Nursing Practice Foundation - Essay Example

of the Nursing Practice Foundation Introduction How medical professionals and consumers define quality in a healthcare environment may vary widely. But, in a consumer-driven marketplace, its important to have a solid understanding of how patients perceive their healthcare experience. In particular, the gap in perception between the nurses definition of quality and that of the consumers of nursing services (patients) may reflect an opportunity for healthcare providers to improve customers perceptions. Quality Nurses Its no secret that nurses are becoming an increasingly rare breed. But how do nurses think quality of nursing should be defined? Whats important and whats not in the minds of nursing professionals? We conducted a study on how nurses define quality healthcare as a potential management tool for recruiting and retention of good nurses. We also located a gap opportunity for healthcare marketers to help delight their patient customers. Trying to get the answers to these questions is where we started. Our thought was that if nursing managers know more about how nurses think about quality, it should help in recruitment and retention of quality-care-delivering nurses. What we found may be of wider application because, with effective internal marketing programs, consumer perception of the quality of their care may be improved. The reasons for the worldwide shortage of nurses according to the nursing literature include aging of the profession with shrinking class sizes for RNs--as much as 50% smaller compared to the 70s and 80s. Further, the womens movement of the 70s and 80s dramatically expanded the professional opportunities for women globally. Nursing has failed to attract males into the profession in sufficient numbers to overcome the loss of women to other professions. [Rogers-Clark] ]9 he overall falling numbers have hit intensive care units (ICUs) particularly hard. ICUs have historically attracted and required younger registered nurses (RNs). The percentage of RNs under age 30 has fallen by nearly 40% since the 80s. The rapid decline in the number of RNs under age 30 in the workforce, together with the aging RN population (nearly 60% of the current RN workforce is age 40 and older), certainly helps explain the current acute shortages in the ICU. With the dramatic changes in nursing demographics, administrators are scrambling to get and retain quality nurses in order to deliver quality healthcare to patients. To address the problem, we first needed to define what quality patient care is--what it looks like--and to define the qualities of good nursing according to nurses. Quality Nursing Defined We examined service quality literature to determine what dimensions explain the variance in customer perception of quality services. The literature indicates that, in service industries such as nursing, achieving and maintaining quality service begins with recruiting the right employees with the right attitudes and the required technical expertise. Training to orient the employee to their expected performance levels then follows good recruitment. Following training, successful managers empower their employees to do their jobs and support them in their efforts. Finally, organizations retain these employees through job satisfaction. All these steps must occur in an environment of a self-monitoring culture of self-motivating employees. That isnt easy to achieve. Successful nursing administrators certainly earn their keep. Beginning in the mid-80s, researchers Len Berry, A. Parasuraman, and Valarie Zeithaml, at Texas A&M University, addressed the major service quality marketing questions of (1) What is service quality? (2) What causes service quality problems? and (3) What can service organizations do to improve quality? They found that quality is whatever the customer defines as quality--not managements or even the employees definition. Customers expectations shape their assessment of the quality of the service. When a discrepancy between customers expectations and the service providers understanding of those expectations occurs, real service quality suffers because what customers expect (the real quality) most likely wont be delivered. The root of any service problem or advantage is typically a "people" problem or advantage, respectively. To avoid misunderstandings, unmet customer expectations, and resulting poor quality perception on the part of customers (patients), organizations should institutionalize and symbolize the important quality dimensions in ways all employees understand and accept. Specific steps recommended by the Texas A&M researchers to achieve service quality are (1) Including all levels of employees in any quality improvement efforts; (2) Viewing skills-development as a process; (3) Closing the quality loop by setting standards then comparing performance to those standards and following with action; (4) investing in problem resolution capabilities; and (5) always communicating often and well inside and outside, the organization. Later these same researchers suggested that one of the keys to improving service quality is to compete for talent and then allow that talent to be free to develop and deliver good service. In short, hire well, train well, empower, and manage with enlightenment. Sound easy? It isnt. Created in 1988, the SERVQUAL scale of Berry, Parasuraman, and Zeithaml is the "gold standard" for service quality examination. It contains the following five dimensions of service quality: (1) Tangibles, such as the physical surroundings, the cleanliness