Verification. Once a solution has been implemented, evaluate it for effectiveness. You may need to restart the process or go back to another step and create a different solution.
Case Study 8-1 describes how one nurse manager used creativity to solve a problem.
Decision Making Considering all the practice individuals get in making decisions, it would seem they might become very good at it. However, the number of decisions a person makes does not correspond to the person’s skill at making them. The assumption is that decision making comes naturally, like breathing. It does not.
The decision-making process described in this chapter provides nurses with a system for making decisions that is applicable to any decision. It is a useful procedure for making practical choices. A decision not to solve a problem is also a decision.
Although decision making and problem solving appear similar, they are not synonymous. Decision making may or may not involve a problem, but it always involves selecting one of several alternatives, each of which may be appropriate under certain circumstances. Problem solving, on the other hand, involves diagnosing a problem and solving it, which may or may not entail deciding on one correct
104 PART 2 • LEARNING KEY SKILLS IN NURSING MANAGEMENT
solution. Most of the time, decision making is a subset of problem solving. However, some decisions are not of a problem-solving nature, such as decisions about scheduling, equipment, or in-services.
Types of Decisions The types of problems nurses and nurse managers encounter and the decisions they must make vary widely and determine the problem-solving or decision-making methods they should use. Relatively well defined, common problems can usually be solved with routine decisions, often using established rules, policies, and procedures. For instance, when a nurse makes a medica- tion error, the manager’s actions are guided by policy and the report form. Routine decisions are more often made by first-level managers than by top administrators.
Adaptive decisions are necessary when both problems and alternative solutions are some- what unusual and only partially understood. Often they are modifications of other well-known problems and solutions. Managers must make innovative decisions when problems are unusual and unclear and when creative, novel solutions are necessary.
Decision-Making Conditions The conditions surrounding decision making can vary and change dramatically. Consider the total system. Whatever solutions are created will succeed only if they are compatible with other parts of the system. Decisions are made under conditions of certainty, risk, or uncertainty.
Decision Making Under Certainty When you know the alternatives and the conditions surrounding each alternative, a state of cer- tainty is said to exist. Suppose a nurse manager on a unit with acutely ill patients wants to decrease the number of venipunctures a patient experiences when an IV is started, as well as reduce costs resulting from failed venipunctures. Three alternatives exist:
● Establish an IV team on all shifts to minimize IV attempts and reduce costs ● Establish a reciprocal relationship with the anesthesia department to start IVs when nurses
experience difficulty ● Set a standard of two insertion attempts per nurse per patient, although this does not sub-
stantially lower equipment costs
CREATIVE PROBLEM SOLVING Jeffrey was just promoted to manager of an acute care clinic, which recently expanded its hours from 6 A.M. un- til 10 P.M. He soon realizes that staff nurses are reluctant to sign up on the schedule and do quality chart audits, an important process used to review clinic operations and patients’ care. He gathers information about qual- ity improvement, reviews the literature on motivation and incentives, and discusses the issue with other nurse managers (preparation).
Jeffrey continues to manage the clinic, thinking about the information he has gathered but does not consciously make a decision or reject new ideas (incuba- tion). When working on a new problem, self-scheduling for the change in hours, he realizes a connection between the two problems. Many nurses complain that by the time they receive the schedule the day shifts are filled.
Jeffrey decides to review the chart audits. Nurses who regularly participate in quality improvement projects will receive a “perk.” They will be allowed, on a rotating basis, first choice at selecting the schedule they want to work (this is the insight stage). He discusses the plan with the staff and proposes a two-month trial period to deter- mine whether the solution is effective (verification).