Implementation of a nursing leadership and management plan

Implementation of a nursing leadership and management plan
Chapter 3: Implementation
Description of Steps
The first step towards the implementation of the capstone project involved meeting with the preceptor to discuss about the project. The discussion focused on the healthcare problem where clarification of the necessary steps for completion was made. The second step involved a literature search to identify credible sources to support the implementation of the new change. The WGU library was consulted during the literature review process where primary research sources provided adequate data on improving communication in healthcare. During this process, the WGU librarian was consulted to ensure the location of relevant sources to support the project. The next step involved the development of a plan to address the challenge of communication based on the literature findings. The SBAR communication tool was identified as the most appropriate measure to solve the communication challenge among nurses. The final step in the project implementation involved the presentation of the proposed plan to the preceptor. Due to the current COVID-19 restrictions, actual implementation at the organizational level was not required.

Discussion of Changes

Changes happen at virtually every point of the project management cycle. Recognizing that changes are inevitable allows the project manager to assume responses to the planning and execution of the change process. During the implementation of the project, various changes to the initial plan were applied to effectively realize the expected outcomes. The first change involved shifting the project from the healthcare organizational level to the institutional level due to the COVID-19 restrictions. The initial plan was to see full implementation of the project including involvement of the hospital administration and the employees. The new idea involved presenting the capstone project to the preceptor for review and provision of feedback. The second change was the adjustment of the time frame for project implementation from six to four weeks. This change was necessary because there was no contact and discussion with external stakeholders. Additionally, the new changes shortened the project management cycle to include literature review, presentation to the preceptor, and discussion of any changes.

Discussion of Barriers

Implementation of major organizational change initiatives presents a challenge for long-term care leadership. Understanding barriers to change can be one of the strategies to ensure the successful completion of projects (Sullivan et al., 2018). One of the barriers to the implementation of the project was the COVID-19 pandemic-related restrictions. Firstly, the restrictions prevented the opportunity to interact with the healthcare organization to experience change management using the new strategy. Secondly, there was limited interaction with the preceptor and free movement to the library to collect data. Most of the work was done online with only a limited number of visits to the library and to the preceptor.

Overcoming Barriers

To overcome the identified challenge, the first step was to seek alternative communication methods with the preceptor during consultation. For instance, the use of emails and zoom meetings turned to be effective in planning for project implementation. The second approach involved was maximization of the little time spent in the library and utilization of the librarian to identify required resources for literature review. Additionally, online search of credible sources from peer-reviewed journals supplemented data from the library sources minimizing visits to the institution.

Identification of Interprofessional Relationships

Interprofessional collaboration is when multiple health workers from different professional backgrounds work together with patients, families, carers, and communities to deliver the highest quality of care. This strategy is identified to improve patient experience during care delivery, improve the health of populations and reduce costs associated with health care. The key strategy to achieving interprofessional collaboration is effective communication. Communication ensures that professional teams work towards achieving the same goals and promotes good relationships between healthcare teams. To ensure the success of the project, the librarian and the preceptor were part of the professionals I interacted with at various stages of the project.

Discussion of Relationships

Nurse educators serve as faculty members in both nursing schools and teaching hospitals, transferring their valuable knowledge, experience, and skillsets to their students who will ultimately serve as the next generation of nurses. These educational professionals also act as advisers and role models for the students. During the project implementation, I maintained a close relationship with my preceptor to gain knowledge and seek guidance on managing healthcare change. The preceptor helped in analyzing the initial steps of the project, highlighting changes, and providing feedback on the progress of the project. The other professional involved in the project implementation was the school librarian. This individual helped in conducting literature searches and identification of credible sources to support the project.

Chapter 4: Post-Capstone Project Considerations
Discussion of Successes
Projects involve activities designed to produce unique results, services, or products. This project involved the improvement of communication among nurses through the implementation of the SBAR communication technique. The first aspect of success was the ability to collect data and design an implementation plan for the improvement of communication for nurses in healthcare. Despite the challenges posed by the COVID-19 pandemic, I managed to engage the preceptor and the librarian to identify the SBAR communication strategy for communication improvement. The interprofessional collaborative practices observed ensured that there was adequate support to the student to fully complete the project.

