Nurses and staffing issues Essay.

Nurses and staffing issues

Instructions:-This is the evaluation rubric from school.
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Score/Level
Articulation of Response (clarity, organization, mechanics)
The candidate provides unsatisfactory articulation of response. The candidate provides weak articulation of response. The candidate provides limited articulation of response. The candidate provides adequate articulation of response. The candidate provides substantial articulation of response.
A1. Problem or Issue
The candidate does not identify an appropriate problem or issue related to practice, policy, population, or education that aligns with organizational priorities that the candidate seeks to solve. Not applicable. Not applicable. Not applicable. The candidate identifies an appropriate problem or issue related to practice, policy, population, or education that aligns with organizational priorities that the candidate seeks to solve.
A1a. Explanation of Problem or Issue
The candidate does not provide a logical explanation of the problem or issue, including why it is applicable to the chosen area of practice and the healthcare environment. The candidate provides a logical explanation, with no support, of the problem or issue, including why it is applicable to the chosen area of practice and the healthcare environment. The candidate provides a logical explanation, with limited support, of the problem or issue, including why it is applicable to the chosen area of practice and the healthcare environment. The candidate provides a logical explanation, with adequate support, of the problem or issue, including why it is applicable to the chosen area of practice and the healthcare environment. The candidate provides a logical explanation, with substantial support, of the problem or issue, including why it is applicable to the chosen area of practice and the healthcare environment.
A2. Investigation
The candidate does not provide a logical discussion of how the problem or issue was investigated. The candidate provides a logical discussion, with no detail, of how the problem or issue was investigated. The candidate provides a logical discussion, with limited detail, of how the problem or issue was investigated. The candidate provides a logical discussion, with adequate detail, of how the problem or issue was investigated. The candidate provides a logical discussion, with substantial detail, of how the problem or issue was investigated.
A2a. Evidence of Problem or Issue
The candidate does not include appropriate evidence to substantiate the problem or issue. Not applicable. Not applicable. Not applicable. The candidate includes appropriate evidence to substantiate the problem or issue.
A3. Analysis
The candidate does not provide a plausible analysis of the state of the situation using current data. The candidate provides a plausible analysis, with no support, of the state of the situation using current data. The candidate provides a plausible analysis, with limited support, of the state of the situation using current data. The candidate provides a plausible analysis, with adequate support, of the state of the situation using current data. The candidate provides a plausible analysis, with substantial support, of the state of the situation using current data.
A3a. Areas Contributing to Problem or Issue
The candidate does not provide a plausible analysis of areas that might be contributing to the problem or issue. The candidate provides a plausible analysis, with no support, of areas that might be contributing to the problem or issue. The candidate provides a plausible analysis, with limited support, of areas that might be contributing to the problem or issue. The candidate provides a plausible analysis, with adequate support, of areas that might be contributing to the problem or issue. The candidate provides a plausible analysis, with substantial support, of areas that might be contributing to the problem or issue.
A4. Proposed Solution or Innovation
The candidate does not provide an appropriate proposal of a solution or innovation for the problem or issue. Not applicable. Not applicable. Not applicable. The candidate provides an appropriate proposal of a solution or innovation for the problem or issue.
A4a. Justification of Proposed Solution or Innovation
The candidate does not provide a logical justification of the proposed solution or innovation based on the results of the investigation and analysis. The candidate provides a logical justification, with no support, of the proposed solution or innovation based on the results of the investigation and analysis. The candidate provides a logical justification, with limited support, of the proposed solution or innovation based on the results of the investigation and analysis. The candidate provides a logical justification, with adequate support, of the proposed solution or innovation based on the results of the investigation and analysis. The candidate provides a logical justification, with substantial support, of the proposed solution or innovation based on the results of the investigation and analysis.
A5. Implementation Resources
The candidate does not provide an appropriate recommendation of resources to implement the proposed solution or innovation. Not applicable. The candidate provides an appropriate recommendation, with insufficient detail, of resources to implement the proposed solution or innovation. Not applicable. The candidate provides an appropriate recommendation, with sufficient detail, of resources to implement the proposed solution or innovation.
A5a. Cost Benefit Analysis
The candidate does not provide an appropriate cost benefit analysis of the proposed solution or innovation. Not applicable. Not applicable. Not applicable. The candidate provides an appropriate cost benefit analysis of the proposed solution or innovation.
A6. Timeline
The candidate does not provide an appropriate timeline for implementation based on the proposal. Not applicable. Not applicable. Not applicable. The candidate provides an appropriate timeline for implementation based on the proposal.
A7. Identification of Key Stakeholders and/or Partners
The candidate does not identify key stakeholders and/or appropriate partners that are important for the implementation of the solution or innovation. Not applicable. Not applicable. Not applicable. The candidate identifies key stakeholders and/or appropriate partners that are important for the implementation of the solution or innovation.
A7a. Importance of Key Stakeholders and/or Partners
