Running Head EVIDENCE-BASED RESOURCING PLAN .docx

Running Head: EVIDENCE-BASED RESOURCING PLAN
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EVIDENCE-BASED RESOURCING PLAN
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Heart Failure Clinic Resourcing Plan
Samantha M. Tallarine
Capella University
Nursing Leadership & Management
April, 2019
Introduction
The major cause of causes of patient disability across most parts
of the world is a chronic disease. Therefore, most individuals
usually seek medical care and are responsible for more than
seventy-five percent of the aggregate spending in healthcare.
Congestive heart failure (CHF), one of the most serious
ailments, is a result of the failure of the heart to pump sufficient
oxygen as well as blood to various parts of the body. More than
14 billion people across the world suffer from heart problems,
and heart failure causes more than 60,000 deaths annually.
Additionally, congestive heart failure costs nations like the

United States, for instance, approximately $35 billion within
one year (Hogle, 2016). This paper is intended to seek the best
strategies that can help in the development of a budget plan,
which will help in the establishment of an effective heart failure
clinic.
Resourcing Healthcare Services
It is exigent for healthcare service provider administrators
to work behind closed doors to ensure that the welfare, as well
as the financial security of the healthcare facilities meets the
standards that are required. This clearly shows that healthcare
facility administrators have to identify all the factors which if
not well facilitated within the budget plan for the clinic may
result in a financial crisis for the institution. Therefore, the
business plan for the healthcare facility should be able to
identify all the categories as well as the subcategories of the
budget which are important or essential to be able to set up an
effective heart failure clinic.
Labor Costs
According to the Center for Disease Control (CDC), staff
benefits, as well as wages, engross up to approximately 60 to 70
percent of healthcare facility expenditures. Likewise, labor
costs from other sources consumed approximately twelve
percent of the healthcare expenditures. The American Hospital
Association put into consideration assumptions for the above-
stated figures. The major assumption is that in any service-
based business providing healthcare services, human capital is
the most important type of capital which is used daily. This
clearly shows that the clinic should be able to give an
approximation of the expenditure from labor; it should also be
able to cater for all the expenditure, which results from labor
(Roman, 2016).
Insurance Billing
The is also another component of the healthcare business
plan which is very crucial; most healthcare facility revenue is
usually earned from insurance services which are billed on
patients upon seeking health care services from the hospital. It

is therefore sufficient to say that the heart failure clinic billing
will come from various sources, which will vary from private
insurance companies, or Medicare and Medicaid, depending on
which population we are dealing with. Regarding the
impoverished patients, the health care facility management
should organize for them to seek healthcare services from the
county or government healthcare facilities. The clinic should
also look into creating funds for those patients whom do not
have insurance or means to pay for the clinics resources,
because the goal of the clinic is to provide care to all patients
regardless of their financial situation. That being said, it may be
possible to have some of the supporting cardiologists that are
part of the staff willing to donate their time pro-bono.
Capital Expenses and Supplies
The hospital expenditure is partially consumed by the
supplies; the total supplies may consume 30 to 40 percent of the
total expenditure in the healthcare facility. Generally, in a
healthcare service business, the supplies are the ones which are
required for the purpose of providing sufficient healthcare
service to the patients. The funds to cater for all the supplies in
the medical care facility are supposed to come from the billings
earned from the services provided to the patients. Since the
clinic is at the first stages of set-up, the construction process
will require huge capital expenditures and hence the facility
might require donations from relevant sources such as the
county government; the donations will be used to cater to the
equipment needs as well as any other emergent expenditure
(Hsieh, 2017).
Contingency Funds/Liability Costs
Bearing the fact that we live in a contentious society, the
healthcare facility will probably have to protect itself in case of
legal confrontations. Errors in patient care or any other
operations within the healthcare facility cannot be ruled out.
Hence, it is very crucial to undertake contingency measures in
the process of setting up the facility. As a result, the clinic
would be smart to set up or establish professional liability

insurance for themselves and their employees (Araujo, 2015).
An example of the contingency fund is the start-up expenses;
these expenses for the clinic can be divided into two major
categories; equipment purchase, which will require
approximately $16,000, and site renovation, which will cost
approximately $5,000. These are among the major stages of the
start-up process; the total expenditure will be approximately
$21,000.
Legal and Professional Standards
The most important thing to do when helping patients is to
ensure that you adhere to medical procedures which are
outlined. The nurses should not only assess every patient on a
personal basis but should also surrender a portion of the control
of the treatment to the patient's capacity as well as readiness to
self-screen. This will play a hand in helping to reduce the cost
of the provision of outpatient services. It will also ensure that
the patient has a sense of autonomy in their own plan of care,
and can help to motivate them to care for themselves when they
are outpatient.
An emotionally intelligent leader would be optimal for the
clinic. “Emotionally intelligent leaders are sensitive to their
own and their followers’ well-being, feelings and emotional
health, and they develop effective personal relationships while
directing followers to common work goals” (Cope & Murray,
2017). This would allow the leaders of the clinic to inspire their
employees to do their best work, and connect with the patients
on a personal level. In forming these relationships with the
patients, it can help motivate them, and can help to ensure that
there are no re-admissions, not only within 30 days, but for
much longer.
Conclusion
In conclusion, there are many different aspects that will go
into creating the budget for the heart failure clinic. First and
foremost, the budget for the actual office space will obviously
come into play. From there, the cost of supplies and actual
medical staff will be the majority of the budget. In ensuring

adequate staffing ratios, and that the clinic is fully stocked, we
can make our patients feel individualized care, and help them to
heal efficiently. Most of the patients who are not insured
usually fear the doctor's office as a result of the expenses they
may incur, but by providing a pro-bono fund we can help those
who are in the most need. This will allow us to help patients
from all financial backgrounds. Therefore, healthcare
professionals in the clinic need to be educated enough to help
them understand the cost of an office visit about the cost of
pharmaceuticals, laboratory testing, diagnostic radiology as
well as an emergency room visit if it is needed.
The people with the most accountability for this project
are the upper management employees, especially the nursing
staff. Since nurses will predominantly run the clinic, it is their
responsibility to ensure patients are not being re-admitted
within 30 days, and that they are thriving on an outpatient basis.
In order to measure the success of the clinic there needs to be a
tracking system in place for patients, and there needs to be a
survey system set up so that we can hear feedback from patients
once they are discharged about what we can improve for them.

Resources
Cope, V., & Murray, M. (2017). Leadership styles in
nursing. Nursing Standard (2014+), 31(43), 61.
doi:http://dx.doi.org.library.capella.edu/10.7748/ns.2017.e1083
6
Glied, S., Ma, S., & Solis-Roman, C. (2016). Where the money
goes: The evolving expenses of the US health care
system. Health Affairs, 35(7), 1197-1203.
Hogle, L. F. (2016). Data-intensive resourcing in
healthcare. BioSocieties, 11(3), 372-393.
Łyszczarz, B. (2018). Indirect costs and public finance
consequences of heart failure in poland, 2012–2015. BMC
Public Health, 18
doi:http://dx.doi.org.library.capella.edu/10.1186/s12889-018-
6034-0
McPake, B., Squires, A., Agya, M., & Araujo, E. (2015). The
economics of health professional education and careers: insights
from a literature review. The World Bank.
Sloan, F. A., & Hsieh, C. R. (2017). Health economics. MIT
Press.
Running head: HEART FAILURE CLINIC 1
HEART FAILURE CLINIC 2

Heart Failure Clinic – Discharge Education Plan
Capella University
Heart Failure Clinic Care Plan
April, 2019
Heart Failure Clinical Care Plan – Discharge Education Plan
Heart failure (HF) is one of the three leading causes of
death, and the most prevalent chronic disease in the United
States. “Readmission rates for HF patients are astronomically
high, with up to 25% of hospitalized patients with HF requiring
readmission within 30 days of discharge. The Hospital
Readmissions Reduction Program (HRRP) of the Patient
Protection and Affordable Care Act aims to address these
concerns by financially penalizing institutions with
unacceptably high risk-adjusted 30-day readmission rates for
HF patients.” (Smith, Fleming, & Gros, 2018) With this new
act, they are putting added pressure on already stretched thin
hospital organizations. In making a completely separate
outpatient clinic strictly devoted to heart failure, the hospital is

taking a step to help decrease the astronomically high
readmission rates, and offering the community much needed
resources.
Patient education is critical in order to decrease
readmission, and to reduce the chance of complications and
unnecessary hospitalizations. That being said, the most
important part of this new clinic will be in discharge planning,
and teaching patients and their caregivers accordingly. It needs
to be understood by the patient and their family that heart
failure is not going to be cured, but it can be managed and the
symptoms can be treated. Medication management and dietary
changes are the best way to combat the symptoms of heart
failure, so before the patient can be discharged we must ensure
that they understand what medications they are taking, why they
are taking them, and how they should be taken.
“It has been long noted in literature that nursing care can
reduce costs, improve patient satisfaction, and improve health.”
(Mensik, 2013) With greater nursing care comes a lower cost
for healthcare, and fewer readmissions. The brunt of this
pressure falls upon the shoulders of the nurse leaders across the
country. In this specific scenario, nurse leaders are extremely
important because nurses will run this clinic with the assistance
of cardiologists. Day to day responsibilities fall under the
nurse’s jurisdiction, which means the leaders, will be
accountable for all their subordinates. The whole staff needs to
come together and work as one in order to provide exceptional
patient care and education.
“Unfortunately, nursing divided the nursing scope into different
functions to be completed by individual RNs, as opposed to
being a part of the overall scope of all RNs. This division of
labor is seen as today’s case managers, utilization managers,
patient care coordinators, and others who are separate from
clinical RNs. Clinical RNs in many settings have been limited
to part of their professional scope, such as assessments,
interventions, and education, and no longer feel care
coordination may be a part of their role or professional

responsibility. If nursing is to have an active role in
transforming health care, it will need to shift more nursing care
from the bedside in a hospital to the outpatient and community
settings through care coordination.” (Mensik, 2013) That being
said, it is up to the nursing leaders to include all team members
in each aspect of the day-to-day operations in order to make this
clinic run smoothly and efficiently. Accountability falls on each
nurse individually as well as their leader; to reduce errors, and
make sure the staff is working in peak form there must be safe
nurse to patient ratios, and adequate staffing in all areas.
In order to manage the clinic efficiently there are many
questions that need to be addressed regarding day-to-day
operation, and how to make sure the patients are receiving
optimal care. There needs to be a clear cut discharge plan, and
it needs to start as soon as the patients are admitted. Although
there are current standards for heart failure, the staff needs to
realize that every case is not textbook, and they need to treat
each patient individually. In doing so, the patients will feel
more motivated to take part in their care, and this will hopefully
lead to compliance with medications and lifestyle outside of the
clinic.
Upon admission, in compliance with the most recent heart
failure guidelines, the first thing that will be explored is the
patient’s biomarkers with a simple blood test, and along with
that, a baseline complete blood count (CBC) and complete
metabolic panel (CMP). In doing this first before any treatment
is administered it allows the staff to see the patient’s initial
results, and establish a baseline of which to work with and they
will know what goals to set for each individual patient. Next,
symptomatic treatment will happen in order to ease the patient’s
anxiety that they are sure to be feeling. This will most likely
include medications, and continuous monitoring of vital signs.
Throughout all of the steps in the admission process, teaching
needs to occur; even if the patient says that they already know
everything they’re being told. Education is the key component
in reducing readmissions, and therefore it needs to have the

biggest emphasis in the clinics care of plan.
Along with patient education, their family members and
loved ones also need to be educated in order to help care for
them once they are discharged. The number one way to ensure
that our teaching is effective is to have the patients and their
caregivers use the teach back method, and reiterate everything
back to the staff members. With education being so important
the staff needs to start giving the patients their discharge
information upon admission, and throughout their whole stay.
There also should be information sessions set up on a weekly
basis that people can attend when they are outpatient.
The staff is sure to come across patients of different races
and ethnicities, which can be challenging when it comes to
educating them. “Recommended techniques to increase cultural
competence in heart failure management include: the use of
professional interpreting services, the use of appropriate
education materials, the recruitment of ethnic minority and
bilingual staff and the training of staff in cultural competency.”
(Brennan, 2015) These are all different ways the clinic can
accommodate those whose first language is not English, and
make sure the patient feels comfortable receiving help from the
staff, and that they fully understand their plan of care.
This clinic can be extremely helpful in reducing
readmissions within 30 days for patients with heart failure. The
nursing staff will be in control, and in doing so will ensure that
patients are receiving the highest level of care. Each patient
will be treated according to current heart failure guidelines and
be made to fully understand their care of plan, as well as their
discharge plan. All patients will receive the same level of care,
and will be accommodated accordingly even if they are not
fluent in English. Translation services will be available for all
possible languages (including American Sign Language), and
there will also be bilingual staff on hand. In taking all the
proper precautions and ensuring proper education, we will be
able to measure the clinic’s effectiveness over time by the
reduced admission rates.

