The following description of the renal unit consists of the system characteristics, inputs, throughput, output, system cycles, and negative feedback (Meyer & O’Brien-Pallas, 2010; Glenister, 2011). The renal unit at the University of Texas Hospital provides renal services and dialysis for the people of Texas State.
The unit has 30-bed capacity for inpatient purposes and a ten-chair dialysis unit for outpatient clients. It caters for patients services such as dialysis, kidney disease care, plasma exchange services, peritoneal dialysis, and kidney transplant services to patients suffering from renal failure, kidney disease, lupus nephritis, and sickle cell disease. The unit’s inputs include six renal nurses (headed by a nurse manager), three nephrologists, two dieticians, and two peritoneal dialysis staff who work in a collaborative teamwork setting (Manley et al., 2014).
The unit runs on funds allocated by the budgeting committee of the hospital as well as donations from well-wishers. General supplies such as drugs, needles, catheters, gloves and so on are obtained from the hospital pharmacy and general store. The nursing staff is involved in carrying out physical examinations, history taking, diagnosis, drug administration, patient monitoring, and patient education among others (Hayajneh, 2007).
Currently, the unit has 76 patients on haemodialysis, 6 patients on post-transplant monitoring, twelve on peritoneal dialysis and three on pretransplantation preparation. Each year the unit has an average output of about seven thousand eight hundred admissions and about ten thousands seven hundred and fifty outpatient clients per annum. This year the unit achieved the Kidney Care Accreditation by the Joint Commission. Furthermore, it is imperative that performance indicators for monthly evaluation such as length of stay, mortality rates, and the incidence of catheter-related infections be carried out to identify successes and failures.
Problem Description
The renal unit is experiencing a shortage in the nurse’s workforce and a high nurses’ turnover which is affecting service delivery and patient outcomes. The problem exists in the input section of the open system. The nurses’ labor force is stretched thin with a nurse-patient ratio of about 1:8. The shortage creates an enormous workload for the nurses resulting in high levels of stress and burnouts due to extended and multiple shifts. Job dissatisfaction and fatigue have contributed to the low rates of nurses’ retention.
Desired Outcome: It is expected that addressing the nurse staffing issues will result in the recruitment and employment of more nurses (minimum of 12) in the renal unit. This will reduce the nurse- patient ratio to a recommended ratio of 1:4 thus reducing the workload per nurse, increase the nursing hours per patient per day, reduce stress and burnouts as well as increase job satisfaction and productivity.
Goal: To reach and maintain the recommended nurse-patient ratio of 1:4 and increase job retention for nurses
Objectives: The aims of addressing the nursing staff shortage include increasing the number of nurses in the renal unit to twelve, to maintain a nurse-patient ratio of 1:4, to increase daily nursing hours per patient, to raise the level of job satisfaction in renal nurses and to reduce the rate of nurses’ turnover.
Policies and Procedures: Recruitment and employment procedures should aim to maintain the recommended nurse-patient ratio and skill mix. Recruitment efforts should include benefits aimed at retaining nurses longer, thus cutting the cost of employment, and training.
Professional Standards: Relevant nursing bodies, such as the American Nurses Association and the American Nephrology Nurses’ Association should register and license nurses.
The proposed resolution to the staffing issue will not only increase productivity but will also play a significant role in creating a friendly and comfortable environment for patients as stated in the hospital’s mission. Satisfied and happy nurses are more likely to offer services with bright smiles.
References
Glenister, D. A. (2011, September). Towards a general systems theory of nursing: a literature review. In Proceedings of the 55th Annual Meeting of the ISSS-2011, Hull, UK (Vol. 55, No. 1).
Hayajneh, Y. (2007). Management for health care professionals series: Systems & systems theory. Retrieved from http://www.hayajneh.org/a/readings/Systems-Theory.pdf
Manley, K., O'Keefe, H., Jackson, C., Pearce, J., & Smith, S. (2014). A shared purpose framework to deliver person-centred, safe and effective care: organisational transformation using practice development methodology. International Practice Development Journal, 4(1).
Meyer, R. M., & O’Brien‐Pallas, L. L. (2010). Nursing services delivery theory: an open system approach. Journal of advanced nursing, 66(12), 2828-2838.