The candidate does not provide a logical discussion of why each key stakeholder and/or appropriate partner is important for the implementation of the solution or innovation. The candidate provides a logical discussion, with no support, of why each key stakeholder and/or appropriate partner is important for the implementation of the solution or innovation. The candidate provides a logical discussion, with limited support, of why each key stakeholder and/or appropriate partner is important for the implementation of the solution or innovation. The candidate provides a logical discussion, with adequate support, of why each key stakeholder and/or appropriate partner is important for the implementation of the solution or innovation. The candidate provides a logical discussion, with substantial support, of why each key stakeholder and/or appropriate partner is important for the implementation of the solution or innovation.
A7b. Engagement with Key Stakeholders and/or Partners
The candidate does not provide a logical summary of the candidate’s engagement with the key stakeholders and/or appropriate partners, including the input and feedback received. Not applicable. The candidate provides a logical summary, with insufficient detail, of the candidate’s engagement with the key stakeholders and/or appropriate partners, including the input and feedback received. Not applicable. The candidate provides a logical summary, with sufficient detail, of the candidate’s engagement with the key stakeholders and/or appropriate partners, including the input and feedback received.
A7c. Success
The candidate does not provide a logical discussion of how the candidate intends to work with key stakeholders and/or appropriate partners in order to achieve success. The candidate provides a logical discussion, with no detail, of how the candidate intends to work with key stakeholders and/or appropriate partners in order to achieve success. The candidate provides a logical discussion, with limited detail, of how the candidate intends to work with key stakeholders and/or appropriate partners in order to achieve success. The candidate provides a logical discussion, with adequate detail, of how the candidate intends to work with key stakeholders and/or appropriate partners in order to achieve success. The candidate provides a logical discussion, with substantial detail, of how the candidate intends to work with key stakeholders and/or appropriate partners in order to achieve success.
A8. Implementation
The candidate does not provide a logical discussion of how the proposed solution or innovation could be implemented. The candidate provides a logical discussion, with no detail, of how the proposed solution or innovation could be implemented. The candidate provides a logical discussion, with limited detail, of how the proposed solution or innovation could be implemented. The candidate provides a logical discussion, with adequate detail, of how the proposed solution or innovation could be implemented. The candidate provides a logical discussion, with substantial detail, of how the proposed solution or innovation could be implemented.
A8a. Evaluation for Success of Implementation
The candidate does not provide a logical discussion of how the implementation could be evaluated for success. The candidate provides a logical discussion, with no detail, of how the implementation could be evaluated for success. The candidate provides a logical discussion, with limited detail, of how the implementation could be evaluated for success. The candidate provides a logical discussion, with adequate detail, of how the implementation could be evaluated for success. The candidate provides a logical discussion, with substantial detail, of how the implementation could be evaluated for success.
B1. Role of Scientist
The candidate does not provide a logical explanation of how the role of scientist was fulfilled during the process of investigation and proposal development. The candidate provides a logical explanation, with no detail, of how the role of scientist was fulfilled during the process of investigation and proposal development. The candidate provides a logical explanation, with limited detail, of how the role of scientist was fulfilled during the process of investigation and proposal development. The candidate provides a logical explanation, with adequate detail, of how the role of scientist was fulfilled during the process of investigation and proposal development. The candidate provides a logical explanation, with substantial detail, of how the role of scientist was fulfilled during the process of investigation and proposal development.
B2. Role of Detective
The candidate does not provide a logical explanation of how the role of detective was fulfilled during the process of investigation and proposal development. The candidate provides a logical explanation, with no detail, of how the role of detective was fulfilled during the process of investigation and proposal development. The candidate provides a logical explanation, with limited detail, of how the role of detective was fulfilled during the process of investigation and proposal development. The candidate provides a logical explanation, with adequate detail, of how the role of detective was fulfilled during the process of investigation and proposal development. The candidate provides a logical explanation, with substantial detail, of how the role of detective was fulfilled during the process of investigation and proposal development.
B3. Role of Manager of Healing Environment
The candidate does not provide a logical explanation of how the role of manager of the healing environment was fulfilled during the process of investigation and proposal development. The candidate provides a logical explanation, with no detail, of how the role of manager of the healing environment was fulfilled during the process of investigation and proposal development. The candidate provides a logical explanation, with limited detail, of how the role of manager of the healing environment was fulfilled during the process of investigation and proposal development. The candidate provides a logical explanation, with adequate detail, of how the role of manager of the healing environment was fulfilled during the process of investigation and proposal development. The candidate provides a logical explanation, with substantial detail, of how the role of manager of the healing environment was fulfilled during the process of investigation and proposal development.
C. Verification Form
The candidate does not provide a completed “Professional Verification Form” from the organizational leader advising the candidate in the leadership experience. Not applicable. Not applicable. Not applicable. The candidate provides a completed “Professional Verification Form” from the organizational leader advising the candidate in the leadership experience.
D. Sources
When the candidate uses sources, the candidate does not provide in-text citations and references. When the candidate uses sources, the candidate provides only some in-text citations and references. . When the candidate uses sources, the candidate provides appropriate in-text citations and references with minor deviations from APA style. When the candidate uses sources, the candidate provides appropriate in-text citations and references with no readily detectable deviations from APA style, OR t