and appearance of employees, communications material, equipment; (2) Reliability, which is the ability of the service provider to do the job correctly and efficiently; (3) Responsiveness, which is the demonstrated attitude of attentiveness to the needs of the patient (or customer), (4) Assurance, which is the ability to provide the customer with the feeling that theyre cared for and their problems will be solved; and (5) Empathy, which is communication of understanding and concern for the patient or customer. The Gap--The Opportunity Services are generally intangible and are inseparable from the person providing the service. This is especially true with high credence services, such as healthcare. A well-known CEO of a successful airline once remarked that, to the customer, coffee stains on the tray table meant that proper engine maintenance wasnt performed. Hes right. Is it too much of a stretch to imagine that a nurse whose appearance is perceived by the patient as sloppy might give the impression that the needle is not sanitary or the medicines are mixed up? Likely not. Firms spend large amounts of creativity, money, and time to materialize the intangible and manage the environment to project a quality image. For example, in services requiring high credence for high quality confidence (e.g., physician, attorney, banker), office environments designed for success will be well-appointed and have the appropriate licenses and degrees in a visible place to build customer confidence. Healthcare is a high credence service because most patients arent medically qualified to objectively evaluate the service received. But they do judge it and use tangibles as an important part of their quality decision. They then use their perception to guide their future behavior. They also share their impressions with friends and family, particularly negative perceptions, and will influence expectations and perceptions of those friends and family. Tips for Managers Undertaking a program of orienting nurses to the importance of tangibles (including their appearance) can help improve patients perception of quality nursing. Obviously, some real land mines exist in such programs--from nurse morale issues (no one wants to feel judged as being sloppy or inadequate) to very real litigation issues. Accordingly, in any plan to improve nursing tangibles, we should expect to take the good advice of the experts and make sure all affected people (i.e., nurses, staff) are included as real participants and are the prime movers of the actions in any programs from its inception. Neatness and cleanliness cant be achieved without the total support of those who must be neat and clean. If the nursing service provider (the nurse) feels forced to behave against her or his will or beliefs, they tend to focus on the lousy way theyre being treated rather than on delighting the customer. And they almost have to pass their feelings on to the patient because the service is inseparable from the (nurse) provider. The typical patient isnt pleased with poor, inadequate service or even adequate service if its delivered by a grouch. The resulting damage to the image of the organization in such instances is expensive and wide ranging. Its also unnecessary. Our advice for improving the perception of the quality of the healthcare your patients receive is to communicate to the nurses how the patient looks at tangibles and set the task of improvement within their range of direct responsibility. Naturally, employees cant be empowered by management from on high. They have to accept the power offered, which means there must be something in it for them. It seems to us that, because quality is viewed by patients as including tangibles, the nursing profession itself must demand appropriate attention be given to tangibles. As research has repeatedly indicated, professionals, whether nurses, engineers, or teachers, generally identify more closely with the profession than with the specific organization they serve. Conclusion Professional nurses now have "skin in the game" for improving tangibles. Accordingly, management should work through the nurses themselves to set customer-determined levels of tangibles for nursing. Encourage the nurses to set the metrics to close the loop (e.g., not more than one snack tray per month allowed from pharmaceutical representatives on the floor per shift), together with a process of feedback and analysis and providing incentives aligned with the agreed-upon goals. Then hold nurses accountable as a team and individually, rewarding results appropriately. Works Cited Aiken, L., et al.: "Satisfaction with Inpatient AIDS Care: A National Comparison of Dedicated and Scattered-bed Units," Medical Care. 35(9):948-962, 1996. Buchan, J.: "Still Attractive After All These Years? Magnet Hospitals in a Changing Health Care Environment," Journal of Advanced Nursing. 30(1):100-108, 1999. Havens, D., and Aiken, L.: "Shaping Systems to Promote Desired Outcomes," Journal of Nursing Administration. 29(2):14-20, 1999. Jones, R.: "Conceptual Development of Nurse-Physician Collaboration," Holistic Nurse Practice. 8(3):1-11, 1994. Kramer, M., and Schmalenberg, C.: "Staff Nurses Identify Essentials of Magnetism," Magnet Hospitals Revisited. Washington, D.C.: American Nurses Publishing, 2002. Scott, J., et al.: "Review of Magnet Hospital Research," Journal of Nursing Administration. 29(1):9-19, 1999. jons, k(2003) Health and Human Behaviour. South Melbourne: Oxford Rogers-Clark, C. Martin- McDonald, K., & McCarthy, A. (2005). 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