Eve Wittlin-Young

University of Central Florida

Leadership Project Power Point

Scenario

Staff nurse is concerned with the shortage of nursing staff present on the unit, as well

as the effects of short staffing when considering the patient’s safety. Staff nurse decides to present ideas to management on ways to promote safe staffing with the

recruitment and retention of nurses.

Background Literature

* The current nursing shortage should be a topic of interest to all, not just nurses, as patient safety is significantly jeopardized as a result of facilities lacking the proper staff to provide care to patients.

* Also, with decreased nurse staffing one is usually to expect an increase in patient ratios and use of unlicensed assistive personnel within the hospital environment, creating an even more dangerous environment for patients (Maurer & Smith, 2009).

* Many studies have shown strong correlations between nurse staffing levels and patient outcomes. The Joint Commission on Accreditation of Healthcare Organizations reported that 24% of adverse events were related to low nurse staffing (Maurer & Smith, 2009). A 2005 survey from Massachusetts licensed physicians indicated that 19% of reported patient deaths were directly attributable to low staffing levels, 82% believed that the patient care suffers from low RN staffing levels and 74% supported mandating minimal nurse- patient ratios for increased patient safety (Cherry and Jacob, 2008).

*A 2002 report, published by the Journal of the American Medical Association, found that surgery patients are faced with an increased risk of mortality and failure-to rescue in hospitals with high patient to nurse ratios (Domrose, 2010). In 2007, a report by the Agency for Healthcare Research and Quality, presented that hospitals with higher levels of nurse staffing had lower hospital-related mortality, decreases in failure to rescue, and shorter hospital stays as well (Domrose, 2010).

Accrediting\ Legislative Mandates*Politically, much effort has been tried to establish minimum

staffing level requirements for a health care facility in the state of Florida.

*Recently on February 24, 2010, Representative Oscar Braynon and Senator Hill filed Florida Hospital Patient Protection Act of 2010 (Florida House of Representatives, 2010).

*This bill would have established minimum staffing level requirements for a health care facility, require that the health care facility annually evaluate staffing levels and update staffing plans; as well as prohibiting the facility from assigning unlicensed personnel to perform tasks that should be performed by a licensed or registered nurse (Florida House of Representatives, 2010).

*This bill was not passed. Currently, only the state of California has implemented mandatory nurse staffing in hospitals. As a result of the mandatory nurse staffing in California, a study released by the state of California Nurses Association has stated that the state’s laws on nurse-to-patient ratios has reduced the patient mortality (Nursing Standard, 2010).

Professional Organizations, Standards/ Position Statements

*Nursing organizations that support safe staffing and have campaigned openly include the American Nurses Association and the National Nurses United

* The American Nurses Association (2010) had even created the campaign “Safe Staffing Saves Lives” that advocates nationally trying to resolve the nurse staffing crises.

*The National Nurses United (2010) created a similar campaign supporting the same concept as the American Nurses Association’s campaign; however their campaign was titled RN-to-Patient Ratios Saves Lives

Stakeholders

*It is clear that the stakeholders are not only to include all nurses, but the entire nation, including the patients, the families, managers and administrators.

*We are all involved in some way to our health care, whether it is through a hospitalized family member or a friend that is receiving care or as an employee of the hospital. The entire nation should share great interest in the need for safer staffing and the current nursing shortage that surrounds us and ultimately affects all of our safety.

Objectives

*My main goal for this project as a staff nurse is to present ideas to management on ways to improve the staffing levels on the unit by not only ways to recruit nurses but to ultimately retain our nurses.

*A clear specific and measurable goal is to improve the unit’s nurse retention from 92% to 100% by the end of 12 months as evidenced by all newly hired nurses completing a minimum of 12 months on the unit and remaining with the organization. Specifically the organization will recruit six nurses to the unit and retain 100% of all the newly hired nurses.

*To also include a goal for the retention of dedicated staff I would like to add an objective of retaining all of our dedicated staff (staff that has been with the organization over one year) as evidence by 100% of dedicated staff remaining with the organization.

Implementation

Involvement of Stakeholders and others who may be

involved

*To successfully obtain the goals of recruiting and retaining nurses to prevent a shortage in staffing, as a staff nurse I would involve the stakeholders that are mainly composed of the unit’s managers and administrators.

*Our goals and objectives can be open to and shared with the public as well, as it is nursing care that we are providing to the people and their families and they have every right to know the actions management is taking to ensure patient safety in the facility.

*Also creating awareness and publishing our efforts to the public on what the organization is currently doing to ensure a safe environment to their patients would be a positive effort on the organization’s part.

Timeline

* Implementation length of this plan is truly continuous, however for the purpose of this project it will specifically be one year, as I will be examining and analyzing data one year from initiating the recruitment of nurses.

