Interview and Interdisciplinary Issue Identification
Running head: Interview & Interdisciplinary Issue Identification
Interview and Interdisciplinary Issue Identification
Stephen Bufano
Interview Summary
For this assessment I interviewed Registered Nurse, Nicole.
Nicole works in a wound center associated with a nearby hospital. The center is outpatient and sees roughly 30-45 patients in a day, depending on which physician is assigned to come in Some days the center sees only physician, but most of the time there will be a different physician for morning and afternoon. The wound center is a medical facility that manages new and chronic wounds that have developed for patients either at home, through a hospital stay, post-surgical, or at times through their stay at a rehabilitation facility. The wound center has only a staff of 5 full time nurses, one part time and one PRN nurse, 4 different physicians, a Nurse Practitioner who is also the center’s manager, 2 secretaries and a director who is from an outside agency named Healogics. The center is open 5 days a week with varying hours of operation due to the physician’s needs and schedule.
Nicole, along with the other 3 full time nursing staff, works as both a floor nurse for the center as well as a case manager for an assigned physician. If she works the floor, Nicole’s role comprises of the first healthcare person the patient sees and the last. They bring in a patient, obtain a set of vitals, obtain any consents needed to see the doctor and to be treated accordingly (which needs resigned once a month), undresses the wound area, cleans and preps the wound area for the physician to come in, and then once the physician is done Nicole will dress the wound according to the physician’s updated orders, educate the patient, send the patient to the front to schedule their weekly appointment, and then also clean the room for the next available patient. Should the patient be a new patient, Nicole will conduct an interview process to ascertain why the patient has been referred to the center, obtain a medical history, review any and all medication currently being taken, obtain photos of the wound for documentation and statistic review.
The days that Nicole acts as a case manage with a physician, she will follow the physician from room to room, depending on the order of arrival, assist with any in-center procedures such as debridement of the wound, applying a skin graft, obtaining cultures, and conveying the new orders to the floor nurses so that the appropriate medication dressing is applied. While working as both a floor nurse and a case manager, Nicole is also tasked with answering phone calls from patients under her assigned physician’s care, as well as any home health agencies who see their patients in between office visits. Nicole must make sure that appropriate charting has been completed, both in the hospital program but also in Healogic’s program (IHeal), in order for physician orders to make it to any outside agency also contracted to care for the patient, and also to ensure appropriate billing. Nicole mentions that in essence the center must perform double charting of all information since Healogics has become invested in the wound center and is also tracking patient care and progress.
The main issues at the wound center Nicole stated was “lack of leadership”, “lack of trained assistive staff”, and “disconnect between hospital policy and Healogics policy”. Nicole points out that when the center is fully staffed with well-trained staff, the days are not so bad, however the center has consistently struggled with turnover since her time there (three years in and she is the veteran nurse). Nicole stated that with the center being understaffed, they are not always able to ensure top level care to patients who truly need it in order to heal from their wounds. The center’s manager does not act in a leadership role, therefore different nurses are doing the same job different ways. Nicole also states when it comes to her physician, it can be very difficult to see patients in a timely manner and the communication between health care workers and the patient to be fluid and understanding. Not only does this physician go to any room he sees in his peripheral vision, therefor not in order of arrival/appointment, but he does not wait for his case manager before going into the new room, which can leave Nicole trying to catch up to the events and conversations in the room between doctor and patient. Nicole states this physician also tends to overbooks his days at the center, and with only a few nurses on the floor they are physically and realistically unable to see the patients scheduled every 15 minutes. Nicole stated she has tried to bring this up to both the office manager and the center director on many occasions and has only been met back with empty promises on the issues to be addressed. Nicole explained that the office staff that schedules utilizes a program that Healogics does not, and therefore schedules up to 9 different people in a 15-minute time frame, citing this as one of the ways Healogics and the center do not work within the same reality. Nicole also states that since the office staff work out of a different program for scheduling, there are instances almost daily where a patient walks in stating they have an appointment, has an appointment card, however their name was not on the list of patients to be seen that day, the only list available to the nurses working there.
Nicole states that most nurses who begin there go through about a two-week period of training, between charting and hands-on with patients, and then are considered “fully trained” and ready to be on their own. Nicole stated management has never attempted to follow-up in those first two weeks with the floor staff to ascertain whether the newly hired nurse will be able to become independent or need more training. Nicole has taken on the responsibility to ensure they are competent when she is in the room with them and makes sure to give them any education in the moment that they need. Nicole mentions no extra compensation is given when they are instructed to train new hires. Nicole also stated that different nurses there work in different ways and can sometimes lead to different assessments in the charting, which can become troublesome when looking up how a patient has been healing while under their care. She cites measuring wounds in different ways can lead to incorrect charting, and in turn to incorrect billing as well.
