NURS 4020 Leadership Competencies in Nursing and Healthcare Pract.docx

NURS 4020: Leadership Competencies in Nursing and
Healthcare Practicum
Practicum Change Project
The practicum is designed to help you develop as a scholar
practitioner and health leader to promote positive social change
in your community. The practicum is an active learning
experience that provides you with the opportunity to apply
nursing knowledge and skills that you are acquiring in NURS
4020 to current or past experiences in a healthcare setting. The
practicum is comprised of selected onsite experiences and
weekly practicum discussions. Throughout your practicum
experience you will collaborate with leaders and other
colleagues, with fellow students in practicum discussion groups,
and with your faculty. Each week of the course outlines specific
activities or reflections you will engage in during your
practicum as you complete your proposed Practicum Change
Project. A complete description is presented on the Practicum
discussion page of each week and a brief outline of the
activities is presented below. The practicum for NURS 4020 is a
minimum of 45 hours.
Practicum Change Project Overview
Practicum Change Project Overview
Each week, your instructor will assign a discussion to the class.
Within an instructor-assigned discussion team, you will
participate in a total of six discussions for this project.
Satisfactory completion of these six discussions and a
PowerPoint Presentation of your Practicum Change Project will
satisfy the requirement for the practicum.
The purpose of the Practicum Change Project is for you to
design and offer a change project specific to your work setting
to be implemented once the course is over and once approved by

management at your setting. The team discussion provides an
avenue for you to share ideas, to critique each other’s work, and
to offer support to each other. Your instructor will visit your
team site to offer guidance as needed. The team discussion is
meant to be relaxed and enjoyable. Have fun!
The following is a list of the weekly, project-related discussions
and activities.
Week 1
· Discussion: Identify a Change Project
Week 2
· Discussion: Apply Change Theory to the Proposed Change
Week 3
· Attend a multidisciplinary team meeting
· Interview a leader from another clinical discipline
· Discussion: Best ways to communicate change
Week 4:
· Discussion: Manage resources for the Practicum Change
Project
Week 5:
· Discussion: Address Quality and Safety Issues
Week 6:
· Discussion: Present Practicum Change Project
Access the following useful information in Course Info:
Practicum Discussion Grading Rubric
PowerPoint Presentation Grading Rubric

Question 1
As discussed earlier, it is common for businesses to change
their structure or decide to start a new business. As you begin to
research different business formations for this week's written
assignment, where are you going to go for assistance? What are
some good resources? Once you decide on the business form,
how do you go about making the change? What is the process?
Question 2
The United States is a nation of many races, ethnicities, and
nationalities. Many groups in this country have experienced
discrimination. Think about discrimination you have
experienced or witnessed and answer the following questions:
· What's the difference between individual and institutional
discrimination? Be sure to give a specific example of each type
of discrimination in your response.
· You are asked to come up with a plan to improve racial and
ethnic relations in your community. What would your plan
include? How would you address both individual and
institutional discrimination in your plan? Explain.
Question 3
Rock-paper-scissors-lizard-Spock is an expansion of the classic
game rock-paper-scissors. It operates on the same basic
principle, but includes two additional weapons: "the lizard" and
"Spock." See the graph below. Find a partner and play the game
a few times. Please answer all of the questions below:
Is it difficult to keep track of all the rules?
Does the graph below do a good job of summarizing all the
different relationships? Is there a better way of explaining all
the different relationships?
How does this game compare to the usual rock-paper-scissors?
In what ways are the dynamics of the games similar? In what
ways are they different?

1
5
NURS 4020: Leadership Competencies in Nursing and
Healthcare Practicum
Practicum Change Project
Practicum Objectives
· Differentiate between leadership and management
· Analyze the impact of leadership and management on
implementing change in the health care environment
· Identify a practicum change project that focuses on a quality
and safety issue
· Evaluate a change theory to use as a framework for your
practicum change project
· Describe your setting's mission, vision, and values in relation
to its strategic plan
· Analyze collaborative and communication strategies used by
multidisciplinary teams.
· Select an effective communication strategy for implementing
the practicum change project
· Evaluate the impact of the practicum change project on
available organizational resources
· Examine the quality and safety issues associated with the
practicum change project
· Justify evaluation strategies for the practicum change project
· Critique practicum change projects

