Critical Analysis of Governance and Leadership Practices in a Long Term Nursing Unit

This critical analysis essay evaluates the governance and leadership practices in a long term nursing unit. It examines the issues related to inadequate staffing, high rate of staff turnover, and inefficient management affecting the quality of care. The essay recommends strategies to improve the situation.

Running Head: Critical Analysis
Assessment
Critical Analysis Essay
Word Count:…
Student Name:……
Submitted to:……..
Griffith University

Critical Analysis 2
Introduction
The assessment critically evaluates the given clinical scenario to analyze the potential issues
associated with governance and leadership practices of the Organization. The aim of the essay is
to specifically examine the factors affecting the delay in recruitment process, unfilled posts,
difficult work culture, high rate of staff turnover, and overtime practices in the long term nursing
unit. The essay concisely describes the scenario and context which affect the delivery of quality
care at the work place. It evaluates the different issues faced by the unit which affect the patients,
and staff. Finally on the basis of evaluations, it recommends the strategies which can be
implemented to assist the delivery of professional quality care. The discussion only focuses on
the given clinical scenario. It will be argued that inefficient management, leadership and
governance at the workplace (as shown in the scenario) can lower down the productivity of the
unit and may worsen the quality of care.
The Context
The most important factors affecting the long term nursing unit are: lack of experienced
leadership (Manager), delayed recruitment process and many unfilled posts, difficult work
culture, high rate of staff turnover, high rate of sick leaves among employees, and overtime
pressure to fill roster deficits. Hiring the inexperienced graduates has resulted into increased
incidents of consumer falls and medication errors since last 6 months. There are several
problems in recruiting the senior and experienced registered nurses in the unit so the
management started hiring young graduates at respective vacant posts for minimizing the
overtime load on the existing staff. Hiring the young inexperienced graduates resulted into

Critical Analysis 3
increased consumer falls and medication errors. None of the nurse already working at the
manager’s post has shown keen interest in continuing her job at the same post. Around 25% of
the fulltime jobs at the unit are vacant. Hiring the inexperienced candidates further increased the
incidents of aggression among the patients and the staff members. Moreover, the lack of
permanent experienced and professionally qualified nurse educator and clinical facilitator has
lowered the quality of staff training and education at the unit.
The most important factor influencing the quality of care is ‘unfilled posts’. The management is
careless about completing the annual recruitments on time. Most of the posts like that of manager
are vacant since two years.
Critical Evaluation
The clinical scenario reflects several issues related to filling leadership roles at the unit, lack of
quality training of nurses, shortage of experienced staff, inadequate compensation and salary,
improper behavioral management of nurses and increasing complaints from the patients.
Inadequate Staffing- Lack of experienced staff threatens the patient safety and health in the unit.
It also increases the rate of injury and fatigue in the staff and compels the existing clinicians to
work for longer hours under stressful work conditions. Inadequate staffing may impede the
efforts of the nurses at work to perform the care processes. According to the Hospital
Readmission Reduction Program by Affordable Care Act, the hospitals having higher nurse
staffs are penalized to 25% lesser extent than the hospitals having lower staff (Gooch, 2015).
According to the reviews of Minnesota Department of Health, the lower levels of nursing staff is
linked to higher patients mortality, falls and failure to rescue during hospitalization (Gooch,

Critical Analysis 4
2015). Moreover, the unavailability of skilled nurses at the unit either due to increasing sick
leaves or due to high staff turnover rate also adversely affects the delivery of quality care.
Shortness of staff makes it compulsory for the nurses to take additional shifts at work, to fulfill
the role of absent coworker, which may be done by missing out going at family functions and
leaving no room for family time (Park, Jeon, Hong & Cho, 2014). It can deteriorate their social
life. Having no time to relax and care for own self may make the staff unsatisfied and frustrated
from the job thereby increasing the intention to escape from the job.
High rate of turnover- The high rate of turnover and intent to leave job may be due to inadequate
compensation in comparison to the workload and stress imposed. The nurses working in poor
working environment and having excessive patient overload are found to be more dissatisfied
with their jobs (McHugh & Ma, 2014). The long shifts and inadequate sleep increases fatigue,
giving rise to negative cognitive emotions and dissatisfaction at work (Gooch, 2015). The wages
though play a significant role however they do not solely lead to better outcomes. Adequate
staffing and favorable work environment is essentially important to retain the employees at their
posts. High rate of sick leaves may be a way to escape the work pressure and highly complex
working environment.
Job Dissatisfaction- The unwillingness of nurses to remain at the same post for longer shows
tough and stressful working conditions and inadequate compensation for the assigned work
(McClellend, 2017). The decision of filling up the vacant positions with graduates is also not a
responsible step. The decision may be taken up for cutting down the costs by the management. It
increases dissatisfaction and rates of complaints among the patients. Greater patient-to-nurse
ratio may lead to higher burnouts and job dissatisfaction (Er & Sokmen, 2018). High workload

