Educational Management Program on Enforcement Autonomous Decision Making Among Novice Graduate Nurses
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Tanta Scientific Nursing Journal Educational Management Program on Enforcement Autonomous Decision Making among Novice Graduate Nurses Walaa Mostafa Abd El Haliem Eid: Assistant lecturer in Nursing Administration, Faculty of Nursing, Tanta University Fouada Mohamed Shaban Prof. of Nursing Administration Faculty of Nursing, Tanta University Safaa Abd Al moneim Zahran Assistant prof. of Nursing Administration, Faculty of Nursing, Tanta University Karima Ahmed El Said Assistant prof. of Nursing Administration, Faculty of Nursing, Tanta University Abstract Background: autonomous decision making (DM) is a positive concept for novice graduate nurses (NGNs) influencing job satisfaction, retention and quality of care. They have to exercise judgments and DM skills through learning DM process to act independently and autonomously. Aim: to assess, design, implement, and evaluate an enforcement educational management program on autonomous clinical and managerial decision making for novice graduate nurses. Setting: study was conducted at Tanta University and El Menshawy Hospital. Subjects: all (90) novice graduate nurses working in above mentioned setting. Tools: Three tools were used including decision making autonomy assessment scale, decision making and principles of autonomy knowledge test and educational enforcement program on decision making and autonomy principles. Results: Pre programs, all NGNs have low level of DM autonomy in clinical and managerial decisions and had poor level of knowledge about DM autonomy principles. Post program, (95.5%) of NGNs had good level of knowledge. NGNs (12.3% and 24.4%) had moderate level of managerial and clinical DM autonomy respectively. Conclusion: NGNs at two hospitals not having the authority and autonomy for making clinical and managerial decisions. Additionally, had lacking knowledge about decision making autonomy principles and facing organizational obstacles that limit their autonomy in DM. Post program, NGNs' knowledge and skills about autonomous DM improved. Recommendations: updating the structure of NGNs' job description including their involvement in decision making. Stress active managerial support to NGNs to improve their decision-making skills and become independent in clinical and managerial decisions. Vol. 11 No. 2 November, 2016 124 Tanta Scientific Nursing Journal Introduction decisions that govern nursing practice and Novice graduate nurses (NGNs) are practice environment. Absence of baccalaureate prepared registered nurses educational program to support their with less than three full years of decision making skills was the first experience in the profession (1,2). managerial barriers for their decisional Technology and research advances, greater involvement. workloads, diminishing resources, and Autonomous decision making considered complexity of nursing care requirement an important element for novice nurses' overwhelm novice graduate nurses (3,4). All professional identity and source of power of these phenomena increased the in their clinical practice (11-13). challenge for decision making by nurses Autonomous decision making not involve (5). For novices, this challenge is even the exercise of routine tasks or the greater and call for effective, independent, unquestioning enactment of physician and competent decision maker (6) .To orders (14). For novice nurses, autonomous assume new and independent roles in their decision making means acting and decide practice NGNs need to develop their independently without being restricted by abilities to problem solving, making bureaucratic rules of hospitals and decisions, acting independently to function receiving orders or permission from others and decide safely (7). based on complex body of knowledge and Basically, novice graduate nurses (NGNs) skills (15,16). Autonomy is an essential as professionals are accountable for attribute for achieving professional status patients with more complex care require by using the power to determine what close observation and specialized needs to be done in providing patient care, treatment (8). They face legal, complex, to act on assessments and to accept and educational problems dictate the accountability for independent decisions demand for professionally prepared (17). It manifested through communication autonomous nurses to fulfill their of mutual respect and trust both intra and professional role and move the profession interprofessionally in clinical settings (18). forward (9). Although nurse specialists Autonomy in clinical and managerial expected to make independent clinical and decisions is required by NGNs when managerial decisions, Eid (2009) (10) assessing the information about patient revealed that nurses specialist not have the needs, putting nursing diagnose and authority and autonomy in making judgment about the patient's health Vol. 11 No. 2 November, 2016 125 Tanta Scientific Nursing Journal problems. Adding that, when deriving the To deal with these concerns NGNs need to outcomes of nursing care provided, be enforced to be autonomous decision developing and planning the nursing maker (28). They need to be trained to procedures, implementing the plan of care incorporate an educational framework that and evaluating the care provided against supports their development. Prerequisite the standard of care (19-21). Variety of intellectual and cognitive skills are needed independent managerial decisions needed in order to manage complex information about resources affecting patient care and to make judgments (29). In addition, including staffing, budgeting, equipment, they need to be trained to exercise supplies, time, and patient assignment to discretionary decision making by using the staff. Moreover, planning, organizing, critical concise to select a course of action collaboration, and quality of professional consistent with client and unit needs. Self practice decisions (22, 23). direction and intellectual flexibility are The nature of novice nurses' clinical required to negotiate and compromise (18). decision making is linear, based on limited Enforcement of educational management knowledge and experience in the program on autonomous decision making profession and focused on single tasks or for NGNs is very important to teach them problems (5,24,25). They tend to view how to make effective decisions by decision making as responding to patient investing their knowledge about decision complaints, and following protocols or making process and supporting them in documented care plans. As they make both successful and unsuccessful decisions decisions; their focus leans toward doing, for increasing their autonomy and control rather than on thinking and reflecting, over nursing practice. Designing and make them rely excessively on more implementing program for novice graduate experienced nurses and avoid situations nurses they will become autonomous, they that require them to make decisions (26). will able to choose a specific course to Consequently, the Institute of Medicine respond to both the problem and the (2008) (27) stressed that a higher level of opportunities that confront them, make clinical decision making autonomy have to judgments about the care that they provide be given to NGNs and that they be trusted to patients and management issues (30). and supported to make autonomous Aim of the study: Assess, design, decisions about patient's care and unit implement, and evaluate an enforcement operations. educational management program on Vol. 11 No. 2 November, 2016 126 Tanta Scientific Nursing Journal autonomous clinical and managerial clinical decisions, it consisted of 34 items decision making for novice nurses. divided into clinical decision in patient Research hypothesis: Improvement of assessment, nursing diagnosis outcome knowledge and skills of autonomous identification, care planning, care decision making among novice graduate implementation and care evaluation. b) nurses. Managerial decisions subscale was used to Materials and Method assess novice gradate nurses' autonomy in Material managerial decisions. It consisted of 38 Study design: Quasi experimental items divided into managerial decisions research design was used to achieve the related to quality of professional practice, aim of present study. Such design fits the quality of support staff practice, nature of the problem under investigation. professional nursing staff development, Setting: The study was conducted at Tanta collaboration, unit governance and University Hospitals and El Menshawy leadership decisions, unit staffing Hospital. Subject: The study subjects decisions, planning, and organizing the consisted of all (90) novice graduate nurses up work unit decisions. The response for to 3 years of experience at Tanta University questionnaire was measured by 3 points Hospital and El Menshawy Hospital. The scaling as follows:- subject was 25 novice graduate nurses at Tanta Never =1 Rarely =2 Always =3 University Hospital and 65 at El Menshawy Part (3): Modified organizational obstacles Hospital. for autonomy in making clinical and Tools: To achieve the aim of the study the managerial decision making (19) questions following tools were used. related to general organizational and Tool I: Decision making autonomy managerial support obstacles affect novice assessment scale consisted of three parts: graduate nurses autonomy in making their Part (1): Characteristics of subject such decisions. The responses for questionnaire hospital name, age, years of experience, was measured on three points likert scaling