Solution.

Problem

Substantively large associations of nursing staff ratios and wide range of outcomes including mortality, failure of appropriate care, and increased lengths of hospital stay, among variety of other outcomes.

Explanation of the problem

Nurses are a representation of the largest group of healthcare professionals in any form of HealthCare facility. So, the assumption is that the nurses’ time is used effectively and adequately. Financial limitations and budgeting restraints restrict adequate nurse staffing to ensure high-quality and individualistic care approach (Blegen, Goode, Spetz, Vaughn, & Park, 2011). Ideally, the demand and supply rule applies to the staffing ratios making a perfect balance between personnel staffing and positive patient outcomes. Excessive workload leads to frequent absenteeism and all over nurses’ burnout (Duffield, 2011). The patients do not receive promised care and attention, rounding up to lower patient satisfaction scores and further effecting the annual budget. The whole process revolves around inadequate nurse staffing.

In as much as nurses have been invisible for a long period of time, being viewed as assistants to physicians, it is without doubt that they spend most of the time with the patients. The process of nursing involves not only tending to the prescribed needs of the patients, but also developing an in-depth understanding of the underlying factors that influence the health of the patient (Yankovic & Green, 2011). As such, it involves creating a relationship with a patient and a level of trust that would allow the patient to open up and speak about themselves. This becomes a problem if the nurse has a large number of patients to attend to within the short period that they are presented with during their shift. The issue of nurse staffing is highly important bin defining the quality of care that patients receive. The quality of care results in nurse-sensitive outcomes, which are variable family caregiver or patient condition, state, or perception, in response to a nursing intervention (Weiss, Yakusheva, & Bobay, 2011). As such, the link between nurse staffing and patient outcome underlies the importance of the problem of understaffing, and hence the need for proper research to be done in the area in order to establish approaches that can be promoted to increase staffing and facilitate positive patient outcomes.

Investigation

A nurses’ retention survey was completed at the rehabilitation hospital which follows “Individualistic Care Model” meaning care tailored to individual patient needs. The nurses reported that their staffing levels are inadequate to perform high-quality care. The assignments are not designed in partnership with the staff nurses but by the managers. A total of 63% nurses reported that new admissions along with existing assignment were a heavy burden and taking time away from patient’s real-time specific needs. Increased patient acuity and shortened hospital stay is playing a detrimental part in further worsening the staffing ratios (Cook, Gaynor, Stephens Jr, & Taylor, 2012).

Evidence of problem or issue

Various studies have been conducted in line with identifying the relationship between nurse staffing and the quality of health care, which is measured through patient outcomes. Most of these studies reveal that there is a connection between nurse-patient ratios and the outcomes of patients. This section reviews some of the studies conducted on this subject and their impact to the general study of the impact of nurse staffing on the quality of care. According to Needleman et al. (2011), a study conducted in every nursing shift in 12 units in one hospital found that low staffing of RNs was associated with higher mortality rates. High patient turnover — admissions, discharges and transfers — during a shift also was linked with greater risk of patient deaths (Needleman, et al., 2011). Such high rates of mortality may be linked to the reduced nurse time allocated to each patient as the high nurse-patient ration means that the nurses have to attend to various patients during their shift, giving no much attention to any of the patients, including those who have been incapacitated and unable to complain about their problems. These type of patients require the nurses to assess and review them frequently in order to identify their needs and address them appropriately.

