NURS FPX 4010 Interview and Interdisciplinary Issue Identification Presentation

Assessments 2,3 & 4. Instructions are detailed in the attached documents. Also each assessment comes with an example. Specific documents for each assessment are also attached.

Interview and Interdisciplinary Issue Identification

Vicki Jahromi

NURS-FPX4010

Capella University

May 15, 2020

Interview and Interdisciplinary Issue Identification

Interview Summary

The interviewee for assessment two is an Advanced Certified Oncology Nurse Practitioner for a large cancer center. Due to the current situation with COVID-19, the interview was conducted via telephone, and the list of questions provided for the assessment was used as a basic guideline. The interview was performed in a semi-structured manner and was recorded. 

The cancer center where the interviewee works is comprised of many different disciplines such as; surgical, radiation and medical oncologists, pain management specialists, social workers, psychologists, nurse practitioners, and nursing staff for each discipline. A vital aspect of this practice is that it has been recently acquired by the Christian Care Health System and went from being a stand-alone medical oncology practice to being part of an enormous healthcare corporation. Naturally, there is an ongoing cultural change for the once independent office.

The primary duties for the NP interviewed are coordinating between disciplines, writing referrals and orders, managing chemotherapy, pain management, education, and follow up calls. The most relevant issue from the nurse practitioner’s perspective is the various professions overstepping their boundaries and interfering in the practice of other disciplines. She states there has been a lack of strong motivational leadership in helping the oncology practice adjust to its new role within the more massive corporation.  

Additionally, collaboration on a large scale happens only when a patient is new to the cancer center. Upon diagnosis, a meeting is held with the patient, medical oncology, radiation oncology, surgical oncology, social work, nutrition, etc. After this initial meeting, collaboration is on an as-needed basis. For example, when chemotherapy is no longer shrinking a patient’s tumor, the medical oncologist, surgical oncologist, and radiation oncologist will meet to discuss alternative options. The organization promotes teamwork but not necessarily true interprofessional collaboration. There is a silo mentality, and the physicians often exude a sense of entitlement.

The interviewee attempted to work on a collaborative team. In one collaborative meeting, Christiana Care indicated it had never used Oncology Nurse Practitioners, and it would need to come up with a job description. Having thirty years RN and NP experience, the interviewee volunteered to assist but was dismissed and told they would let her know when the job description was completed. Hussain et al. (2015) suggests employee involvement is a crucial tool for overcoming resistance to organizational change, and it increases members’ input into decisions that affect the organization’s performance and well being.

Issue Identification

The issue identified during the interview is one discipline going outside its scope of practice and infringing on another discipline’s duties. For example, the medical oncology group manages a patient’s pain until it feels the patient’s pain is no longer controlled. The patient is then referred to the pain management group. Problems occur when a patient is having uncontrolled pain and mentions this at a visit with his/her medical oncologist. Does the practice adjust the pain meds? Or make the patient wait several days for an appointment with pain management? Similar problems occur among other disciplines as well. A multidisciplinary approach is appropriate for this problem, as it has the potential to disrupt patient care. Moreover, evidence supports the use of interprofessional practice as it leads to improved patient care, enhanced patient safety, and prevention of medical errors (Bosch & Mansel, 2015).

Change Theory

The journals used to research change theory were all scholarly and peer-reviewed and to ensure their relevance all were published in the last five years. Change theory offers methods for understanding an organization, its groups, the values and beliefs they possess, and how this set of beliefs influences the culture of the organization and its openness to change. Depending on the particular theory, suggestions are made on how best to alter that belief system to motivate change.

Kurt Lewin’s Field  Theory offers a way of learning about group behavior by analyzing the relationships of interrelated environmental factors such as; the internal structure of the organization, its strategy, management and personnel, and external factors like policy or the economy. Understanding these forces allows practitioners to comprehend why groups act as they do and what forces need to be strengthened or diminished to bring about change (Hussain et al., 2016). Lewin’s theory is relevant because the culture of Christiana’s organization needs to be a target for change so that collaboration becomes the norm. This means thoroughly analyzing the groups within the organization and targeting their beliefs about their practices and the particular role they play in patient care and then presenting them with evidence supporting intercollaboration.

