Effect of Nursing Shortage and Turnover on In-Patients Running Head: PICOT STATEMENT PAPER 1 Effect of Nursing Shortage and Turnover on In-patients Nursing shortage and turnover is a serious problem experienced in the United States of America (USA) and the world at large. Many states in the USA have inadequate nurses which end up impairing the quality of service given to the patients especially in-patients. The few nurses available cannot completely meet the needs of the patients especially those who critically needs total care and attention. The few nurses available are usually stressed and in a hurry trying to care for a high number of patients which is usually impossible. This situations adds stress to them and increase their chances of quitting the job. Nurses play a pivotal role in caring for these patients especially the ones admitted in long term acute care facilities (LTAC) since they continuously monitor the patients in critical conditions and provide necessary treatments and medicine to save the lives of the patients (Stone et al., 2006). There are various reasons which can be associated with the nurses' shortage and turnover and these include inadequate nursing educators, inequitable distribution of nurses, high turnover rate and aging workforce to name but a few. These problems can be solved by investing in the development of nurses to make them happy and well equipped with the knowledge and skills required to handle their tasks. This can be through training them regularly, giving them a chance to further their education as they work, paying them well and giving them appropriate compensations among other key strategies. PICOT Statement Considering the patients in long term care facilities, do effective investment in the development of nurses compared to the current standards of nurse staffing in the USA essential in improving the quality of care of the in-patients? Clinical problem The shortage and turnover of nurses is an issue that has raised a lot of concern as far as the health of the patients is concerned. This issue has resulted in long patients stay in hospitals, increased bloodstream infections and increased fatalities. The patients in acute long term care units require total attention and monitoring than any other patients requiring basic care. This is to ensure that their conditions are kept in control. In fact, one nurse should only handle three or four patients maximum because of the criticality of these patients. The inadequate of nurses in the section makes each nurse to handle more than five patients and this decreases the quality of care given to these patients and increases fatalities or longer stays. (Thompson et al., 2013). It is therefore vital for the government and healthcare departments to effectively invest in the development of nurses to increase their number, education, abilities, and motivation. There should .

1. Effect of Nursing Shortage and Turnover on
In-Patients
Running Head: PICOT STATEMENT PAPER
1
Effect of Nursing Shortage and Turnover on In-patients
Nursing shortage and turnover is a serious problem experienced
in the United States of America (USA) and the world at large.
Many states in the USA have inadequate nurses which end up
impairing the quality of service given to the patients especially
in-patients. The few nurses available cannot completely meet
the needs of the patients especially those who critically needs
total care and attention. The few nurses available are usually
stressed and in a hurry trying to care for a high number of
patients which is usually impossible. This situations adds stress
to them and increase their chances of quitting the job. Nurses
play a pivotal role in caring for these patients especially the
ones admitted in long term acute care facilities (LTAC) since
they continuously monitor the patients in critical conditions and
provide necessary treatments and medicine to save the lives of
the patients (Stone et al., 2006). There are various reasons
which can be associated with the nurses' shortage and turnover
and these include inadequate nursing educators, inequitable
distribution of nurses, high turnover rate and aging workforce to
name but a few. These problems can be solved by investing in
the development of nurses to make them happy and well

2. equipped with the knowledge and skills required to handle their
tasks. This can be through training them regularly, giving them
a chance to further their education as they work, paying them
well and giving them appropriate compensations among other
key strategies.
PICOT Statement
Considering the patients in long term care facilities, do
effective investment in the development of nurses compared to
the current standards of nurse staffing in the USA essential in
improving the quality of care of the in-patients?
Clinical problem
The shortage and turnover of nurses is an issue that has raised a
lot of concern as far as the health of the patients is concerned.
This issue has resulted in long patients stay in hospitals,
increased bloodstream infections and increased fatalities. The
patients in acute long term care units require total attention and
monitoring than any other patients requiring basic care. This is
to ensure that their conditions are kept in control. In fact, one
nurse should only handle three or four patients maximum
because of the criticality of these patients. The inadequate of
nurses in the section makes each nurse to handle more than five
patients and this decreases the quality of care given to these
patients and increases fatalities or longer stays. (Thompson et
al., 2013). It is therefore vital for the government and
healthcare departments to effectively invest in the development
of nurses to increase their number, education, abilities, and
motivation. There should be adequate schools and nursing
educators to educate and train all the nursing students. As well,
nurses should undergo regular training and education to ensure
they have the necessary skills and education required in their
work. They should be compensated properly and provided with
a conducive working environment which will increase their
working morale (Chandra, & Willis, 2005).
Evidenced-based