In addition, evidence suggests that improving nurse work environments in hospitals could result in improved patient outcomes, including better patient experiences and higher satisfaction ratings. Patient-to-nurse ratios in hospitals do affect patient satisfaction ratings and recommendation of the hospital to others (McHugh, Kutney-Lee, Candiotti, Sloane, & Aiken, 2011). Patient satisfaction is determined by the level by which patients feel that their needs have been met. Apart from the immediate clinical needs, patents have underlying needs that require holistic nursing to identify and meet them. Another systematic review and meta-analysis by Kane, Shamliyan, Mueller, Duval, and Wilt (2007) revealed consistent evidence that an increase in Registered Nurse (RN) to patient ratios was associated with a reduction in hospital-related mortality, failure to rescue, and other nurse-sensitive outcomes, as well as reduced length of stay. An increase in total nurse hours per patient day was associated with reduced hospital mortality, failure to rescue, and other adverse events (Kane, Shamliyan, Mueller, Duval, & Wilt, 2007).

The Institute of Medicine, in a study of the nursing work environment, recommends that the length of nursing shifts be limited to 12 hours in any 24-hour period, whether mandatory or voluntary (Institute of Medicine, 2004). This recommendation is highly considerate of the workload that the nurses are exposed to, especially in cases where the ratio between nurses and patients is high. In such cases, the quality of care is further affected by the level of fatigue of the nurses, which leads to stress. By limiting the shifts to 12 hours, the workload of the nurses is reduced, limiting their level of fatigue and allowing them to offer their best quality of care to the patients that they interact with. Reducing the shift hours allows the nurses to have enough rest and hence to attend their shifts while in the right state of both mind and physicality to effectively identify the needs of the patients and to appropriately address them (Bolton, et al., 2007).

On the other hand, results from a sample of Pennsylvania hospitals indicates that increased nurse staffing is associated with reductions in atelectasis (lung collapse), decubitus ulcers, falls, and urinary tract infections (Kovner & Gergen, 1998). These conditions require much attention from the nurse during nursing care in order to identify them and address them accordingly. In cases where the number of nurses is much lower than that of patients and hence each nurse is allocated a high number of patients, the nurses spend less time by the patient bedside and hence only monitor the vitals of the patient and ensure that the patient adheres to the treatment regime (Aiken, et al., 2011). It requires more engagement and assessment of the patient to identify some of the health complications that may arise and hence to effectively address them. By increasing staffing, the patients are able to secure enough time with their allocated nurses, an aspect that promotes proper care.  

Analysis

Quality nursing care is very crucial to saving lives. When the nurses are short staffed and forced to work with high nurse-to-patient ratios, the patients suffer multidimensional effects. The nurses at the Rehabilitation hospital reported that other disciplines assume that the nurses are there to give medications to the patients. The standardized nurse-to patient ratio is 6 patients to a nurse, but on regular basis nurses end up with 8 patients including a discharge and a new admission, so making it about 9 patients to interact with. Other disciplines usually question the nurses about how hard it is to give medications to 8 patients, completely looking away from the multidimensional focus of nursing. After analysis of the Retention survey completed by the nurses, it was reported that patients tend to get more infections, less care, increased number of falls per shift, inadequate discharge instructions and education (Tschannen & Kalisch, 2009). On contrary when nurses are appropriately staffed, they spend more time with patients than on computers. The patients are more likely to understand how to manage their diabetes, walk with crutches, watch for signs of infection or brain injury, so they can prevent further illness or deterioration or know when to seek help. When nurses have fewer patients they are more likely to intercept and prevent errors, so fewer patients die or get injured (Sun, et al., 2013). And when nurses have more time to advocate with physicians, insurance companies or others about the patient’s care plan to make sure the patient gets everything s/he needs, patients are more likely to thrive.

Areas contributing to problem

The nurses at the Rehabilitation hospital identified various areas that contribute to the problems experienced as a result of staffing. One of the areas addressed involves the burden of admissions added on nurses during any time of the day an aspect that denies them enough time to adjust to routine. In this case, the nurses are forced to leave their assigned patients and to attend to the new admissions, who not initially included in the schedules, an aspect that increases the nurse-patient ratio as the shift progresses, and contributes to the reduction in the quality of care provided (Aiken, et al., 2014). On the other hand, the discharge planning and working with the doctor and case managers to get organized for the discharge takes away a lot of time from other patient’s care. The discharge process is more involving and takes up most of the nurses’ time, reducing the time that such nurses spend with their patients, an aspect that has negative effects on the quality of care offered and the level of satisfaction among the patients (Penoyer, 2010).

