Leadership and management

Leadership and management

Part I

Introduction  

Latifa hospital is a government hospital. It`s  the largest hospital for maternity and children in UAE. It was built in 1987. The previous name for the hospital was Al Wasel hospital, in 2012 it was renamed to Latifa hospital per His Highness Mohammed Bin Rashid Al Maktoum the resident on Dubai.

Latifa hospital provide a tertiary care for maternal and neonatal services, from surgeries to ICU, as well as treatment for metabolic and genetic issues. The hospital has a well-equipped Neonatal Intensive Care Unit and an expert team of health care professionals who provide international levels of neonatal, Pediatric  and maternal care. (Government of Dubai, Dubai Health Authority, n.d., 2016)

There are several ward in Latifa hospital such as, antenatal, labor room, operation theater, post natal, pediatric medical, pediatric surgical and infection unite.

Latifa Hospital was accredited by the Joint Commission International (JCI) in 2007, 2010, and 2013. Also, they was accredited for this year 2016. It was award as ‘Baby Friendly hospital’ in February 2011 by UNICEF.

The vision, mission, and values

The vision of Latifa hospital is to be the leading model of excellence in specialized health care for women and children. The mission of Latifa hospital is to provide customer focused, high quality health services to women and children in a professional environment, serving all UAE Nationals, Dubai Residents and referrals. There are some values that the hospital are following such us excellence, customer services, commitment, creativity, team spirit, and safety. (Government of Dubai, Dubai Health Authority, n.d., 2016)

Organization design

Latifa hospital follow the system theory, which composed of different interrelated elements. It`s a collection parts that brought together to accomplish some goals. The systems can be open which affected by the environment  or closed which does not affected by the environment. (Study.com, n.d.)

The chart below will demonstrate the organization structure of Latifa hospital.

Health Regulation Department
Medical tourism Office
Assistant Director
Director Office
Customer Satisfaction Office
Clinical Governance Office
Quality Assurance Section
Registration and Accreditation Section
Health Regulation Section
Quality Assurance Section
Facility Monitoring Unit
Facility Registration Unit
Facility Regulation Unit
Professional Registration Unit
Professional Regulation Unit

 

 

 

 

 

 

 

 

 

 

 

 

Chart1: Organization Structure

 

Type of nursing delivery system

I interviewed an In charge nurse of Labor Room. I gathered some information about the hospital and the unit itself. The labor room composed of two category. The first stage of labor which contains for rooms with 4 beds, and the second stage of labor which contain 8 single rooms. It`s connected with one  side of the operation theater for cesarean and the other side with the intensive care unit for emergency cases. There are approximately 6000-7000 deliver per a year. 30% of the deliveries are cesarean.

The nursing delivery system of the labor room is Total patient care. Which means a registered nurse is responsible for all aspect of care for one or more patient, and this is what I watched. There are advantages and disadvantages of this model of care. The advantages are, the patient will meet all of his need of care, and the trust relationship between the RN and patient`s family will build up. However there are disadvantages such as, RN`s can perform task that can easily done by less skilled person, and it can be very costly. The diagram below will show the nursing management structure of labor room in 2016.

 

 

 

 

 

 

Typical day       

The typical day of the nurses starts by taking the over the counter drug that has been used from the previous shift. Then take the nursing handover or patient report for the important cases from the previous shift. Then assign the nurses with their patients. After assigning the nurses, the nurse will go to check the pad bedside, patient condition or status, and document patient care. Also, the nurse will assist for deliveries. Then the nurse will attend doctor`s round to give a feedback or an over about patient condition. Later on, the nurse will meet the nursing administration requirements which includes submitting the important and needed things. Add to that. The nurse will see and check staffing and skill mix which means each shift have adequate staff toward over the duty, not only for the current shift, for the next shift also. Moreover, inspect the whole unit for any deficiency and perform necessary actions.

The key players in the labor room are, Nurses, who are caring for maternal and the newborns. Midwifes, who are looking after the maternal throughout  a phase of antenatal care, during labor and birth, and for up to 28 days after the baby has been born. (NCT, n.d., 2016) Obstetrician, is a physician who has successfully completed specialized education and training in the management of pregnancy, labor, and pueperium (the time-period directly following childbirth.(Health community, n.d.)  Neonatologist, is a primary care physician who assist in delivery when the newborn is premature, or has a serious illness, injury, or birth defect. (Healthy children, n.d.) Anesthetists, who Provide enough pain relief to allow you to deliver your baby with minimal pain and anxiety, leaving you free to fully participate in the experience. Some examples of pain relief are, local anesthesia, general anesthesia, spinal and epidural. (American Association of Nurse Anesthetist, n.d.), and Medical specialist.

Current challenges

There are some current challenges that are facing the nursing department such as, documentation, there are too many papers and form the nurses should document. The second challenge is non-nursing job like, educating the students and become a messenger. The third challenge which is lack of specialty nurses.

