Essay on Negative Culture Plagues Medical-Surgical Units: Impact on Nurses

Introduction

Most medical-surgical units struggle with a negative culture characterized by low employee satisfaction and a high turnover rate. Their departments tend to trail behind the financial and nursing indicators of the entire hospital. The vast majority of nurses on these units do not take part in career advancement programs. Consequently, an unhealthy culture exists in the units, including gossip, a lack of teamwork, and a sense of favoritism. Nurses gradually get used to and accept the toxic work environment while becoming desensitized to bullying. The negative culture associated with medical-surgical units must change.

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Affected Population

The population to be affected by the change is the nurses assigned to medical-surgical units. Medical-surgical nursing happens to be the single biggest nursing specialty in the United States. The registered nurses belonging to this specialty primarily practice in hospital units. Their roles involve caring for acutely ill adult patients suffering from a wide range of diseases and medical conditions, or are recovering from surgery. For anyone who has ever been hospitalized, the nurse who cared for him or her is most likely a medical-surgical nurse.

A notable characteristic of medical-surgical nurses is that they are excellent coordinators. They are among the most skilled multitaskers in a clinical setting. At any given time, a medical-surgical nurse is juggling care for several patients that includes administering medications, offering patient education, discharging some patients, and admitting new ones. The nurse does all this while keeping the unit's entire healthcare team on the same page. Medical-surgical nurses are always moving physically, emotionally, clinically, and intellectually. They happen to be the healthcare professionals who coordinate care for patients round the clock. Such a working environment makes it easy to induce a negative culture in medical-surgical units.

Literature Review

The article titled Nurses' perceptions of bedside clinical handover in a medical-surgical unit: An interpretive descriptive study contains useful information on how to bring about change in medical-surgical unit culture. It contains findings of a research study on how nurses perceive bedside clinical handover in an inpatient medical-surgical unit. Clinical handover is the exchange of relevant and crucial patient care from one healthcare provider to the other. The effectiveness of such a handover is determined by the transfer of important information and continuity of high quality patient care. In a medical-surgical nursing setting, bedside clinical handover usually takes place during shift changes. Various nurses take part in such a handover whereby each contributes to ensure continuity of quality healthcare and patient safety.

The study involved interviews conducted on nurses working in an acute-care hospital. The subjects described that bedside clinical handover has the potential to compromise confidentiality of patients. They mentioned that patients, their family members, and the hospital were some of the constant sources of distractions and interruptions. Also, bedside clinical handover served as a communication platform amongst nurses, and between patients and nurses. The study's results offered an insight into how nurses perceive bedside clinical handover and presented a basis for medical-surgical nurses to boost the handover process.

The content and context of change of shift report on medical and surgical units is another article that can help bring about change in medical-surgical unit. It contains findings of a study to find out the current context and content of CoSR (change of shift report) on medical-surgical units. It also explored whether medical-surgical nurses utilize computerized support in the course of a CoSR process. It is worth bearing in mind that a CoSR is a common handoff that can lead to gaps in patient care. The study involved observation of face-to-face, bedside, and audiotaped CoSRs on several medical-surgical units in acute care facilities. The study exposed high noise levels, lack of content structure, failure to use electronic records, and interruptions in the units as part of the CoSR process. The findings present some of the ways in which CoSR can be improved. They include an evaluation of the types of reports suitable for certain units, determination of a tailored and consistent report structure, a reduction in noise and interruptions, and figuring out the suitable content for computerization.

The article titled Introduction of a team-based care model in a general medical unit outlines a new model that makes patient care in a medical-surgical unit more patient-centered and family centered. The model also enables the unit to utilize its health human resources more effectively by boosting collaborative practice. It includes changes to how nurses and other healthcare providers deliver care as well as changes to skills mix aimed at supporting the new processes. The model introduces evidence-based care processes such as comfort rounds, initial patient orientation and assessment, patient whiteboards, team huddles, and bedside shift reports. A small portion of patients admitted to the unit are cared for by small teams of nurses. This model is meant to enhance quality of patient care and safety by enabling medical-surgical nurses work better within a collaborative practice environment.

Findings from the study showed that overall, the new care teams and care processes outlined in the model worked excellently. Unit collaboration and culture were improved together with role clarity, patient care, and scope of practice. Staff surveys were conducted, whose responses were overwhelmingly positive as they showed considerably positive changes. According to administrative data, there were slight reductions in overall patient length of stay, staff vacancies, 30-day re-admissions, the overtime rate, and staff absenteeism. The study's findings prove that this is the ideal model to bring about change in medical-surgical unit culture.

Draft Implementation Plan

To induce change in medical-surgical unit culture, it is important to assess both the unit and the team. Most such units lack a formal recognition program and do not have unit celebrations. One way to change this culture involves initiating a new formal employee recognition program meant to standardize and boost fairness in selecting the employee of the month and year. The shared governance model can be used to recreate the unit-based council in a way that involves all team members in the decision-making process.

Unit managers and supervisors can set one-on-one meetings with staff members with the aim of getting to know each other. The superiors get to discover the strengths, shortcomings, and long-term goals of medical-surgical nurses and other employees. By applying employee rounding data, the management can work with staff members in order to offer them growth opportunities. The unit can put in place a formal nursing development program whereby the management encourages staff members to take part in their career's growth and development. The managers and supervisors can communicate a shared vision by motivating staff to be innovative and risk takers for them to improve.

References

Hastings, S. E., Suter, E., Bloom, J., & Sharma, K. (2016). Introduction of a team-based care model in a general medical unit. BMC health services research, 16(1), 245.

Roslan, S. B., & Lim, M. L. (2017). Nurses' perceptions of bedside clinical handover in a medical-surgical unit: An interpretive descriptive study. Proceedings of Singapore healthcare, 26(3), 150-157.

Staggers, N., & Jennings, B. M. (2009). The content and context of change of shift report on medical and surgical units. JONA: The Journal of Nursing Administration, 39(9), 393-398.