Conclusion
DISPLAY 7.8 Sample Nursing Service Philosophy
The philosophy of nursing at County Hospital is based on respect for the individual’s dignity and worth.
We believe that all patients have the right to receive effective, evidence-based nursing care. This care is a personal service that is based on patients’ needs and their clinical disease or condition.
Recognizing the obligation of nursing to help restore patients to the best possible state of physical, mental, and emotional health and to maintain patients’ sense of spiritual and social well-being, we pledge intelligent cooperation in coordinating nursing service with the medical and allied professional
practitioners. Understanding the importance of research and teaching for improving patient care, the nursing department will support, promote, and participate in these activities. Using knowledge of human behavior, we shall strive for mutual trust and understanding between nursing service and nursing employees to provide an atmosphere for developing the fullest possible potential of each member of the nursing team.
We believe that nursing personnel are individually accountable to patients and their families for the quality and compassion of the patient care rendered and for upholding the standards of care as delineated by the nursing staff.
The unit philosophy, adapted from the nursing service philosophy, specifies how nursing care provided on the unit will correspond with nursing service and organizational goals. This congruence in philosophy, goals, and objectives among the organization, nursing service, and unit is shown in Figure 7.2.
LEARNING EXERCISE
7.5
Developing a Philosophy Statement
R
ecover Inc., a fictitious for-profit home health agency, provides complete nursing and supportive services for in-home care. Services include skilled nursing, bathing, shopping, physical therapy, occupational therapy, meal preparation, housekeeping, speech therapy, and social work. The agency provides round-the-clock care, 7 days a week, to a primarily underserved rural area in Northern California.The brochure the company publishes says that it is committed to satisfying the needs of the rural community and that it is dedicated to excellence.
A S S I G N M E N T:
Based on this limited information, develop a brief philosophy statement that might be appropriate for Recover Inc. Be creative and embellish information if appropriate.
Although unit-level managers have limited opportunity to help develop the organizational philosophy, they are active in determining, implementing, and evaluating the unit philosophy. In formulating this philosophy, the unit manager incorporates knowledge of the unit’s internal and external environments and an
understanding of the unit’s role in meeting organizational goals. The manager must understand the planning hierarchy and be able to articulate ideas both verbally and in writing. Leader-managers also must be visionary, innovative, and creative in identifying unit purposes or goals so that the philosophy not only reflects current practice but also incorporates a view of the future.
Like the mission statement, statements of philosophy in general can be helpful only if they truly direct the work of the organization toward a specific purpose. A department’s decisions, priorities, and accomplishments reflect its working philosophy.
A working philosophy is evident in a department’s decisions, in its priorities, and in its accomplishments.
A person should be able to identify exactly how the organization is implementing its stated philosophy by observing members of the staff, reviewing the budgetary priorities, and talking to consumers of health care.
The decisions made in an organization make the philosophy visible to all—no matter what is espoused on paper. A philosophy that is not or cannot be implemented is useless.
Societal Philosophies and Values Related to Health Care
Societies and organizations have philosophies or sets of beliefs that guide their behavior. These beliefs that guide behavior are called values. Values have an intrinsic worth for a society or an individual. Some strongly held American values are individualism, capitalism, and competition. These values profoundly affected health-care policy formation and implementation with the result being a US health-care system that
historically promoted structured inequalities. Passage of the Affordable Care Act in 2010 reduced the number of uninsured in this country and made care more accessible and affordable for many Americans, but numerous health-care disparities still exist. Despite the highest spending as a percentage of gross domestic product, American consumers had the least number of physician visits and the shortest average hospital stay.
Although values seem to be of central importance for health-care policy development and analysis, public discussion of this crucial variable is often neglected. Instead, health-care policy makers tend to focus on technology, cost–benefit analysis, and cost-effectiveness. Although this type of evaluation is important, it does not address the underlying values in this country that have led to unequal access to health care.
Individual Philosophies and Values
As discussed in Chapter 1, values have a tremendous impact on the decisions that people make. For the individual, personal beliefs and values are shaped by that person’s experiences. All people should carefully examine their value system and recognize the role that it plays in how they make decisions and resolve conflicts and even how they perceive things. Therefore, the nurse-leader must be self-aware and provide subordinates with learning opportunities or experiences that foster increased self-awareness.
At times, it is difficult to assess whether something is a true value. McNally’s (1980) classic work identified the following four characteristics that determine a true value:
1. It must be freely chosen from among alternatives only after due reflection.
2. It must be prized and cherished.
3. It is consciously and consistently repeated (part of a pattern).
4. It is positively affirmed and enacted.
If a value does not meet all four criteria, it is a value indicator. Most people have many value indicators but few true values. For example, many nurses assert that they value their national nursing organization, yet they do not pay dues or participate in the organization. True values require that the person take action, whereas value indicators do not. Thus, the value ascribed to the national nursing organization is a value indicator for these nurses and not a true value.
