The number of states in the United States pursuing legislation focusing on the issue of nurse-patient ratio has increased significantly within the past fifteen years. Staffing ratio is treated as a powerful tool that can transform the nature of healthcare delivery in the country (Peikes et al., 2014). Proponents of improved staffing ratios offer various potential benefits such as increased patient satisfaction, reduced shortage of healthcare workers, job satisfaction, and continuous recruitment of nurses (Antwi & Bowblis, 2016). This policy issue can be pursued by healthcare leaders who want to transform the nature of nursing. Unfortunately, achieving desirable nurse-patient ratios is a major challenge that requires the combined efforts of different stakeholders in the healthcare sector.
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The issue of staffing ratio has been selected because it aligns with most of the organizational priorities I am planning to address (Peikes et al., 2014). The policy issue is related to the practice of many healthcare workers. Although it might be hard to have an acceptable nurse-patient ratio across the nation, a number of measures can be implemented to ensure my hospital maintains a considerable number of healthcare practitioners.
Investigation of the Problem
Mandatory staffing ratios in healthcare institutions remain a controversial issue in the United States. Many stakeholders in the healthcare sector such as patients, registered nurses, unions, hospitals, lobbyists, and physicians have been unable to identify the best measures towards dealing with this problem. Past studies have argued that mandatory staffing ratios can promote healthcare delivery and improve patient satisfaction. However, financing has remained a unique challenge in the American healthcare sector since the early 1990s (Antwi & Bowblis, 2016). The efforts undertaken by the state of California towards the end of the 20th century failed to deliver positive results. The number of registered nurses working in different hospitals reduced significantly. Consequently, more patients were no longer receiving quality healthcare services.
In the recent past, states such as New Jersey have introduced new laws aimed at increasing the number of nurses. Some scholars have argued that “increased number of medical workers can improve the healthcare delivery process” (Peikes et al., 2014, p. 143). Unfortunately, current evidence fails to explain how mandatory staffing ratio is linked to improved client outcomes (Reinhard & Hassmiller, 2014). Increasing nurse-patient ratio has also been criticized by many scholars because the initiative ignores most of the other critical factors associated with medical practice. For instance, hospitals can employ more nurses who lack adequate education, experience, or skill sets. While many policies might emerge requiring hospitals and healthcare institutions to implement mandatory staffing ratios, chances are high that other critical indicators of health might be ignored and eventually disorient the care delivery process.
State of the Situation
The selected problem of staffing ratio presents a wide range of issues that affect the welfare of many patients. It is agreeable that the United States is far from having an acceptable nurse-patient ratio. Some states have implemented various laws to increase the number of nurses and physicians providing medical support to the targeted patients. The “premise behind such regulations is that increased number of nurses will alleviate workloads, reduce burnout, and improve patient outcomes” (Antwi & Bowblis, 2016, p. 12). The most discouraging fact is that the implemented policy has failed to deliver admirable results. Additionally, some hospitals have gone ahead to hire more workers without considering their competencies and nursing philosophies. These factors have led to increased staffing ratios and poor patient outcomes.
On the other hand, America as a whole has a major shortage of healthcare professionals. Institutions planning to hire more professional nurses and physicians have to accept this reality. It is therefore agreeable that more hospitals might be unable to meet these policy requirements in the country. The absence of adequate training programs to equip new workers with adequate skills and evidence-based concepts makes it hard for many hospitals to offer quality healthcare services (Albina, 2016). Staffing ratios in the United States have not been adopted evenly across the country. Lack of funding, acquisition of modern health technologies, and increased costs of drugs have discouraged medical institutions from hiring more professionals. Policymakers and politicians in the country have failed to collaborate with different players in the sector in an attempt to come up with appropriate staffing ratios (Ball, Doyle, & Oocumma, 2015). That being the case, the combination of these causal factors has made staffing ratio one of the most controversial issues in the healthcare sector.
Staffing ratio is “a critical problem that is shrouded in mystery” (Albina, 2016, p. 76). This happens to be the case because most of the states that have implemented powerful policies to increase the number of healthcare workers have not recorded positive results. Since this is a national problem that might find a solution in the future, the targeted hospital has the potential to implement powerful strategies to ensure its patients receive quality care (Browning, Torain, & Patterson, 2016). That being the case, various solutions can be proposed in order to deal with the issue of nursing shortage in the institution.