Frequent call outs and shortage of PRN pool to cover for the absenteeism also puts extra burden on nurses who reported to work in a timely manner, increasing burnout levels. The nurses revealed that a duty roster is created at the beginning of the shift, which determines allocation of the roles and assignment of nurses to patients. Nevertheless, with increased rates of nurse absenteeism and turnover, the available nurses are forced to adopt to an abrupt change of schedule, one that requires them to fill in for those nurses who are absent or have left the organization. As a result, the nurses bear a burden of additional patients, whom they are expected to care for. With the increased need for quality care, the nurses are expected to identify and address the needs of the high number of patients assigned to them, an aspect that compromises the quality of care they offer and leads to nurse fatigue, stress, and depression, aspects that further impede the delivery of quality care (Van den Heede, Clarke, Sermeus, Vleugels, & Aiken, 2007).

The shortage of assistive personnel and their extensive assignments takes away the help from nurses leading them to perform the job duties of Certified Nursing Assistants (CNAs) as well. Licensed Practical Nurses (LPN) and Registered Nurses (RN) delegate roles to CNAs who assist patients with their health care needs. These CNAs, also referred to as Nurse Assistants (NAs), play an important role in reducing nurse patient care as some of the patients are assigned to them for care, with the nurses playing only the supervisory role (Shekelle, 2013). As such, in the case where there is a shortage of such assistants, the nurses have to bear it all, taking all the responsibilities that involve patient care. This is overwhelming for the nurses and hence affects the quality of such care as it limits the amount of time they allocate to each patient.

Patient census based staffing leads to overburden in case the census increases suddenly with utter number of admissions. Such a type of staffing places a fixed number of patients under the care of each nurse, an aspect that makes it a huge challenge to adjust to changes in the number of patients who require care (Shamliyan, Mueller, Duval, & Wilt, 2007). This forces the nurses to absorb the increase in the number of the patients, an aspect that further increases the tasks that they are required to do within their limited shift time. Such unplanned increases in the number of patients that require care interferes with the nurses’ established care schedule, forcing them to cut on some of the time that they had allocated to the other patients in order to be able to care for the added patients. As a result, the attention given to each patient and the quality of care is affected, and the rate of nurse burnout is increased, an aspect that leads to a further decrease in the quality of care.

Cost containment is the major issue effecting the relationship between the management nurses and staff nurses. The management nurses are more concerned with reducing the costs incurred in the care process in order to increase the organization’s profitability (Shamliyan, Kane, Mueller, Duval, & Wilt, 2009). The nurse leaders have thus distanced themselves away from the nurses and hence fail to understand or overlook the issue of staffing, an aspect that leads to reduced attention given towards the need to increase nurse staffing in order to increase the quality of patient care. This inconsideration for the importance of nurse-patient ration by the hospital’s administration is a major contributor towards increased nurse burnout and decreased quality of care. The increase in nurse burnout and work-related stress also contributes to an increase in nurse turnover, an aspect that further affects the nurse-patient ratio.

Proposed solution or innovation

After thorough analysis of the survey and cost analysis, an appropriate solution was that was proposed by the staff nurses was to open up a position for an RN to be an Admission and Discharge nurse. The sole responsibility of the staff nurse should be collaborating care towards discharge planning with the team and working on new admissions.

Justification of proposed solution

As identified by the nurses the admission of new patients and discharge of others takes time away from the patients that are already under the care of the nurses. In as much as the nurses have already established a preplanned schedule and a sequence with which they care for their patients, inadequate staffing requires them to take time away from such a schedule and care for the arising needs such as the admissions and the discharges (Nickitas, Middaugh, & Aries, 2011). Some of these processes are highly involving and require much of paper work, an aspect that takes even more tome of the nurse, thus leading to inadequate time allocated to the patients. As a result, there is less interaction between the patient and the nurse for patient-centered care to be initiated and thus the nurse only sticks to the prescribed treatment regime, an aspect that leads to failure to identify any arising needs of the patient. This contributes to poor quality of patient care and a low rate of patient satisfaction. In addition, the additional work results in a high rate of nurse workload and burnout (Hall, 2005). By creating an additional spot within the organization for a RN who will take care of the admission and discharge processes would ensure that the nurses keep to their patient care schedules and hence spend more time with their patients, an aspect that positively contributes to the quality of care.

