problem solving strategies in nursing

The Value of Critical Thinking in Nursing

• How Nurses Use Critical Thinking
• How to Improve Critical Thinking
• Common Mistakes

Some experts describe a person’s ability to question belief systems, test previously held assumptions, and recognize ambiguity as evidence of critical thinking. Others identify specific skills that demonstrate critical thinking, such as the ability to identify problems and biases, infer and draw conclusions, and determine the relevance of information to a situation.

Nicholas McGowan, BSN, RN, CCRN, has been a critical care nurse for 10 years in neurological trauma nursing and cardiovascular and surgical intensive care. He defines critical thinking as “necessary for problem-solving and decision-making by healthcare providers. It is a process where people use a logical process to gather information and take purposeful action based on their evaluation.”

“This cognitive process is vital for excellent patient outcomes because it requires that nurses make clinical decisions utilizing a variety of different lenses, such as fairness, ethics, and evidence-based practice,” he says.

How Do Nurses Use Critical Thinking?

Successful nurses think beyond their assigned tasks to deliver excellent care for their patients. For example, a nurse might be tasked with changing a wound dressing, delivering medications, and monitoring vital signs during a shift. However, it requires critical thinking skills to understand how a difference in the wound may affect blood pressure and temperature and when those changes may require immediate medical intervention.

Nurses care for many patients during their shifts. Strong critical thinking skills are crucial when juggling various tasks so patient safety and care are not compromised.

Jenna Liphart Rhoads, Ph.D., RN, is a nurse educator with a clinical background in surgical-trauma adult critical care, where critical thinking and action were essential to the safety of her patients. She talks about examples of critical thinking in a healthcare environment, saying:

“Nurses must also critically think to determine which patient to see first, which medications to pass first, and the order in which to organize their day caring for patients. Patient conditions and environments are continually in flux, therefore nurses must constantly be evaluating and re-evaluating information they gather (assess) to keep their patients safe.”

The COVID-19 pandemic created hospital care situations where critical thinking was essential. It was expected of the nurses on the general floor and in intensive care units. Crystal Slaughter is an advanced practice nurse in the intensive care unit (ICU) and a nurse educator. She observed critical thinking throughout the pandemic as she watched intensive care nurses test the boundaries of previously held beliefs and master providing excellent care while preserving resources.

“Nurses are at the patient’s bedside and are often the first ones to detect issues. Then, the nurse needs to gather the appropriate subjective and objective data from the patient in order to frame a concise problem statement or question for the physician or advanced practice provider,” she explains.

Top 5 Ways Nurses Can Improve Critical Thinking Skills

We asked our experts for the top five strategies nurses can use to purposefully improve their critical thinking skills.

Case-Based Approach

Slaughter is a fan of the case-based approach to learning critical thinking skills.

In much the same way a detective would approach a mystery, she mentors her students to ask questions about the situation that help determine the information they have and the information they need. “What is going on? What information am I missing? Can I get that information? What does that information mean for the patient? How quickly do I need to act?”

Consider forming a group and working with a mentor who can guide you through case studies. This provides you with a learner-centered environment in which you can analyze data to reach conclusions and develop communication, analytical, and collaborative skills with your colleagues.

Practice Self-Reflection

Rhoads is an advocate for self-reflection. “Nurses should reflect upon what went well or did not go well in their workday and identify areas of improvement or situations in which they should have reached out for help.” Self-reflection is a form of personal analysis to observe and evaluate situations and how you responded.

This gives you the opportunity to discover mistakes you may have made and to establish new behavior patterns that may help you make better decisions. You likely already do this. For example, after a disagreement or contentious meeting, you may go over the conversation in your head and think about ways you could have responded.

It’s important to go through the decisions you made during your day and determine if you should have gotten more information before acting or if you could have asked better questions.

During self-reflection, you may try thinking about the problem in reverse. This may not give you an immediate answer, but can help you see the situation with fresh eyes and a new perspective. How would the outcome of the day be different if you planned the dressing change in reverse with the assumption you would find a wound infection? How does this information change your plan for the next dressing change?

Develop a Questioning Mind

McGowan has learned that “critical thinking is a self-driven process. It isn’t something that can simply be taught. Rather, it is something that you practice and cultivate with experience. To develop critical thinking skills, you have to be curious and inquisitive.”

To gain critical thinking skills, you must undergo a purposeful process of learning strategies and using them consistently so they become a habit. One of those strategies is developing a questioning mind. Meaningful questions lead to useful answers and are at the core of critical thinking .

However, learning to ask insightful questions is a skill you must develop. Faced with staff and nursing shortages , declining patient conditions, and a rising number of tasks to be completed, it may be difficult to do more than finish the task in front of you. Yet, questions drive active learning and train your brain to see the world differently and take nothing for granted.

It is easier to practice questioning in a non-stressful, quiet environment until it becomes a habit. Then, in the moment when your patient’s care depends on your ability to ask the right questions, you can be ready to rise to the occasion.

Practice Self-Awareness in the Moment

Critical thinking in nursing requires self-awareness and being present in the moment. During a hectic shift, it is easy to lose focus as you struggle to finish every task needed for your patients. Passing medication, changing dressings, and hanging intravenous lines all while trying to assess your patient’s mental and emotional status can affect your focus and how you manage stress as a nurse .

Staying present helps you to be proactive in your thinking and anticipate what might happen, such as bringing extra lubricant for a catheterization or extra gloves for a dressing change.

By staying present, you are also better able to practice active listening. This raises your assessment skills and gives you more information as a basis for your interventions and decisions.

Use a Process

As you are developing critical thinking skills, it can be helpful to use a process. For example:

• Ask questions.
• Gather information.
• Implement a strategy.
• Evaluate the results.
• Consider another point of view.

These are the fundamental steps of the nursing process (assess, diagnose, plan, implement, evaluate). The last step will help you overcome one of the common problems of critical thinking in nursing — personal bias.

Common Critical Thinking Pitfalls in Nursing

Your brain uses a set of processes to make inferences about what’s happening around you. In some cases, your unreliable biases can lead you down the wrong path. McGowan places personal biases at the top of his list of common pitfalls to critical thinking in nursing.

“We all form biases based on our own experiences. However, nurses have to learn to separate their own biases from each patient encounter to avoid making false assumptions that may interfere with their care,” he says. Successful critical thinkers accept they have personal biases and learn to look out for them. Awareness of your biases is the first step to understanding if your personal bias is contributing to the wrong decision.

New nurses may be overwhelmed by the transition from academics to clinical practice, leading to a task-oriented mindset and a common new nurse mistake ; this conflicts with critical thinking skills.

“Consider a patient whose blood pressure is low but who also needs to take a blood pressure medication at a scheduled time. A task-oriented nurse may provide the medication without regard for the patient’s blood pressure because medication administration is a task that must be completed,” Slaughter says. “A nurse employing critical thinking skills would address the low blood pressure, review the patient’s blood pressure history and trends, and potentially call the physician to discuss whether medication should be withheld.”

Fear and pride may also stand in the way of developing critical thinking skills. Your belief system and worldview provide comfort and guidance, but this can impede your judgment when you are faced with an individual whose belief system or cultural practices are not the same as yours. Fear or pride may prevent you from pursuing a line of questioning that would benefit the patient. Nurses with strong critical thinking skills exhibit:

• Learn from their mistakes and the mistakes of other nurses
• Look forward to integrating changes that improve patient care
• Treat each patient interaction as a part of a whole
• Evaluate new events based on past knowledge and adjust decision-making as needed
• Solve problems with their colleagues
• Are self-confident
• Acknowledge biases and seek to ensure these do not impact patient care

An Essential Skill for All Nurses

Critical thinking in nursing protects patient health and contributes to professional development and career advancement. Administrative and clinical nursing leaders are required to have strong critical thinking skills to be successful in their positions.

By using the strategies in this guide during your daily life and in your nursing role, you can intentionally improve your critical thinking abilities and be rewarded with better patient outcomes and potential career advancement.

Frequently Asked Questions About Critical Thinking in Nursing

How are critical thinking skills utilized in nursing practice.

Nursing practice utilizes critical thinking skills to provide the best care for patients. Often, the patient’s cause of pain or health issue is not immediately clear. Nursing professionals need to use their knowledge to determine what might be causing distress, collect vital information, and make quick decisions on how best to handle the situation.

How does nursing school develop critical thinking skills?

Nursing school gives students the knowledge professional nurses use to make important healthcare decisions for their patients. Students learn about diseases, anatomy, and physiology, and how to improve the patient’s overall well-being. Learners also participate in supervised clinical experiences, where they practice using their critical thinking skills to make decisions in professional settings.

Do only nurse managers use critical thinking?

Nurse managers certainly use critical thinking skills in their daily duties. But when working in a health setting, anyone giving care to patients uses their critical thinking skills. Everyone — including licensed practical nurses, registered nurses, and advanced nurse practitioners —needs to flex their critical thinking skills to make potentially life-saving decisions.

Meet Our Contributors

Crystal Slaughter, DNP, APRN, ACNS-BC, CNE

Crystal Slaughter is a core faculty member in Walden University’s RN-to-BSN program. She has worked as an advanced practice registered nurse with an intensivist/pulmonary service to provide care to hospitalized ICU patients and in inpatient palliative care. Slaughter’s clinical interests lie in nursing education and evidence-based practice initiatives to promote improving patient care.

Jenna Liphart Rhoads, Ph.D., RN

Jenna Liphart Rhoads is a nurse educator and freelance author and editor. She earned a BSN from Saint Francis Medical Center College of Nursing and an MS in nursing education from Northern Illinois University. Rhoads earned a Ph.D. in education with a concentration in nursing education from Capella University where she researched the moderation effects of emotional intelligence on the relationship of stress and GPA in military veteran nursing students. Her clinical background includes surgical-trauma adult critical care, interventional radiology procedures, and conscious sedation in adult and pediatric populations.

Nicholas McGowan, BSN, RN, CCRN

Nicholas McGowan is a critical care nurse with 10 years of experience in cardiovascular, surgical intensive care, and neurological trauma nursing. McGowan also has a background in education, leadership, and public speaking. He is an online learner who builds on his foundation of critical care nursing, which he uses directly at the bedside where he still practices. In addition, McGowan hosts an online course at Critical Care Academy where he helps nurses achieve critical care (CCRN) certification.