The first approach is improving the level of cooperation between nurses and physicians (Albina, 2016). These relationships should be established in such a way that they promote the delivery of quality patient care. The second initiative will focus on the effectiveness of different departments in the hospital (Peikes et al., 2014). This means that more nurses will collaborate to offer patient-centered care. The third step will focus on the best approaches towards improving the expertise, skills, and competencies of the nurses in the organization.
It will also be appropriate to hire new nurses and caregivers to ensure more patients get the required support. The nurses will be empowered and trained in order to become competent providers of medical care. They will be equipped with evidence-based competencies and technological skills that can improve the outcomes of more clients. Physicians and departmental head nurses will be involved throughout the process in order to produce positive results (Ball et al., 2015). Patient-specific plans can be used to ensure the right number of nurses is available in every department depending on the number of the targeted patients.
This discussion shows clearly that the hospital will be in a position to meet the needs of its patients. This is the case because the proposed solutions are justifiable, attainable, and realistic. For instance, the hospital can use its resources to hire more caregivers and equip them with the right competencies. The approach will empower the nurses and make them competent providers of patient-centered care. Creation of patient-specific teams and staffing plans will ensure every nurse is aware of the needs of his or her patients (Wong, 2015). These measures will ensure the institution has a remarkable staffing ratio. Continuous assessment will be done to identify new areas for change or improvement.
The above solutions require adequate resources in order to record positive outcomes. The first solution revolves around the recruitment of several nurses and caregivers to address the problem of shortage in the hospital. The second approach is training the healthcare workers in order to become competent providers of care. It will therefore be appropriate to have the right personnel and materials to support the training program (Peikes et al., 2014). A new change focusing on better patient-guided staffing plans will be used to promote healthcare delivery processes in the institution. The institution will be required to allocate enough funds to support these solutions.
Some of the training materials include computers and writing materials. The educators will also be paid in order to feel empowered (Wong, 2015). The training program is expected to take around forty days. From this analysis, it is agreeable that the required computers will cost around $2,000. The hospital will use $1,000 to purchase various learning materials. The estimated salary/time of the hired nurses will be $1,200 and $600 for nurse aids. Four instructors (or trainers) will be hired to support the initiative. The trainers will get a total of $4,000 throughout the period. This is the case because they will earn $100 per day. Each instructor will earn $25/day.
Training cost = $12.5/hour (12.5×2) = $25/day for every instructor
After implementing these initiatives, the hospital will be able to record positive benefits. This is the case because the levels of effectiveness, timeliness, safety, and delivery of patient-centered care (Ball et al., 2015). Scientific evidences show conclusively that increased number of healthcare workers in a hospital impacts financial outcomes and quality of cost. For instance, every newly-hired nurse has the potential to increase the financial outcomes of a hospital by over $8,500 per month.
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The use of these resources will ensure the hospital saves most of the finances used to tackle various medication errors. Increasing the number of healthcare workers will play a positive role towards improving the health outcomes of the targeted patients. The levels of efficiency and safety will increase significantly in the hospital (Ball et al., 2015). These benefits should therefore be used to support the importance of the proposed solutions.
The diagram presented below gives a summary of the major steps that will be taken to implement the proposed solutions. The timeline for each of the steps and activities is also indicated. These steps will play a positive role towards implementing the above proposal.
Importance of Stakeholders
Throughout the implementation process, several stakeholders will be consulted in an attempt to achieve the targeted objectives. The hospital administrator (HA) will be informed about the proposed solutions. The leader will be expected to be part of the solution by providing the right resources and support. The human resources (HR) department will hire and monitor the training procedures implemented in the hospital (Ball et al., 2015).
The head of the finance department will offer useful incentives to ensure the cost benefits analysis of the solutions are completed in a timely manner. The nurses, physicians, and caregivers will also play a critical role throughout the implementation process. These workers will empower the new nurses and guide them to offer quality care. The HR department will support the implementation process. Finally, the targeted patients will be informed about the proposed solutions (Browning et al., 2016). They will be expected to cooperate and support their healthcare providers. By so doing, the solutions will eventually make a huge difference and drive performance in the hospital. Members of the community will be also informed about the new solutions because they stand a chance to benefit from them.
Engagement with Stakeholders
I have communicated with these stakeholders in order to ensure they support the proposed solutions. Internal memos and letters were used to inform different individuals in the institution about the project. The head of departments and the HA received letters informing them about the intended project. Patients were also informed about the solutions by their respective caregivers (Ball et al., 2015). The hospital wrote letters to different churches and government facilities to inform more members of the community. These stakeholders were pleased with the idea and promised to support the implementation process. I intend to collaborate with departmental heads and the HA throughout the process. Healthcare workers will be guided to be part of the new changes (Browning et al., 2016). Patients will be encouraged to present their feedbacks and views in order to make the necessary improvements.
