Nursing profession is one of the professions, where the professionals have to deal with diverse range of aspects including both the service users and other service providers’ issues. Thus, the nursing professionals have to be more focused upon maintaining the quality of care provided, in any circumstances and accountable for the health outcomes of the patients (Roberts et al. 2009). Thus, nurses should have the competence to handle contemporary situation in healthcare. Based on the skills and competencies the health care authorities recruit a nurse, but there are a number of factors in a microenvironment of the health care, which can motivate or demotivate a nursing professional to retain her job in this sector. The key issues that influence the nursing professional’s recruitment and retention in the health care organization include authority, autonomy and staffing issues. My sole focus in this essay would be to explore micro-politics environment in the hospital and how it influences the nursing practice with a greater focus on the “person centered care” (Wu et al. 2012). One key issue in this context is the gap between the expression of nurse’s adoption of the holistic patient care aspects and the reality of practice obtained through the research data. Thus, identifying and mitigating the micro political issues are essential for understanding the influences on nurse’s recruitment and retention in the health care settings. Some of the issues, which would be focused in this essay are, autonomy, horizontal violence, staffing issues, power relations and oppressed group behavior.
Nowadays, recruiting a skilled nurse and retaining the staff for longer period is one of the key challenges for the hospital or other health care programs. The health care organizations are undertaking a number of strategies for retaining the nurses for longer period. Nursing shortage is one of the common issues in the health care sector. In spite of implementing diverse range of effective strategies, due to the influence of some micro politics related factors, nurses have to undergo unpleasant environment, sometimes, which is related to lack of support, lack of management or dominance of higher authority people. In this context, I will discuss some particular micro political issues, which are most common reasons behind the poor recruitment and retention of the nursing staffs in the organization.
According to Laschinger (2012) understanding nurse’s perceptions about their workplaces supports the effective recruitment and retention strategies. American Nurses Association (ANA) and American Academy of Nursing recognized the “magnet characteristics”, which are characterized as the organizational factors, supporting the effective nursing practice and working conditions in health care environment. I have revealed from the study that, with the use of these magnet characteristics, we would be able to understand the micro-political environment, which is accountable for poor nursing recruitment and retention strategies. During my personal experience as a nurse, I have encountered some of the common micro-politics issues in the health care settings. One of the common issues is horizontal violence (Sawatzky and Enns 2012). Horizontal violence is the practice, which is being practiced within nurse professionals. It promotes a negative work environment, decreasing the efficiency of teamwork and reducing the quality of patient care. While reviewing the previous articles, I have revealed that horizontal violence has a significant negative impact upon the management and retention of a nurse for longer period in the nursing care settings. If we try to find the evidence on horizontal violence, we might not get enough information, because, in most cases, the incidences are not reported. However, recent reports have highlighted 65 to 80% cases of horizontal violence in health care settings (Ceravolo et al. 2012). Strengthening. Bullying is the most common form of horizontal violence in nursing domain. In Australia, approx 50% nursing student experiences horizontal violence and humiliation (King-Jones 2011).
I have revealed from the report of Dumont et al. (2012) that the newly graduate nurses experiences a higher level of horizontal violence, which results in extended absenteeism, sometimes this situation leads to absenteeism. The resulting effects of horizontal violence include detrimental effects to the professionals. As a newly graduate nurse, I have also gone through a phase, when horizontal violence affected my self-esteem and promoted my burnout. In this context, I have critically evaluated the effects of horizontal violence and found that these kinds of situation can hamper the work of entire health team. I have observed the effects of horizontal violence from very close proximity (Sorensen et al. 2008). One of my colleague experienced anxiety and sleeping disorder. Other health effects of HV include depression, low self-esteem and agitation. The rate of leaving the job after experiencing horizontal violence is not rare. Due to the poor teamwork as a result of horizontal violence, essential information related to patient care is eliminated and the victimized nurse become in a poor position from where she might not be able to deliver promising nursing care to assigned patient, which in turn results in compromised health outcomes of the patient (Hayes et al. 2012). It also causes enhanced cost to patient, their families as well as organization. In contrast, a good management system, that can resist any kinds of practices related to horizontal violence, in the organization, can effectively enhance the nurse’s satisfaction level as well as can influence nurse’s retention for longer period.