What is Critical Thinking in Nursing? (With Examples, Importance, & How to Improve)

Successful nursing requires learning several skills used to communicate with patients, families, and healthcare teams. One of the most essential skills nurses must develop is the ability to demonstrate critical thinking. If you are a nurse, perhaps you have asked if there is a way to know how to improve critical thinking in nursing? As you read this article, you will learn what critical thinking in nursing is and why it is important. You will also find 18 simple tips to improve critical thinking in nursing and sample scenarios about how to apply critical thinking in your nursing career.

What is Critical Thinking in Nursing?

4 reasons why critical thinking is so important in nursing, 1. critical thinking skills will help you anticipate and understand changes in your patient’s condition., 2. with strong critical thinking skills, you can make decisions about patient care that is most favorable for the patient and intended outcomes., 3. strong critical thinking skills in nursing can contribute to innovative improvements and professional development., 4. critical thinking skills in nursing contribute to rational decision-making, which improves patient outcomes., what are the 8 important attributes of excellent critical thinking in nursing, 1. the ability to interpret information:, 2. independent thought:, 3. impartiality:, 4. intuition:, 5. problem solving:, 6. flexibility:, 7. perseverance:, 8. integrity:, examples of poor critical thinking vs excellent critical thinking in nursing, 1. scenario: patient/caregiver interactions, poor critical thinking:, excellent critical thinking:, 2. scenario: improving patient care quality, 3. scenario: interdisciplinary collaboration, 4. scenario: precepting nursing students and other nurses, how to improve critical thinking in nursing, 1. demonstrate open-mindedness., 2. practice self-awareness., 3. avoid judgment., 4. eliminate personal biases., 5. do not be afraid to ask questions., 6. find an experienced mentor., 7. join professional nursing organizations., 8. establish a routine of self-reflection., 9. utilize the chain of command., 10. determine the significance of data and decide if it is sufficient for decision-making., 11. volunteer for leadership positions or opportunities., 12. use previous facts and experiences to help develop stronger critical thinking skills in nursing., 13. establish priorities., 14. trust your knowledge and be confident in your abilities., 15. be curious about everything., 16. practice fair-mindedness., 17. learn the value of intellectual humility., 18. never stop learning., 4 consequences of poor critical thinking in nursing, 1. the most significant risk associated with poor critical thinking in nursing is inadequate patient care., 2. failure to recognize changes in patient status:, 3. lack of effective critical thinking in nursing can impact the cost of healthcare., 4. lack of critical thinking skills in nursing can cause a breakdown in communication within the interdisciplinary team., useful resources to improve critical thinking in nursing, youtube videos, my final thoughts, frequently asked questions answered by our expert, 1. will lack of critical thinking impact my nursing career, 2. usually, how long does it take for a nurse to improve their critical thinking skills, 3. do all types of nurses require excellent critical thinking skills, 4. how can i assess my critical thinking skills in nursing.

• Ask relevant questions • Justify opinions • Address and evaluate multiple points of view • Explain assumptions and reasons related to your choice of patient care options

5. Can I Be a Nurse If I Cannot Think Critically?

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Nurse leaders as problem-solvers

Addressing lateral and horizontal violence.

Anthony, Michelle R. PhD, RN; Brett, Anne Liners PhD, RN

Michelle R. Anthony is a program coordinator at Columbia (S.C.) VA Health Care System. Anne Liners Brett is doctoral faculty at the University of Phoenix in Tempe, Ariz.

Acknowledgment: The authors acknowledge the support of the University of Phoenix Center for Educational and Instructional Technology Research.

The contents of this article do not represent the views of the US Department of Veterans Affairs or the United States Government.

The authors and planners have disclosed no potential conflicts of interest, financial or otherwise.

For more than 126 additional continuing-education articles related to management topics, go to NursingCenter.com/CE .

Earn CE credit online: Go to http://nursing.ceconnection.com and receive a certificate within minutes .

Read about a qualitative, grounded theory study that looked to gain a deeper understanding of nurse leaders' perceptions of their role in addressing lateral and horizontal violence, and the substantive theory developed from the results.

The issue of lateral and horizontal violence (LHV) has plagued the nursing profession for more than 3 decades, yet solutions remain elusive. The significance of LHV isn't lost on nurse leaders because it creates an unhealthy work environment. Research literature worldwide has continued to report the prevalence of disruptive behaviors experienced by nursing students, novice nurses, and seasoned nurses in the workforce. The World Health Organization, International Council of Nurses, and Public Services International have recognized this issue as a major global public health priority. 1

LHV, also called nurse-on-nurse aggression, disruptive behavior, or incivility, undermines a culture of safety and negatively impacts patient care. 2,3 This experience, known to nurses as “eating their young,” isn't only intimidating and disruptive, it's also costly and demoralizing to the nursing profession and healthcare organizations. 4,5 Although the impact of LHV can be dreadful for both the institution and its staff, little is known about the reasons for these behaviors among nursing professionals. 2

LHV encompasses all acts of meanness, hostility, disruption, discourtesy, backbiting, divisiveness, criticism, lack of unison, verbal or mental abuse, and scapegoating. 6 The sole intent of bullying behaviors is to purposefully humiliate and demean victims. Bullying behaviors also taint healthcare organizations; cause irreparable harm to workplace culture; breakdown team communication; and severely impact the quality of the care provided, thereby jeopardizing patient safety. 7,8 Researchers have reported that acts of LHV are used to demonstrate power, domination, or aggression; for retribution; to control others; and to enhance self-image. 9-12

Previous studies have shown that the frequency of LHV in healthcare organizations is quite severe, with about 90% of new nurses surveyed reporting acts of incivility by their coworkers. 13 Sixty-five percent of nurses in one survey reported witnessing incidents of despicable acts, whereas another 46% of coworkers in the same survey reported the issue as “very serious” and “somewhat serious.” 13

LHV poses a significant challenge for nurse leaders who are legally and morally responsible for providing a safe working environment. 2,6 The purpose of this qualitative, grounded theory study was to gain a deeper understanding of nurse leaders' perceptions of their role in addressing LHV and develop a substantive theory from the results.

Literature review

A paucity of evidence exists in the literature regarding how nurse leaders perceive their role in addressing LHV. 14 Studies have shown that this phenomenon is attributed to heavy workloads, a stressful work environment, and lack of workgroup cohesiveness, as well as organizational factors such as misuse of authority and the lack of organizational policies and procedures for addressing LHV behaviors. 15

In one study, one-third of the nurses reported that they had observed emotional abuse during several of their work shifts. 16 Another study indicated that 30% of survey respondents (n = 2,100) stated LHV occurs weekly. 17 A third study revealed that 25% of participants noted LHV happened monthly, and a fourth study of ED nurses reported that about 27.3% of the nurses had experienced LHV perpetrated by nursing leadership (managers, supervisors, charge nurses, and directors), physicians, or peers in the last 6 months. 18

In a survey completed by members of the Washington State Emergency Nurses Association, 27% of respondents experienced acts of bullying in the past 6 months. 19 Another study reported that 27% to 85% of nurse respondents had experienced some form of uncivil behavior. 20 Other data have shown that those more vulnerable to violent, disruptive, and intimidating behaviors are newly licensed nurses beginning their careers. 21

Although nurse leaders can be perpetrators of LHV, they play an essential role in addressing LHV behaviors and creating a safe work environment. 22 The literature suggests that, in many cases, a lack of awareness and response by nurse leaders adds to the prevalence of LHV. 23 This may be due, in part, to nurse leaders being aligned with the perpetrators who are creating the toxic work environment. 6 The literature suggests that an environment where staff members feel safe to practice results in a culture that decreases burnout and promotes nurse retention and quality outcomes. 24,25

This qualitative, grounded theory study focused on nurse leaders' perception of their role in breaking the cycle of LHV for staff members whom they supervise. Two research questions guided the study: 1. How do nurse leaders perceive their role in addressing LHV among nursing staff members under their supervision? 2. What substantive theory may emerge from the data collected during interviews with nurse leaders?

A grounded theory methodology was used to explore the nurse leader's role in addressing LHV with the intent of developing a substantive theory through the meaningful organization of data themes to provide a framework to address the phenomenon of LHV. Purposive sampling was used to recruit a total of 14 participants for this study from a large healthcare system in the Southeastern US. The participants were chosen because of their experience with LHV and their ability to discuss and reflect on those experiences. Informed consent was obtained before the start of the study, which included explaining the reason for the study and what to expect. In addition, permission was obtained from the Institutional Review Board.

Data collection and analysis

Demographic data collected to describe the sample included gender, age range, number of years holding a management position, supervisory responsibility, and highest degree obtained. (See Table 1 .)

Semistructured, in-depth interviews were the primary mode of data collection. The recorded interviews were conducted face-to-face and lasted about 60 minutes. Data collection continued until saturation was achieved. Data saturation occurred when no new descriptive codes, categories, or themes were emerging from the analyzed data. The interviews were transcribed verbatim and verified through a member check process.

During the data analysis process, themes and patterns were identified. Data from each participant's interview were examined to determine if the responses were aligned with the identified themes. Analysis of the data included coding at increasingly abstract levels and constant comparison. Qualitative software assisted in coding the information and uncovering subtle trends.

Four themes emerged from core categories developed during the qualitative data coding process.

Theme 1: Understanding/addressing LHV . In question one, participants were asked to describe their understanding of LHV. Five subthemes emerged from the data collected with this question. (See Table 2 .)

Theme 2: Experience addressing LHV . In the second question, participants were asked about their experience with addressing incidents of LHV. Six subthemes were identified. (See Table 3 .)

Theme 3: Role perception in addressing LHV . In the third question, participants were asked what they perceive their role to be in addressing LHV. Six subthemes resulted from this question. (See Table 4 .)

Theme 4: Organizational impediment to addressing LHV . In question four, participants were asked to describe the factors within the organization that influence or impede their role in addressing LHV. This question yielded nine subthemes. (See Table 5 .)

Substantive theory

As a result of the themes that emerged from the data, a substantive theory was developed. This is especially important for the nursing profession to develop as a scientifically based practice. Theories help guide research and provide the expansion, generation, and validation of the science of nursing knowledge. 26 The substantive theory will help nurse leaders become more cognizant of the role that effective leadership plays in preventing or intervening in incidents of LHV in the workplace. The analysis revealed that nurse leaders are aware that the quality of patient care and staff well-being can be adversely affected by the impact of LHV.

