety context, it is clear that power has a dramatic impact on patient care. If power is directed organizationally toward an ethic of care, a caring environment is fostered. Patient safety in such an environment would be cultured through a formative, continuous quality improvement approach.
Ethic of Justice
Conversely, an ethic of justice is inordinately concerned with justice as fairness and a preoccupation with metting out such justice. It involves a commitment to human rights and the notion of public restitution regardless of context. For example, if power is directed organizationally toward an ethic of justice, a judicial environment is fostered. Patient safety in such an environment would be cultured through a summative reporting approach. Interestingly, research has shown that the latter is not as effective as the former, which underscores the evidence that mandatory reporting is not an effective approach to patient safety. Instead, strategies for patient safety should be formative and be focused on caring for the caregiver by providing educational opportunities that feature self-assessment, self-reflection, and self-correction. Other innovations for best practices for patient safety involve organizational evaluation over individual evaluation as a way to divert attention from the blame game and focus instead on continuous quality improvement.
NR506NP-11157
Week 2: References
Week 2: References
Week 2
References
Buppert, C. (2017). Nurse practitioner’s business practice & legal guide (6th ed.). Jones & Bartlett.
DeNisco, S.M., & Barker, A. M. (2015). Advanced practice nursing: Essential knowledge for the profession. (3rd ed.). Jones & Bartlett Publishers.
Letz, K. (2017). The NP guide: Essential knowledge for nurse practitioner practice. (3rd ed.). American College of Nurse Practitioner Faculty.
Teitelbaum, J. B., & Wilensky, S. E. (2017). Essentials of health policy and law (3rd ed.). Jones & Bartlett Publishers.
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NR 506 Week 8
Berwick et al. (2018) highlight that primary research, clinical trials, and implementation research should inform global patient care decisions and nursing practice decisions. I have learned that interventions proposed to enhance health outcomes, especially in low-resource settings, should be evaluated and their efficacy proved locally before being implemented in other larger settings.
Nurses engage in evidence-informed decision-making, which is crucial in promoting optimal health outcomes. Evidence-informed decision-making is a continuous process that incorporates evidence from clinical expertise, research findings, client preferences, and other available resources to inform nurses’ decisions that affect patients and nursing practice. Evidence is an important element in making informed decisions in all domains of nursing (Williams et al., 2018). It is also fundamental to improving the healthcare system. Nurses obtain evidence to guide decision-making from research and the scientific evaluation of practice. The types of evidence that nurses can use include information obtained from a wide range of rigorous methodologies, including quantitative studies, qualitative studies, and meta-analyses.
This course has equipped me with immense knowledge of health policy and advocacy. I will apply the knowledge from this course to lobby state and federal governments for healthy public policy, regulation, and legislation that are evidence-informed. In the upcoming practicum experience, I will use knowledge from this course to champion equitable population health services and policies. This is by engaging in advocacy initiatives for equity and social justice in health care access, allocation of resources, and access to other economic and social services. Economically and socially disadvantaged people are the most impacted by public policy health (Williams et al., 2018). Therefore, they can significantly benefit from policies that seek to ameliorate social circumstances that affect them.
I will apply the content from NR506NP to the upcoming clinical courses to identify healthcare issues that can be addressed through policy and advocacy. Besides, I can apply the course content to identify the ethical, political, and historical factors that impact healthcare policies. Furthermore, I will apply the knowledge in other courses when assessing the controversies and challenges concerning the existing and upcoming healthcare policies and understand what bars some policies from being enacted.
References
Berwick, D., Snair, M., & Nishtar, S. (2018). Crossing the Global Health Care Quality Chasm. JAMA. doi:10.1001/jama.2018.13696
Williams, S. D., Phillips, J. M., & Koyama, K. (2018). Nurse advocacy: Adopting a health in all policies approach. Online Journal of Issues in Nursing, 23(3). https://doi.org/10.3912/OJIN.Vol23No03Man01
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