A-Level Coursework: Performance Improvement Analysis

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Human Resources -- Performance Improvement Analysis

The analysis is focused on a 32-year-old female Registered Nurse (here called XX) working in the Telemetry unit of an acute care hospital. XX has been employed by the acute care hospital for approximately 3 years total and in the Telemetry unit for six months. XX is a native of Jamaica and has a thick accent that is sometimes hard to understand. The nature of our work relationship is that we are colleagues in this unit, having worked together for the past six months, essentially 40 hours per work week. The specific performance problem requiring assessment is XX's repetitive failure to attend to patients who are toileting. The most recent incident involved an 88-year-old female patient who suffers from Stage 4 Colon Cancer and was admitted for syncope and to rule out pneumonia. Due to the patient's admission for a fall for unknown reasons, she was deemed a fall risk. The patient is prescribed Oxycontin ER 10mg p.o. b.i.d. And Hydrocodone/APAP 5/500 1 tab p.o. q 6 hours prn pain. While toileting the patient on a commode at approximately 10:45 PM, XX left the patient unattended for approximately 5 minutes, telling the patient to use the call light to summon XX. At approximately 10:50 PM, the patient's respiratory therapist entered her room and found the patient on the floor conscious but unable to get up without assistance. That patient complained of pain in the left side of her face including cheek and chin, left arm and shoulder and left hip. Patient's attending physician ordered X-rays of only her pelvis and right and left hips, however, finding no fractures. XX reported that XX was very frustrated because the patient did not appear to understand that she should use the call light to summon XX. Upon review, XX appears unaware of or apathetic to the hospital policies and procedures requiring constant supervision of this and other patients who are fall risks.

2. Body

Rating XX using the Individual and Organizational Precusors Scale (IOPS), XX received a disturbingly low score.

1 -- Awareness (Silverman, Pogson, & Cober, 2005, pp. 139-140): Her awareness rated a 1, as her statements regarding the patient indicate that she has little to no awareness of the need for her to change and constantly monitor all patients who are fall risks.

1 - Sense of Necessity (Silverman, Pogson, & Cober, 2005, pp. 139-141): XX shows little desire to change her own behavior and constantly monitor fall-risk patients; rather, she blamed the aged, cancer-ridden, highly drugged patient for the patient's own fall.

2 - Confronting Change (Silverman, Pogson, & Cober, 2005, pp. 140-1): XX has at least some awareness of the aspects of constantly monitoring a patient, as she has successfully monitored other patients off and on in other circumstances.

2 - Willingness for Feedback (Silverman, Pogson, & Cober, 2005, pp. 140-1): XX has at least the awareness of our reaction to the patient's fall and that she is in trouble because of it; consequently, she merits approximately a 2 in that she has some willingness to listen about the problem.

1 -- Development Orientation (Silverman, Pogson, & Cober, 2005, pp. 140-1): XX does not appear to seek opportunities for growth and development. If she was a person seeking opportunities for growth and development, her reaction to the patient's fall would have been different: she would have accepted accountability for the incident and explained her difficulty in constantly monitoring the patient in terms of her own shortcomings rather than blaming the patient.

7 - TOTAL SCORE. XX should be categorized as Unaware. Through her neglect of the fall-risk patient despite clear hospital policies and procedures and her immediate reaction of blaming the aged, cancer-ridden, drugged patient for her own fall, XX has shown herself to be very nearly unable or unwilling to close her performance gaps. Furthermore, this is not an isolated incident of patient neglect on XX's part. Obviously, XX will require a development guide, intensive coaching (Brocato, 2003, p. 18) and personal accountability with the imposition of significant consequences.

Rating the acute care hospital according to the Organizational Precursors Items, unfortunately the hospital received a deservedly low score.

1 -- Organizational Alignment (Silverman, Pogson, & Cober, 2005, pp. 141-3): the supervising nurse's immediate reaction to the incident and to XX's excuse was "You NEVER leave a fall-risk patient alone when the patient is out of bed." The supervising nurse also immediately referred to hospital policies and procedures to that effect. However, XX was obviously unaware or unconcerned about the supervising nurse's principles and about applicable hospital policies and procedures, even after 3 years at the hospital and 6 months in the Telemetry Unit. Consequently, organizational expectations obviously do not filter down to the individual level in this instance.

2 -- Organizational Feedback Environment (Silverman, Pogson, & Cober, 2005, pp. 141-3): The performance practice of constantly monitoring fall-risk patients does not flow through the entire organization because it was clearly not impressed upon XX. However, the nursing supervisor was immediately and clearly aware of the desired performance practice and did communicate those to XX and to the patient's concerned family members.

3 -- Formal Individual Growth Opportunities (Silverman, Pogson, & Cober, 2005, pp. 141-3): The hospital does provide adequate number and quality of growth opportunities for willing employees, and some continuing education is mandatory for RNs.

3 -- Accountability (Silverman, Pogson, & Cober, 2005, pp. 141-3): There is inconsistent accountability in the organization for desired changes. Depending on the desire, awareness and practices of the individual employee and supervisor, the hospital's desired changes are implemented to varying degrees of effectiveness. For example, I am certainly aware of hospital policies and procedures regarding fall-risk patients and have never varied from that high standard; however, a fellow RN in the same unit has exhibited very poor adherence to those policies and procedures over a six-month period.

1 -- Compensation System (Silverman, Pogson, & Cober, 2005, pp. 141-3): There are no variable pay systems for RNs in this hospital.

10 -- TOTAL SCORE. The hospital is categorized as a Static Organization that fails to reinforce change and forces employees to seek help outside the hospital for change. This categorization is fitting. The organizational expectation of closely monitoring fall-risk patients did not filter down to all employees. In addition, the practice of closely monitoring fall-risk patients is clearly inconsistent throughout the hospital, as some employees adhere to the policies and procedures while others do not. Fortunately, the hospital does offer adequate opportunities for learning and development, which are used to varying degrees by employees. Nevertheless, the level of accountability for monitoring the fall-risk patients is inconsistent, depending on the employee and his/her supervisor and there is no monetary encouragement for appropriate changes by employees.

The Performance Improvement Action Plan for XX should be extensive. XX has a significant problem with change but so does the organization (Silverman, Pogson, & Cober, 2005, p. 143). Training-related actions should be employed in the form of mandatory in-service training about acute care for fall-risk patients -- and for all hospital policies and procedures for standards of care - including proficiency testing by a specified date in order for XX and any other employee to be cleared to work on any unit (Schraeder & Jordan, 2011, p. 6). In addition, the supervising nurse should coach XX (Brocato, 2003, p. 19): the supervisor will need to get to the root of the problem through a series of questions to find whether a lack of knowledge or a lack of desire cause XX's failure; if the answers lead the supervising nurse to believe the root is a lack of knowledge, XX must be taught whatever knowledge she needs but lacks; if, on the other hand, a lack of desire is the root, the supervising… [END OF PREVIEW]

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