In addition, because our values change with time, periodic clarification is necessary to determine how our values may have changed. Values clarification includes examining values, assigning priorities to those values, and determining how they influence behavior so that one’s lifestyle is consistent with prioritized values.
Sometimes, values change as a result of life experiences or newly acquired knowledge. Most of the values we have as children reflect our parents’ values. Later, our values are modified by peers and role models. Although they are learned, values cannot be forced on a person because they must be internalized. However, restricted
exposure to other viewpoints also limits the number of value choices a person is able to generate. Therefore, becoming more worldly increases our awareness of alternatives from which we select our values.
Occasionally, individual values are in conflict with those of the organization. Because the philosophy of an organization determines its priorities in goal selection and distribution of resources, nurses need to understand the organization’s philosophy. For example, assume that a nurse is employed by County Hospital, which clearly states in its philosophy that teaching is a primary purpose for the hospital’s existence. Consequently, medical students are allowed to practice endotracheal intubation on all people who die in the hospital, allowing the students to gain needed experience in emergency medicine. This practice disturbs the nurse a great deal; it is not consistent with his or her own set of values and thus creates great personal conflict.
Nurses who frequently make decisions that conflict with their personal values may experience confusion and anxiety. This intrapersonal struggle ultimately will lead to job stress and dissatisfaction, especially for the novice nurse who comes to the organization with inadequate values clarification. The choices that nurses make about client care are not merely strategic options; they are moral choices. Internal conflict and burnout may result when personal and organizational values do not mesh.
LEARNING EXERCISE
7.6
Reflecting on Your Values
U
sing what you have learned about values, value indicators, and value clarifications, answer the following questions. Take time to reflect on your values before answering. This may be used as a writing exercise.1. List three or four of your basic beliefs about nursing.
2. Knowing what you know now, ask yourself, “Do I value nursing? Was it freely chosen from among alternatives after appropriate reflection? Do I prize and cherish nursing? If I had a choice to do it over, would I still choose nursing as a career?”
3. Are your personal and professional values congruent? Are there any values espoused by the nursing profession that are inconsistent with your personal values? How will you resolve resultant conflicts?
When a nurse experiences cognitive dissonance between personal and organizational values, the result may be intrapersonal conflict and burnout.
As part of the leadership role, the manager should encourage all potential employees to read and think about the organization’s mission statement or philosophy before accepting the job. The manager should give a copy of the philosophy to the prospective applicant before the hiring interview. The applicant also should be encouraged to speak to employees in various positions within the organization regarding how the philosophy is implemented at their job level. For example, a potential employee may want to determine how the
organization feels about cultural diversity and what policies they have in place to ensure that patients from diverse cultures and languages have a mechanism for translation as needed. Finally, new employees should be encouraged to speak to community members about the institution’s reputation for care. New employees who understand the organizational philosophy will not only have clearer expectations about the institution’s purposes and goals but also have a better understanding of how they fit into the organization.
Although all nurses should have a philosophy comparable with that of their employer, it is especially important for the new manager to have a value system consistent with that of the organization. Institutional changes that closely align with the value system of the nurse-manager will receive more effort and higher priority than those that are not true values or that conflict with the nurse-manager’s value system. Managers who take a position with the idea that they can change the organization’s philosophy to more closely agree with their own philosophy are likely to be disappointed.
It is unrealistic for managers to accept a position under the assumption that they can
change the organization’s philosophy to more closely match their personal philosophy.
Such a change will require extraordinary energy and precipitate inevitable conflict because the organization’s philosophy reflects the institution’s historical development and the beliefs of those people who were vital in the institution’s development. Nursing managers must recognize that closely held values may be challenged by current social and economic constraints and that philosophy statements must be continually reviewed and revised to ensure ongoing accuracy of beliefs.
Goals and Objectives
Goals and objectives are the ends toward which the organization is working. All philosophies must be translated into specific goals and objectives if they are to result in action. Thus, goals and objectives
“operationalize” the philosophy.
A goal may be defined as the desired result toward which effort is directed; it is the aim of the philosophy.
Although institutional goals are usually determined by the organization’s highest administrative levels, there is increasing emphasis on including workers in setting organizational goals. Goals, much like philosophies and values, change with time and require periodic reevaluation and prioritization.
Goals, although somewhat global in nature, should be measurable and ambitious but realistic. Goals also should clearly delineate the desired end product. When goals are not clear, simple misunderstandings may compound, and communication may break down. Organizations usually set long- and short-term goals for services rendered; economics; use of resources, including people, funds, and facilities; innovations; and social responsibilities. Display 7.9 lists sample goal statements.