Organizational Analysis

Nurses focus on providing the best quality of care to patients. To have the ability to provide the best quality of care to patients, nurses need a work environment that values and respects nurses, and provides resources for nurses to provide quality care to patients. “A magnet hospital is stated to be one where nursing delivers excellent patient outcomes, where nurses have a high level of job satisfaction, and where there is a low staff nurse turnover rate and appropriate grievance resolution” (Center for Nursing Advocacy, 2008, p. 1). Requirements for obtaining magnet status are stringent.

Obtaining magnet status is a long and arduous road, which requires a firm commitment by the organization. This paper will provide a thorough analysis of the organizational and managerial structure of Summerlin Hospital in Las Vegas, Nevada, using the 14 forces of magnetism outlined by the ANCC, in an effort to determine if, in fact it is worthy of the magnet status. Summerlin hospital is a member of the Valley Health System, which also includes four other sister hospitals in Las Vegas, and Valley Health System is a subsidiary of Universal Health Services one of the largest health care management companies in the nation.

Summerlin hospital sits on the most western border in the Las Vegas valley, serving the master-planned community of Summerlin. The hospital just completed an expansion that includes six floors, 173 additional patient rooms, bringing the total to 454 private patient rooms. Summerlin hospital sits on a 40-acre campus, along with three medical office buildings. Summerlin hospital was originally constructed in 1997, with 200 plus patient rooms. The hospital has added services over the years such as a Pediatric emergency room in 2005, and a level three NICU in 2007, expanding to meet the needs of the community.

The hospital has 1,600 physicians on staff, which covers more than 30 areas of care. Summerlin hospital wants to meet the needs of the community by providing high quality care to the members of the community the hope is, that consumers will continue to seek care at the hospital, and also recommend the hospital to their family and friends. Summerlin is currently running positive campaigns that focus on community members recommending the hospital. Advertisements on the local television reveal former patients and what these patients sought care for at Summerlin, and why they would recommend or go back to the hospital. Nursing Leadership

The 14 forces of magnetism are broken down into three areas, leadership, quality of care, and professional development. The first force of magnetism in achieving magnet status is the quality of the nursing leadership of the organization. The Chief Nursing Officer of Summerlin hospital is Lynette Ball, RN, MSN; she obtained the position of CNO in the fall of 2009. The CNO is the highest level of nursing executive in the hospital. The managers and nursing staff look to the CNO to provide leadership, visionary goals, ensuring the delivery of quality patient care, and coordinate and monitor the hospital’s regulatory compliance.

The CNO is very active throughout the hospital units, she is a visible leader, and she makes rounds on the units, talking with the staff regarding any issues the staff may be having. The CNO is the vessel for the staff, to bring forward any issues that need to be resolved on an administrative level. The current CNO Lynette, has 20 years of various experience in leadership, she has had many positions working as a staff nurse, charge nurse, manager and then director of the Intensive Care units at Summerlin hospital. She has a foundation and understanding of the issues the nurse’s face in the hospital.

Lynette encourages the managers and the nursing staff to obtain further education in specialty areas, promoting certification in addition to recommending advance degrees to nurses. As the CNO, Lynette has a commitment to ensure the staff of the hospital is providing the highest quality of care to the patients and is requiring the charge nurses of the units to obtain certification in their specialties. Quarterly the CNO hosts open forum meetings, and the staff, and managers from all the departments attend, sharing ideas, any issues, and actions for meeting the goals of the ospital.

The CNO extends an open door policy, in that any member of the staff is capable of access to her, and discuss issues regarding the units, staff, etc. The CNO encourages issues be dealt with on the specific units, but if staff feel there is no resolve, issues can be brought to the CNO. A sense of community exists throughout the hospital in the various units. Although each unit functions as a separate entity, any unit can call on another in search of the unit’s expertise, and this is a team approach which is ongoing throughout the hospital.

At the highest level is the CNO, each unit also falls under a nursing director, who oversees a few units, each unit has a manager. The managers of the units have 24/7 accountability for the unit. The managers of the units oversee the budgets of each unit and work with the human resources department in hiring staff, and dealing with personnel issues. The managers of the unit are also responsible in providing evaluations of the staff, which work under the manager. In general, employees of the hospital share excitement regarding the changes in the hospital, and the positive experiences that have resulted from the CNO.

The staff of the hospital shares a sense, and belief that the administration, is finally considering the employees, who keep the hospital operating, and an interest in employees taking pride in their workplace. Employees take part in a satisfaction survey every six months, regarding the workplace, and the employee’s satisfaction. Based on the satisfaction survey, committees are in place to address the main themes brought up in the survey, and to resolve issues. The composition of the committees are staff from several units, and have a specific task to address, and resolve.

The goal is to retain employees, and make the workplace a family atmosphere, which encourages teamwork. Employees also complete a self-evaluation annually before the managers of the units perform the annual evaluations. Each nurse is also asked to perform peer reviews on colleagues, thus giving the manager of the unit a good understanding of the staff, positives, and negatives. Encouragement comes from nursing administration for the nurses to participate on committees within the hospital, or units, for changes to occur, and make the work environment pleasant.