The second theme in my unit outcome is related to the topic discussed above, as horizontal violence is one of the key issues in micro-political environment in health care settings. Another key issue in this context is autonomy. Autonomy is a common issue in health care context, which influences nursing staff’s dissatisfaction in teamwork, resulting in enhanced nursing turn over. Autonomy refers to such practice, when the nursing staff acts according to his or her knowledge in team, instead of taking other’s opinion (Twigg and McCullough 2014). From my perspectives, the person who is applying autonomy in a team wants to direct or control the other members of the team, which might not be satisfactory to the other members in the team. As a result, the dissatisfaction leads to nursing burnouts, less participation in the decision-making processes, which in turn promotes the thoughts of leaving the job. Thus, it should be treated as a critical cause of nursing turn over. As health care practices can be enhanced through teamwork, autonomy is usually not preferred, instead of that; a democratic leadership is usually preferred for prioritizing the thoughts of all the members in the health care team and considering the best parts in their concepts.
To meet the objectives of the person centered care, the teamwork is mostly preferred. On the other hand, providing autonomy to every person is necessary in all conditions. In some cases, it has been seen that the higher authorities are using autonomy as a tool of controlling the other nursing staffs. I have seen that, nurses, who prioritize their autonomy more than the values of being a member of multidisciplinary health care team, are mostly seen to misinterpret patient medication or reports. I have also revealed that many physicians declare them as care giver of a patient, playing the role of a registered nurse autonomously. These members may not have good training, thereby lowering the quality of health care practice. According to Van den Heede et al. (2013), “Not even all nurses agree that they are members of an autonomous profession, in our view mistaking a lower level of practical power for a conceptually subordinate practice role, and maintaining that physicians have final authority over all patient care decisions”.
I have experienced power relation related issues, while working in a health care setting as a registered nurse. The relationship between nurses, doctors and patients affects the experience of patient as well as nurses. A well managed power relation can promote the long-term retention of a nurse in a health care organization; in contrast, inappropriate relationships or power relation issues can lower the satisfaction of nurses, doctors or patients. I have seen that it is a common issue in multidisciplinary team, which promotes inappropriate behavior of nurses with patient, thereby deteriorating nurse-patient relationship. Usually problem arises when there is a lack of means through which the nurse’s perception can be adequately communicated (Knudson 2013). I have evaluated the reason behind moral suffering of nurses in a nursing care team, which includes such situations, when the nurses are able to make their moral judgments for the team or for the patients, but the decision-making is hindered due to lack of power issues. Thus, the nurse managers or leaders should consider power relation issues during the decision-making and related practices. It can significantly affect the patient-centered care, due to the hindrance in nurse-patient relationship as a result of “lack of power” issues of nurses, which in turn dissatisfies nurses, thereby enhancing the chance of increased nurse turn over.
Oppressed group behavior has been recognized in nursing practice over more than 2 decades, which has been considered as one of the common and pivotal issue in nursing care. According to my knowledge, oppressed group behavior is the kind of behavior of the group members, which might hurt a team member, affecting the person’s thought process. In nursing, while working in a multidisciplinary team, I have experienced oppressed behaviors from my team mates. From my experience, I have seen that, due to lack or leadership and management skills of the team leaders, these kinds of behaviors are prioritized and performed. However, these kinds of behaviors are not needed in the health care settings, as it can indirectly affect the patient’s outcomes.
In a team, oppressed behavior of the group member usually highly demotivates the staff and influence staff turnover. Murata (2014) stated that, the presence of oppressed group behavior in a health care team results into lowered nurse self-advocacy, burnout and negative aspects of the organization. The final outcome is nurse’s dissatisfaction, which in turn leads to leaving the job. With oppressed group behavior, person centered care service provision is usually not possible, as these kinds of decision enhances stress, anxiety or depression, thereby lowering the nursing staff’s participation in the team decisions, leading to the poor group performance, satisfaction and retention of nurses in the organization. It has been argued by Carrigan (2009) that nursing is an oppressed group, as it lacks power and control in the organization. I have revealed that the presence of oppressed behavior has been enhanced. From my perspective, the key reason behind these behaviors is that where the powerful people promote their own features as more valued, the dominated people feels devalued and thereby developing a distain for themselves and low self-esteem. I have experienced two behaviors “silencing” and “horizontal violence” described as oppressive group behavior, which can lead to increased nursing turnover (Tillott et al. 2013).