Data themes were used to formulate the following theory: Nurse leaders address LHV affecting their staff members by solving problems, creating a safe work environment, and reducing institutional barriers that impede addressing LHV in a timely fashion. Nurse leaders perceive their role as a problem-solver, which is a necessary step in advocacy. 27 Problem-solving is a process that contains the elements of decision-making and critical thinking. 28

The theory that emerged from the core categories explicitly focused on the central phenomenon of LHV in the nursing work environment. Figure 1 shows the interrelatedness of the themes to the resultant substantive theory.

Discussion and implications

The study results have several implications for both the nursing profession and nurse leaders. The nursing profession requires decisive and robust leadership, and the role of the nurse leader is to be a combination of nurturer, investigator, and judge to examine incidents of LHV. 26,29-32 Nurse leaders are responsible for setting the tone and expectations for a safe work environment. This includes modeling the expected ethical behaviors; for example, doing the right things for the right reasons, being collegial toward each other, and being respectful of other's differences. One participant remarked, “This is a different world based on how I was raised. I was raised to be respectful to people.”

In addition, nurse leaders are responsible for enforcing policies created to address disruptive behaviors and working with the administration as soon as an incident occurs. Past research indicates that a healthy and collaborative work environment fosters nurse engagement and patient safety. 25,30 Staff members and patients need a leader to protect them when necessary; thus, the nurse leader needs to “walk the walk” in providing a safe environment for all. Nurse leaders engaged in these kinds of behaviors are providing strong leadership and practicing strong decision-making, thus ensuring the continued robustness of their organizations.

Recommendations and limitations

Future research could replicate this study in a different geographic region to explore the causes of LHV by soliciting the views of nursing students, new graduate nurses, and nurse educators from unionized and nonunionized hospital systems and comparing the results to further understand this phenomenon. Additionally, developing a tool to test the substantive theory could substantiate the nurse leader's role as a problem-solver to address incidence of LHV in the workplace.

The decision to conduct this study in one type of healthcare organization limits the ability to compare the interviewed nurse leaders' experiences with nurse leaders in other healthcare organizations. The experiences of nurses in other healthcare organizations may be different; thus, overall generalizability of the study may be limited.

Say “no” to the status quo

The results of this study support the findings of previous researchers. 23,31,33,34 Accepting the status quo is unacceptable and can cause irreparable harm to organizational well-being if LHV isn't addressed. Collaboration between nurse leaders and administrators is essential to successfully reduce institutional obstacles that prevent the timely handling of LHV incidents. The role of the nurse leader as a problem-solver should be clear, defined, and well supported to seek resolutions to toxic behaviors that are hurting the work environment. But we must remember that creating a policy doesn't equal change. Every employee from the lowest level in the organization to the highest ranks of administration must model civil behaviors.

INSTRUCTIONS Nurse leaders as problem-solvers: Addressing lateral and horizontal violence

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• Read the article. The test for this CE activity is to be taken online at http://nursing.ceconnection.com .
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• For questions, contact Lippincott Professional Development: 1-800-787-8985 .
• Registration deadline is June 3, 2022 .

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Lippincott Professional Development is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

This activity is also provider approved by the California Board of Registered Nursing, Provider Number CEP 11749 for 1.5 contact hours, and the District of Columbia, Georgia, and Florida CE Broker #50-1223.

Payment: The registration fee for this test is $17.95.

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Conflict Resolution Strategies for Nurse Leaders

3 min read • September, 18 2023

Conflicts are inevitable when you work in a stressful environment like health care. Tension and stress can result from miscommunication and differing opinions and priorities. You can't ignore a volatile situation between staff members as a nurse leader. Conflicts within your nursing team can create an uncomfortable work environment for everyone. It's often not the conflict that's your biggest challenge — it's how you work to resolve it.

Conflict Management in Nursing

Discord can stem from opposing personalities, biases, or perceptions, and internal or external stressors. To be an effective nurse leader, you may need to provide guidance and coaching to help your team resolve conflicts.

Examples of Nursing Conflicts

Consider these nursing conflict scenarios:

• Staff conflicts regarding workload distribution, staffing ratios, and shift preferences
• Interdisciplinary disagreements about treatment plans, responsibilities, or decision-making processes
• Ethical disputes on topics such as end-of-life care, patient autonomy, and resource allocation
• Communication breakdowns resulting in misunderstandings or lack of information
• Discrepancies in management styles, decision-making authority, or organizational policies
• Role conflicts resulting from overlapping roles or ambiguity in responsibilities
• Resource conflicts due to limited supplies, equipment, or budget allocations

Potential Responses to Conflicts in Nursing

The health care environment requires teamwork to provide safe, quality care. It's in everyone's best interest to work collaboratively to resolve the conflict. How you and your staff respond to a conflict will vary based on the situation and individual personalities. Try these five approaches to resolve interpersonal conflicts among your team:

• Accommodation . Use this strategy to maintain peace and harmony by smoothing over differences. This method of conflict management in nursing may be appropriate when escalating the issue could create a severe disruption.
• Collaboration . This approach, committed to solving the problem by objectively evaluating differing views, can lead to creativity and new ideas.
• Compromise . This bargaining strategy recognizes the importance of resolving the relationship and can provide a temporary solution.
• Avoidance . In situations fueled by intense anger, avoiding conflict also provides a short-term resolution.
• Competition . Another short-term solution involves assertively resolving a conflict when one person has more decision-making power.

Additional Conflict Resolution Strategies in Nursing

Nursing conflict resolution requires patience, active listening skills, and a commitment to finding a beneficial solution. The goal is to address conflicts among your nursing staff and promote a safe and harmonious work environment that provides quality patient care.

Ignoring the problem may result in your staff developing resentment toward the person who made the work environment uncomfortable. Rushing to fix the conflict without determining the source of the issue could lead to other problems. Treat the situation like a conflicting diagnosis and identify the source of discord before proceeding.

Tips for Conflict Resolution in Nursing

Conflict resolution in nursing requires communication, collaboration, and listening. Here are practical tips for navigating conflicts:

• Create a supportive environment that encourages active listening and honest conversation.
• Make sure you fully understand the situation.
• Approach the problem objectively and, if necessary, seek additional perspectives from your human resources department or another nurse leader.
• Facilitate constructive dialogue to work toward a mutually agreeable solution.
• Seek the conflict's root cause.
• Find solutions that aren't quick fixes but address the core problem.
• Ask questions to prompt different perspectives and creative solutions.
• Identify and discuss underlying interests to soften rigid views.
• Find common ground and work toward a mutual agreement.
• Emphasize the importance of collaboration.
• Develop effective communication and conflict-resolution skills.
• Support suggestions for productive and innovative solutions.
• Rule out and quickly address bullying and incivility .
• Admit and apologize if you've played a role in the conflict.
• Be consistent with standards and potential consequences.
• Handle conflicts fairly and transparently.
• Document the situation, steps taken, and the resolution.
• Monitor to ensure the problem gets resolved and doesn't reoccur.

Conflicts in health care vary in nature and complexity. Other strategies, such as arbitration or involving an ethics committee, may be appropriate depending on the circumstances. Be alert for signs of a conflict before a situation becomes volatile or uncomfortable. Sometimes, despite your best efforts, disciplinary action may become necessary.

Dealing with conflict fairly and effectively can help you gain the respect of your nursing staff and grow as a leader. Conflict resolution in nursing leadership identifies underlying issues and creates better solutions. By listening and collaborating, you can resolve conflicts constructively to maintain a positive work environment.

Images sourced from Getty Images

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• Problem Solving in Nursing Management

Dive deep into the multifaceted world of nursing management with a special focus on problem-solving. This comprehensive guide presents a detailed look at the process, importance, and challenges of problem-solving in nursing management. By highlighting essential skills, neurologically based frameworks, and the relationship with decision-making, it offers both theoretical understanding and practical solutions. Explore real-life case studies, leadership's role, and the link with critical thinking. This is an enriching journey towards developing strategic competencies and achieving effective problem-solving in a vital healthcare sector.

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• Staff Development
• Staffing Models
• Staffing in Nursing
• Stakeholder Engagement
• Strategic Planning in Nursing
• Time Management
• Waste Disposal in Hospital
• Worker Safety
• Workforce Planning
• Workplace Harmony
• Nursing Theories
• Types of Nursing

Understanding Problem Solving in Nursing Management

Problem solving in nursing management is a crucial process that you need to grasp as a prospective or current nurse. This involves using a logical, systematic approach to resolving issues encountered in a nursing environment, focusing on maintaining quality patient care .

Problem Solving: This is identifying and overcoming obstacles to achieving a goal. In nursing, this generally revolves around improving patient health outcomes and ensuring efficient healthcare facility operations.

Importance of Problem Solving in Nursing Management

Nursing professionals are constantly faced with intricate issues that require decisive and effective solutions. The ability to implement problem-solving is crucial in maintaining optimal patient care , operational efficiency , and fostering team collaboration.

For instance, suppose a sudden shortage of resources like catheters or syringes is experienced in a healthcare facility. In such a case, the nursing manager will need to swiftly solve the problem either by reallocating resources, timely ordering supplies, or finding a temporary alternative, ensuring the patients' needs are continually met.

Key Skills Required for Problem Solving in Nursing Management

Effective problem-solving in nursing management is anchored on a set of key skills. These abilities equip you to navigate complex situations and formulate impactful solutions. They include:

• Critical Thinking: This is your ability to analyse situations in detail and understand their implications.
• Decisiveness: The readiness to make important decisions swiftly and confidently.
• Communication: Sharing and receiving information clearly and effectively.
• Collaboration: Working effectively as part of a team.

These skills are interconnected. For example, your ability to think critically informs your decisiveness. Your decisions are then made clear to your team through effective communication, and together, through collaboration, the problem is solved.

Common Challenges in Problem Solving in Nursing Management

In your nursing management journey, you will come across multiple challenges when attempting to solve problems. These obstacles might occur due to several factors, such as resource limitations, personnel issues, and complex patient needs .

While these challenges can be daunting, equipping yourself with robust problem-solving skills will help you navigate these complications and maintain high standards of patient care.

Scrutinising the Problem Solving Process in Nursing Management

Delving deeper into the problem-solving process in nursing management, you get to navigate its intricacies and mechanisms. This exploration can bolster your abilities to resolve complex situations in your nursing career.

Steps involved in the Problem Solving Process

Problem-solving in nursing management is a multifaceted task that often involves several steps. To understand how to tackle issues expertly, you will need a clear understanding of each stage.

Problem-Solving Process: A systematic approach used to address complications and make decisions. In nursing, it’s composed of several steps, each essential to the resolution of issues.