Resources
Brennan, E. J. (2015, November 11).
1004BritishJournalofNursing,2015,Vol24,No20©2015MAHealth
careLtd Heart failure care for patients who do not speak
English. Retrieved from
http://web.a.ebscohost.com.library.capella.edu/ehost/pdfviewer/
pdfviewer?vid=1&[email protected]
Hobbs, J. K., Escutia, D., Harrison, H., Moore, A., & Sarpong,
E. (2016). Reducing hospital readmission rates in patients with
heart failure. Medsurg Nursing, 25(3), 145-152. Retrieved from
http://library.capella.edu/login?qurl=https%3A%2F%2Fsearch.p
roquest.com%2Fdocview%2F1798714013%3Faccountid%3D279
65
Mensik, J. S. (2013). Nursing's role and staffing in accountable
care. Nursing Economics, 31(5), 250-3. Retrieved from
65
Smith, K., Fleming, J. P., & Gros, B. (2018). Editorial:
Transitional care clinics to reduce 30-day readmissions in heart
failure patients. Cureus, 10(1)
doi:http://dx.doi.org.library.capella.edu/10.7759/cureus.2069
Sterne, P. P., Grossman, S., Migliardi, J. S., & Swallow, A. D.
(2014). Nurses' knowledge of heart failure: Implications for
decreasing 30-day re-admission rates. Medsurg Nursing, 23(5),
321-329. Retrieved from

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Tait, G. R., Bates, J., LaDonna, K. A., Schulz, V. N., Strachan,
P. H., McDougall, A., & Lingard, L. (2015, August 19).
Adaptive practices in heart failure care teams: Implications for
patient-centered care in the context of complexity. Retrieved
from https://www-ncbi-nlm-nih-
gov.library.capella.edu/pmc/articles/PMC4547636/
Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey, D. E.,
Colvin, M. M., . . . Westlake, C. (2017, April 28). 2017
ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA
Guideline for the Management of Heart Failure. Retrieved from
http://www.onlinejacc.org/content/early/2017/04/20/j.jacc.2017.
04.025?_ga=2.96365141.896462440.1554532261-
762466827.1551779369
Zaya, M., Phan, A., & Schwarz, E. R. (2012). The dilemma,
causes and approaches to avoid recurrent hospital readmissions
for patients with chronic heart failure. Heart Failure Reviews,
17(3), 345-53.
9256-0
Running head: RESPONSE PLANS 1
RESPONSE PLANS 2

Response Plans
Capella University
Response Plan
March, 2019
Response Plan for Inpatient Nephrology Unit
Change Theory
Kurt Lewin had a change theory that involved three stages
of change – unfreeze, change, refreeze. In this theory the basic
idea is that in order to implement change you need to do away
with current practices, implement the change, and then continue
on with the new changes. In breaking down the system to see
why patients are having an increased length of stay and
implementing new guidelines and procedures to correct this
problem, we are benefiting both our patients and our facility.

The main focus is to optimize our patient’s health, and to also
provide quality care to as many people in need as possible. If
we have the same patient’s day after day with increased stays
just for simple reasons such as recording intake and output and
performing daily weights we are doing the community a
disservice, and preventing new patients from receiving help.
Strategies and Rationales
In order to effectively care for the patients within the unit,
doctor’s orders must be carried out dutifully. Nursing is a career
that includes the continuity of care, which means that when it
comes to patient care it is not specifically set to one shift or
another. In truth, weights need to be taken during both shifts
and intake and output records need to be continuous. The
patient should be weighed before breakfast, before dialysis, and
after dialysis. This means that the schedule of their care will
revolve around their dialysis schedule and that both shifts will
have to do their part.
In dealing with intake and output, it will be mandated to be in
the chart at the end of each shift, therefore giving the oncoming
shift a clean slate to deal with. This will need to be included, as
part of the bedside shift report, and each nurse needs to hold the
other accountable. Also, each patient’s space needs to be
marked with a “Strict I&O” sign to act as a reminder for all
healthcare workers. Leadership also needs to make the patients
aware that they are part of their own healthcare team and that
they need to make sure to communicate with their nurses what
they drink, and how many times they use the bathroom.
As a manager, with the help of the supporting staff, they will
need to scour the EMR (electronic medical record) and see who
exactly needs to be spoken to about their charting habits. In
speaking with staff individually it allows the opportunity to
educate them on what they are doing wrong, and how they can
fix their mistakes. It also opens up the communication line for
them to be able to ask questions, and to let them know how
serious upper management is about this issue. This would
require an emotionally intelligent leader in order to keep the

staff working together and efficiently. “Emotionally intelligent
leaders are sensitive to their own and their followers’ well-
being, feelings and emotional health, and they develop effective
personal relationships while directing followers to common
work goals.” (Cope & Murray, 2017)
Expected Outcome
After implementation of the new protocols, the hope is to see
patients having decreased stays, as well as the opportunity to
treat more people from the surrounding community. On top of
providing quality care to the patients, I hope to also instill a
sense of camaraderie between the different shifts of nurses. As
stated earlier, nursing is a career that includes the continuity of
care, therefore there needs to be teamwork not only among
those on the same shift, but also those to follow the care after
them. In promoting this positive attitude in the work place I
believe only good things can come about, and the patients will
benefit immensely.
Professional Standards
Professional standards need to be in prime function for the
good of the patients. In order to ensure they are receiving
optimal care the nurses need to make sure that each step of the
nursing process is being implemented and that every staff
member is doing their due diligence. The nursing process
ensures that nurses stay within their scope of practice and
operate under legal pretenses. If they stray from this process
they can be operating outside of their scope of practice, which
opens them up to legal action being taken against them.

Response Plan for School Nurse
Change Theory
Ronald Lippitt was a theorist who presented a change
theory that was similar to the actual nursing process. I think this
would be the best approach to handling this particular issue of
educating adolescents on practicing safe sex, and having their
parents on board with it. The theory is broken down into seven
phases within four elements as follows:
Assessment:
Phase 1: Diagnose the problem
· 15% increase in students contracting sexually transmitted
diseases and three girls in the junior class are pregnant
Phase 2: Assess motivation and capacity for change
· The community insists on only teaching abstinence, and the
school board does not want to anger the parents. There is almost
guarantee to receive resistance to new policies being put into
place.
Phase 3: Assess change agent’s motivation and resources
· The problem is a growing community health issue, and needs
to be corrected immediately. With proper knowledge, and
providing adolescents with resources to practice safe sex the
budding epidemic can be decreased greatly.
Planning:
Phase 4: Select progressive change objective
· Educate adolescents on the benefits of abstinence, but also
prepare them for when they do start having sex.
Phase 5: Choose appropriate role of the change agent
· Sex education needs to be included in health class for the first

year of high school in order to educate the students effectively.
Implementation:
Phase 6: Maintain change
· Let parents be active in classes, and offer resources to attend
family counseling to help open communication between the
parents and their children.
Evaluation:
Phase 7: Terminate the helping relationship
Strategies and Rationale
As stated above, the plan is to implement a sex education
class and integrate it into the school curriculum. It would be
most effective for incoming freshman to take as part of their
health class. The class will first and foremost preach abstinence,
and all the benefits of abstaining, but it will also educate the
students about safe sex practices and the dangers of having
unprotected sex. Most high school age kids fear pregnancy as
the repercussions of having unsafe sex, but they are not even
aware of all the different STD’s they can contract.
In order to not anger the parents, the school board needs to
step in and explain the necessity of this new program. The
parents need to be made aware of the growing problem, and they
should also have the opportunity to see exactly what will be
taught to their children. In giving the parents a say in the
curriculum, maybe it will make them more open to educating
their children properly. The school can also set up family
counseling sessions to help initiate conversation within the
home, and not make the subject of sex so taboo.
A resonant leader would thrive in this scenario because
they would be able to connect with their employees, as well as
their patients. Resonant leaders are able to draw on their
emotions, which would be perfect in this scenario in dealing
with parents. They are especially effective when it comes to
conflict resolution, which there is sure to be a lot of when
you’re dealing with angry parents.
Expected Outcome
A hopeful outcome would be that sexual education is

implemented into the school curriculum, and there is a decrease
in overall instances of sexually transmitted diseases. Initially,
the school board may experience some push back from the
parents who are so adamant about abstinence, but the goal is to
ultimately have the parents on board with the new curriculum.
In involving parents in the classes, and offering counseling
sessions the school can open up communication within families,
and also educate these students to make the best possible
choices. In educating them on both abstinence and safe sex
practices, it can be ensured they have all of the information
needed to make good choices.
Professional standards are extremely important in this
particular case because they are dealing with both children and
their parents. It is also a massive health concern to allow the
current practice to stay in place; therefore it is significant to
make sure these kids are practicing either abstinence or safe
sex. In the process of educating both the students and their
parents it is of the utmost importance to remain professional,
and be aware of the sensitive material in which they are
teaching.
Response Plan for Pediatric Vaccinations
Change Theory
Lewin’s change theory would fit best in rectifying the
problem of pediatric vaccinations for this scenario. The three
step process – unfreeze, change, refreeze – allows you the time
to examine the whole situation, keep what is working, and
change what needs to be changed. If parents continue on the
path of not vaccinating their children then the chance of herd
immunity greatly decreases, and those who are not eligible for
vaccination are at an even greater risk. As the manager of the
pediatric unit it is their responsibility to make sure the staff can

educate the parents in a respectful manner, and be non biased in
their assessments.
Strategies and Rationale
In order to go about this without stepping on too many toes, the
healthcare providers in the practice need to come together and
brainstorm on what is the best way to deliver information to the
parents. They also need to be trained to decipher on who can
actually be exempt from the vaccinations due to medical or
religious issues, and who is just afraid of the information
they’ve been given. The first step would be to educate all the
staff in order to allow them to the opportunity to teach the
parents of the patients about facts vs. fiction. In today’s age of
social media and constant Internet access, many people are
accessing websites that are not factual, and are meant to spread
lies. For every parent that wants an exemption, there should be
a process put into place in order for both parties to get the
information they need.
The first step should be a counseling session between the
healthcare provider and the parents. They should explore what
their main reason is in asking for exemption; if it were a
medical or religious belief then we would start them in the
process of applying for those specific exemptions. If it is solely
based on philosophical reason then they need to explore further
into what exactly they are under the impression of, and how
they can make sure they are given all the facts. The practice can
also set up an information session for parents to come speak to
different healthcare providers, and maybe some representatives
from the companies who manufacture the vaccines.
In order to handle this situation, a transformational leader
would be most effective in dealing with angry and scared
parents. “These leaders are motivational and empowering and
they inspire others to identify with and pursue a long-term
vision.” (Cope & Murray, 2017) In trying to convince scared
parents to vaccinate their children, the staff and leader included
are facing an uphill battle. In having a leader who can help
parents understand the benefits vs. the risks, and do it in a way

that will be sensitive and effective, is extremely important.
Expected Outcome
The expected outcome would of course to have all children who
are not medically or religiously exempt from the vaccines,
receive them. There are many children for whom vaccines are
medically contraindicated, but they can be protected by what is
none as herd immunity if the others around them are vaccinated.
If majority of parents start receiving exemption, this threatens
the herd immunity, and makes the whole community susceptible
for these preventable diseases. It is their job to ensure that the
community remains safe, and in order to do that, they need to
ensure the children are vaccinated.
In dealing with both parents and children we need to be
extremely cautious in how we proceed with parents who are
against vaccinations. An effective nurse leader knows how to
manage their staff and give them the tools for success. In
ensuring the staff is fully educated on vaccines, you give them
the resources needed to effectively deal with parents, and
continue to educate those around them. A good leader also
knows that no task is easily completed, and that this will most
likely be an ongoing issue that can take years to rectify. In
knowing that this will be an uphill battle, the manager can make
sure that your resources are ongoing throughout the year, and
that they are allowing a safe space for parents to come and
voice their opinions and get educated as needed.