Critical Analysis 5
makes the routine exhaustive and renders the recovery difficult. It makes the job satisfaction
unachievable. Many nurses doing long shifts regularly may suffer from shoulder pain,
cardiovascular diseases and other chronic medical health conditions. It may deteriorate the
mental ability and the capacity to take proper decisions and may harness the safety of patients
(Bettencourt, 2017).
Recruiting more nurses consistently improves the productivity of the hospital, lowers down the
retraining costs and turnover thereby enhancing the patient outcomes positively (McHugh & Ma,
2014).
Poor work environment- The employees used to work overtime in every shift to overcome the
deficits in the roster. The nursing unit observes nearly 25% vacancy at the full time job positions.
Inexperienced fresh graduates don’t have behavioral skills to deal with the patients. Lack of
proper training increases the aggressive behavior among the staff and the patients. They do not
know how to manage their attitude and behavior while being with the patients. There is no
permanent trainer employed at the post of nurse educator and the post observed four nurse
educators since the last 9 months. The post of clinical facilitator is also unoccupied.
Recommendations and Strategies
Necessary developments and improvements should be done to create nurse friendly working
conditions in the long term care unit. The management should emphasize on creation of a
hospital policy to support the professionally favorable environment. Such initiatives may
improve the staffing and nurse retention, safety of the patients and the quality of care leading to
further improvements in the nursing practices (Er & sokemen, 2018).

Critical Analysis 6
The unit should have a strong permanent clinical leadership. There should be chief nurses to
manage the nursing workforce. Standard training should be imparted to the staff to improve their
competence level. Professional judgments can be replaced by the policies, protocols and rules.
There should be focus on Quality Improvements and streamlining process to achieve better
outcomes.
Inadequate staffing may be addressed by reducing the patient to nurse ratio. The institutions can
be made more competitive. Treatment processes can be streamlined to achieve a decline in
medication errors, morbidity, length of stay, mortality and hospital re-hospitalization rates
(Izumi, 2012).
Highly competent, experienced and skilled nurses with better communication may reduce the
rate of patient falls, medical errors, and mortality (Paulsen, 2018). There should be minimum set
of prescribed skills and expertise for every post at the unit. Hiring fresh graduates at the
responsible posts should not be allowed. After hiring, proper training should be provided by the
standard nurse educator to facilitate effective implementation.
Quality Improvement Strategies may involve Computer based Reminder Systems and decision
support for care providers, regular conferences and workshops to improve knowledge,
promotion of patient education, feedback and audits to assess the performance of care providers
(Daly, Jackson, Mannix, Davidson & Hutchinson, 2014). The incentives and compensation
should be provided to nurses on basis of their performance and assessment of quality indicators.
There should be requirements of license for the nurses to be hired at senior posts.

Critical Analysis 7
Weak leadership framework should be strengthened and leadership related interventions can be
framed to improve the delivery of quality care. The processes of HR management must hire the
candidates with clinical expertise and experience for the related post (Govender, Gerwel, &
Kader, 2018). Timely recruitment must be done at all the posts. The individual level performance
of the nurses should be assessed to encourage better performance.
Conclusion
The clinical scenario provided for critical analysis and evaluation involves several issues related
to inefficient management, lack of effective governance and policies, shortage of adequate
staffing, job dissatisfaction among nurses, a number of vacant posts, and recruitment of
inexperienced graduates at the permanent posts for temporary time period to overcome the roster
deficits. The staff has to do overtime most of the times which reduces the overall productivity of
the delivered care. The recommendations to improve the condition involve timely recruitment of
all the vacant posts with skilled and expert candidates. Regular training and quality assessment
of staff can improve the condition effectively.

Critical Analysis 8
References
Bettencourt, E,(2017). Five problems nurses face today. Retrieved from
http://blog.diversitynursing.com/blog/5-problems-nurses-face-today
Daly, J., Jackson,D., Mannix,J., Davidson,P.M., & Hutchinson,M. (2014). The importance of
clinical leadership in hospital setting. Journal of healthcare leadership.
2014(6).75-83. Doi: https://doi.org/10.2147/JHL.S46161
Er,F. & Sokmen,S.(2018). Investigation of the working conditions of nurses in public hospitals
on the basis of nurse-friendly hospital criteria. International Journal of Nursing
Sciences. 5(2). 206-212. Doi: https://doi.org/10.1016/j.ijnss.2018.01.001
Gooch,K.(2015). 5 of the biggest issues nurses face today. Retrieved from
https://www.beckershospitalreview.com/human-capital-and-risk/5-of-the-biggest-
issues-nurses-face-today.html
Govender, S., Gerwel Proches, C. N., & Kader, A. (2018). Examining leadership as a strategy to
enhance health care service delivery in regional hospitals in South Africa. Journal
of multidisciplinary healthcare, 11, 157-166. doi:10.2147/JMDH.S151534
Izumi S. (2012). Quality improvement in nursing: administrative mandate or professional
responsibility?. Nursing forum, 47(4), 260-7.

Critical Analysis 9
McClellend, M.( 2017). Nurse led reform. Scholarly Journal of American Nurses Association.
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McHugh, M. D., & Ma, C. (2014). Wage, work environment, and staffing: effects on nurse
outcomes. Policy, politics & nursing practice, 15(3-4), 72-80.
Park, M., Jeon, S. H., Hong, H.J., & Cho, S.H. (2014). A comparison of ethical issues in nursing
practice across nursing units. Nursing Ethics, 21(5), 594–607. DOI:
https://doi.org/10.1177/0969733013513212
Paulsen,R.A. (2018). Taking nurse staffing research to the unit level. Wolters Kluwer Journal.
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