The nursing field is tasked with delivering health care that is effective, efficient, timely, and accessible. These measures of quality nursing care can be achieved when nursing practice is properly coordinated. Nursing staffing levels play a critical role in nursing administration. Nurse administrators should ensure that there are adequate nurses in the health facilities to deliver quality patient centered care. The available nurses should have the right skills and knowledge to deliver the services demanded by the patients. However, too many nurses may not be economical. Therefore adequate staffing is a serious issue in nursing administration which involves ensuring there are an adequate number of suitably qualified nurses to deliver the demanded services.
The Staffing Problem in Nursing Practice
Staffing involves managing employee schedules to maximize output. In nursing practice, having inadequate number of nurses makes it impossible for the delivery of safe, dignified and compassionate care putting patients at risk.. Nurse staffing is related to the quality of care offered and better patient outcomes. Having lower levels of staffing by nurses is related to increased risk that patients will get complications and die while a larger number of nursing care hours is associated with better care for hospitalized patients (Needleman, Buerhaus, Mattke, Stewart, & Zelevisky, 2002). Therefore, when nurse administrators want to improve service delivery and the quality of health care offered, nurse staffing should me a major point of consideration.
Nurse staffing impacts nursing management and leadership through the requirement of nurse leaders to develop suitable job descriptions and skill mix for nurses to meet the patient’s needs. Proper staffing ensures that nurses are able to practice to the full extent of their training, skills and knowledge; makes institutions with robust nurse staffing programs to be attractive to the best nursing talent. In addition, staffing impacts health care systems in the world, because of the central role nurses play in health care delivery. The measure of nurses to patient ratio or the percentage of nurses in the population is a measure of the efficiency of the health care system. In the veteran’s hospital where I completed my practicum, nursing staffing has room for improvement. This is based on the observation that new nurses rate the scope of work in the veteran’s hospital lowly compared to their previous hospitals. Nursing staff dissatisfaction is a major case of low quality health care services and can be addressed through adequate staffing. Improving nurse staffing can be achieved through changes in nurse’s job description, benchmarking nursing practice, or hiring ore nurses to reduce workload (Brown, Donaldson, Burnes & Aydin, 2010). Of these methods, benchmarking is the most suitable one in the veteran’s hospital. Changing job descriptions is challenging in a veterans hospital because strict government control while hiring new nurses reduces workload without necessarily addressing the other nurse staffing problems. Benchmarking is rational because it allows an institution to compare its performance with that of other institutions and use their experience to improve. It has also been applied widely with positive outcomes as demonstrated below. Benchmarking is discussed further with light to my practicum at a veteran’s hospital and the problem of nurse staffing.
Benchmarking
Nurses interact directly with patients and play a critical role in health care service delivery especially patient centered care. It is therefore important for nurses to understand their performance. Benchmarking is a practice through which nurse practitioners compare their own practice, process, philosophy, policies, and outcomes against targets which represent high performance and high quality (Ellis, 2002). Benchmarking nursing practice involves establishing what makes a difference in the patient’s perception of quality care, setting standards to achieve this best practice, evaluating performance, and combining the experiences of peers with personal ideas to meet and possibly exceed the new standards. Benchmarking is a valuable tool in improving the quality of care offered. It can be applied to many aspects of nursing to solve challenges and improve care.
One of the successful applications of benchmarking is in the Chilean primary health practice. Chile has been revamping its health care system and the result is a system that provides equitable and quality care and has positive outcomes such as infant mortality and life expectancy. Despite these positive steps on a national scale, improvements are needed on the local levels to ensure equitable and accessible health care services. Ramilez-Valdinia, Maturana and Salvo-Garrido reported a multiple stage approach for performance improvement in primary health care practice in Chile (2011). The study aimed at measuring the efficiency of healthcare system so as to identify areas that need improvement. It identified areas with inefficiencies in terms of large per capita spending on health with small numbers of hospital visits or poor patient satisfaction scores. The high ratio of nurses to patient in the rural areas is a possible cause of lower efficiency when compared to the urban areas. This study also identified various data that can be used to measure nursing outcomes and the general performance of a health cares system.
Benchmarking theory is built on the basis of comparing performance, identifying gaps and changing the process to close the identified gaps. Despite its proven ability to improve quality and service delivery, benchmarking still lacks sufficient theoretical basis to guide its multi-faceted application hence its scope has been limited to strategies and systems (Yasin, 2002).
