NURS 511-Group 4 Sociology of Error

NURS 511-Group 4
Sociology of Error
Presented by Joe Johnson, Joan Kronlein,
Sheila Lucas, and Karrie Pater
Sociology of Error & Reasons for
○ 30% turnover rate with nurses in the first year of practice, jumped to
57% the second year of practice (Candella, 2005)
■ Reasons include poor communication and relations with
management and peers, stress and feelings of inadequacy with
the same workload as more experienced nurses, poor orientation
and role transition, struggles with organizations and fears of
harming patients
○ Institute of Medicine Recommendations to Create Nurse Residency
Why has this Idea Lasted?
● Poor leadership styles that are not conducive to fostering
mentorship of new nurses
○ Past nursing leadership styles have been more transactional in
their approach to leading
○ Mentality of “This is how I learned and I managed just fine”
(“Sink or swim” mentality)
● Cost associated with creating mentorship or residency programs
○ Without organizational support, nursing is limited in how they
can support their new nurses (financially)
Appropriate Change Theories
Social Capital Theory
Social Cognitive Theory
Social Capital Theory
A theory that would be useful in assessing the support within an
environment is the Social Capital Theory (Hofmeyer, 2013). This
theory was chosen because it reflects the importance of
relationships and networks in healthcare. This theory would be
used for assessment of the social capital within the work
environment where relational problems are hidden.
Social Capital Theory
Why use the Social Capital Theory?
1. Simple to use
2. Easy to understand
3. Relates well to the problem described
4. Can be used at the individual and global levels
5. Identifies areas of needed change
(Dudley-Brown, 1997)
What is Social Capital?
A term that is not agreed on but includes “trust, mutual
understanding, and shared values and behaviours that bind the
members of human networks and communities and make
cooperative action possible” (Hofmeyer, 2013, p. 783). “Trust and
cooperation are learned behaviors, indicating that social capital can
be created” (Pender, Murdaugh, & Parsons, 2011, p. 73).
Social Capital: What is involved?
Social Capital Theory involves: (From both the structure and cognitive levels)
1. “Analyzing existing close ties and networks within the
2. “Fostering open ties and networks within and outside
the unit”.
3. “Fostering linkages and network capacity across the
organization and beyond”.
(Hofmeyer, 2013, p. 784)
Social Capital: What is the key?
According to Hofmeyer (2013) “in order to identify the presence or
absence of social capital in teams of nurses, we would expect to find
questions about the extent to which nurses’ trust and cooperate with
each other, communicate and share [emphasis added] critical
information about patient care, manage difference and disputes, and
include newcomers and float nurses in the networks” (p. 785).
Social Cognitive Theory
In order to foster communication to increase Social Capital…
The Social Cognitive Theory would then be used to plan the
change toward a more supportive environment.
Through modeling, observation, efficacy, and outcome
Suggested Leadership Approach Transformational Leadership
Supports a positive mentorship approach
Demonstrates active listening
Learning from mistakes
Welcomes feedback with positive suggestion
Celebrates small and large milestones
Develops competency in the nursing profession
○ “Provides new nurses with a method of taking an active and
participatory role in policy within a new nurses jurisdiction and
power” (Valentine, 2002. p4)
Strategies for Change
● Transformational leadership
● Change will be second order change (ie. a new way of doing
● Identify problems related to retention of new nurses
● Obtain support from nursing management, leaders and
stakeholders for a program to increase new nurse retention
Strategies for Change (cont.)
● Conduct a SWOT analysis of current state of current system of new
nurse orientation
● Research literature to identify best practice to improve
orientation/mentorship programs to increase retention of new
● Form a change-group to evaluate current problems and new ways
to address the problem for a positive outcome
● Develop new orientation/mentorship program to incorporate best
● Obtain buy-in and educate new mentors on the new process
● Initiate new process
● Evaluate results through retention percentage, and surveys
conducted with all stakeholders on process.
● Adjust program as needed based on evaluations
(Marshall, 2011)
Implementation Challenges
Resistance of staff to improving the orientation/mentoring process will be
addressed by education about the costs of not retaining new nurses
Concerns of the hospital regarding increased cost for orientation will be
handled by explaining the costs of replacement of staff as compared to the
cost of recruitment and orienting new staff
Reluctance of staff to be involved in the new process will be dealt with by
appealing to their desire to be appropriately staffed with well prepared
The Leaders Relationship with
Leaders should:
● Understand
● Embrace
● Deal effectively with conflict (Weiss & Hughes, 2005)
● Conflict is a stage for learning and insight
● It lends to creative solutions
● Preset mechanisms to deal with conflict can save time and lead to new
positive outcomes
(Weiss & Hughes, 2005)
Role of Conflict and Resistance
Complex systems perspective: Conflict and resistance are a part of a
complex system based on key principles including: relationships,
diversity, self-organization and coexistence of order and disorder.
Transformational Leadership perspective: A transformational leader by
definition develops the leadership capacity of an entire team. Thus,
a transformational leader can cultivate an environment where a
difference of opinion or debate can fuel creative thinking and
consensus. The leader sees the value of different opinions and uses
these differences to create effective change.
Dudley-Brown, S. L. (1997). The evaluation of nursing theory: a method for our madness.
International Journal of Nursing Studies, 34(1), 76–83.
Hofmeyer, A. T. (2013). How can a social capital framework guide managers to develop positive
nurse relationships and patient outcomes? Journal of Nursing Management, 21, 782–789.
doi: 10.1111/jonm.12128.
Institute of Medicine. (nd)The Future of Nursing: Leading Change, Advancing Health. Report
Recommendations. Retrieved From:
Marshall, E. (2011). Transformational leadership in nursing. New York, United States: Springer
Publishing company.
References cont.
Niemeyer, K. (2013). Change theories for leadership in complex organizations. Retrieved from
NURS 511 content page.
Pender, N., Murdaugh, C., & Parsons, M. A. (2011). Health promotion in nursing practice (6th
ed.). Upper Saddle River, NJ: Pearson
Valentine, S. (2002). Nursing leadership and the new nurse. Journal Of Undergraduate Nursing
Scholarship, 4(1), Retrieved from:
Weiss, J. & Hughes, J. (2005). Want collaboration? accept- and actively manage- conflict.
Harvard Business Review, 93-101. Retrieved
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