Implementation resources

To employ an additional Registered Nurse, there are various resources, including recruitment resources and employment resources that an organization must put in place. In this case, recruitment resources refer to all the resources that are required to advertise and select the nurse. Financial capital is important in facilitating a newspaper advertisement of the additional RN position. According to the hospital policy, all vacant positions should be advertised to invite individuals from diverse backgrounds to apply for them. The advertisement services are to be outsourced to one of the major newspaper dailies. Another resource that is required is a hall in which the interviews of the approved applicants will be carried out. Such a hall may be the hospital’s boardroom, or staffroom. A panel of interviewers including the heads of the nursing department and representatives from the human resource department are also important as they are the ones to vet the applicants and to use the established criteria to come up with the most qualified applicant. The organization will also have to revise its budget in order to include the additional cost of an extra RN in the form of salary disbursements.

Cost benefit analysis

As compared to the benefits that the company will have to reap from the process of hiring an extra RN to run the patient admission and discharge processes, the costs remain insignificant. In this case, the costs to be incurred include the costs of advertising the position and those of compensating and remunerating the new employee, in addition to other benefits that the new employee is to receive such as insurance benefits, among others. In as much as this costs may be seen as high at a glance, the advantages of creation such a position is tremendous. The cost of poor quality patient care is high, which includes increased patient dissatisfaction and a high rate of patient turnover (Gordon, Buchanan, & Bretherton, 2008). With increased rates of dissatisfaction among patients there would be tainting of the organization’s reputation through the word of mouth, an aspect that would lead to reduced admissions in the hospital and hence a reduced profit margin.

Timeline

Activity	July	August	September	October
Advertising RN position
Collecting of applications
Reviewing applications and shortlisting first stage qualifiers
Conducting interviews
Selecting the most qualified candidate
Training selected candidate
Assigning new RN

Identification of key stake holders

The key stake holders involved in the entire process of analysis and intervention were the CEO of the hospital, Chief Nursing Officer, Educator, Quality Improvement Manger, Nursing Supervisors, Charge Nurses, and above all the staff Nurses. The chain of command model was followed to work the way up to the management team. The nurses reported all the incidences at various different times throughout the shortage phase. It was no news to anyone but an actual attempt to fix problem of shortage of staff nurses was “The News”. The team was very open and helpful to work towards improvement of the staffing issues. The CEO played an important role towards allocation of resources and get permission from the company board.

Importance of key stakeholders

Importance means the priority given to satisfying the needs and interests of the stakeholders for being involved in the project and for the project to be successful as well. Influence and power of the stakeholder can affect the success or failure of the entire project. Power is very important in terms of initiating and constraining a project. It is important to know the positive as well negative influence a stakeholder can have on the project.

All the stakeholders played a major role to bring about the change that was much needed. The CEO was an important entity in ensuring that the implementation had all the resources it required in terms of capital by gaining buy-in from the members of the hospital board. The Chief Nursing Officer is the link between the management and the staff nurses, ensuring that the concerns of the nurses are properly shared with, and appropriately addressed by the management, while also ensuring that the change message is well communicated to the nurses and other health care providers across the organization. The educator is important in training both the newly employed RN in view of his or her new role, as well as training the rest of the nurses on how they can promote the quality of patient care. The Quality Improvement Manager has a role in ensuring that all the stakeholders play their role towards facilitating improvements in the quality of patient care. They also establish feedback mechanisms through which the satisfaction of the patients can be rated, to allow for effective response. The Charge Nurses and Nurse Supervisors have an important role to play in facilitating the implementation of the various measures put in place by the management to promote the quality of care by overseeing the roles of the nurses and motivating them towards success (Wan, Breen, & Zhang, 2010). Lastly, the nurses have the major role to play in ensuring that the functions directed at promoting the quality of care are effectively implemented. These include reporting to work on time, establishing proper schedules that would ensure proper management of the patients, applying effective care models that would facilitate timely identification and addressing of patient needs, reducing the cases of absenteeism, and reviewing patient satisfaction and areas that require improvement upon discharge (Aiken, et al., 2014).

Engagement with key stakeholders

All the stakeholders mentioned above were very involved in the whole project. It consumed about 40% of their work time for an entire working month. The CNO personally interviewed nurses and participated in the Retention survey. The nurses took the time to share their concerns with all the stakeholders. An open door policy was adopted by the CEO to communicate better. Since this whole process, the relation between the staff has improved much and become less restrictive.

