Promedica

            Promedica is a large health system
in the Northwest Ohio and Southeast Michigan areas, which includes 13 hospitals
and numerous other facilities including outpatient labs, clinics, and housing. Promedica
prides itself on being a unified system with values that are consistent
throughout. I work for one of the smaller hospitals, Promedica Defiance
Regional Hospital (PDRH), in the Women’s Center, which is the labor, delivery,
recovery, and postpartum unit. We also occasionally care for postoperative
gynecological patients. This paper will discuss the mission and values of
Promedica from the large infrastructure down to my small unit at one of its
smallest hospitals.

Promedica’s Mission, Vision, Values, and Goals

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            Promedica is very
prideful for being part of this large community. The organization is a major
sponsor of our event stadium, which hosts minor league hockey games, concerts,
and other shows year-round. We also have a minor league baseball team which Promedica
sponsors. Various parades, festivals, and other events also are funded in part
by this company. Last summer, Promedica moved all of its corporate offices to
downtown Toledo. In addition to all the construction work with renovating
several buildings and parking garages, this brought new life to downtown Toledo
in the form of restaurants, a new hotel, and other businesses.

            From its website,
Promedica’s mission is to “improve health and wellbeing (About Promedica,
2018).” The company also serves the medical needs of underprivileged and helps
those who cannot afford their medical bills. Every outpatient and inpatient is
screened for hunger and provided with a box of food if needed as well.
Diversity is very important to Promedica, from including a patient’s spiritual
and cultural needs are met to dietary customs for employees and visitors
(Diversity, 2018).

Nursing Mission of Promedica

            Promedica describes its nursing
mission as collaborating with the rest of the healthcare team and providing
compassionate, capable care for patients. Nurses within Promedica also advocate
for their patients. 

Unit Nursing Mission and Consistency with Promedica

            The Women’s Center cares for women from antenatal visits
to labor and delivery to the postpartum period. Our mission as a unit is to
provide the best, most evidence-based care for each patient, and to deliver our
care with safety and patient satisfaction in mind. This is a direct reflection
of Promedica’s mission to provide great care and keep patients healthy and
happy.

My Role of the Unit’s Mission

            As a floor nurse in the Women’s Center, I am very proud of our
unit and I strive to give the best care I can for each patient. I participate
in three different committees which contribute to our unit’s mission. The
Breastfeeding Committee seeks to make breastfeeding easier and more successful
for each mom who chooses this feeding method. The Unit-Based Council (UBC) researches
and implements the latest in evidence-based practice for best patient outcomes,
as well as provides patient safety and competency education for the unit. The
Green Team helps the hospital and community with recycling responsibly, cutting
down on waste, and decreasing electric and water usage.

Nursing Department Structure

            With the Women’s
Center’s implementation of a computer charting system two years ago, the unit
became a decentralized unit. There are two main nursing stations, but there are
several workstations throughout the department outside patient rooms as well as
inside. There are additionally workstations on wheels (WOWs) that can be
brought and used virtually anywhere in the department. These stations allow for
nurses to work anywhere within the unit instead of at one central location
(Bayramzadeh & Alkazemi, 2014). Prior to the computer charting system, the
unit was more centralized because all charting was done on paper at a single
nursing station.

            Our unit consists
of 18 floor nurses working first, second, or third shift. We also have a triage
nurse who works during part of each first and second shifts. We do not utilize
charge nurses, and there are three nurses regularly scheduled each shift. When
the unit is slow a nurse is on call, and when it is busy we add a third or
fourth nurse. We have a house supervisor in charge of the entire hospital at
all times, as well as a department manager during first shift. Above our
department manager is the director of women’s and surgical services, and above
her are the hospital’s president and vice president.

Adding to the concept of shared
governance are the UBC as described above, the Leadership Committee on which
our manager sits, and our monthly unit meetings to discuss and plan for best
practice for patient health and safety. Shared governance also enhances employee
satisfaction and retention because we feel that we have a say in how our jobs
are done (Myers,
Parchen, Geraci, Brenholtz, Knisely-Carrigan, & Hastings, 2013).

The nursing organizational
model followed by the Women’s Center is patient-centered care because it is
based highly on customer service and the patient’s individual needs (Huber,
2014). Patients have an active role in their care, and upon admission the
nurses ask appropriate screening questions in order to anticipate and plan for
needs. For example, I might ask a patient who she intends to have in the
delivery room with her when it is time to push. If she tells me that she would
like to have her husband, mother, mother-in-law, best friend, and two sisters
in the room, I would discuss this with her and her entourage and help them plan
for this.  Using this patient-centered
care for labor and postpartum mothers is an effective means to manage
expectations and educate patients from preadmission to the inpatient stay to
after discharge (Moore, Low, Titler, Dalton, & Sampselle, 2014).

Pros and Cons of Organizational Model

            Patient-centered
care is positive in that patients feel that they have a say in their care and
choices available for them. It is important for patients to feel educated and
empowered when it comes to their care. Another benefit is collaboration and
consistency across the board, between all disciplines. Because the patient is
at least in part directing her care, doctors and nurses and other healthcare
providers will give similar service.

            Patient-centered
care does have some negative aspects. One such con is that patients believe
they have done research before an admission and have a plan of care for their
hospital stay. This can mean they are less receptive to education by nurses and
physicians and are less flexible when it comes to wavering from that plan. One
specific example of this is a written birth plan for a first time mother. The
mother may decide what her ideal birth is like, but is unable and unwilling to
accept that her plan may not go perfectly. When the plan deviates, she becomes
upset.

            A second
negative of patient-centered care is that patients can overstep their role as
their own advocate in a way that then supersedes the professional training of
doctors and nurses. An example of this is patient-reported pain and subsequent
interventions. Healthcare workers are now taught that a patient’s pain is
whatever the patient says it is, and patient satisfaction dictates that we must
offer interventions including medication for this pain. I think nursing
judgement should be a factor in medication administration, and in my nursing experience
it is not. One article points to the case of Michael Jackson. He requested
propofol from his personal physician so that he could sleep. It is possible
that the physician tried to educate Michael on the risks of taking this drug
and offered alternatives. However, Michael was ultimately prescribed this
medication, which caused his death by oversedation (Heidenreich, 2013).

Nursing Strategies to Strengthen the Mission and Vision

As an obstetrical nurse in the ProMedica
Health System, there are several things I can do to strengthen the mission and
vision of improving health and bettering the community. I try to make every
patient interaction an opportunity for education for the whole family, such as immunizations,
breastfeeding, tours of the Women’s Center, and smoking cessation. My unit also
helps new mothers procure car seats, cribs, formula, diapers, and clothing for
their babies if they are unable to procure these items. We offer a one-time
postpartum home health visit to check on mom and baby and address any concerns.
I always try to advocate for my patients as well, with the discharging
obstetrician or pediatrician, and with the lactation consultant as needed. The quality
of my work is not driven by patient satisfaction scores but by personal connections
with my patients and feeling that I have helped them in some way. Because I love
my job and truly care about my patients, my unit’s patient satisfaction scores
are quite high.

In conclusion, ProMedica Health
System operates with the goals of improving patient health and making the
community a better place to live. From the top of the corporation all the way
down to nurses and other employees at one of the smallest hospitals like
myself, we all strive to meet the Promedica mission. Committees and councils
contribute to this cause, as do changes to our units such as decentralization,
staffing input through shared governance, or the patient-centered care concept.
As a nurse working within the system with the most up-to-date and effective
standards of care, I am proud to say that I am an employee here and that I improve
the health and wellbeing of my patients.

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