Here are the key steps:

• Identification: In this stage, you recognise the existence of a problem. It is essential to understand the barriers to your goals and spotlight areas that require improvement.
• Definition: You clearly articulate the problem. By understanding its nuances, magnitude, and implications, you can efficiently tailor a solution.
• Analysis: This involves examining the problem closely from different perspectives, which includes understanding the cause and effect, stakeholders involved, and potential impacts.
• Development of Solutions: Here you brainstorm possible solutions. It's essential to contemplate multiple alternatives to ensure the most effective resolution is chosen.
• Decision Making: In this step, you select the best solution based on the gathered information and analysis. Considerations may include effectiveness, resources needed, and potential side effects.
• Implementation: You put the chosen solution into action, carefully monitoring its effectiveness and making necessary adjustments.
• Evaluation: Finally, you assess the outcome. This helps to determine the effectiveness of your solution and informs future problem-solving efforts.

Neurological Framework for Problem Solving in Nursing Management

Many problem-solving methods exist, but one valuable perspective is through understanding the neurological framework in nursing management. This biological approach delves into how your brain processes information and develops solutions.

Neurological Framework: A biological perspective that explains how a nurse's brain processes, analyses, and responds to problems encountered in the nursing environment.

This framework refers to cognitive processes which involve:

• Critical thinking: This involves actively and skillfully conceptualising, applying, analysing, and evaluating information gathered from observation, experience, reflection, or communication.
• Decision making: This is the cognitive process of selecting a course of action from multiple possibilities. It's based on both intuition and logical reasoning.
• Problem-solving: This involves overcoming hurdles and finding a conclusion, and it usually includes decision-making. It involves creativity and critical thinking to arrive at effective solutions.

Role of Creativity in the Problem Solving Process

Nursing management often involves complex and unique problems. To effectively tackle these challenges, it's crucial to breed creativity in the problem-solving process.

Imagine there's a sudden surge in patient intake due to a local health crisis, resulting in a bed shortage. A creative solution might be to convert other non-critical spaces such as conference rooms temporarily into patient monitoring units, thereby managing the surge effectively.

Importance of Team Collaboration in the Problem Solving Process

In a nursing environment, you are not working in isolation. Collaboration is a critical aspect of problem-solving in nursing management, as diverse insights can lead to innovative and effective solutions.

Consider a scenario where there's a need to implement a new system for managing patient records. To effectively solve potential issues in system implementation, you might need input from various team members including nursing staff, IT specialists, and data management experts. Each member's contribution, based on their expertise and perspective, is crucial in charting a comprehensive problem-solving strategy, ensuring the successful implementation and integration of the new system.

Decision Making and Problem Solving in Nursing Management

Decision making and problem-solving are two interconnected aspects in the realm of nursing management. Understanding their correlation and distinctiveness is key to effectively managing issues and improving patient outcomes in a healthcare setting.

The Interplay between Decision Making and Problem Solving

The connection between decision making and problem solving in nursing management is truly significant. In almost every situation where a problem arises, decision making is an inseparable component of the problem-solving process.

Decision Making in Nursing: This involves selecting a course of action from different alternatives. It is the bridge connecting problem analysis with implementing solutions, and it requires evaluation of information, predicaments, and possible outcomes.

Once you have identified and defined a problem, analysed it, and developed potential solutions, the next step involves decision making. This is where you select the most suitable solution among the alternatives.

For instance, if you are dealing with a bed shortage problem in your healthcare facility, some possible solutions could be outsourcing to other healthcare facilities, using other spaces such as conference rooms as makeshift wards, or deploying portable hospital beds.

Each of these solutions has its pros and cons, and it's here that decision-making skills come into play. You'll need to compare and contrast each option, considering factors like cost, time, resources available, and the overall impact on patient care. The chosen solution is then implemented, and the effects are evaluated for future reference.

Distinguishing Decision Making from Problem Solving in Nursing Management

Though inherently connected, problem solving and decision making are distinct processes within nursing management. Where problem-solving is a comprehensive process that entails identifying, analysing, and solving issues, decision making is a component nested within this process, acting as the transition point from analysis to action.

Problem Solving in Nursing: This is a broader process involving the identification of an issue or obstacle, systematic analysis to understand it, devising potential solutions, choosing the most suitable through decision making, implementing it, and finally reviewing the effectiveness of the implemented solution.

Consider a real-life scenario such as medication errors. If these errors are occurring frequently in your healthcare setup, the problem-solving process will involve identifying the issue (increased medication errors), defining and analysing it (finding the root causes, such as miscommunication or system glitches). This would then lead to brainstorming potential solutions, like improved communication systems or enhanced employee training. The decision-making process would then come into play when choosing the best solution to implement.

Techniques for Effective Decision Making in Problem Solving Scenarios

Effective decision making underpins successful problem solving in nursing management. Implementing the right techniques can enhance your decision-making process, thus leading to more effective problem resolution.

Some proven techniques include:

• Pros and Cons Analysis: List the advantages and disadvantages of each solution to help you visualise the impacts of each decision.
• Decision Matrix: Establish criteria and rate potential solutions. The choice with the highest score is then considered the best decision.
• Cost-Benefit Analysis: Determine the financial implication of each decision and compare it to the benefits. Solutions with a high benefit-cost ratio are preferred.

Working collaboratively to brainstorm and analyse solutions promotes critical thinking and creativity, ensuring that the chosen solution maximises the use of resources and improves patient outcomes .

In unavoidable circumstances where decisions have to be made rapidly and with limited information, using intuition, a nurse's experience, and insights combined with analytical thinking can be beneficial. This is where the balanced blend of clinical expertise and effective risk-taking come into play.

Decision making is never static in nursing management. The cyclic nature of the decision-making process, where outcomes of decisions are continually assessed and feedback is used to improve future decision making, showcases its dynamic and iterative nature. This reinforces the vital role decision making plays in the problem-solving process.

Unpacking Examples of Problem Solving in Nursing Management

By exploring various examples and case studies, you gain a practical view of problem-solving in nursing management. These insights can better equip you to tackle real-life challenges in a healthcare setting.

Case Study Analysis of Problem Solving Scenarios

Case studies provide a thorough view of how problem-solving strategies are applied in various nursing management scenarios. Analysing such cases exposes you to diverse methods and solutions and encourages you to think critically and innovatively.

Case Study Analysis: A detailed examination of a particular instance or event to draw conclusions, develop solutions, or learn from the situation.

Let's investigate a case concerning patient waiting times. In a healthcare facility, it is observed that patients often have to wait for prolonged periods to receive care, leading to dissatisfaction and affecting the overall quality of service. The problem-solving steps might look like this:

• Identification and Definition: The problem is identified as long patient waiting times. It is defined as patients waiting more than 45 minutes to receive care.
• Analysis: The cause of the problem is found to be a shortage of nursing staff during peak hours.
• Development of Solutions: Several possible solutions emerge, such as recruiting additional staff, offering overtime to existing staff, or streamlining operational processes to reduce inefficiencies.
• Decision Making: After careful analysis, it is decided to hire additional part-time staff to handle peak hours.
• Implementation: The recruitment process is initiated and new members integrated into the team.
• Evaluation: After a few months, waiting times are reassessed. A significant reduction is observed, confirming the effectiveness of the solution.

Case study analysis provides a rich source of knowledge and transferable insights that can be helpful in similar or entirely different scenarios. Drawing parallels from varying contexts and understanding how solutions are adapted to unique situations helps bolster your problem-solving skills and adaptability in nursing management.

Varied Approaches to Problem Solving in Different Nursing Scenarios

Different nursing scenarios call for diverse problem-solving strategies. Understanding the varying approaches, from algorithm-based to intuition-driven, equips you to manage multidimensional and intricate issues effectively.

Algorithm-based Approach: This involves following a clearly defined set of rules or procedures to solve a problem. It can be applicable in situations with defined parameters and scope, such as diagnosing a health condition based on a specific set of symptoms.

Intuition-driven Approach: This combines a nurse's experience, knowledge, and instinct to solve a problem. It applies to ambiguous scenarios where conventional rules may not be applicable, such as managing a patient's fear or anxiety.

Problem-solving in nursing management is all about adapting to the environment and the situation. The right approach may vary, calling for flexibility, creativity, critical thinking, and a deep understanding of the issue for successful resolution.

Real Life Applications of Problem Solving Strategies in Nursing Management

The real world of nursing is complex and dynamic, and various problem-solving strategies can apply on any given day. To navigate smoothly, you need to understand how the various approaches can be adapted to specific situations.

Consider solving a recurrent communication issue within your nursing team. The algorithmic approach might involve establishing clear communication protocols or using digital tools to streamline interaction. However, the intuition-driven approach might involve informal team-building meetings to foster better personal connections. In this situation, the best solution might be a blend of the two approaches to ensure both procedural clarity and improved team relationships.

The key takeaway here is that there is no "one-size-fits-all" solution in nursing management. Problem-solving requires flexibility, openness, and the ability to judge which strategy will perform best in a particular scenario.

Exploring Nursing Management Problem-Solving Strategies

Problem-solving strategies in nursing management form the backbone of effective healthcare services. By ensuring that nursing personnel can tackle issues with aplomb and proficiency, these strategies contribute significantly to patient satisfaction and positive outcomes.

Development of Strategic Problem-Solving Competencies

The first step towards demystifying problem-solving processes in nursing management is the development of strategic problem-solving competencies. The journey from novice to expert involves honing these skills and integrating them into your practical work.

Strategic Problem-Solving Competencies: These are a set of core skills that facilitate effective problem-solving in nursing management, including critical thinking, innovative thinking, collaboration, adaptability, leadership, and decision-making.

Acquiring these skills involves both academic learning and practical experiences. Gaining theoretical knowledge lays the foundation, while integrating this knowledge within a clinical context enriches and refines these competencies.

• Critical Thinking: This involves analysing situations from multiple perspectives, evaluating different solutions, and making informed decisions.
• Innovative Thinking: Innovative thinking pertains to thinking outside the box, especially when conventional solutions are inadequate.
• Collaboration: In nursing, effective problem-solving often requires collaborative efforts, valuing diverse ideas and working towards common goals.
• Adaptability: Healthcare settings are continually changing, and the ability to swiftly adapt to new situations is crucial.
• Leadership: Good leadership skills facilitate effective management of teams and ensuring that everyone is following the established problem-solving process.
• Decision Making: Ability to implement effective decisions is vital for successful problem solving.