I have reviewed the surveys where nurses have discussed about their work life in hospital as a nurse. In most cases, I have seen that the question is unresolved. Sometimes results revealed the nature of their job, however, in most cases, nurses were not willing to express their actual feelings about their job. It indicates the dominance of power relationships. The other higher designation authorities usually control nurses in a multidisciplinary team (Duffield et al. 2011). Thus, to work peacefully, nurses have to follow all the instruction in the power relationship, which hampers her dignity as well as autonomy.
Staffing issue is another significant issue in contemporary health care context. Effective nurse staffing can help to keep nurses satisfied and patients safe. Improved nurse staffing is a good retention strategy, on the other hand a poor nurse staffing, for instance, if the staffing level is not appropriate, the nurses tend to leave their positions. I have revealed that to retain a specialty nurse, hospital authority has to bare $80, 000 (Dotson et al. 2014). Through the analysis of government reports of health care sectors, I have found that quality of nursing care saves lives. If nurses are forced to work in a high pressure, due to short supply of staffs, nurse’s burnout becomes higher, with negative patient outcomes. Due to short supply of staff, the remaining nurses become accountable for more complex care of more than one patient. It affects the mental stability and self-confidence of the nurse and get irritated due to huge pressure. From my personal experience,
I can say that, when a nurse has to work 24X7, the normal work-life balance is hampered, which can also affect the patient’s outcomes. This micro political issue can hamper the person-centered care and the perception of a patient about the nursing practices. Evidences say that more nurse burnout enhances the chance of patient infection and an unsafe environment, in contrast, appropriate staffing causes less death. When there is adequate staffs in a hospital, nurses can balance their work through the equal distribution of patient’s accountability within the existing staff, which helps the nurses to focus on the patient’s issues precisely. It reduces the chance of errors and nurse’s burnout. As a result nurse-patient relationship also gets strong, which is an important part in holistic and patient-centered nursing (Buffington 2012). In this context, nurse would be able to balance their work and life and would be satisfied. Finally, it would promote retention of a skilled nurse for longer period.
From the above discussion, I have gained an in-depth knowledge about several significant micro-political issues related to nursing care. I have modified my perception about the micro-political environment in the nursing. I have revealed that proper management and monitoring is required for recruiting and retaining nurses in the health care settings. From my perspective, as I have discussed above, to retain a specialty nurse, the organization has to spend adequate amount of money, sometimes, management does not implement a retention strategy, rather recruit newly graduate nurses in low payment with a thought that it would be better to recruit more new staffs than investing money for retaining a single specialty nurse. However from my perspective, this micro-political viewpoint is not right, because, the newly recruited nurses might not be as skilled as the experienced one; thus, either the organization have to invest for providing them a good training session, or the quality of health care would be lowered, affecting the health outcomes of a patient (Kean and Haycock-Stuart 2011).
In my future practice, I would always try to be responsible for all the aspects of my patients and would try to meet my professional standards and ethical codes. In a managerial post, I would attempt to implement effective strategy for retaining nurses and explore their expertise in emergency, instead of recruiting unskilled nursing staffs, thereby enhancing the quality of nursing practice (Leiter et al. 2009). Finally, as I know that health care provision following a holistic perception is only possible through effective teamwork, I would prefer democratic leadership and would try to discuss my perception with my teammates, for giving value to their perceptions. From my perspective, it is the only way to meet holistic needs of patients as well as to satisfy nursing staffs.
In conclusion, I would say that, the micro politics and related environment has a great influence upon the recruitment, retention as well as satisfaction of the nursing staffs. To deal with nursing retention strategies, the initial requirement would be to ensure a healthy and safe environment, where nurses can effectively work and become satisfied with high quality work and cooperation from their colleagues as well as higher authorities. In this context, i have revealed essential knowledge about relevant political issues that I would experience during my nursing carrier, which would promote my critical thinking skills to deal with these issues.
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