Discussion Requirements
Post your responses to the Discussion based on the course
requirements. Your initial postings must be 250–350 words (not
including the full references). Keep your responses succinct.
Your written assignments must follow APA guidelines. Be sure
to support your work with specific citations from this week's
Learning Resources. Other scholarly sources may also be
used to support your work. Refer to the APA Publication
Manual to ensure that your in-text citations and reference list
are correct.
Post your response by Day 4 of this week. Respond by Day 7 to
at least two of your colleagues' postings in one or more of the
following ways:
· Ask a probing question.
· Expand on the colleague's posting.
· Offer polite disagreement or critique, supported with
evidence.
In addition to, but not in place of, the above you may:
· Offer and support an opinion.
· Validate an idea with your own experience.
· Make a suggestion or comment which guides or facilitates the
Discussion.
Support your response with references from the professional
nursing literature.
Week 1: Practicum Change Project
Team Discussion
Identify a Change Project

This week introduced the concepts of leadership and leadership
theories. In addition, the media presentation and textbook
readings discussed the difference between leadership and
management. As you begin your practicum this week discuss
with your manager possible change projects that focus on a
quality and safety issue that are needed in the agency. Observe
your manager and other leaders at your location. Identify how
management and leadership activities contribute to successful
change initiatives. Informally discuss options with your
manager.
Please address the following:
· What did you see as the difference between leadership
activities and management activities?
· How do management and leadership activities contribute to the
success of change initiatives?
· What change projects are needed in your agency at this time?
· Which of these projects will you select for your practicum
change project?
Team Discussion
Apply Change Theory to the Proposed Change
In week one, you formulated some initial ideas about a
Practicum Change Project. You discussed possible change
projects with your manager and identified a project for your
practicum.
This week has presented information on change, change
management, and how an organization's mission, vision, and
values are reflected in its strategic plan. Using the information
presented in the resources, complete the following two activities
with the guidance of your instructor.
Your instructor has assigned you to apply change theory to the
proposed change. Check for consistency between the proposed
change and the mission/vision/values/strategic plan for the
agency. Read more about change theory in your textbook.

· Which change theory will you use as a framework for your
change project and why?
· Is there consistency between the proposed change and the
mission, vision, and values of the agency?
· If so, describe.
· If not, how will you address the inconsistencies?
Team Discussion
Collaborative and Communication Strategies
You are now in the third week of working on the Practicum
Change Project. So far, you have refined your change project
and chosen a change theory to organize your approach to the
project.
Now, let's begin work on week 3 of the Practicum Change
Project!
This week your instructor has assigned you to seek input on the
possible change from stakeholders, attend a multidisciplinary
team meeting, and interview a leader from another clinical
discipline.
Part I: Observation
Attend a multidisciplinary team meeting. Observe the
communication skills used by the team leader and the group
process. Consider the following questions as you observe the
meeting:
· Who served as the team leader? What leadership style did you
observe?
· How well did the team work together?
· Was there group conflict? If so, how was it resolved?
· Were there any outcomes from the group meeting?
· Did you see evidence-based care or decisions during your
observation?
· How was nursing involved in the multidisciplinary group?

Part II: Interview
Interview a leader at least one level above your current or
immediate past position from another clinical discipline
(pharmacy, respiratory, case management, social work,
medicine—not nursing). Ask the following questions:
· How would you describe your leadership style?
· What communication skills do you use?
· What conflicts have you had to manage in the last 3 months?
· What techniques and strategies do you use to work together to
promote multidisciplinary teamwork?
Part III: Discussion
Identify ways in which you collaborated with other
professionals regarding your activities.
· Think about the stakeholders impacted by the change. How
can the change theory you have chosen influence the success of
a change project?
· How can the multidisciplinary team of leaders impact the
change project?
· What is the best way to communicate the change within the
agency?
Week 4: Practicum Change ProjectTeam Discussion
Manage Resourcesfor Practicum Change Project
You are now half-way through the course. Thanks for all of
your hard work on your project thus far!
Now, let's begin work on week 4 of the Practicum Change
Project!
This week your instructor has assigned you to evaluate
resources and develop a budget to fund the Practicum Change
Project. Determine if the resources are available for the project
(i.e., salaries, supplies, equipment, technology, and
education)and develop and present the budget in the practicum
discussion area.

Team Discussion
Post your responses to the Discussion based on the course
requirements. Your initial postings must be 250–350 words (not
including the full references). Keep your responses succinct.
Your written assignments must follow APA guidelines. Be sure
to support your work with specific citations from this week's
Learning Resources. Other scholarly sources may also be
used to support your work. Refer to the APA Publication
Manual to ensure that your in-text citations and reference list
are correct.
Address Quality and Safety Issues
You have accomplished a lot in the past four weeks. Just two
weeks to go.
Now, let's begin week 5 of the Practicum Change Project!
This week your instructor wants you to identify one quality or
safety issue in your setting that will be addressed by the
Practicum Change Project.
· What data did you use to identify the quality or safety issue?
· How will the Practicum Change Project address the quality
and safety issue?
Team Discussion
PowerPoint Presentation
Please submit your PracticumPopulation Project PowerPoint to
the Week 6 Assignment submission link below as well as to
your Group Week 6 Discussion 2 area.
Present Practicum Change Project