Resources
Adolescent and School Health. (2018, June 14). Retrieved from
https://www.cdc.gov/healthyyouth/sexualbehaviors/
Clinical practice guidelines for chronic kidney disease:
Evaluation, classification and stratification. (2002). Retrieved
from
https://www.kidney.org/sites/default/files/docs/ckd_evaluation_
classification_stratification.pdf
Cope, V., & Murray, M. (2017). Leadership styles in
nursing. Nursing Standard (2014+), 31(43), 61.
doi:http://dx.doi.org.library.capella.edu/10.7748/ns.2017.e1083
6
Prevention of Measles, Rubella, Congenital Rubella Syndrome,
and Mumps, 2013: Summary Recommendations of the Advisory
Committee on Immunization Practices (ACIP). (2013, June 14).
Retrieved from
https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6204a1.htm
Tiffany, C. R. (1994). Analysis of planned change
theories. Nursing Management, 25(2), 60. Retrieved from
http://library.capella.edu/login?url=https://search-proquest-
com.library.capella.edu/docview/231415471?accountid=27965
Vaccine Recommendations and Guidelines of the ACIP. (2018,
January 11). Retrieved from
https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-
specific/mmr.html
Running head: PROFESSIONAL DEV. NEEDS 1

PROFESSIONAL DEV. NEEDS 2
Professional Development Needs Assessment
Capella University
February, 2019

In this paper, the different roles of nurse leaders will be
identified as well as the similarities and differences between
leadership and management. Leadership is defined as the
process of influencing people to accomplish goals, and
management as the coordination and integration of resources
through planning, organizing, coordinating, directing, and
controlling to accomplish specific institutional goals and
objectives. Employees are only as good as the managers that
lead them. This is especially true within the field of nursing due
to its necessity for teamwork, and problem solving. According
to Diane Huber, “quality of life depends on the quality of
leaders.” (Huber, 2018, p. 1) There have been debates on the
differences between management and leadership, but in order to
provide exemplary patient care they both need to come into
play.
Leader and Manager
Usually, managers focus more on day-to-day activities
while leadership is more focused on the “big picture” problems
within the unit and hospital. “Although there are many
similarities between leadership and management-both involve
the direction and influence of others, and both entail the
accomplishing of tasks and goals of an organization-there are
significant differences. Leadership is a process of influencing
others through effective relationship skills, whereas
management is a formal position with specific functions.
Ideally, a nurse can be both a leader and a manager
simultaneously.” (Murray, 2017, p. 46)
Almost all situations require some level of management
and leadership. Managers do not always make good leaders, and
leaders are not always good managers; there are different skill
sets that accompany both positions. Also, somebody could be a
good leader in certain scenarios, but not in others and with or
without the title of leader. Especially within the healthcare
field, it is important that nurses feel comfortable in a leadership
role. Managers aren’t always available on all shifts so it’s
imperative that all nurses feel comfortable to step up when

needed, especially when it comes to caring for their patients. It
can be hard to confront a doctor, especially for new nurses, but
sometimes it is in the patient’s best interest for the nurse to
question an order.
Key Concepts That Facilitate Collaboration and Support
Interprofessional Teams
“The extent to which different healthcare professionals work
well together can affect the quality of the health care that they
provide. If there are problems in how healthcare professionals
communicate and interact with each other, then problems in
patient care can occur. Interprofessional collaboration (IPC)
practice-based interventions are strategies put into place in
healthcare settings to improve work interactions and processes
between two or more types of healthcare professionals.”
(Zwarenstein, Goldman, & Reeves, 2009) Some things that can
be done to facilitate positive interdisciplinary relationships are
daily rounding with all members of the healthcare team, and
monthly meetings. If all members of a healthcare team are on
the same page with the care plan and familiar with each other it
will provide a better healing environment. It will also open the
door for better communication and understanding between
healthcare professionals.
Leadership Self-Assessment
I would describe my leadership style as somewhere
between authoritarian and democratic. Authoritarian leaders
tend to dictate task lists to their followers and advise them on
what techniques to use to get those tasks done. A democratic
leader usually encourages discussions among all team members
to make decisions, and focuses more on human relations and
teamwork. In order to create a balance among team members, it
is important the leadership isn’t afraid to step in when needed,
but that they also allow their subordinates the opportunity to
work independently and hone their own leadership skills. When
first coming into a leadership role, it is important to have an
open door policy with the rest of the team and to let them know
that you are an approachable leader, but you also have to

enforce that you will not be disrespected or taken advantage of.
It is a difficult task to take on a new role of such importance,
but I believe that with the right balance I can create an efficient
work place that is also a place that people love to work.
Skill Development
In order to be a successful and effective leader, I think it’s
important to be able to switch back and forth between
leadership styles when the situation calls for it. One set
leadership style is not efficient because all different scenarios
can pop up throughout the work day, and in order to react
accordingly to the problem, a leader needs to be flexible and
always on their toes. It’s also important to get to know your
workers, because not every person responds the same to
criticism or praise. Some people thrive when they feel they have
something to prove, while other can become discouraged. In
getting to know your workers, you can figure out how you can
motivate them to do their best work for you.
Another important part of being a successful and effective
leader is to know exactly what is needed to keep your facility
running efficiently. This means knowing the roles of each
person staffed underneath you, better than they know it
themselves. That way you are always prepared to help them if
they come across a problem, as well as being able to train new
employees to work at the same high standard you hold the rest
of the employees to. I think a key part in that understanding is
maybe to have a few days put aside where the leader can spend
some time with employees learning the ins and outs of each
position so they can really know what each position entails.
Conclusion
In conclusion, leadership is not a role that a person should
take lightly. It entails so much responsibility, and the job does
not stop when you go home for the night. In order to be an
effective leader, a person needs to meet certain qualifications
and be prepared to have a lot of on the job training. There are
many types of leaders, and different leadership styles one can
follow, but a good leader pulls from all the different types, and

adapts as the situation calls for them to do. I believe that
leaders should have to spend a day in their subordinate’s shoes
in order to learn what their jobs truly entail, and in order to get
to know how they work.
Resources
Huber, D. (2014). Leadership and management principles.
In Leadership & nursing care management (pp. 1-36). St. Louis:
Elsevier.
Murray, E. (2017). Nursing leadership and management for
patient safety and quality care. Retrieved from
https://ebookcentral-proquest-com.library.capella.edu
Zwarenstein, M., Goldman, J., Reeves, S. Interprofessional
collaboration: effects of practice‐based interventions on
professional practice and healthcare outcomes. Cochrane
Database of Systematic Reviews 2009, Issue 3. Art. No.:
CD000072. DOI: 10.1002/14651858.CD000072.pub2.
MOBILIZATION PLAN
SAMANTHA TALLARINE
CAPELLA UNIVERSITY
ORGANIZATIONAL AND SYSTEMS MANAGEMENT FOR
QUALITY OUTCOMES

JULY, 2018
Mobilization plan in place for international medical mission
Topics addressed:
Identifying stakeholders and effect plan will take on them
Impact on staffing
Mission statement, and distribution of power
Assurance of quality of care and safety for participants
Breaking barriers in a potentially hostile environment
MEDICAL MISSION FOR NURSING PROFESSIONALS
“Medical mission teams provide healthcare goods, services, and
education to help fill the gap where access to care is extremely
limited.” (Hawkins, 2013)
Scenario:

A nursing facility has recently committed 20 nurses to
participate in a 4-month long multinational effort to treat
patients exposed to a highly contagious virus in a “hot zone” in
Africa. There will be physicians, as well as administrative staff
that will also take place in the mission. Nursing professionals
will make up the majority of the staff because they handle will
be handling administering treatment as well as monitoring the
patients for the physicians.
This mobilization plan will tackle the following:
Identifying the major stakeholders within the health care system
that will be affected.
Analyze the mobilization efforts impact on staffing and nursing
care in the home nursing facility.
Describing the organizational structure that will be in place, and
the distribution of power.
Assessing the effect of the organizational structure on the staff,
and how to empower each level.
Evaluating potential power conflicts when dealing with health
care personnel from Africa.
Evaluating the potential for issues that personnel may come
across, and how to avoid future mishaps.
2
Stakeholders affected by mobilization:
Hospital board members
Investors
Organizational leadership and management team
Nursing Leadership
Physicians
Patients
Impact on staffing patterns and nursing care?
Potential for further staff shortages
Stakeholders

Stakeholders affected by mobilization plan:
Hospital board members
Investors
Organizational leadership and management team
Nursing leadership
Physicians
Patients
How will staffing patterns and nursing care be impacted?
Staff shortages can occur due to nursing professionals making
up the majority of the team
Nurses who stay behind will face the potential for:
Longer shifts
Working shifts or days they aren’t accustomed to
Increased need for float nurses
Overall increased workload
“The social structure of an organization influences the flow of
information, resources, and power among its members.” (Meyer
& Huber, 2014) Therefore, each stakeholder has the potential to
be impacted by the mobilization plan. In order to effectively
complete this medical mission, everybody needs to be on board
and be willing to pick up the slack that will be left behind due
to the different staff members taking temporary leave.
3
Recruitment of Per Diem hospital staff
Float pools

Form unit teams
Leadership training
Shared governance
Softening the Impact on Staffing Patterns and Nursing Care
Mobilizing 20 healthcare professionals will leave behind a big
gap in the medical center. In order to alleviate the pressure for
the staff left behind there are different approaches that can be
taken; one specific thing is not going to keep the hospital
running, but if all interdisciplinary members band together and
work to improve in all areas this can become possible.
Recruitment of Per Diem hospital staff
Since the majority of the members of the mobilization team are
going to be nursing professionals, the nursing staff is going to
take the greatest hit. Per diem nurses who are experienced can
be a major asset to the team while also ensuring that the nurses
who left come home to their respective positions. I would
suggest that a minimum of 5 years nursing experience be
required, only because the full time nurses on the unit will
already be stretched too thin to have to accommodate a new
nurse. Experienced nurses will also bring better insight into
patient care, and ensure that the patients do not feel the strain
of the limited nursing personnel. “The major goal of staffing
management is to provide the right number of nursing staff with
the right qualifications to deliver safe, high-quality and cost-
effective nursing care to a group of patients and their families
as evidenced by positive clinical outcomes, satisfaction with

care, and progression across the care continuum. (Birmingham,
Pickard, Carson & Huber, 2014)
Float Pools
Increasing the number of nurses within the float pool will ease
the needs of units who may suffer from the medical mission.
“Pool nurses are assigned each day to one of the units in the
pool, where a pool typically contains between 3 and 7 units.”
(Maass, Liu, Daskin, Duck, Wang, Mwenesi, Schapiro, 2015)
This allows for nurses from multiple units to be part of the
medical mission without one unit taking too much of a hit. It
also allows for the mission team to have a well rounded team
with different aspects of experience. By increasing our float
pool, it allows the float nurses to help pick up the slack and
keep each unit running smoothly.
Form Unit Teams:
A team is defined as “a small number of people with
complementary skills who are committed to a common purpose,
performance goals, and approach for which they hold
themselves mutually accountable.” (Huber, 2014) In this case,
teams will be formed within each unit in order to ease the loss
of staff. There will be a nurse manager in charge, and the rest of
the staff will be paired off in order to help each other pick up
the slack. Unit teams will help everybody stay on task, and
allow for a smoother work day. It will help the staff to work
collaboratively and interdependently, as well as ensuring safe
patient care. This is especially helpful when float nurses are
being implemented because it will allow them to be paired with
a nurse who works on the unit regularly, allowing for a
seamless transition.
Leadership Training:
In order to effectively lead, nurse managers should be required
to go through leadership training. This will allow managers to
experience different leadership types, and can help guide them

to see what approach they want to take to lead their staff.
“Determining the structure is a key responsibility of leaders and
managers in planning an organization that is conductive to high-
quality nursing care.” (Meyer & Huber, 2014) Mandatory
leadership training will be effective in shaping how a unit will
be run, and will help to develop strong leaders that will be able
to lead during the potential staff shortage during the medical
mission; it will also help to give them a sense of empowerment.
Shared Governance:
“A dynamic process for achieving organizational effectiveness
by promoting decision-making and accountability for practice
through empowerment.” (Hoying & Huber, 2014) That is the
definition of shared governance. Many people would describe it
as a framework to help nurses feel a sense of empowerment
which would lead to an increase in autonomy and confidence. In
implementing shared governance a support structure needs to be
put into place, and continuous support from upper management
is a must. This will give our staff nurses the opportunity to
perform autonomously in certain aspects of their job, and allow
nurse leaders some breathing room while handling the staffing
aspect of their unit. This has the potential to help the unit run
smoother during the absence of the staff on the medical mission.
4
Shared governance
Hierarchical decentralization
Open system theory
Organizational Structure of the Medical Mission Team

