Nursing Unit Manager (NUM) & Midwifery Group Case Study - Nursing Assignment Help

Assignment Task

Nursing Scenario
You have been working in a work unit for the past two years. In this time the long-term Nursing Unit Manager (NUM) has retired and there has been seven different nurses acting in this position. None of the nurses who have acted in the position have expressed a desire to continue in the role when it is advertised. The work unit has a reputation for having 'a difficult culture'. There is a higher than average staff turn-over rate and the sick leave is double the hospital average. Overtime is required of staff on every shift to fill deficits in the roster and there are 25% of Full Time Equivalent (FTE) positions unfilled. This unit has had difficulty recruiting senior experienced Registered Nurses (RNs), and management have recently decided to hire more graduates to reduce the cost of overtime staff. In the last 6 months medication errors and consumer falls have significantly increased, and there has been increasing reports of aggression between staff and from consumers. Complaints from consumers and
families are steadily increasing. The Nurse Educator (NE) role is not permanently recruited to and there has been four NEs in the past nine months. The Clinical Facilitator (CF) role is unfilled.
 

Midwifery Scenario
You have been working as a Caseload Midwife for the past 5 years in a Midwifery Group Practice (MGP) attached to a regional hospital within 45-minute transfer time of a major tertiary referral centre. You joined the practice when it was first established. In the first 3 years, two groups of 4 Full Time Equivalents (FTE) midwives have established a solid reputation for the provision of a high quality continuity of care service that has been in high demand and oversubscribed in the local community. Collaboration with medical colleagues has been effective. During the first 3 years 90 % of women booked in with the MGP have had their birth attended by their named Midwife and consumer satisfaction surveys have been favourable. The average spontaneous vaginal birth rate during this period was 88% and breastfeeding rates at 6 weeks postnatal 94%. However, over the past two years things have changed. The inaugural Midwifery Unit Manager (MUM) retired, and a new MUM was  recruited. The hospital has also had its clinical services framework reviewed. Two new Obstetric Consultants in partnership with private practice rights have been appointed to the hospital. As per the new clinical services arrangements the Obstetric Consultants provide consultation and medical review for all women booked with the MGP (low and high risk). Five of the original eight midwives have now left the MGP. Recent clinical audit shows the caesarean rate is 22%, (8% elective caesareans) and relationships with the medical staff is strained. Only 65% of women in MGP have their named Midwife in attendance at the birth. Consumer satisfaction surveys indicate that many women are now dissatisfied with the level of continuity in the Midwife model and would consider standard medical led care for their next birth. Two of the eight FTE MGP midwife positions are vacant. Despite extensive advertising over 6 months there have been no applications for these positions. The MUM advises that the hospital executive is considering ceasing the MGP and reabsorbing the existing six FTE midwives back into core midwifery staffing positions.

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