Congratulations! You are now in week 6. This is our last week
of the team discussion board.
This week your instructor has assigned you to create and post a
PowerPoint presentation that summarizes your Practicum
Change Project. Post your PowerPoint presentation by Day 3of
this week. (See Rubric in Course Info).
In this Discussion, post the Practicum Change Project you
developed.
In addition and based on your experiences, observations, and
readings, compose a Discussion post that responds to the
following:
· Review all of your team members' presentations in your group
and provide feedback on the proposed change project including
feedback on the proposed evaluation strategies.
RE: Group D Discussion 2 - Week 1
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Total views: 23 (Your views: 7)
Leadership VS. Management
Leadership and management terms have been viewed
synonymously by various people across the world. An
individual can possess good leadership qualities, but he/she may
not be a good manager. It implies that nurses can hold
managerial positions, but they may not have many leadership
skills in the nursing profession (Louis, 2010).
According to Suvillan (2013), leadership activities and
management activities in nursing differ. Occasionally, nurse
leaders don’t usually have authority that has been delegated to
them. They acquire their power from other individuals in the
organization. They participate in different activities that are
aimed at achieving the following output. Motivating nurses to
administer quality care, as well as inspiring nurses during
occurrence of conflict to boost their morale. Also, the activities

help in influencing nurses to take appropriate courses of actions
with regards to the health status of a patient. Finally, they
empower nurses to provide quality health care. According to
Louis (2010), a good nurse leader should posses excellent
interpersonal and communication skills as they will help
him/her to empower and influence other nurses. On the other
hand, management activities in nursing profession entail making
decisions concerning certain nursing practices and having
control of people and all processes that arise on a daily basis.
Apart from this, management activities about nursing practice
also include coordination of resources such as personnel and
finance. Also, management activities help in coordinating the
rewarding and punishing nurses, adherence to rules, as well as
ensuring that the goals of the organization have been met
(American Nurses Association, 2010).
Contribution to Change Initiatives
Management and leadership contribute to the success of change
initiatives in different ways. For instance, the practice of
rewarding hard working nurses motivates them to participate in
activities that are aimed at bringing change. Moreover,
empowerment of nurses enables them to dedicate their time and
efforts to initiatives that are aimed at bringing change.
Therefore, empowering of nurses plays a significant role in the
success of change initiatives as they are committed to
participate in change initiatives (Suvillan, 2013).
Change Projects in My Facility
I work in a cardiac surgical intensive care unit. We have shared
governance in place to help with the usual ICU related
problems such as falls, pressure ulcers, catheters acquired
urinary tract infections, hospital acquired pnumonia, surgical
sites and central line infections amongst other. Several changes
projects are required by my agency at the moment. The most
urgent ones include the adaptation of evidence-based cultural
interventions, increase in the number of nurses and equipment
to be able to meet the ever increasing number of patients, and
transformation of patient's care.

My Project Choice
Because the patient satisfactory rate is low on my unit, I choose
to work on the transformation of patient's care as my practicum
change project. The hospital sends out surveys to patients upon
discharge, but the unit I work on usually receives poor ratings.
During my practicum, I will go over the reasons why and what
changes can be implemented to such as offering quality services
to patients so as to ensure that they are satisfied.
References
American Nurses Association. (2010). Nursing: Scope &
standards of practice. Silver Spring,
MD: American Nurses Association.
Louis, R. (2010). Management and Leadership. Journal of
Public Health Management and
Practice. Vol 2, 174-176
Sullivan, E. J. (2013). Effective leadership and management in
nursing. (8th ed.). Upper Saddle
River: Pearson Prentice Hall.
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What is change? It is primarily adjusting from one type of

