Leadership and Nursing Care Management

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Leadershipand Nursing Care Management

Leadershipand Nursing Care Management

Topic1: Role of nurse manager in re-engineering of the health care

Healthcare organizations engage in the process of re-engineering theirfacilities with the objectives of enhancing the entire process ofdelivering care to patients. According to Boland (1996) the goals ofre-engineering the health care system includes reordering priorities,provision of cost-effective care, enhancing efficiency, and increasevalue to patients. The nurse managers play critical roles during theplanning and the implementation of the re-engineering plan. Forexample, nurse managers identify the key areas that need to beredesigned and determine overlapping functions within theirrespective departments (Boland, 1996). This is the first step towardsenhancing health care efficiency through re-engineering. The nursemanagers understand nurse functions that are duplicated or those thatcan be combined to enhance efficiency without reducing the quality ofcare. Therefore, nurse managers are in a better position to presentinform the re-engineering teams about all areas that limit nursesfrom delivering care efficiently.

Thenurse manager also has a role to play in enlisting the support ofmembers of staff within the nursing department, since staffresistance might limit the success of the re-engineering process. Theentire process of re-engineering needs an effective leadership stylethat integrates staff participation, staff empowerment, anddelegation, all of which are provided by the nurse managers in theirrespective departments (McConnell, 2010). By empowering members ofstaff within the nursing department, nurse managers are able toreduce staff resistance to the process of re-engineering. Nursemanagers also empower other nurses by facilitating an effectivecommunication regarding the purpose as well as the progress of there-engineering process and presenting their views to the topmanagement of a health care organization. By empowering nurses withintheir departments, nurse managers are able to enlist their supportand increase chances for the success of the health re-engineeringprocess.



Classmate1 addressed all the key roles of a nurse manager in the process ofre-engineering. The most important roles include restructuring thecurrent procedures as well as process, implementing there-engineering plan, passing information to employees, andencouraging employees to use the new tools. However, it would beclearer to state that nurse leaders are responsible changes inprocedures that influence the functions of the nurses and therelationship between the nurses and other health care providers(McConnell, 2010). In the case of sharing information about there-engineering plan, nurse manager informs junior nurses in order tosolicit their support and reduce their resistance to change.


Theclassmate addressed the basic functions or roles of a nurse managerin the process of re-engineering a health care organization, but in avery general way. Some of the fundamental functions addressed in thearticle include supporting other members of staff, providingfeedback, implementing the re-engineering plan, and supplying theresources required for a successful implementation (McConnell, 2010).The role of supporting the junior nurses and staff is very criticalbecause a successful process of re-engineering should start from thetop-executive. Therefore, supporting the junior staff ensures thatthey buy the idea and play a role during the implementation. However,most of the issues addressed by the classmate are irrelevant to thetopic of organizational re-engineering. For example, the classmatecould establish the link between the roles of nurse managers andlicensing of staff and empowering patients.


Classmatethree lays down the foundation of the topic by giving a correctdefinition of the process of re-engineering. For example, theclassmate makes a critical statement that re-engineering goes beyondthe normal process of organizational change. However, the classmatefails to address the roles played by the nurse managers infacilitating the process of re-engineering. Instead, the classmatestates that clinicians in general are the ones who are expected toreduce the cost and enhance quality in the health care sector. Theclassmate should have addressed the critical roles played by thenurse managers in the process of planning (such as restructuring thepresent process), implementing (such as guiding and encouraging thejunior nurses), and assessing the success of the re-engineering plansin enhancing the quality and containing the cost of care (McConnell,2010).


Thestudent gives a unique view of the contribution that nurse managersmake in the process of re-engineering their organizations. Theclassmate links the role of nurse managers with three of themanagement functions, including planning, controlling, andorganizing. This implies that nurse managers take part in the processof planning for re-engineering, control activities as well asresources, and organize members of staff who are expected toimplementing the process of re-engineering. In addition, theclassmate makes a critical observation that innovation is among thekey factors that necessitate organizational re-engineering, whichrequire nurse managers to restructure organizational processes toaccommodate these innovations (Hostetter, 2008).


Boland,P. (1996). The role of re-engineering in health care delivery.ManagedCare Quarterly,4 (4), 1-11.

Hostetter,M. (2008). Quality matters. CommonwealthFund.Retrieved January 6, 2016, fromhttp://www.commonwealthfund.org/publications/newsletters/quality-matters/2008/september-october/in-focus-reengineering-health-care

McConnell,C. (2010). Unmiker’smanagement skills for the new health care supervisor (5thed.).Burlington: Jones and Bartlett Publishers, LLC.

