Essay On Micro Politics Factors

 

In the field of nursing and healthcare, staff retention and keeping them satisfied for a long period of time is increasingly becoming challenging for nursing mangers, administrators, and healthcare policymakers (Gibson et al. 2020). Recruitment of staff is another important area that impact the flow of adequate number of staff in care facilities (Sepasi et al. 2016). However, what is more important is to retain the recruited staff so that they stay a chosen healthcare organization for a long period of time. In addition to that, keeping the nursing professionals with any chosen healthcare is not only based on their salaries and payments but also on how they receive treatment from others and how others perceive them (Gibson et al. 2020). In the present global healthcare scenario, due to a lot of internal micropolitical factors nursing professionals are being forced to leave their present jobs and often they are being forced by their professional environments to permanently switch their jobs from nursing to some other dimensions (Rogers et al. 2020). Over the last fifty years, a lot of studies have been carried out to understand what really forces or motivates nursing professionals to resign, and scholars have found that increasing dissatisfaction generated due to micropolitics in care settings such as power relations, oppressed group behaviours, staffing issues, autonomy-related matters, and horizontal violence force nurses to quit (Mikaelian and Stanley 2016). The paper aims to provide insights on various kinds of micropolitical factors in care settings and how they impact recruitment and retention of nursing staff.

 

 

Micropolitics in the context of healthcare refer to impact of internal politics of a healthcare facility concerning vision, goals, direction and governance, and decision -making of the care facility concerned (Sepasi et al. 2016). However, there are opinions and survey-based studies that showed how positive micropolitics shape healthcare outcomes formatively but there is no surety regarding the exact or the most covetable form of power relations (Gibosn et al. 2020). There are five major elements of micropolitics in healthcare that are very common to almost 95% of the present global healthcare scenario (Cashmore et al. 2016). The main concern from these micropolitical factors is that they are almost unavoidable and rather there is an urgent need to regulate and control these factors to the most of their capacities (Rogers et al. 2020).

 

Horizontal violence which is known as lateral violence is a type of aggressive behaviour by groups or individuals which is very hostile and adverse towards other members or groups shapes healthcare micropolitics in a remarkably significant manner (Bloom 2019). Novice nurses most of the times during their initial years of service gets impacted by horizontal violence. Seniors or other novice nurses out of frustration and resentment often harm other nurses due to internal dissatisfaction and unconsciousness or displacement if psychologically observed (Rosi et al. 2020). Lateral violence or horizontal violence is a form of violence as per sociological lens that refers to the fact or expression and outburst of rage and anger towards members within a group of similar workers, communities, or marginalized groups where the oppressed tortures or dominates over the oppressed and not the oppressor (Blackstock, Salami and Cummings 2018). This type and form of violence is very common in the context of the Aboriginal communities in the US, Canada, New Zealand, and Australia. Most of the crimes and culpable social acts related to the Aboriginal communities in these anglicized nations are attributed to lateral or horizontal violence where one member of the community oppresses and tortures or bully other members of the same community in place of responding to the real oppressors. Likewise, in healthcare field, nurses often out of disillusionment and frustration tend to harm other nurses though unconsciously but both physically and mentally (Taylor 2016). This unacceptable, destructive, and intolerable phenomenon prevalent in the global healthcare scenario impacts the wellbeing of nurses. Horizontal violence in healthcare is such as toxic practice that damages and disrupts the image, reputation, overall functioning, and power relations of the care facility at large. However, most of the times, horizontal violence in the context of healthcare facilities is nonphysical (Rosi et al. 2020). In Australian healthcare context, horizontal violence is prevalent in both covert and overt behavioural outcomes of the staff. On the basis of this behaviour which is behind oppressing the people of the same groups, psychology of displacement is the major contributor whereby a person out of an unconscious defensive mechanism tend to substitute goals for a new object or aim which is very unacceptable and dangerous (Bloom 2019). As per Freud, displacement among nurses can be explained via dream-distortion, replacement by something which is mere illusion, and shifting from important to unimportant priorities and works (Blackstock, Salami and Cummings 2018). Moreover, Otto Fenichel also commented on displacement or horizontal violence-based redirection and postponement or both. He mentioned that paths of displacement depend on the very nature of the drivers of displacement and psychoanalysis (Rosi et al. 2020). Moreover, as per the concept of transferential displacement, past feelings and attitudes impact the feelings an attitude of the present and due to which transfer occurs in the mind of a perpetrator. Thus, due to horizontal violence, nurses are very much distressed and damaged internally and they are in a state of continuously escaping their present situations and workplace at large (Bloom 2019). Thus, addressing horizontal violence is pivotal in deciding the fate of a care facility or else it will damage the image of the care, force nurses to quit, and patients to be discouraged to visit the setting (Kiprillis et al. 2021).

