Correct Staffing Case Study
Correct Staffing: To Be or Not to Be Tom is an excellent nurse. He wants to do the very best he can in taking care of his patients. He became a nurse because he believes taking care of others is the core of being human. As he goes to work today, he begins to wonder if today will be like most days or will it be a good day because the hospital has chosen to have enough nurses for patients. Tom’s story is not unusual. Many nurses have been put in positions that to take care of patients, they must disregard other duties or even other patients. This short changing of patient care is not in the best interest of patients or the healthcare institution the patient choses to visit. Nurses are at the core of patient care. They are also the largest
…show more content…
group involved in direct patient care. Nurses are the stop-gap to reduce harm and prevent negative outcomes. Adequate staffing helps reduce negative outcomes. These negative outcomes include acquiring a urinary tract infection or pneumonia, shock, longer hospital stay, or even death (Stanton & Rutherford, 2004). These negative outcomes directly affect the institution and result in increased cost and monies lost. Institutions should be interested in having correct staffing ratios, resulting in better patient outcomes and better patient satisfaction.
Description
Nurses are at the forefront of patient care and are the largest group within the health care organization.
They direct and coordinate care in the hospital setting and attempt to achieve great patient care. The patient population is getting older and sicker prior to coming the hospital. More nurses are needed to meet the needs of this aging patient population (American Association of College of Nursing, 2017). The hospital leaders have agreed to form a vision, mission, and values of the institution that is centered on patient care. High quality patient care is dependent on the adequate number of nurses to take care of the patients. Nurses should be given the chance to provide high quality care that is centered on the patient. Hospitals should make the sure enough nurses are available to achieve the common goal of high-quality patient centered …show more content…
care.
Vision
The institution states that its mission is committed to the care and improvement of human life, above all else. The vision is that together we will be the premier healthcare destination for all we serve. The hospital has a value system based the ICARE mnemonic. ICARE stands for integrity, compassion, always, respect, and excellence. Nurses and employees are encouraged to help bring the vision, mission, and values to fruition. The vision of the hospital is reached by nurses and employees using the value system in how they treat patients and each other. The institution places a high priority on ethical standards and employees are encourage to treat each other and patients as they would want to be treated. The hospital believes that everything should always be done the same time, to everyone, regardless of who they are, while giving compassion in every area of service. Mutual respect is encouraged between all employees. As each of the values is implemented, a culture of excellence is attainted and the mission is achieved of being the premier healthcare destination. Knowing the mission, goal, and values of the hospital will determine how patient care is given and perceived to be given in the community. The institution is also dedicated to providing high-quality patient care. Since nurses are a major part of the workforce in this hospital, it is important for nurses to know and help the hospital achieve those goals. Hospital should in turn, should give nurses the resources to achieve their mission of providing high-quality patient centered care. Proper staffing will enable both groups to achieve the same goal.
Players
Hospital leaders have a mission in place to be the premier healthcare destination for they serve and adequate staffing should be at the core of things needed to achieve that mission.
Nurses at the bedside are aware of the goals, mission, and values of the hospital. Together, the charge nurse and staff nurses use available staff to best coordinate care of the patients in a safe manner. When correct staffing needs are not with guidelines for the patient acuity or census, the unit manager, or director is notified. If no action is taken, then the issue is taken to that Chief Nursing Officer (CNO) of the hospital.
Although, not directly involved in the patient care aspect, but nonetheless present, is the nurse’s union. The union’s presence was brought to the hospital at the request of the nurses because the nurses saw that the hospital had little interest in keeping to safe nursing staffing ratios. When staffing is not within correct parameters, nurses can sign an Assignment Despite Object (ADO) provided by the union, which basically informs administration that as nurses, the whole group disagrees with how the unit has been staffed.
The house supervisor is another person involved in the staffing matrix. It is the house supervisor that is responsible for getting agency nurses, assigning float pool nurses, and ensuring adequate staffing throughout the hospital. The house supervisor answers directly to upper management and determines how many patients are in the hospital and
where patients are admitted.
Organizational Structure.
The organization structure of this institution is based on shared governance. Nurses are governed by nurses. The chief nursing officer (CNO) is the head of nursing department. The chief executive officer (CEO) oversees that day to day running of the ancillary staff and other building needs. The chief financial officer (CFO) is responsible for the financial well-being of the hospital. Together these individuals answer to an executive board and strive to run an efficient hospital.