Nurses annual evaluations specifically focus on his/her performance on the unit, any leadership opportunities, and whether or not the nurse took steps to meet their goals, set the year before. Nurses are the greatest asset to any health care organization; they function as the “skeleton” of the hospital. The hospital is very generous in offering sign-on, and retention bonuses for the nursing staff, helping to preserve the experienced nurse population at the hospital. Nurses are also offered self scheduling on the units, which permits nurses to work with one another in filling vacancies in the schedules of the units, and promotes team cohesion.

In addition the staffing office also helps meet the needs of the units when there are sick calls. The staffing office in conjunction with the units helps to mobilize staff to other units, which may be short staff and also keeps track of the patient census of the hospital. Staffing of the units is reflective of internal and external factors, and reflects safeguards of employee rights, and a safe work environment. Quality of Care The review of the quality of care that patient’s receive at Summerlin hospital is diverse.

A majority of patients report positive remarks regarding nursing care. A minority of patients report of the horrifying experiences they have had on units. Even providers will request to have patients moved to different units because of patient complaints about care. The units all need to provide the same quality of care for every patient, and family that arrives on their units. The units with poor reputations and the nurses who work there feel as though they are providing quality care to their patients to the best of their abilities, and with the resources provided them.

The CNO in conjunction with the managers of these units are working to improve the perception of the units and work with the nurses in identifying the issues, i. e. lack of staff. Involvement of nurses at all levels of the organization, is imperative for quality improvement planning and processes. Nurses and the various departments are also encouraged to bring forth any issues they may have that hinder or delay care for patients. An example for labor and delivery is the poorly functioning ultrasound machine.

The nurses on the unit rely on the ultrasound, for various diagnostic indications. The ultrasound machine on the unit needs frequent repair, and needs replacement with a more current machine. While the unit was requesting a new ultrasound, the unit worked in conjunction with radiology to move patients through radiology quickly for diagnosis purposes, yes, it was not a streamlined process, but it was a working process. The departments of the hospital work together to present processes, which improve outcomes for patients, and the departments work well together.

Interdisciplinary collaboration in providing the highest quality of care to the patients seen at Summerlin is obvious with the review of patient care in patient conferences, and the different review boards. One example is the labor and delivery unit, the nurses meet with a perinatologist weekly, and review fetal monitor strips, the course of action that was taken and the outcomes, and then what could have improved from the situation. The rounds have an interesting component because, nurses are able to take a step back from the situation and have other professionals review the situation, and get suggestions for the next time.

The review is informal and non-confrontational. The review of monitor strips is an excellent opportunity for learning, it occurs every week on Wednesdays on the unit, in between day and night shift, so nurses on shift may attend, and those coming in, come in early, and learn from this valuable opportunity. The administration and unit managers encourage the nurses at Summerlin hospital to belong to professional nursing organizations but do not offer any incentive, for becoming a member.

For example the nursing director of women’s services, the manager of the NICU, and the nurse educator for women’s services is a member of AWHONN, (Association of Women’s Health, Obstetrics and Neonatal Nurses), so the nurses on the unit have the ability to access the journals because these team members bring them in, for the staff to read. The nurse educator will print various articles of current issues, etc, and post the articles on all the units, giving the staff nurses updates on current nursing practices across the nation in women’s health.

The current policies and procedures of the women’s health department (labor and delivery, postpartum, gynecology, nursery and NICU) are in accordance with national professional standards. Community involvement of Summerlin hospital is obvious. The hospital works in conjunction with other community organizations, and departments such as the Metro Police Department, and the Las Vegas Fire Department, along with Safe-Kids. Free infant car seat checks, by certified car seat installation technicians offered the first Saturday of the month.

Every month a lunch and learn, is offered to the community regarding various health topics, the speakers are typically physicians and nurse practitioners promoting preventative care to community members. The emergency department sponsors a community program as well for the children of the community, with topics on bicycle safety, helmets, swimming safety, etc. There is always ample participation and interest in the programs offered to the community. A negative, which needs improvement at Summerlin hospital, is the availability of literature, to support the nursing care provided.

Yes, the units have journals from the team members of professional organizations; however, the staff that are not members are reliant on the members to bring in journal articles. The concept of evidence-based practice, is while on the women’s health services units, is followed because the policies and procedures are written based on the guidelines provided by AWHONN, nurses are not seeking out any other research material to support the care given to patients. The environment needs to change in the hospital, promoting the access to research literature.

Many nurses participate in caring for patients with the attitude of “that’s the way we have always done it”, of course, with a few modifications as the policies and procedures are made current, with the guidelines of professional practice; however bedside nurses have moved away from understanding the importance of research in every day practice. The CNO, directors and unit managers need to stress the importance of evidence-based practice, and provide a supportive environment for the nurses, which allows for ample time to research, and education.

