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IN THE FIELD OF HEALTH CARE EVIDENCE BASED PRACTICE IS MOST IMPORTANT FOR MOST ACCURATE CARE AND TREATMENT.FOR THIS PURPOSE RESEARCH IS COMPULSORY.THIS PRESENTATION TELLS ABOUT THE IMPORTANCE OF RESEARCH,LEADERSHIP AND MANAGEMENT IN NURSING.
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Running head Analysis of a pertinent healthcare issue 1Analysi.docxtoddr4
Running head: Analysis of a pertinent healthcare issue 1
Analysis of a pertinent healthcare issue 9TITLE
STUDENT
SCHOOL
As you all know, healthcare is always in high demand. With such a growing demand for healthcare services creates an even greater demand for health providers. Because the populations demand for healthcare is ever-growing and lack of health providers is on the rise, patient care deficits are prevalent. Patient care is not being met because there simply aren't enough providers to provide care for every patient in need. On the other hand, health care providers and organizations are suffering too. The workload is very strenuous on healthcare providers and detrimental to healthcare organizations. In our organization we are affected by this by having an overwhelming demand of patients in our emergency rooms and an underwhelming amount of staff to accommodate these patients.
In more detail this affects our organization by causing an increase in nurse burnout, 30-day readmits, and poor patient satisfaction scores to name a few examples. Heavy workload environments along with poor patient to nurse ratios contribute significantly to nurse burn out (Norful, 2018). Because of this, the chances of nurses making medical errors are more likely. As a result, our organization chances of liability for medical errors are increased. If patient care was not provided adequately because of lack of providers, many patients will come back to the hospital within 30 days. When this happens often insurance companies find the hospital responsible and will not pay (Park, 2018). As a result, the hospital is held accountable for lack of care and suffers financial losses. Satisfaction rating by patient often result in greater financial opportunities for our organization. A lot of patient dissatisfaction responses came from their needs not being meet. Things such as time spent with physicians and wait time to be seen are common issues.
Now that we know what the issue is what are we going to do about it? Though the lack of healthcare providers is a prominent issue for all healthcare entities it is not a new. For years studies have been conducted to help alleviate this issue. In a study, advanced scheduling was used to alleviate high wait times and overall continuity of patient care (Qu, 2007). The daily health care provider demand was examined along with the patient need to create a schedule that consist of adequate provider to patient ratios. As a result, healthcare providers were not overbooked, and patients had less of a wait time and more time spent with providers.
In another study, federal qualified health centers were initiated in order to decrease the shortage of health providers (Xue, 2018). These health centers provided underprivileged communities that did not have access to health care facilities, a place where they could be seen by primary providers. As a result, the demand for healthcare providers decreased in the e.
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 .
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Unit 1Emergency Department Overcrowding Due to L.docxwillcoxjanay
Unit 1
Emergency Department Overcrowding Due to Lack of Access to Primary Care
Teresa Cochran
November 12, 2015
Emergency Department Overcrowding Due to Lack of Access to Primary Care
Emergency Department overcrowding related to patients seeking care for non-emergent conditions is an increasing concern for hospitals across the country. In rural areas, this issue is of concern not only for patient care but also has an impact economically on hospital financial viability.
Current Situation
Emergency Departments are designed to provide expedient care for individuals with emergent, life-threatening situations. However, in the current state, emergency departments are increasingly serving as a source of providing primary care. The resulting inappropriate use of the emergency department for non-emergent visits has been shown to increases cost, impact patient safety and quality.
Healthcare organizations must find and development innovative methods to provide quality patient care while maintaining low cost and maximum efficiencies. While demand for Emergency Services grows in part due to an aging population, the volume also has grown due to lack of primary care physicians and patient preference. The financial pressures faced by hospitals due to reductions in reimbursement necessitate a restructuring of the standard model of healthcare care delivery.
Problem Statement
As the population continues to grow emergency departments will continue to see not only acute illness but more chronic illness. It is essential for health care systems to continue in developing new and innovative means related to optimization of care delivery. Specifically this will identify factors that affect overutilization of the emergency department by individuals that are more appropriately treated in the primary care setting. Therefore, the increasing use of emergency departments will impact overall patient care due to lack of continuity that is provided in the primary care setting for chronic illness.
