Leadership and Management in Nursing

Case Study #1

With approximately a 30-bed-medical-surgical holding capacity, the director of nursing feels that it is important to expand the cardiac care services unit as a way of enhancing quality health care delivery to the community. Due to an increase in demand of medical services, the hospital administration has embarked on expand strategy, which is one of the most aggressive strategic planning methods. The procedure demands identification of the exact need for expansion, which later leads to focusing and development of specific estimates of time and resources needed to implement the expansion effort. During the implementation of this expand strategy, several factors will be considered. In particular, it is important to consider the constituency of the expansion and the relevant partners involved to ensure the procedure is fully implemented. In this case, the relevant stakeholders involve both the parties in the community and within the hospital premises. Some of the key stakeholders involve the management committee, strategy group, the medical board, department heads, and patient partnership forum. Along with these major stakeholders, the community around the hospital and the hospital employees are also part of the strategic plan. The hospital is conversant with the challenges faced by the community when accessing quality healthcare and the expansion of the hospital is for the benefit of the people within the community. Other stakeholders within the hospital include the hospital staff where the cardiac care unit will be constructed. After delivery of the facility, the current employees will be part of the team that will help in implementing the care delivery. Moreover, in case the hospital feels the need to hire new employees, the current ones still have a stake in the extension of the facility, as they will be required to accommodate and give relevant support to the new caregivers.

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Implementing the Strategic Plan

Essentially, creating a comprehensive strategic plan is dependent on several factors but the most important of all is ensuring credibility, capacity, consistency and commitment towards the project is maintained (Alston & Bryson, 2013). The first step would be circulating a draft strategic plan to all relevant stakeholders and wait for their feedback. After reviewing their response, the next step would be to make sure that all contributions are considered when drawing the final expansion plan. For the strategic plan to be successful, it is important that the hospital has sufficient resources to carry out the expand strategy. The hospital management is already aware of the current economic climate and pressure and will be committed to utilizing the resources in an effective and efficient way. Some of the key resources that would be required for successful implementation of this strategic plan would be appropriate knowledge and skills, which include human workforce to help in delivering the objectives of the plan. Similarly, it is important to provide hospital staff and managers with information and development programmes, which would allow them to fully partake in the project and ensure its proper implementation.

Major Issues Associated with the Expansion Strategic Plan

 Expansion strategic plans of existing services in a hospital highly depend on various major issues. The first issue demands knowing and understanding the exact implications of the existing resources to the project and the exact requirements to implement fully the upcoming project. The second major issue that largely influences the expand strategy is the infrastructural requirements needed to ensure successful completion and implementation of the plan. The third and most important issue is how the existing structures complement the new services planned for the hospital as a whole and delivery of healthcare programs within the facility. Lastly, it is important to consider the legislative frameworks both national and local that are in place and how they may affect the pre-planned expansion strategic plan.

Case Study #2

Jane has been managing three hospitals for the last six years. Her work has been overwhelming after management eliminated middle management positions as way of leveraging on the losses suffered during the last fiscal year. As a result, Jane has had so much to do in every single day and has adopted several strategies to help her manage her workload within the stipulated time.  Unfortunately, Jane is yet to succeed in managing her time. Based on this information, this study explores various strategies that would have been employed to help solve Jane’s problem. From the case study, it is clear that Jane spends most of her time responding to open-door visits and replying to emails. However, as Sullivan (2013) elaborates, to be effective nurse managers should be well organized and understand what is important by order of priority. Things such as emails should have designated filters to sort out the most urgent to be responded to immediately or what needs an automated message. By automating emails from specific senders, Jane can easily free her desktop of the extra workload that takes up most of her time. Another thing, the several drop-in visits can be eliminated by directing and encouraging the individuals to first look for solutions and only report the most complex of problems to Jane’s office. Although the process is time-consuming in the beginning, Sullivan asserts that it will eventually take care of the unnecessary interruptions.

Managing Time Wasters and Interruptions

Time wasters are activities that prevent an individual from accomplishing the pre-planned work procedures or from achieving the pre-set goals. According to Sullivan (2013), some of the common time wasters include interruptions from text messages, emails, telephone calls, and drop-in visitors. Meetings whether scheduled of unscheduled, failure to define individual goals and priorities, lack of daily plan on tasks to be accomplished by the end of the day are also some of the common time wasters in management. Nevertheless, as Sullivan notes, time wasters can be managed to reduce their effects and gradually improve on managing time. The first and most important step is analyzing how time is being used and whether it is appropriate to the role of the individual. It is likely to find that more time is wasted doing unproductive work and can thus be diverted to activities that generate a specific outcome beneficial to the individual and organization.