Shared governance is intended to involve nurses to identify problems, provide solutions, and execute research. Ideas are submitted up the chain of command to the administrators for approval. Ultimately it is not the nurse that has the final say on how things are run on the unit or how much staff is present per shift.
Problem
Staffing at this facility is consistently below the norms of recommendations in other facilities and in other states. However, this is not the case with every unit in the hospital. The burn unit and labor/delivery unit have adequate staffing and hence, have the highest patient satisfaction scores and lower falls. Other units that have fewer nurses than recommended have lower patient satisfaction and more falls. It is apparent that the number of nurses to take care of patients is directly related to patient satisfaction and falls. More nurses mean less falls and higher patient satisfaction. Nurse have expressed that they are consistently short a nurse or two during their shift. In an atmosphere where life and death are constant threat, fewer nurses can have drastic consequences. The hospital is STEMI, Stoke, and Trauma certified and patient population can be taxing to even the seasoned nurse. Hospital stays have become shorter and the patients have become sicker. This puts more pressure on the nurse to do more with less, or just not do something that should be done to promote health. At times nurses are not only caring for their own patients, but caring for another nurses’ patients while that nurse is at lunch or dealing with an emergency. The problem is wide spread at this institution and it is the hospitals responsibility to do right by nurses. The problem has become so endemic that new hire nurses will quit their job because of the conditions.
Data Support/Factors Impacting Quality/Staffing factors
Data support was obtained by interviewing nurses on various units in the hospital. Recent new hires were interviewed, as well as, seasoned nurses who have worked for the hospital several years. Nurses on a telemetry unit report taking care of 5 critical patients, when the assignment called for only 4 patients to be assigned. This was reported as a common occurrence on the unit and happened 5 out of 7 times. Intensive care unit (ICU) nurses report taking care of 3 patients during a shift 4 out 7 times, when the assignment is clearly only 2 patients per nurse. All nurses expressed feeling unsafe and attributed these feeling to incorrect staffing rations. No lunch relief was reported and nurse would have to double their patients when a nurse took lunch or was dealing with a crisis. Seasoned nurses report that these types of assignments have been the norm for the hospital and they felt nothing was going to change how things were done. A relatively new nurse, taking care of 3 patients, reported that she had a patient fall because she was dealing with patient in crisis and all the other nurses had 3 patients. The nurse reported that there was no way to keep the patient safe and now they are making the nurse attend mandatory fall training. These interviewees confided that the nurses were burnt out and looking elsewhere for employment. There is a high turnover rate in this hospital and nurses state it is because of staffing ratios.
Future Goal Providing high quality patient centered care to all patient is the premier goal of the hospital. Having adequate staffing to provide that goal would be the sub goal, but very necessary to meet the main goal. At the same time, patients will be safer, have a higher satisfaction with their care, and return to the institution for continued care. Ultimately nurse staffing would resemble the mandated staffing ratios put in place by California law.
Literature Support Literature supports proper staffing ratios. The American Nurse (2017) correctly states nurse’s workload will reduce with higher staff ratios and hospital readmissions will decrease. The research found that hospitals with the higher staffing rations were twenty-five less likely to be penalized for readmissions. In another article, hospitals who experienced less nurse burnout, attributed to more patients per nurse, had fewer surgical infection and fewer urinary tract infections (Cimiotti, Aiken, Sloane, & Wu, 2012). Furthermore, job satisfaction is related directly to higher nurse to patient ratios. Nurses that worked in a less stressful environment were resistant to mental and physical exhaustion, had less days missed from work, and lower rates of attrition (Sacco, Ciurzynski, Harvey, & Ingersoll, 2015). The issue of safe staffing for nurses is so paramount that some states have made mandatory staffing ratios. California was the first to implement such laws in 2004 and required hospitals to have mandated staffing levels for ICU patients be to 1:2, step down patients be 1:3, telemetry patients 1:4, and med/surg patients be 1:5 (Tellez & Seago, 2013). Other states have followed California’s example, but Missouri has yet to follow in California’s footsteps. A study conducted in military hospitals found that inadequately staffed nursing units had increased adverse events such as, falls with injury, injury to nurses, needle sticks, and medication errors (West, Patrician, & Loan, 2012). Lastly, another study links nurse staffing and patient mortality (Rosenburg & Pfiefer, 2011). The evidence is insurmountable that nurse and patient safety should be paramount to hospitals. Wouldn’t it be in the best interest of the hospital to adequately staff nursing units? To think otherwise would be criminal.
