Role of the Nurse Manger in the Clinical Outcome of Dialysis Patients Term Paper

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¶ … Nurse Manger in the Clinical Outcome of Dialysis Patients

The objective of this research is to investigate how the manager 'nurse leadership' effect patients in terms of clinical outcomes in regards to dialysis patients. This role is one that is critically important specifically relating to medications given during dialysis and in monitoring lab values.

The work of Karen Steib entitled; "Nephrology Nursing" relates that career paths of the nephrology nurse may include "direct care of patients with end-stage renal disease (ESRD) who receive dialysis or who undergo renal transplants as well as education of patients, communities or health professional about risk factors that can result in chronic kidney disease. Another career path is in research into the effectiveness of treatment modalities and the impact of nursing practices and patient outcomes or as well may be a career path of advocacy and working with government agencies in developing health policies that will serve to improve the care provided kidney disease patients. (paraphrased, 2008) it is important to understand as stated by Steib that "nephrology nursing encompasses total patient care, because the kidneys affect every other major system in the body-cardiovascular, pulmonary, gastrointestinal, etc. Co morbidities, especially diabetes and high blood pressure, are usually causative factors in CKD and must be addressed concurrently. And because treatment for kidney disease is costly, patients also face numerous psychosocial and financial issues." (2008)

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Term Paper on Role of the Nurse Manger in the Clinical Outcome of Dialysis Patients Assignment

For the nephrology nurse who has the capacity to deal with the "bigger picture" this means overseeing sometimes multiple dialysis centers many hundreds of patients. Steib (2008) for others it may mean overseeing only one dialysis unit. Steib (2008) relates that patients who are involved in dialysis sometimes must go in three and four hours at a time and multiple days per week making treatment feel like a job to them. (Steib, 2008; paraphrased) the work of Thomas-Hawkins, Denno, Currier, and Wick (2003) entitled: "Staff Nurses' Perceptions of the Work Environment in Freestanding Hemodialysis Facilities" states that a study conducted of a hemodialysis work environment states that the majority of perceptions of the hemodialysis work environment "were evident" however "discontent with many aspects of the work setting also was apparent." (2003) it is stated that "low levels of agreement with several characteristics that distinguish magnet hospitals environments were noted..." (Thomas-Hawkins, Denno, Currier, Wick, 2003) it was agreed among 34% of nurses that "the dialysis unit determined its own policies and procedures" and 36% agreed that nursing contributions to patient care were publicly acknowledged." (Thomas-Hawkins, Denno, Currier, and Wick, 2003) Finally fifty percent agreed that new and innovative ideas about patient tare were supported." (Thomas-Hawkins, Denno, Currier, and Wick, 2003) This study reports findings on PES-NWI subscales that "the mean score for the Nurse Participation in Dialysis Provider Affairs subscale was 2.25, indicating that this sample did not perceive that their work environments supported a participatory role and valued status for nurses." (Thomas-Hawkins, Denno, Currier, Wick, 2003) Stated as the mean score for the "Nurse Manager Ability, Leadership and Support Nurses subscale of 2.62 is stated to indicate that "the nurses agree, somewhat, that the nurse manager had a critical role and supported nurses in their dialysis units." (Thomas-Hawkins, Denno, Currier, Wick, 2003) Specifically it was reported by 59% of nurses that their nurse manager was a good leader and manager while 60% of nurses agreed "that the nurse manager backed up the nursing staff in decision making. However, only one half of the nurses agreed that they were given praise and recognition for a job well done." (Thomas-Hawkins, Denno, Currier, Wick, 2003) it is critical to note that "the staffing and resource adequacy subscale mean score of 2.28 indicates that respondents, overall, disagreed that there was adequate staff and support resources to provide quality patient care in their current job." (Thomas-Hawkins, Denno, Currier, Wick, 2003) Also stated in the study findings reported by Thomas-Hawkins, Denno, Currier, Wick are the following statistics:

Nurses who disagreed there were adequate support services allowing nurses to spend time with patients 60%

Nurses who disagreed that there were enough RN on staff to Provide quality patient care 61%

