NURS4405 Nursing Leadership

1. Would you prefer that your unit be part of a centralized or decentralized organization? Explain why you chose one over the other.

 

2. Will your unit have a shared governance model? What are the advantages and disadvantages of a shared governance model? What committees/councils will you create to help lead your unit? What will the committees focus on?

 

3. Research and describe at least three models of care delivery using evidence-based sources. One model needs to be an innovative/future models. Then choose one of these models to be used on your nursing unit. Justify your decision.

1. Centralization and decentralization are the two main structures of an organization. An organization can adopt either structure in the running of its activities to achieve certain desired outcomes. In a centralized management, Harper, (2015) the power to make decisions is concentrated at the top management. The decisions made at the top are communicated to other levels of workers in a rather vertical system. However, in a decentralized management, the power to make decisions is delegated to other levels of staff. The decisions made at the decentralized organization reflects team participation and delegation.

According to Piper, & Schneider, (2015) one major difference between the centralized and the decentralized organization is the structure and authority. In a centralized system, few people make decisions and pass the decisions to the other workers at lower levels of management. The decision making in the centralized organization is comparatively slow but it reflects higher levels of coordination and leadership. The centralized structure is largely practiced in small organizations. On the other hand, in a decentralized system, the authority to make decisions is delegated to different levels of management across the management structure. The decision making is relatively faster and there is collective responsibility and sharing of burden. This system is mainly practiced in larger organizations.

In my unit, I would prefer the decentralized organization despite the fact that it is a small unit with only 25 medical beds. The main reason is that the decentralized system unlike the centralized system empowers the employees to propel the organization forward by having the organization’s objectives and goals when carrying out activities and discharging duties. Again, when people are empowered to make decisions, they are not only bound to implement these decisions but they are also obliged to ensure that they work for the common good of the organization. Decision making is also considerably faster in a decentralized system which increases performance of the employees argues Thomas, (2015). It is therefore in my view that a decentralized system would be more effective as opposed to a centralized one.

2. Shared governance refers to collaboration with staff in decision making to achieve desired outcomes such as high quality care, professionalism and competence and developing a holistic approach to care. Shared governance focuses on six major aspects which include; defining the confinements of decision making, collaborative efforts between staff and workers, meeting formally and more often, agendas to be discussed are planned and disseminated prior to the meeting, relationship between members and staff is guided by well stipulated and spelled out principles and finally, there is continued strive for consensus in decision making which reflects shared decision making.

Blais, (2015) holds that shared governance has several advantages that makes it an effective and efficient model of governance. Shared governance empowers employees as they feel an integral part of the organization. The model encourages accountability from employees as it has a natural system of ensuring checks and balances where every employee has a stake in decision making and implementation process. Shared governance also encourages communication and team work among employees which helps to improve quality and consistency. Better decisions are arrived at due to involvement of a larger team.

The disadvantages of shared governance are; for one, it slows decision making as the workers struggle to achieve a consensus decision. The time taken to plan and organize various activities also slows the progress of the organization. Another disadvantage is that the fact that many people are involved in decision making, does not guarantee that they make decisions in good faith and in the best interests of organization. The model is therefore subject to manipulation by workers to suit personal goals over institutional goals (Huber, 2017).

The main objective of shared governance is to ensure representation of all the committees that are involved in an issue that is being deliberated upon (Ott, & Ross, (2014). The involvement of all committees to take part in a decision that is going to affect them induces compliance to the decisions made. Creating four main committees to lead the unit is necessary. These committees include the students, senior staff, subordinate staff and the oversight committee.

Each committee has specific roles. The student committee will deliberate largely on matter affecting the student nurses. The senior staff is concerned with the overall management of the unit, the committee focuses on improving efficiency. The subordinate staff committee will focus on the functionality of the smaller units and issues affecting them and finally, oversight committee assesses the success and failures of the unit and focus on better ways of achieving goals and efficiency in the unit.

3. There are various nursing care models that can be adopted in a nursing facility. According to Finkelman, (2015). The choice of the model is influenced by the circumstances that surround the facility such as work load, number of qualified practitioners and the relevant skills. The major models include team nursing, primary nursing and progressive patient care. Team nursing involves use of an overall leader and various other workers. This may depend on specialty and skills of the nurse leader. The nurse leader supervises the other members in his/her team.

Primary nursing refers to a rather individual-like model of care. A nurse is assigned several patients throughout their stay in the hospital. The method ensures care for the patients around the clock. The nurse assumes complete responsibility over the patients and provides individualized support to the patients in accordance to their needs. In case of any challenges facing the patient, the nurse communicates to other health providers. The last model is the progressive patient care.

Cherry, & Jacob, (2016) in the progressive patient care model, patients are grouped according to their various conditions and their needs. The nurses and care providers then distribute themselves in terms of care requirements in the hospital. The model has been defined as a care where the patient has the right bed with the right medical attention. The model has been termed as innovative as it helps hospital workers to organize hospital facilities in accordance to their uses and their relation where related facilities are put together.

The best suited method for the facility is the primary health care. This is an efficient model in a comparatively small unit for achieving the best outcomes. The method has been regarded as too costly. However costs can be minimized to achieve technical efficiency.

References

Blais, K. (2015). Professional nursing practice: Concepts and perspectives. Pearson.

Cherry, B., & Jacob, S. R. (2016). Contemporary nursing: Issues, trends, & management. Elsevier Health Sciences.

Finkelman, A. (2015). Leadership and management for nurses: Core competencies for quality care. Pearson.

Harper, C. (2015). Organizations: Structures, processes and outcomes. Routledge.

Huber, D. (2017). Leadership and Nursing Care Management-E-Book. Elsevier Health Sciences.

Ott, J., & Ross, C. (2014). The journey toward shared governance: the lived experience of nurse managers and staff nurses. Journal of nursing management, 22(6), 761-768.

Piper, L. R., & Schneider, M. (2015). Nurse executive leadership during organizational mergers. Journal of Nursing Administration, 45(12), 592-594.

Thomas, T. (2015). Management and leadership for nurse administrators. Jones & Bartlett Publishers.