In order to effectively complete this medical mission
communication needs to be excellent, and everybody needs to
have a clear vision of their role within the team. When team
members know their roles it allows for a good work
environment with little to no conflict. By pulling examples from
different theories and organizational structures it can provide a
well rounded structure for the medical mission team to follow
Shared Governance:
This will create the framework of the structure and allow for
empowerment of all mission team members. All team members
will be responsible for their own actions and allow for full
accountability. This will bring together all team members
regardless of title because shared governance promotes no
transfer of power which lets nurses acquire legitimate power
and authority. Respect and trust will be easy to come by among
all team members when everybody feels a sense of autonomy
and empowerment.
Hierarchical Decentralization:
Hierarchical decentralization goes hand in hand with shared
governance; allowing for authority to be spread down through
the hierarchy. Instead of leaving all decisions to be made within
the upper management team, this structure allows for all
members of the interdisciplinary team to work together as well
as having a sense of autonomy. The medical mission team will
be composed of a number of different healthcare professionals
so in order to keep each member happy and working as a team,
allowing each member to control their own outcomes will help
the team atmosphere. It will reduce any added conflict in what
is sure to be an already high stress environment. Each staff
member will in turn feel empowered to take control, and
Open System Theory:
The health care organization is “characterized by energy

transformation, a dynamic steady state, negative entropy, event
cycles, negative feedback, differentiation, integration and
coordination, and equifinality.” (Meyer & Huber, 2014) In order
to be effective, the different units need to be willing to adapt to
whatever environment they’re in. This is specifically effective
for a medical mission because the atmosphere is so
unpredictable and the staff needs to always be on top of their
game. In implementing the structure around an open system our
staff will have the autonomy necessary to man their own
stations of the “hot zone” which will cause them to feel
empowered. The boost in confidence will help the staff to keep
pushing through their time away in Africa, and ensure peak
patient care and quality outcomes.
5
Organizational Structure of the Medical Mission Team
Mission Coordinator: Person in charge of organizing the entire
medical mission team. This person is the top of the leadership
structure, and will be the liaison between the other
multinational teams that are present in the “hot zone”. They will
be the person that is in touch will all members of the
interdisciplinary team and be in charge of creating the plan both
before hand and while on the ground.
Leading Physician: This will be the main point of contact for

physicians, and will also work hand in hand with the rest of the
leading staff to coordinate patient care, and how supplies will
be used. They will disperse daily tasks, and handle the
scheduling of the physicians in the team.
Physicians: Supportive staff to the lead physician. They will
work together with the nursing professionals to provide optimal
patient care.
Leading Nursing Professionals: Main point of contact for the
nursing professionals. They will also be working with the other
leading staff to coordinate patient care, and how supplies will
be used. They will disperse daily tasks, and handle the
scheduling of the nursing professionals in the team.
Nursing Professionals: Supportive staff to the lead nursing
professional, as well as the physicians. They will work hand in
hand with the physicians and supportive staff to provide optimal
patient care.
Leading Administrator: Main point of contact for administrative
staff/supportive staff. They will be handling taking inventory
before the trip as well as throughout, assisting with making
schedules, and managing all resources. They will also be held
accountable for maintaining communication throughout the
mission between interdisciplinary team members, as well as
communication with our home base in the hospital.
Administrative/Support Staff: Assist all team members in tasks
that require help, and help the day to day operations run
smoothly.
All staff will work together to maintain an effective work
environment and to ensure quality patient care. Day to day
operations will be inclusive of all team members, and there will

be constant communication throughout each assignment.
Although there are leadership positions incorporated, all team
members will have some degree of autonomy, and will be able
to work within the scope of their practice to make decisions and
empower each other. Daily meetings will take place among
leadership as well as team members to ensure that the patients
are receiving everything they need, and to give each team
member a voice.
6
Mission Coordinator
Leading Physician
Leading Admin.
Nursing Professionals
Leading Nursing Professional
Physicians
Admin./Support Staff

Leadership is all inclusive when dealing with team members
Shared governance and hierarchical decentralization model is
carried out effectively
Empowerment = key leadership component
Empowerment within Team Members
“Empowerment is defined as giving people the authority,
responsibility, and freedom to act on what they know and
instilling in them belief and confidence in their own ability to
achieve and succeed.” (Cox & Huber, 2014) It entails two steps;

transfer of actual power, and inspiration of self-confidence. A
work environment which empowers its workers allows the staff
to come to work with a positive attitude, and it has been shown
to give employees the opinion that their work holds a greater
meaning for them.
This medical mission team will be all inclusive, and allow for
all team members to have a voice. There will be experienced
leaders in place, but that is just the framework to help other
members who may not have been in a leadership role
previously. All team members will have a degree of autonomy,
and this will help build confidence as well as improve upon
communication skills. Leaders will be involved with team
members to ensure all members stay within their scope of
practice, and to lend a helping hand when needed. Supplies,
resources, and staff will experience shortages so in creating a
decentralized hierarchy we can ensure that staffing levels are
optimized to deliver effective patient care.
7
Key actions that can be taken in order to keep patients and
personnel safe and receiving the best care:
Patient-Centered Care
Collaborative Leadership
Safety Climate
Conflict Resolution
Appropriate Training
Assuring Quality Care and Patient Safety

Patient-Centered Care
“The re-design of patient care in the acute care setting so that
hospital resources and personnel are organized around the
patient’s health care needs.” (Huber, 2014) Participating in
patient-centered care allows for the patients to always be
number one, while allowing for the health care team to take care
of both the patient and family members collaboratively. It
ensures that decisions are based solely on patient needs, and
will optimize the way treatment is delivered..
Collaborative Leadership
Shared governance can help to incorporate a collaborative
leadership approach within the medical mission team. All team
members must collaborate, not only just the leadership with
each other, but all staff must work to have constant
communication within the other departments. “Collaborative
leadership in health care has been associated with improved
patient outcomes, a reduction in medical errors, and lower staff
turnover; it may also reduce the amount of workplace bullying
and disruptive behavior.” (Hoying & Huber, 2014)
Safety Climate
By pushing a safety climate, it will allow all members of the
medical mission to focus on safety within the team, as well as
the organization within the “hot zone”. This will be
implemented to keep both health care professionals, and the
patients safe. The focus is on making sure that nurses
specifically are able to identify what is normal for the patients
within the medical mission, so that they can recognize any
deviations from baseline. “Regardless of whether the focus of
safety is on the patient or the nurse, the likelihood of injury can
be lessened where there is a cohesive team.” (Bellot & Huber,
2014)
Conflict Resolution

If conflict is to arise during the mission, resolution needs to be
swift and effective in order to keep our patients receiving
constant quality care. This is where leadership will come into
play most to provide techniques to give all parties involved an
opportunity to speak their peace. Leadership will ensure that
communication is open, and that all methods are exhausted if
needed to resolve the problem.
Appropriate Training
In working with a different culture, the health care team needs
to make sure they are undergoing the correct training to get a
better idea of what they will encounter once on the ground in
Africa. Whether that be sensitivity training in order to deal
effectively with what they will see, or if they need specific
medical training to deal with the virus. Doing a simulation lab
to better prepare for the mission also can be helpful, and will
allow for team members to work together before real patients
are involved.
8
Working with team members who have never worked together,
as well as dealing with multinational contingents can cause the
following issues:
Internal conflict of power
Cultural differences
Jurisdiction issues
Unwillingness to participate in shared governance model
Potential Power Issues

Nurses specifically will need to fight to maintain their power
throughout the mission because other cultures may not be used
to nurses working autonomously as has been outlined in this
presentation. Also, physicians within the team may not be used
to nurses having a say and manning their own unit teams.
Culturally, all team members may not be able to be cognizant of
actions that are potentially offensive to the other multinational
teams present, or the people of Africa. There also may be an
issue when it comes to making decisions that include other
health care teams. Leaders from different areas may feel they
are entitled to make decisions, while other team leaders feel
they are; working together and communicating efficiently will
be the most productive way to get through the 4-month mission.
9
Language barriers
Unawareness of cultural practices
Different standards of practice
Potential Multicultural and Diversity Issues
Language barriers will be the number one issue faced while on
this mission. Although translators will be part of the
interdisciplinary team that is being sent to Africa, there are so
many different dialects that there is always the potential for
miscommunication. 20 health care team members with all
different backgrounds are being brought together to enter this
“hot zone”, and although there will be training before leaving
it’s impossible to completely grasp the culture they’ll be
experiencing. A lot of the knowledge they gain will be through

experiences, so there is potential to offend the people they will
be working with. Protocol will also be completely different, and
will take time to get used to.
The mission team’s top priority is to respect the people and the
culture of Africa, and provide patients with the best quality care
possible. There may be issues that come about, but as long as
they are dealt with in a timely and respectful manner the
mission will be productive.
10
Planning a medical mission is no easy feat. There are
bound to be hiccups along the way, but ensuring that team
members get to know each other prior to embarking on the
journey, and allowing each member to work autonomously will
allow for a less hostile work environment. When it comes to
working as a unit with other health care teams, our members
need to be culturally aware of who they are dealing with, and
learn how to be respectful. Our team needs to feel empowered in
order to provide quality patient care, and help to get this virus
under control.
Conclusion
11
Bellot, J. (2014). Organizational climate and culture. In D. L.
Huber (Author), Leadership & nursing care management (pp.
55-64). St. Louis: Elsevier.

Cox, K. B. (2014). Power and conflict. In D. L. Huber
(Author), Leadership & nursing care management(pp. 159-
185). St. Louis: Elsevier.
Hawkins, J. (2013). Potential Pitfalls of Short-Term Medical
Missions : Journal of Christian Nursing. Retrieved from
https://journals.lww.com/
journalofchristiannursing/Fulltext/2013/12000/
Potential_Pitfalls_of_Short_Term_Medical_Missions.23.as
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References
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Hoying, C. (2014). Decentralization and shared governance. In
D. L. Huber (Author), Leadership & nursing care
management (pp. 246-255). St. Louis: Elsevier.
Huber, D. L. (2014). Professional practice models.
In Leadership & nursing care management (pp. 256-273). St.
Louis: Elsevier.
Maass, K. L., Liu, B., Daskin, M. S., Duck, M., Wang, Z.,
Mwenesi, R., & Schapiro, H. (2017). Incorporating nurse
absenteeism into staffing with demand uncertainty. Health Care
Management Science, 20(1), 141-155.
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References

Manion, J., & Huber, D. L. (2014). Team building and working
with effective groups. In Leadership & nursing care
management (pp. 128- 146). St. Louis: Elsevier.
Meyer, R. M. (2014). Organizational structure. In D. L. Huber
(Author), Leadership & nursing care management (pp. 226-
Noguchi, N., Inoue, S., Shimanoe, C., Shibayama, K., &
Shinchi, K. (2016). Factors associated with nursing activities in
humanitarian aid and disaster relief. PLoS One, 11(3)
doi:http://
dx.doi.org.library.capella.edu/10.1371/journal.pone.01511
70
References
Running head: SAFETY SCORE IMPROVEMENT PLAN 1
SAFETY SCORE IMPROVEMENT PLAN 9