As part of the Valley Health System (VHS), a university exists; staff members need to attend the university at least annually for corporate compliance with education in blood borne pathogens, tuberculosis, back safety, etc. Every two years nurses receive certification in BCLS, neonatal resuscitation, pediatric advanced life support, and ACLS. The various nurse educators (certified to instruct the courses) throughout the hospitals teach these courses. Annual evaluation of unit-based competencies occurs on the unit with the nurse educator, or a designated preceptor, as the nurse is performing the competencies.

The nurses and staff of the hospital can access the monthly offerings for other courses. Nurses attend a formal orientation, when accepting a staff position at Summerlin hospital. Orientation begins with hospital orientation, and continues with credentialing nurses to make sure they understand the equipment used, the common hospital policies, and annual competencies using blood sugar testing. The remainder of the orientation is unit-specific; the duration of the orientation falls on the evaluation of the preceptors, for the nurses, and staff.

Preceptors attend a course on precepting. Preceptors are nurses with clinical expertise, interested in teaching, new nurses or nurses to a specialty area. “Preceptors guide new nurses as they transition from academic institutions to the professional world-and, in some cases, from one nursing specialty to another. Nurse Preceptors use the standards of professional practice and patient care experiences as a framework for clinical teaching” (Paterniti, 2006, p. 25). Nursing preceptors require patience, and need to have a desire to teach, and enjoy teaching.

So often preceptors are chosen by the fact they are the one with the most experience, and this should not be the case. The CNO and unit managers need to ensure that the preceptor is willing and able to teach, and not just designate any nurse to fill the role of preceptor. The unit managers and CNO are flexible with the preceptors throughout the hospital, and make considerations for preceptors on the unit that offer autonomy. The preceptor and orientee are not considered as part of the nursing staff for the unit, so the patient load is appropriate for teaching, and learning.

Every nurse is different and learns at a different pace, so the time frame for the orientation needs to be adaptable to each orientee, based on the judgments of the preceptor. In the women’s health services department, there is a high turnover rate, for employees. The environment of the unit is chaotic, and stressful, which is the normal environment for every hospital unit, nurses, and managers, etc need to promote a better learning and working environment, to encourage nurses to stay at the bedside and care for patients. Every nurse is an educator.

The need for providing patient education is a main function of a nurse. Every nurse at Summerlin hospital functions as an educator. The moment a patient walks into the hospital, education is ongoing for the patient and family. Nurses are constantly providing the patients with education regarding procedures, and explanations of the plan of care, and helping patients and families understand, and anticipating the educational needs of the patient and family to ready the patient for discharge. The hospital offers patient specific classes throughout the hospital units, focusing on anticipated needs for a hospital admission.

An example is the prenatal course. Patients that will be delivering at Summerlin, are given encouragement from their physicians to attend the prenatal course, which offers a tour of all the units, and information regarding what to expect in labor and delivery, postpartum, and in providing care to their infants. Education is also provided regarding what to expect in labor and delivery, pain relief options, etc. Reviews of the participants of the class reveal that the information provided is useful, valuable, and informative.

Professional Development The CNO of Summerlin hospital is an active participant in the decision-making and strategic planning of the hospital. She is someone who is very visible, and approachable, by all staff. The CNO is the vessel by which issues are brought to the attention of the administration. The CNO is visionary and is taking the steps necessary to create a better working environment for the employees of the hospital, and create an environment, which the nurses provide the highest quality care to patients.

The CNO is a nurse who has worked at the bedside, at Summerlin hospital, and she appreciates and recognizes the effort of the employees and nurses of Summerlin hospital. Nurses are the “skeleton” of the hospital, without nurses a hospital would not exist. Nurses collaborate with other team members to provide high quality care to patients. Documentation of this collaboration is evident in the plan of care for patients, patient rounds are attended by the nurses along with physicians, and documentation to the changes of the plan of care occur in the patient plan of care and medical records.

Again, there needs to be more emphasis placed on evidence-based care and nurses researching clinical questions they may have regarding the care of their patients, and having informed discussion with physicians, and truly advocating for their patients. Many educational opportunities exist for the nurses at Summerlin hospital. Daily classes at the university, provide nurses the opportunity to educate themselves on EKG readings, or the latest treatment options for diabetes, giving the nurses education to grow personally and professionally.

The hospital does support nurses in returning to formal education with tuition reimbursement, however; there needs to be more allocation of funds to individual units for nurses to attend conferences and seminars. Nurses would be more apt to furthering their education, with a clinical ladder in place, to promote nurses professional development. Currently, there is no motivation for nurses to take courses, unless they seek personal and professional growth. A limit to the growth opportunity exists at Summerlin.

Motivation for obtaining professional certification or furthering education does not exist. A staff nurse with a certification is the same as a staff nurse without certification. An emphasis needs to be placed on professional growth for the nurses, whether monetary reward, or promotion through a clinical ladder. The nurses that receive professional certification or further education need to be recognized, as having a commitment to providing the highest quality care to the patients, they serve.

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