Reflection on Application of Time Management Skills

As a nurse I am used to having both short and long-term goals, most based on the demands and needs of the patients rather than personal achievement as a nurse. A critical application of time management skills would be in establishing my own goals and setting time frames to accomplish them. Moreover, these skills will enable me to think and start planning about what might happen in the future, when and how it is likely to happen. Without future orientations, my activities as a nurse may not bear any positive outcomes that will help meet my personal and individual goals.

Change in Healthcare is Inevitable

On two occasions, patients have come to the hospital with various complications for treatment. The care team resolves the issue, but forgets one standard treatment, which later causes harm to the patients. For the first patient, the subsequent medical error made the situation worse, resulting in increased stay at the hospital than the patient anticipated. For the second patient, the results were more devastating as the patient died in the process. After a comprehensive medical assessment, it seems that the two incidences would have been prevented if quality healthcare delivery was observed. Despite improvements in the medical field, substantial signs of continuing poor-quality health care delivery are still evident. Healthcare facilities have serious deficiencies that have continued to cause harm to patients and even placed them at the risk of serious injury or death. After discussing with a nurse leader, I have come up with a centerpiece of improving quality of care at the hospital to prevent such incidences from occurring again. The plan involves urging all my colleagues to take the vital signs properly to ensure that the condition of the patient is fully understood and assessment commenced accordingly. The next step involves utilizing resources, infrastructure inputs, and use of simple quality improvement tools as a way of improving quality health care in the hospital.

Strategies for Change

Improving quality care in health closes the gap and improves value in the health delivery system. Nevertheless, several strategies must be applied for successful implementation of quality care improvement.

Use of Patient Registry. Patient registries store uniform data with specific outcomes predetermined for clinical or scientific purposes and for a particular population of patients (Grossman, 2010) In this case, patient population is defined through a certain disease, condition, or exposure to various factors. These registries are designed in such a way that medical personnel can use them in decision making as compared to those used for descriptive purposes. They can be used in determining the clinical outcome of a test or treatment, as well as measure the safety of various procedures intended for quality care improvement.

Data Analytics. Data analytics is a method that uses observational data from national and global billing data and is a critical tool in closing the knowledge gap between quality care delivery. As Grossman elaborates, it consists of large data sources integrated with alternate techniques that can easily be linked to diagnoses and available clinical resources. The biggest potential of this method lies in its ability to provide a better understanding of care patterns and natural history of diseases. Unfortunately, while this strategy has a lot of potential, they are limited to administrative data, and decisions regarding clinical interventions may require additional clinical studies.

Strengthen the Workforce. Medical care relies on service provided by humans and not machines. To improve quality care, it is important to mandate sufficient care giving personnel especially the number of certified personnel (Grumbach & Bodenheimer, 2004). The other mechanism would be to improve their wages, benefits, and their working conditions as a way of retaining qualified staff. However, this strategy has one shortcoming; it requires more finances to accomplish these goals, which may strain the management of the health care facility.

Roger’s Diffusion of Innovation Theory in Applying Change

When planning change, several approaches and theories help overcome resistance and go on to achieve the high goals of the organization. Quality care delivery is a continuous system, where change must be impacted, new practices adopted, and amplified using theories such as diffusion of innovation (Kaminski, 2011). The theory claims that advances are due to emerge and it is important that all members of the health care delivery actively participate in effecting quality care changes.


Alston, F. K., & Bryson, J. M. (2013). Creating and implementing your strategic plan: A workbook for public and nonprofit organizations. San Francisco, Calif: Jossey-Bass.

Grossmann, C. (2010). Clinical data as the basic staple of health learning: Creating and protecting a public good : workshop summary. Washington, D.C: National Academies Press.

Grumbach, K. & Bodenheimer, T. (2004). Can Health Care Teams Improve Primary Care Practice? JAMA, 291(10), pp. 1246-1251.

Kaminski, June. (2011). Diffusion of Innovation Theory: Theory in Nursing Informatics Column. Canadian Journal of Nursing Informatics, 6(2), pp. 1-7.

Sullivan, E. J. (2013). Effective leadership and management in nursing. Boston, Pearson.

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