Achieving optimal staffing levels of nurses especially in the cardiac unit is a huge milestone that would help in minimizing adverse events, increase job satisfaction among nurses and ultimately foster quality outcomes. Hence, this emphasizes the need to develop a comprehensive implementation plan relating to the proposed solution in order to ensure that the intervention is properly integrated into the organizational system and subsequently enhance care delivery. The project is based in a cardiac care unit and shall involve various stakeholders including: the senior hospital administrators, nurse managers and the general nursing staff. Thus, it is important to obtain the approval from the relevant stakeholders specifically the senior hospital administrators as well as the nurse manager in order to be allowed to access the necessary clinical records and engage the nursing staff as well as the other relevant stakeholders in the project.
Since the project mainly focuses on changing the current policy (recruitment and staffing of nurses and assistant nurses), the process of obtaining the necessary approval shall mainly involve the senior hospital administrators whereby this shall involve educating them on various aspects as well as components pertaining to the project and encouraging their active participation in the project. Specifically, the senior hospital administrators/hospital management shall be provided with a change proposal detailing the impact of inadequate staffing levels of nurses on the patient outcomes. In addition, the change proposal shall describe the need to improve the level of nurse staffing particularly by recruiting additional nurses as well as Unlicensed Assistive Personnel (UAPs) in order to improve care delivery and consequently the patient outcome. More importantly, the change proposal shall describe the cost and the benefits for implementing the proposed change i.e. the budgetary implications associated with the implementation process and the benefits that accrue following the implementation of the proposed change whereby this shall also help in securing the support as well as active participation of the hospital management.
Following approval of the project, it is necessary to secure the support of the organization’s leadership as well as the general staff in order encourage their active participation and foster optimal implementation of the proposed change. With regard to this, the nurse managers as well as the general nursing staff on the various aspects as well as components pertaining to the project. Through a scheduled meeting and using handouts as well as PowerPoint presentations the aforementioned groups shall be educated on the impact of nurse staffing on patient outcomes whereby this shall involve proving them with the necessary information on the impact of low staffing of nurses on patient mortality, as well as morbidity and the healthcare costs. Additionally, the two groups shall be educated on the need to adopt the proposed change based on the benefits that accrue from its implementation specifically reduction in the occurrence of adverse events, increasing job satisfaction among nurses as well as minimizing healthcare spending. This shall help in fostering their support as well as encourage their active involvement in the project. Through the departmental meeting and using pamphlets as well as oral presentations, the nursing staff shall also be educated on the impact of the proposed change in regard to minimizing their workload and the need to foster teamwork in their work setting so as to ensure optimal care delivery.
As aforementioned, it is apparent that increase in incidences of adverse events is the key problem due to inefficient recruitment as well as staffing of nurses in the organization whereby this results to unsafe staffing levels of nurses in the unit. Typically, the nurse-patient ratio in the unit is 1:7 or 1:8 and as a result the unit has witnessed an increase in the nurses’ workload as well as work-pressure since the unit mainly comprises of patients with critical conditions that require frequent care. This has caused many nurses to leave the organization due to work-related stress and job dissatisfaction since they are forced to work for extra hours in order to cover for the deficit whereby this has compounded the problem further. As a result of poor staffing of nurses, the unit has witnessed an increase in incidences of adverse events such as increase patient falls, pressure ulcers as well as wrong medication administration mainly due to poor delivery of healthcare. With regard to this, it is apparent that the organization requires an immediate solution, hence the need for implementing the proposed solution. The proposed solution focuses on recruiting more nurses as well as unlicensed assistive personnel in order to improve the efficiency and effectiveness in care delivery and ultimately the patient outcomes. As such, the goal would be to have at least six nurses to cover for at most thirty six patients since the unit has a bed capacity of thirty six patients. In addition, the proposed solution focuses on recruiting at least four nurse assistants to assist the nurses with patient care in every shift.
The main reason for selecting the aforementioned solution is to enhance the delivery of healthcare in the unit since poor staffing of nurses is the primary cause of increased adverse events. Thus, recruiting more nurses and UAPs as well as ensuring proper staffing of nurses in the unit would help in minimizing the occurrence of adverse events and ultimately result to quality outcomes among patients. On the other hand, adopting and implementing the proposed solution would help in minimizing the nurses’ workload as well as burnout and subsequently enhance job satisfaction. Consequently, this would help in minimizing nurse turnover thereby enhancing the provision of healthcare. On the other hand, implementing the proposed solution shall help in minimizing the level of health expenditures among the patients as well as the organization especially due to a reduction of the length of hospital stay and re-hospitalization rates. The solution is supported by various literature information that shows that promoting optimal sufficient staffing levels of nurses helps in reducing the occurrence of adverse events and leads to quality care delivery. According to Cho at al. (2015), improving nurse staffing usually results to a reduction in incidences of missed care and leads to quality patient outcomes. Specifically, ensuring adequate staffing of nurses helps in reducing incidences of pressure ulcers, patient falls as well as infections acquired in the hospitals since adequate staffing fosters optimal surveillance of patients and care delivery (Cho at al., 2015, p. 273).
