After the program has been implemented, nursing staff at the moments of rapid environmental change have changed their roles and efficiently assisted each of them as for example (nurses leaders assisted staff nurse in the newly admitted patient, staff nurses helped the custody nurses in counting and storing the unit supplies, and the custody nurses received patients and endorsed them like other nurses) they became more adaptable, efficient and flexible.
Consequently, nursing staff gained higher level of situational awareness which was closely related to higher mutual performance monitoring. Nursing staff, with all nursing categories, at the beginning of the shift have actively scanned and assessed all unit level elements to gain information or understanding, or to maintain awareness to support team functioning. They have asked about the events which could affect team performance as a whole for example events were related to; status of patients (e.g. number, general status, transferred patients, patients at the previous shift, if their relatives accompanied the patients, etc.); status of the staff themselves (e.g. number of present staff, the workload, assigned unit and managerial duties, number of absent staff, the fatigued and stressed staff and the presence of supplementary staff, etc.); status of the working environment (e.g. new devices were available, the place of medication and supplies, the availability of the administrative information, etc.).
Regarding the observed NTW elements of the backup behavior dimension, the results of the study indicated that there were statistically significant differences between its elements during (pre, immediately post-program implementation and three months later) where obviously all items’ mean scores increased immediately post-program implementation compared to preprogram and relatively gained small decrease three months later. The results indicated that the majority of the study participants were observed highly not performing the element of “initiating assistance before being asked” followed by the element of “working with other staff to accomplish an emergent tasks” which increased post program implementation and relatively gained small decrease three months later.
As a result of nursing staff’s situational awareness, nursing staff were more able to be backed up at changeable case because they recognized the areas of defects and the exact times to initiate assistance instead of waiting to be asked for help.
Nursing staff became more oriented about how to describe, predict, and explain each of their behavior and choose effective response regarding to certain unit and patient’s situation, which enables them to mutually know their roles, and coordinate their performance to balance their workload and finish their assigned tasks. Nursing staff became team leadership oriented and were able to mutually supervise and monitor their working environment, and inspect that they were progressing towards finishing their tasks in efficient manner whatever the presence of severe shortage at that moments. This monitoring ensures that the team is able to adaptably accommodate for changes in the environment when they occur (Duel, 2010).
Regarding the observed NTW elements of the adaptability dimension, the results of the study indicated that there were statistically significant differences between its elements during (pre, immediately post-program implementation and three months later) where obviously all items’ mean scores increased immediately post-program implementation compared to preprogram and relatively gained small decrease three months later. The results indicated that the majority of the study participants were observed highly not performing the element of “accepting any form of change faced during working shift” followed by the element of “acting behind other staff while being in problem” which increased post program implementation and relatively gained small decrease three months later.
It was obviously noticed that, nursing staff lacked the flexibility to be easily engaged in unrelated areas of work as for example, the custody nurses were not able to handle patients or stand during receiving new critical admissions because they most of time assigned for counting unit supplies and infusion bottles rather than dealing with patient the case that made them away from core nursing skills and made a big defect during the moments of sever nursing shortage. Continuing the previous example, those nurses in fact were dominating their certain skills and definitely weren’t obligated from unit nurse leaders to change their role as well as lacked the proper educational background and qualifications because they all hold a diploma’s degree in nursing which disabled them to easily adapt to any changeable situation.
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