Evidence-based practice is a clinical problem-solving approach that involves the integration of research evidence, clinical expertise, and a patient’s preferences (Bonds, 2018). Nurses use evidence-based practices to make well-informed decisions on different aspects of patient care especially communication of patent care. This project was a success because it demonstrated the use of evidence-based practice to improve communication among nurses. SBAR communication tool is supported by the IHI and other literature to improve communication among healthcare professionals. The tool allows accurate communication of patient information between individuals using structured processes.

Teamwork in health care employs the practices of collaboration and enhanced communication to expand the traditional roles of health workers and to make decisions as a unit that works toward a common goal (Moss et al., 2016). The implementation of this project involved input from the preceptor and the librarian. Throughout the project, these teams were able to work collaboratively leading to the realization of the expected outcomes. The preceptor provided guidance during the initial stages of the project and also gave timely feedback to facilitate the completion of the project. The librarian was readily available for consultation regarding literature review and the location of credible sources for the project.

How Successes Will Inform Future Projects

Organizational change is a continuous process that involves the creation of new systems, procedures, and the introduction of technologies to achieve set goals. The success of one project translates to the success of other projects because new approaches that maximize outcomes are realized. The success of this project indicates that interprofessional communication is crucial during change management. The involvement of the preceptor and librarian in the project ensured that the student set the goals right and achieved them on time. Future projects should utilize the interdisciplinary approach for success.

The second aspect that can be utilized in future projects is the use of the evidence-based practice in managing organizational change. The implemented strategy was based on professional guidelines from the IHI that recommended the use of the SBAR technique to improve communication in healthcare. Upon literature review, numerous articles were identified to support this strategy. The use of evidence-based practice made the completion of the project easy because it promoted the acceptance of the strategy by the preceptor and the planning of implementation.

Aspects that Did Not Go Well

Improving healthcare quality and safety is notoriously difficult, and the results of improvement interventions can sometimes be disappointing. One aspect that did not go well was the ability to fully implement the project at the organizational level due to the COVID-19 restrictions. The project did not provide the student with an opportunity to interact with healthcare organizational leaders to influence change. Secondly, there was limited involvement of many stakeholders during the planning and implementation of the project. The only stakeholders available were the preceptor and the school librarian. This means that the interprofessional collaboration part was not fully utilized. Lastly, commitment to the project did not happen as anticipated due to the changes made in the implementation phase. Lack of organizational involvement meant that the time for the project was reduced by two weeks and there was no motivation to carry out the project with accuracy and precision.

Understanding What Did Not Go Well

Most of the shortcomings of the project were a result of the COVID-19 restrictions to project implementation. Understanding this weakness leads to a call for early preparation for project implementation in the future. There is a need to analyze the risks and uncertainties that might result due to changes in the project management cycle. Secondly, I believe future projects during this pandemic should involve topics that can be easily implemented in the healthcare organization to give the student an opportunity to influence healthcare organizational change.

Explanation of How Gap was Bridged

Poor communication between nurses and other health care providers can have a significant negative effect on patient safety, quality of care, and patient outcomes. The problem of communication among the nurses in the organization was identified to hinder the delivery of safe patient care. There was a lack of a communication strategy for nurses and this called for improvement. According to a review of literature, the SBAR communication strategy was identified to be the most effective way of improving communication among nurses in the facility. The reason for selecting this tool was because it offered a practical strategy to assist nurses to implement a non-hierarchical communication model for improving clinical care outcomes (Bonds, 2018). Additionally, the IHI supported the use of the tool to improve communication in healthcare, not only for nurses but also for the physician teams. Upon identification of this strategy, a narrative paper was submitted to the preceptor for review because actual implementation at the organizational level was not allowed. A positive response from the instructor indicated that the project explained ways to address communication barriers among nurses.

Supporting the Plan

Although actual implementation of the new change is not required, this discussion highlights measures that can be used by the healthcare organization to support the change. The short-term plan for maintaining the new change will involve the use of a bedside shift reporting (BSR) checklist by the charge nurses. The checklist will ensure that shifts are handed over using the correct technique while identifying areas that might be challenging to staff. Secondly, routine audits will be made in every department to ascertain the improvement of communication among nurses. Long-term maintenance of the project will involve continuing education of staff on SBAR communication, especially for new employees. The educational programs will serve to remind nurses of the importance of the new change and how it has helped to improve quality and patient safety in the organization. Lastly, setting policies to guide the new strategy will be crucial to sustaining the new communication strategy in the facility.

