Methods of Obtaining Necessary Approval and Securing Support from Organization Leadership and Fellow Staff
The first approach will be to Leverage current research since significant research exists on the negative impact of heavy nurse workloads on patient outcomes and on appropriate minimum staffing ratios. This can be a means of convincing legislators, organizations and concerned stakeholders about the merits of such mandates and the need to adopt the process.
Secondly, support can be secured through emphasizing on the importance to patients and bottom line. That is unless the idea of minimum ratios in incorporated into the healthcare system, hospitals will be prone spend significant time and money attempting to solve the issue. (Carayon et al, 2006) Consequently, supporters can reduce their resistance by focusing on the expected positive impact on patient outcomes such as lower patient mortality, reduced costs, nurse turnover, and hospital reputation.
Description of Current Problem
The intense workload of hospital nurses is a major issue in the American health care system. Firstly, demand for nurses rising due to rapid population growth. Between 2000 and 2020, the United States population is expected to grow by 18 percent (31 million), but the over-65 population, with more health care needs, is expected to increase by 54 percent (19 million (Carayon et al, 2007). Secondly, the availability of nurses is inadequate to meet the current need, and the shortage is anticipated increase intensively since demand rising and nursing schools are unable to keep up with the elevating educational demand. Thirdly, due to increased health care costs since the 1990s, hospitals minimized their nursing staffs and instead established mandatory overtime policies to cater for unexpectedly elevated demands, these significantly increased nursing workloads. (Carayon & Alvarado 2007). Fourth, increasing cost pressure has forced health care organizations to decrease patient length of stay. As a result, are nurses currently catering for patients who are sicker than in the past; therefore, their work is more intensive.
There are several important consequences of high nursing workload. Research shows that a heavy nursing workload adversely affects patient safety. Furthermore, it negatively affects nursing job satisfaction and as a result, contributes to high turnover and the nursing shortage. In addition to the higher patient acuity, work system factors and expectations also contribute to the nurses’ workload: Heavy nursing workload increases burnout and job dissatisfaction, which in turn contributes to high nurse turnover.
Detailed Explanation of Proposed Solution
Minimum Staffing Ratios
The implemented standards should to specify minimum nurse-to-patient staffing ratios to be sustained always by different hospital units and departments. It may also be necessary if hospitals can achieve these needs through contracted staff to complement employed nurses.
Unit-specific staffing minimums are significant since minimum ratios differ by specialty and department; Additional staffing can be done when patient acuity is high. The legislation requires hospitals to sustain and utilize a classification system to measure patient acuity, and to add registered nurses if accepted by the system. The system should take into account intensity of patient illness, need for specialized equipment and technology, patient self-care abilities, and the extent of practice of the nursing staff. (Baumann et al, 2001). Unlicensed staff should be regulated where Hospitals shouldn’t assign unlicensed staff to perform nursing operations and invasive procedures. Registered nurses must perform these tasks. Consequently, it’s important to assess the competency of nurses and provide significant orienting before getting the mandate to perform in any clinical. Conversely, registered nurses need to be accommodated in areas of shortages since the legislation allows these institutions to meet the State mandate with a lower nursing skill mix. In addition, staffing records should be maintained in hospitals as a condition for licensure to enhance compliance.
Hospitals need to be supported to meet the requirements in accordance to the legislation. For instance, the federal government offered 3 years of funding to help in hiring additional nurses and to bolster nursing education programs at colleges and universities. Hospitals need to be supported in hiring staff. Hospitals should apply for grant money to help them hire more registered nurses. (Kuehn , 2007). Consequently, Support for nursing education is a very significant approach. Community colleges and universities receive State funding to increase the capacity of their nursing programs. Through these funds, more nursing instructors may be hired and to provided with additional supervised clinical experiences.
Rationale for Selecting Proposed Solution
The current state of health care delivery system is substantially deteriorated especially in nurse patient ratio and extensive workload for nurses. Therefore, there is need for sensitive care hospitals to maintain minimum nurse-to-patient staffing ratios. Required ratios vary by unit, ranging from 1:1 in operating rooms to 1:6 on psychiatric units. The proposed change will require hospitals to uphold a patient acuity classification system to direct additional staffing incase need arises, assign certain nursing functions only to licensed registered nurses, determine the competency of and provide appropriate orientation to nurses before assigning them to patient care, and keep records of staffing levels. The legislation has will improve levels of staffing and create more reasonable workloads for nurses in hospitals, resulting to fewer patient deaths and higher levels of job satisfaction than in other states without mandated staffing ratios (Lundstrom et al, 2002).
Evidence from Review of Literature to Support Your Proposed Solution and Reason For Change.
Intense patient workloads for nurses has significantly led to poor patient outcomes and reduced job satisfaction. Yet the minority states need healthcare facilities to sustain minimum nurse-to-patient ratios, leaving nurses to care for a substantial number of patients at a time.
Association between heavy workloads and poor patient outcomes
According to numerous studies, heavier nursing workloads are linked with poor patient outcomes such as deaths, complications, and medical errors. For instance, the study by (Aiken et al 2002) found that every additional patient added to a nurse’s workload increased mortality within 30 days of admission by 7 %, and elevated the risk of an undetected medical complication causing preventable death or injury by the same magnitude. In another study by (Kane et al 2007), increased registered nurse staffing lead to decreased mortality on intensive care, medical, and surgical units; decreased risks of hospital-acquired pneumonia, unplanned extubation, respiratory failure, cardiac arrest, and failure to rescue; and shorter lengths of stay for surgical (31 percent) and intensive care unit (ICU) patients (24 percent). On the same, other studies have confirmed that increased nurse staffing leads to improved patient results.
