D221 Organizationnal Systems and Healthcare Transformation copy copy copy finally copy
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D221
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Feb 20, 2024
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Uploaded by LieutenantKoalaMaster1061
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Colt Beachboard
Western Governors University
Organizational Systems and Healthcare Transformation Kallie Gatzemeier
May 22, 2023
2
Practice Improvement Plan
A1. Nursing burnout is a healthcare related situation that has the potential to negatively
impact patients by decreasing the quality of care that is provided.
A2.
I have been a Registered Nurse (RN) for almost 15 years. Over the course of my career, nursing burn out has been a consistent issue of matter that has become more significant over the last 5 years where I work. The trend of the organization that I work for has released an annual report of the individual employee satisfaction; resulting in a higher percentage of RNs reporting that feelings of nursing burnout has increased. When follow ups were made throughout the organization, anonymous concerns noted was higher acuity of patients were not divided between the patient and staff ratio. This resulted in difficult working conditions that still are occurring within the system. Caring for patient is a truly burdensome task that puts substantial physical and
psychological pressure on nurses. Patient usually have high demands and expectations of nurses, while nurses may not have the ability or the means, due to working conditions, to fulfill all patient’s expectations. The combination of the two factors puts nurses at high risk for burnout (Theofanidis, 2022). An increase in nurse burnout can be detrimental to patient care because of the decrease in quality of care that is provided, resulting in an increase in patient mortality rate. Patient acuity in general floors has an average of 5.6 required RN hours per patient day. In general wards, available RN hours per patient day reach only 50% of required RN hours to meet patient needs. Workforce measures are comparable among unit-clusters, and average missed nursing care is 21%. Patient outcomes vary among unit-clusters. Patient acuity is similar among unit-clusters, while nurse staffing coverage is halved in general. RN education, expertise and
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missed care, mortality, skin injuries and risk of family compassion, and fatigue rates are higher in general wards (Juve, 2020). Therefore, establishing a process to have adequate patient staff ratio is important to have a higher quality of care to be provided to patients. A.
Two national patient safety goals provided by Joint Commission that apply to this situation are improving staff communication and use of medication safely. Improving staff communication applies to this situation because communication is a requirement involved in providing patient care. A decrease in communication between staff could result in not reporting test results or other important information of a patient to another staff involved in patient care that could hinder diagnosis, proper care, or extended patient stay from increase amount of carry over time from performance of test/labs to results provided time. Safe medication administration applies to this situation because of the demands that are required when providing medication. An increase in nurse burnout could lead to a decrease in proper procedure, correct labeling, proper identifying of patient prior to administration of meds, and ensuring correct record keeping of the patients' meds. To decrease demands required by nurses when they become burned out, they potentially can try to take short cuts that could be detrimental to patient care. A3. Nursing burnout can impact patient care by having decreased quality care that is provided. It can
result in nurses having decreased time to ensure each patient within their care has proper
education on their diagnosis and safety, which can make patient make avoidable mistakes that
could hinder their outcome. An increase in patient falls could result from decrease in attention to
patient care. An increase in nurse demand within their patient, could result in delayed medication
administration to patients. A delay in medication administration could cause patient to have an
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increase in patient due to not having a routine schedule. It could also hinder patient if nurses try
to take a short cut with medication prosecute if the nurse prepares meds away from sterile fields,
mis interpret orders by dosage, or mis labels meds. They could also have decreased safety for the
patient if proper identification is avoided. Nurse burn out can be a safety concern within staff in
ways of decreased communication, increase demand of hours worked from staff resigning from
work condition, and by having simple task be neglected or picked up from another staff that
would increase the demand from their job. The results from decreased in patient care and safety
concerns within staffing will affect the health care organization. It can lead to an increase in
patient stay, which would cost the hospital revenue. It can result in lawsuits if actions are taken
by patients due to decreased quality care that resulted in harm. It can also cost the hospital more
money to have adequate staffing if required to reach out beyond full time employees to cover
shifts. 4 The recommendation that I propose is for the organization to adopt the Patient Acuity Tool to