Resources for Post-Implementation

To support the new communication strategy, various resources will be required. Firstly, BSR checklists will be required during the short-term sustainability of the project. The checklists will be used by the charge nurses to monitor SBAR communication in every handoff shift. Secondly, the conference room will be used to conduct continuing education and train new employees on the use of the new technique to improve communication. Hospital whiteboards will be frequently used to highlight the ongoing quality improvement program and to communicate the new strategy to all patients. Regarding personnel required for the support of the change, the clinical nurse educator and the IT department will be key towards ensuring the communication strategy works.

Chapter 5: Reflection

Integration of MSN Program Outcomes

Assemble Scientific Findings

The fourth MSN program outcome requires nurses to assemble scientific findings from nursing, biopsychosocial fields, genetics, public health, and organizational sciences for the continual improvement of nursing care across diverse settings (American Association of Colleges of Nursing (AACN), 2011). The project ensured the implementation of change using scientific evidence from research and national guidelines. For instance, the SBAR communication tool adapted in the organization was designed by the Institute of Healthcare Improvement (IHI). The tool is also supported by other professional organizations like the Joint Commission and the World Health Organization to have a huge impact on communication in healthcare. Apart from these professional bodies, the project involved a review of 30 credible sources from different databases to support the selected communication strategy.

Master’s-Level Nursing Practice

The ninth MSN program outcome requires Master’s-level nursing graduates to have an advanced level of understanding of nursing and relevant sciences as well as the ability to integrate this knowledge into practice (AACN, 2011). The project implementation demonstrated the integration of this outcome through taking precautions and following the COVID-19 guidelines for project implementation. Additionally, I understood that nursing care interventions included both direct and indirect care components. Formulation of a plan to improve communication in healthcare was part of the indirect nursing care component.

Abstract

The quality of communication interactions between nurses and patients has a huge impact on patient outcomes. Effective communication requires an understanding of the patient and experiences expressed to provide high-quality, safe, and cost-effective care. The problem identified in the organization was poor communication among the nurses, especially during the shift handoff process. There was a lack of clear communication strategies that resulted in increased medication errors, poor patient satisfaction, and lack of patient involvement in their care. To address this challenge, the plan was to implement a standardized communication tool that could be used by nurses to communicate patient information during shift handoffs. Because of the COVID-19 pandemic, the actual implementation of the project at the healthcare organizational level was not required. Upon identification of the problem, the next step involved a literature review to identify an evidence-based strategy to address the communication challenge. The literature review process utilized 30 credible sources that identified the use of SBAR (Situation, background, assessment, recommendation) communication strategy as the most appropriate solution to address the healthcare problem. The final step of implementation involved the submission of the proposal to the preceptor for approval.

References

American Association of Colleges of Nursing. (2011). The essentials of Master’s

education in nursing. Washington, DC: Author.

https://www.aacnnursing.org/portals/42/publications/mastersessentials11.pdf

Bonds, R. L. (2018). SBAR tool implementation to advance communication, teamwork, and the perception of patient safety culture. Creative Nursing, 24(2), 116–123. https://doi.org/10.1891/1078-4535.24.2.116

Moss, E., Seifert, P. C., & O’Sullivan, A. (2016). Registered nurses as interprofessional collaborative partners: Creating value-based outcomes. Online Journal of Issues in Nursing, 21(3), 4.

https://doi.org/10.3912/OJIN.Vol21No03Man04

Sullivan, J. L., Adjognon, O. L., Engle, R. L., Shin, M. H., Afable, M. K., Rudin, W., White, B., Shay, K., & Lukas, C. V. (2018). Identifying and overcoming implementation challenges: Experience of 59 noninstitutional long-term services and support pilot programs in the Veterans Health Administration. Health Care Management Review, 43(3), 193–205. https://doi.org/10.1097/HMR.0000000000000152

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