Term Paper on "Nursing Management Initiator Role"

Quoted Instructions for "Nursing Management Initiator Role" Assignment:

Essay reflectin upon my weaker managment role "initiator". Useing my experience for this reflective analysis, required to support my analysis with reference to appropriate literature. Write about this experience using format a)an***** the sequence of events, b)an***** my feelings at the time c) were there any other issues that required to be explored d)an***** the part I played in each event in terms of management role identified (initiator) e) review and discuss any insights that have become apparent when looking back. Below is a draft I submitted for review -- this is first paper I've written in over 25yrs. I was told not to use appreviations, its too chatty, how does this relate to answering the question, use 10 references in alphe order. and I need to be dicussing one role that I am operating and find a weakness in myself. To begin introduction explaining the role I am going to discuss.

One of the roles a nurse, who manages patients, is that of initiator. As an initiator, you lay foundation of care to be provided (Hesketh 1997).

Through my work at a large health organization, I have found this to be a weakness of mine.

I receive calls from patients, that I triage their signs and symptoms for home advice, clinic appointment; emergent care verses telephone treatment/protocols available to me.

A recent and frustrating call came the other day. Without well-defined communication skills, the nurse cannot establish therapeutic relations with the patient (Hood). The review of the following call should demonstrate my lack of ability to direct, communicate, and thus act well as the initiator role (Hesketh 1997).

I received a call from a patient of Vietnamese decent. The call comes to me with a Cantonese interpreter who works for our organization. The interpreter is a medical legal one who can not interpret anything, just repeat what the patient is saying.

The call is lengthy, and from the start irritating to me and difficult to get straight answers to my assessment question. Most of which are yes or no questions. The patient keeps repeating the same signs and symptoms of chest congestion for 3days. And that she wants to see her MD only.

My job is to triage the chest congestion statement for either home care advice or appointment to the clinic to rule out bronchitis or pneumonia. But, in order to triage I need clear answers to my questions of fever? Chest pains? Wheezing? And what has she done so far to care for herself. Based on the answers to such questions, the computer program will assign an urgent same day appointment, or advice home care advice. It is clear from the start that the patient is not interested in advice, and I fear she will not qualify for an appointment based on cold like symptoms I’ve gathered so far.

I realize after much work with the culture they often do not want RN advice. They frequently only accept direct MD advice or appointment. So, I explain via the interpreter that I am getting an appointment but she must answer the question first as her physician has asked me to gather information first. I used this statement in hopes that she will cooperate more (Quinn 2003). She seems a little irritated but reluctantly answers my questions. After the verbal assessment is complete, she indeed does not qualify for an appointment under our computer system. She warrants advice at the least and telephone treatment with cough syrups at the most. The call has now become lengthy, frustrating for myself, the patient, and the interpreter and it is apparent I can’t give her what she wants. Lack of time, lack of information, too much uncertainty, organizational systems, and human factors, all may have added to the problem. (Murdock 1993). Thus compromise is the only solution left to me. I must message her primary physician with the signs, and symptoms, her desires and explain to the patient it may be 24-48 hours before he gets back to her, with either an appointment or a telephone consult personally.

Had I better defined the problem early on in the call, I could have cut the frustration on both our parts and gone directly to the objective of requesting an appointment via a message for cold signs and symptoms.

Being more decisive would have leaded me to generate as many potential solutions as possible. Present them clearly to the patient and allowed the patient to choose home advice, telephone treatment, or message to her physician for a call back (Hesketh 1997).

I think my bias with the cultures belief of an MD being the only one to help her got in my way of truly and objectively helping her, and I lacked good communication skill imperative to being a good initiator. As well as me getting frustrated with the lengthier call than usual. At the time we had numerous patients on hold for RN help.

REFERENCES:

Hood, L., and Leddy, K. L. (2003). Conceptual Bases of Professional Nursing.

Hesketh, A and Dowling, M (1997). Facts not Fiction. Scotland UK: Centre for Medical Education University of Dundee.

Murdock A and Scutt C. (1993). Personal Effectiveness. Oxford: Butterworth-Heinemann.

Quinn, Faerman, Thompson and McGrath (2003). Becoming a Master Manager.

E-Mail me with any questions.

Thank You

Sally