* In order to retain the committed nurses of the unit as well as the newly recruited nurses, management must be creative in expressing to staff how they are truly and continuously appreciated. Throughout the year, management can dedicate several days to show staff appreciation; management may even consider having a short morning meeting upon nurses’ arrival to offer words of encouragement and acknowledgement of their excellent work.

* In order to recruit nurses to the unit, managers will offer a tea and tour, where the organization welcomes new nurses to have some light snacks and beverages and tour the hospital. It would give the nurses a great opportunity to see the hospital and the unit specifically; also it would allow the interested nurses an opportunity to interact with the unit managers and ask detailed questions.

Education

*The unit will educate all staff members of our goals and objectives by having assistant nurse managers create posters and provide in-services to all nursing staff members to ensure awareness of the unit’s goals of improving patient safety with nurse retention and recruitment.

Budget

Staff Budget

*As a staff nurse, I will discuss with management the number of nurses that is needed to appropriately staff the unit. Based upon the 112 bed facility and the current number on nurses that are employed with the organization that the unit requires six new nurses to maintain appropriate safe staffing.

* I would first like to seek the approval for hiring additional nurses for the unit, preferably the six nurses. Once the unit manager gains approval to hire and depending on the positions approved, we can then estimate a basic budget for start- up costs.

* For instance, if the request to hire six new nurses were to be approved then we can think about costs for orientation. The nurse educators of the unit can then set the nurses up in an orientation plan that consists of a schedule of unit specific classes and job training for a period of six to twelve weeks, depending on the success/ comfort level of the individualized nurse. Two nurse educators will be teaching the necessary classes, such as the NICU course, to the new nurses in one of the organization’s classrooms receiving their base pay of $22.00 an hour for six hours a day, for eight days, for a total cost of $2,112.00. The new nurses will receive their base pay of $19.00 an hour for six hours, for eight days with the cost of $912.00 per nurse for their eight day course orientation. Providing the total cost of course orientation of $7,585.00. Then to estimate that all of the six nurses that were hired work three twelve hour shifts a week with a preceptor for a total of six weeks $19.00 an hour would cost the unit $4,104 per nurse over the six weeks of orientation. Providing a grand total of both course and unit orientation for the six nurses of $32,209

Supply Budget

*Supplies that will be needed for the tea and tour event in the hopes of recruiting new nurses to the organization would include signs that announce and direct the tea and tour, tables and chairs for both the managers and interested guests, pens, paper, assortment of tea, and light snacks such as shortbread cookies to entertain our guests. This event is to be hosted by our administrative staff that will be receiving their salary pay during this time. Estimating costs for supplies include: $5.00 a sign for four signs ($20.00), tables and chairs ($25.00 a set includes four chairs and one table) for four sets totals $100.00. Pens and paper total cost $25.00, tea and snacks created by the organization’s café $30.00. Total of estimated supplies cost for the tea and tour event $175.00.

*Supplies needed in order to retain our dedicated nurses would include small chocolates to give out to staff provided by the organization’s café on special occasions throughout the year ($38.00,) having pizza days for the nurses (once a month for 12 months, five dollars a pizza for five pizzas total $300.00), small gifts from the organization such as pens or tote bags can also show great appreciation of their excellent work (2.00 an item for 72 items totals $144.00). Estimated total of costs for retention of nurses project $482.00.

Evaluation

Time/ frequency- markers for evaluation, data collection and

measurement*My markers for evaluating whether the organization was successful in

their efforts of recruiting and retaining nurses would include working with the organization to analyze the statistics and data obtained from human resources.

*Specifically, I will be looking at the number of nurses that were newly hired and compare that to the number of newly hired nurses that had left the organization within a year and the number of newly hired nurses that had remained with the organization. I would like to determine if we had met our goal of retaining all of the newly hired nurses for at least one year. I would also examine the number of dedicated staff that had stayed with the organization and look at their years of loyalty in order to determine, if we had met our goal of nurse retention of our dedicated staff as well. Another option would be to present surveys to the nursing staff to determine their satisfaction with the organization and offer a section for the employees to offer input anonymously on ways to improve the unit and whether they are satisfied with serving the unit and if they have plans to leave the organization due to dissatisfaction.

Data Analysis

* In order to analyze whether my ultimate goal of attaining appropriate staff to ensure patient safety was met, I would work with our unit management and risk management to gather statistics and data.

*Specific data that includes all of the errors and injuries that had resulted in patient harm/ injury throughout that year on our unit and then examine the number of nurses that were working during these adverse events to determine if there was a correlation between short staffing and patient errors and injuries. Hopefully, I would then find that there were very few errors, if any that had resulted in patient harm, as the objectives of recruitment and the retention of nurses were successfully met and had ensured safety to our patients. This would also then satisfy my concerns as a staff nurse and justify that safe and appropriate staffing does in fact prevent patient injuries and errors from occurring.