behavior or environment to another. In Management, change is
welcomed to increase production and facilitate effectiveness
(Sullivan, 2013). In health care, change is a must given the
dynamic nature of technology, social, political and economic
domains.
Researchers have spent sleepless days and nights trying to come
up the best and most delivering change theory. After my
consideration and comparison, I found Roger’s theory, advanced
in 2003 more useful in my field of specialization. Rogers came
up with a groundbreaking change theory, composing of five
stages. These stages are awareness stage, interest creation stage,
evaluation of effectiveness, implementation stage and finally
the adoption stage (Sullivan, 2013). In my project, it is my duty
to post-discharge calls to monitor the patients and assist in
preventing hospital readmissions.
In implementing change to this project, Rogers theory is the
most useful as it provides step by step analysis of how to go
about the project. It helps the change process to be adjusted as
required during the process of implementation.
The facility I work for is part of the Medstar Group. The
mission of Medstar Group is to provide healthier lives to people
and ensure the cost of the healthcare system is convenient to all.
It is the goal of the group to uplift integrity, compassion,
performance and innovation as its key values. The group
envisions providing a high value of service to its clients
together with becoming an outstanding medical center. The
envisaged change is instrumental in improving the health of
patients while reducing incidences of hospitalization. It is the
mission of the group. The main vision of Medstar Group is to
escalate the quality of life of all people. The planned changes
will energize this vision (Diers, Hendrickson, Rimar, &
Donovan, 2013).
In summary, the proposed change in my project can best be
executed using the Rogers theory due to its organization and
flexibility. The change is in line with the Medstar Group’s
mission and vision where I work. The change will lead to

improvement or the companie's goals, mission and vision.
References
Diers, D., Hendrickson, K., Rimar, J., & Donovan, D. (2013).
Understanding NursingUnits With Data and Theory. Nursing
Economic$, 31(3), 110-117.
nursing. (8th ed.). Upper Saddle
River: Pearson Prentice Hall.
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Change is an important process for any organization aiming to
continue delivering quality services to its clients. This
assignment presents how effective communication and
collaboration with other stakeholders are critical to the
implementation of change at the Medstar Group, which entails
the introduction of post-discharge calls aimed at preventing
further patient readmissions.
At the multidisciplinary meeting to evaluate the hospital on how
it could improve the inpatients' experience in the hospital
environment. The institution's medical director acted as the
meeting coordinator, who employed a democratic leadership
style. The leader allowed the contribution of every participant
in the discussion. Conflicts in the form of disagreements were
solved through compromise (Losa Iglesias & Becerro De
Bengoa Vallejo, 2012). The decision and counterarguments were
based on the principles of nursing. In the end, the group
proposed a plan to improve the patient experience at the

institution.
The interview I indulged in with the director of the pharmacy
division of the organization proved much insightful. The
director described himself as a servant leader, who was focused
on the achievement of the hospital goals and upholding of its
values (Sullivan, 2013). The leader argued that communication
is critical to influencing the workforce; this is the reason he
endeavoured to pass important messages through face-to-face
communication. The leader claimed to believe in the uniqueness
of every member of his department and thus worked towards
harnessing their different strengths.
The proposed change at the institution called for the
involvement of every stakeholder; from the top-level
management down to the patients. The Rogers Theory proved to
help in implementing the change in phases, which was expected
to enable its evaluation and modification. The theory appeared
to facilitate change and support its benefits. As a result, I was
compelled to adopt it (Institute of Medicine Shaping the Future
for Health, 2000). The multidisciplinary team was to help refine
the change to make it compatible with every department, which
was expected to help in its swift adoption (Stringfellow, 2012).
The best way to communicate the project proved to be through
the multidisciplinary team meetings (Laureate Education, Inc.,
2010). The leaders were then supposed to relay the change to
their staff after the discussion, which was aimed at facilitating
its support by the staff.
References
Institute of Medicine Shaping the Future for Health (2000).
Crossing the quality chasm: A new health system for the 21st
century. Retrieved from
http://www.iom.edu/~/media/Files/Report%20Files/2001/Crossi
ng-the-Quality-
Chasm/Quality%20Chasm%202001%20%20report%20brief.ashx
Laureate Education, Inc. (Executive Producer). (2010).
Leadership competencies in nursing and healthcare:
Communication, teamwork, and managing conflict. Baltimore:

Author.
Losa Iglesias, M., & Becerro De Bengoa Vallejo, R. (2012).
Conflict resolution styles in the nursing
profession. Contemporary Nurse: A Journal For The Australian
Nursing Profession, 43 (1), 73-80
Stringfellow, A. (2012). 5 strategies for managing workplace
conflicts. OPEN forum. Retrieved from
https://www.americanexpress.com/us/small-
business/openforum/articles/5-strategies-for-managing-
workplace-conflicts/
Stuart, F. (2014). Most Effective Communication Skills in
Workplace. The ACPE Blog. Retrieved from
http://blog.acpe.edu.au/index.php/careers/effective-
communication-skills-workplace/
Sullivan, E. J. (2013). Effective Leadership and Management in
Nursing (8th ed.). Upper Saddle River: Pearson Prentice Hall
AnneMarie Wouapet
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My change project implemented in the hospital critical unit I
work on must be well budgeted just like any other high
magnitude project (Schmidt & Brown, 2012). With the