Safety Score Improvement Plan for Newark Beth Israel
Capella University
Organizational and Systems Management for Quality Outcomes
Safety Score Improvement Plan
July, 2018
Safety Score Improvement Plan for Newark Beth Israel
Newark Beth Israel Medical Center is the largest hospital
in Newark, New Jersey. They have 480 total staffed beds, and
are at the forefront of medicine when it comes to heart, as well
as lung transplantation. Although they have a B rating
according to the Hospital Safety Score Web Site, they do have
some areas to improve upon; an example of this is patient falls.
Their score of 0.541 is just below the average (0.371) however,
still unacceptable.
The drop in average of patient falls negatively impacts the

image of the hospital, which can lead to decrease in patients,
and a drop in funding. Although Newark Beth Israel is
functioning at an above average level, there is always room for
improvement. Improving upon the fall protocol on each unit,
and educating nurses, doctors, and other members of the
interdisciplinary team, we can all work together to make patient
falls a thing of the past.
Contributing Factors to Patient Falls
“According to the Agency for Healthcare Research and
Quality, more than 1 million patient falls occur each year in the
United States.” (Murphy, Murphy, Hastings, & Olberding, 2015)
Falls are something that have become common in the healthcare
field, but can often become deadly to a patient; “10% result in
serious injuries such as fractures or head trauma.” (Murphy,
Murphy, Hastings, & Olberding, 2015) What isn’t discussed
about patient falls is that they also lead to an increased stay for
patients, making them more susceptible to infections that they
may have never come across if they were being cared for at
home. Also, if a patient falls while in the care of the healthcare
professionals in the hospital, Medicare and Medicaid do not
reimburse the hospital for costs associated with that injury.
Therefore, the higher fall rate during hospitalizations, the more
of a loss the hospital is working at.
Stubbs, and Sikes explored falls on inpatient pediatric
units, and were able to pinpoint some factors that were found to
increase the likelihood of falls. “Increased length of stay, need
for antiepileptic medication, seizure disorders, physical therapy
or occupational therapy assistance, and musculoskeletal
conditions. Other studies have shown that pediatric inpatients at
greatest risk for falls are either less than 3 years old or an
adolescent with a neurological diagnosis.” (Stubbs & Sikes,
2017) Adult patients also face similar risks when faced with
these conditions, and increasing age is the most prevalent.
Protocols currently in place in hospitals are also
questionable, and many nurses believe that there is not enough
being done to inform members of the healthcare team of a

patient’s risk level. Another issue is that units aren’t staffed
efficiently enough to monitor the patients throughout their
hospital stay. Family members can be incorporated into the care
plan, but the level of their competency needs to be measured
before any responsibility is placed upon them. This would
require more counseling, as well as more staff for evaluation
and implementation. Falls cannot be reduced and eventually
eradicated within the hospital until all members of the
interdisciplinary team are on the same page and willing to work
together.
Nurse Leaderships Role in Fall Prevention
The upper management within the nursing department
needs to dedicate themselves to staying on top of their current
employees to be monitoring patients at all times. They need to
make sure that they are following protocols in place, as well as
being open to listen to any suggestions that may be made.
Nursing leaders need to offer an open platform for all
employees, and be willing to implement changes that are needed
to suit the needs of both the staff and the patients. Also, future
employees should go through a rigorous orientation period,
which equips them with the tools they need to assess for the risk
of falls occurring, as well as being trained to step in at any
moment that a fall does occur.
Policies and Procedures
Within the Newark Beth Israel Medical Center, policies
and procedures need to be amended to ensure patient safety.
Upon researching what they are doing to reduce their number of
falls, I came across a serious lack of policy regarding the
matter. It seems they are more concerned of any legal action
that would be taken against them after the fact, rather than
trying to eliminate the risk in the first place. Nursing
leadership, as well as the floor nurses need to take matters into
their own hands and start the process to implement a new policy
to help protect their patients, which helps the nurses in the long
run. Patient falls are considered “a nurse sensitive measure and
nurses play a key role in this component of care.” (Quigley &

White, 2013) That being said, nurses have everything to gain by
implementing changes within their units to help patients get
optimal care, as well as protecting their own license.
Systems Theory
“Complex adaptive system theory, and outgrowth of
complexity theory, suggests that the relationship between
elements or agents within any system is nonlinear and that these
elements are the key players in changing settings or outcomes.”
(Marquis & Huston, 2017) This means that if an individual acts
one way, they may not act the same way the next time they’re
faced with the same scenario. As humans, we learn from our
mistakes as well as our triumphs; nobody knows how they will
react in a certain situation, until faced with it. This is relevant
to the issue with patient falls because it theorizes that if a nurse
is properly trained and goes through a rigorous orientation and
possible simulations, they will be better equipped to handle all
aspects of their jobs, particularly falls.
That being said, if nurses start implementing new policies
within this organization we will have policies and procedures
that come from first-hand experience. Nurses are taught to
always advocate for their patients, and this opportunity allows
them to do that for all their patients at once, both current and
future. Having seasoned nurses bring their experiences one by
one to the nursing leadership will ensure that we will have new
policies that fit the needs of both the patients and the nurses.
Although nurses receive majority of the blame for when a
patient experiences a fall, some patients are prone to falls
regardless of receiving excellent care. Having a policy that
which protects the nurse from being wrongfully accused, as well
as one that protects patients from any negligence is the ultimate
goal.
Recommendations for Safety
Through my research, I’ve come across many different
suggestions to reduce the growing number of falls reported
during hospitalizations. There are a number of different ideas
that all could work if implemented correctly. A system also

needs to be put in place to monitor the effectiveness of these
strategies. Nursing leadership working hand in hand with their
subordinates, as well as the rest of the interdisciplinary teams
can lead to greater patient safety which in turn will lead to
higher reviews for the hospital, and will allow for full
reimbursement for stays from Medicare and Medicaid.
6-Pack Prevention Plan
One proposed solution is to have a prevention program in
place that “includes a fall-risk tool; ‘falls alert’ signs;
supervision of patients in the bathroom; ensuring patients’
walking aid are within reach; toileting regimens; low-low beds;
and bed/chair alarms.” (Barker, Morello, Ayton, Hill, Brand,
Livingston & Botti, 2017) The study received positive reviews
amongst the nursing staff, and with proper implementation can
be extremely productive. If this were to be put into place, there
would need to be proper training sessions before
implementation. Nurses should be paired up in order to help
each other properly survey their patients, and assess their risk
level. Pairing up nurses, preferably a seasoned nurse with a new
nurse, allows the proper amount of surveillance, and will
provide extra hands on deck to care for patients effectively.
In order to measure the effectiveness of this program, data
would need to be conducted of what the fall percentage is prior
to implementation, as well as the fall rate at least one year after
implementing it. Also important, is to make sure your staff is
happy as well. Surveys would need to be conducted of the
employees, as well as patients and their families to monitor how
the new protocols are being perceived.
Roundtable Debriefings
In 2012, a Falls Roundtable intervention was brought into
discussion to be implemented in the emergency department in
an urban hospital. The whole point of this was to allow for
debriefing when an incident occurs to achieve fall-reduction
rates. This leads to actually confronting the issue, and speaking
about what happened, as well as figuring out a way to prevent
future incidents. It is a meeting held weekly and includes “1

nursing quality outcomes coordinator, 2 acute care clinical
nurse specialists, the director of acute care nursing services, 1
physical therapist, 1 education and development nurse, and 1
pharmacy resident.” (Murphy, Murphy, Hastings, & Olberding,
2015) The nurse who was caring for the patient at the time of
the fall was always part of the debriefing as well, in order to get
the complete picture of what occurred and could lead to a better
overall outcome.
This plan only works in conjunction with other fall
precautions; alone, it was not found to consistently keep fall
rates decreased. It did however, lead to the staff becoming more
engaged in implementing new fall-prevention measures, and
being more focused on their individual patient outcomes. Nurse
leadership can use this as one of the tools to reduce falls, and
boost morale among the staff. Instead of automatically
penalizing nurses for their patients experiencing a fall, it allows
them a safe space to explain what happened, and different
perspectives among healthcare professionals to come up with
new and ever changing protocols.
Red Light, Green Light
This proposed solution brings all members of the
healthcare team together, as well as the family members of the
patients. The process started with physical therapists assessing
the patient’s functionality and if they were at risk or not, and
then assessing family member’s ability to assist the patient. A
status of either red light, or green light was then assigned to
each patient and their family to help further the nurse’s
knowledge of which level of care needed to be administered.
This was an ongoing process, and patients were repeatedly
assessed in order to keep their status up to date. With this
protocol in place, “the fall rate decreased from 8.8 falls per
1,000 patient days in 2009 to 3.8 falls per 1,000 patient days.”
(Stubbs & Sikes, 2017)
This was implemented by making training sessions
mandatory for all team members involved in patient care. New
employees were also trained specifically in transferring

patients, as well as with the equipment they would be using.
Mandating training sessions allows for nurses to gain
confidence before even seeing any patients, which will lead to
sharpening their skills as well.
Implementing Change
The current system in place is that if a patient experiences
a fall, an incident report is supposed to be filed. It is unknown
if falls that do not result in any further injury are always
reported. One way to ensure that patients are being treated
fairly, and incidents are always reported is to have cameras
within the rooms. This would ensure that nothing was missed,
and can also be used for training purposes for new hires. There
can be bi-weekly, or monthly progress meetings where a nurse
meets with their managers and other members of the nursing
leadership to review tapes of their actions.
Although cameras in patient rooms can be very beneficial,
there are obstacles the hospital would need to go through to
implement it. We would need patient consent for them to be
watched under constant surveillance. Also, knowing you are
being filmed can cause stress on the nurse, and may actually
lead to more mistakes being made; especially in new graduates.
Conclusion
In regarding patient falls, it is obvious that something
needs to be done. Besides the fact that reimbursement for falls
doesn’t occur, but our patients need to feel safe in our hands. A
patient who feels confident in their doctors, and nurses will feel
hopeful, and work towards their goals of complete rehabilitation
from their injury or illness. No one proposed solution has been
proven to be the answer to all of our problems, but in picking
and choosing from each theory we can come up with new
protocols. Nurse leaders will be at the forefront of fall
reduction, and will motivate their subordinates to partake in
leadership roles as well. Our patients and their families will
also play integral parts in their welfare, leading to a well-
rounded and well thought out care plan. We need to help our
patients to help ourselves in the long run.

References
Barker, A. L., Morello, R. T., Ayton, D. R., Hill, K. D., Brand,
C. A., Livingston, P. M., & Botti, M. (2017). Acceptability of
the 6-PACK falls prevention program: A pre-implementation
study in hospitals participating in a cluster randomized
controlled trial. PLoS One, 12(2)
doi:http://dx.doi.org.library.capella.edu/10.1371/journal.pone.0
172005
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and
management functions in nursing: Theory and application.
Philadelphia, PA: Lippincott Williams & Wilkins.
Murphy, L. M., Murphy, S. O., Hastings, M. A., & Olberding,
A. (2015). Are interprofessional roundtable debriefings useful
in decreasing ED fall rates? findings from a quality-
improvement project. Journal of Emergency Nursing, 41(5),
375-380.
doi:http://dx.doi.org.library.capella.edu/10.1016/j.jen.2015.02.0
05
Pelletier, L. R. (2014). Quality and safety. In D. L. Huber
(Author), Leadership & nursing care management (pp. 291-321).
St. Louis: Elsevier.
Quigley, Patricia A, PhD, MPH, CRRN,F.A.A.N., F.A.A.N.P.,
& White, Susan V, PhD, RN, CPHQ,F.N.A.H.Q., N.E.A.-B.C.
(2013). Hospital-based fall program measurement and
improvement in high reliability organizations. Online Journal of
Issues in Nursing, 18(2), 19-5. Retrieved from
65
Stubbs, K. E., & Sikes, L. (2017). Interdisciplinary approach to
fall prevention in a high-risk inpatient pediatric population:
Quality improvement project. Physical Therapy, 97(1), 97-104.
Retrieved from

65
Running head: EXEC. SUMMARY OF ORG. DIVERSITY 1
EXEC. SUMMARY OF ORG. DIVERSITY 2
Executive Summary of Organizational Diversity
Capella University
August, 2018

