NURS 4110 Week 11 Policy Voice Reflection Example

From the Nurses' Station to the Public Record: A Reflection on Developing a Policy Voice

Student Name

College of Nursing, Walden University

NURS 4110: Leadership and Health Policy

Instructor Name

Month Day, Year

From the Nurses' Station to the Public Record: A Reflection on Developing a Policy Voice

This reflection follows the reflective cycle set out by Gibbs (1988), which moves from description through feelings, evaluation, analysis and conclusion to an action plan. I have given the most room to analysis and action, because those are the stages where a reflection either changes behavior or does not.

Description

In the first week of this course, our composite telemetry unit received notice that the hospital was changing its policy on cardiac monitor alarm responsibility. Monitor technicians would no longer phone the nurse for every alarm; instead, some alarm types would go directly to nurses' handheld phones. At the nurses' station that evening I complained for most of a break about the change. I said the policy had been written by people who had never answered an alarm at 0400. A colleague asked me who had written it. I did not know. I had no idea whether it came from nursing leadership, the biomedical engineering department or a committee, and I had not asked.

Feelings

At the time I felt frustrated and certain I was right. Looking back, the stronger feeling is embarrassment. I had strong views about a policy and no knowledge at all of how it had been made, which meant my frustration had nowhere to go except the break room.

Evaluation

Some of what I said that night was sound. The change did add interruptions for nurses, and two of my concerns later turned up in the unit's feedback. What was poor was the form. A complaint at the station reaches nobody who can revise a policy, and it teaches newer nurses that complaining is what experienced nurses do about policy. Measured against the definition of leadership our class discussed in the first week, whether bedside knowledge reaches whoever writes the rule, my response that night failed.

Analysis

Three pieces of work from this quarter explain why I responded that way and what has changed.

The first is my Leadership Practices Inventory. My lowest-ranked practice was inspiring a shared vision. In the framework of Kouzes and Posner (2017), this is the practice of picturing what could be and bringing other people to want it too. My complaint about the alarm policy described only what was wrong. I had not tried to describe a better arrangement, such as a trial on one unit or tiered alarm routing, that colleagues and managers might support. The inventory put a name to a pattern that I had not recognized: I am comfortable following rules and uncomfortable proposing alternatives.

The second is the stakeholder map I built for a state staffing committee bill. In that exercise I placed hospital chief nursing officers as persuadable, with interests that partly aligned with staff nurses even though they sit inside hospital management. Making that map changed how I think about my own hospital. I had treated the people who wrote the alarm policy as a single opponent. The map taught me to ask who decided, what each party wanted, and who might be moved. Our chief nursing officer, it turns out, chairs the committee that approved the alarm change, and she has an interest in nurse retention that my concerns speak to directly.

The third is the peer feedback on my advocacy letter. Two reviewers told me that my request to the senator did not appear until the fourth paragraph. Moving it to the first line changed the whole letter, because everything after it became support for a clear request. The same lesson applies at the unit level. A concern that opens with a specific request, reviewed by the right body, is something a committee can act on. A complaint is not.

The ANA Code of Ethics gives this change a professional basis rather than only a personal one. Its final provision places on the profession, acting through its organizations, the work of voicing nursing's values and building social justice into health policy, and the interpretive statements make clear that individual nurses take part in that work (American Nurses Association [ANA], 2015). Read that way, advocating on the alarm policy was not an optional extra for a nurse interested in leadership. It was part of my obligation as a nurse who had knowledge the policy's authors lacked.

Conclusion

The habit I have changed is this: when a policy frustrates me, I now find out who made it and how it can be revised before I say anything about it. Then I put my concern in writing, with a specific request in the first line. I have not stopped disagreeing with policies. I have stopped keeping my disagreements at the nurses' station.

Action Plan

One step is already taken. In Week 9, our state board of nursing published a proposed rule on the delegation of tasks to unlicensed assistive personnel in acute care, with a public comment period. I read the proposed text and submitted a written comment supporting the rule's requirement that the delegating nurse assess the patient first, and asking the board to clarify how the rule would apply to telemetry monitor technicians. The comment is now part of the public record, and the board will review comments before it adopts the rule.

One step is planned. By the end of next month I will request a place on the agenda of the committee that approved the alarm policy, with a one-page summary of six months of unit feedback on alarm routing and a proposal to trial tiered routing on our unit for ninety days. I will ask our unit's clinical nurse specialist to review the summary before I submit it. If the committee declines, I will ask what evidence would change its decision, and I will collect it.

Gibbs (1988) describes the action plan as the point where reflection prepares for the next time the situation arises. For me, the next time is already scheduled.

References

American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Nursesbooks.org.

Gibbs, G. (1988). Learning by doing: A guide to teaching and learning methods. Further Education Unit, Oxford Polytechnic.

Kouzes, J. M., & Posner, B. Z. (2017). The leadership challenge: How to make extraordinary things happen in organizations (6th ed.). Wiley.