 

Autonomy is similar to the independent working conditions and to the extent a person gets liberty to work independently and freely. In the context of nursing and healthcare, autonomy refer to the level of freedom to work in any concerned care facility and managing minor incidents which might arise during exercising duties by their own (Pursio et al. 2021) Moreover, autonomy in the field of nursing also refer to the fact of granting nurses the power to exercise management of a patient without going to the physicians and other healthcare staff regarding what needs to be done with the patients concerning their conditions. However, it must not be misunderstood and confused with interprofessional collaboration where a nursing professional may have to collaborate with a specialized cardiac surgeon but in autonomy a nurse is empowered with certain decision-making permissions that allow optimized patient care without distraction and harassment (Costa, Santos, and Costa. 2021). In some of the cases, though a nurse needs to call physicians and other healthcare staff when the condition of a patient concerned deteriorates rapidly and beyond the knowledge of the nursing professional. In the present healthcare scenario, nurses are expected to enjoy marked autonomy in exercising their duties and patient care or else delayed response and permission form physicians may deteriorate the condition of a patient beyond recovery to normalcy (Galbany-Estragués and Comas-d’Argemir 2017). Thus, swift decision-making forms the position of nursing professionals are covetable to elevate care outcomes and patient recovery in a faster, smoother, and continued manner. However, there are concerns regarding the degree to which nurses should enjoy autonomy in exercising their daily job roles (Pursio et al. 2021).

 

Power Relations is the key to a successful and effective interpersonal communication and in any professional field. In the context of nursing, power relations refer to the relative power, influence, dominance, and power status that nurses enjoy over patients or other colleagues in a care facility. The interactive relationship between a nurse and their patients is not always dominating and pleasant but there are a lot of challenges and concerns over the power equations in the relationship concerned. Moreover, there are also areas of conflict that are common when a nursing staff come in contact with other staff such as physicians which lead to adverse care outcomes that are though preventable. Thus, experts deem power relations as a major factor in recruitment and retention of nursing staff as this very interactive relationship and maintaining its power relations are the key to a heathy professional nursing practice. Conceptualization of power is more laid on using the power and bidirectional influence of power or communication effectively. Depending on the situation, both power and influence can be used either formatively and negatively. In healthcare, power is often attributed as an asymmetric factor which signify how healthcare staff dominate over the patients and in most of the cases, the use of jargon explanation of care guidelines, dictation of topics and suggestions, questioning, interruption, and initiatives disserve the very purpose of patient outcomes. Moreover, often powerless speech from nurses is deemed by experts as nothing more than polite formulations, hedges, and hesitations.

 

Oppressed Group Behaviours is a new concept in nursing which has major roles in deciding staff retentions and care outcomes. Most often, a nursing staff lashes out at the other one due to a chronic feeling of powerlessness and frustration generating out of their daily job roles. If a person in a group feels relatively less powerful than others, they tend to fight with each other due to their powerlessness which is often orchestrated by others more powerful than them in the group. Moreover, repeated events of abuse, rebuking, and chiding behaviours by physicians to nurses have created rooms for most of nurses to feel hopeless, frustrated, and feel powerless. In the longer run, these factors motivate nurses to suffer from low ego and self-respect that creates inspirations for them to quit their jobs. Hence, it is the job role of nurse managers to address the hierarchical matters, providing rooms for equal space to all less-experienced members, and creating harmony among the workers of a healthcare facility.

 

Staffing issues are another major area of the care dynamics that shape the overall image and success of a care facility (Jacobs 2021). Over 70% of the healthcare around the world are facing shortage of staff which is the biggest challenge indeed related to staffing and retention of the staff. 76% of the healthcare in Australia and Canada witnesses’ issues in staff retention and the consequent challenges associated with staffing (Ramussen et al. 2020). Staff shortages are very common not just in Australia but it tormented the US as well during the first and second waves of the COVID-19 pandemic. Most of the hospitals in the US were going through a nightmare during the middle of 2020 and early 2021 due to huge shortage of nursing staff even after heavy and overloaded recruitments. The challenges that were facing the healthcare managers and authorities are not related to recruitment issues but they were facing hard times to manage the unprecedented void crated due to repeated resignations and attritions of nursing staff. There are many challenges related to micropolitics in healthcare but staffing issues is something to which the healthcare managers and policymakers must look into immediately or else the situations that might come in the future may distort the overall care flow in healthcare.