The field of nursing is such a broad field that can take its
members in any direction of healthcare. There are so many
different sub-specialties that nurses can partake in, and they
have the opportunity to care for patients from all different
cultural and spiritual backgrounds. When working in a hospital
setting, nurses must be trained to deal with all possible
populations in order to effectively care for their patients.
Culturally competent care ensures that patients are receiving the
optimal treatment they deserve. “Patient-centered care is much
more complicated than what white papers and policies call for;
it entails a consideration of what it really means to respect
every culture as equal rather than for the dominant culture to
dictate what is right and wrong. As a society, patient-centered
care calls for some soul searching and accepting that other
cultures have a right to exist.” (Ong-Flaherty, 2015)
The Impact of a Diverse Workforce on Patient Outcomes
Since the 1990s, the American Association of Colleges of
Nursing (AACN) has supported and endorsed training its nurses
in cultural competence. A nursing workforce needs to be
inclusive of all cultures, but also needs to be inclusive all of all
lifestyle types as well. The LGBTQ community is continuously
growing, and we as healthcare workers need to educate
ourselves on how to care for this population effectively. When
patients deal with healthcare professionals who can relate to
their culture, or speak their language it makes them more
comfortable, and can promote a healing environment. “Non-
English speaking clients may be more likely to keep follow-up
appointments when working with health care providers who
speak their language, contributing to better treatment
utilization.” (Noone, Wros, Cortex, Najjar & Magdaleno, 2016)
A major transplant center hospital on the East Coast
focuses their resources on providing an environment full of

diversity and inclusion. They consider diversity, inclusion, and
health equality as part of their mission statement. Diversity is
defined as a variety of patterns which includes but is not limited
to values, customs, differences, and similarities. Inclusion is a
proactive approach to leveraging diversity by consciously
inviting, welcoming, respecting, and engaging each other
without bias. Health equity is defined as the results from
delivering high quality patient care to our diverse patients and
our diverse communities in ways that accommodate their
cultural, social, and physical differences. The same healthcare
center has also spearheaded a campaign for LGBTQ healthcare
equality; they have implemented safe spaces, as well as
adjusting policies to reflect the needs of, and protect the rights
and privileges of patients, employees, and physicians as well as
the surrounding community.
Integration of Multiculturalism and Diversity into
Organizational Practices and Staffing
The organization being described has a very diverse
workforce, and many of their department heads are of the
minority population. During the hiring process, they take into
account if the potential employee can speak any other
languages. The hospital is in an urban setting with a high
population of patients that speak Creole, so they strive to hire
nurses, as well as nursing assistants who can help to
communicate with this population of patients. They also
promote a shared governance structure, and evidence based
practice and research strategies.
In order to care for the growing immigrant population this
healthcare organization has been changing the way they care for
patients, as well as how they communicate with the surrounding
population. They have just recently implemented community
outreach programs that are run by bilingual physicians and
nurses to ensure that all aspects of the health care process are
being met for non-English speakers. In doing this, they are
forming relationships and bonds with their patients, and easing
them into the healthcare system. These patients are now

reporting that they feel more comfortable seeking help knowing
that they will not face a language barrier.
In order to provide competent care, a hospital should be
using the systems theory to have a checks and balance within
the organization. “A key principle of systems theory is that
changes in one part of the system affect other parts, creating a
ripple effect within the whole.” (Huber, 2014) This organization
in question has recently implemented NetLearning competencies
that need to be met by all employees. These NetLearning
courses consist of HIPPA refreshers, LGBTQ training, gender
equality, culturally competent care, as well as many other
subject areas. These courses are assigned on a monthly basis,
and are ongoing throughout your whole employment. In
providing these ongoing courses, they are working towards
ensuring their employees are constantly reminded of the
standards they set for their staff, as well as keeping educated on
the most recent policies that are being implemented to ensure
competent care in all parts of the healthcare process.
Evidence-Based Proposals for Empowerment of a Diverse
Workforce
In order to make sure the surrounding community is
receiving the optimal healthcare, we need to understand not
only their medical needs, but their cultural and spiritual needs
as well. The main issue that they have experienced is language
barriers. There has been such an influx of immigrants from all
different countries, so the rapidly changing community needs a
healthcare organization that adapts to their needs just as
rapidly. Community outreach needs to increase, and the hospital
needs to be aware of which cultures they will predominantly be
dealing with. In accessing this information, they can then
recruit staff specifically tailored to deal with their community
population.
The organization can also look into implementing a
clinical area that has specific days and times where non-English
speaking patients can come receive preventive care from
healthcare workers of the same descent. In providing culturally

competent preventive care, we can help to reduce the amount of
chronic illnesses that may be seen in the future. As far as on the
multiple units in the hospital, leadership needs to continue to
hire diversely, and make sure they are enforcing the continuing
education of its staff members; especially on the subject of
being culturally competent, and handling the LGBTQ
community.
Conclusion
Culturally competent care is one of the most important
things we can provide for our patients as healthcare
professionals. One sure way to do this is to provide a diverse
workforce, as well as properly educated staff. “In childhood, the
culture in which we are nurtured influences our perspectives,
morals, beliefs, thoughts, and behaviors.” (Ong-Flaherty, 2015)
That being said, it is the duty of nurses and other healthcare
workers to make sure they are caring for their patients in the
ways they need and want. It is important to realize that you
should not be caring for your patients the way that you would
want to be treated, but in the way that they want to be treated.
The healthcare organization that was evaluated in this paper has
taken steps to ensure cultural competency, but there is always
room for improvement. Until healthcare professionals are aware
of the populations that they serve there will always be a gap
between them and their ever changing communities.
References
Almutairi, A. F., Adlan, A. A., & Nasim, M. (2017).
Perceptions of the critical cultural competence of registered
nurses in canada. BMC Nursing, 16
0242-2
Huber, D. L. (2014). Leadership and management principles.

Elsevier.
Munro, E., & Hubbard, A. (2011). A systems approach to
evaluating organisational change in children's social
care. British Journal of Social Work, 41(4), 726–743.
Njie-Mokonya, N. (2016). Internationally educated nurses' and
their contributions to the patient experience. Online Journal of
Issues in Nursing, 21(1), B1-B9.
doi:http://dx.doi.org.library.capella.edu/10.3912/OJIN.Vol21No
01Man05
Noone, J., Wros, P., Cortez, D., Najjar, R., & Magdaleno, L.
(2016). Advancing health equity through student empowerment
and professional success: A statewide approach. Journal of
Nursing Education, 55(6), 316-322.
doi:http://dx.doi.org.library.capella.edu/10.3928/01484834-
20160516-03
Ong-Flaherty, C. (2015, October). Critical cultural awareness
and diversity in nursing: A minority perspective. Retrieved from
https://ac-els-cdn-
com.library.capella.edu/S1541461215000968/1-s2.0-
S1541461215000968-main.pdf?_tid=a87d670f-5dc8-438f-a263-
6d75514bbeb8&acdnat=1534788103_77fbb7e180e5479ed7688b
511cb0e317
Popper-Giveon, A., Keshet, Y., & Liberman, I. (2015,
November/December). Increasing gender and ethnic diversity in
the health care workforce: The case of arab male nurses in
israel. Retrieved from https://ac-els-cdn-
S0029655415002559-main.pdf?_tid=b513174b-3ce8-4178-83ce-
716f433dda13&acdnat=1534789230_aefce479a71b477c91689ee
75bbf714e
Schmidt, B. J., MacWilliams, B. R., & Neal-Boylan, L. (2016,
March/April). Becoming inclusive: A code of conduct for
inclusion and diversity. Retrieved from https://ac-els-cdn-
S8755722316301302-main.pdf?_tid=97a554f0-dc02-424c-af2d-

74162a930313&acdnat=1534788157_17327c978115054c092297
f0589cbe11
Running head: STAFF SHORTAGE 1
STAFF SHORTAGE 2
Staffing Shortages in the World of Nursing
Capella University
Impact Report to Senior Leadership
June, 2018

Impact Report to Senior Leadership
Employees are only as good as the managers that lead
them. This is especially true within the field of nursing due to
its necessity for teamwork, and problem solving. According to
Diane Huber, “quality of life depends on the quality of leaders.”
(Huber, 2018, p. 1) There have been debates on the differences
between management and leadership, but in order to provide
exemplary patient care they both need to come into play. Many
theories have been proposed as to what the exact qualities of a
leader are, but there are so many different types of leaders that
nobody has been able to agree on a concrete list of “leadership
traits”.
Ideally, a manager would take on the role of a leader, but
time and time again we have come across those people who rise
to the challenge and fit perfectly into a leadership role.
Whoever the leader may be, they need to work on the issue of
nursing staff shortages because it is a problem that doesn’t seem
to be going away. Staff shortages not only effect patient care,
but the overall day to day operations of the hospital. It is up to
the managers and the leaders of the nursing staff, as well as the
leaders of the hospital to staff each floor safely and effectively.
It is extremely important to recognize when the staff is
inadequate on certain units, especially in the emergency room.
This will be researched using the struggles of a hospital in a
suburb of a major city. The hospital in question is an award
winning, teaching hospital with 745 beds and two campuses.
Despite their awards, they have faced an immense nursing
shortage which has led to patient’s complaints, and loss of trust
in the hospital.
The Nursing Challenge
Staffing shortages in the nursing profession cause extra
stress on both the patients, and the healthcare workers

themselves. Registered nurses make up the largest population
within the healthcare field (almost 3.1 million U.S. registered
nurses), yet we still see staffing issues. There are many factors
that go into the consideration of a unit being “understaffed”,
and number of employees is surprisingly not the main one. Most
of the resources I used talk about the issue of having brand new
nurses on units that they are not necessarily ready for, and
without senior staff to guide them it causes a major safety issue
for patients. As a graduate nurse just about to enter my first
nursing job, I can immensely relate to this. Although I am
confident I am educated enough to understand what is going on
with my patients, actually being solely responsible for their
care, and doing everything on my own is an anxiety ridden task.
Confidence comes with experience, and like all professions, the
experience comes from on the job training. The difference with
healthcare professions is that we learn while we have people’s
lives on our hands and do not have room for error.
The System/Organization
This organization is one of the nation’s healthcare
institutions, and has grown into a major teaching hospital as
well as a tertiary care center. Through their mission statement
they vow to care for the community in an effective and safe
process, but being short staffed contradicts that. They are the
preferred hospital to go to within the county, but more so
because of lack of options. The hospitals upper management has
done the best with what they have available, but there is so
much room for improvement when it comes to staffing.
Systems theory tells us that “changes in one part of the
system affect other parts, creating a ripple effect within the
whole.” (Huber, 2018, p. 30) That being said, if a hospital is
short staffed you will see patient care suffering, doctors and
nurses taking on more than they’re used to, and eventually
ratings for the hospital will go down. Having a hospital getting
bad reviews is unacceptable, especially within a community that
is already frustrated with it. This will cause people to have a
mistrust in the healthcare delivery system, and can lead to

people not even seeking help.
The organization is trying to take steps to better qualify
their already existing staff members. They offer tuition
reimbursement for nurses who want to pursue an advanced
practice degree. This will lead to more skilled and educated
nurses who can train new nurses, and provide the appropriate
level of care needed; especially in high pressure units such as
the ER, or ICU.
SWOT Analysis
This hospital, has gone through changes to accommodate a
growing population, and they have both benefits and setbacks
from this. This SWOT analysis will put into perspective the
things that are positive and should continue, as well as the
things that need to be changed.Strengths
· Located in small community, and best option available
· Large facility and receives federal funding
· Multiple specialty centers
· Participates in community outreach
· Affordable care offered (FAP)
· Working to ensure meaningful access to healthcare services
for people who are not fluent in English, or hearing impaired
patients
· Multiple awards won for performanceWeaknesses
· At least 55-minute wait time in ER (even during an asthma
attack)
· One nurse may have up to 20 patients in 1 shift
· Teaching hospital so has a large influx of new graduates with
little to no experience
· Population within the community is growing, and people are
living longer so more chronic illnesses seen
· Lack of communication between different nursing units
· Float pool lacks depthOpportunities
· Offers tuition reimbursement for nurses to advance degree
· Creation of new nurse leadership position to integrate change
and effective staffing
· More detailed orientation to the unit staff will be working on

· Team building exercises throughout the different units, not
just one specifically
Threats
· Health care programs have been dealing with budget cuts
· Lack of nurses pursuing advanced degrees
· High nurse to patient ratio leads to “burn-out”, and higher
stress levels which leads to nurses leaving the organization for a
more relaxed work environment
In order to bring the hospital to its full potential, the SWOT
analysis can help to laser in on what exactly needs to be
changed. Leadership needs to come to terms with the fact that
nurses are not superheroes, and need to be given the proper
resources to care for their patients effectively and efficiently.
The New Leadership Position
The new position that will be created within the
organization is Chief Nursing Officer (CNO). In order to be
eligible for the position, the candidate must be a Doctor of
Nursing Practice (DNP) with at least 10 years of nursing
experience; past leadership experience will be preferred. The
candidate chosen will work side by side with hospital
management to ensure that the nurses are being heard, and that
staffing is adequate for the level of intensity of each unit.
The CNO will give the nursing staff a voice with the
higher ups of the hospital, as well as working with the nurse
managers and charge nurses to hear the needs of the employees
themselves. On top of just advocating for current employees,
the CNO will also weigh in on new hires, and ensure that they
are being trained adequately and effectively. Also, a mentorship
program will be put into place; allowing graduate nurses to
work directly with seasoned, experienced nurses. This will
boost morale, influence teamwork, and also help new nurses
gain the confidence they need to do their best work. Happy
nurses will lead to improved patient care, and an overall
increase in patient satisfaction.
Conclusion

The nursing field will always be one that is high pressure,
and high stress, but with a change in how we staff our units, we
can make the work environment more efficient. “The major goal
of staffing management is to provide the right number of
nursing staff with the right qualifications to deliver safe, high-
quality and cost-effective nursing care to a group of patients
and their families as evidenced by positive clinical outcomes,
satisfaction with care, and progression across the care
continuum.” (Pickard, Carson, Huber, 2018, p. 367) Ensuring
that the hospital has a CNO with all the qualifications and
capability to run a smooth operation will lead to a solution to
nursing shortages, and increases in patient satisfaction.
References
Huber, D. (2014). Leadership and management principles.