group involved in direct patient care. Nurses are the stop-gap to reduce harm and prevent negative outcomes. Adequate staffing helps reduce negative outcomes. These negative outcomes include acquiring a urinary tract infection or pneumonia, shock, longer hospital stay, or even death (Stanton & Rutherford, 2004). These negative outcomes directly affect the institution and result in increased cost and monies lost. Institutions should be interested in having correct staffing ratios, resulting in better patient outcomes and better patient satisfaction.
Description
Nurses are at the forefront of patient care and are the largest group within the health care organization.
They direct and coordinate care in the hospital setting and attempt to achieve great patient care. The patient population is getting older and sicker prior to coming the hospital. More nurses are needed to meet the needs of this aging patient population (American Association of College of Nursing, 2017). The hospital leaders have agreed to form a vision, mission, and values of the institution that is centered on patient care. High quality patient care is dependent on the adequate number of nurses to take care of the patients. Nurses should be given the chance to provide high quality care that is centered on the patient. Hospitals should make the sure enough nurses are available to achieve the common goal of high-quality patient centered …show more content…
care.
Vision
The institution states that its mission is committed to the care and improvement of human life, above all else. The vision is that together we will be the premier healthcare destination for all we serve. The hospital has a value system based the ICARE mnemonic. ICARE stands for integrity, compassion, always, respect, and excellence. Nurses and employees are encouraged to help bring the vision, mission, and values to fruition. The vision of the hospital is reached by nurses and employees using the value system in how they treat patients and each other. The institution places a high priority on ethical standards and employees are encourage to treat each other and patients as they would want to be treated. The hospital believes that everything should always be done the same time, to everyone, regardless of who they are, while giving compassion in every area of service. Mutual respect is encouraged between all employees. As each of the values is implemented, a culture of excellence is attainted and the mission is achieved of being the premier healthcare destination. Knowing the mission, goal, and values of the hospital will determine how patient care is given and perceived to be given in the community. The institution is also dedicated to providing high-quality patient care. Since nurses are a major part of the workforce in this hospital, it is important for nurses to know and help the hospital achieve those goals. Hospital should in turn, should give nurses the resources to achieve their mission of providing high-quality patient centered care. Proper staffing will enable both groups to achieve the same goal.
Players
Hospital leaders have a mission in place to be the premier healthcare destination for they serve and adequate staffing should be at the core of things needed to achieve that mission.
Nurses at the bedside are aware of the goals, mission, and values of the hospital. Together, the charge nurse and staff nurses use available staff to best coordinate care of the patients in a safe manner. When correct staffing needs are not with guidelines for the patient acuity or census, the unit manager, or director is notified. If no action is taken, then the issue is taken to that Chief Nursing Officer (CNO) of the hospital.
Although, not directly involved in the patient care aspect, but nonetheless present, is the nurse’s union. The union’s presence was brought to the hospital at the request of the nurses because the nurses saw that the hospital had little interest in keeping to safe nursing staffing ratios. When staffing is not within correct parameters, nurses can sign an Assignment Despite Object (ADO) provided by the union, which basically informs administration that as nurses, the whole group disagrees with how the unit has been staffed.
The house supervisor is another person involved in the staffing matrix. It is the house supervisor that is responsible for getting agency nurses, assigning float pool nurses, and ensuring adequate staffing throughout the hospital. The house supervisor answers directly to upper management and determines how many patients are in the hospital and
where patients are admitted.
Organizational Structure.
The organization structure of this institution is based on shared governance. Nurses are governed by nurses. The chief nursing officer (CNO) is the head of nursing department. The chief executive officer (CEO) oversees that day to day running of the ancillary staff and other building needs. The chief financial officer (CFO) is responsible for the financial well-being of the hospital. Together these individuals answer to an executive board and strive to run an efficient hospital.
Shared governance is intended to involve nurses to identify problems, provide solutions, and execute research. Ideas are submitted up the chain of command to the administrators for approval. Ultimately it is not the nurse that has the final say on how things are run on the unit or how much staff is present per shift.
