LEADERSHIP FUNCTIONS & MANAGEMENT PLANNING Competency 723.1.1: Strategic Working Relationships The graduate integrates leadership and management roles and functions to meet current and anticipated demands. Competency 723.2.1: Influence and Strategic Decision Making The graduate develops and applies strategic plans for an organization. Objective 723.1.1-03: Develop a plan for adapting specified management functions to meet given changes in nursing practice. Objective 723.1.1-07: Apply the concepts of systems thinking in a given nursing situation. Objective 723.2.1-05: Conduct a SWOT (strengths, weaknesses, opportunities, threats) or gap analysis for a given nursing management situation. Introduction: Changes in the nursing leadership structure are sometimes required to accommodate overall changes in the healthcare system. One such instance is the need for nurses to become more independent and take more responsibility for decision making on each clinical unit. Changing existing systems may be difficult but necessary in todays healthcare environment. Systems thinking provides a framework in which components of a system are viewed in isolation in order to understand the whole. In a hospital setting, a SWOT analysis provides a subjective assessment of the information gained in systems thinking and then places it in a format that helps understanding, presentation, discussion, and decisionmaking about a larger problem. As a nurse leader, you can use these strategies to understand underlying issues that may present as a larger problem. In a 300-bed suburban tertiary care hospital in Chicago, the new Chief Nursing Officer, Dr. M, notices that the transfer of Emergency Department (ED) patients to the clinical units often takes more than 15 hours and mostly occurs after 8:30 p.m. This time period occurs during the 12.5 hour PM flex shift, leaving most of the paperwork for that staff. The PM flex nurses seem to have to process all the admissions. As a result, the patients are lying on stretchers for long periods of time, and they are complaining about long ED waits. This delay in transferring patients is not the only problem Dr. M noticed. The hospitals patient satisfaction scores in overall care are declining. To make the situation worse, this negative information is being printed in local newspapers. Another problem becoming more evident is that the staff nurses call the supervisors for answers to most unit problems and the personnel seem stagnant and non-productive. In the hospital where Dr. M had previously worked, units were led by nurse managers who assumed 24-hour responsibility for patient care rather than head nurses and assistant head nurses who were unionized and functioned for their own 8-hour shifts. Dr. M knows that nurse managers will require more money to move to a 24-hour schedule. For this to happen, the Board will have to be convinced to provide funding for the nurse managers salaries and for the managers to raise their educational level to at least a masters level or to hire new staff with these credentials. Dr. M will also have to persuade the head nurses and assistant head nurses to leave the union in order to become management or lose their positions of authority. Yet, Dr. M is convinced that the change to using nurse managers could improve overall functioning of the hospital by decreasing cost and waste while increasing productivity. The hospital where Dr. M works has grown from a small community hospital of about 50 beds to its present size of 300 beds over a period of 100 years. It is a community icon but has just been purchased by a large university medical center that is quite progressive in its approach to patient care and staff development. The community hospital has been losing a lot of money recently and, in essence, is being rescued by the larger institution. It is suspected that part of the financial drain was the result of the ED being used for primary care by local residents who have no insurance, as well as the lack of productivity in the ED. The patient care units and the attending physicians have also played a part in the problem, as discharges are not completed until midafternoon, leaving the ED backed up and overcrowded because of the lack of available beds. Most of the staff working at the community hospital have been there for decades and seem firmly entrenched in the old ways of running the institution. Three-fourths of the nurses have associates degrees, slightly under a quarter have BSNs, and the few who have masters degrees are administrators or clinical specialists. Dr. M is the only nurse on staff who has a doctoral degree. The physicians, many of whom are old friends with Board members and have been working at the institution for many years, still believe nurses should blindly follow orders. Recently, however, Dr. M and a new medical chief of staff from the university hospital have replaced the old guard in top leadership positions. The current CEO is also about to retire. Dr. M needs help performing a SWOT analysis before continuing with the plan. You are a nursing management consultant Dr. M has hired to help with this task.