Interview Summary
I interviewed a former nursing colleague, Emily Wood, who now works at Robert Wood Johnson Barnabas Health in New Jersey, a healthcare organization that provides care services to a large portion of New Jersey community members. This facility is also the biggest academic healthcare system in the state, providing comprehensive healthcare services as well as bringing the best of research and teaching, academic medicine, and community partners together to improve health outcomes for individuals and communities. Emily works as a registered nurse in the cardiothoracic ICU, and her roles include overseeing the nursing department during her shift and providing nursing care to patients with critical heart issues and conditions. She is trained in providing comprehensive care to patients needing medical or surgical treatment for conditions like chest trauma, heart failure, heart disease, and lung conditions in ICU settings. Besides, she is responsible for providing respiratory support, administering medications, monitoring patients’ vital signs, and performing advanced interventions, including vasoactive medication titration, hemodynamic monitoring, and mechanical ventilation.
During my interview with Emily, I enquired whether her organization was facing any current issues or had experienced any in the past. She stated that one of her unit’s major current issues was getting qualified nursing staff to care for patients. The unit is understaffed and overstretched and requires the charge nurse for all shifts (Emily is the charge nurse during her shift) to assign duties to nurses from other departments to maintain minimal staffing. However, the problem with this strategy is getting less qualified nurses for the ICU. With this problem, Emily and other nurses have to work extra hours or even an extra shift to assist other nurses in caring for patients and also directing other less qualified nurses on what to do. In addition, this problem has led to poor coordination and communication with other professionals in the unit including cardiologists, physicians, and other support staff as nurses are overloaded and burned out, which can put patient safety at risk through medical errors.
While the organization has tried hiring more registered nurses for the unit, it appears that qualified nurses have failed to apply for the positions. The unit has been getting new nurses, but due to inadequate training, the charge nurse has to assign qualified nurses to train the less qualified ones. This wastes a lot of time in the unit and affects their ability to serve patients’ needs effectively hence the need for interdisciplinary collaboration.
Issue Identification
The issue of understaffing and poor coordination in the cardiothoracic ICU is an interdisciplinary problem that requires teams such as nurses, cardiologists, physicians, and other support staff to work collaboratively to find ways to address this problem. With less qualified staff, the unit is overstretched, which affects the ability to attend to patients’ needs. As described by Emily, the overload in the ICU has resulted in burnout among nurses as the department continues to find qualified registered nurses. In the ICU section, patient safety is of utmost concern for healthcare professionals. However, various factors can compromise patient safety, including ineffective teamwork, psychological and physical overload of health professionals, and failed organizational processes (Garcia et al., 2019). The healthcare organization has failed to adopt effective hiring strategies to reach out to a diverse range of registered nurses. As a result, the ICU section has missed out on qualified nurses who could resolve the issue of understaffing.
While there has not been an immediate solution to the hiring process, the current personnel are overloaded and work extra shifts, leading to burnout and poor communication and coordination with other health professionals. Therefore, this issue requires an immediate solution using the interdisciplinary approach. This approach is suitable since it entails combining the expertise of professionals from various disciplines to provide effective and comprehensive solutions to complex issues. By bringing together health professionals with diverse perspectives, an interdisciplinary team can provide a more effective and holistic approach to care, ultimately resulting in efficient use of healthcare resources, improved quality of care, and better patient outcomes.
Change Theories That Could Lead to an Interdisciplinary Solution
The Plan-Do-Study-Act (PDSA) cycle is a quality improvement framework that is utilized in healthcare environments and can be applied to inform interdisciplinary solutions to the issues the cardiothoracic ICU section faces at the healthcare organization. The staff shortage experienced in ICU has created problems in communication and coordination, which could potentially jeopardize patient safety. The PDSA change model is related to the issue of understaffing as it outlines various steps in developing an effective solution to the organizational issue. Using the PDSA cycle requires the interdisciplinary team to work together in identifying the problem, implementing a solution, and evaluating the potential solution to the organizational problem (Prybutok, 2018). While other change models, such as the ADKAR and Lewin’s Change model, can inform an interdisciplinary solution to the present issue, the PDSA cycle is desirable since it focuses on continuous improvement and can be effectively applied to identifying and implementing a solution to the problem the cardiothoracic ICU department is currently facing.