Moreover, ensuring optimal staffing of nurses promotes the efficiency as well as the effectiveness in the delivery of healthcare whereby this leads to better outcomes among hospitalized patients. A study by Nantsupawat et al. (2015) found out that high nurse-patient ratios are associated with an increase in the emotional exhaustion as well as job dissatisfaction whereby this leads to high rates of nurse turnover and poor delivery of healthcare. Thus, improving the patient-nurse ratios helps in enhancing job satisfaction among nurses and minimizes nurse burnout whereby this improves retention of nurses and consequently enhances patient safety (Nantsupawat et al., 2015, p. 117). According to Yu et al. (2015), shortage of nurses is usually associated with an increase in job dissatisfaction among nurse and usually leads to nurse burnout and consequently nurse turnover whereby this compromises the provision safety in regard to the care provided to patients. Thus, improving the patient-nurse ratio is an effective approach that helps in promoting quality care delivery and reduces the nurses’ intention to leave the organization (Yu et al., 2015, p. 347). However, staffing of nurse should be based on the workload since the nurses workload varies from one care setting to the other. For instance, the cardiac care unit usually comprises of patients with critical conditions that require constant surveillance and frequent care, therefore it is necessary to ensure that the unit has sufficient nursing staff in every shift in order to ensure that patients are provided with quality care. Overall, the literature information shows that achieving optimal staffing of nurses is an effective intervention that provides a myriad of benefits to patients, nurses and the entire organization that include; improving job satisfaction among the nurses, fostering quality outcomes among patients and minimizing healthcare spending among the patients as well as the organization.
After obtaining the necessary approval and support all the involved stakeholders the proposed change shall be incorporated into the organizational structure and workflow. Therefore, it is necessary to come up with a change team that shall be responsible with promoting the adoption as well as the implementation process. The change shall comprise of the nurse manager, human resource manager as well as selected members of the nursing staff. The initiation of the change process shall be carried out by the project manager (myself) through a scheduled meeting with all the involved stakeholders. In order to promote optimal integration of the change into the organizational culture and workflow, it is necessary to come up with an appropriate timeline pertaining to the implementation process whereby the project shall be conducted for a period of six months. The first month shall involve educating the nursing staff as well as the nurse manager on the aspects pertaining to the implementation process and selecting a change team to promote the process of implementation. With regard to this, the key stakeholders involved in the project shall be provide with educational materials such as handouts containing the necessary information relating to the project. The first month shall also involve gathering the relevant information from the clinical records whereby this information shall be used as the baseline data for assessing the effectiveness of the intervention.
In addition, recruitment of nurses as well as nurse assistants shall be carried out during the first month whereby this shall be done in liaison with the human resource manager as well as the hospital management. Within the second month, the newly recruited nurses as well as nurse assistants shall be trained on the procedures as well as processes within the unit. Subsequently, the newly recruited members of staff shall be integrated into the organizational system through the guidance of the nurse manager as well as the change team. Additionally, the members of the change team shall be tasked with mentoring the newly recruited members of staff so as to foster their optimal integration into the organizational system and subsequently improve care delivery. The project shall be evaluated periodically from the third month until its completion whereby various outcomes measures in order to assess the implementation process and make the necessary adjustments whereby the information obtained from the assessments shall be compared with the baseline data in order to come up with valuable information regarding the implementation process. Among the key outcome measures to be utilized in the evaluation shall include satisfaction of nurses both the novice as well as the proficient nurses. Moreover, the rates of re-hospitalization and the patients’ length of stay shall be used in assessing the effectiveness of the program in regard to improving care provision since an improvement in the patient-nurse ratio is usually associated with a decrease in the occurrence of adverse events whereby this shall help in making the necessary adjustments such as fostering the appropriate mix pertaining to nursing skills. With regard to this, various
The implementation process shall involve the utilization of various resources that include; educational materials such as handouts, pamphlets, computers and projectors. The computers and projectors to be used for storage and education purposes shall be provided by the organization. However, printing of the handouts as well as pamphlets shall be made through contacting a firm since purchasing a printer may be expensive for this purpose. The total budget for reading materials and stationery and training of the newly recruited nurses as well as nurse assistant is estimated at about $3,500. On the other hand, the project shall involve a budgetary allocation for catering for the salaries and wages of newly recruited nurses as well as nurse assistants. With regard to the assessment tools, questionnaires, tests both pre-tests and post-tests shall be used in assessing the progress of the implementation and the effectiveness of the intervention after the completion of the project. In relation to this, questionnaires shall be used to obtain the necessary information relating to job satisfaction, workload and the level of burnout among the nurses whereby this shall help in evaluating the project’s effectiveness. Additionally, pre-tests as well as post-tests given to nurses shall be used in assessing their level of knowledge pertaining to nurse staffing, teamwork and collaboration after the implementation process.
Furthermore, clinical records shall be used in collecting the relevant information relating to the mortality rates, length of patient stay in the hospital, morbidity rates and the rates of pressure ulcers as well as falls. With regard to this, the information obtained after the implementation process shall be compared with the baseline data in order to evaluate the effectiveness of the intervention in regard to minimizing the occurrence of adverse events.
Overall, the project shall mainly focus imparting knowledge to all the involved stakeholders on the benefits associated with optimal nurse staffing and the need to ensure adequate staffing levels in order to foster sustainability of the intervention. More importantly, the intervention will be revised periodically with respect to the outcomes in order to ensure adequate staffing and ensure quality outcomes among patients within the unit.
References
Cho, S. H., Kim, Y. S., Yeon, K. N., You, S. J., & Lee, I. D. (2015). Effects of increasing nurse staffing on missed nursing care. International nursing review, 62(2), 267-274.
Nantsupawat, A., Nantsupawat, R., Kulnaviktikul, W., & McHugh, M. D. (2015). Relationship between nurse staffing levels and nurse outcomes in community hospitals, Thailand. Nursing & health sciences, 17(1), 112-118.
Yu, D., Ma, Y., Sun, Q., Lu, G., & Xu, P. (2015). A nursing care classification system for assessing workload and determining optimal nurse staffing in a teaching hospital in China: A pre‐post intervention study.International journal of nursing practice, 21(4), 339-349.
