Introduction of the Organization
Provide a concise description of the healthcare organization, including type of agency, size, geographic location, services provided, target clientele, accreditation status, and community relationships.
The name of the healthcare organization I work for is North Texas State Hospital (NTSH), a forensic mental health facility built on a sixty-nine acres north-west of Vernon, Texas. The Vernon State Hospital serves the whole state of Texas, providing forensic psychiatric services to adults and teenagers; thirteen to seventeen years old. The hospital takes care of individuals with mental health illness with or without drug dependency issues and involved with the judicial system or law enforcement agents. These individuals are facing felony charges and will be on pre-trial assessment for competency and insanity. These individuals cannot stand trial due to mental retardation. Persons from jails are also taken into the hospital for psychiatric evaluation.
North Texas State Hospital is accredited by the Joint Commission on Accreditation of Healthcare Organizations (Joint Commission). In regard to community relationships, the community is able to offer services such as donating secondhand clothing, funding, and providing Christmas gifts, cakes for birthdays and any other special events through Volunteer Services.
Examination of the Organization
Identify the organization’s mission, philosophy, and the administrative structure. Identify the type of organizational structure the facility represents (functional, matrix reporting, joint practice, etc.). Give examples that support the type you selected.
The North Texas Hospital’s (NTSH) mission statement is “To support the recovery of persons with mental illness so they may more fully assume the responsibilities of citizenship and enjoy its benefits” (Texas Department of State Health Services, 2012)
The NTSH Philosophy is well spelt out. We envision becoming a nationally recognized leader in the provision of inpatient psychiatric services that are recovery oriented and underpinned by a commitment to a social learning model of psychiatric rehabilitation. We envision a hospital that is continually improving, customer driven, innovative in service provision and dedicated to the elimination of restraint and seclusion. We envision an organization that recognizes the dignity and worth of all individuals while appreciating and honoring our corporate responsibility to the larger community and to the citizens of Texas (Texas Department of State Health Services, 2012).
The NTHS embodies service-line structures. Clinical services are structured around clients with certain disorders (Sullivan, 2012). The individuals that are served by NTSH have psychiatric challenges. At the helm of the organizational structure is the Superintended overseeing the whole facility followed by departments and functional services that offers patient needs like nursing service, pharmacy service, dietary service and social worker services (Sullivan, 2012). Everything is put in place, organized and coordinated according to the patients’ needs in taking care of mental illnesses to meet set goals and outcomes (Sullivan, 2012).
Strengths and Limitations
Discuss major strengths and limitations of the organization.
The major strengths of NTSH are well experienced and educated health professionals. The hospital has Psychiatric Doctors, Psychologists, Pharmacists, Dieticians, Social workers, Nurse Practitioners, RNs and LVNs. The system promotes education advancement for any staff members willing to take further education. The hospital has therefore strong professional team. The hospital also provides monetary incentives and benefits to retain professionals. There is also strong teamwork which is shown by how different units and departments work together to ensure efficiency and effectiveness in service delivery. There is also continuous staff training and development meant to maintain and improve service delivery by health personnel. There are also high standards to keep up with safety of patients by maintaining safe work environments and practices.
Limitations include high staff turnover which is most rampant among lower level positions. Calling in is another characteristic problem that continues to hound NTSH units especially within low ranking positions again. This problem is exacerbated by the inability of immediate managers to resolve this crisis amicably. Often the way in which particular cases are handled result in worsening the situation by demotivating hard workers who sometimes end up care free too. Another limitation is poor communication amongst health staff. There is poor flow of communication in the chain of command. This often results in miscommunication and a major source of conflict, this has grossly affected the bottom of the organizational structure. Another major limitation which is sneaking of drugs and cigarettes into units by staff members. Although there is a strong security manning the facility 24/7, sadly illegal drugs still find their way in.
Care Delivery System
Describe the nursing care delivery system(s) used. Include delegation examples of manager, charge nurse, licensed staff to unlicensed staff.