government becoming strict on hospital reimbursement, quality
patient care has become the constant initiative towards meeting
goals. Signed in 2010 by the president, the Affordable Care Act
went into effect on June of 2012. Section 3014 of the
Affordable Care Act focuses on quality measures for patient
improvement while in the hospital. Aligned with the Centers for
Medicare and Medicaid Services, this ensures that hospitals will
meet the goals with establishing their core measures. Under
HCAPS scores, departments are graded on the work given and
the patients that were discharged provide feedback on their
hospital stay. The categories graded are hospital cleanliness,
staff responsiveness, environmental noise, physician
communication, nurse communication, medication/discharge
information, pain control, and willingness to recommend.
This year's budget for our hospital is relatively stretched. Most
of the expenses may remain constant, but two big issues have to
be considered. The hospital is eager to move with technology
while at the same time improving the quality of services offered
to the patients by making sure the nurses elevate their
knowledge through training. At least all nurses will be attending
two hours of training per day in shifts. Those scores in each
category are graded from a zero to one hundred percent and are
calculated monthly on a year round basis to see which areas
need improvement. The overall goal is maintain a ninety and
above in all categories . Our system has become a pay for
performance system. The work the nurses do in regards to
patient care reflect back on the facility and its budget if
satisfaction is not met.
A structure that should be implemented as a tool to improve
consumer satisfaction around the unit is hourly rounding on
patients. This initiative tool was designed to meet the needs of
patients on a constant basis with around the clock attention. The
goal is for nurses involved in hourly rounding protocol to find
their shifts less stressful, their time more productive, and their
patient safety and satisfaction scores hitting all-time highs
(Leighty, 2006). This would not only fall on the nurses to fulfill

but also on the unit manager, charge nurses, therapists, case
managers, and even the doctors to perform. The phrase, “Is
there anything else I can do for you before I go?” should
become a common phrase within the floor itself. Another tool
that can be implemented on the floor would be daily care plans.
These care plans can have a list of a patient’s up to date
hospital status such as medication list, doctors on their case,
therapy, and procedures. These can be distributed by the nurses
with a brief explanation of their care and answer any questions
the patient or family may have including education. If a patient
is going to get discharged within the next few days, a quick
survey to the patient or family can be passed out. The goal is to
answer any issues or concerns while the patient is still the
hospital. By meeting these goals before discharge, it hopefully
will reflect upon patient surveys scores that are sent out after
they are home.
By assessing the needs on the floor based on priority, the
budget requests will be met in all areas. Personnel and overtime
accounted for areas of the budget that were inaccurate.
Accountability for why these areas were inaccurate was
partially due to workload and patient acuity leading to nurse
turnover and a decrease in patient care. This cycle then puts
remaining floor nurses to work overtime causing the overtime
budget to decrease. Patient acuity can be distributed using a
point system assigned to each patient. By assessing each patient
and assigning the proper points to each nurse, it will hopefully
distribute the workload to the staff as a whole. Having a
transactional leader who is open and receptive to the staff will
open a forum of communication on the floor. Answering
questions and taking feedback will hopefully create an
environment that empower each employee to take initiative and
create ideas that will help the floor and improve patient care
delivery. Getting staff involved to help improve patient
satisfaction will reflect on survey scores that ultimately will
dictate hospital reimbursement. Promoting hourly rounding and
distributing care plans on the unit should become a structure

used on a daily basis as quality measures of improving hospital
stay. By fulfilling all these tasks, the unit manager should have
a strong cohesive unit aimed at retaining staff and achieving the
overall goal of promoting quality patient care.
The Nurse Manager has a lot of challenges ahead of her of
ensuring nurses get trained as well as they work well. The
following tables detail how the budget will look like for the unit
(McConnell, 2004).
Surgical Intensive Care Unit
Surgical Intensive Care Unit
Bed Capacity
24
Pt Days
11,790
ADC
% Occupancy
32.3
89.7
11,790 pt/days/ 365 days
32.3 ADC/24beds x 100
Nursing
Hours/Pt Day
8.14
Standard
Nsg Hours
Required/Yr
FTES
95,971
46.1
11,790 pt days x 8.14
95.971 hrs/ 2080
Nsg Hours
Required/Day
#Staff

262.93
32.9
32.3 ADC x 8.14 262.93/8 hr shifts
Budget for Payment of Care Unit Personnel
Officers
Salary budgeted
Nurse Manager
$ 80,700
Clinical Coordinators
$115,556
Care Manager
$40,400
Clinical Mentor
$56,456
Nurses
$278,432
Other hospital assistants
$80,345
TOTAL
$651,889
For years, the hospital has been faced with dire shortage of
equipments and supplies. However, of recent, we have been able
to purchase substantial amounts of equipments under
government sponsorship. The following table outlines what to
be purchased this year (Sullivan, 2013).
Equipments and Supplies
Item
Amount each
Total cost
Laptops
12
$200
Beds