Success

The whole project was a great success. Staying within the boundaries of the budget, the team was able to effectively create a new RN position that mitigated the challenge of nurses having to leave their patients in order to attend to the patient admission and discharge processes. A highly qualified nurse was recruited to fill the position. The criteria used included a Bachelors of Nursing, an experience in the out-patient clinic, an experience in the emergency department, conversant with the Electronic Health records (EHRs) system, and respectful of the needs of the patient. All the stakeholders were engaged in the establishment of the criteria and the identification of measures that ought to be upheld in order to facilitate quality patient care.

Implementation

To create a new RN position in order to counter the problem of staffing in the hospital, and to facilitate nurse training in order to facilitate the quality of care, it is important to engage all the stakeholders in order to ensure that they are well involved in the establishment of measure that can be upheld to ensure success of the project (Blegen, Goode, Spetz, Vaughn, & Park, 2011). It is important to invite applicants from a wide range of backgrounds in order to have a rich supply of skills from which to selected an individual who will help the hospital to meet its needs and cut on the rime spent by the nurses attending to admission and discharge needs. A proper job description should also be established to allow the applicants understand their expected role in the organization so as to attract applicants who meet the position’s requirements. On the other hand, it is important to facilitate the training of the practicing nurses in order to ensure that such nurses are way aware of the approaches through which they can ensure that each patient is allocated enough time to meet their needs regardless of the nurse-patient ratio (Teeter, 2014).

Evaluation of success of implementation

Various measures can be employed in evaluating the success of the implementation process. One of the measures that would be used to determine if the process is a success is the rate of satisfaction of patients as measured through a discharge questionnaire. On the other hand, the length of stay of the patients in the hospital is an indication of the quality of care that they receive, with a reduced length of stay being a clear indication of improved quality of care (Penner, 2013). Reduced rates of absenteeism and nurse turnover would also be indications of reduced nurse burnout and stress and increased satisfaction among the nurses as a result of reduced workload (Allbee, et al., 2012). Last but not least, an improved relationship between the nurses and the patients and increased patient recommendations would indicate an increase in the level of satisfaction among the patients with the services offered by the organization and positive impact of the hospital’s reputation as a result of the patient’s word of mouth.

Fulfillment of roles

Role of scientist

The role of a scientist was fulfilled through reviewing the various researchers that have been carried out on the same issue of concern, staffing, in order to establish justification of the importance of the issue. Scientists use tangible evidence to support their various phenomenon, and hence a review of primary researches that have already been carried out allowed me to use evidence not from one but from different resources to establish the relationship between nurse staffing and patient outcomes.

Role of detective

Detectives engage in a review of evidence on the site in order to determine the actual course of different situation and the relationship between given variables. In this case, I achieved the role of a detective by engaging the nurses from the hospital in order to understand, first-hand, the various factors that affect the issue of staffing and patient care quality within their organization.

Role of manager of healing environment

The role of the manager of healing the environment was achieved by establishing a solution to the identified problem of nurse-time with other patients being taken away by the need to address admission and discharge cases. The proposed solution was creating an additional RN position that would deal with patient admissions and discharges.

References

Aiken, L. H., Cimiotti, J. P., Sloane, D. M., Smith, H. L., Flynn, L., & Neff, D. F. (2011). The effects of nurse staffing and nurse education on patient deaths in hospitals with different nurse work environments. Medical care, 49(12), 1047.

Aiken, L. H., Sloane, D. M., Bruyneel, L., Van den Heede, K., Griffiths, P., Busse, R., & McHugh, M. D. (2014). Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study. The Lancet, 383(9931), 1824-1830.

Allbee, B. H., Marcucci, L., Garber, J. S., Gross, M., Lambert, S., McCraw, R. J., . . . Slonim, T. A. (2012). Avoiding Common Nursing Errors. Philadelphia: Lippincott Williams & Wilkins.

Blegen, M. A., Goode, C. J., Spetz, J., Vaughn, T., & Park, S. H. (2011). Nurse staffing effects on patient outcomes: safety-net and non-safety-net hospitals. Medical care, 49(4), 406-414.

Bolton, L. B., Aydin, C. E., Donaldson, N., Brown, D. S., Sandhu, M., Fridman, M., & Aronow, H. U. (2007). Mandated nurse staffing ratios in California: a comparison of staffing and nursing-sensitive outcomes pre-and postregulation. Policy, Politics, & Nursing Practice, 8(4), 238-250.