Research Objective
This research proposal will evaluate the feasibility of incorporating a medical home into the emergency department setting, therefore, reducing overcrowding in the Emergency Department. This increased access to primary care will ultimately increase access to quality care in the most appropriate cost-effective setting
Research Question
The intended purpose of this research proposal will examine the concept volume and acuity of patients seen in the Emergency Department. The following questions will be addressed. What measures can be implemented to reduce the overutilization of the ED yet offer the appropriate level of care for the patient? What barriers are associated with accessing sustained primary care?
Hypothesis
In order to improve outcomes, healthcare organizations must evaluate the feasibility of healthcare redesign related to the delivery of care. By restructuring how and where care is delivered will reduce the number of non-eme ...
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1. RUNNINGHEAD: Strict Patient-Nurse Ratio Policy 1
Student Name:
Strict Nurse-Patient Staffing Ratio Policy
Course Name:
Course Instructor:
Date of Submission:
Introduction
The policy that was to be implemented was a strict nurse-patient staffing ratio. This issue
was a priority because the nurses were experiencing horrific stories when their patient ratio got
out of hand. A nurse who was working on a 36-bed med-surgical unit in an inner city hospital in
2. RUNNINGHEAD: Strict Patient-Nurse Ratio Policy 2
New York had a direct horrific experience in regard to the matter. The nurse was working on an
eight-hour night shift. Owing to call-outs, the regular nurse-to-patient ratio of 1: 7 was not
observed. Instead the nurse was to attend to eighteen patients. There was a policy in the hospital
that prevented nurses from the specialty areas to be floated to the other units. From that stand,
there was no in-house help and the nurse had to frantically attend to the eighteen patients until a
third nurse came in two hours later.
Any nurse with a group of acute care, sick patients was bound to get overwhelmed. The
nurse was completely overwhelmed with the task to an extent of forgetting the patients to be
attended. A nurse working with such large number of patients could not be able to administer
adequately to them. The patient stood to suffer from harm since the nurse would practically fail
to monitor them well in the way they were responding to the treatment. On the side of the nurse,
he would be overworked and overwhelmed which reduced his normal performance terribly even
after getting a relief and assignment of the normal ratios. In the community hospitals, the nurse-
to-patient ratio was 1:8 in the med-surgical unit. On the progressive care unit, the ratio was 1:5.
When there was a call-out and a nurse was floated from another unit, assignments had to be
switched so that the floated nurse had no IV drip or IV push cardiac medication. In addition,
each nurse had to oversee one or two of the float nurse’s monitored patient. Hence, the nurses
became overloaded with work. Technically, the nurse-to-patient ratio then is 1:7 which puts the
patients in danger of being harmed.
There was an incidence when with the technically 1:7 ratio, three patients of a nurse
coded, one after the other. The nurse had no time to look in on the other patients or to monitor
their charts. It was impossible for the nurse to do so since the three of his patients ended up in the
ICU. The nurse was frazzled and headed home three hours later after the expiry of his normal
3. RUNNINGHEAD: Strict Patient-Nurse Ratio Policy 3
twelve hours shift. He was scheduled to work that night too which left him exhausted and
questioning the satisfaction of his job.
Specific Problem
When patients were acutely sick, the amount of patients a nurse had needed to be
controlled to protect the patient from harm. Ratios were not only a good idea but they were
necessary for the safety of the nurse and the patient. There was a growing concern that
inadequate staffing was harming the patients. The harm was mostly in the areas where there was
critical illness or the need of extra care. In the cases where nurses were assigned more than the
usual number of patients or in the event that there was a high patient turn-out in a shift; the
patients experienced high mortality rates. A legislation mandating minimum staffing ratios was
required to ensure long-term sustainability. Research showed improvement in patient outcomes
with improved nurse-to-patient staffing ratio. When nurse-to-patient ratios were as depicted by
the California law in the three states (California, New Jersey, Pennsylvania) the nurses' were
significantly satisfied with their job. The nurses and the patients reported better care and
improvement in the quality of the health services provided. (Aiken, et al., 2010). It was vital that
a mandatory nurse-to-patient staffing ratio policy be implemented to alleviate nurse workloads,
increase job satisfaction, and ultimately, produce better patient outcomes (Tevington, 2011).
