WORKPLACE ASSESSMENT1

Workplace Assessment

Geraldine Sanfillippo

Thomas Edison State College

NUR-632

February 24, 2012

WORKPLACE ASSESSMENT1

Workplace Assessment

Categories of the Questionnaire

The culture of health care helps define the organization and is reflected in the behaviors and beliefs of its members. It is important for leadership to create an environment where staff can thrive. Values and beliefs need to be ingrained throughout the organization.According to Porter-O’Grady, the culture of healthcare excellence embodies professional behaviors of autonomy, personal accountability for competence and honesty. Surveys allow the organization to have a better understanding of the employee’s perception of the work environment, the leadership within the organization and their ability for professional growth. Surveys help to identify if the staff mirrors managements vision of the organization. The American Nurse Credentialing Center (ANCC) nurse opinion questionnaire can be divided into at least 4 distinct categories ("ANCC”). The four categories represented in the questionnaire are as follows:

Organizational questions focus on the relationship between the vision of the organization and how well it translates to the employee and their involvement in the organization. Is there a collaborative relationship in decision making?

Leadership Support is looking at the relationship between the nursing leadership and staff. Is the leadership team available through open communication and participation in decision making?

Quality of Professional Practice focuses on those questions that favor the professional models of care, consultation and resources, autonomy and nurses as teachers. These professional practices are examples of the Forces of Magnetism

Personal/Professional Development questions provide a snapshot of how the organization provides opportunities for the nurse’s professional advancement. Are there programs in place that allow them to advance professionally certification in their specialties? Does the organization encourage and support higher education?

Category / Questions
Organizational / 1,2,3,and 15
Leadership Support / 4, 5, 21 and 25
Quality of Professional Practice / 6,7,8,9,10,11,12,13,14,23 and 26
Personal /Professional Development / 16,17,20,22 and 24

Theories represented

The focus of administrative theories is on the total organization and how it attempts to extend principles that will support leadership to become more effective. The three theories that I have chosen to examine and relate to the ANCC questionnaire will include, Fayol’s 14 principals of management, McGregor- Burns Transformational Leadership and The Hersey-Blanchard Situational Leadership Theory.

Through Fayol’s work, organizations are offered 14 principals of management intended to guide managers to function more effectively.

James MacGregor Burns initially introduced the term transformational leadership in 1978 when he used it to describethe process by which "leaders and followers raise one another to higher levels of morality and motivation". Later Bernard Burns, a disciple of Burns, further defines this type of leadership as how the leader affects followers who are intended to trust admire and respect the transformational leader. This type of leadership works from the premise of inspiration rather than the reward and punishment. The components of transitional leadership include:

  • Charismatic influence of leadership to make followers want to identify with the leader
  • Inspirational Motivation the ability of the leader to articulate a vision that the followers find appealing
  • Intellectual stimulation, leaders are willing to take risks and solicit ideas from their followers.
  • Individualized consideration, the leader acts as a coach or mentor while listening to the needs and concerns.

The Hersey-Blanchard theory states individual leaders of employees, instead of using one style, should adapt their leadership style based on the needs of the employee. According to Hersey and Blanchard leader styles can be broken down into four categories; telling, selling, participation and delegation (Hersey & Blanchard, 1997). “The single biggest way to impact an organization is to focus on transformational leadership. There is almost no limit to the potential of an organization that recruits good people, raises them up as leaders and continually develop them.”(Maxwell, 2001, p. 18)

Question 1. Nursing enjoys strong and effective representation on planning and policy making bodies within the organization?

We can apply Fayols principle 8 as it applies to today’s environment. Decision making is no longer made by upper management with the trickle-down effect. Today decisions are made based on the expertise of those needed to solve the problem (Rodrigues, 2001). Unit practice councils and shared governance is an example of how this works in today’s environment.

Transformational leadership depends on a high level of engagement between leaders and their subordinates and stimulating them into action with more ideas that are more proactive instead of reactive (Kelly, 2003). Burn’s transformational leadership has the potential to motivate staff to higher self actualization (Habel & Sherman,).

Through participation in planning and policy making of the organization, the organization participates in situational leadership through participation. Leaders focus more on the relationship and the group works as a team and shares decision making responsibilities.

Question 2. Quality assurance / improvement activities are implemented with staff nurses involvement.

Fayol’s principle 13, initiative can be applied to this question in the survey. Organizations today rely less in hierarchical elements and more on the employee who thinks independently and takes initiative to implement ideas (Rodrigues, 2001). Again we look at the unit practice councils developed to identify and examine practice concerns in their particular specialty areas. Through this evaluation staff identifies opportunities for improvement, develops and implements a plan.

Transitional leadership in healthcare encourages empowerment of the workforce. This can best be described as self- directed allowing staff to take responsibility and provides the authority to make decisions on matters that affect them. This allows for a more collaborative environment and promotes creativity in solving issues (Trofino, 1995).

Hersey-Blanchard situational leadership theory can best be described as participating (S3) where they work together as a team and shared decision making responsibilities and the ability to function independently(Hersey & Blanchard, 1997).

Question 3. Staff nurses have access to clinical experts including but not limited to advance practice nurses.