Topic2: Continuous quality improvement

Continuousquality improvement (CQI) refers to a process that facilitates theachievement of quality standards in incremental steps. In otherwords, an organization that adopts CQI considers quality improvementas a non-stop process whereby all members of staff are encouraged andsupported to offer quality services than they have done before(Burkoski &amp Yoon, 2013). A nurse manager would apply the conceptof CQI by structuring the work setting in order to facilitate thenurses’ ability to engage in actions that will improve care andreduce medical errors. The process would start with the developmentof a quality improvement program that has specific goals, such as thetarget percentage of reduction in cases of medical errors per month.This would be followed by the definition of the improvement process,its implementation, and evaluation (Burkoski &amp Yoon, 2013). Thesuccess of the CQI would be measured by determining changes in thenumber of cases of medical errors and patient satisfaction.

Theprocess of structuring the work setting would involve thedetermination of how individual and teams of nurses can collaborateamong themselves and with other members of staff within the healthcare organization in order to achieve the workplace objectives. Forexample, the nurse manager would assign the most complicated anddemanding roles to the most experienced nurses. This would befollowed by the formation of work teams comprising of the mostexperienced and the newly recruited nurses. The newly recruitednurses would learn and gain experience faster when working withnurses who have been delivering care to patients for many years. Thiswould in turn reduce chances for medical errors and create a platformfor inexperienced nurses to increase their competence with time andcontinue delivering quality care. The aspect of continuous qualityimprovement is confirmed by the fact that working in team facilitateslearning, which implies that each nurse would learn new techniquesand apply them in improving the quality of care (Kift, Creagh &ampQuinn, 2007).



Thestudent holds that CQI is based on the feedback regards, andcomplains raised by clients. By accepting criticism, the classmate isable to learn new ideas that facilitate continuous improvement interms of the level of quality of services as well as efficiency inthe delivery of care. Although relying on the feedback of clients iscorrect, it is important to base the process of CQI on research andempirical findings to inform the process of quality improvement(Hunters, Ober, Paddock &amp Levan, 2014). This is because researchis more reliable in helping the health care provider understand thecurrent trends that affect the quality of care than customercomplaints.


Thestudent presents a unique and an effective way of improving qualitycontinuously through the discharge follow-up and up-dating thecurrent information system. The classmate touched on one of thecritical issues in the health care setting. This is becausepost-discharge practices adopted by individual health careorganizations are associated with mortality of patients (Pouw, Peelen&amp Moons, 2013). This implies the process of enhancing the qualityof care with the objective of satisfying patients should includepractices (such as follow-up) that go beyond the care that is offeredwithin the hospital premises.


Thestudent makes a correct suggestion by stating that one way ofembracing CQI is through the streamlining of the staff educationalprograms with the objective of ensuring that they are up-to-date. Theapproach is correct because education and staff training providenurses with new knowledge and equip them with skills that theyrequire to adopt the modern practices (Borate &amp Borate, 2014).With new skills, nurses are able to offer services that address thespecific health needs of the modern clients. Therefore, an effectiveprocess of CQI is based on data, facts, and credible information.


Borate,S., &amp Borate, L. (2014). Acase study approach for evaluation of employee training effectivenessand development program.Chennai: Global Business Research.

Burkoski,V. &amp Yoon, J. (2013). Continuous quality improvement: A sharedgovernance model that maximizes agent-specific knowledge. NursingLeadership,26, 7-16.

Hunters,B., Ober, J., Paddock, M., &amp Levan, D. (2014). Continuous qualityimprovement in addiction treatment settings: Design and interventionprotocol of a group randomized pilot study. Addictionand Clinical Practice,9 (4), 1-11.

Kift,K., Creagh, S., &amp Quinn, C. (2007). Teamguide.East Lismore: Southern Cross University.

Pouw,E., Peelen, L., &amp Moons, K. (2013). Including post-dischargemortality in calculation of hospital standardized mortality ratios:Retrospective analysis of hospital episode statistics. BJM,347, 59.

Topic3: Health care organization

BostonChildren’s Hospital

Thesuccessful growth of the health care networks is dependent on theircapacity to address the specific needs of their patients. The healthcare networks are expected to prepare themselves for ongoing trends(such as the population ageing, increase in cases of chronicconditions, population diversity, and demand for quality) in order tosurvive a stiff competition in the next decade (Brown, 2015). Thispaper will address the preparedness of the Hospital Corporation ofAmerica (HCA) to address the health needs of citizens in the decade.The paper will focus on issues of network growth, nurse staffing,patient satisfaction, and resource management.