Thresholds and corrective action to be taken if thresholds not met

* Multiple statistics and studies have shown strong correlations between nurse staffing levels and patient outcomes. The Joint Commission on Accreditation of Healthcare Organizations reports that 24% of patient adverse events were related to low nurse staffing (Maurer & Smith, 2009). You can clearly understand how being inappropriately staffed with registered nurses, does in fact, lead to poor patient outcomes and places all of our patient’s safety at risk. This is what leads me to believe that this plan of retention and recruiting nurses will promote and ensure patient safety. Also take onto consideration that in 2007, a report by the Agency for Healthcare Research and Quality, published that hospitals with higher levels of nurse staffing had lower hospital-related mortality, decreases in failure to rescue, and shorter hospital stays (Domrose, 2010).

* I personally would work with management and administration to discover the numbers of adverse events that had taken place on our unit during that year and examine the nurse to patient ratios and compare them to the previous years to see if the plan of staff retention and recruitment had made a particular difference. If The Joint Commission on Accreditation of Healthcare Organizations reports that 24% of patient adverse events were related to low nurse staffing (Maurer & Smith, 2009) I would then compute what percentage of our unit’s adverse events were due to low nurse staffing and hopefully find that it is less than ten percent, as we have improved our staffing on the unit with our objectives being met.

* However, if I was to discover that our goals were not met after gathering all of the data and that we were not successful in retaining our nurses and not successful in our recruitment which had then lead to adverse events and patients harmed, I would then turn to our staff directly. I would like to meet with them all and discuss what changes they believe should be made in in order to promote the safest environment possible to our patients and then report ideas to management.

Plan to Maintain Stakeholder Buy-in and How to Sustain the

Improvement*It is with the belief that with this particular plan and with our objectives being met, the statistics of improved patient safety, as well as increased patient satisfaction with a full staff of delighted nurses, the stakeholders will be incredibly content and continue supporting our organization.

* Sustaining this change will definitely be a challenge, however, a challenge that the organization will have great interest in supporting and willing to maintain, especially with gathered statistical evidence that supports our goals and objectives for this project.

Anticipated Obstacles

Actions to Prevent and Methods to Address if

Encountered*Anticipated obstacles would include inadequate staff that

results from “call offs” and “call sick”, as well as, a low nurse satisfaction that would lead to a high turnover rate and an increase in adverse events.

* In order to prevent inadequate staff resulting from nurses who are not satisfied with the unit, I would suggest having meeting s with the dissatisfied nurses and speak with them about their unhappiness and their specific reasons for dissatisfaction and possible ways improvements can be made for the future.

*Although, I would be unable to prevent nurses from calling out sick or calling off from work due to personal reasons we would have alternative plans to maintain appropriate staff to ultimately decrease the risk of adverse events. For example, we would have the option to call pool staff into work, follow an on-call list or possibly “borrow” nurses from other similar units that are fully staffed and utilize their presence safely.

*With utilization of alternative plans our unit will be adequately and safely staffed with registered nurse to promote the most absolute safest environment to our patients at all times.

ReferencesAmerican Nurses Association. (2010). Safe Staffing Saves Lives. Retrieved October 17, 2010, from

http://www.safestaffingsaveslives.org/

Cherry, B., & Jacob, S. (2008). Contemporary Nursing. Issues, Trends and Management

(4th ed.). St. Lewis: Elsevier Mosby.

Domrose, Cathryn. (2010). States Consider Merits of Mandated Staffing Ratios. Retrieved

October 17, 2010, from http://news.nurse.com/article/20100210/NATIONAL02/102080086/-1/frontpage

Florida House of Representatives. (2010). HB 1283 Health Care. Retrieved October 8, 2010, from

http://www.myfloridahouse.gov/Sections/Bills/billsdetail.aspx?BillId=44052

Maurer, F., & Smith, C. (2009). Community/ Public Health Nursing Practice: Health For

Families and Populations (4th ed.). St Louis, MO: Elsevier Saunders.

National Nurses United. (2010). RN-to-Patient Ratios Saves Lives. Retrieved October 17, 2010, from

http://www.nationalnursesunited.org/ratios/

Nursing Standard. (2010). Study links patient fatalities to low nurse ratios. Nursing Standard, 24(34), 6.

Retrieved from CINAHL Plus with Full Text database.

U.S Department of Health and Human Services. (2004).The Registered Nurse Population: Findings from

the 2004 National Sample Survey of Registered Nurses. Retrieved October 17, 2010, from

http://bhpr.hrsa.gov/healthworkforce/rnsurvey04/