The present paper is devoted to the investigation of the Nursing Department of the State University of New York Health Science Center at Brooklyn (NDS) from the perspective of the systems theory. The understanding of systems is essential for healthcare professionals because the analysis of varied events, phenomena, and institutions is helpful for the continuous improvement of the quality and safety of healthcare (Glennister, 2011; Johnson, Miller, & Horowitz, 2008). The present work analyses NDS and discovers that more attention should be paid to nurses’ feedback, which can be achieved through the revision of the existing communication and teamwork guidelines.
A system consists of several elements that are interrelated and interconnected; all these elements collaborate to achieve a common goal, which is the system’s goal or aim (Johnson et al., 2008, p. 3). The goal of NDS consists of promoting nursing education, research, and professionalism while “delivering the highest quality patient-centered care” (SUNY Downstate Medical Center [SDMC], 2015, p. 4). Thus, NDS has a typical healthcare system goal (Hayajneh, 2007).
Concerning NDS’ elements, its input involves highly professional human resources, state-of-the-art equipment, high-quality materials, time, and money (SDMC, 2015, pp. 3, 32-33). These forms of input generally correspond to the typical input required by a healthcare center (Hayajneh, 2007). Moreover, the organization promotes evidence-based practice, which implies that research can also be viewed as a form of input.
The throughput of NDS is incredibly diverse, but general activities are health care, patient education, nurse education, nursing research, and advocacy (SDMC, 2015, pp. 3-4). These processes are likely to result in healthier and better-educated patients and community, more qualified personnel, and new information that can be used in nursing. The final output of NDS, therefore, consists of the continually improved care, safety, and quality of life of the community, which is also typical for a healthcare organization (Hayajneh, 2007).
NDS points out that it is interested in gathering patient feedback, and its annual nursing education includes a module on the process (SDMC, 2015, p. 41). Also, NDS mentions monitoring certain activities (like the staffing process), which are likely to produce feedback if necessary. Finally, the communication between nurses and their superiors is carried out with the help of formal meetings, nursing shift reports, and various methods of fast communication for urgent situations (SDMC, 2015, pp. 31-32). All these opportunities can be used to deliver feedback, but it should be pointed out that NDS does not emphasize nursing feedback.
The cycle of events analysis focuses on the cyclic interrelations between the elements mentioned above (Glennister, 2011). For example, the input of human resources, information, time, and learning materials is employed in the throughput of nurse education, resulting in improved human resources that can be employed for the nurse education processes. Moreover, the feedback related to the throughput can improve the learning materials, which will be used for future education.
Similar cycles of events can involve nursing research, in which time, human resources, and information produce more information. Given the fact that NDS is devoted to nursing research, evidence-based care, and continuous improvements (SDMC, 2015, pp. 46), these cycles are an important part of its work. To sum up, NDS appears to be a relatively common (normal) nursing system, the interrelated elements of which tend to form functional cycles of events.
Addressing the Issue
The present analysis suggests that one of the problems that NDS can be interested in resolving is the lack of focus on negative feedback from nurses. The system includes the opportunities for delivering this feedback, but the fact that feedback is not encouraged may signal inefficient engagement and is likely to result in issues. Indeed, in the systems theory, feedback is the information that can be used to evaluate and improve the system, and negative feedback is crucial for timely actions in the case of problems (Hayajneh, 2007).
Nurses, who are typically trained in system thinking (Glennister, 2011; Johnson et al., 2008), are a central element of healthcare systems (Gibb, Freeman, Ballantyne, & Corlis, 2015; Maenhout & Vanhoucke, 2013), which makes their feedback particularly useful (Hodge, Campbell, & Tobar, 2016). As a result, the following plan of addressing the issue is provided.
The desired outcome consists of improving the supply and use of nurses’ feedback as a part of the negative feedback element of the system. A key component of issue resolution is the development of goals (Manley, O’Keefe, Jackson, Pearce, & Smith, 2014). The goals and objectives that can facilitate the change include the communication of the clear message about the importance of nurses’ feedback and the development of appropriate mechanisms for its solicitation and use (Gibb et al., 2015). More specific SMART goals can be set after detailed organizational research.
These goals can be used to develop policies and procedures in collaboration with the Nursing Practice Council of NDS (SDMC, 2015, p. 31). Some of the suggestions can include the adjustment of the existing communication guidelines to highlight the importance of nurses’ feedback (for example, the improvement of SDMC (2015) guide) and the development of new ones, especially if new communication channels are going to be considered. An example of a new channel is an online forum for nurses and their managers.
The existing channels need to be adjusted to include feedback soliciting, which can be easily performed for non-urgent communication like formal meetings and reports. Also, it will be helpful to review the teamwork guidelines, which can be aligned to foster communication and support (Gibb et al., 2015). In the process of developing these guidelines, it would be helpful to review nurses’ opinions on the topic (Gibb et al., 2015; Manley et al., 2014), which should demonstrate the management’s commitment to the promoted idea.
The majority of nursing professional and ethical standards require nurses’ engagement in the improvement of their organization, community, and healthcare in general, which is explicitly stated, for example, in the Code of Ethics and Standards of Practice of the American Nurses Association (2015a, 2015b).
The proposed change is clearly in line with these standards, which means that it is going to forward the goals of NDS and its mission of the improvement of care. Also, the change is in line with the organization’s values. For example, it will help to maintain the culture of inclusion promoted by NDS; also, it would be expected to foster teamwork (Gibb et al., 2015, p. 120), which is one of the key principles upheld by the organization (SDMC, 2015, pp. 26-27). Finally, the proposed change is also likely to improve the climate of NDS by enhancing the nurses’ commitment to the organization and fostering engagement and inclusion (Gibb et al., 2015, p. 121). Thus, the proposed change is appropriate for NDS.
The present paper suggests that NDS is a normal and well-developed healthcare system. However, NDS appears to have an issue that consists of a lack of focus on the nurses’ feedback. The paper offers a plan for the elimination of the issue, which involves the development of some mechanisms for feedback solicitation and use. The proposed solution is in line with the organizational and general nursing values and is going to contribute to the achievement of the system’s goal.
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