Paper
Thursday, July 22, 2004
Improving Nursing Workplaces
Marianne P. McLennan, BScN, MEd, Quality Improvement, Quality Improvement, Vancouver Island Health Authority, Nanaimo, BC, Canada
| Learning Objective #1: Describe how social dynamics in settings can shape nursing work problems and influence improvement efforts |
| Learning Objective #2: Identify implications if workplaces are reconceptualized as practice settings co-owned by interacting nurses and managers |
Objective: To explore how nursing work settings shape issues and organizational policy making by describing how one priority issue, improving management, was understood. Design: A qualitative research design was used to explore key stakeholder perspectives so that social dynamics that interact to shape the management issue and proposed solutions could be illuminated. Population, Sample, Setting, Years: The investigation was conducted in 2003, within one Canadian health care organization in order to ensure a common administrative context. Concept: Work as a setting, which contains environmental characteristics that influence nurses’ health and productivity as well as facilitates or blocks improvements, was explored. Methods: Interviews with the chief nurse and three kinds of stakeholder focus groups were conducted: nurses; nurse managers, and union representatives. Content analysis was used to define the management issue, potential improvements, and desired results. Findings: Participants agreed on aspects of the management problem and desired results, however, differed in suggested improvement strategies because of divergent views about root causes of the problem. Evidence of human agency suggested that people are active both in assessing and acting on the meaning that things have for them as individuals and as groups. Conclusions: Developing definitions of work issues within their unique setting supports policy formulations that resonate with local people and their situations. Explicit leadership expectations for managers that emphasize fundamental staff relationship building are needed to engage nurses in jointly owning their workplaces. Implications: Recognizing that nursing leadership is embedded in settings amid active people and changing circumstances challenges traditional action -result thinking and therefore, represents a fundamental shift in prevalent leadership practices with significant implications for education and research.
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Sigma Theta Tau International
July 22-24, 2004