Chapter 19: Workforce Engagement and Collective Action
Collective action is effective in:
Amplifying the influence of individuals.
Government and third-party payers announce reduction of compensation for the delivery of patient services. Hospital STV has a flat organizational structure. After the funding announcements, senior officials at the hospital meet and make decisions regarding cost containment of new revenue streams. This action is consistent with:
A tendency to concentrate decision making during economic downturns at the top administrative level.
Awareness and use of power have been challenging for nurses in general because of:
A tradition of obedience to authority.
In looking at an organizational chart for her institution, Jennifer notes that nursing is led at the senior level by a non-nurse executive. Jennifer expresses concern that this is a reflection of how nursing is viewed within the organization. Jennifer's comments reflect:
An awareness of how organizational culture is reflected in organizational structure.
Sarah determines, in partnership with her patient, that current medications are not enabling her patient, a married account executive with fibromyalgia, to continue with her employment and family responsibilities. After searching for additional information on fibromyalgia, Sarah finds nonpharmacologic interventions that are supported through credible evidence. Sarah suggests that the patient, her physician, and she meet to discuss the medications and possible options and a plan of care for the patient's discharge. This action exemplifies which of the four historical concepts identified by Lewis and Batey?
Authority
Sandra, an RN on the surgery unit, is assisting with a procedure in the patient examination room. The physician orders a medication to be given through IV. Sandra questions the order, based on her knowledge of the patient's history and of other medications that the patient has been given. The physician reiterates the order and Sandra refuses to give it. In this instance, Sandra is demonstrating:
Autonomy. In this situation, Sandra is exemplifying autonomy, which is the act of making independent decisions in the best interests of the patient, based on her knowledge and experience. This is analogous to the example in the text where the workers on the manufacturing floor have the independence to say "Stop the line" when something is wrong. Key to the concept of autonomy is decision making and the level of independence that is given. Accountability refers to achievement of outcomes, and authority refers to the capacity to make decisions.
A Magnet™ hospital surveys the staff about job satisfaction. This type of environment, in which nurses have authority and autonomy, is linked with:
Client satisfaction with the healthcare organization.
In an inner-city area, a group of nurses meet and develop a plan to negotiate with local businesses to support a breakfast program for young elementary schoolchildren. This is an example of:
Collective action.
You are hired as a new manager. When the offer of employment is made, you agree to at-will employment. Later, you become very concerned about the policies and practices of your organization and their impact on patient care. You speak with your supervisor several times about your concerns, but no action is taken. In considering your next steps, you:
Consider your increased vulnerability under the terms of your employment.
The Emergency Department nurses' decision to organize for the purpose of collective bargaining is being driven by a desire to:
Create a professional practice environment.
The Emergency Department staff members are concerned that working long hours without rest puts patient safety at risk. One staff member decides that she will risk her job and become a whistleblower. Whistle-blowing is an appropriate recourse when management:
Delays responding to repeated efforts to provide safe care.
As a new nurse manager who has "inherited" a unit with high nurse turnover and complaints of patient dissatisfaction, your first course of action would be to:
Determine levels of nurse engagement on the unit.
Nurses on the dialysis unit notice that changes in labeling of fluids have meant several alarming near misses in terms of wrong administration of fluids. They take this concern to the unit manager. As an advocate of nurse autonomy, the most appropriate response in this situation would be to:
Discuss concerns about the labels and develop potential solutions that take into account changes that can be made at the local level and those that need system intervention.
Nursing labor management partnerships:
Engage nurses at all levels in problem solving for better patient care.
The chief nursing officer utilizes the hospital's workplace advocacy to help the overwhelmed Emergency Department staff. Workplace Advocacy is designed to assist nurses by:
Equipping them to practice in a rapidly changing environment.
In accomplishing the goal of breakfast for children in elementary school, Leanne is particularly effective in approaching businesses with the needs that the group has determined and articulating the ways that the group has found for businesses to participate. Leanne is exemplifying:
Followership.
Martin, the unit manager, receives complaints from community agencies that patients who have been discharged from his unit seem to lack understanding about their disorder and immediate strategies for managing elements of their care. Martin checks the patient teaching sheets and notes that the sheets are initialed by staff. He calls the agencies and indicates that teaching has been done. Martin's follow-up to complaints from the community is:
Indicative that he does not clearly understand the concept of accountability.
On Unit 62, the nurses and the unit manager have been involved in shared decision making related to the model of nursing care delivery that the unit will adopt. All individuals have participated and been involved in decision making and implementation of changes. When issues arise during implementation, it is expected that:
Individual expertise will be utilized to provide solutions, but that responsibility for the change is shared.
Senior executives at Hospital A determine that the hospital will engage in a strategic planning process after changes in healthcare funding and concerns expressed in the community about care that is being delivered at the hospital. The senior executives decide on a participatory process in which staff are widely consulted regarding input about the organization and the external environment and are actively invited to be part of decisions related to the mission statement, goals, and objectives. For true shared governance to be seen as part of this approach:
It must be evident in the outcomes of the process that staff and senior executives have partnered on the decisions.
The staff members in a local Emergency Department are experiencing stress and burnout as the result of excessive overtime. The staff decides to unionize to negotiate for better working conditions. The increase in unionization within health care may be attributed to the:
Number of people who are involved in health care.
he Emergency Department staff decides to use a collective bargaining model for negotiation rather than a traditional trade union model. A traditional trade union model is characterized by:
Positional conflict. Collective bargaining encompasses management support of labor's initiative, a spirit of trust between labor and management, and resolution of problems. It replaces the positional conflict that has been associated with traditional trade unions. Models such as the interest-based problem solving (IBPS) model seek to avoid positional conflicts such as those between labor and management that do not take into account the opposing party in any way.
Nurses in an Emergency Department, in an inner-city neighborhood characterized by high levels of violence, are concerned with low levels of security presence in their department. Security levels have recently been decreased and the nurses question why this has occurred. An appropriate action would be to:
Provide nurses with information about rationale for recent changes in security staffing.
While making rounds, a night supervisor finds a unit with a low census and too many staff members. The night supervisor is performing as a statutory supervisor when he or she:
Recommends transferring a nurse to another service.
In Hospital STV, senior administration is strongly oriented toward fiscal and social conservatism. The nursing department is deeply concerned with the provision of quality to the community, which includes a high number of poor and unemployed. To accomplish the goals of the nursing department, resources need to be allocated that administration is not able to allocate. Nursing and administration:
Represent separate subcultures in the institution.
In a nurse managers' meeting, strategies for ways to help retain staff are discussed. One strategy for assisting nurses in developing collective action skills is:
Taking the opportunity to work with a mentor.
Martin, the unit manager, receives complaints from community agencies that patients who have been discharged from his unit seem to lack understanding about their disorder and immediate strategies for managing elements of their care. Martin checks the patient teaching sheets and notes that the sheets are initialed by staff. He calls the agencies and indicates that teaching has been done. Potential outcomes of Martin's actions include (select all that apply):
a. Poor morale on the unit. b. Disruption in community relationships. c. Corruption of patient-staff relationships. Kupperschmidt (2004) points out that when accountability is not accepted, then relationships suffer, professional practice is diminished, and self-esteem suffers.
