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Leadership Experience (nurse-to-patient Ratio)
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The modern health care services in most health care centers and by most medical professionals depend on several factors. Among the factors are the availability medical facilities, proper medication, and readily available and easily accessible health care centers. The health care professionals can use them as major steps towards the process of enhancing the care services. Although they may be used as major steps towards improving health care services, they should also be concerned with the number of nurses attending each patient popularly known as a nurse-to-patient ratio. Identifying and maintaining the appropriate blend of nursing staff per patient in the hospital is essential in the process of delivery quality care to the patient population.
Various medical professionals claim that to increase job satisfaction and decrease job-related fatigue and burnout, there should be a reduction in the nurse workloads. The nursing process or procedure I wish to discuss is the nurse-to-patient ratio in my work environment. I am sure this is a dilemma or problem in numerous work settings, especially in the medical practitioners. I have firsthand information on how the elevated nurse-to-patient ratio has affected patient care and the outcomes have left the medical field wanting. The identification and maintenance of the appropriate blend of nursing staff are crucial to the delivery of quality patient care.
The nurse-to-patient ratio in my present position is one nurse to 6-7 patients. Besides the nurse-to-patient ratio overwhelming, it is also dangerous for the nurse and the patients. The nurse cannot provide adequate, sufficient and quality care to their patients with such a high patient acuity. Because of possible inadequate and quality care, new health concerns may arise that extend the patient’s hospital stay and increase the costs of their care.
Investigation of the Problem
Several studies reveal that there is a significant relationship between the nurse-to-patient ratios and the patient outcomes. Nurse staffing committees are in a place that requires having policies and procedures that reflect the needs of the patient population and align them with the skills, experience and knowledge of the appropriate nurse. It is paramount to have policies that address nurse staffing since it increases patient satisfaction and safety and decreases additional health issues. These policies are imperative and crucial for nurses as they reduce the stress of excessive patients and improve their efficiency (Shekelle, 2013).
Additionally, per the American Nurses Association (2015), having an adequate nursing staff helps to decrease patient complications and problems, reduce medication errors, reduce mortality and improves and enhances patient satisfaction. Not only do the patients benefit from an adequate nursing staff, but the nurses do as well. Adequate staffing helps reduce nursing burnout and fatigue and improves both nursing retention and job satisfaction and fulfillment (American Nurses Association, 2015).
Furthermore, per Moore & Waters (2012), each additional patient assigned to a nurse increased patients’ 30-day mortality rate by 7 percent, “failure-to-rescue” rates increased by 7 percent, the probability of nursing job dissatisfaction increased by 15 percent, and the nurse burnout rate increased by 23 percent!
In past years, there has been increasing demand for more registered nurses in the hospitals due to the intensified demands and stresses from patients. The safety, as well as the quality of patient care, has a direct relationship to the size and experience of the nursing staff. The low levels of hospital nurse staffing have an association with more adverse health outcomes. Many patients with a high acuity add responsibilities to the nurses, thereby increasing their workload. The expectation is that a high level of nursing staff may have positive impacts on the quality of care and nurse satisfaction.
Analysis of the State of the Situation
The Nurse Staffing Committee has a mandate of ensuring that the ratio of nurses to patients is at an optimum level that leads to increased patient safety and quality of care. The Nurse Staffing Committee is responsible for the decision on the appropriate number of patients that each nurse is assigned. The Committee is comprised of qualified professionals in human resources and nursing (nurses, nurse’s aides). The Nurse Staffing Committee has a Chairperson, Secretary, Financing Officer, and the other general members. The major function of the committee is to conduct research, read reports on acuity and patient satisfaction and determine the appropriate nurse-to-patient ratios based on its research.