14
$560
Surgical equipments
14
$120,654
ward construction
1
$50,023,400
Patient care supplies
-
$480,890
Ophthalmoscope
20
$140,456
Committee meeting expense
-
$ 1,200
TOTAL
$50766160
I am convinced beyond doubt that with such kind of a budget,
the institution will have a good opportunity to find sources of
funds or be able to convince the sponsors to surrender money
for its expenditure. If the budget is implemented to the letter,
the institution will have something good to show come next year
(Grundgeiger, Sanderson, MacDougall, & Venkatesh, 2010).
References
Grundgeiger, T., Sanderson, P., MacDougall, H. G., &
Venkatesh, B. (2010). Interruption Management in the Intensive
Care Unit: Predicting Resumption Times and Assessing
Distributed Support. Journal of Experimental Psychology-
applied. doi:10.1037/a0021912
Leighty J. (2006). Studer Group You Called? Hourly Rounding

Cuts Call Lights Retrieved from:
https://www.studergroup.com/dotCMS/knowledgeAssetDetail?in
ode=323256
McConnell, C. R. (2004). Managing employee performance. The
Health Care Manager, 23(3), 273-283. Retrieved from
www.aspenpublishers.com
Schmidt, N. A., & Brown, J. M. (Eds.). (2012). Evidence-based
practice for nurses: Appraisal and application of research (2nd
ed.). Sudbury, MA: Jones & Bartlett Learning.
nursing (8th ed.). Upper Saddle River: Pearson
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The nursing shortage is a safety issue that I will be addressing
in my Practicum Change Project. Nursing shortages are a
predictable occurrence in healthcare. In the United States alone,
five significant shortages have happened in the last 50 years

(Censullo, 2008).The lack of nurses lasts 1 to 2 years. It is
predicted the by the year 2016 nearly 587,000new jobs will be
on available for new nurses (Aiken, Cheung, & Olds, 2009); the
United States Bureau of Labor and Statistics have determined
there will be a shortage of 581,520 nurses by the year 2018
(Conley, 2012). According to the Joint Commission on
Accreditation of Healthcare Organizations (JCAHO), the
growing shortage of nurses in America's hospitals is putting
patient lives in danger and requires immediate attention. "The
current nursing shortage threatens to heavily impact our
citizens' health and our nations' security preparedness" (Person,
2003). The nursing shortage that is sweeping across the United
States has been upgraded from a health crisis to a national
security concern. A recent study in Pennsylvania found that
surgical patients in hospitals with high patient-to-nurse ratios
experience higher rates of mortality and deaths following
complications. Nurses working in these establishments tend to
experience greater burnouts, job dissatisfaction, which in turn
leads to poor patient care. "A recent national survey found that
an astounding 75 percent of RNs feel that the quality of nursing
care at their facility has declined during the past two years, with
68 percent of RNs citing staffing levels as a major contributing
factor to this problem." (AFSCME, 2003). Accountability is
required in the work arena as the acuity of the patients is high.
Patient satisfaction, complying with the National Patient Safety
Goals, and never events as well as extensive documentation can
be difficult for the nurse transitioning into a new role.
National Patient Safety Goals, and never events as well as
extensive documentation can be difficult for the nurse
transitioning into a new role. The holidays, weekends and
various shifts to meet the demand of the already short nursing
workforce cause some graduate nurses to leave the profession
thus decreasing the nursing supply. Universities and colleges
are not able to meet the growing demands of providing nursing
education and clinical rotations in the associate or baccalaureate
programs (Erlen, 2004). In 2008 more than 40,000 potential

nurses were turned away from universities or colleges for
registered nurses (Aiken, et al., 2009). The inability to access
these programs were due to the lack of nursing instructors for
the classroom and for the practical instruction in the clinical
areas. Individuals feel the shortage is related to decreased job
satisfaction and wages. What this establishes is the lack of
supply or qualified instructors available for meeting the
growing demands for nurses. The lack of educational instructors
causes a decrease in the number of nursing students accepted.
The decrease in the students in the qualified programs causes a
drop in the number of nurses in the market for the vacant or new
jobs. The decline in nursing instructors is due to the educational
requirements of the instructor such as the baccalaureate (BSN)
and masters (MSN) in nursing. The low wages and the
educational requirements to teach nurses keeps many from
becoming instructors (Yucha, Carolyn; Smyer, Tish; Strano-
Perry, Sybil, 2014). According to research and statistics the
demand for registered nurses will continue to grow. The supply
of nurses will increase when the universities and colleges
provide the nursing instructors to meet the demands of the
students. Nursing schools need to find a means to provide
competitive salaries in order to reduce the nursing shortage.
Marginal Analysis
As stated, the second economic tool to discuss is marginal
analysis as it relates to the nursing shortage and health care
facilities. When using cost or revenue as a measure of supply
and demand, the difference between the cost/revenue and supply
and demand is the marginal analysis (Getzen,2007). In the
healthcare field, the marginal analysis can be the cost of the
nursing staff as compared to the revenue generated from the
inpatient admission. When a nursing shortage occurs and there
are not enough nurses to
staff the department, patients may have to be transferred to
another facility. When the transfer occurs, the hospital loses
revenue. To understand the concept better let’s imagine a