Role of Leadership in Implementing Problem Solving Strategies

The role of leadership in implementing problem-solving strategies must not be understated. Effective leadership not only guides teams through problem-solving processes but also fosters a supportive environment where team members feel safe to contribute ideas and question assumptions.

Leadership in Nursing: This involves guiding, motivating, and supporting nursing staff to deliver quality healthcare services. Also, it encompasses enhancing team cooperation, improving communication, and fostering a culture of continuous learning.

Leadership employs a variety of approaches in implementing problem-solving strategies. Different leadership styles can be applied based on the nature of the problem and the team dynamics. Transformational leadership, for instance, inspires others to exceed their personal goals and work for a collective purpose. On the other hand, participative leadership encourages open discussions and collective decision-making, promoting a more inclusive and democratic problem-solving process.

Leadership is also instrumental in creating an environment that encourages the sharing of problems openly, without fear of judgment, hence facilitating early identification and efficient resolution of issues. By also ensuring that learning opportunities are provided to enhance team problem-solving capabilities, leadership positively influences problem-solving outcomes.

Use of Resources in Problem Solving Strategies

Effective resource utilization is a critical component of successful problem-solving strategies in nursing management. The term 'resources' in this context includes human resources such as nursing staff and doctors, as well as material resources like medical supplies, equipment, and facilities.

Resource Utilisation: This refers to the efficient and effective use of available resources to achieve desired outcomes. In nursing, it involves ensuring that staff, equipment, and supplies are optimally used to deliver quality healthcare services and solve arising problems.

Problem-solving often necessitates the optimal use of available resources. For example, if there is an issue of high patient-to-nurse ratio, one of the possible solutions could be redistributing nursing staff according to workload and patient needs, or hiring additional staff if finances permit.

Every solution should be weighed based on its resource implications. The best solution is often the one that optimally utilises available resources to provide the maximum benefit. For example, while hiring additional staff might solve the problem, it might not be the best solution if the budget is very limited. In such a case, reallocation of existing staff may be a more practical solution.

Similarly, if there is a shortage of a particular supply, then alternatives may need to be sought, or rationing implemented. A critical analysis of such situations is necessary to ensure that the solutions proposed and implemented do not create other problems related to resource allocation and use.

It's also important to remember to continuously evaluate the impact of your solutions on resource utilisation. This will not only help you ensure sustainable use of resources but also contribute to continuous improvement in problem-solving strategies.

Understanding the stages of problem-solving in nursing practice is fundamental to addressing various challenges that arise in the healthcare sector. These problem-solving stages enable you to identify issues, create and implement solutions, and review the outcomes for improvement purposes.

Initial Assessment and Identification: The First Stage of Problem Solving

The initial phase of problem-solving in nursing management involves the assessment and identification of the issue at hand. This stage is critical as the correct identification of the problem lays the foundation for effective solution design and implementation.

Initial Assessment: This is the preliminary evaluation of the situation, leading to the recognition of existing problems. This stage involves observation, questioning, and data gathering to understand the issue better.

This initial step requires keen observation skills and critical thinking. While observation helps in gathering relevant details, critical thinking enables you to scrutinize this information and identify potential problems. You could also use feedback from your team and other relevant stakeholders to gain a comprehensive understanding of the issue.

For instance, suppose you discover unusually high levels of patient discomfort during specific hours. The initial assessment might involve examining patient records during these hours, observing nursing practices in these time frames, and seeking feedback from both patients and nursing staff. This comprehensive approach could potentially reveal the issue, like a shortage of staff during peak hours, leading to delayed or inefficient care.

Formulating Actionable Solutions: The Mid Stages of the Problem-solving Process

Once the problem is identified, the next phase is generating actionable solutions. The validity and effectiveness of these solutions significantly influence the problem-solving process's success, thus necessitating careful deliberation and thorough evaluation.

Actionable Solution: A practical, feasible strategy that can be implemented to resolve the problem. It's typically developed through brainstorming, analysis, and evaluation of various alternatives.

The process of formulating actionable solutions involves brainstorming potential remedies, evaluating these against a set criteria, and choosing the most viable option. Ideally, this should be a collaborative effort involving all relevant stakeholders. Collaborative problem-solving encourages diversity in ideas and promotes inclusivity.

Innovation is a key driver in formulating actionable solutions. Traditional problem-solving methods might fail in the face of complex or unique problems, necessitating innovative ideas. Remember, the most effective solutions often result from 'thinking outside the box'.

Evaluation and Reflection: The Final Stage of Problem Solving

The final stage of problem-solving is evaluation and reflection. After implementing the chosen solution, it is essential to assess its effectiveness in solving the identified problem. This stage offers an opportunity to learn from the implemented action and make necessary adjustments for future improvement.

Evaluation and Reflection: This stage involves reviewing the implemented solution to assess its effectiveness. Reflection involves learning from the process and experiences to ensure continuous improvement.

To achieve meaningful evaluation and reflection, a systematic approach must be adopted. Begin with the assessment of the effect of the solution on the original problem. Have the waiting times reduced following the staff adjustments? Is there an improved level of patient comfort? These are the kind of questions you need to address.

Following the evaluation, it's crucial to reflect on the entire process. Consider what worked well and what didn't. Reflecting on these experiences offers valuable insights that can be used to improve future problem-solving processes.

Take the earlier example of high levels of patient discomfort due to staff shortage during peak hours. Suppose, after implementing the solution of adjusting staff schedules, you find that there's a significant improvement in patient comfort levels. This shows that your solution worked. However, during reflection, you realise that the process took more time than necessary due to delayed decision-making. For future improvement, you could consider setting specific timelines for each stage of the problem-solving process.

In conclusion, problem-solving is a cyclical process. It doesn't end with implementing a solution; instead, it opens doors for continuous learning and improvement. Adapting to this cycle is key to honing your problem-solving proficiency in nursing management.

Critical Thinking and Problem Solving in Nursing

Problem solving in nursing management is underpinned by the practice of critical thinking. An understanding of the delicate interplay between these two capabilities is central to the enhancement of nursing management and the ultimate delivery of efficient patient care.

The Connection Between Critical Thinking and Problem Solving in Nursing

There is a strong relationship between critical thinking and problem solving in nursing, evidenced by the significant role each plays in the healthcare sector. Critical thinking provides the foundation upon which problem-solving strategies are built.

Critical Thinking: This is the disciplined process of analysing, interpreting, evaluating, and drawing conclusions from varying levels of data, information or experiences. It involves a deeper level of thinking to understand, evaluate and resolve complex issues or situations.

The process of problem-solving often begins with an evaluation of the situation, gathering data, appraising the data, and coming with strategic solutions. By applying critical thinking, you can get a clear understanding of the problem, which helps devise more effective solutions.

For example, in implementing new protocols in a nursing unit, critical thinking may involve evaluating the necessity of the change, the potential effect on the nursing staff’s workflow, and patient care. The ability to think critically facilitates well-informed decisions, thereby enhancing the problem-solving process.

Beyond problem identification and solution generation, critical thinking is also instrumental in the review phase of the problem-solving process. It allows you to reflect on the effectiveness of implemented solutions, the overall process, and areas that could be improved. Therefore, the integration of critical thinking not only enriches problem-solving but also contributes to continuous learning and improvement in nursing management.

Enhancing Critical Thinking for Effective Problem Solving in Nursing Management

Enhancing critical thinking skills in the nursing workforce enriches problem-solving efforts and ultimately results in improved patient outcomes and service delivery. This strengthening could be achieved through several strategies.

Enhancing Critical Thinking: The process of improving critical thinking skills to enhance one's ability to evaluate complex situations effectively and make informed decisions.

Firstly, continuous learning and professional development activities such as workshops, seminars, and online courses can provide essential tools for sharpening critical thinking skills.

Secondly, fostering a culture of open communication and collaborative problem-solving offers great benefits. These platforms facilitate the sharing of diverse perspectives, promoting deep analyses, and enriching the problem-solving process.

Lastly, reflective practice can also positively impact critical thinking abilities. Regular reflection on your practice, experiences, and learnings enables you to identify gaps in your thinking and areas of improvement. It encourages a deeper level of thinking that enriches the problem-solving process.

• Continuous learning and participation in professional development activities.
• Fostering a culture of open communication and collaborative problem-solving.
• Engaging in reflective practice regularly.

Examples of Critical Thinking Leading to Effective Problem Solving

The application of critical thinking skills often results in improved problem-solving outcomes in nursing management. Several instances illustrate this relationship.

For instance, consider a situation where a nursing unit has seen a significant increase in medication errors. The nursing manager applies critical thinking to evaluate the situation, identify potential causes, and devise solutions. Through an in-depth review of pharmaceutical administration procedures, team collaboration, discussion, and data evaluation, the nursing manager identifies the root cause - an overly complicated method of logging medication.

Armed with this information, they innovate a simpler, more effective system. By cutting down on needless complexity, the nursing unit sees a drastic decrease in medication errors. This example shows how the application of critical thinking streamlined a complex process, providing an effective solution to the problem at hand.

Another instance could be changing patient demographics, with more elderly patients requiring care. A nursing manager applies critical thinking to understand the unique needs of these patients and the potential challenges that might arise in catering to these needs. As a result, they develop tailored care plans and training programmes for the nursing staff to better care for elderly patients, resulting in improved patient satisfaction.

These examples highlight how critical thinking can lead to effective problem solving in nursing management, ultimately resulting in better service delivery and patient care. Therefore, enhancing critical thinking should be seen as a vital strategy for improving problem-solving proficiency in nursing management.

Problem Solving in Nursing Management - Key takeaways

• Problem Solving in Nursing Management: It is a thorough process involving the identification, analysis, and (de)cision-making to solve issues in nursing management. It also includes implementation and review of the effectiveness of the solutions.
• Decision Making Techniques: Different techniques such as Pros and Cons Analysis, Decision Matrix, and Cost-Benefit Analysis can enhance the decision-making process in problem-solving scenarios.
• Case Study Analysis: It involves the detailed examination of various scenarios to inform problem-solving strategies and practice.
• Approaches to Problem-Solving: Different approaches may apply in different nursing scenarios, such as the algorithm-based approach for well-defined scenarios and the intuition-driven approach for ambiguous situations.
• Strategic Problem-Solving Competencies: These are essential skills including critical thinking, innovative thinking, collaboration, adaptability, leadership, and decision-making, crucial in effective problem-solving.
• Leadership in Nursing: Leadership plays a key role in guiding, motivating, and supporting nursing staff. It influences the successful implementation of problem-solving strategies.
• Resource Utilisation: Efficient and effective use of available resources, such as nursing staff, equipment, and supplies, is vital in problem-solving in nursing management.
• Stages of Problem Solving in Nursing Practice: The stages include the identification, analysis, and resolution of problems, which are crucial in responding to challenges in the healthcare sector.

