Nursing Leadership Term Paper

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Hepatitis C Exposure Incident Report

Recently eighty patients at the Norman Regional Hospital have tested positive for Hepatitis C Employee James Hill admitted to reusing needles up to 25 time a day while administering pain medication. At least 38 cases can be positively associated with exposure at the clinic, while another 35 may be associated. As acting Nurse Manager, I have been assigned the task of developing a strategy for dealing with this situation. The following will discuss the issues and policies involved in effectively dealing either the current situation and developing a plan to prevent future similar events from occurring.

This issue is multifaceted and there are several elements to consider when dealing with the issue. The first concern is the safety of the infected patients. The second is that there many be possible violations of Federal laws involved. The third issue is to analyze the situation from a management standpoint and to assess the conditions that led to the event and analyze how to prevent them in the end. The fourth consideration is how to prevent a media circus and restore public faith in the Hospital.

Regulations regarding the control of exposure to bloodborn pathogens is contained in 29 CFR 1910.1030, (OSHA Directive CPL 2-2.44D, 1999). Under this regulation each facility must have a plan in place to prevent exposure to bloodborn pathogens. This exposure plan is required to be updated annually. Under this regulation all human blood is to be treated as if it is contaminated. Failure to comply with this guideline will result in a citation or other corrective action to the facility. The incident contained in this report represented a violation of Federal law under the mentioned statute. These issues must be dealt with in a way as to prevent future exposure episodes. These regulations also include protocols to follow in the case a series of patients are exposed to bloodborn pathogens. In this particular situation, strict adherence to the protocols regarding infected patients must be followed as there is no other alternative (OSHA, 2001).

Currently the Norman Regional Hospital has Bloodborn Pathogen Exposure Plan in place. This plan is reviewed annually as mandated by OSHA. In the case of this exposure it is clear the methods and procedures contained in the plan were ignored by the employee involved. The plan strictly prohibits the reuse of needles from one patient to another. Until now the Bloodborn pathogens plan has been reviewed by administration and handed down in an authoritarian manner to employees. Many of the employees feel that some of the procedures in the plan take too much time and that they are pressured with increasing patient loads, therefore steps get skipped.

Perhaps, instead of an authoritarian approach to leadership in this case, Robert House's path-goal leadership approach may be more effective in raising the employee level of consciousness in regards to the necessity of following the rules. This approach would turn the focus from a more us against them situation, seen with the authoritarian approach to a group goal oriented approach. The group goal in this case, would be to eliminate the possibility of patient exposure to bloodborn pathogens.

The second situation that arises from the exposure incident is that corrective measures must be taken to eliminate the possibility of the situation reoccurring in the future. In an interview with the employee, James Hill, several concerns arose. James had always been an exemplary employee since his employment in 1993. When asked the reason for the blatant violation of protocol, he cited the that they are being placed under more and more pressure to work more quickly due to increased patient load. The pressure to perform has become so great the many employees are beginning to develop their own short cuts in order to keep up. James explained that while he was aware of the risks and regulation associated with bloodborn contaminant exposure, the pressure to work faster outweighed the possibility of consequences.

Staff has been managed with an authoritarian approach of concrete regards and punishments. In this case, James felt the risk of being punished for being non-productive would be more than the slight perceived risk of patients becoming ill from his actions. Under the authoritarian leader model, John knew the punishment sand risks of breaking protocol, however, in his mind weighed the law of averages and decided that there was very little chance of getting caught due to the patients becoming exposed to bloodborn contaminants (Leonard, 1995).

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Under the current system of hospital leadership, a list of violations is in existence and a written set of punitive measures for each violation. This system has proven to be fair in execution in h past. However as can be shown by this incident, it does not guarantee that a severe safety violation will not occur. The reason for this lies in motivational theory (Deci, 1971). Current theory on motivation states that persons make decisions based on a personal set of perceived benefits and perceived costs. In order to promote a behavior, the benefits must outweigh the costs. By the same token, in order to promote a behavior, the costs must outweigh the benefits (Leonard, The criteria for establishing what constitutes a perceived cost and perceived benefits is highly individual and based on each person's past experiences.

The authoritarian system operated under the assumption hat the costs (listed punishments) would exceed the perceived benefits of an activity. The example presented here is a clear example of a circumstance where the person was faced with facing once risk, falling behind on work, and another risk, potentially contaminating a patient. Both of these actions have costs. In this case, the person knew that they would definitely get in trouble for falling behind in work, while the potential of contaminating a patient was only slight. Even though under the current system, the punishment for contaminating a patient involved immediate termination of employment, and the punishment for falling behind on work was a reprimand, the person took the action that had the least probability of occurring. This was revealed in the interview with the employee and is consistent with current motivational theory.

It is clear that the authoritarian system is not working and will not be the solution to preventing future exposure incidents. The employees have expressed that they are pressured to handle more and more work and that there is no channel to air their complaints, without fear of reprimand. The first thing that needs to be established is a mechanism for employees to bring problems to the attention of management without feeling threatened. Leaders, including myself need to be more conscious of promoting open communication between employees and supervisors. Employees need to feel that they are an active part of the decision making process instead of having an increasing number of rules thrust upon them.

Employees need to feel that they are an important part of the process. In a sense, employees must have a roll in future policy making and problem solving. This would give them a feeling of owning the policies and decisions. They would feel that there is a reason for them and that they own them in a sense. This would make future infractions of the rules less likely than under the current leadership style.

As Fiedler's contingency theory states that a leader is more effective if they can develop a report with their employees. Under the authoritarian model currently being used, report is not important, only the rules (Dean and Meyer, 2002). This is an area of concern at this hospital. The employees currently feel that management is imposing ever-increasing rules on them and that they are constantly stressed to try to come up with ways to meet all the demand being placed upon them. They feel that they do not have any control over the workload placed on them. They also feel that these rules are being placed on the demand that they have no control over them. This can lead to feelings of helplessness and victimization.

Management must balance the need to meet an increasing patient demand, while still maintaining a high quality of care. Patient and employee safety must be the primary goal on the list. Perhaps techniques found in Robert House's path-goal theory could be of assistance. The employees and managers must develop a set of group goals and then all must be involved in brainstorming and implementing solutions to the problems. This would give employees a stake and an "ownership" of the group goal and the solution. This would make them more motivated to follow the procedures, because they helped to develop them (Thomas and Velthouse, 1990).

As far as the public relations issue is concerned, Norman Regional Hospital is facing a crisis. The media did hear of the event when an angry patient called them and alerted them. There has been great public concern about patient safety at the hospital. Bruning and Ledingham, (1998) found.....

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