The Nurse Staffing Committee understands the value of the change of policy on the current nurse-to-patient ratios. The American Nurses Association embraced the idea of introducing the Registered Nurse Safe Staffing Act of 2003. It seeks to ensure that the patients receive safe and quality nursing care in hospitals, as well as health care institutions. The Act requires the creation of staffing systems that address the patient care needs. As such, the Nurse Staffing Committee is a result of the provisions of the Act and helps to address the nurse-to-patient ratios. Thus, the Committee supports the current process change out of obligation by law to address the patient care needs through increasing the nursing staff. The decision maker also understands the rising patient acuity that contributes to increased pressure on both the patients and the nurses.
The Nurse Staffing Committee in my select hospital chose to implement the process of change of policy on nurse-to-patient ration after identifying specific challenges in the hospital. One problem was the increased medical and medication errors since one nurse had the responsibility of attending to several patients thereby lowering the efficiency and productivity. Another concern was increased patient dissatisfaction by the nature of the services offered by the nurses due to the nurses being overwhelmed. There were many patient falls due to understaffing. Additionally, the nurses also complained of fatigue and burnouts that lowered their productivity in the work. These concerns prompted the Nurse Staffing Committee to consider the idea of revising the policy on the nurse-to-patient- ratios to address the underlying challenges.
Solution to the Problem
The practice change to help in addressing the current challenges is a change of policy in the nurse-to-patient ratios. Presently, the ratio stands at one nurse to 6-7 patients who are dangerous and overwhelming. Thus, the recommendation is having a ratio of one nurse to 3-4 patients as an attempt to increase patient satisfaction and safety. According to the American Nurses Association, the registered nurse acknowledges and emphasizes that the staffing issues are a major concern that influences the safety of the patients and the nurses. The change of nurse staffing policy has impacts - both on the patients and the practice settings as shown in the evidence-based studies.
Resources to Implement the Proposed Solution
a) American Nurses Association (2015) Nurse staffing; the nursing world, Retrieved from http://www.nursingworld.org/nursestaffing
b) McDonagh ML. (2014) Nurse Unions Continue to Push for Nurse-Patient Ration Legislation, Littler Mendelson Publications c) Moore, A., & Waters, A. (2012). Getting ratios right, for the patients' sake: Nursing Standard, 26(31), 16-19.
c) Shekelle, P. G. (2013). Nurse-Patient Ratios as a Patient Safety Strategy: Annals Of Internal Medicine, 158404-409.
d) Tevington, P. (2011). Professional Issues. Mandatory Nurse-Patient Ratios: MEDSURG Nursing, 20(5), 265-268.
A cost-benefit analysis is a method used to examine overall benefits of a proposal. The cost and benefits of alternative ways of using resources are assessed in monetary terms. Cost is defined as the actual cost associated with an activity for the purpose of analysis (Burns & Grove, 2009).
1. Costs are measured by the actual use of resources.
Examples: supplies such as flyers, signs, equipment, etc. An actual numeric dollar amount can be attached to these items.
Two wheelchairs = $900.00
2. Costs are also measured by time used or lost to educate staff and increases or decreases in workforce
Examples: Estimated salary/time of staff doing education and of staff being instructed.
Education of one triage nurse = $1100.00
Patient Care Technician (PCT) = 1.6 total FTE $10.00/hr. plus benefits = $41,861/yr.
3. Benefits are measured by ensuring safety, effectiveness, timeliness, efficiency, and equitable patient-centered care (Lighter, 2011).
Examples: preventions of falls, decreasing patients leaving without being seen in the emergency department, decrease infection rates, improving the quality of life, etc.
Stakeholders are the parties with an interest in something and are affected by an action, objective or policy either directly or indirectly. A stakeholder can be a person with something to gain or lose from the outcomes of a process. The term can also refer to the people, groups or organizations whose input in the process is crucial. They can also be any group or individual directly affected by the achievement of an objective. The key stakeholders in the process of changing the policy on nurse-to-patient ratios include legislators, the Nurse Staffing Committee, nurse representatives (American Nurses Association), patient representatives and the community leaders. Stakeholders are the determinants of the success of the process of policy change. The stakeholders employ different strategies to influence a modification or a change of policy. The involvement of the stakeholders in the policy change process requires that they understand and support the need for policy change. Thus, the process starts by sensitization of the stakeholders on the current issue and the proposed change highlighting the associated benefits.