Current projects

The projects that the labor unit are working on are, reducing the postpartum hemorrhage, surgical cite infection, electronic health record, staff satisfaction and patient satisfaction.

Part II

Description of the problem

Shortage of specialized nurses occurs when the requirement of nursing services and care exceed  the supply of nurses in the work environment (academia, Basu, K, & Gupta,A). Nurses can notice the shortage of nurses specialty  by the prevalence of diseases, complications, errors, and available technology. Most of the nurses who are working in labor room are Registered Nurse. they had an experience in the unit to fulfill the specialized nurses role, therefore they become more competent on the field.

The impact of the problem on the nursing staff

Lack of specialized nurses being experienced worldwide. It affects both the patient and the nursing staff. Nurses are the heart of health care system. They seem as a multifunctional and hard worker. Khumari Shamikam (2015) argued that ‘’More than 75% of registered nurses believe the nursing shortage presents a major problem for the quality of their work life, the quality of patient care, and the how long the nurses can spend with patients. Further According to Buerhaus et al. (2005) nurses see the shortage in the future as a catalyst for increasing stress on nurses (98 %), lowering patient care quality (93 %) and causing nurses to leave the profession (93 %).’’ Shortage of specialized nurses influence staff performance and provision of care to the patient. The staff will be under overload work, stress which will lead to malpractice toward the patient care. It can result to fatigue, injury, and job dissatisfaction. On the other hand, the patient will be more susceptible to medical errors and medication errors which will threaten his/her life. (American nurses association, n.d.)

Literature search about the problem

Shortage of specialized nurses is a worldwide issue. This paper will demonstrate how nursing shortage is becoming a serious problem among United state population which was published in 2003. Lack of nurses is not a current problem. It`s a past problem that the U.S people are facing and affected by.  For sure, the solutions will not look like the past. They will be more creative solutions to put a limit toward this shortage because of the advancement of life and technology, science and studies. As Janiszweki (2003) argued about the factors that contributing to nursing shortage is that “the growing population of the USA after World War II precipitated the need for more community hospitals staffed by licensed nurses, and shortages in the 1970s and late 1980s were fueled by nurses dissatisfaction with working conditions and lack of professional autonomy” (p. # xyz). Other contributing factors like ageing RN workforce, declining enrollment, and poor image of nurses. The solution of all these factors was continuation of education, recruitment effort, and improving the image of nurses.

The second literature was published in 2004 which is talking about the hospital nursing staffing and the patient outcomes. Unfortunately, the patient outcomes associated with the adverse side. How is that? The literature should that the staffing has a link with patient mortality. As Diane Heinze (2004) argued that ‘’Pronovost revealed in his Maryland hospital study, that decreasing the ICU nurse-patient ratio increased the risk of in-hospital mortality.’’ Also, the staffing has a link with the length of stay. Of course, if there is the shortage of nursing staff the patient will stay longer rather than been discharged because the staff does not have the aplenty time to provide a full care for each patient. Add to that the literature showed that the staffing has a link with patient complications. ‘’ Although all studies determined an inverse relationship between staffing ratios and complications. Several studies focused on specific complications that occur at unit levels, such as falls, medication errors, and rates of decubiti.’’ (Research dimension. 2004)

Solutions suggested based on the current organizational needs  

       Some of the solutions that have been suggested to the administration of Latifa hospital to improve and increase the specialized nurses the specialty courses and training for the staff which includes, midwifery courses, NICU courses, Pediatric courses and diabetic nurse education courses. These are the projects that is the hospital work on it to solve the issue of specialized nursing shortage.

Nursing education and training

  • Support health care employers to create staff development programs and lifelong learning.
  • Institute an education and practice system to promote and development of a good number and training process.
  • Create a Schedule for stuff nursing to attend lectures and practical training.
  • Put benefits for employees who are committed to attending lectures, and evaluate staff after each lecture.
  • Activating the role of the clinical instructor in each department.
  • Orientation program for new stuff nursing.

The evaluation

Evaluate the process of the education and training and the effectiveness of the programs offered to employees.

  • Having a good number of specialized nurses
  • High quality of care Decrease mortality rate
  • Evaluation of staff performance their commitment to attend the lectures
  • Evaluate the quality of care provided to patients
  • Decrease the stress on the stuff, and promoted their performance

Follow-up plan to prevent the problem from recurring in the future

There are several tips the nurses can follow to prevent recurring the problem and enhance nursing such as:

  • Offer more flexibility into work environment structure and scheduling
  • Reward experienced nurses for serving as mentors to new nurses
  • Increase salary and benefits programs
  • Ensure adequate nurse staffing
  • Implement programs that encourage and allow older nurses to remain in the workforce
  • Promote consistent data collection at the national, state, and local levels to help assess gaps and aid in appropriate planning to reduce the gaps