patient has come to the emergency department and the
emergency department doctor determines the patient requires an
admission. Before the admission can occur, a decision has to be
made to determine the availability of necessary equipment,
appropriateness of the admission as well as the adequacy and
skills of nursing staff. If the critical decision is made the
resources are available the patient will be admitted. If the
determination reflects the lack of appropriate supplies, nurses or
skills then the decision to transfer the patient will be declared.
Once the patient is transferred to another facility, revenue is
lost. When a trend or increased in the volume of transfers is
higher than a determined rate for the facility measures need to
be put into place to be able to accept the admissions. With the
nursing shortage, the hospitals senior management team must
determine ways to restructure staffing within the hospital to
meet the demands of the admissions. The team may also choose
to hire RN’s on an as needed basis. The marginal analysis will
assist in determining the cost of staff and revenue, it will show
when it is cost effective to hire more nurses or to implement the
restructuring of staff or the hiring of nursing staff. Conclusion
With the projection of nearly 587,000 new jobs by 2016, there
will continue to be a demand for nurses (Aiken, et al, 2009).
The affordable care act may elicit an increase in patients
entering the healthcare arena for the first time in years. The
supply for nurses or nursing instructors is not an overnight fix
to the issue. Increasing the wages for the instructors at the
universities and colleges may retain professors however the
requirements to teach are bachelors and masters prepared
nurses. With the increase in the instructors to teach nursing
more nurses can return to obtain a higher level of education and
an increase in graduate nurses may emerge helping decrease the
nursing shortage? Short staffed health care facilities may not
have to transfer patients to other facilities increasing revenue
and making it cost effective to hire more nursing staff.
References

Censullo, J. (2008). The nursing shortage: Breach of ideology
as an unexplored cause. Advances in Nursing Science, 31(4),
E11-E18. Retrieved from http://search.proquest.com. Conley, B.
(2012). What Does "Shortage" Really Mean? Tennessee Nurse,
75(1), 5. Retrieved
from
http://content.ebscohost.com.ezproxy.apollolibrary.com/pdf29_
30/pdf.
Erlen, J. A. (2004). Wanted-nurses: Ethical issues and the
nursing shortage. Orthopedic Nursing, 23(4), 289-92. Retrieved
from http://search.proquest.com/docview/195969568. Getzen, T.
E. (2007). Health economics and financing. (3rd ed.). John
Wiley and Sons, Inc.: Hoboken, NJ. Yucha, Carolyn; Smyer,
Tish; Strano-Perry, Sybil (2014). Sustaining nursing programs
in the
face of budget cuts and faculty shortages. Journal of
Professional Nursing, 30 (1) 5–9.
http://dx.doi.org/10.1016/j.profnurs.2013.07.002.

Nurses are often pressured into taking short cuts to save
hospitals money. Most of the time, this results in inadequate
care provided to patients. Hospitals have found that with lower
nurse to patient ratios will enhance the ability to recruit new
nurses at lower costs. "Research shows there are concrete costs
of inadequate RN staffing. Nurses report that they are assigned
too many patients to be able to deliver optimal nursing care and
adequately supervise support staff. With too many patients to
care for, a hospital RN might not have time to clean a urinary
catheter frequently enough to prevent a urinary tract infection.
The nurse may not have enough time to ensure that a bedridden
patient is turned, allowing secretions to build up in the patient's
lungs resulting in pneumonia. These are among the hospital
incurred infections that are preventable with appropriate RN
staffing" (Myers, 2003). All these issues therefore lead to poor
patient satisfaction rates in the unit and throughout the facility I
work for.
My Practicum Change Project will address the nursing shortage
safety issue by achieving staffing levels that will provide
optimal patient outcomes, staff satisfaction and organizational
objectives through the development of appropriate “models of
care”. The models should define the roles of technical and
support staff and their responsibilities and delineate scopes of
nursing practice with corresponding competencies. In the
profession of nursing, nurses can be leaders and managers. In
this role, nurses are responsible for the quality of client care
through a process, which is known as quality assurance.
"Quality assurance consists of the quality control activities that
evaluate, monitor, or regulate the standard of services provided
to the consumer" (Lemone & Burke,199 7).
My hospital also need to find ways to retain their nursing staff
by:
1. Respect: recognizing and treating nurses as professionals and
developing collaborative practice initiatives among nurses,
physicians and other disciplines to develop mutual respect and

