Introduction
According to Butts and Rich (2005), leadership in a clinical setting is a process that ought to shape the goals of the medical care organizations, motivate the behavior of the nurses towards the accomplishment of goals, and help to define the overall culture of the medical organizations. Since the goals of a clinical staff must be patient-centered, the managers who hold the authority should ascertain that the implementation of the relevant leadership is affected. This can be achieved by influencing all team members in the medical circle to do their best.
Discussion
Background of the Study
The health care crisis in the United States is limited to specific problems of shortage of professional medical practitioners, financial constraints for proper management of the health care settings, management effectiveness and efficiency, adoption of innovation, and provision of quality health services (Grumbach & Bodenheimer, 2004). These problems are not new as they are widely covered by existing literature. The good management system is a reform developed to improve efficiency and health service outcomes for the patients. This can be done by bridging management goals and nursing goals through effective communication, coordination, and team management through ethical principles and at the same time, working alongside the patients and the relatives of the patients (Henderson, 2010).
The debate of organizational hierarchy in the health care settings remains since the solution to these problems persists because of the differences of opinion encountered in the management process (Rouse, 2010). This calls for investigating the importance of the clinical stakeholders to come up with a good decision-making process. This is important as it contributes to evidence in resolving the debate. The study of management role is also necessary because ethical dilemmas that result from organizational hierarchies affect multiple stakeholders including the nurses, patients, and the managers since they are concerned with cost and risk management for the patients receiving health care.
Problem Statement
There has been evidence that the unethical practices on the part of the nurse practitioners result from the lack of proper respect between nurses as well as between nurses and doctors (Grumbach & Bodenheimer, 2004). This is so because there are unspoken hierarchies within clinical settings, which have resulted in disrespect within the nursing unit. The competition of these hierarchies results in a lack of morals that the doctors/physicians may have while dealing with the nurses. The presence of discord between the nurses encourages the culture of disrespect within the health care setting. Therefore, medical practitioners need to respect each other before they gain respect from others as well as from those outside the clinical setting.
In addition, various movies suggest that nurses are always after having dates with the doctors and are hence used as sex objects to gain a promotion or work effectively with the doctors (Greenfield, 1999). This makes the viewers or rather the patients have a negative perception, as the behavior of the nurses and the doctors is portrayed in a negative manner, which is aimed at creating attention to the viewers. It is therefore not a new thing for society to perceive a nurse practitioner as being promiscuous.
This dilemma has listed the required facts that present us with some unethical practices that are facing today nursing practitioners. This dilemma helps to show that poor medication can result from ineffectiveness and inefficiency in the management system that is caused by unethical practices of the nursing practitioners. In addition, the dilemma shows us that that the legal relationship that is required between a nurse and a doctor / superior is lacking (McMahan & Hoffman, 2010) This is one of the major causes of the extensive use of unethical principles in this health care setting.
A Proposed Plan for Addressing This Problem
Before coming up with a proposed plan for addressing this problem, it is vital to investigate the problem to address it comprehensively. The investigation of this problem involves assessing how important the nurses are in improving health care service based on how well they observe the ethical principles (Gold, 2001). By using a case study method, data will be collected based on the importance of the role of nurses in a health care setting in providing quality care for the patients. Therefore, nurses are the main source of data because they provide insight on the operation and the various challenges that they encounter in the course of their work as well as the effect it has on health care service delivery processes and outcomes (Pozgar, 2007).
The investigation will be based on a qualitative study, as this facilitates a thorough investigation of the research problem through collecting data of nurses based on their perspectives and personal experience of the dilemmas they have undergone in the health care setting (Speziale & Carpenter, 2007). The data will be based on the unethical practices of disrespect between the medical practitioners. The investigation will be done using the qualitative method, as the qualitative method is well applicable with studies that require a comprehensive investigation of accounts and descriptions of the research problem studied (Creswell, 2003).
The case study will be descriptive, as this will help the nurses to express themselves fully in a storyline way about the dilemmas they have come across that are caused by organizational hierarchies. The descriptive case study involves the causal investigation of the research problem by using a wide range of data (Miles, 2003). This is essential since using a wide range of data will enhance a thorough investigation of the problem, and therefore give me more insight in addressing the problem. These methods will include document analysis, interviews, and observation. The descriptive case study will also involve linking the professional nurses’ roles at all levels with the professional doctors’ roles to enhance the healthcare processes and outcomes. This will help to define the role of hierarchies and how it has affected the nurses’ roles at all levels as well as identify the various ways of addressing this issue.
The proposed plan for addressing this problem will involve transforming the health care setting by implementing new processes that are aimed at improving the workflow as well as health service delivery outcomes in the clinical setting. This will involve focusing on organizational culture, improving human relations and change processes, and the role of technology as this will enhance the organizational values through the creation of cohesion between the medical practitioners (Reese & Dontag, 2001).In addition, the plan will involve defining the role of a nursing practitioner to eliminate the unspoken hierarchies (American Nurses Association, 2008)
The clinical transformation will involve explaining the implementation and defining an organizational culture that facilitates a good workflow as well as health service outcomes for the patient. This is because focusing on organizational culture helps to build human relations hence increasing collaboration not only with the workers of the same discipline but also with workers of different disciplines. This results in improved performance in the health care delivery system.
Possible Barriers While Implementing Solutions
It is worthwhile to note that the Patients and family members can hinder the implantation of this plan. This is because they can have negative views of nurses either trying to have a relationship with the doctor or being a servant with little knowledge of providing medical care. This can result in a case where a nurse is not sure about an ethical issue, and he/she is required to conform to her superior in this case, who is a leader for the correct assessment (Marcia, 2000).
Recommendations for Overcoming These Barriers
It is therefore vital to give the nurses a certain degree of responsibility for their work so that they do not have to keep on asking for direction (Gastmans, 2010). In case the direction is called for, a proper communication system should be implemented that will serve to protect the ethical issues of the health care team. The use of modern technology such as the use of medical health records can eliminate this barrier since it creates room for privacy on the part of the nurse practitioners.
In addition, the importance of integrating the electronic medical record in a clinical setting is essential because it acts as decision support for the nurses. The decision support mechanism helps to prompt and give an alert where the clinical practitioners are not complying with professional as well as ethical practices. In addition, the electronic medical record contains Electronic communication and connectivity between the nurses and their superiors, thus eliminating problems that may result from miscommunication between the health care practitioners (Institute of Medicine, 2001). This serves to eliminate the perception of the patients about the immoral relationship between the doctors and the nurses.
Conclusion
The study seeks to investigate and address the problem of disunity between the different hierarchies of nurse practitioners. This has played a critical role in affecting the attitude of the patients towards the nurses. This shows that it is of utmost importance to have good cohesion between the medical practitioners to achieve the objectives of a health care setting. The implementation can be achieved through resolving the ethical problem by implementing new processes that are aimed at improving workflow as well as health service delivery outcomes in the clinical setting. This involves focusing on organizational culture, improving human relations and change processes, and the role of technology in solving problems, as well as defining the role of nursing practitioners.
However, some limitations are faced with this innovation as the patients and family members can hinder the implementation of this plan. This is because they can have negative attitudes towards the nurses. It is therefore vital to give the nurses a certain degree of responsibility for their work so that they do not have to keep on asking for direction. In case directions are called for, the use of modern technology such as the electronic medical record can be used as it contains electronic communication and connectivity between the nurses and their superiors, with enough privacy for the worker. This in turn helps to create a good reputation for the nurse practitioners at all levels.
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