Today’s interpretation of Fayol’s principle 12 that describes the on-going employee training and development. This is best explained through the concept of nurse mentorship programs designed to pair a novice or new employee with an advanced practice nurse for the first year of employment to ease the transition to nursing or the organization. Hopefully this will establish a relationship that last beyond the prescribed year.

The transitional leader of today must be encouraged to emerge in the organization to educate and develop novice nurses and serve as preceptors, mentorsand coaches. Achieving this type of teamwork will help support the growth of synergistic relationships (Trofino, 1995).

Hersey and Blanchard define this process as influencing the activities of an individual or a group in efforts toward a common goal in a given situation. This type of leadership works with or through individuals and groups to accomplish organizational goals (Trofino, 1995, p. 44). This can be described as the stage where competent leaders are encouraged to act as consultants helping to guide and be involved in decision making

Question 4. I am empowered to manage my nursing practice

The application of Fayol’s principle 2 today would be that employees are empowered. Organizations today emphasis less the practice of the boss but more the participation of the employee in decision making through self managed work teams with decisional autonomy and control of activities. The manager in these situations act more as a coordinator (Rodrigues, 2001, p. 881).

Burns view of transformational leadership is one in which the follower is seen a vital member of the team and encourage to participate in a shared governance environment to enhance a sense of belonging among staff (Habel & Sherman,). Individuals are valued for their individuality and their contribution to the organization.

Based on Hersey-Blanchard situational leadership and maturity levels, staff in the S 4 / M4 level of maturity is encouraged to work independently with much of the decision making belong to the staff. Additionally they tend to take on the sole responsibility for the accomplishment of the task (Hersey & Blanchard, 1997).

Relevance to Nursing Administration

Rapid changes and increasing difficulty in today’s healthcare environment requires staff to be empowered. The workforce needs to be self directed, and the authority to make decisions and take responsibility for situations that affect them. One of the most important evolutionary forces in transformational health care is the shift from management to leadership in nursing. The leader has become the catalyst empowering nursing staff to move in the direction of patient directed health outcomes (Trofino, 1995, p. 42). Critical to the power of transitional leadership is the need to promote and support purpose that is always in the best interest of both the leaders and the followers (Trofino, 1995). Transformational leaders must be encouraged to emerge in an organization to educate and develop their staff. Transformational leadership is a motivational style of management whereby employees are encouraged to achieve greater performance through inspirational leadership which develops employee self confidence and higher achievement of goals (Scotti, 2010). For an organization to create and sustain a culture of excellence in patient care and outcomes, this type of leadership is essential.

Positive Work Environment

As nurses, we constantly strive to achieve better patient outcomes. The focus of the questions that I have chosen is to examine if nurses have the ability to be heard with respect to their practice. Are they involved in the decision making of the organization and do they have the necessary resources to be successful? The ANCC recognizes a dynamic transformational driven culture as part of a Magnet environment. A shared governance model is essential to embrace and enhance transformational and innovation where nurses can communicate and share their ideas. Nursing surveys are conducted annually to gauge how the professional nurse feels about the organization, leadership support, quality of professional practice and professional development. Is the organization using the appropriate tool? Nursing practice makes a difference in care if nurses are empowered and nurses have influence over their work environment. For nurses to be successful, an environment supporting nursing must exist.

Applicability to Nursing

Throughout the years there have been several employee surveys used in our organization and most recently the ANCC for nursing as recommended for Magnet facilities. It has been my experience that staff is reluctant to participate in surveys because they feel they are not reliable and for fear of retaliation to their unit if poor results are received. Staff does not look at the survey the same way leadership does. Unless leadership takes the time to review the importance of the survey and the results, staff looks at it as a means to complain and that it is one more time when nothing will be done to correct problem. They need to understand that surveys are an effective tool to have their voices heard and acted upon by senior leadership. Individual department results should be shared with staff and they should be engaged in the action plans to correct the areas with opportunity for improvement identified in the survey. There should be timelines established to review outcomes and to reassess the plan if necessary. Unless the organization is willing to develop its own annual survey, I believe that the ANCC captures the essence of what is important in nursing today.

References

Habel, M., & Sherman, R. O. (). Transformational leadership - a growing promise for nurses. Retrieved from

Hersey, P., & Blanchard, K. H. (1997). What is situational leadership theory? Management of organizational behavior. Retrieved from

Kelly, M. L. (2003, January 1). Academic advisors as transformational leaders. The mentor. Retrieved from

Maxwell, J. C. (2001). The 17th irrefutable laws of teamwork; embrace them and empower your team (1st ed.) []. Retrieved from

Nurse Opinion Questionnaire - American Nurse Credentialing Center - ANCC. (). Retrieved from

Porter- O’Grady, T., & Malloch, K. (2007). Managing for success in health care. St Louis, Missouri: Mosby.

Rodrigues, C. A. (2001). Fayol’s 14 principles of management then and now: a framework for managing today’s organizations effectively. Management Decision, 39/10, 880-889. Retrieved from

Scotti, K. (2010). Transformational leadership. Retrieved from

Trofino, J. (1995, August). Transformational leadership in health care. Nursing Management, Vol.26 No. 8 (42-47).