Negative implications for nurses as well
The study by Aiken also found that every additional patient assigned to a nurse resulted to a 23-percent increase in the risk of nurse-reported “burnout” and a 15-percent increase in the risk of a nurse being dissatisfied with their job. Another study by (Sloane et al 2010)found that nurses in states without mandated minimum staffing ratios reported greater levels of burnout, job dissatisfaction, and turnover; these nurses also felt that patients received poorer quality care.
Few states addressing minimum staffing levels through legislation
Despite the evidence cited above, only a few of states have established any form of legislation related to minimum nurse-to-patient ratios, with most having requirements that address only a specific unit or type of unit. Legislators are still reluctant to require hospitals and health systems to hire more nurses, predominantly with ongoing shortages in numerous regions.
Description of Implementation Logistics
First, drafting legislation should be done with help of various organizations around the states that are responsible for staffing and meeting various healthcare needs. It’s necessary to collaborate with different stakeholders across the state to verify how the legislation could be shaped to minimize opposition. While initial drafts include actual staffing ratios, the implementation processes need to be overseen by various health department around the country that will manage the process to establish the ratios and communicate them to hospitals.
Drafting the legislation will be followed by Conducting staffing ratio study, it’s important to work with researchers so as to evaluate appropriate staffing ratios. The comprehensive study evaluates staffing systems in all health facilities in the country and conduct surveys with nursing directors all over the state. Conversely, it is important to work in hand with the stakeholders and researchers and acquire various ideas about relevant levels of staffing
Final ratios need to be Determined and broadcasted depending on the need of various regions and hospitals basing on the finding by various researchers and other contributing stakeholders. The state should formally communicate the ratios to hospitals through the State hospital association and to nurses via nursing professional organizations. In addition, the popular and health care media strongly covered the development process and the announcement of the final ratios. Funding should be increased to improve nursing supply
Resources Required For Implementation
Staffing
The federal government together with various departments of Health Services should increase the number of staff to accommodate the additional requirements created by the legislation as noted earlier, nurse staffing levels at health facilities also increased to meet the new requirements, with the level of increase varying by hospital. (Alper et al, 2006)
Costs
The federal government needs to prepare for incurring costs related to the staff added at various departments of Health Services, educational institutions with nursing programs, with the goal of increasing the nursing supply
Assessment
After the intervention, the assessment process will involve incorporation various nurse sensitive clinical and human resource indicators and this include adverse drug intervention, patient falls, misuses of overtime, rate of staff turnover, complaints of patients and their families and injuries that affect health service providers (Parker D &Lawton , 2000)
Push for legislation instead of other forms of policies
Legislation mandating minimum staffing ratios is required to ensure long-term sustainability, since such legislation will be more complex to adjust than general hospital policies or professional association recommendations.
Need for ongoing reporting
Implementing Legislation alone does not ensure compliance over time. As a result, hospitals should be required to report staffing ratios on an ongoing basis so as to create accountability and allow for monitoring and oversight (Carayon , et al. 2005). And finally Support nursing education: Financial support for education can help ensure a steady stream of new nurses into the workforce, which helps hospitals meet the staffing requirements
Reference
Aiken, L.H., et a(2010) l. Implications of the California nurse staffing mandate for other states. Health Serv Res. 2010;45(4):904-21.
Aiken, L. H, , et al(2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA.288(16):1987-93.
Alper, S. J, et al(2006). Protocol violations during medication administration in pediatrics. The Human Factors and Ergonomics Society; Proceedings of the Human Factors and Ergonomics Society 50th annual meeting; Santa Monica, CA: The Human Factors and Ergonomics Society;. pp. 1019–23.
Baumann, A, et a(2001)l. Healthcare restructuring: the impact of job change. Can J Nurs Leadersh.;14:14–20.
Carayon, P, & Alvarado C(2007). Workload and patient safety among critical care nurses. Crit Care Nurs Clin North Am.;8(5):395–428.
Carayon, P, , et al(2006). Work system design for patient safety: the SEIPS model. Qual Saf Health Care.;15(Suppl I):i50–8.
Carayon, P, , et al(2007). Evaluation of nurse interaction with bar code medication administration technology in the work environment. J Patient Safety.;3(1):34–42.
Carayon, P, et al. (2005). Employee questionnaire survey for assessing patient safety in outpatient surgery. In: Henriksen K, Battles JB, Marks E, et al., editors. Advances in patient safety: from research to implementation. 4 . Rockville, MD: Agency for Healthcare Research and Quality;. pp. 461–73.
Kane R. L, et al. (2007) The association of registered nurse staffing levels and patient outcomes: systematic review and meta-analysis. Med Care. ;45(12):1195-204.
Kuehn, B.M.(2007). No end in sight to nursing shortage: bottleneck at nursing schools a key factor. JAMA. 298, 1623–5.
Lawton, R. (1998)Not working to rule: understanding procedural violations at work. Saf Sci.;28:77–95.
Lundstrom, T, et al(2002). Organizational and environmental factors that affect worker health and safety and patient outcomes. Am J Infect Control. 30(2):93–106.
McHugh MD, , et al(2011). Contradicting fears, California’s nurse-to-patient mandate did not reduce the skill level of the nursing workforce in hospitals. Health Affairs. 1;30(7):1299-1306.
Needleman, J, et al(2002). Nurse-staffing levels and the quality of care in hospitals. N Engl J Med. 346(22):1715-22.
Parker, D &Lawton R(2000). Judging the use of clinical protocols by fellow professionals. Soc Sci Med.;51:669–77.
US DHHS. HRSA Bureau of Health Professions National Center for Health Workforce Analysis. Projected supply, demand, and shortages of registered nurses: 2000–2020. Rockville, MD: U.S. Government Printing Office; 2002.