Leadership Strategy

All journal articles used to research leadership were scholarly and peer-reviewed. Their relevance was secured by ensuring all were published in the last five years. Leadership strategy is an attempt to organize, guide, and maintain the sincere and ardent commitment of the people carrying out a business strategy. The research has shown that the leadership style best suited for driving change is the transformational style. These leaders are defined as charismatic and inspirational; they possess effective communication skills, motivate, engage, and empower the team (Bergstedt & Wei, 2020). The interviewee feels that the current leadership is weak, and there is a lack of communication and transparency. A transformational leader will possess the skills needed to move the cancer center towards an interdisciplinary approach.

Collaborative Approach

Throughout the literature, a familiar concept for driving successful intercollaboration is putting the patient first.  According to Tomasik et al. (2015), “Focusing on the patient from their unique perspective serves as an equalizer in that patients’ interests supersede the potentially competing interests of individual team members. It helps people “connect the dots” between their role, patient care, and the mission of their organization” (p15). This is particularly true for the cancer center as the physicians and individual practices tend to operate in a bubble, and it can be disruptive to patient care.

Additionally, Tomasik and Flemming ( 2015) calls for the use of active and respectful communication as a tool for building interprofessional collaboration. Healthcare professionals often have their own ideas about what constitutes successful communication. The authors argue that having a common language allows team members to avoid barriers to effective communication. The healthcare facilities successfully using interprofessional practice have uniform documentation, forums, emails, and meetings that involve all team members. 

One example of standardized communication that is seen throughout organizations successfully using collaborative practice is interprofessional rounding. This is seen as a highly effective practice that allows individuals to understand both their own and others contributions to the team. Open and respectful communication can contribute to problem- solving as a group, and open discussion allows for different perspectives to be heard (Tomasik & Flemming, 2015). Interprofessional rounding at Christiana Care would be beneficial as many of the professions are often infringing on the practices of others. Daily collaborative rounding would alleviate this issue as well as give a unique insight into how to prevent it from happening in the future.

Conclusion

Change theory, leadership, and collaborative practice are all tools needed to improve the nature of healthcare, but none of these tools act independently. Change theory provides a mechanism for examining the culture of an organization and determining what it will take to produce change. However, change theory needs to be driven by effective leadership. The same is true for intercollaboration. The organization must be inspired and motivated towards this method of practice. Change theories might tell us how to get there, but ultimately it comes down to leadership style and being able to stimulate the workforce into accepting the concept of interdisciplinary practice.

References

Batras, D., Duff, C., & Smith, B. J. (2015, November 14). Organizational change theory: Implications for health promotion practice. Health Promotion International, 31, 231-241. http://dx.doi.org/10.1093/heapro/dau098

Bergstedt, K., & Wei, H. (2020, February ). Leadership strategies to promote frontline nursing staff engagement. Nursing Management, 48-53. http://dx.doi.org/10.1097/01.NUMA.0000651204.39553.79

Bosch, B., & Mansel, H. (2015, July). Interprofessional collaboration in healthcare: Lessons to be learned from competitive sports. CPJRPC, 176-179. http://dx.doi.org/10.1177/1715163515588106

Dyess, S. M., Sherman, R. O., Pratt, B. A., & Hanisko, L. C. (2016, January 14). Growing nurse leaders: Their perspectives on nursing leadership and today’s practice environment. The Online Journal of Issues in Nursing, 21(). http://dx.doi.org/10.3912/OJIN.Vol21No01PPT04

Hussain, S. T., Lei, S., Akram, T., Haider, M. J., & Hussain, S. H. (2016, July 14). Kurt Lewin’s change model: A critical review of the role of leadership and employee involvement in organizational change. Journal of Innovation & Knowledge, 3, 125-127. http://dx.doi.org/10.1016/j.jik.2016.07.002

Tomasik, J., & Flemming, C. (2015). Lessons from the field: Promising interprofessional collaboration practices. Retrieved from www.rwjf.org/en/library/research/2015/03/lessons-from-the-field.html

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