Applying Nursing Theory to Guide Leadership Nurse leaders are faced with issues or problems on a daily basis that are often expected and sometimes unexpected. It “comes with the territory’ so to speak. If there were no issues to solve or hurdles to overcome the necessity of designating a leader would not seem quite as important. Nurse leaders can tackle issues that occur in their work environment using nursing theory to guide them. Nursing theory provides a framework that nurse leaders can use to implement interventions or changes to positively impact the staff they lead.
This framework of the theory will set he standards for achieving the desired outcomes and is based on knowledge that is gleaned from practice and/or research. Grand, middle-range or practice theory can all be utilized by nurse leaders to guide them in practice, however, depending on the circumstances, a middle-range theory may be better than a grand theory in certain situations and vice versa. In very specific instances in which a clearly defined issue in practice is noted a practice theory may be the best choice of a nursing theory to use to address the issue.
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For the purpose of this paper Kola’s Theory of Comfort, a idle range theory will be used as the guiding theory. This writer has not had the experience of directly applying a nursing theory to solve an issue in nursing practice. Kola’s Theory of Comfort asserts that if one’s comfort can be increased by identifying and addressing the needs of the individuals in a particular practice setting this will promote or encourage Health Seeking Behaviors (HAS) (wry. Decontrolling. Com). Increased comfort is the relief, ease or transcendence in four contexts (physical, physiotherapist, environment and social).
This paper will resent the issue of nurse turnover in an organization and strategies from Kola’s Theory of Comfort will be developed to help nurse leaders address this problem. This will be done by applying concepts and principles from the theory with one strategy being described in-depth. Scholarly literature will be included to provide evidence supporting the issue and rationale for the strategy. Expected outcomes from the strategy will be proposed and concluding statements will identify new knowledge learned from applying nursing theory to impact nursing issues. Description of Issue
A large insurance company had implemented a new model of care that required the hiring of four hundred new staff to provide high risk case management to a targeted population. This company also had set a target date of twelve months to enroll nine thousand members into the new program and was in contract with the state to reach this goal. New staff was being hired on a weekly basis as members were being enrolled into the program. The program, being newly developed, was in a state of constant change. New staff were oriented by staff who were only hired Just the month or two before them.
As the target date approached, the goal of enrolling nine thousand members was falling short by about three thousand and now the staff was given additional duties. One new task added was that of making visits to providers to showcase the new model of care in hopes of receiving referrals into the program. In on e Runs were given ten task AT slanting star won strictly enrolled monomers into the program through a telephone queue. The process of completing an enrollment took one to two hours depending on the complexity of the case.
The Runs were given instructions that two engagements of members in to the program daily ere top priority over all other tasks. However, the expectation that all other tasks would also be completed was implied. The expected case load of each nurse was seventy five members in the proposed model. This included quarterly face to face visits with the members. Due to the rapidly increasing numbers of members coming into the program under the added efforts of Runs doing enrollment case loads swelled to one hundred to one hundred and twenty for some nurses.
The breaking point had been breached and now staff were beginning to leave or going on FEM. for various seasons. The case loads from these Runs had to be covered by the remaining staff. Staff started working even longer hours (twelve to sixteen hours) on several days weekly. Staff felt like they did not have the opportunity to provide care that was quality and meaningful. They were not able to use the knowledge and skills they acquired to make an impact on another’s health status as they thought would be.
The job became more of completing assigned tasks rather than using nursing knowledge and Judgment. According to Chain (2009) “When nurses perceive a lack of autonomy n their Job, this is a leading cause of Job dissatisfaction for nurses and a major factor when deciding to leave the Job” (p. 21). Instead of providing the care they thought they would be providing, they were reigning in members too program with the promise of improved health while they felt their own health was being neglected or jeopardized due to added stress, no time for breaks or guaranteed family time.