The nursing care delivery systems used by NTSH appear to be both functional and team nursing whereby the nursing needs of the patients are broken down in tasks that are assigned to Registered Nurses (RNs), Licensed Vocational Nurses, (LVNs), and Psychiatric Nursing Assistants (PNAs) so that the skill and licensure of each is utilized to one’s best ability (Sullivan, 2012). PNAs assists with activities of daily living, and obtain vital signs, LVNs administer treatment and RNs assesses the patient. In some instances, it is team nursing whereby an RN will be in charge and will be leading other RNs, LVNs and PNAs to provide care under his/her direction. Usually the charge RN will spend time in managerial duties including care plans development and updating, solving challenges encountered by rest of team members and collaborating with Physicians and other health professionals (Sullivan,2012). Various staff within the psychiatric setting are responsible for providing nursing care to all patients. Psychiatric Nursing Assistant (PNA) delivers nursing patient care under supervision of a Registered Nurse (RN). Duties includes observing, reporting and documenting, patient conditions and behaviors; interacting with patients therapeutically. The PNA has a primary responsibility to maintain direct and on-going therapeutic interactions with patients to promote living and social skills, thus and assists patients with activities of daily living, hygiene, and eating in order to promote independence and self-care. They also monitor patients as assigned and provides observation to ensure the health and safety of all persons. Obtains and records vital signs, meal consumption, and hours of sleep, and actively promotes safety through the continuous monitoring of the environment and active engagement with patients, to minimize unsafe situations and injuries. The LVN also works under the direct supervision of a Registered Nurse to provide care and treatment, and to promote the general welfare of those served. Responsibilities include: acknowledging and verifying physician’s orders, administering medications, assisting with sick call, providing and/or monitoring treatments, performing screening tests as ordered, collecting specimens for laboratory examination, and scheduling necessary appointments/consultations. RN can delegate duties to both LVNs and PNAs. The RN works under the direct supervision of the Nurse Manager to provide routine care and treatment and performs initial and on-going assessment develops and implements nursing interventions, collaborates with other health care professionals towards the development recovery plan, provides patient/family education regarding illness process, medications, coping skills to patients and families. Establishes, monitors, and maintains the therapeutic milieu through clinical supervision.
The Nurse Manager primarily supervises RNs in the chain of command although he/she oversees the whole unit. The Nurse Manager position is very involving and is responsible for administration of unit dealing with patient care and staff issues. The Nurse Manager coordinate with the Charge RN in dealing with matters that in shift scheduling and task delegation for the running of the unit. The Nurse Manager report to the Assistant Director of Nursing (ADON). The Assistant Director of Nursing steers the direction the unit should take through the Nurse manager. The Nurse Manager also keep the ADON updated on the status of the unit as far as achieving set objectives is concerned.
Outcomes and Measurements
Discuss two specific patient outcomes and explain how they are measured and monitored. Include one system–wide outcome and one nurse–sensitive clinical indicator.
The leadership of the State Hospitals provide the framework for planning, directing, coordinating, providing and improving services which are cost effective and responsive to community and patient needs and improve patient outcomes. A governing body and management structure will ensure that the organization provides quality services in a culture focused on recovery in a safe and therapeutic environment. This goal also addresses the relationship between the Superintendent, the Governing Body and the functional responsibilities of executive level management. Specific management responsibilities include maintaining and/or setting up the structure needed for effective operations; establishing an integrated safety program; developing information and support systems; recruiting and maintaining appropriately trained staff; conserving physical and financial assets; and maximizing reimbursement potential. The system wide outcome here is manifested by the restoration of per capita competency that is shown in end of year reports.
One example of one nurse–sensitive clinical indicator is describing a patient outcome within the psychiatric setting. When patients are admitted to the psychiatric hospital in most cases they are not stabilized on psychiatric medication. Upon arriving to the facility, they are disheveled, they are not in touch with reality. These patients are aggressive, they lack social skills, and they are coming straight from the jail their behavior is out of control and lack sense of humor and. These patients have committed felony crimes and they are considered manifestly dangerous and they are not yet medicated. Most of the patients would have been found incompetent to stand trial due to insanity. Most of the patients are admitted for a period of one hundred and twenty days. Through the nursing interventions in collaboration with the other healthcare professionals towards recovery of the patients within a few weeks of admission transformation is noticed. During their stay the nurse will provide education regarding illness process, medications, coping skills to patients. Patients are encouraged to comply with their treatment regime. They are taught social skills and appropriate behaviors. Once these patients are stabilized upon medication and appropriate socialization their behavior will change and their competency will be restored.