In supporting the use of the PDSA cycle change model, the article “Ninety to Nothing: a PDSA Quality Improvement Project” was published in the International Journal of Healthcare Quality Assurance, which publishes high-quality case studies and research in the field of healthcare quality improvement. This implies the article has undergone extensive evaluation and review by experts in this field, hence increasing its credibility. Besides, the study utilizes the PDSA cycle framework commonly used in healthcare quality improvement initiatives, and findings from the study are relevant to organizations seeking to improve their organizational processes to achieve better patient outcomes.
Leadership Strategies That Could Lead to an Interdisciplinary Solution
As the charge nurse, Emily acts as the leader of all other nurses during her shift. Whenever there is a problem, it is her duty to ensure the problem is effectively resolved. While the department is experiencing staffing issues that have affected communication and coordination, adopting the situational leadership strategy can help develop an interdisciplinary solution. The approach is relevant to this issue since it entails adjusting leadership style to meet the needs of the present situation as well as the involved team members (Belrhiti et al., 2018). To apply situational leadership, the leader assesses the situation, adapts leadership style, fosters communication and coordination, and provides resources and support to ensure the interdisciplinary team performs their duties effectively.
The article “Complex Leadership in Healthcare: A Scoping Review” was published in the International Journal of Health Policy and Management, which is a well-respected peer-reviewed journal in the field of healthcare management. The article synthesizes existing literature to provide a comprehensive scoping review on the topic while providing a detailed and clear methodology, lending credibility to their findings. In addition, the article addresses a crucial topic in healthcare leadership and is relevant to healthcare professionals interested in enhancing their leadership skills to effectively navigate different complexities in the healthcare system.
Collaboration Approaches for Interdisciplinary Teams
In order to improve interdisciplinary collaboration at Robert Wood Johnson Barnabas Health, interprofessional education (IPE) is an essential strategy that should be adopted. This strategy focuses on the significance of training healthcare professionals from other departments to promote collaboration and team-based care. The cardiothoracic ICU department faces the problem of less qualified and trained staff, which can be addressed through this collaboration approach. Furthermore, the team strategies and tools to enhance performance and patient safety (TeamSTEPPS) is another collaboration approach. This is an evidence-based approach to team-based care that comprises diverse strategies and tools for improving collaboration, leadership, and communication (Rosen et al., 2018). TeamSTEPPS aims to develop shared decision-making processes and common goals to enhance coordination and communication to improve patient outcomes, therefore relevant to the issue the cardiothoracic ICU department faces.
The collaboration approaches discussed above have been supported by Rosen et al. (2018) in their article “Teamwork in Healthcare: Key Discoveries Enabling Safer, High-Quality Care.” This article provides an extensive analysis of the literature on teamwork in healthcare and summarizes key findings on the topic. By using rigorous methodology in identifying and analyzing relevant studies, the authors lend credibility to their findings. Besides, the article emphasizes the importance of teamwork in ensuring high-quality care and improving patient outcomes. Therefore, the topic is relevant in the modern healthcare environment, which recognizes the importance of team-based care and interdisciplinary collaboration.
References
Belrhiti, Z., Nebot Giralt, A., & Marchal, B. (2018). Complex leadership in healthcare: A scoping review. International Journal of Health Policy and Management, 7(12), 1073–1084. https://doi.org/10.15171/ijhpm.2018.75
Garcia, C. L., Abreu, L. C., Ramos, J. L. S., Castro, C. F. D., Smiderle, F. R. N., Santos, J. A. D., & Bezerra, I. M. P. (2019). Influence of burnout on patient safety: Systematic review and meta-analysis. Medicina (Kaunas, Lithuania), 55(9), 553. https://doi.org/10.3390/medicina55090553
Prybutok, G. L. (2018). Ninety to nothing: A PDSA quality improvement project. International Journal of Health Care Quality Assurance, 31(4), 361–372. https://doi.org/10.1108/IJHCQA-06-2017-0093
Rosen, M. A., DiazGranados, D., Dietz, A. S., Benishek, L. E., Thompson, D., Pronovost, P. J., & Weaver, S. J. (2018). Teamwork in healthcare: Key discoveries enabling safer, high-quality care. The American Psychologist, 73(4), 433–450. https://doi.org/10.1037/amp0000298
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