insisting on work environments free of fear and intimidation.
2. Leadership: Management of health care provider
organizations should support the role of nursing leadership. The
nurse manager’s position description should emphasize
retention of staff at the front line of care delivery. Concurrent
with providing nurse managers the tools to retain
staff, nurse managers must also clearly understand their
responsibility and accountability for nurse retention.
3. Mentoring: Establish effective mentoring programs for new
nursing graduates. Establish mentoring programs for aspiring
nurse leaders; offer mentors to new nurse managers.
4.Continuing Education: Enhance continuing education
opportunities for currently employed nurses through tuition
reimbursement, flexible scheduling, and career ladders.
Continuing education opportunities keep nurses current on
clinical issues and demonstrate organizational
commitment to nurses.
References
American Federation of State, County, and Municipal
Employees (AFSCME). (2003) Is There Really a Nursing
Shortage? The Critical Need to Bring Nurses Back to the
Hospital Industry Retrieved: November 12, 2015 From:
http://www.afscme.org/una/sns02.htm
ASCP Board of Directors (1996, March) ASCP Principles for
Achieving Quality Care in Nursing Facilities. ASCP Online.
Retrieved November 12, 2015 from:
http://www.ascp.com/public/pr/other/principles.shtml
Lamone, P. & Burke, K. (2000) 2nd ed. Clinical Handbook for
Medical Surgical Nursing. Upper Saddle, NJ: Prentice Hall.
Myers, G. (2003, February) Executive Budget Relating to
Health Issues. Retrieved: November 12, 2015 from:
http://www.nysna.org/programs/NPS/testimonies/budgetII.htm
Censullo, J. (2008). The nursing shortage: Breach of ideology
as an unexplored cause. Advances in Nursing Science, 31(4),
E11-E18. Retrieved from http://search.proquest.com.
Conley, B. (2012). What Does "Shortage" Really Mean?

Tennessee Nurse, 75(1), 5. Retrieved
from
http://content.ebscohost.com.ezproxy.apollolibrary.com/pdf29_
30/pdf.
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NURS 4020 Leadership Competencies in Nursing and
Healthcare

Practicum Change Project PowerPoint
Grading Criteria
Create a PowerPoint presentation that summarizes your
Practicum Change Project. Include a minimum of 8 slides (15
maximum) and the following information provided below. The
PowerPoint Presentation is worth a maximum of 200 points and
is posted in Week 6 Practicum Discussion. Points will be
awarded as follows.
Requirement
Criteria
Points
Title Page
Follows APA requirements for the title page
10 points
Describe the proposed change including evidence to support the
project. Identify the quality and safety issue addressed by the
project.
Collaborates with professionals in the facility to discuss the
need for the proposed change.
Identifies the quality and safety issue addressed by the project.
20 points
Describe the change theory and model used as framework for
the project. Apply the steps of the change theory to the project
development process.
Selects one of the major change theories and applies the project
development process to each step of the theory.
Discusses how the project aligns with the facility mission,
vision and values.
30 points
Describe your collaborattion with multidisciplinary team
members.
Describes the members of the multidisciplinary team and their
role in the proposed project.
30 points
Present the proposed budget for the project.

Develops a realistic budget for the project including salaries,
equipment, supplies, education, travel and so forth. Justifies
the need for the budget items.
30 points
Discuss the quality and safety issue addressed by the project.
Discusses the quality and safety issue and how the project will
help decrease the incidence of the issue in the facility.
30 points
Describe dissemination strategies and justify the selection of
the strategies
Describes the most effective way to disseminate the final
project if the opportunity were available to do so.
30 points
A minimum of 5 scholarly references are used in the project
including peer-reviewed research articles and textbooks.
References are current and are peer-reviewed research articles
and/or current textbooks.
20 points
Total
200 Points
Deductions - 25 Points may be deducted for:
Late posting of PowerPoint (Post by Day 4)
Inadequate number of references to support your project.
Errors such as: typos, grammar, spelling, punctuation, syntax,
or lack of APA style or incorrect APA formatted references.

NURS 4020 Leadership Competencies in Nursing and Healthcare Pract.docx

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