One of the major concepts presented
by the Theory of Bureaucratic Nursing is the dilemma faced by nurses to meet
patient care needs while balancing the often equally stressful and taxing
corporate demands of the healthcare organization. As an ER/Trauma nurse for 5
years now, I can say that I have had first-hand experience when managerial
decisions do not necessarily translate to better, if not good, patient care.
Staffing remains to be the biggest
challenge that every manager meets on a day-to-day basis. Quite a global
phenomenon since time immemorial, shortage of staff is addressed by various
shifting methods to ensure that the number of nurses is adequate at various
times of the day. Here in UAE, it is expected that the hours 7-11AM and 3Am-7AM are
lull times. That is, patient census is controlled at a minimum; hence, staffing
is decreased to 13 nurses instead of the full rota of 17. Such a staffing
method is efficient in controlling the need to call for overtime and is
therefore beneficial for the healthcare organization.
However, in the Emergency
Department, we cannot say definitively that there are as they say "lull
times." In my perspective, the concept of Emergency Nursing is being
prepared for all cases at all times, meaning at whatever part of the day. True
is the case where an ER unit may have ZERO census for 2 hours. But it is also
true that a 30-bed capacity ER unit can also become full in 30 minutes, most
especially in cases of trauma cases or disasters. In such a scenario, shortage
in staff will definitely pose as a problem to meet the high demand for patient
care.
Another idea presented by the theory
is the concept of "opportunity cost" where the healthcare institution
should realize that nurses are vital resources of the hospital that can
translate to revenue if appropriately managed. In Tawam Hospital, several
programs for staff have been initiated to uplift the standard of living of all
members of the healthcare team. A bus shuttle has been provided to transport
staff from hospital accomodations to and around the hospital vicinity. Several
light fixtures have been installed to ensure safety of staff who are coming or
going to the hospital at awkward times (I myself have a shift that ends at 3AM)
and most recently, night shift allowance has been raised to a competitive
rate.
All the previously mentioned efforts
are all geared towards increasing staff satisfaction. Putting the theory into
perspective, an increase in staff satisfaction will elevate standards of
patient care and furthermore staff retention as evidenced by studies looking at
the cost of training new staff versus the cost of retaining a staff.
– Julius G. Lejarde, RN
Nurses need to focus on therapeutic care regardless of patient’s social status and treat patient equally and righteously to meet the holistic care that the patient deserves. Administrators should recognize the nurse-patient caring relationship as having an intangible value and they should consider it as a return on investment
– Katryn Joyce A. Lavarias, RN
Caring is affected by
different factors such as our own culture, education, family back ground and
more. As a care giver we also have our own perception of how caring should be.
However, in providing care we should be sensitive to the culture, socio-economic,
education, legal aspects, and political background of our clients for our
nursing interventions to be successful.
Like the patients who
are for surgery. Sometimes patients refuse surgery even their doctors insist
because of personal reasons. If we further assess them. They will tell their
cultural beliefs, financial and legal matters. This will help us to give health
teaching appropriate in their present condition.
– Le Divine Miguel, RN
Dr. Ray’s theory has
taught me that even though I had new roles to fulfill, my actions, words and
decisions should always remain grounded in caring. No matter what level,
specialty, area, training or country we are in, caring should always be our
first priority as nurses. It is necessary for nurses to forge good
relationships with other departments of the hospital to be able to care for
patients, staff and the unit. It takes a whole village to administer quality
care and we should learn to utilize the resources that are given to us. The
theory also made me think higher of my profession – to hold my own against
other leaders because Nursing is a well-grounded profession with its own
principles, skills and body of knowledge.
Dr. Ray’s Theory of
Bureaucratic Nursing has given me the opportunity to care for our patients even
from afar by ensuring that the nurses that care for them are skilled, pleasant
and well-rounded. I can guarantee that the unit will be able to perform the
procedures needed by the patients anytime by ensuring adequate stocks and well-maintained
equipment. Dr. Ray has taught me that although this is not the conventional
nurse patient relationship, it is also a form of caring.