Elsevier.
Huber, D., & Workman, L. L. (2018). Confronting the Nursing
Shortage. In Leadership & nursing care management (pp. 339-
Johnson, W. G., PhD., Butler, R., PhD., Harootunian, G.,
M.S.(c), Wilson, B., PhD., & Linan, Margaret, M.S., M.P.H.
(2016). Registered nurses: The curious case of a persistent
shortage. Journal of Nursing Scholarship, 48(4), 387-396.
doi:http://dx.doi.org.library.capella.edu/10.1111/jnu.12218
Kerfoot, K. M. (2017). A legacy of improving staffing and
scheduling: An interview with carol ann cavouras. Nursing
Economics, 35(4), 201-204. Retrieved from
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Pickard, B., & Carson, L. (2018). Staffing and Scheduling. In
D. Huber & S. E. Birmingham (Authors), Leadership & nursing
care management (pp. 367-386). St. Louis: Elsevier.
Porpora, T. (2015, May 11). ERs in critical condition, nurses
say; patients cite long waits. Retrieved from
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ult_i.html
Wolf, L. A., Perhats, C., Delao, A. M., Clark, P. R., & Moon,
M. D. (2017). On the threshold of safety: A qualitative
exploration of nurses’ perceptions of factors involved in safe
staffing levels in emergency departments. Journal of Emergency
Nursing, 43(2), 150-157.
03
Running Head: WORKPLACE VIOLENCE 1
WORKPLACE VIOLENCE 5

Nursing and Workplace Violence
Capella University
Policy, Law, Ethics, and Regulations
May, 2019
According to the occupational safety and health administration
(OSHA), more than 2 million workers are victims of violence in
the workplace every year. Violence can arise in any workplace,
and it may emanate from violent acts by coworkers, patients,
their family members, criminals, and visitors, causing concerns
about personal safety (Dehghan-Chaloshtari & Ghodousi, 2017).
In the healthcare setting, violence can take different forms like
physical assault, verbal aggression, or even the use of deadly
weapons against patients, physicians, and other workers.
Besides all these aspects, the employers in the healthcare
setting have an obligation to provide a safe working
environment that is free from recognized hazards.
The risk factors for workplace violence vary from one hospital
setting to another, and some of the common factors include
failure to train staff and facilitate policies that will prevent and
manage a crisis in times of violent acts within the hospital
setting and accessibility to firearms. Nurses, for instance, have
experienced violence for a long time, and they have been told it
is part of their job in the past. Currently, awareness is being
raised that violence is not part of their job, and they do not have
to be assaulted (Abdellah & Salama, 2017). There has been
reluctance by the federal, states and local governments
lawmakers to pass and approve legislation that will offer

healthcare workers legal protection from workplace violence
despite continuous advocacy by professional bodies in
healthcare. In most states, violent assaults have been classified
as 'class A misdemeanors,' but with effective law and advocacy,
the assaults for instance in Texas have been classified as 'third-
degree felonies' (Docksai, 2018).
Guns in the U.S. have been a highly politicized issue hindering
effective regulation. They are easily accessible to patients,
family members, among others, and contribute to healthcare
workplace violence. On November 19th, 2018, in a Chicago
based Mercy Hospital & Medical Center, four people died in a
gun-related shooting (Rappleye, 2018). As a result of such kind
of shootings and deaths, social workers, nurses, and physicians
have joined hands to seek funds and lobby for government
support for legal support against gun violence through
facilitating effective violence prevention strategies.
There are other factors that contribute to workplace violence
such as inadequate security, working directly with people who
are volatile, for instance patients who are under the influence of
alcohol, drugs, and others may have a history of violence,
patients having to wait for long to be served and work
environments that are poorly designed (Cdc.gov, 2019).
OSHA recommends that to protect against violence in the
healthcare setting; providers develop an effective program that
will prevent workplace violence (OSHA.gov, 2019). The
program is to include;
· Commitment by the management and participation from
workers: the management needs first to recognize that
workplace violence is a safety and health hazard and also
provide the needed resources to and motivation to workers to
facilitate dealing effectively with workplace violence. Regular
committees and team meetings can be held to ensure that
violence prevention program is in operation (OSHA.gov, 2019).
· Analyzing the workplace and identifying hazards: this
involves an assessment of the workplace to identify potential
and existing hazards for workplace violence. The team should

set the time within which a comprehensive workplace analysis
should be done to single out the hazard and new situations that
could result in violence.
· Preventing and controlling hazards: this is a guideline in
which appropriate steps are taken to control or prevent hazards
that were identified. The implemented controls should be
evaluated more often to facilitate any needed updates
(OSHA.gov, 2019).
· Enhancing training programs on safety and health: these
programs will ensure that healthcare workers are aware of the
potential hazards and how they can protect themselves. The
training content can be reviewed on an annual basis to integrate
other new relevant information.
· The final guideline is keeping records and evaluating the
violence prevention program. This will be essential for the
identification of any deficiencies or any changes that need to be
made.
Concerning personal and shared roles as well as those of
employers and registered nurses, the position of the American
Nursing Association (ANA) is to create and maintain a culture
of respect that is free from "incivility, bullying and workplace
violence" (Nursingworld.org, 2015). The employers and the
registered nurses have a legal, moral and ethical responsibility
of facilitating a work environment that is healthy and safe for
patients and their families, but also for all members of the
healthcare team. The ANA intends to protect nurses from the
different types of violence through the use of resources, policy,
and advocacy, among other methods. The ANA has zero
tolerance on workplace violence and its policies compared to
those that healthcare organizations put in place concerning
workplace violence. Some of the policies in its position
statement include;
· Offering education programs on bullying and incivility as well
as prevention strategies.
· Offering a mechanism through which RNs can seek support
when they feel threatened.

· Encourage the registered nurses to report any incidence of
violence, participate in educational programs, and learn the
policies and procedures within the organization.
· The nurses and their employers should establish a shared
commitment that will promote a safe environment, which will
enhance dignity and respect (Nursingworld.org, 2015).
The employers should be in the forefront to prevent violence,
and they, therefore, need to implement OSHA's safety and
health program. This program should be evaluated periodically
and enhance the specific prevention strategies and safety
policies in different areas such as environmental designs,
administrative controls, provide the hospital workers with
safety tips and modifying their behavior (Cdc.gov, 2019).
Employers can install metal detectors like security devices, and
this will prevent people who are armed, e.g., with guns from
entering the hospital environment. Good lighting in the
hallways and cameras can be installed for security purposes.
Monitoring, alarms, and signaling systems can be developed for
use during an emergency. The healthcare employer should
design and install a system in which the security personnel can
be alerted in case of violence.
When responding to violence, hospital workers should watch for
signals such as the presence of a weapon, threatening gestures,
anger, and frustration. In return, they should maintain behavior
that will dissolve the rage, such as avoiding giving orders,
matching the threats, or avoiding any aggressive behavior
(Cdc.gov, 2019). Safety policies and prevention strategies have
been proven to be effective, and therefore, hospitals should
develop a violence prevention program that is comprehensive to
provide healthcare workers with a safer working environment.

Resources
Abdellah, R. F., & Salama, K. M. (2017). Prevalence and risk
factors of workplace violence against health care workers in
emergency department in Ismailia, Egypt. Pan African medical
journal , 26(1), 1-8.
Cdc.gov. (2019). The National Institute for Occupational Safety
and Health (NIOSH): Violence Occupational Hazards in
Hospitals. Retrieved 2019 йил 16-05 from Centers For Disease
Conntrol and Prevention: https://www.cdc.gov/niosh/docs/2002-
101/#What%20are%20the%20risk%20factors%20for%20violenc
e?
Dehghan-Chaloshtari, S., & Ghodousi, A. (2017). Factors and
characteristics of workplace violence against nurses: a study in
Iran. Journal of interpersonal violence , 0886260516683175.
Docksai, R. (2018). Lawmakers and Hospitals Take Action to
Curb Violence Against Nurses. Retrieved 2019 йил 16-05 from
Nursing Licensure Organization:
https://www.nursinglicensure.org/articles/workplace-
violence.html
Nursingworld.org. (2015 йил 22-07). ANA Positio
Statement:Incivility, Bullying, and Workplace Violence.
Retrieved 2019 йил 16-05 from American Nurses Association:
https://www.nursingworld.org/practice-policy/nursing-
excellence/official-position-statements/id/incivility-bullying-
and-workplace-violence/
OSHA.gov. (2019). Guidelines for Preventing workplace
violence for Healthcare and Social Service Workers.
(https://www.osha.gov/Publications/osha3148.pdf).
Rappleye, E. (2018 йил 20-11). Perspective: Addressing gun

violence is 'professional, moral and ethical duty' of healthcare
providers. Retrieved 2019 йил 16-05 from Hospital Review:
https://www.beckershospitalreview.com/hospital-physician-
relationships/perspective-addressing-gun-violence-is-
professional-moral-and-ethical-duty-of-healthcare-
providers.html
Nursing Practice and School Health Privacy
Capella University
BSN-FP4006
Health and Wellness Issues Affecting Adolescents
Mental Health
Early pregnancy and Childbirth
Alcohol and Drugs
Obesity
Bullying
HIV/AIDS and other Infectious Diseases
Mental health - According to the studies carried out by WHO,
depression is one of the leading causes of illness among the
adolescence, followed by suicide. Other factors such as poverty
and humiliation can increase the risk of developing mental
problems. However, creating life skills among adolescents and

offering them psychological support in their institution and
community, can help boost their mental health. Also, programs
can be organized to create awareness among them regarding
such issues and how to avoid them.
Early Pregnancy and Childbirth- It is evident that girls aged
between 15-19 years die out of complications related to
pregnancy and childbirth globally. However, approximately
11% of these girls are from the low and middle-income
countries.
Alcohol and drugs - This is one of the primary concerns in most
countries across the world. It reduces the self-control among
adolescents and also exposes them to some risky activities such
as reckless driving and unsafe sex.
Obesity – Due to an increase in technology, teenagers are more
likely to spend time on their computers, phones, and playing
video games than partaking in physical activity. On top of the
increase of sedentary lifestyles, access to fast food is increasing
adolescents chances of becoming obese. This places children at
higher risk for cardiovascular diseases, and diabetes at a young
age.
Bullying - one of the most significant issues adolescence are
experiencing. This could come from their peers due to various
factors like how they look, their backgrounds, or their academic
excellence among other factors. In Australia, it is estimated that
one out of six children is bullied. The influx of social media has
increased the likelihood of being bullied because people do not
have to do it face to face, and now can take place in cyber
bullying all across the world.
HIV/AIDS- According to the estimation in 2016, 2.1 million
adolescents were living with HIV. A good number of them were
exposed to HIV/AIDS during birth and live with this status

unaware.
2
Privacy Law and its impact on School Nurses
Definition
Refers to the laws that are aimed at regulating, storing and
using personal information of individuals that that can be
collectable to the government, public and private organization.
It is considered in the context of a person privacy rights or at
reasonable expectations of privacy.
Impact of privacy law to school nurse
It allows the nurse to retain the information regarding the
patient and keep it confidential.
It also protects the nurse from community or peers who may
need to access the information of a certain patient.
Students are also protected and their information is preserved as
private and confidential and cannot be accessed without their
consent.
CONT..
A patient’s right to privacy entails all confidential information
that is related to the patient. When dealing with adolescence, it
is essential to maintain this as many deal with several issues
that require to be protected from their peers. As a school nurse,
one needs to maintain a high degree of discretion, and storing
the information of each patient without disclosure. All countries
are seeking to ensure that privacy of every individual is being
protected, and therefore, laws and regulations are being set to
take care of such issues regarding the patients (Taylor, Williams
& Blythe, 2015)
3
Laws that relate to adolescence safety and health
Health Insurance Portability & Accountability Act (HIPAA).

