Management and Leadership in the Nursing Practice

Managementand Leadership in the Nursing Practice

Managementand Leadership in the Nursing Practice

Effectivemanagement and leadership are critical tools that the health carefacilities, similar to other organization need to enhance theircapacity to deliver quality services. Challenges that occur in thehealth care facilities are opportunities for the nurse leaders tovalidate their skills as they work to excel in executing theircomplex leadership roles and responsibilities. Measures taken toaddress the challenges that the health care facilities should supportthe delivery of quality care, ease access, and ensure the long-termsustainability of the entire health care system (Kelly &ampCrawford, 2013, p. 4). This paper will provide a discussion on theuse of the 8 D problem solving tool to address the issue of nurses’workload at the ABC Tertiary Care Facility.

Discipline0: Plan

The8 D problem solving tool recommends that a succinct plan should bemade, which should outline the strategy that will be used to addressthe challenge at hand. This includes the determination of the membersof the problem solving team, time required, and resources required toaddress the problems (Hill, 2014, p. 1). To address the workloadworries at the ABC Tertiary Care Facility, a team of four will beformed. The team will be composed of a registered nurse from Team 1,a licensed practical nurse from Team 2, unit’s human resourcesmanager, and the nursing unit manager. The team will require twoweeks to analyze the workload problem in the facility and proposerecommendations. Resources required include time, notebooks, pens,and a computer. The team will use the unit facilities to conductmeetings, which will reduce the cost of hiring a conference facility.

Discipline1: Building the team

Thisis the first step in the 8 D step problem solving tool. At this step,a team of stakeholders will be formed and set ready to analyze theproblem of workload worries. One of the key considerations whenselecting members of a problem solving team is the skills (Khan,Hafeez, Saeed, 2012, p. 317). To this end, the team selected toaddress the issue of nurses’ workload at the facility will becomposed of individuals who served in either of the Team 1 and Team 2for not less than 6 months. Selecting the members from differentteams will allow diversity, which will in turn result in theidentification of a creative and a viable solution.

Discipline2: Describe the problem

Problemdescription will take place once the team has settled down. This willbe accomplished with the help of the problem-definition process tool.The first step involves the writing of the initial problem statement,which aligns the team members about the problem being addressed(Mukka, 2014, p. 1). In the present case, the problem statement willbe “We want to address the issue of nurses’ workload at ABCtertiary care facility”. This is based on the fact that nurses havebeen complaining about the workload. From case, the unit manageroverhears Jenny Marloone complaining about the workload she assignedin Team 2 compared to Team 1. Therefore, the second step will involvechecking whether the problem is being addressed at the right level.This will involve the assessment the powers and responsibilities ofthe team to address the workload issue at the unit level. In thethird step, the team will frame the problem situation. This will beaccomplished by determining the reality (such as inadequacy ofnurses) and expectations (such as availability of a sufficient numberof nurses to share roles and shifts).

Discipline3: Implementation of the temporary fix

Implementationof a temporary fix is crucial when the problem being addressedaffects the quality of services, results in displeasure of customers,and slows down the work process. Nurses’ outcome is directlyinfluenced by workload (Al-Kandari &amp Thomas, 2008, p. 139).Consequently, the team will identify a temporary fix to the issue inorder to ensure that patients get quality services. In the presentcase, a temporary fix may include the recruitment of interns, hiringsome nurses on a contractual basis, or paying the overloaded nursesfor extra tasks they do. The idea of a pay for extra work is based onthe fact that nurses perceive that they have been receivinginadequate pay for the workload. For example, Kelley Morris remarksthat nurses are reassigned out of Team 2 because they becomefrustrated, especially by inadequate for the workload. This willprovide a temporary solution as the team progress with the process offinding a permanent solution.

Discipline4: identification and elimination of the root cause

Oncea temporary fix is implemented, the team will focus on identifyingthe underlying cause of nurses’ workload at the facility. This willbe accomplished by conduct a cause-effect analysis. The analysis willbe expected to reveal all the possible causes of the nurses’workload, including those that the nurses and unit manager are notaware. Once of the root causes have been identified, the team willembark on the determination of the most viable permanent solutions.The Straw Man Concept will be used to identify the possiblesolutions. Straw Man Concepts involves drawing of the first draftthat is presented for criticism as well as testing (Stringcan, 2013,p. 1). The feedback received is used to frame a permanent solution.