Also, many studies had established that larger nurse-to-patients ratio contributed to poor patient
outcomes. The outcomes were medical errors, complications and more patient deaths. (McHugh,
Kelly, Sloane & Aiken, 2011). A survey was carried out in 2003 (NEPPC, 2005) and two thirds
of the MNA members were positive that insufficient nursing care brought serious medical
complications and could be fatal. The survey found that, more than 85% of the nurses felt that
they were being overworked in terms of the patients they were forced to take care of. Many
4. RUNNINGHEAD: Strict Patient-Nurse Ratio Policy 4
studies by other organizations like the Health Research and Quality, Joint Commission on the
Accreditation of Health indicated try tract infection, pneumonia, ulcers, sepsis, cardiac arrest,
gastrointestinal bleeding and a longer hospital stay. In some cases, death could occur.
The Significance of the Implementation of the Policy
1. Implementation of mandatory nurse-to-patient staffing ratio: 1. 5 protected the patient.
Caring for twelve patients was accompanied by difficulty in remembering all the
specifics of all the patients. It was almost impossible and not safe.
2. There was need to protect the nurse whose licenses were directly in the line when they
were required to take care of large numbers of patients, that was not practically possible
with a normal human being.
3. The policy would also serve to keep facilities honest and prevent them from assigning
nurses too many patients as they felt was possible.
Thoughts on Issue
The issue of the patient-nurse ratio had been having controversies as to which ratio was
exactly the most optimum level. The level was in regard to ensure patient safety and the quality
of health services they received. The nurses on the other hand were not to be overworked or
underworked. The assigned number of patients a nurse was to administer to was a critical point
of examining. The time allocated for each shift was also very important as long hours of work
would cause fatigue and affect quality of the performance negatively. The state and the local
Government were entirely left with the choice as to the right nurse-to-patient ratio. However, it
5. RUNNINGHEAD: Strict Patient-Nurse Ratio Policy 5
was very important for qualitative research is done and a recommendation be done based on this
rather than implementing a policy blindly.
Current Status of Issue
The situation that had left the state entirely to making the choices as to what ratio was
adequate was challenged in the year 2013. Many bills that included the legislation to implement
nurse- patients staffing regulations were introduced. (Melissa, 2014) However, the congress had
not taken any action on the bills apart from referring them to committees. In California, they had
a policy that restricted their ratios to 1:5 in their hospitals. They also prohibited against
mandatory overtimes. Many states were following suit with some states requiring the hospitals to
have a staffing regulation committee that would oversee the staffing depending on the nature of
the hospital. An act that was called the Florida Hospital Patient Protection act was filed in the
senate and the state house. The bill set terms of the nurse to patient ratios to be varying from one
registered nurse attending five patients. The bill set terms that the registered nurse would even
attend to one patient for patients receiving conscious sedation, active labor, in trauma or in
operating room. However, the bill lay in the hands of the committee and no further action had
been taken.
Conclusion
1. The nurse-to-patient ratio was found to be the key in ensuring patients` safety, protecting
the nurses and ensuring the overall quality of the health service.
6. RUNNINGHEAD: Strict Patient-Nurse Ratio Policy 6
2. The adequate ratio was in question but it was felt that, a ratio of 1:5, and varying to one
depending on the critical level of the patient was advocated for
3. California was the only state that had implemented such a law, but it had been in practice
for a very short time to warrant its benefits
4. The health providers should were hand in hand with the state and the local Government
to establish the best way to go about it
5. For long term sustainability, a legislation that mandated the maximum staffing ratios was
important. The legislation would be important because it would take more time to amend
it than hospital policies which could be amended anytime.
7. RUNNINGHEAD: Strict Patient-Nurse Ratio Policy 7
References
Melissa L (2014) Nurse Unions Continue to Push for Nurse-Patient Ratio Legislation.
Retrieved on 12 Nov, 2014 from: http://www.littler.com
NEPPC, (2005) Nurse-to Patient Ratios, Research and Reality. Retrieved on Nov 12,
2014 from: http://www.bostonfed.org/economic/neppc/conreports
LH Aiken. (2010) The Aiken Study:DPEAFLCIO. Retrieved on Nov 11, 2014 from:
Tevington P. (2011). Mandatory Nurse-Patient Ratios. Retrieved on Nov 11, 2014 From:
http://www.ncbi.nlm.nih.gov/
MD. McHugh. (2011) Contradicting Fear, California`s Nurse-to-Patient Mandate.
Retrieved on Nov 11, 2014 from: http://www.ncbi.nlm.nih.gov/