Nurses who disagreed that there were enough staff to get the work

Done and enough opportunities to discuss patient care problems

With other nurses 55%

Nurses who agreed that physicians and nurses had good working

Relationships 68%

Nurses who agreed that there was collaboration between Nurses and physicians 62%


Thomas-Hawkins, Denno, Currier, Wick states that the magnet hospitals "were distinguished by organizational characteristics that promoted professional nursing practice." (2003) Attributes included were those such as: (1) decentralization decision making by bedside caregivers; () inclusion of chief nursing executive in top management decision making; (3) strong, supportive, and visible nursing leadership; (4) unit self-governance; (5) participative management with open communication; (6) good nurse-physician relationships and collaboration; (7) low nurse turnover rates; (8) adequate staffing levels; (9) richer nursing skill mix that indicates a high priority is placed on quality nursing care; (10) flexible scheduling; (11) recognition for excellence in practice; and (12) opportunities for professional development and career advancement. (Thomas-Hawkins, Denno, Currier, Wick, 2003)

This study relates that two in ten nurses in this study and in dialysis units were planning to look for another position of employment in the near future. Nurses in this study were from the following types of organization:

Profit dialysis facilities 74%

Not-for-profit 19%

Unsure of the facility's classification 6%

Urban facilities 41%

Suburban 39%

Rural 18% (Thomas-Hawkins, Denno, Currier, Wick, 2003)

It is stated in this study that those in the sample below the age of 30 having a "potential for a long-term career in nephrology was quite low (5%)." (Thomas-Hawkins, Denno, Currier, Wick, 2003) This work states that as the generation of nurses in the 'baby boomer' generation "begin to retire, career opportunities for women continue to broaden, and the nursing faculty shortage worsens, dialysis providers will likely continue to face difficulty in filling vacant nursing positions." (Thomas-Hawkins, Denno, Currier, Wick, 2003) These authors relate in their report that solutions needed in addressing "the shortage of nurses in hemodialysis settings must not only include strategies to increase the supply of new nurses entering nephrology settings, but must also include efforts to retain current nurses and to adapt the hemodialysis work environment to support the practice of an aging workforce. Clearly, the traditional use of rewards for new employees to increase staffing levels, such as sign on bonuses, penalizes those who remain loyal. To retain nurses, dialysis organizations will have to develop policies that foster, recognize, and reward retention and organizational loyalty. Moreover, while a richer nursing skill mix is characteristic of magnet hospital environments, the typical skill mix in hemodialysis units is 30% licensed (including RNs and licensed practical nurses) to 70% unlicensed personnel." (Thomas-Hawkins, Denno, Currier, Wick, 2003) One identified challenge for "executive/administrative staff in dialysis organizations is to identify effective models of care for hemodialysis units that enable nurses to provide quality patient care (e.g., the use of an advanced practice nurse as part of the dialysis team) as well as gain a clear understanding of what is required to ensure successful implementation of these models."

It is stated additionally in the study findings that nurses in this studied were not asked in relation to their "reasons for leaving" however "data from other studies have indicated that job dissatisfaction and burnout may be important predictors of nurses' intentions to leave their jobs for example, 43% of hospital nurses who reported high burnout and were dissatisfied with their jobs intended to leave their current job within the next 12 months compared to only 11% who were not burned out and who remained satisfied with their jobs. Inasmuch as job satisfaction and low levels of emotional exhaustion and burnout are features of magnet hospital environments, dialysis organizations might consider a retention strategy that includes the assessment of these important nurse outcomes and their relationship to hemodialysis nurse retention." (Thomas-Hawkins, Denno, Currier, Wick, 2003) Finally, recommendations of this study state: "Factors contributing to job dissatisfaction and burnout in hemodialysis facilities could be explored and addressed, and the impact of these efforts on retention could be documented." (Thomas-Hawkins, Denno, Currier, Wick, 2003)


The following table lists the responses of nurses in this study on various items included in the survey:

Nurse Participation in Dialysis Provider Affairs


Nurse managers consult with staff on daily problems and procedures

Staff nurses have the opportunity to serve on committees

An administration that listens and responds to employee concerns

Opportunities for advancement nurse in senior management in your organization is highly visible and accessible to staff (e.g., VP, Director of Quality Management)

Career development/clinical ladder opportunity

Staff nurses are involved in the internal governance of the dialysis unit

Opportunity for staff nurses to participate in policy decisions (Thomas-Hawkins, Denno, Currier, Wick, 2003)

Nursing Foundations for Quality of Care


High standards of nursing care are expected by the administration

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"Role of the Nurse Manger in the Clinical Outcome of Dialysis Patients."  April 30, 2008.  Accessed September 24, 2020.