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Chief nursing executive’s (CNE) role demands accountability to attain higher unit-level quality outcomes. A key area of accountability for CNEs is patient care delivery. Leadership visibility that comes from working with RNs for at least four hours each month can foster a culture of quality and inspire true collaboration among staff nurses. Through this experience, the CNE can assess and address any communication lapses in patient charting and briefings during handovers that could lead to medical errors and affect patient safety (Blake, 2015). Thus, he/she will get an opportunity to set a tone of improved communication among nurses as well as between RNs and doctors or patients.
The experience also creates a culture of openness where staff nurses anticipate the CNE’s coming to their unit and are comfortable approaching him or her. The CNE can learn how well RNs jointly evaluate patient cases and explore optimal treatments during group rounds. He/she can also ascertain how well they understand his/her instructions and receive feedback on a new change in routine practice (Blake, 2015).
The excellent professional rapport established by working together would allow RNs to communicate their work challenges that affect direct patient care and motivate turnover to the CNE. Staff nurses experience barriers such as lower job satisfaction, heavy workloads, patient acuity, and limited autonomy that affect performance at the point of care (Chiang, Hsiao & Lee, 2017). The approach is also crucial in managing conflicts that could affect collaboration and compromise patient safety.
A Major Benefit of Working with CNE
Staff nurses consider working with the CNE a hallmark of effective decision-making and clinical leadership. According to Blake (2015), RNs must feel like valued partners in clinical care and overall hospital performance. Therefore, working with the CNE would provide an avenue for the participation of staff nurses in decision-making in their unit. They can inform the CNE the problems faced in the wards and, if prompted, suggest improvements for better patient and nurse outcomes. Additionally, direct feedback from the CNE can help them improve their practice. The joint rounding also provides an opportunity for meaningful periodic recognition of staff, which is an important motivator (Blake, 2015). Related secondary effects include job satisfaction and nurse retention.
Effect of the Chain of Command
A key measure of healthy work environments is authentic leadership. This concept entails reducing the barriers to collaboration such as intimidating behavior and inadequate communication. One way in which an authentic nurse leader can achieve this standard is through routine meetings that allow staff nurses to raise their concerns (Blake, Leach, Robbins, Pike, & Needleman, 2013). Follow-up actions and feedback can lead to accountability at all levels. In this regard, the chain of command diminishes when leaders work with staff to actualize the change desired. Their main aim is to identify and address barriers to ineffective care delivery and poor nurse outcomes that would not be resolved if the hierarchical structure is maintained.
Medication Administration Competencies
Specific clinical competencies in this domain that can be measured include safe practice when administering high-risk medicines. Nurses and other members of the healthcare team should have the capacity to review formulary or dosage limits and high-alert medications before administration (Shastay, 2016). They should explain drug indications and contraindications and be able to obtain patient consent to treatment. Other measurable specific competency areas may be procedures for intramuscular injections, oral medications, and topical applications.
This domain deals with competencies required to care for a patient at his/her stage of life (Strader & Giacomo-Geffers, 2017). Competency determination can be based on knowledge of development across the lifespan, assessment, and interpretation of clinical data to give age-specific care, and appropriateness of communication with the patient. Other core skills that can be assessed include safety culture (e.g., eliminating hazards to reduce falls among the elderly), health promotion (self-care and proper nutrition), and age-related illness recognition and management (Strader & Giacomo-Geffers, 2017). The case manager must show these competencies when caring for patients of different ages given their unique attributes and needs.
Intravenous Medication Administration and Care of the I.V. Site
The major competency measurements can be the use of standard practices in the placement and management of intravenous devices and medication delivery information (Shastay, 2016). Preparing I.V. medications, labelling and administering them, and recognizing errors are other skills that can be assessed. The clinician should also be able to state prescribed fluids and syringe drivers.
The assessment should measure competencies in holistic care planning and evaluation. The specific areas of focus can be a case manager’s performance in developing a plan of care, review progress after a certain period, identify and integrate a patient’s goals and strengths into practice and prioritize his/her spiritual, psychological, and emotional preferences. He should also demonstrate skills in promoting self-care and trusting therapeutic relationships.
Documenting patient care in electronic health records (EHRs) is a meaningful use requirement (Mitchell, 2015). The main competencies that can be measured in this domain can be the time spent entering data into the EHR, confidence in using this documentation system, and the commission of entry errors. These variables could indicate their proficiency in this domain.
Blake, N., Leach, L. S., Robbins, W., Pike, N., & Needleman, J. (2013). Healthy work environments and staff nurse retention: The relationship between communication, collaboration and leadership in the pediatric intensive care unit. Nursing Administration Quarterly, 37(4), 356-370. Web.
Blake, N. (2015). The nurse leaderʼs role in supporting healthy work environments. AACN Advanced Critical Care, 26(3), 201–203. Web.
Chiang, H. Y., Hsiao, Y. C., & Lee, H. F. (2017). Predictors of hospital nurse’s safety practices: Work environment, workload, job satisfaction, and error reporting. Journal of Nursing Care Quality, 32(4), 359–368. Web.
Mitchell, J. (2015). Electronic documentation: Assessment of newly graduated nurses’ competency and confidence level. Online Journal of Nursing Informatics (OJNI), 19(2), 1-10. Web.
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Shastay, A. D. (2016). Evidence-based safe practice guidelines for I. V. push medications. Nursing, 46(10), 38-44. Web.
Strader, M. K., & Giacomo-Geffers, E. (2017). Implications of the Joint Commission’s 2016 deletions for staff education and training requirements for 2017. Web.