Problem
Staffing at this facility is consistently below the norms of recommendations in other facilities and in other states. However, this is not the case with every unit in the hospital. The burn unit and labor/delivery unit have adequate staffing and hence, have the highest patient satisfaction scores and lower falls. Other units that have fewer nurses than recommended have lower patient satisfaction and more falls. It is apparent that the number of nurses to take care of patients is directly related to patient satisfaction and falls. More nurses mean less falls and higher patient satisfaction. Nurse have expressed that they are consistently short a nurse or two during their shift. In an atmosphere where life and death are constant threat, fewer nurses can have drastic consequences. The hospital is STEMI, Stoke, and Trauma certified and patient population can be taxing to even the seasoned nurse. Hospital stays have become shorter and the patients have become sicker. This puts more pressure on the nurse to do more with less, or just not do something that should be done to promote health. At times nurses are not only caring for their own patients, but caring for another nurses’ patients while that nurse is at lunch or dealing with an emergency. The problem is wide spread at this institution and it is the hospitals responsibility to do right by nurses. The problem has become so endemic that new hire nurses will quit their job because of the conditions.
Data Support/Factors Impacting Quality/Staffing factors
Data support was obtained by interviewing nurses on various units in the hospital. Recent new hires were interviewed, as well as, seasoned nurses who have worked for the hospital several years. Nurses on a telemetry unit report taking care of 5 critical patients, when the assignment called for only 4 patients to be assigned. This was reported as a common occurrence on the unit and happened 5 out of 7 times. Intensive care unit (ICU) nurses report taking care of 3 patients during a shift 4 out 7 times, when the assignment is clearly only 2 patients per nurse. All nurses expressed feeling unsafe and attributed these feeling to incorrect staffing rations. No lunch relief was reported and nurse would have to double their patients when a nurse took lunch or was dealing with a crisis. Seasoned nurses report that these types of assignments have been the norm for the hospital and they felt nothing was going to change how things were done. A relatively new nurse, taking care of 3 patients, reported that she had a patient fall because she was dealing with patient in crisis and all the other nurses had 3 patients. The nurse reported that there was no way to keep the patient safe and now they are making the nurse attend mandatory fall training. These interviewees confided that the nurses were burnt out and looking elsewhere for employment. There is a high turnover rate in this hospital and nurses state it is because of staffing ratios.
Future Goal Providing high quality patient centered care to all patient is the premier goal of the hospital. Having adequate staffing to provide that goal would be the sub goal, but very necessary to meet the main goal. At the same time, patients will be safer, have a higher satisfaction with their care, and return to the institution for continued care. Ultimately nurse staffing would resemble the mandated staffing ratios put in place by California law.
Literature Support Literature supports proper staffing ratios. The American Nurse (2017) correctly states nurse’s workload will reduce with higher staff ratios and hospital readmissions will decrease. The research found that hospitals with the higher staffing rations were twenty-five less likely to be penalized for readmissions. In another article, hospitals who experienced less nurse burnout, attributed to more patients per nurse, had fewer surgical infection and fewer urinary tract infections (Cimiotti, Aiken, Sloane, & Wu, 2012). Furthermore, job satisfaction is related directly to higher nurse to patient ratios. Nurses that worked in a less stressful environment were resistant to mental and physical exhaustion, had less days missed from work, and lower rates of attrition (Sacco, Ciurzynski, Harvey, & Ingersoll, 2015). The issue of safe staffing for nurses is so paramount that some states have made mandatory staffing ratios. California was the first to implement such laws in 2004 and required hospitals to have mandated staffing levels for ICU patients be to 1:2, step down patients be 1:3, telemetry patients 1:4, and med/surg patients be 1:5 (Tellez & Seago, 2013). Other states have followed California’s example, but Missouri has yet to follow in California’s footsteps. A study conducted in military hospitals found that inadequately staffed nursing units had increased adverse events such as, falls with injury, injury to nurses, needle sticks, and medication errors (West, Patrician, & Loan, 2012). Lastly, another study links nurse staffing and patient mortality (Rosenburg & Pfiefer, 2011). The evidence is insurmountable that nurse and patient safety should be paramount to hospitals. Wouldn’t it be in the best interest of the hospital to adequately staff nursing units? To think otherwise would be criminal.