–
Erika B. Macairan, RN
In our world of modern innovations, everything is
seemingly becoming always in its fast phase. One way or another, unexpected
situations will arise in the most unforeseen way, and most of the time we’ll be
caught off guard. As I came to know about bureaucratic nursing, I thought of
this as a perfect guide for us nurses to go with the complexities that has
brought by the changes in the view of many about caring. Let me give you the
current condition of the institution I am working in now as an example. This hospital
started catering services merely a year and like other newly established
organizations, it still does not have a strong foundation when it comes to a
systematic flow of work. In this point of time, bureaucracy and its principles
can be used as a framework in starting to shape the organization the way the
administration want it to be. In this theory, all the aspects of an health care
organization is tackled, may it be the legal, cultural, economic, political,
ethical, educational and technological part of it. The concept focuses on the
organization itself and the factors that affect its quality of care rendered to
its clients. It encompasses various strategies on how we can comply with
demands of our changing environment and lifestyle of the people in it. A
multi-cultural organization like the one I work in will greatly benefit from
this theory if only its principles are well applied. In bureaucratic nursing
theory, an innovative, more competitive and a standardized manner of caring can
easily achieved.
–
Chenee Mueliza H. Liberato, RN
The bureaucratic care
theory of Dr. Marilyn Ray emphasized caring as the central concept of her
theory. According to the study conducted by Ray, there is a link between caring
and positive patient outcomes. How are we going to achieve this? Building
rapport to our patient is very important. They should feel that we are capable
of providing quality care that they need during our first encounter with them.
This is our hospital’s mission. We are patient-centered and want to deliver
quality care beyond their expectation. The survival of healthcare organization
is based on this. Right now, our hospital (newly operational) is not yet
systematized and the administration is still struggling in formulating policies
and protocols.
–
Richelle Ann Mora, RN
The priority role of the
nurse is to give care to the patient in a compassionate way. A care must be given
to the patient regardless from where they come from and whatever their status
in life. In giving the needs of the patients, certain aspects in the
organization must be consider in giving a complete care. In connection to
Marilyn Ray’s Theory of Bureaucratic Nursing, it is all about the relationship
of the organization or institution, the units within, and the staff in dealing
the patients in giving care and providing their needs. It is also the process
of give and take. The institution will plan the concrete structural memorandum
relaying it to the units. The units will implement on what is in the memorandum
through the staff. The memorandum is directed in patient care which is the
priority goal.
–
Marie Grace C. Lim, RN
Nursing theory is
essential to the continuing evolution of the discipline of nursing. Several
trends are evident in the development and use of nursing theory. On a positive
note, nursing theories are being embraced by healthcare organizations to
structure nursing practice. In relation to my current work of practice,
bureaucratic caring is used when political, economic, legal, spiritual caring
and technological decisions were made. An example is our case of cerebral palsy
with severe weight loss and malnutrition in which Percutaneous Endoscopic
Gastrostomy Tube (PEG) was recommended by the doctor to correct patient’s
nutritional deficits. Despite of all advantages, health benefits, health
teachings imparted to the parents and family, they opted for signing refusal of
treatment instead for some socio-cultural concerns.
The essence of caring as
mentioned in bureaucratic nursing was applied to this practice as knowledge,
compassion, empathy were rendered to the patient and family. Legal
concept of bureaucratic caring was also involved when parents took the responsibility
and accountability of their decisions in accordance to the hospital’s policies
and procedures.
–
Asnairah Mamangcao, RN
The hospital that I used
to work in is a tertiary hospital but we lack equipment needed for care. That’s
why it underwent several changes in management and I was there to experience 3
management shifts. Being a charge nurse entails a lot of responsibility because
due to lack of staff nurses, we charge nurses also do bedside care aside from
the paper works that needs to be done. The Bureaucratic theory of Caring and
its principles are used as a framework in starting to mold the hospital’s
administration and organization.
An example of which, is
the technological aspect of the theory. One major reasons of the management shift
is to upgrade the hospital’s resources to adapt with the fast-paced and modern
world we have now. Machines like infusion pumps, cardiac monitors and syringe
pumps are one of the few machines that need to be upgraded for us to deliver
more precise IV fluids and to monitor the patient’s condition inside the PICU.