The strategies to use involve lobbying for support especially to the stakeholders involved in the main affairs of discussing and legislation of the policy. The process involves calling for conferences and advocating for the support of the policy. It can also be in the kind of demonstrations that seek to address the problem through legislation. In some instances, it requires that the stakeholders have complete details of the policy before supporting or rejecting a policy. As such, the use of the available communication channels could help in familiarizing the stakeholders about the process of policy change.
Implementation of the Proposed Solution and the Effects
The proposed change is regarding the change of the nurse-to-patient ratio. The present ratio is one nurse to six or seven patients. The research studies conducted previously reveal that the ratio is ineffective in meeting the demands of patient safety and satisfaction. Thus, the policy change recommends that the new ratio is one nurse to three or four patients. It is essential to both the patients and the nurses in practice as earlier explained. The change of policy will ensure that a fewer number of patients are under the care of one nurse, thereby improving the efficiency and productivity of the services offered.
According to the American Nurses Association (2015), the health care leaders have an opportunity to develop innovative strategies for a collaborative effort and solutions that create a safe environment for the patients and the nurses. As such, the implementation process will require staffing solutions through leadership support and recognition of the need for adequately registered nurses able to deliver quality patient care. Thus, the implementation process will assess the skills, education, and training of the nurses within their specific settings during the entire process.
McDonagh (2014) recommends the need for legislation to implement the nurse-to-patient staffing requirements. The process has been successful in several states, but the enactment of the nurse-to-patient ratio nationally has been a slow moving proposal. California is the only place in the United States that has passed the required legislation in addressing the problem of nurse shortage (Leigh, Markis, Iosif & Romano, 2015). Thus, for effective policy change process, there ought to be adherence to the existing legislation on nurse-to-patient ratios. The nurse-to-patient ratios may vary from one state to another, but the main issue should be safe and quality care for the patient and the prevention of nurse fatigue and burnout.
The implementation of the change of the policy on nurse-to-patient ratio has associated benefits to the nursing practice. The American Nurses Association (2015) reports that this strategy results in reduced nurse fatigue and nurse burnouts. In practice, nurses who work long, extended workdays have a high susceptibility to developing fatigue symptoms. These nurses also have burnouts since their job requirements are demanding and challenging. As such, it results in reduced productivity. The change of policy of the nurse-to-patient ratios helps to improve nurse retention and job satisfaction. As such, many nurses have the willingness to work in environments where they are not stressed and strained.
Moore and Waters (2012) focus on changing the nurse-to-patient for the good of the patient. Their article reveals that addressing the current problem in nursing staff helps to improve the skill-mix (the ratio of nurses to support staff) for the registered nurses. There are mixed reactions to the policy change, but the underlying issue is this association benefits both the practice and the patients. The consideration of the nursing staff ratios helps to uphold the medical staff qualifications since they tend to work in their areas of specialization without digressing (Shekelle, 2013). The failure of having an appropriate nurse-to-patient ratio makes the medical staff work in diverse areas that may not be their areas of specialization. As such, there is decreased productivity in such circumstances.
As a Scientist
As a scientist, I worked in the healthcare and carried out several laboratory tests and techniques on some tissue samples and fluids. My tests helped the clinicians in the process of diagnosing the diseases. Additionally, I evaluated the effectiveness of the treatments the patients were receiving in the health care centers. My work as a scientist was extremely important in various hospital departments. The functions I carried out were wide ranging. For example, I worked in medical conditions such as diabetes, cancer, malaria, AIDS, food poisoning among others. I also carried out tests for emergency blood transfusion which would enable me has an analysis if the victim has had a heart attack. All the above tests would enable me to have a clear understanding of the nurse-to-patient ratio and how the available nurses would be distributed to cater for the big number of patients. Although I was not a scientist, I carried out some activities in the investigation process that would put me on the same trail as a scientist. Besides the above activities, others were (Moore & Waters, 2012):
• I worked with the computers, complex automated machinery, medical microscopes, and highly technology laboratory equipment. Most of them helped me to analyze and evaluate results from my investigation.