 

Resistance of nursing staff is another factor related to micropolitics in the field of nursing. Nurses often resist changes in care plan, organizational management, and may also acts as blockages in harnessing any constructive change concerning the sustainability of the care facility in the longer run which makes the care facility a very sluggish one and averse to change.

 

Gender-based protests and exhibition of unity among the females nursing staff are also common in healthcare micropolitics. It may happen out of a strong reason or out of any propagandist moves as most of the feminist movements of the present time are meaningless which are filled with more politically motivated, misanthropic, and anti-man sentiments that could create a long-term disharmony in a healthcare facility.

 

Healthcare institutions and facilities are very similar to other social entities that involve major stakeholders, power dynamics, hierarchy, and pluralism. There are numerous kinds and types of staff starting with physicians to nurses. However, all of these staff are placed in unique hierarchies that are further governed by the leaders of the healthcare concerned. Different roles, expectations, and priorities often intervene with each other that ultimately impact care and service delivery to clients or patients. Moreover, different power relations in the healthcare impact interprofessional functioning that also either positively or negatively impact care delivery and patient recovery. In such a complex and intricate care dynamics, new joiners among nursing workforce in any healthcare institute often face difficulties to adapt and fit into the facility, especially the novice nurses. Horizontal violence is one of the major micropolitical factor facing healthcare and impacting the recruitment and retention of nurses at large.

 

Horizontal violence is unacceptable, destructive, and intolerable phenomenon prevalent in the global healthcare scenario impacts the wellbeing of nurses. It has all the possibilities to create the highest form of disservice in staff retention and managing a compact and comprehensive flow of care delivery and patient outcomes. Moreover, it is the sole reason for over 80% of the attrition cases of novice nurses leaving nursing profession in Australia permanently. Lesser autonomy leads to more dissatisfaction among nursing professionals which motivate them to resign and quit the field of profession. Hence, the priority regarding facilitating autonomy to the nursing professionals is based on catering towards ensuring the maximum permissible levels of autonomy and making nurses more apt and professional in understanding how to serve autonomy provided to them to the provide the best possible care outcomes and swift decision-making in saving critical patients. As far as a power relation are concerned, a healthy power relation in healthcare caters to staff retention, more job satisfaction, and better patient outcomes form a facility concerned (Rosi et al. 2020). Repeated events of abuse, rebuking, and chiding behaviours by physicians to nurses have created rooms for most of nurses to feel hopeless, frustrated, and feel powerless which motivates nursing staff to quit their jobs in the longer run. Staffing issues create more workload on the existing staff which often extends their shifts and enhances scope for burnouts, dissatisfaction, and exodus from the profession (Kiprillis et al. 2021). Staff resistance in the longer run makes the care facility a very sluggish one and averse to change which also reduces job satisfaction of other apt nurses that are willing to test their professional acumen. Moreover, gender-based is a priority area on which nurse managers must look into with proper planning and response or else it also retards care delivery and functioning of a healthcare setting (Mikaelian and Stanley 2016). Additionally, these factors motivate nurses to suffer from low ego and self-respect that creates inspirations for them to quit their jobs. Hence, it is the job role of nurse managers to address the hierarchical matters, providing rooms for equal space to all less-experienced members, and creating harmony among the workers of a healthcare facility (Cashmore et al. 2016).

 

 

The paper provided insights on various kinds of micropolitical factors in care settings and how they impact recruitment and retention of nursing staff. It was observed that micropolitics in the context of healthcare refer to impact of internal politics of a healthcare facility concerning vision, goals, direction and governance, and decision -making of the care facility concerned.  There are five major elements of micropolitics in healthcare that are very common to almost 95% of the present global healthcare scenario such as horizontal violence, autonomy, power relations, oppressed group behaviours, staffing issues, resistance among nursing staff, and gender-based protests among female nurses. Addressing these micropolitical issues in healthcare should be the priority of the hour or else reactive hiring and too much recruitment will have no impact or surety in retaining staff. Thus, planned management, strategies that are practical, and futuristic vision with unmatched leadership in the need of the hour for global healthcare settings concerning nursing retention.

 

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