If not, there would be complications in the patient’s condition which can lead
to legal issues and which can lead to the bad image of the hospital, to the
nurse and to the end of our career.
–
Jewelle Lauren Peña Moya, RN
Related to my work as an
intensive care nurse. Given a scenario a female morbid obese patient on her
critical days in the hospital intubated and unconscious due to sedation drip
flowing who has a responsible party who signed Medical order life sustaining
for of full code. Key concepts of Marilyn Anne Ray’s theory is always in use.
Such as Caring for critically ill patients requires patience and honesty. For
example in assessing the patient on a specific time needed such as checking
blood sugar of a patient every fifteen minutes with relation to giving insulin
drip to a patient and at the same time checking patients vital signs to a
patient who requires checking for appropriate intervention. Spiritual ethical nursing
and legal, Since the patients wish is full code then as a nurse I need to abide
with the patients wish of resuscitation for it is ethically right to give what
the patients wish. When it comes to key concept of education, as a nurse of the
patient I educated and update the family members responsible for the patient on
the status of the patient with regards to plan of care and medication being
given to the patient. Physical, It is my goal for the patient who is sedated
and bedridden not to have any bed sores so as a nurse it is my duty to
reposition the patient every two hours and make sure that the patient is not
lying on a wet mattress to avoid any skin issues. Socio Culturally as an Asian
nurse communicating with Caucasian of African American it is my responsibility
to give respect and privacy to the patient as needed. With regards to
Technological. It is my responsibility to be aware of the machines being used
such as ventilator machine of my patient who is intubated, Tele monitor to
alarm me of any ischemia, vital signs equipment placement and positioning, use
of hoyer lift if needed and setting of bed and also the Intravenous pump for
giving medications. And when it comes to economics. Money is needed for
hospitalization. To financially fuel the expenses of medications and hospital
stay. And politically no matter what the financial background of the patient we
have this EMTALA law where in care needs to be given no matter what the
patients financial or socio economic status is. So to sum it all up I can say
that we have been practing what Marilyn ANNE Ray’s theory as a whole for the
patients optimal well being.
– Jinus
Jose J. Miranda, RN
Changes in
the health care environment have raised many questions related to patient care.
Cited an example how I understood Dr. Marilyn Ray Theory of Bureaucratic
Nursing. I worked in Kingdom of Saudi Arabia from 2009-2014. As we all
know that living in KSA is like almost living in a prison without bars. Not
allowed to take pictures in government institution and even in our hospital
were not allowed to post pictures without permission of the managers. My 5
years in PICU was so smooth until on my 5th year, we had a CORONA-MERS
OUTBREAK. Wherein all of the hospital staffs was affected. The administrators
had to come up and decide strict policies to prevent the spread of disease. It
was an eye-opener for all of us to be more keen and protect ourselves. The
hospital provided a unit only for patients and staff who are affected by the
disease and even close relatives not allowed to visit. Nurses were being
pulled-out in each unit to take care of them. It was really difficult time. My
2 close friends were even affected but I can’t even visit them since it was
hospital policy. If the immediate family members were resisting to come and
visit especially during code blue/green situations — really a big fight with
the security and ended up giving what they want provided that they will wear
all the protective gears ( as shown in my picture above)
As much as
we want to give the best care to our clients, we are also guided by the
policies in every institution that we need to follow. In the theory of Dr.
Marilyn Ray it focuses in the right
direction to bring about an interdependent relationship between caring and
bureaucracy. In the words of Dr. Ray:
– Girlie Domingo Meneses, RN
Currently working as a
Quality Management Division Staff in Cardinal Santos Medical Center. In
Dr. Ray's Theory and in my form of work as part of the Administrative side I
may say, we are dealing with the nurses and
other health care personnel on how effective they are in providing services to
the patients. Also, come up with a more strategic and effective ways in
providing satisfactory health care services. By means of rendering
satisfactory health care services and patient satisfaction, it increases the hospital's
revenue thus, having a well-compensated and satisfied nurses.
– Aldheja Sheriel Ann T. Medrano, RN
.jpg)