• I assisted in making sure that all the required turnaround times for reporting the outcomes would be achieved wherever it was possible
• I gave the investigation outcomes to the medical staff that would then use the outcomes to make the necessary changes in the medical field.
• I used the information technology to record and analyze data accurately, write the reports from the findings, and finally share the results.
• I also responded and redirected all the professional enquiries.
As a Detective
My work as a detective or a medical fraud investigator was reviewing and analyzing suspicious medical claims during the investigation and implementation of the nurse-to-patient ratio. I would analyze all the medical claims that would have been filled by the patients in the various hospitals, providers, and the insurance carriers. I conducted my investigations by having close observations at the medical records, interviewing various medical personnel, and communicating closely with the insurance claims adjusters. I would also identify fraudulent claims while gathering evidence and reporting my findings to the regulatory authorities who would go on to take the necessary steps towards prosecutions. I would also work long hours that would spill to weekends trying to collect all the necessary data that would enable me to have the informed changes in the nurse-to-patient ratio. I was also ultimately responsible for the various activities that would enable the team to undertake the research project. It would include compliance with the federal, state, and local laws. Others would include institutional policies and all the ethical principles. I remained solely responsible even in the cases where some aspects of the research would be delegated to the junior members of the research team (Leigh et al., 2015).
As a Manager of the Healing Environment
As a manager of the healing environment, I created a physical setting and organizational culture that would offer support to the patients and families imposed by diseases, hospitalization, medical visits, the healing process, and bereavement. It would have been created by ensuring that the ratio of nurse to the patient would be ideal. I would ensure that nurse-to-patient ratio would make a significant difference in how quickly the patients recover from illnesses or adapts to particular acute and chronic medical conditions. My goal as a manager of the healing environment during the processing of gathering knowledge and the research would be engaging the patients in the process of self-healing and spiritual growth according to Shekelle (2013).
There are other factors that contribute to the success of the health care services. However, there is no more outright one than the ratio of nurses to patients. The current status of the healthcare services in the United States and indeed the whole world would improve significantly with an increase in the nurse-to-patient ratio. Additionally, it would reduce the rates at which illnesses spread in the world and also be in a position to prevent contracting some diseases that are preventable in the current generation.
American Nurses Association (2015). Nurse Staffing. Retrieved from http://www.nursing world.org/nursestaffing
Leigh, J., Markis, C., Iosif, A., & Romano, P. (2014). California's nurse-to-patient ratio law and occupational injury. International Archives of Occupational & Environmental Health, 88(4), 477-484. doi:10.1007/s00420-014-0977-y
McDoagh, M. L. (2014). Nurse Unions Continue to Push for Nurse-Patient Ratio Legislation. Retrieved from http://www.littler.com/publication-press/publication/nurse-unions-continue-push-nurse-patient-ratio-legislation
Moore, A., & Waters, A. (2012). Getting ratios right, for the patients' sake. Nursing Standard, 26(31), 16-19
Shekelle, P. G. (2013). Nurse-Patient Ratios as a Patient Safety Strategy. Annals of Internal Medicine, 158(5_Part_2):404-409.doi:10.7326/0003-4819-158-5-201303051-00007
Tevington, P. (2011). Professional Issues. Mandatory Nurse-Patient Ratios. MEDSURG Nursing, 20(5), 265-268
Sherry Roberts is the author of this paper. A senior editor at Melda Research in research paper writing help 24 hours if you need a similar paper you can place your order for a custom research paper from research proposal writing services.
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