establish proper patient acuity to provide fair staff to patient ratios and prevent nurse burnout. In
North Carolina there are no laws that set standards for staff to patient ratio, which allows for
organizations within the state to have more control on how the organization allows for staffing to
occur. This approach scores a patient on a scale of 1 to 4 on acuity level. This allows each RN to
score their patient; relay the information to the charge RN which would allow fair distribution of
patient through the next shifts. This process, if adopted properly, would increase ease of acuity
among caseloads, increase staff satisfaction, and increase patient quality of care provided. The
patient acuity tool is ranked from stable, moderate risk, complex patient, and high-risk patient. In
order to score the patient with one of these categories, clinical patient characteristics and nurse
workload indicators are assessed. An example of assessments include: vitals, medication,
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drainage devices, pain management, cardiac, respiratory, education, wound, continence, ADLs,
isolation, and safety. Once scored, patient will be divided up into groups a max of 6 patient per
caseload. Within the caseload, a nurse can have a max of 2 high risk patient with a higher amount
of lowe risk patients. To every distribute the acuity of patients, no caseload should consist of
more than 2-3 higher acuity patients without an added RN to the caseload to alleviate the
demands on the current staff of the said caseload. In the quality improvement study performed by
Johnson (2023), it explained that RNs completed questionnaires during each 12-hour shift over a
2-week period. Nurses responded that the PAT served as their voice for the patients cared for
(95%), that its categories represented the patients cared for (95%), and that it accurately
discriminated among patients with different staffing considerations (95%). Seventy-five percent
"agreed" to "strongly agreed" that the PAT provided more equitable assignments than the
previous tool used to complete staff assignments, was user-friendly (65%), and that they could
use it promptly (50%). RNs surveyed to identify barriers to equitable and safe staff assignments
and improved nurse satisfaction. Based on the RNs' survey responses, PATs were revised or
developed to address the needs of the RNs who provide patient care. Adopting a PAT that
promotes RN satisfaction and safe patient care ensures that nursing and patient needs are met
(Johnson, 2023).
4A The recommendation of adopting a patient acuity scale aligns with the principle of high
reliability because it uses the said principles when incorporated properly. It involves culture by
having a teamwork-based work environment. This allows staff within the caseload to work
together as a team, which requires an increase in communication. It allows for a positive
reinforcement of holding one another accountable. It also allows increase in patient and staff
safety of being able to work together to avoid injuries. It required leadership from each staff.
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Everyone has something to offer that can aid in building a strong team. When each person in
challenged to do their best and allowed to use their strong skills and work on their weaker skills,
it aids growth to the leadership of each team. It also aids in the education that is occurring within
the department. It requires each person to be transparent. They would have to do continuous
learning. They will also have to be a reliable worker. It also shows room for improvement
through measurable evidence. 4B Two potential barriers to adopting the patient acuity scale is compliance for the nursing staff
and adequate staffing. Change can be a challenge and some staff can be resistant. Some may
recognize the change as another added task to their already busy workload by adding time to
their day to be educated on the process and how to properly score the patients; with ensuring
proper scoring. If scoring the acuity of patients incorrectly, it can cause a high acuity patient to
be added to caseload that was already fairly distributed among the care team. This would require
increased work and decrease patient care across the caseload due to the amount of time required
from staff members between the patients. Adequate staffing can be a barrier to the process
because not every staff member always works the full 12 hours shifts. Some come in at different
times and some pick up shorter sets of hours. This could hinder the process because there may
not be coverage for part of the said shift, which would increase the demand from the others
within the caseload.
4C Two potential interventions to minimize barriers in relations to staff compliance and adequate
staffing would be to ensure adequate education provided throughout with having staff surveys
and monthly audits on effectiveness/satisfaction; and to ensure that staffing is adequate with the
proper amount of flexibility within each group to ensure fair and safe caseload is maintained.
Education throughout this process would increase the staff’s knowledge of identifying acuity;
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which would increase their speed to rate patients more quickly while continuing to rate
efficiently. Once a routine is set and each staff knows their demands within their role and able to
effectively rate acuity and provide proper care, the speed of quality care should be increased.