3. Solution
The evidence-based solution to increase the number of nurses
and prevent their turnover is effectively investing in the
development of nurses. Proper investment in the development
of nurses includes increasing nurse educators, allowing nurses
to further their education when they are still working, regularly
training them, providing them with proper compensations to
increase their motivation to work and ensuring there is a
conducive working environment. These strategies will increase
the number of nursing students, make nurses happy, motivated
and comfortable when working and will, therefore, reduce their
shortage and turnover. As a result, the quality of care given to
in-patients will improve and the deaths, infections and longer
stays of the patients will also decrease (Thompson et al., 2013).
Nursing Intervention
The role of nurses is very important when it comes to caring for
in- patients. In fact, nurses are termed as “hearts and souls“ of
the hospitals. They are referred to as patients advocates since
they are the ones who spend most of the time with the patients.
They are the ones who administers and evaluate the treatment

4. given to the patient. According to the research, nurses play an
instrumental role in treating and following the patients to
ensure that they are well and healthy and that their condition is
in control (Butcher et al., 2018). They do research on the best
practices for the patients and also educate the patients and their
families on the ways to keep their conditions in control and live
healthy lives. LTAC nurses continuously assess and monitor
their in- patients to ensure that they provide quality and timely
care to safeguard the lives of the patients. They can change
treatments where necessary to better meet the requirements of
the patients. LTAC is a demanding section and requires
adequate nurses to effectively care for the patients. According
to AACCN (American Association of Critical Nurses), each ICU
nurse should only serve one or two patients (Nursing.com,
2018) this also goes for LTAC patients who are high acuity
patients and also require a high level of care.
Patient Care
Patient’s families must be totally involved in the LTAC section
as to be in a position to make important decisions pertaining to
their family member admitted in LTAC especially the vent
patients who do not have advanced directives. The patient’s
families should be given the necessary education to ensure that
they know the need for the provided treatments and
interventions in helping their loved one(s) recover. The success

5. of the intervention will only be realized if the patient’s family
comply with the medical guidelines and effectively collaborate
with the nurses. The nurses regularly assess the patients to
know whether to change or add additional treatments to improve
patients care.
Health Care Agency
Vibra long term acute care care hospitals are out to ensure that
patient live a healthy life. They carry out research regarding
various illnesses and injuries all with the aim of ensuring that
they provide quality care to the patients and help them recover.
The success of the LTAC units is gauged using the rate of
survival for the patients and their stay in the facility. The
research conducted by the clinic shows that after admission to
the LTAC, the patients should undergo physical and
rehabilitation therapy and services to increase their chances of
survival. The research also showed that early mobility services
to the patients after going to the LTAC is vital in decreasing
their stay, the cost of the care, patients and anxiety and as well
improve their strength and functional abilities. The nurses in
Vibra hospital collaboratively work together with the doctors
and specialists in different areas such as speech, language, and
respiratory therapies to ensure they provide the best care to the
patients. In order to provide these patients with the best
interventions, medical services, and therapies, nurses must be

6. adequate to properly meet these requirements.
Nursing Practice
It is the nurses’ responsibility to provide a safe, secure and
conducive environment for the patients to ensure that they live
healthy lives. As well, they should assist the patient’s family to
understand their conditions and the importance of the provided
medications, therapies and interventions (Maier-Lorentz, 2008).
The nurses have a pivotal role in ensuring that the patients stay
in the LTAC is reduced, reduce infections probable to the
patients, reduce fatalities and as well help the patients recover
and have a normal life. When the nurses effectively collaborate
with the patient’s family and other care specialists, it will be
possible to prevent deaths and minimize in-patients stay.
Conclusion
PICOT STATEMENT PAPER
2
The United States has a massive nursing shortage, and the

7. problem is only set to grow. Due to an influx of patients into
our health system, the retirement of baby boomers, and
educational bottlenecks, nursing positions aren’t being filled
fast enough to keep up with demand ("Shocking Truth about the
Nursing Shortage in the United States," 2018). Currently,
Vibra hospital of Springfield is experiencing a high level of
nursing shortage and turn over , this is hugely because of
unstable patient census. When patient census decreases, nurses
are being called off and this affects their pay checks seriously,
when it persists for a long time some nurses can no longer
handle it making them go seek employment elsewhere. When
eventually patient census comes up like it has at the moment,
there will not be enough nurses to take care of these patients
adequately. Many at times the patient to nurse ratio goes up to
8:1 which makes it difficult to give these patients the best care
they deserve.
References
Butcher, H. K., Bulechek, G. M., Dochterman, J. M. M., &
Wagner, C. (2018). Nursing Interventions Classification (NIC)-
E-Book. Elsevier Health Sciences.
Chandra, A., & Willis, W. K. (2005). Importing nurses:
Combating the nursing shortage in America. Hospital Topics,
83(2), 33-37.
Maier-Lorentz, M. M. (2008). Transcultural nursing: Its
importance in nursing practice. Journal of cultural diversity,