The Benchmarking Cycle and Implementation
The process of benchmarking can be considered as a five step cycle where all steps are interrelated but are performed independently. This cycle is adopted from Rosswurm & Larrabee who considered a cyclic model for changing to evidence based practice from ordinarily practice (2007). Step one is identifying the factors that can take the organization to the next level in terms of quality of care offered. This involves setting strategic objectives based on credible findings on which factor the patient’s value most in determining the quality of care they are receiving. In the issue of nurse staffing, strategic objectives are related to having adequate nurses who have the right skills and knowledge and can be maintained economically. After setting the strategic objectives, the second step involves assigning metrics to these objectives. Metrics are measurable outcomes that can be used to demonstrate whether or not a particular objective has been achieved. Besides being measurable, the metrics should have a strong correlation with nursing care outcomes or with patient satisfaction and perception of quality. Some measurable metrics in the problem of nurse staffing levels include descriptors of nursing care such as nurse staffing hours, skill and knowledge mix, nurse to patient ratios, workload intensity and voluntary turnover and nurse satisfaction measures (Brown, Dnaldson, Burnes, & Aydin, 2010).
The third step in the bench marking cycle is measuring the current performance of the organization and comparing with set standards. This is done using the identified metrics. The nursing administrators should determine the skills and knowledge mix currently in use, nurse to patient ratios and customer perception. This allows the organization to compare to position with the set standards or with peers. Standards are set by industrial regulators and give the minimum acceptable performance. In nurse staffing problem, the problem of bench marking nursing performance is affected by the role of nurses. The role can vary widely as is the case for nurse practitioners where state boards of nursing determine the scope of practice for nurses in their jurisdiction. Where the cope of nursing is limited and nurse practitioners require physician supervision to perform some duties such as prescribing controlled substances and drugs, it becomes necessary to consider the available physicians when benchmarking nurse’s performance.
This step allows the organizations to identify areas in their nurse staffing that have weaknesses and strengths and to identify the possible level of performance based on the comparison with other organizations (Kay, 2007). Once performance gaps in the nurse staffing levels have been identified, the fourth step can be implemented.
The fourth step focuses on modeling operational excellence. This involves at deciding which steps will close the operational gaps identified in the previous step. Modeling operational excellence involves the scope, time, cost, quality, procurement, human resource, communication, and integration management (Ghoddousi, Yavati & Hosseini, 2010). While benchmarking the nurse staffing problem these factors should be applied. Scope management determines how the duties and roles of nurse’s best meet the patient’s needs. Time management determines how much time a patient gets to spend with the nurse. This is affected by the nurse to patient ratio. Cost management ensures that the hospital has a nursing staff that is competitively compensated compared to nurses in other organizations so as to maintain high morale. The nurses should be integrated in decision making on how to close the identified gaps through effective communication.
Modeling operational excellence in nurse staffing problem involves getting the right number of nurses, with the right skill set and knowledge to deliver quality health care services. Once the changes that can close performance gap have been implemented, the final stage of the benchmarking cycle is reached.
The final step of the benchmarking cycle involves measuring, validating and improving the model of operational excellence. An institutional experience is combined with knowledge from other comparable institutions to identify areas of improvement. This is followed by setting up of strategic objectives to achieve improvement hence completing the cycle.
When implementing benchmarking at the veterans hospital to address the problem of nurse staffing, the identified five step cycle will be used. This will allow the hospital to compare its services with other veteran’s hospitals and identify gaps which can be closed through improving the quality of care offered. The overall goals will be to improve nurse to patient ratio, improve skills mix in the nursing staff, improve quality of care offered, and improve nurse’s satisfaction with their work. On a short term a skill survey will be conducted to determine which skills are missing in the existing nursing staff. This will form the basis of in-house training and new hiring to improve nurse to patient ratio. On a long term, the quality of care offered as determined from health outcomes and patient satisfaction will be determined as will the level of nurse satisfaction. Improved quality of health care and nurse’s satisfaction will be used to gauge success of the program.
References
Brown, D.S., Donaldson, N., Burnes, B. L., & Aydin, C. E. (2010). Nursing-sensitive
benchmarks for hospitals to gauge high-reliability performance. Journal of Health care Quality, 32(6). 9-17.
Ellis, J. (2001). Introducing a method of benchmarking nursing practice. Professional nurse
(London, England), 16(7), 1202.
Ghoddousi, P., Yavari, H., & Hosseini, M. (2010). Competitive benchmarking of Iranian
construction companies management performance. (2010). TTEM- Technics Technologies Education Management, 5(3), 621-634.
Kay, J. F. (2007). Health Care Benhmarking. Medical Bulletin 12(2), 22-27.
Needleman, J., Buerhaus, P., Mattke, S., Stewart, M., & Zelevinsky, K. (2002). Nurse-staffing
levels and the quality of care in hospitals. New England Journal of Medicine 346(22), 1715-1722.
Ramírez-Valdivia, M., Maturana, S., & Salvo-Garrido, S. (2011). A Multiple Stage Approach for
Performance Improvement of Primary Healthcare Practice. Journal of Medical Systems, 35(5), 1015-1028.
Rosswurm, M. A., & Larrabee, J. H. (2007). A Model for Change to Evidence‐Based Practice.
Yasin, M. M. (2002). The theory and practice of benchmarking: then and now. Benchmarking:
An International Journal, 9(3), 217-243.