Flashcards in Problem Solving in Nursing Management 14

The algorithm-based approach involves following a clear set of rules or procedures to solve a problem, often with defined parameters. The intuition-driven approach combines a nurse's experience, knowledge, and instinct to solve a problem, especially in ambiguous scenarios.

The first stage of problem solving in nursing practice is initial assessment and identification, which involves the evaluation of the situation to recognise existing problems. This stage requires observation, questioning, and data gathering.

Problem solving is a broader process involving the identification of an issue, systematic analysis to understand it, devising potential solutions, choosing the most suitable through decision making, implementing it, and finally reviewing the effectiveness of the implemented solution. Decision making, on the other hand, is a component nested within this process.

Critical thinking provides the foundation for problem-solving strategies in nursing. It involves the disciplined process of analysing, evaluating, and interpreting data, which allows for a clear understanding of the problem and thus the generation of effective solutions. Critical thinking also enriches the problem-solving process by facilitating review and continuous improvement.

The final stage of problem solving in nursing practice is evaluation and reflection, where the effectiveness of the implemented solution is assessed, and learnings are drawn from the process for future improvement.

Problem-solving in nursing management is crucial in maintaining optimal patient care, operational efficiency, and fostering team collaboration by resolving intricate issues with decisive and effective solutions.

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The influencing factors of clinical nurses' problem solving dilemma: a qualitative study

Affiliations.

• 1 Department of Nursing, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China.
• 2 Tongji University School of Medicine, Shanghai, China.
• 3 Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
• PMID: 36120892
• PMCID: PMC9518267
• DOI: 10.1080/17482631.2022.2122138

Purpose: Problem solving has been defined as "a goal-directed sequence of cognitive and affective operations as well as behavioural responses to adapting to internal or external demands or challenges. Studies have shown that some nurses lack rational thinking and decision-making ability to identify patients' health problems and make clinical judgements, and have poor cognition and response to some clinical problems, easy to fall into problem-solving dilemma. This study aimed to understand the influencing factors of clinical nurses' problem solving dilemma, to provide a basis for developing training strategies and improving the ability of clinical nurses in problem solving.

Methods: A qualitative research was conducted using in-depth interviews from August 2020 to December 2020. A total of 14 participants from a tertiary hospital in Shanghai, China were recruited through purposive sampling combined with a maximum variation strategy. Data were analysed with the conventional content analysis method.

Results: Three themes and seven subthemes were extracted: nurse's own factors (differences in knowledge structure and thinking, differences in professional values, poor strain capacity); improper nursing management (low sense of organizational support, contradiction between large workload and insufficient manpower allocation); patient factors (the concept of emphasizing medicine and neglecting to nurse, individual differences of patients).

Conclusion: The influencing factors of clinical nurses' problem-solving dilemma are diverse. Hospital managers and nursing educators should pay attention to the problem-solving of clinical nurses, carry out a series of training and counselling of nurses by using the method of situational simulation, optimize the nursing management mode, learn to use new media technology to improve the credibility of nurses to provide guarantee for effective problem-solving of clinical nurses.

Keywords: Nurse; problem solving; qualitative research.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

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Developing Strategy: A Guide For Nurse Managers to Manage Nursing Staff's Work-related Problems

The purpose of this study was to assess nursing staff's work-related problems as perceived by their managers and thereafter develop strategies that would serve as a guide for nurse managers to manage these problems.

A descriptive research design was used. The participants included in the study consisted of the following two groups: Group 1—a convenience sample of 150 first-line managers working at three different hospitals; and Group 2—a panel of experts for the Delphi technique, selected using the Snowball sampling technique. Tools for data collection included the following: Tool 1—questionnaire about nursing staff's problems; Tool 2—Delphi technique to develop strategies for managing nursing staff's problems; and Tool 3—opinionnaire format.

The recruited first nurse managers were of the opinion that job stress, work overload, conflict, workplace violence, poor performance, staff turnover, demotivation, lack of empowerment, and staff absenteeism were among the common problems faced by staff nurses at work.

From the expert panelists’ perspectives, the newly developed strategy in this study was considered valid; the researchers recommend the strategy developed in this study to be universalized in different health care settings and used as a guide for nurse managers.

Introduction

Nursing is a high-pressure job. Contrary to popular belief, nurses’ duties consist of more than just checking vital signs and administering medication. They have many responsibilities to attend: helping patients, assisting in procedures, documenting care, as well as filling leadership roles at hospitals, health systems, and other organizations. However, issues at the organizational, state, and national levels have brought about considerable challenges, making it difficult for nurses to do their job effectively. It is essential to first recognize and understand every possible challenges faced by nurses to deal with them efficiently and find the best possible solutions to mitigate them [ 1 ].

Workplace-related problems are common nationally and internationally. Among the most frustrating personnel problems is that of absenteeism—the rate at which an individual misses work on an unexpected basis. In the health care industry, this results in the impediment of the provision of health care to patients, specifically the health care institutions that are associated with a shortage of available staff [ 2 ]. Work stress, particularly in the nursing profession, has become a major problem that nurses face; excessive pressure, a heavy workload, job insecurity, low levels of job satisfaction, internal conflicts, and lack of autonomy contribute to that stress [ 3 ].

In addition, interpersonal conflict is another area of frustration in the nursing profession. It is often considered a negative term because individual interests are perceived to be in conflict or negatively affected. Furthermore, workplace conflict is always associated with lower-quality patient care, higher rates of adverse effects, a higher level of staff burnout, and greater direct and indirect costs of care [ 4 ].

Lack of empowerment is a significant work-related problem that nurses may be exposed to. Powerless nurses make for unproductive, discontent nurses, who are more vulnerable to burnout and depersonalization. Empowerment for nurses consists of three components: a workplace that has the necessary structures to support empowerment, a psychological belief in one's ability to be empowered, and acknowledgment that there is power in the relationships and care that nurses afford. To help nurses become empowered and use their power for better patient care, a more comprehensive understanding of these three components is required [ 5 ].

The nursing shortage is one of the many issues that needs attention and necessitates involvement of all health care parties. Nurses always work in a high-risk environment; they are prone to numerous occupational health hazards that have harmful effects both on their mental and on their physical health, as well as on their productivity and efficacy at work [ 6 ]. Workplace violence is an incident of hostility that may be physical, sexual, verbal, emotional, or psychological and it takes place when nurses are abused, threatened, or assaulted in situations related to their work. Such violence upsets the organization in different ways, for example, the loss of competent and trained nurses, a decrease in nursing productivity, and a bad reputation of the organization in society and legal issues related to the safety of employees [ 7 ].

In Egypt, nursing as a profession is affected by numerous factors that are considered dilemmas for working as a nurse. These factors included media, public image, social prestige, lack of role models, physician–nurse interaction, ineffective learning environment, risk for violence, exposure to health hazards, conflict, stress, and exposure to infection [ 8 ]. Challenging workplace conditions that nurses face in Egypt include little institutional recognition or support, shortage of nurses, insufficient funds, and high turnover of ministers and decision makers at the Ministry of Health and Population (MOHP) , which in turn hinders the setting of rules to support nursing reforms, maldistribution of nurses in different health services, poor image and poor public perception of nursing, insufficient salaries, and risks during night shifts [ 9 ].

Nurse managers are tasked with the near-impossible to ensure the care provided in the unit is of high quality, keep patients and families satisfied with the care, as well as achieve productivity goals, all while addressing the needs of the staff. [ 10 ]. The complex work environment necessitates that nurse managers remain up to date with the latest scientific developments in their field. They must also be able to analyze problems effectively and consequently determine the right course of action for each situation to achieve the most favorable outcome. Thus, nurses working in managerial positions must develop their problem-solving skills. Current literature recommends that nurse manager candidates should receive additional training in several areas including problem-solving skills. This training should be an essential part of orientation programs designed before promotion to managerial positions [ 11 ].

Significance of the study

Tailoring strategies to solve nurses' work-related problems requires a rich understanding of the most common problems that nurses face during their work by their nurse managers who are expected to handle all problems that evolve in their areas of work. Moreover, in Egypt, many nurse managers in different clinical settings are promoted to managerial positions based on their years of experience regardless of their educational or managerial qualifications, thus remain unfamiliar with and untrained in problem solving skills as a paramount managerial requirement. Consequently, effective strategies must be put in place to inform them about ideal processes for managing their staff work-related problems. Thus, the purpose of this study was to assess nursing staffs' work-related problems as perceived by their managers and thereafter develop strategies that would serve as a guide for nurse managers to manage these problems.

Research questions

Q1. What are the common work-related problems of the nursing staff?

Q2. What are the strategies that can be used by nurse managers to manage nursing staff work-related problems?

Q3. What are the panel of experts' opinions regarding the newly developed strategy?

Conceptual framework

The American Association of Critical-Care Nurses developed a model for a healthy work environment (HWE), consisting of six standards, which are used by researchers as a conceptual framework for the present study. Strategies for solving work-related problems were derived as criteria through which the six evidence-based essential standards could help to create work and patient care environments that are respectful, safe, and humane to staff and all. These standards include the following: Skilled c ommunication —nurses must be proficient in communication skills (written, verbal, and nonverbal communication) as they are in practical skills. Ineffective professional relationships lead to mistrust, disrespect, stress, and dissatisfaction. True c ollaboration —this is the process that is based on mutual respect for knowledge and abilities of other professionals who are involved in patients’ care. Nurses must be relentless in pursuing and fostering true collaboration. Effective d ecision m aking —nurses must be valued and committed partners in formulating policy, directing and evaluating clinical care, and leading organizational processes. Staffing o ptimization —staffing process must ensure the effective match between patient needs and nurse competencies. Meaningful r ecognition —nurses must be recognized and must recognize others for the value each brings to the work of the organization. Authentic l eadership —nurse leaders must fully embrace the imperative of an HWE, authentically live it, and engage others in its cultivation. Nurse leaders must be positioned to influence decisions that affect nursing practice and the work environment. [ 12 ].