Corporate compliance was called anonymously with complaints of working conditions and a state wide meeting was held with the RAN case managers to gather information. Staff was assured that their concerns were being heard and efforts would be made to improve the current state of affairs. Nurse retention for this company is of utmost importance for multiple reasons. According to Forest and Klein (2011) replacing an RAN can cost as much as 1. 5 to 2. 5 times the average nursing salary. They also write that the national turnover rate in the United States is 15%. (p. 57). In addition if turnover is not halted case loads will swell further causing further turnover and preventing members from receiving the case management they so badly need. Applying Concepts and Principles of Theory Applying Kola’s Theory of Comfort as a framework to decrease nursing turnover can help the nurse leader impact this nursing issue. According to Callback, Tilting and Droning (2006) “Comfort Theory proposes that when the comfort of nurses is enhanced, nurses are more satisfied, more committed to the institution, and able to work more effectively. P. 539). Nurses who are more committed to the company and more satisfied would be less likely to leave. In addition if nurses were able to work more effectively they could carry heavier works loads temporarily until new staff could be hired and trained. Nurse leaders can reduce nurse turnover rated by increasing comfort of the nursing staff. Strategy The strategy proposed to decrease nurse turnover using Kola’s theory will be increasing nursing comfort on these four levels: physical, physiotherapist, environmental and social.
Proposal for increasing the physical comfort of nursing star working In case management would Include allowing nurses to Ana work on time or at least allowing nurses to flex their schedule. Currently staff is expected to start at eight in the morning and work until tasks are completed and at least until our thirty in the afternoon. Currently nursing staff are working over until six or seven in the evening. By allowing staff to flex their time either when they start or the actual days of the week they work could provide comfort.
Competitive salary with excellent benefits and retirement would also be proposed to provide for physical comfort with the potential for yearly bonus to reward nurses who are carrying increased workloads due to turnover. Nurse leaders will provide for nursing physiotherapist comfort by providing role clarity, respect and utilizing skills and talents optimally. Callback et al. , 2006). Nursing staff will be permitted to submit preferences for members assigned to their case load according to their individual clinical practice experience allowing their skills and talents to be used optimally.
Currently staff is assigned members randomly based on geographical location, current case load numbers and at random. If nurses with mental health backgrounds were allowed to care for members mainly with mental health issues they would be more efficient in their work and provide better care for their members making them more satisfied. Nurse leaders and upper management will improve the environmental comfort of nursing staff by promoting political transparency and trustworthiness within the institution. (Callback et al. , 2006).
Nursing staff will be updated at least quarterly on current measures that are being under taken to address the current issue of nurse turnover and a proposed plan to help current staff handle high case loads and additional tasks preventing them from giving optimal care to their members. Additionally, new staff will be provided with a qualified preceptor to assist them in he orientation period. Lastly nurse leaders will provide for the social comfort of the nursing staff by making communication a top priority with staff and advocating for staff with upper management to address issues experienced by nurses.
Nurse leaders will additionally provide for adequate training and educational opportunities to provide nursing with the resources needed to optimally do their work. Ethical Aspect Nurse turnover is a source of an ethical dilemma for nurses and a cause of moral distress. While nurses know that leaving their positions would increase workloads for hose who remained, it was essential to their own personal sense of well-being that they resign. Providing less that optimal care to members in case management because case loads are too heavy is one example of moral distress.
According to Burrton and Tucked (2012) “Moral distress has implications for the nurse and the nursing workforce. Morally distressing situations contribute to decreased quality of care and diminished workplace satisfaction for staff, lead to physical and emotional illness, burnout and staff turnover” (p. 321). Providing nursing staff education and sources to do their Job optimally and allowing staff to provide case management services to members based on their clinical practice history will help to diminish the potential for moral distress.
Expected Outcomes Increasing the comfort of nurses in case management will help to decrease turnover rates. Nurses will attain a sense of value to the company if they have their comfort needs addressed by the company and this will promote a sense of Job satisfaction Ana more reactive work naiads. By Increasing JODI satisfaction ten turnover rate will slow and nurses will better be able to manage their increased work dad due to increase effectiveness.
Increasing nursing satisfaction will positively affect the care they provide for their members which will in turn strengthen the organization. Nursing staff will have decreased stress which will impact their health in a positive way. Conclusion Nursing theory provides a framework for nursing practice that defines what is to be done and why. It is based on practice and research and also guides practice and research. Nursing theory promotes the practice of nursing by defining it from other disciplines and clarifying its purpose.
Using a nursing theory to solve issues in the reactive of nursing provides the leader with concepts that guide their actions using a framework developed from research and practice. This writer has learned that nursing theory can be applied to situations in practice that need to be resolved using proven methods. It has also been learned that a nursing theory can be applied in more than one fashion such as Kola’s Theory of Comfort. This theory can apply to patients in any setting, the staff caring for patients and even relieving stress in college students (handicraftsmen. Com).