Issue Identification
The main issue identified repeatedly through the interview was a lack of cohesion between the hospital policies that the center operates under, and Healogics’ policies that they must also adhere to. If the disconnect continues, the nurses will continue to struggle to be on the same level of understanding with patient care, which can lead to serious problems for the center should a medical error occur. The nurses will also continue to be overwhelmed and must deescalate frustrated patients who have endured long wait times due to overscheduling.
Change Theories That Could Lead to an Interdisciplinary Solution
Kurt Lewin’s change theory could be a plausible solution to help Nicole’s center to create a solution. There are three phases to Kurt Lewin’s change theory, unfreeze, modify (transition), and refreeze. When there is a recognition for change, that is the unfreeze phrase. This phase identifies what needs changed and then fosters the replacement of old attitudes and behaviors. Change (transition) is to then plan the change, implement the change developed and then help employees learn new concepts. Once the changes have been implemented, this is the refreeze phase. (Shirey, M.R., 2013)
The change theory by Kurt Lewin could possibly be successfully utilized in the wound center. The center manager, Cindy, has heard from Nicole and other staff members about the ongoing challenges, so she realizes the issues exist and a change is needed. Starting with the first phase, unfreeze, Cindy could meet with the staff and identify specific actions within the center that are no longer beneficial, and then flowing into the next phase she could work with the staff and the director to develop a new policy to help ensure the center runs more smoothly. She then could ensure policy education to all staff members is completed to a singular standard. Once education is complete, Cindy can implement the new department policy and follow-up to confirm the staff are following all new procedures and activities.
Leadership Strategies That Could Lead to an Interdisciplinary Solution
Suliman et al. (2020) stated that there are three different types of leadership styles, transformational, transactional, and passive avoidant. Transformational leaders take their follower’s ideas about what they feel is important, and changes the way they see their environments, challenges and opportunities, and themselves in a new way. Transactional leaders work with persons and/or teams to identifying and creating detailed work goals, establishing specific work objectives, determining individuals’ ability, and defining what benefits followers can look to obtain when they complete the task effectively. Passive-avoidant leaders, in turn, do not thoroughly recognize challenges and they also avoid any intervention on their part.
For the center, I do not believe utilizing the transformational style would be beneficial. Staff may feel as if leadership is not listening to their concerns and instead changing the conversation to something else. Cindy could utilize the transactional style in order to collaborate with the staff to identify and develop policies and work-related goals. This allows the staff to feel like their concerns have been heard and are a valuable part of the team that can contribute to new ideas. Utilizing this style would also help Cindy to identify different issues within the center, not just for the nurses but for the front desk clerical workers.
Collaboration Approaches for Interdisciplinary Teams
The interview with Nicole highlighted some of the challenges the wound center is currently experiencing. Management who has not seen to be present or attentive, staffing issues, scheduling discrepancies, etc. One of the main stressors Nicole mentioned was the physician with which she case manages. He does not follow the order/flow of the patient appointments, does not collaborate closely with his case manager, and leaves staff confused and frustrated in his wake. This kind of provider can be incredibly difficult to work with. This kind of behavior could be behind partially why there is such a high turnover rate at the center.
A journal article by Jihad Mustapha identifies the importance of interdisciplinary relationships within a facility such as the wound center. He states that “the patient is the most important part of the puzzle”, and that they “should always be the center of attention”. Patient-centered care is becoming more and more common practice within healthcare. Team members must work together in order to give the patient the care they deserve and need. A staff at odds with each other can not possibly be as effective in delivering care. Dr. Mustapha also states that “a liaison between members of the team is also essential to building a successful interdisciplinary relationship.” If Cindy were to step up, listen to the nurse’s concerns, she could go to the doctor at the wound center and have a professional conversation concerning the events of the day. Dr. Mustapha also states that the team does not have to always agree, but instead “should always discuss the issues that are causing tension”. This would allow input and collaboration between all members of the wound center in order to provide better care.
References
Mustapha, Jihad A, MD,F.A.C.C., F.S.C.A.I. (2019). Patient focus, interdisciplinary collaboration key in CLI teams. Cardiology Today Intervention, 8(3), 8. Retrieved from http://library.capella.edu/login?qurl=httpswww.proquest.comtrade-journalspatient-focus-interdisciplinary-collaboration-keydocview2304086605se-2accountid27965
Shirey, M. R. (2013). Lewin’s theory of planned change as a strategic resource. JONA: The Journal of Nursing Administration, 43(2), 69–72. https://doi.org/10.1097/nna.0b013e31827f20a9
Suliman, M., Almansi, S., Mrayyan, M., ALBashtawy, M., & Aljezawi, M. (2020). Effect of nurse managers’ leadership styles on predicted nurse turnover. Nursing Management, 27(5), 23–28. https://doi.org/10.7748/nm.2020.e1928
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