Developing techniques for repetitive tasks is similar to finding the fastest method, but it focuses on specific tasks that are repeated again and again, such as client teaching.
Many clients come to the hospital or ambu- latory center for surgery or invasive diagnostic tests for same-day treatment. This does not give nurses much teaching time. Using video- tapes and pamphlets as teaching aids can reduce the time needed to share the informa- tion, allowing the nurse to be available to answer individual questions and create indi- vidual adaptations. Many facilities are using these techniques for cardiac rehabilitation, pre- operative teaching, and infant-care instruction.
CONCLUSION
Time can be our best friend or our worst enemy, depending on our perspective and how we manage it. It is important to identify how you feel about time and to assess your own time management skills. Nursing requires that we perform numerous activities within what often seems to be a very short period of time.
Knowing this can create stress. Learn to dele- gate. Learn to say, “I would really like to help you; can it wait until I finish this?’’ Learn to say no. Most of all, learn how to make the most of your day. Finally, remember that 8 hours should be designated as sleep time and several more as personal or leisure (“time off’’) time.
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84 ❖ Essentials of Nursing Leadership and Management
R E F E R E N C E S
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Boston: Allyn & Bacon.
Brider, P. (1992). The move to patient-focused care. Am J Nurs, 92(9), 27–33.
Chappel, E.D. (1970). Culture and Biological Man:
Exploration in Behavioral Anthropology. New York:
Holt, Rinehart, & Winston. (Reprinted as The Biologi- cal Foundations of Individuality and Culture. Hunting- don, NY: Robert Krieger, 1979.)
Drucker, P.F. (1967). The Effective Executive.New York:
Harper & Row.
Gahar, A. (2000). Programming for College Students with Learning Disabilities. (Grant No.: 84-078C) http://
www.csbsju.edu. February, 16, 2000.
Gonzalez, S.I. (1996). Time management. The Nursing Spectrum in Florida, 6(17), 5.
Ferrett, S.K. (1996). Connections: Study Skills for College and Career Success.Chicago: Irwin Mirror Press.
Hammerschmidt, R., & Meador, C.K. (1993). A Little Book of Nurses’ Rules.Philadelphia: Hanley & Belfus.
Haynes, M.E. (1991). Practical Time Management. Los Altos, CA: Crisp Publications.
Matejka, J.K., & Dunsing, R.J. (1988). Time manage- ment: Changing some traditions. Management World, 17(2), 6–7.
Meyer, C. (1992). Equipment nurses like. Am J Nurs, 92(8), 32–38.
Moshovitz, R. (1993). How to Organize Your Work and Your Life.New York: Doubleday.
Prescott, P.A. (1991). Changing how nurses spend their time. Image, 23(1), 23–28.
Robichaud, A.M. (1986). Time documentation of clinical nurse specialist activities. J Nurs Adm, 16(1), 31–36.
Sleeping on the job. (1993). Am J Nurs, 93(2), 10.
Turkington, C.A. (1996). Reflections for Working Women:
Common Sense, Sage Advice, and Unconventional Wisdom.New York: McGraw-Hill.
Webber, R.A. (1980). Time Is Money! Tested Tactics That Conserve Time for Top Executives.New York: Free Press.
S T U D Y Q U E S T I O N S
1. Develop a personal time inventory. Identify your time wasters. How do you think you can eliminate these activities?
2. Create your own client care worksheet. How does this worksheet help you organize your clinical day?
3. Keep a log of your clinical day. Which activities took the most time and why?
Which activities took the least time? What situations interfered with your work? What could you do to reduce the interference?
4. Identify a task that is done repeatedly in your clinical area. Think of a new, more efficient way to do that task. How could you implement this new rou- tine? How could you evaluate its efficiency?
C R I T I C A L T H I N K I N G E X E R C I S E
Antonio was recently hired as a team leader for a busy cardiac step-down unit.
Nursing responsibilities of the team leader, in addition to client care, include meeting daily with team members, reviewing all admissions and discharges for acuity and length of stay, and documentation of all clients who exceeded length of stay and the reasons. At the end of each month, the team leaders are required to meet with unit managers to review the client care load and team member per- formance. This is the last week of the month, and Antonio has a meeting with the unit manager at the end of the week. He is 2 weeks behind on staff evalua- tions and documentation of clients who exceeded length of stay. He is becoming very stressed over his team leader responsibilities.
1. Why do you think Antonio is feeling stressed?
2. Make a “things to do” list for Antonio.
3. Develop a time log for Antonio to use to analyze his activities.
4. How can Antonio organize and streamline his work?
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Organizations, Power, and Empowerment
O U T L I N E Understanding Organizations Types of Healthcare Organizations Organizational Climates
Goals Structure Processes Power Definition Sources
Empowering Nurses Professional Organizations Collective Bargaining
Participation in Decision Making Shared Governance
Enhancing Expertise Conclusion
O B J E C T I V E S
After reading this chapter, the student should be able to:
• Recognize differences in sponsorship, climate, goals, structure, and informal processes in various health care organizations.
• Define powerand empowerment.
• Identify sources of power in a healthcare organization.
• Describe several ways in which nurses can be empowered.
C H A P T E R 7
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The subjects of this chapter—organizations, power, and empowerment—are not as remote from a nurse’s everyday experience as you may first think. Consider the following scenar- ios, which are analyzed later in the chapter:
S c e n a r i o 1
In school, Hazel Rivera had always received high praise for the quality of her nursing care plans. “Thorough, compre- hensive, systematic, holistic—beautiful!”
was the comment she received on the last one she wrote before graduation.
Now Hazel is a staff nurse on a busy orthopedic surgery unit. Although her time to write comprehensive care plans during the day is limited, Hazel often stays after work to complete them. Her friend Carla refuses to stay late with her. “If I can’t complete my work during the shift, then they have given me too much to do,” she explains.
At the end of their 3-month probation- ary period, Hazel and Carla received writ- ten evaluations of their progress and comments about their value to the organi- zation. To Hazel’s surprise, her friend Carla received a higher rating than she did. What happened?
S c e n a r i o 2
The nursing staff of the critical care depart- ment of a large urban hospital formed a research utilization group about a year ago.
They had made a number of changes in their practice based on reviews of the research on several different procedures and were quite pleased with the results.
“Let’s look at the bigger picture next month,” their nurse manager suggested at one of their meetings. “This time, let’s look at the research on different models of client care. We might get some good ideas for our unit.” The staff nurses agreed. It would be a nice change to look at the way they organized client care in their department.
The nurse manager found a wealth of information on different models for organ- izing nursing care. One research study about a model for caring for the chronical- ly critically ill (Rudy et al., 1995) particu- larly interested them because they had had many clients in that category.
Several nurses volunteered to form an ad hoc committee to design a similar unit for the chronically critically ill within their critical care department. When the plan was presented, both the nurse manager and the staff thought it was excellent. The nurse manager offered to present the plan to the vice president for nursing. The staff eagerly awaited the vice president’s response.
The nurse manager returned with dis- couraging news. The vice president did not support their concept and said that, although they were free to continue devel- oping the idea, they should not assume that it would ever be implemented. What happened?
Were the disappointments experienced by Hazel Rivera and the critical care department staff predictable? Could they have been avoid- ed? Without a basic understanding of the