The relationship between the study's conceptual framework, the developed strategies, and staff nurses' workplace-related problems was represented as follows: the six HWE standards provided the evidence-based mechanisms for guiding actions and behaviors of nurse managers with their subordinates and considered the origin on which the current developed strategies was based. Therefore, the developed strategies will be the methodological framework to manage different arising work-related problems, including decreasing stress and workload, eliminating sick leave and absenteeism, optimizing staff in the unit, promoting nurses' satisfaction and retention, improving nurses' motivation and empowerment, reinforcing team spirit and moral, and reducing interpersonal conflict and workplace violence.

Study design

The study adopted a descriptive research design.

Setting and samples

The study was conducted at three different hospitals in Egypt, two in the Delta Region and one in Cairo, all which provide secondary health care services.

Hospital (1): it is affiliated to the Ministry of Higher Education. It consists of four buildings: the main building, the specialty hospital building, the emergency building, and the oncology institution. Its bed capacity stands at 1200 beds.

Hospital (2): It is affiliated to the higher authority of educational hospitals and institutions. It consists of four buildings: the main building, the economy building, the outpatient clinics, and the hemodialysis building. Its bed capacity is 863 beds.

Hospital (3): It is affiliated to the Ministry of Health. It includes the health services sector in addition to a research center. Its bed capacity is 945 beds.

The participants included in the study were composed of two groups

Group 1: first-line nurse managers: nonprobability convenience sampling technique was used to select 150 first-line nurse managers working at hospital (1) ( n  = 50), hospital (2) ( n  = 50), and hospital (3) ( n  = 50).

Inclusion c riteria: the study included first-line managers of different ages, different educational qualifications in nursing (including a bachelor and technical degree in nursing), both gender, different marital status, working at different units and departments at the respective hospitals, and who have six or more months of experience at their current position.

Methods of recruiting nurse managers

To recruit nurse managers as study participants, the researchers revised the employees' database within each hospital to specify the nurse managers who met the inclusion criteria. A sampling frame was established for all nurse managers meeting the criteria. The researchers contacted them personally to explain the aims of the study in addition to procure their acceptance to participate in the study.

Group 2: experts of nursing management: the snowball sampling technique was used to select the panel experts for the Delphi technique that was used for the development of the strategy.

Inclusion criteria: the snowball sampling technique was useful in this research to achieve the inclusion criteria that are listed below:

• 1. The expert must be either a professor of nursing management at a faculty of nursing in Egypt or have a nursing director position within Egyptian hospital, with at least 1-year experience in the current position.
• 2. The expert must have a specific interest in the research topic, either through previous research work or practical experience at hospitals.

This technique resulted in a panel of seven professors of nursing management from different nursing faculties across Egypt and eight nursing directors from different hospitals in Egypt. They were then contacted personally to be recruited for the study.

Ethical consideration

To conduct the study, this study was approved by the institutional review board of the Menoufia University (Approval no. 86). Written approval was obtained from the medical and nursing authority at the aforementioned study setting following an explanation of the purpose and procedures of the study. The respondents' rights were protected by ensuring voluntary participation, and informed consent was obtained after explaining the purpose, study procedures, and potential benefits of the study. The respondents were assured that the data would be treated as strictly confidential.

Measurements/instruments

1 — Questionnaire about nursing staff s' problems.

This was a self-administered questionnaire designed by the researchers after reviewing the relevant literature. This questionnaire was used for conducting a preliminary study about the common nursing staffs' work-related problems as perceived by first-line nurse managers, and the proposed strategies for managing these problems. It included two open-ended questions, namely:

• 1. What are the common problems faced by nursing staff?
• 2. From your point of view, what are the strategies you can use to manage these problems?

The face and content validity of this questionnaire was tested by a panel of five experts in nursing management.

Scoring of questionnaire:

The nurse managers’ responses regarding work-related problems were rated on three-point Likert scale as follows:

• • Uncommon problems <40%
• • Average common 40–<60%
• • Common problems ≥60%

2 — Delphi technique to develop the strategies for managing nursing staff problems.

The Delphi technique is a widely used and accepted method for arriving at a consensus of opinion concerning real-world knowledge solicited from experts within certain topic areas [ 13 ]. A questionnaire that included strategies for managing nursing staffs’ problems was distributed for each Delphi round.

Expert panelists rated each item within strategy on three-point Likert scale from as follows: agree, need of modifications, and disagree.

The responses with highest score was considered as follows:

• • Agree, which requires to be fixed in the following rounds.
• • Need modification, which requires restatement in the following rounds.
• • Disagree, which requires to be excluded in the following rounds.

3 — Opinionnaire format.

This tool was designed by the researchers to validate the new strategy format. It contained items that examined the clarification of the strategy purpose, its comprehensiveness, clarity, and simplicity, along with how comprehendible, applicable, and feasible it was.

Data collection/procedures

• o The preliminary study was conducted from September 15, 2018, till November 17, 2018.
• o The questionnaire concerning the nursing staffs’ problems was distributed to first-line nurse managers to determine the common nursing staffs’ work-related problems. These responses were then analyzed to prioritize and rank the nursing staffs’ problems. Problems that scored ≥60% were considered common problems. The implementation of this scoring method lowered a total of 13 reported problems to nine, which were later included in the developed strategies. In addition, the proposed strategies by first-line managers were used by the researchers as a guide for developing the strategy format.
• o The Delphi technique was used to develop the strategies for managing the nursing staffs’ problems. The Delphi process lasted 3 months, starting from December 1 till the end of February 2019, until consensus regarding the strategies was achieved. The Delphi process consisted of three rounds: the first round traditionally begins with an open-ended questionnaire, which is used to elicit the experts' opinions regarding the strategies that can be used by managers to manage nursing staffs’ problems. Nine of 13 problems were included as the strategies' dimensions, each of the dimensions included had its own explanatory note and a blank area for experts to write proposed solutions for managing each problem. After receiving the participants' responses (from experts and first-line managers), researchers organized, refined, and added other strategies derived from previous literature on nursing problems (including published research findings and recommendations and textbooks), and then converted the collected information into a well-structured questionnaire. This questionnaire was used as the survey instrument for the second round. In the second round, each Delphi participant received a questionnaire comprising 79 items and was asked to review the items summarized by the researchers. Accordingly, Delphi panelists were required to rate or “rank-order” items to establish preliminary priorities among items. Each item within strategy was rated on three-point Likert scale from as follows: agree, need of modifications, and disagree. The highest score throughout the three scale was considered. In the third round, each Delphi panelist received a questionnaire that included the items summarized by the researchers in the previous round and was asked to revise their judgments.
• o The newly designed strategies were validated by an opinionnaire format distributed to the panel of experts after the third round of the Delphi technique.

Data analysis

Results were collected, tabulated, and statistically analyzed by an IBM personal computer and statistical package SPSS 22.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics such as numbers and percentages were used to determine common nursing staff problems, analyze Delphi rounds and the expert panelists’ opinions regarding the face and content validity of the developed strategies.

The distribution of sociodemographic characteristics of the studied nurse managers is displayed in Table 1 . As shown in the table, the highest percentage of studied first-line managers were between the age of 30–40 years (43.3%). All of them were women (100%) because the male gender only recently joined the faculty of nursing. Regarding years of experience, most of them had 5–10 years of experience (37.4%). More than half of the studied first-line managers were married (55.4%). In addition, most of them had a bachelor degree in nursing (91.4%). More than half of them were working in critical and emergency care units (51.3%). Lastly, most of them had attended workshops on human resource management (56.6%).

Table 1

Distribution of Sociodemographic Characteristics of Studied Nurse Managers ( N  = 150).

Note . yrs =years.

As is evident from Table 2 , the most common staff nurses’ work-related problems as perceived by nurse managers were job stress, work overload, staff absenteeism, demotivation, lack of empowerment, staff turnover, workplace violence, staff conflict, and poor staffs’ performance (≥60%). On the other hand, lack of organizational justice, limited resources, nursing shortage, and unclear job description were average common staff nurses’ work-related problems (40–<60%).

Table 2

Staff Nurses' Work-related Problems as Perceived by Nurse Managers at the Study Setting ( N  = 150).

The experts’ opinions regarding items to be included in the strategy to solve nursing staffs’ work-related problems are illustrated in Table 3 , which displays the second Delphi round with a response rate of 100%. Most experts (95.2%) agreed on most of the proposed items to manage staff problems after they had been summarized by the researchers following the first round. The total percentage for modified items was 3.9%, whereas the total percentage for disagreed on items was 1.9%. One item of the proposed strategy (decrease the threat to worker safety) with percentage 73.4% was disagreed on by the panel of experts, thus it was excluded from the strategy in the third round. The number of modified items came in at two as follows, representing 66.0% and 54.0%, receptively: (1) develop group goals and projects that will build a team spirit and (2) creates and disseminates a clear policy that violence, verbal and nonverbal threats, and related actions, will not be tolerated.

Table 3

Number and Percentage Distribution of Experts Opinions Regarding Items of the Strategy to Solve Nursing Staff's Work-related Problems (Second Round; N  = 15).

Final experts’ opinions regarding items to be included in the strategy to solve nursing staff’s work-related problems are shown in Table 4 , that represents the round three with a response rate of 100%. This represents the final draft of the strategy to manage nursing staff’s work-related problems developed by the researchers. The total percentage of panel of experts' agreement regarding the developed strategy was 98.9%, whereas modified items stood at 1.1%.

Table 4

Number and Percentage Distribution of Experts’ Opinions Regarding Items of the Strategy to Solve Nursing Staff's Work-related Problems (Third Round; N  = 15).

The panel of experts' opinions regarding face and content validity of the developed strategy are presented in Table 5 . According to this table, the developed strategy was valid from the panel of experts' perspectives as all of them [100%] agreed that the strategy is comprehensive, clear, simple, understandable, applicable, and feasible.

Table 5

Panel of Experts' Opinion Regarding Face and Content Validity of the Developed Strategy ( N  = 15).

Workforce issues and challenges at the workplace are significant because they have an important impact on nurses’ ability to deliver safe, effective, and high-quality care. Maintaining a conducive work environment is the shared responsibility of employers, management, and staff. Staff nurses have a paramount role in keeping a supportive work environment, but nurse managers can certainly have a significant impact [ 12 ]. Thus, the aim of this study was to assess nursing staff’s work-related problems as perceived by their managers and thereafter develop strategies that would serve as a guide for nurse managers to manage these problems.

