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Case Study for University Medical Center, Lubbock, Texas.

Analysis and Intervention As the charge nurse of a 54-bed cardiac unit at University Medical Center (UMC), part of my job is to ensure that all operations on this unit run smoothly. I primarily work the day shift or 2nd shift since the hospital maintains a 24 hour work schedule. The organization is old and traditional, sporting an excellent reputation for the quality of its medical services to all her patients. Team nursing is the model of nursing care delivery that is practiced at UMC and has served the needs of the hospital very well. Nurses have made team nursing into a packaged procedure, dividing the labors of the team, using flow charts, and setting up informal routines for getting the work done. Nursing histories and care plans have been designed from a template to fit any patient. As a result the process of creating a new client treatment plan only involves a simple check of all items that fit a particular case without much after thought to the process The director of nursing generally makes the decisions regarding policy changes and passes the information down the organizational ladder. The cardiac unit is comprised of 3 teams (3 team leaders) consisting of 18 clients. Five Registered Nurses (RN) including the charge nurse

Everyday, I meet with the staff every morning and afternoon for report and again for team conference when time permits. If there are problems, the team leaders come to me for assistance and vice versa. Otherwise, I generally leave the team leaders alone. For the last 24 months the quality of nursing care has been second to none in the region.

However, for the past several weeks I have noticed that (i) the patients call lights were not answered promptly and within 2 minutes, (ii) increasing tardiness at morning reports and therefore leading to overtime hours for the 1st shift as they have to wait for the 2nd shift to arrive. Finally (iii) staff members have been found spending more and more time talking to each other in the conference room than with their patients.

I believe that nursing care is not as individualized and proactive as it ought to be. The discrepancies I have observed could affect our quality of service in the long run if not corrected. So I contemplate an intervention strategy which begins with an environmental diagnosis of the situation in order to choose a leader behavior style.

I plan to use two tools to enable me develop a solution action plan: Force Field Analysis and the Change Process by Lewin to move East 4 at UMC from the present state [ with deficiencies mentioned above] to the optimal state [without deficiencies].

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