Surveys would be provided for staff to fill out that would rate their satisfaction with the process,
recognize the continued difficulties, and be able to rate their strengths and weaknesses so that
unit managers can help their staff grow. This process would help identify continued barriers and
help the staff growth into a more solid team that can perform their jobs to help provide quality
care in a fair and safe manner for the staff. To ensure that adequate staffing is maintained,
incentives can be offered to cover open shifts. Additional staff numbers can be added to help aid
in delegation of tasks for the patient caseload. For instance, when an open shift of an RN is
needed, but able to be filled, double the LPN or medic shifts can be opened to help delegate tasks
within their scope of practice to reduce the number of tasks that the other RN would be a
responsible for to make their tasks focus on the increased requirements. If no open shift was
covered, there will be a place of actions taken that would require unit managers, department
manager, or admin to cover the open slots to ensure that the responsibilities of the rest of the
team is not increased to maintain a fair balance. This requires teamwork and when higher parties
participate in helping covers gaps when needed, will show that staff are cared for and could
increase their job satisfaction. 4D Implementing this recommendation is significant in shared decision making among the
relevant stakeholders because it can increase the quality of care provided to patients, which could
decrease the amount of stay, costs, and increase satisfaction within the system. The primary
stakeholder would be the patient. The patient deserves to be a decision maker during the plan of
treatment. This means that they are well educated by caregivers to understand their diagnosis,
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treatment options, and to be provided with quality care throughout their hospital stay. The care
team which includes CNAs, LPN, RN, Unit Managers, Physicians, Social Workers, and
Pharmacist, etc. The care team are stake holders involved that can help implement this process
change. Their involvement in ensuring proper execution is vital for it to be effective. They are
impacted by ensuring proper acuity is noted to each caseload to ensure fair assignments which
entail the amount of work required by each discipline. They work together to provide quality
care, but to also ensure that each person is doing their part. Hospital administration and insurance
companies are also incorporated into the stake holders since the costs determine functionality
within the hospital and insurance reimbursement. When patients are provided with quality care
and proper treatment is provided efficiently, a patient’s stay can be shortened which can allows
the hospital to have a quicker in/out process that could increase the income. Insurance companies
are affected when hospitals provide care that could be out rules with proper attentiveness from
hospital staff. Insurance allots monies to the patient based on diagnosis. When patients have re
admits shortly after their stay, it causes additional monies to be payed that could have potentially
been avoided if actions had been taken sooner during the patients stay. 4E AN outcome measure that can be used to evaluate the results of the recommendation would
be quality surveys. The surveys would be composed of questions that regard to staff members
satisfaction of the change, the process, and how they deem it to be effective. It would include
evaluation of what they feel is working and what is not working. It will ask staff to determine
their strengths/weakness so that managers can help work with each staff for “growth” within
themselves. It would also include an evaluation of the “teamwork” experience so that tasks
delegation can be taken into consideration when caseload assignments are made.
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4F The current care delivery model that is used within my facility is Team Nursing. Within team
nursing, the team is composed of the RN manager. Under the manager, there is a group of
providers such as RN, LPN, Medic, and an CNA that is assignment to each caseload. When the
patient acuity rating would be applied to the team model, it would allow for a fair distribution of
patients with each caseload be assignment. This allows for each member be assigned to certain
tasks within the caseload patients. When fair and adequate a quality is assigned, each member
within each caseload can perform their tasks effectively and ensure that their work is done
without rush of working quicker to ensure all patient are taken care of; with some having more
required work than others within another caseload. This allows one to work together when tasks
are accomplished to a sure that patient are receiving quality care within an acceptable amount of
time.
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Works Cited
Johnson, K., Haines, J., Woock, L., Madden, B., Sundstrom, G., & Razo, S. (2023). Implementing a patient acuity tool: Perceived effectiveness for more equitable staff assignments.
Nursing
,
53
(3), 53–58. https://doi.org/10.1097/01.NURSE.0000919000.40286.de
Juvé, U. M., González, S. M., López, J. M. M., Planas, C. M., Rodríguez, F. H., Batuecas Duelt, I. J., Tapia, P. M., Pons Prats, M., Jiménez, M. E., Barberà Llorca, M. À., Asensio, F. S., Berbis, M. C., Zuriguel, P. E., Delgado, H. P., Rey Luque, Ó., Zabalegui, A., Fabrellas, N., & Adamuz, J. (2020). Acuity, nurse staffing and workforce, missed care and patient outcomes: A cluster unit level descriptive ‐
‐
comparison.
Journal of Nursing Management
,
28
(8), 2216–2229. https://doi.org/10.1111/jonm.13040
Theofanidis, D., Boukas, A., & Fountouki, A. (2022). A “New Pandemic” at Hand: Burnout of Nursing Staff.
International Journal of Caring Sciences
,
15
(3), 2028–2035. ‘
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