Discipline5: Verifying the solution

Thefifth discipline involves a thorough testing of the proposed solutionbefore it is fully implemented. The team will test the proposedsolution by conducting the impact analysis and the blind spotanalysis. Impact analysis ensures that unexpected consequences willnot take place in the future (Hill, 2014, p. 1). Impact analysis willbe done by brainstorming the major areas affected (Team 1 and Team2), evaluating the negative as well as the positive impacts, andmanaging the consequences of the proposed solution. The blind spotanalysis, on the other hand, ensures that the team has not overlookedthe key factors or made incorrect assumptions when drafting thepermanent solution. Blind spot analysis will be conducted by checkingthe process of decision making sing by the team against the commonblind spots list.

Discipline6: Implementing the permanent solution

Oncea permanent solution has been identified and tested, it will beimplemented step by step. The implementation process will bemonitored closely to ensure that the solution works correctly, whileavoiding any unexpected side impacts. The solution will beimplemented by the facility as a whole, but it will be theresponsibility of the health unit manager to monitor theimplementation process and determine its success.

Discipline7: Prevent the problem from recurring

Aftermonitoring the progress and success of the program in addressing theissue of workload, the unit manager will gather the members of theproblem solving team. The second gathering will focus on theidentification of strategies that should be used to prevent therecurrence of the problem in the future. This is a critical step thatmight call for radical changes in the facility’s policies,standards, and procedures as well as the unit’s training manual inorder to ensure that they reflect the new solution that hasimplemented (Hill, 2014, p. 1). In addition, the unit manager mightconsider changing the management procedures and practices if therewill be convincing evidence that such changes will prevent therecurrence of nurses’ workload in the future.

Discipline8: Celebrate team success

Thelast step in the problem solving process is to reward the team’ssuccess. This involves an expression of gratitude and appreciation ofthe contribution made by each of the team members from the firstphase of the problem solving process to the implementation (Hill,2014, p. 1). In this step, the unit manager will organize acelebration party, which will be instrumental in communicationappreciation to all the team members. The unit manager will use thisparty to inform the team members that their hard work made adifference. Before disbursing the gathering, the unit manager willmake a post-implementation review, which will involve the analysis ofwhether the implemented solution has been working as anticipated. Thereview will also include a mention on whether the solution haveimpacted the way the facility should be addressing its challenges inthe future. This will mark the end of the process of addressing theissue of nurses’ workload at the ABC Tertiary Care Facility.


Healthcare facilities, similar to other organizations face seriouschallenges that threaten the process of delivering quality servicesto their clients. The management of the health care facilities has aprimary responsibility of ensuring that these pressing challenges aresolved and the chances for their recurrence reduced. The choice ofthe problem solving tool selected by the management depends on thetype of problem being addressed, effectiveness of the availabletools, and the intended outcome. In the case of the ABC Tertiary CareFacility, 8 D problem solving tool will result in the successfulreduction of the nurses’ workload and prevention of workload in thefuture. The effectiveness of this tool is based on the fact that itencourages the use of teams in the process of solution finding. Thisensures that the proposed solution is owned by employees who areexpected to implement it, which in turn increases the acceptance ofthe recommended solution.


Al-Kandari,F. &amp Thomas, D. (2008). Adverse nurse outcomes: Correlation tonurses’ workload, staffing, and shift rotation in Kuwaitihospitals. AppliedNursing Research,21, 139-146.

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Kelly,P. &amp Crawford, H. (2013). Nursingleadership and management (2ndCanadian ed.).Ontario: Nelson Education Ltd.

Khan,S., Hafeez, A., Saeed, M. (2012). The impact of problem solvingskills of head’s on students’ academic achievement.InterdisciplinaryJournal of Contemporary Research in Business,4 (1), 316-321.

Mukka,M. (2014). Effective problem definition: How to get more than halfway to solve your problem. CocatalystLimited.Retrieved November 16, 2014, from

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