Each of the identified stakeholders will support the implementation of the solution. The targeted patients will offer appropriate feedbacks that can be used to make the relevant improvements. The healthcare workers will be used to form patient-specific staffing teams (Ball et al., 2015). The heads of different departments will offer the required technical guidance. The HA will support the project financially. The HR will recruit the right nurses and monitor the training process. Members of the community will be used to gauge the success of the project.
The implementation process for the proposed solution will be completed using three steps. The first one will be the pre-implementation phase. During this step, the required resources for the project will be acquired. The targeted skill sets, experiences, and competencies of the nurses will be outlined during this stage (Ball et al., 2015). The major stakeholders will be consulted during this phase. The second one is the implementation stage. This step will be used to implement the intended change. More nurses will be hired, mentored, and trained by their respective instructors (Peikes et al., 2014). New teams capable of providing patient-centered care will be formed. The last step will focus on monitoring and evaluation. The purpose of this phase is to identify the recorded results and offer new incentives to make suitable adjustments.
The success of the proposed project will ensure the healthcare facility is able to offer evidence-based services. A powerful evaluation strategy will be used to monitor the success of the project. The use of journal entries will ensure every activity is completed in a timely manner (Reinhard & Hassmiller, 2014). A supervisor will be hired to monitor the progress of every action plan. The supervisor will coordinate various operations and departments. The individual will collect feedbacks form different stakeholders. Areas of weakness will be addressed whenever they are identified. The evaluation plan will be aimed at ensuring that the project delivers the intended objectives.
Personal Role Reflection
As a nurse practitioner, I have observed that the hospital lacks competent caregivers who can support the health needs of the targeted clients. Cases of medication errors have been on the rise. Job dissatisfaction has become a common problem in the hospital. The nurses working in the hospital do not form multidisciplinary teams to support the changing needs of their patients (Wong, 2015). Hiring more health practitioners and training them can transform the experience of many patients.
It is the role of nurses to participate in scientific inquiry. This practice is appropriate towards acquiring new evidences that can inform healthcare concepts and decisions (Browning et al., 2016). I completed the tasks below in order to participate in scientific inquiry and apply evidence to my nursing practice.
- Analyzed the ratio of nurses to patients in the hospital
- Observed the healthcare delivery procedures embraced in the institution
- Obtained feedbacks from patients and other key stakeholders
- Documented the collected information and data obtained from different departments
Manager of the Healthcare Environment
Leadership skills empower nurses to become competent managers of their healthcare environments. The nurse should “create, coordinate, monitor, and advocate for an interdisciplinary healthcare environment that affirms the dignity of the human experience” (Wong, 2015, p. 277). I therefore implemented these action plans to deal with the identified problems.
- I assessed patients in order to understand their health goals and outcomes
- I ensured members of staff were trained and equipped with the right skills
- I monitored the training procedures implemented in the hospital
- I collaborated with other practitioners in order to improve healthcare delivery
- I designed a new health promotion model for the nurses in the hospital
Albina, J. (2016). Patient abuse in the health care setting: The nurse as patient advocate. AORN Journal, 1(1), 74-81.
Antwi, Y., & Bowblis, J. (2016). The impact of nurse turnover on quality of care and mortality in nursing homes: Evidence from the Great Recession. Upjohn Institute Working Paper, 16(1), 1-39.
Ball, K., Doyle, D., & Oocumma, N. (2015). Nursing shortages in the OR: Solutions for new models of education. AORN Journal, 101(1), 115-136.
Browning, H., Torain, D., & Patterson, T. (2016). Collaborative healthcare leadership a six-part model for adapting and thriving during a time of transformative change. Center for Creative Leadership, 1(1), 1-17.
Peikes, D., Reid, R., Day, T., Cornwell, D., Dale, S., Baron, R.,…Shapiro, R. (2014). Staffing patterns of primary care practices in the comprehensive primary care initiative. Annals of Family Medicine, 12(2), 142-149.
Reinhard, S., & Hassmiller, S. (2014). The future of nursing: Transforming health care. The AARP International Journal, 1(2), 1-12.
Wong, C. (2015). Connecting nursing leadership and patient outcomes: State of the science. Journal of Nursing Management, 23(1), 275-278.