Cook, A., Gaynor, M., Stephens Jr, M., & Taylor, L. (2012). The effect of a hospital nurse staffing mandate on patient health outcomes: Evidence from California’s minimum staffing regulation. Journal of Health Economics, 31(2), 340-348.

Duffield, C. (2011). Nursing staffing, nursing workload, the work environment and patient outcomes. Applied Nursing Research, 24(4), 244-255.

Gordon, S., Buchanan, J., & Bretherton, T. (2008). Safety in Numbers: Nurse-to-Patient Ratios and the Future of Health Care. Ithaca: ILR Press.

Hall, L. M. (2005). Quality Work Environments for Nurse and Patient Safety. Sudbury, MA: Jones & Bartlett Publishers.

Institute of Medicine. (2004). Keeping Patients Safe: Transforming the Work Environment of Nurses . Washington, D.C.: National Academies Press.

Kane, R. L., Shamliyan, T. A., Mueller, C., Duval, S., & Wilt, T. J. (2007). The association of registered nurse staffing levels and patient outcomes: systematic review and meta-analysis. Medical care, 45(12), 1195-1204.

Kovner, C., & Gergen, P. J. (1998). Nurse staffing levels and adverse events following surgery in US hospitals. The Journal of Nursing Scholarship, 30(4), 315-321.

McHugh, M. D., Kutney-Lee, A., Cimiotti, J. P., Sloane, D. M., & Aiken, L. H. (2011). Nurses’ widespread job dissatisfaction, burnout, and frustration with health benefits signal problems for patient care. Health Affairs, 30(2), 202-210.

Needleman, J., Buerhaus, P., Pankratz, V. S., Leibson, C. L., Stevens, S. R., & Harris, M. (2011). Nurse staffing and inpatient hospital mortality. New England Journal of Medicine, 364(11), 1037-1045.

Nickitas, D., Middaugh, D. J., & Aries, N. (2011). Policy and Politics for Nurses and Other Health Professionals. Sudbury: Jones & Bartlett Publishers.

Penner, S. J. (2013). Economics and Financial Management for Nurses and Nurse Leaders (2nd ed.). New York: Springer Publishing Company, LLC.

Penoyer, D. A. (2010). Nurse staffing and patient outcomes in critical care: a concise review. Critical care medicine, 38(7), 1521-1528.

Shamliyan, T. A., Kane, R. L., Mueller, C., Duval, S., & Wilt, T. J. (2009). Cost savings associated with increased RN staffing in acute care hospitals: Simulation exercise. Nursing Economics, 27(5), 302.

Shamliyan, T., Mueller, C., Duval, S., & Wilt, T. J. (2007). Nurse staffing and quality of patient care. Rockville, MD: Agency for Healthcare Research and Quality.

Shekelle, P. G. (2013). Nurse–patient ratios as a patient safety strategy: a systematic review. Annals of internal medicine, 158(5 part 2), 404-409.

Sun, B. C., Hsia, R. Y., Weiss, R. E., Zingmond, D., Liang, L. J., Han, W., & Asch, S. M. (2013). Effect of emergency department crowding on outcomes of admitted patients. Annals of emergency medicine, 61(6), 605-611.

Teeter, K. (2014). Relationship Between Job Satisfaction and Nurse to Patient Ratio with Nurse Burnout. New York: Gardner-Webb University.

Tschannen, D., & Kalisch, B. J. (2009). The effect of variations in nurse staffing on patient length of stay in the acute care setting. Western Journal of Nursing Research, 31(2), 153-170.

Van den Heede, K., Clarke, S. P., Sermeus, W., Vleugels, A., & Aiken, L. H. (2007). International experts’ perspectives on the state of the nurse staffing and patient outcomes literature. Journal of Nursing Scholarship, 39(4), 290-297.

Wan, T. T., Breen, G.-M., & Zhang, N. J. (2010). Improving the Quality of Care in Nursing Homes: An Evidence-Based Approach. Baltimore: The Johns Hopkins University Press.

Weiss, M. E., Yakusheva, O., & Bobay, K. L. (2011). Quality and cost analysis of nurse staffing, discharge preparation, and postdischarge utilization. Health services research, 46(5), 1473-1494.

Yankovic, N., & Green, L. V. (2011). Identifying good nursing levels: a queuing approach. Operations research, 59(4), 942-955.