TheHCA has a master plan that will help it reach more clients in thenext decade. The master plan will facilitate the expansion of thenetwork through merger with other established health care facilities,expansion of the current facilities, and construction of new ones.However, HCA has developed a culture of expanding its network bymerging with other facilities more than focusing on growth throughother methods. In preparation to expand its services I the nextdecade, HCA has already acquired about a total of 15 health carefacilities between 2011-2015, which has helped the HCA increases itsbed capacity by about 3,900 (Cooper, 2015). HCA’s management holdsthat the objectives of making these acquisitions and mergers includeincreasing the market share, obtaining a consistent growth in orderto meet the needs of a growing population, leveraging the scale. Themanagement of HCA has also made an announcement that is looking forother large non-profit making facilities for acquisition (Cooper,2015). HCA has also embarked on a mission to acquire health carefacilities that will help it reach special categories of patients.For example, the acquisition of CareNow in 2015 was intended to helpHCA serve patients who need urgent care.


Thehealth care organizations have been facing staffing challenges, suchas the shortage of registered nurses and the lack of a workforce thatcan serve a diverse clientele. In the case of HCA, the management hasreviewed its recruitment policy in order to employ nurses fromdifferent backgrounds with the objective of enhancing its capacity toserve patients who come from different backgrounds (HCA, 2015). Apartfrom increasing the number of nurses, HCA is currently recruitingnurses who are competent enough to serve older adults and patientsfrom different cultural backgrounds (HCA, 2015). This is in line withprojections that the diversity of the U.S. population will continueto increase as the baby boomers continue to retire and immigrantscontinue to enter the U.S. This makes it appropriate for the HCA toprepare its workforce to address emerging challenges by recruitingnurses who are sensitive to the needs of the new categories ofpatients.


HCAconsiders employees and finance as some of its most criticalresources since their management influences its growth capacity in adirect way. To this end, the management focuses on the properutilization of these two categories of resources to achieve theorganization’s strategies. For example, HCA has been acknowledgedfor having the best compensation scheme in the health care sector(HCA, 2015). The scheme includes medical benefits, educationalbenefits, retirement benefits, long-term disability benefits, andCorePlus benefits that cover legal as well as short-term disabilityexpenses. This is part of HCA’s plan to manage its human resourceseffectively. In addition, the management of HCA has started todiversify in regions with established economies, including the largecities (Cooper, 2015). This will ensure that the financial resourcesare invested in acquisitions that will make a good return. A propermanagement of human and financial resources will help HCA exploitother resources.


Anincrease in demand for quality care and effective administration ofservices are some the common trends in the health care sector. Thisimplies that the health care facilities can satisfy their clients byoffering quality care an in a more convenient way. The management ofHCA seeks to enhance the quality of care by adopting the moderntechnology. For example, HCA was named as the most wiredorganizations in the health care sector (Paslick, 2014). The newtechnology will help HCA deliver quality care, serve more patientswithin a shorter time, and reduce the cost of delivering care. HCAhas a staff training program that equips nurses as well as othermembers of staff with skills that they require to deliver servicesthat meet the expectations of the organization’s clients.


Playerin the health care sector has been forced by changes taking place inthe U.S. economy to adopt the necessary changes that will help themdeliver up-to-date services. In the case of HCA, the management hasinvested heavily in acquisitions that will help the network serve thegrowing population and adopt the modern technology with the objectiveof enhancing the quality of care that is highly demanded by patientsin the contemporary society. In addition, the ongoing recruitment ofnurses takes account of the demand for nurses who are competentenough to serve the diverse clientele in the next decade.


Brown,B. (2015). Topseven health care trends and challenges for 2015: From our financialexpert.Salt Lake City, UT: Health Catalyst.

Cooper,L. (2015). HCAHoldings is planning large hospital system acquisition.New York, NY: The Street Inc.

HCA(2015). Investor relations: Executive officers. HCA.Retrieved October 19, 2015, fromhttp://investor.hcahealthcare.com/corporate_governance/directors_officers?page=1

HCA(2015). Healthywork environment.Nashville, TN: HCA.

Paslick,M. (2014). HCA Named one of the most wired healthcare system foryears running. HCA.Retrieved January 6, 2016, fromhttp://www.hcatodayblog.com/2014/07/17/hca-named-oneofthe-most-wired-healthcare-system-four-years-running/

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