8. 15(1), 37-43.
Nursing.com (2018). What Does an ICU Nurse Do? Retrieved
from: https://www.bestmasterofscienceinnursing.com/faq/what-
does-an-icu-nurse-do/
Stone, P. W., Larson, E. L., Mooney-Kane, C., Smolowitz, J.,
Lin, S. X., & Dick, A. W. (2006). Organizational climate and
intensive care unit nurses’ intention to leave. Critical care
medicine, 34(7), 1907-1912.
The Shocking Truth about the Nursing Shortage in the United
States (2018). Retrieved from
https://getreferralmd.com/2017/12/on-the-verge-of-a-nursing-
shortage/
Thompson, D. A., Hsu, Y. J., Chang, B. H., & Marsteller, J. A.
(2013). Impact of nursing
staffing on patient outcomes in the intensive care unit.
Journal of Nursing Care, 2(128),
2167-1168.
Running head: BENCHMARK CAPSTONE PROJECT CHANGE
PROPOSAL1
BENCHMARK CAPSTONE PROJECT CHANGE PROPOSAL
2

9. Daily Chlorhexidine (CHG) Bath in Oncology Patients to
Prevent Hospital Acquired Infections (HAIs)
Daily Chlorhexidine (CHG) Bath in Oncology Patients to
Prevent Hospital Acquired Infections (HAIs)
HAIs are disease process developed by the patients during
hospitalization. According to Centers for Disease Control and
Prevention, (CDC), (n.d),” healthcare-associated infections are
infections that patients acquire during the course of receiving
treatment for other conditions within a healthcare setting”.
Healthy People 2020, (2014) explained that “Modern healthcare
employs many types of invasive devices and procedures to treat
patients and to help them recover. Infections can be associated
with procedures (like surgery) and the devices used in medical
procedures, such as catheters or ventilators” HAI includes
central-line-associated bloodstream infection (CLABIs), urinary
tract infection (CAUTI), surgical site infection (SSI),
ventilator-associated pneumonia (VAP), and the issues of
multidrug-resistant organisms (MDRO), including methicillin-
resistant staphylococcus aureus (MRSA), clostridium difficile
infection, and vancomycin-resistant enterococcus (VRE)( CDC,

10. n.d).
Background
HAIs are significant precipitate of sickness and death in the
United States and are linked to extensive surge in health care
expenses each year. Every now and then, 1 out of every 25
patients admitted in the hospital are affected by HAI” (Health
People 2020, 2014). According to Donskey and Deshpande,
(2016), “Patients colonized or infected with health care-
associated pathogens often carry the organisms on their skin.
Such contamination may lead to infection when factors such as
devices, catheters, and wounds provide a route for pathogens on
skin to reach normally sterile sites. Additionally, Waknine,
(2013) also stated that notwithstanding prevalent application of
evidence-based practice, up to $9.8 billion is disbursed yearly
for management of HAIs, hence infection from wound post
operatively is the most expensive to treat.
Nevertheless, skin infection can correspondingly be a
contributory factor to the spread of pathogens because of
environmental peeling and transference to the hands of
employees. Consequently, there is a solid validation for efforts
to diminish the problem of microorganism on skin (Donskey &
Deshpande, 2016, P 17).
Problem Statement
Several studies on HAIs in United States (U.S) shows a rise in
the infectious process leading to several diseases conditions that

11. escalates costs and secondary complications. It is predicated
that up to 250,000 patients are infected with central line-
associated blood stream infections (CLABSIs) every year. The
expenses for treating individual CLABSI is projected to range
from $16,000 to $29,000, resulting in an additional admission,
and increases the probability of causing death by 35% (Pagan,
2017). CAUTI is also budgeted to be treated with up to $350
million (Saint, Gaies, Fowler, Harrod & Krein, 2014). Other
studies noted varying burden of costs and related death rate that
are applicable to other HAIs (VAP, SSI, BSI). Healthcare
members are supposed to handle patients with central lines,
ports, catheters, v ventilators with extreme caution, observing
strict aseptic protocol when caring for them. HAIs arise when
there is a breach in this protocol.
Purpose of the Change Proposal
Owing to the increase in the incidence of HAIs, in addition to
the percentage of death caused by HAIs and the burden of cost
they create with prolonged hospital stay, the writer planned to
get to the root of the problem by conducting a study to
recommend a change among oncology patients in writer’s unit.
The recommendation for change is likely to enhance patients’
survival rate, prevent infection, reduce hospital stay as well as
increase satisfaction and reduce costs. Additionally,
recommendation for change is supposedly anticipated to help in
educating the healthcare providers based on evidence-based

12. practices aimed to reduce/prevent HAIs by using chlorhexidine
gluconate daily in bathing patients susceptible to HAIs.
PICOT
The utilization of the PICOT question formula has made the
development of answerable research question easier and can be
used to note if planned change actually occurred. The writer of
this work used a PICOT declaration which was useful in the
provision of positive rejoinders to the research question, “In
Adult Oncology patients, does the use of Daily CHG bath
compared to use of soap and water affect the incidence of HAI
(CLABSI) throughout period of hospitalization.
Literature Search Strategy Employed
The writer of this work acknowledged EBP