With regards to the first study question, the common staff nurses' work-related problems as perceived by nurse managers were job stress, work overload, staff absenteeism, demotivation, lack of empowerment, staff turnover, workplace violence, staff conflict, and staff poor performance. Although lack or organizational justice, limited resources, nursing shortage, and unclear job description were average common problems. From the researchers’ point of view, the selected study hospitals were large public hospitals with high patient flow, thus these problems were common.

The current findings was in agreement with the study conducted by Mahran et al [ 9 ], who reported that the most common challenges and crisis facing critical care nurses were large number of patients in intensive care units, work overload, working atmosphere filled with tension and stress, fear of the possibility of infection from patients, increased working hours and long shift, and have conflict between nurses and doctors.

The study carried out by Rani and Thyagarajan [ 14 ] was in line with present study findings, which reported that most nurses complained of a heavy workload, which is considered the primary contributing factor for work-related stress. Similarly, results from the study performed by Godwin et al [ 15 ] reinforced the proposition that nurses experienced an above-average level of work-related stress. Accordingly, the study by Vernekar and Shah [ 16 ] concluded that 98.4% (from a total of 253 nurses) experienced moderate to very severe stress. In addition, increased nursing workload is one of the main challenges of national and international nursing. The study conducted by Madadzadeh et al [ 17 ] concluded that 83.3% of a total of 80 respondent nurses reported a high workload.

The present study found absenteeism as the third highest work-related problem. Accordingly, Kurcgant et al [ 18 ] revealed that absenteeism is a world-wide problem increasing at an alarming rate, which could result in the hindrance of delivery of health care to patients, particularly in health care organizations associated with shortage of number of available health staff. Furthermore, ineffective routine, work pressure, inability to manage the working tasks, as well as an uncomfortable environment have a major influence on the rates of absence.

The present study findings showed staff conflict as a work-related problem. In accordance, nurses in the study conducted by Jerng et al [ 19 ] reported that the conflicts they experienced were mainly with other health care professionals, with a majority more specifically reporting intragroup conflicts with physicians. In light of this, our study results may be interpreted as follows: in hospitals, individual professionals have different goals, expectations, values, and beliefs making conflict unavoidable when working as a team.

This study shows that lack of empowerment was a common work-related problem among nurses as reported by first-line managers. Fittingly, Al-Dweik et al [ 20 ] concluded that lack of nurses’ empowerment is a significant problem and many nurses do not feel empowered and feel that organizational support is lacking. Moreover, when nurses are not properly empowered, many negative consequences will ensue, such as feelings of lack of control and having little influence on outcomes, which in turn leads to frustration at work, decreased job satisfaction, and increased risks of burnout.

Regarding the problem of nurses' demotivation, it represented a common work-related problem according to first-line managers' opinion, which contradicted the findings of Weldegebriel et al [ 21 ] about nurses’ work motivation. The latter study revealed that most nurses were intrinsically motivated, and about half of the respondents also reported external work motivation. The contrasting study findings can be attributed to differences in working conditions, policies, and regulations that govern nursing jobs.

Violence was reported as a common problem within the study's settings. This problem was also evident in the study conducted by Fute et al [ 22 ], who reported that, a significant proportion of nurses faced violence while providing care at public health facilities. In addition, this exposure to violence perpetrated by their patients or relatives was 86.0% alone and 80.0% among physician's violence in different health care settings in Beni Suef Governorate, Egypt [ 23 ].

Health care workers usually work in an unsafe environment because of a lack of security guards in some departments or ineffective security staff, as security is unarmed and patients are usually accompanied by several relatives. With a lack of awareness in Egypt concerning the nature of the health care service and its complications, there is an increased risk of misunderstanding and misconception of rules and regulations that govern health care facilities, which can lead to certain types of violence [ 24 ].

This study used the Delphi technique, which can usefully influence many areas for managing clinical activity and solving operational problems by identifying and obtaining agreement on the underlying factors and strategies of resolutions. In the same way, Sim et al [ 25 ] used the Delphi technique in their study to conclude that consensus was achieved between nurses on the most important concepts, which can provide the basis for measuring the quality and safety of nursing practice in a comprehensive way. The Delphi technique was also used to reach the findings of Bjorkman et al [ 26 ], which presented a consensus view of tele-nurses’ experiences of important obstacles and prerequisites in their work environment.

With reference to the second study question, nurse managers from different study settings suggested certain strategies for managing nursing staff's work-related problems, which were later organized by the researchers and validated by expert panelists. In addition, reviewing related literature by the researchers helped in formulating the current strategies in light of the present study conceptual framework (The American Association of Critical-Care Nurses' 6 HWE standards). The developed strategies were in accordance with the assumption by Munro and Hope [ 27 ], who proposed that developing an HWE in which the nursing staff feels supported physically and emotionally; where one feels safe, respected, and empowered is a crucial role of nurse managers who are always looking for effective strategies and solutions for advocating their staff nurses. In addition, nurse managers should uphold the responsibility to strive for a positive work environment for their subordinates.

The current developed strategies for managing work-related stress and workload incorporated certain criteria that reinforce the standards of skilled communication, true collaboration, meaningful recognition, staff optimization, and authentic leadership, which agreed with the findings of Vernekar and Shah [ 16 ], who found that most nurses adopt the following stress management strategies: identify the source of stress and avoid unnecessary stress, manage time better, adjust standards and attitudes, and express feelings instead of bottling them up. In the same line, Madadzadeh et al [ 17 ] concluded that a deep and comprehensive imbalance between resources and tasks and expectations has been perceived by the participants to be the main source of work overload and further recommended that paying more attention to resource allocation, education of the quality workforce, and commitment with job description by managers is of paramount importance.

The present study developed various strategies for managing the problem of absenteeism that derived from the standards of authentic leadership, meaningful recognition, and staff optimization within the study conceptual framework, which was corroborated by Kurcgant et al [ 18 ], who further recommended the introduction of policies that would address absenteeism in the workplace and assist and recognize nurses who handled the workload of colleagues who are continuously absent. In addition, ward managers are required to use nursing staff abilities and build trusting relationships with them so that nurses feel they can rely on and confide in them. Other strategies for mitigating absenteeism in the present study were formulated as solutions for overcoming the common causes of this problem, as reported by Kanwal et al [ 2 ] in their study.

Referring to the current strategies for managing conflict, they were based on the HWE standards of skilled communication, true collaboration, and effective decision making. The study by Shah [ 28 ] suggested different strategies than the current one for dealing with staff conflict, including the application of formal reporting systems such as incident reporting systems to improve interpersonal conflicts based on the proposition that management of the reported events are mainly task-oriented, helped to weaken the tension between the workers, and focus more on the goal of the task and the expected level of provided care.

The developed strategies for boosting nurses’ empowerment in the present study stemmed from the standards of skilled communication, meaningful recognition, and authentic leadership, which was in agreement with those of Al-Dweik et al [ 20 ], who showed that nursing leaders play a significant role in creating a positive work environment by emphasizing self-related performance and authentic leadership to enable nurses to perceive more access to workplace empowerment structures.

By reference to current strategies for managing demotivated staff, they were originated from various standards within the HWE conceptual framework. The study by Drake [ 29 ] coincided with current strategies, which reported that managers should have clear expectations for workers and communicate these expectations effectively, be fair and consistent when dealing with all employees, provide opportunity for participation and input from all subordinates in decision making whenever possible, give subordinates recognition and credit, and develop the concept of teamwork and group goals.

In the same context regarding the previous strategies, the study conducted by Adjei et al [ 30 ] recommended that hospital management should continue to praise and recognize the nurses individually or as a team for their achievement and contribution toward the organization. In addition, career development, job enrichment, and providing greater autonomy would also enhance nurses' performance level in their jobs. It is suggested that implementing interventions in terms of training, guidance, and counseling would be able to produce motivated and high-performing nurses in the hospitals.

Regarding the topic of violence management, the strategy at hand focused primarily on being proactive in dealing with violence events and reinforcing protection and safety measures for the staff, which was in correspondence with the study by Boafo and Hancock [ 31 ], which recommended various strategies for managing violence as follows: ensuring a safe and respectful workplace environment, as well as integrating comprehensive prevention programs, reporting mechanisms, and disciplinary policies, policymakers and other stakeholders should establish health and safety programs for the prevention and management of workplace violence. Finally, according to the present study, it is important that security is boosted at various governmental hospitals, especially the regional ones. It is also advisable to give precedence to women and young nurses.

Lastly, on managing turnover as a work-related problem in the study settings, the current measures focused on maintaining workplace environment with necessary elements that can keep nurses from leaving their job, which mainly based on all the standards of HWE. In agreement, Bogonko and Kathure [ 32 ] recommended to improve salaries and allowances (terms of service) proportional with qualifications and experience, review and improve scheme of service for nurses for clear career advancement, support and recognize nurses, create more training opportunities such as seminars/updates and workshops, and award recognition to those who develop their skills.

Study implications

The developed strategy is recommended to be adopted for newly appointed first-line nurse managers during their transition from practicing nursing' roles to managerial roles, as well as for different nurses in managerial positions as an evidence-based tool to deal with existing workplace-related problems. Health care organizational policies need to be refined to be more flexible in adopting different strategies. The spread of COVID-19 has put new pressures on already strained health systems across the world. So far, hospitals are facing severe crises trying to deliver necessary care, whereas managers are making heart-breaking decisions on how to allocate scarce resources. It would be helpful to replicate this study at different hospitals with larger sample size to assess the emerging nursing staff’s problems in times of crises and refining current strategies to be suitable to deal with emerging problems during times of adversity.

Study limitations

The use of nonprobability convenience sampling and small study sample size may limit the generalization of the study findings. In addition, different policies in health care settings from which nurse managers were recruited limited the possibility of reaching the most effective strategies as they listed only the strategies that were available to them.

In the light of the present study, it can be concluded that the nurse managers who participated in this study perceived job stress, work overload, conflict, workplace violence, poor performance, staff turnover, demotivation, lack of empowerment, and staff absenteeism as common problems faced by staff nurses at work. On the other hand, other problems such as lack of organizational justice, unclear job description, the nursing shortage, and limited resources were less common. The developed strategy to manage staff nurses' work-related problems was valid and in line with the panel of experts' opinions and perspectives; all of the experts agreed that the strategy was comprehensive, clear, simple, understandable, applicable, and feasible.

Conflict of interest

The researchers declared no conflict of interest.

Acknowledgments

Our great thanks are submitted to ALLAH who provided us with the ability to complete this work. We would like to offer special thanks to nurse managers and the panel of experts for their participation and cooperation to complete this study.