SPUR 2023: Bridgett Scott, W’23

My SPUR research interests originated through an intersection between my clinical experiences and education thus far as a student nurse and my Wharton Leadership Journey Course: MGMT 3010: “Teamwork and Interpersonal Dynamics.” This course taught me how to think critically about team dynamics and important phenomena such as emotional intelligence, how to enact change, the dynamism between the rational and subconscious mind, various leadership styles and the merits of each, and different hinderances to efficient teamwork and how to overcome these obstacles. I wanted to continue to deepen my understanding of these dynamics through real-world observation in US Healthcare systems and literature review.

In my experiences working and volunteering at healthcare organizations across America, I have repeatedly encountered a central tension that can broadly be described as stakeholder dissatisfaction. Stakeholders within these healthcare systems can include shareholders, donors, doctors, nurses, other medical personnel, administrative employees, other employees (maintenance, food service, etc.) patients, families, and other members of the executive team. The dissatisfaction that I have witnessed most specifically from nurses, patients, families, and members of the executive team are often categorized by a disconnect between their intentions, all of which have been very admirable, and a system that is governed by complex policies, and sometimes, an administration that seems to be removed from the point-of-care interactions which I have primarily witnessed between nurses and patients. Although my observations have provided only the smallest fraction of a window into the healthcare system at large, I have found that nurses have an uncanny ability to liaise between administration and patients and I want to investigate this positive nexus of communication and attempt to discover if it could be more broadly harnessed throughout healthcare systems to optimize communication efficiency, effectiveness, and nursing stakeholder satisfaction.

For my SPUR research, I was fortunate enough to be able to perform observations and conduct survey-style interviews with various members of the nursing stakeholder group throughout the entire nursing chain of command at Children’s National Medical Center in Washington, DC.

I had the opportunity to survey nurse educators who were formerly floor nurses, charge nurses, and shift coordinators on their floor, the Director of Central Nursing Operations in the Central Staffing Office, the Performance Improvement Coordinator, the Executive Director of Patient Care Services and Operations, two Nurse Managers, a Nurse Navigator, the Director of the Department of Nursing Science and Professional Practice & Quality Research Integrity Officer, and the Chief Nursing Officer. I began my investigation by asking these individuals a five-question stakeholder satisfaction survey that I formulated based on motivational interviewing techniques.

My qualitative research survey responses allowed me to identify patterns resulting in three tangible recommendations for improving communication efficiency, effectiveness, and stakeholder satisfaction within the nursing stakeholder group at Children’s National. Based on my interviews,  , Children’s is operating with suboptimal communication efficiency and nursing stakeholder satisfaction based on l , too much individual discretion in terms of effective-and-closed-loop communication, and lack of adequate representation on the executive board.

In order to optimize communication efficiency, effectiveness, and stakeholder satisfaction specifically throughout the nursing chain of command at Children’s National Medical Center, my recommendations are as follows: I would encourage the organization to be more transparent about their relationship and responsibilities with relation to the nurse’s union, use a programmatic approach to standardize and close the loop with regards to communication within the nursing chain of command, and elevate the Chief Nursing Officer to the Board of Directors from which platform she will be able to better elevate the concerns of many different stakeholder groups. This case study has opened my eyes to many different interpersonal dynamics within this hospital system and has invoked future research interests including investigating the role and effect of nurses acting on executive boards.

I am very grateful to my faculty advisor, Dr. Julie Sochalski, the Wharton Summer Program for Undergraduate Research, and all of my interviewees and facilitators at Children’s National Medical Center who made this research a possibility.