It was approved by US legislature in 1966 to improve the
effectiveness and efficiency in health care systems
Family Educational Rights and Privacy Act of 1974 (FERPA)
It is a state law that aims at protecting the student privacy in
regard to education records
Children's Online Privacy Protection Act (COPPA)
This law was formulated to safeguard the children aged below
13 years against site web operators.
Confidentiality issues are increased during the adolescence
stage and can be critical barriers to the young adults when it
comes to receiving health care. It should be noted that health
care providers should be aware of laws that affect the
confidentiality of the individuals. The Privacy rule, based on
requirements contained in HIPPA of 1996 provides the
protection against parents accessing protected health
information for the young adults and liberated minors. It also
protects them when a parent or guardian assents an agreement of
confidentiality between the health care provider and the
adolescent. On the other hand, FERPA gives parents and
students’ basic rights such as right to inspect and evaluate all
records of a student maintained by the school. Right to consent
in writing to reveal some personal information from the records
of students and many other rights. COPPA allows parents to
have an access on what their children view online. Further, it
requires that site operators give parents permission to evaluate
any information obtained from their children.
4
Benefits of Privacy Laws
Privacy law is essential as it helps to encourage vital values
such as
Personal independence
Respect
Dignity of human being

Cont...
5
Benefit to Students
Students are protected against malicious individuals and all
their information is maintained as private and confidential.
They are also protected from site operators who may disclose or
use their information for ill purposes. This is facilitated through
COPPA law which allows parents to review all information on
their children
The law offers freedom as they can do what they like under
unfair influence or control
Security – students are not bothered since their information is
protected. This could be either their health status or an issue
they are struggling with
Benefits to School
The school is able to collect information that is relevant without
being held liable
In cases, where some students are involved in crime activities it
is allowed that such information br disclosed without
limitations and the school will not be held liable
Cont…
It is the right of people to be free from intrusion into personal
matters. The students’ privacy right covers education records,
conducts and admission. When such is disclosed this is termed
as violation of privacy rights. Also, in regard to benefit of
privacy laws in schools is that it protects them. In cases of
where a certain student is involved in crime such information
can be disclosed and be helpful to the society. Additionally, the

school nurses are also protected and have the right to preserve
all the information of their patient (Smith & Stepanov, 2014).
6
Benefits to school nurse
They can freely maintain confidential information of their
patient without being coerced to reveal such information
The privacy role is also of great benefit when dealing with
parents of certain students who want critical information
regarding their children who are not minors.
Develops trust
The Evidence-based ethical strategies
Electronic Health Records (EHR) and meaningful use
It increases the privacy of the students information especially
on sensitive matters
Increases the accessibility to care among adolescence
Creating awareness to the parents and young adult on the
policies and laws
Every body is aware of their rights
Nurses are able to work efficiently and with clear cut
guidelines. Students may feel hesitant to seek healthcare advice
because they are afraid of their parents being notified, but if we
ensure them that we will keep the meeting as confidential as
possible (barring any life threatening scenarios), they will feel
more comfortable. Parents can also rest assured that their
children will receive optimal healthcare in a safe space.
8
Conclusion
School nursing is a critical practice that ensures the wellness,
lifelong achievement and the academic excellence of the
students. Ensuring students are healthy and safe while in school

should be the first priority for the school and health care
providers.
Resources
Brewin, D., Koren, A., Morgan, B., Shipley, S., & Hardy, R. L.
(2014). Behind closed doors: School nurses and sexual
education. The Journal of School Nursing, 30(1), 31–41.
Smith, M. K., & Stepanov, N. (2014). School-based youth
health nurses and adolescent decision-making concerning
reproductive and sexual health advice: How can the law guide
healthcare practitioners in this context? Contemporary Nurse:
A Journal for the Australian Nursing Profession, 47(1/2), 42–
50.
Taylor, J. F., Williams, R. L., & Blythe, M. J.
(2015). Healthcare reform, EHRs, and adolescent
confidentiality. Contemporary OB/GYN, 60(8), 34, 36–37.
RUNNING HEAD: END-OF-LIFE DECISIONS 1
END-OF-LIFE DECISIONS 2
End-of-Life Decisions
Capella University
May, 2019

Role of the Nurse in End-of-Life Decision-Making
“End-of-life nursing encompasses many aspects of care: pain
and symptom management, culturally sensitive practices,
assisting patients and their families through the death and dying
process, and ethical decision-making” (Hebert, Moore &
Rooney, 2011). Nurses are playing crucial roles in the in end-
of-life decision making regarding the patients and other
members of family. Clarification of the family roles is the first
role that is played by nurses. The families of the patients
sometimes also develop some roles which are majorly informal.
For instance, there are roles that are dedicated to the members
of family regarding provision of primary care. Suppose a person
becomes seriously ill, before their stay in the Intensive Care
Unit, there is always a member of the family who is supposed to
act as the primary caregiver. However, the individual acting as
the primary caregiver may serve as the primary decision maker
or not. Moreover, nurses play another part in the process of
deciding end-of-life by advocating for their patients, and
communicating with the patients and their family members.
It is extremely important that patients facing the end of their
life remains comfortable, and if possible “have some pleasure in
daily life” (Nakano, Sato, Katayama & Miyashita, 2013). In
helping the patients and administering palliative care, or
assisting them in making their plans, nurses help the patient to
remain autonomous. Nurses spend the most time with the
patients, so it works best to have them help patients and their
family members in this time of need to understand all their
options. That is one of the biggest roles that the nurse can play
when it comes to patient’s making decisions about their end-of-

life care.
Legislation that generated end-of-life health care policies
Patient Self Determination Act (PSDA) is the legislation that
led to the generation of the end-of-life healthcare policies;
Congress enacted it in the year 1991. The act mandates that the
facilities of healthcare that were receiving Medicare funding or
aid were required to provide the patients with written
information indicating the rights of the patients to get involved
in the medical decision making alongside writing advanced
directives. The legislation was as a result of concern from
various persons who were having significant concerns with the
policies of health care and not for a medical case that was
specified. The people who were concerned in the healthcare
policies had interests in ensuring that patients are allowed to
take part in the process of making decisions. The healthcare,
proxies, and living wills alongside all other advanced directives
are enabling the patients to decide on the kind of measures they
do or do not want to be used if they become debilitated.
Primary policies regarding current health care practices
Oregon’s Death with Dignity Law is one of the policies that was
put in place in 1997 to allow adult Oregonians who were
terminally-ill to utilize self-administration of doses of
medications which are lethal. Secondly, there is a policy of
death with dignity act that Oregon passed about healthcare
decision-making. The law was enacted to allow patients who
were dying with choices of ending their lives and ensuring that
the patient remains autonomous throughout the rest of their life.
This can help those with agonizing terminal illnesses escape
some of their inevitable suffering.
Ethical Considerations that have influenced policy decisions
Autonomous Decision Making is one of these ethical
considerations. Making this decision is one of the processes of
thoughts that are complex and is setting up various challenges
for both the patients and their members of families towards
coming up with healthcare decision regarding the end of life.
People have the chance to make decisions regarding there end of

life treatment preferences. Additionally, there is ethical
consideration that is influencing decision policy with reference
to the end-of-life healthcare decisions in directives that are
advanced are usually allowing persons who are competent to
prototype as well as engage in the documentation of the
decision plan with regard to healthcare in advance directives
suppose they become incapacitated in the future Healthwise
(Leach, 2016, p. 39).
Resources
Hebert, K., Moore, H., & Rooney, J. (2011). The Nurse
Advocate in End-of-Life Care. The Ochsner journal, 11(4), 325–
329.
Leach, D. R., (2016). Ethics and end of life issues. Oxford
Medicine Online.
Meyers, D. E., & Goodlin, S. J., (2016). End-of-Life Decisions
and Palliative Care in Advanced Heart Failure. Canadian
Journal of Cardiology, 32(9), 1148-1156.
Nakano, K., Sato, K., Katayama, H., & Miyashita, M. (2013).
Living with pleasure in daily life at the end of life:
Recommended care strategy for cancer patients from the
perspective of physicians and nurses. Palliative & Supportive
Care, 11(5), 405-13.
doi:http://dx.doi.org.library.capella.edu/10.1017/S14789515120

00442
Norlander, L. (2014). To comfort always a nurse's guide to end-
of-life care. Retrieved from https://ebookcentral-proquest-
com.library.capella.edu
Zaal-Schuller, I., Willems, D., Ewals, F., Van Goudoever, J., &
De Vos, M. (2016). How parents and physicians experience end-
of-life decision-making for children with profound intellectual
and multiple disabilities. Research in Developmental
Disabilities, 59, 283-293.
RUNNING HEAD: MORAL DILEMMA & ETHICS 1
MORAL DILEMMA & ETHICS 2
RUNNING HEAD: MORAL DILEMMA & ETHICS3
Moral Dilemmas and Ethical Decisions
Capella University
May, 2019
Looking after patients in an emergency room brings forth
ethical dilemmas. Owing to the limited time and the condition
of the victim in addition to the absence of treatment history,

difficulties usually occur. The nurse is faced with minimal time
to analyse all the details regarding the patient in question. It is
therefore recommended that the nurse should make a quick
assessment and take the necessary action which is by the
hospital protocol. This chaos that occurs in emergency rooms
poses a distinct ethical challenge, which calls for nurses to
familiarize themselves with ethical principles as well as
concepts.
Health care protocols and policies guiding triage attention in the
event of an emergency
“Nursing intuition and subjective decision making are required
even with the most advanced triage systems, further leading to
variability in triage processes and outcomes. Given the
associated risk in the triage environment, as our patient
demands evolve, so must our nursing practice to ensure
optimum patient outcomes” (Domagala & Vets, 2015). Nurses
expect to treat patients and also save lives. While assessing
patients and beginning the triage process, nurses must be able to
separate patients into emergent, urgent, and non-urgent. In
effectively classifying the patients in this way they can assure
that the most serious injuries and illnesses are being treated
first in order to save lives.
Strategies Used During Triage
According to Aacharya, Gastmans, and Denier there are
numerous different strategies that can be implemented when
triaging patients. “The most commonly used guidelines for ED
triage on the international literature are The Manchester Triage
Score, The Canadian Triage and Acuity Scale (CTAS), The
Australasian Triage Scale (ATS), and Emergency severity
Index. In ESI, there are five-levels of these triage score. In
addition national and institutional guidelines are also developed
and used in practice” (Aacharya, Gastmans & Denier, 2011).
CTAS and ATS break down their triage system into 5 tiers;
Resuscitation – Level 1 (0 minute wait), Emergency – Level 2
(10-15 minute wait), Urgent – Level 3 (30 minute wait), Semi-
urgent/less urgent – Level 4 (60 minute wait), Nonurgent –

Level 5 (120 minute wait). Manchester Triage Score goes as
following; Immediate (Red) – Level 1 (0 minutes), Very urgent
(Orange) – Level 2 (10 minutes), Urgent (Yellow) – Level 3 (60
minutes), Standard (Green) – Level 4 (120 minutes), Nonurgent
(Blue) – Level 5 (240 minutes). All the systems use a 5-tiered
system, but differ on the time expected for patients to see the
provider.
The Emergency Service Index (ESI) is what is most
commonly used in United States hospitals. It is also a 5-tiered
system that relies on nurses to triage patients effectively into
the appropriate category using both their judgment and
diagnostic testing. Level one requires immediate life-saving
interventions, level two consists of high-risk patients (i.e.
dyspnea, confusion, extreme pain, lethargy, etc.), and the
following three tiers are non-emergent cases that can afford to
wait for medical treatment. In learning the ESI effectively,
nurses can efficiently triage patients and ensure people are
receiving the correct level of care.
Medical attention disparities effects on treatment decisions
Unfortunately, it is not uncommon to hear that someone died in
a particular hospital as a result of neglect by the clinicians.
Treatment disparities occur as a result of institutionalised
inequities and not technology, medication or access. Even
though the process helps make swift decisions, it serves as an
avenue through which impressions and assumptions flow which
in effect brings about biased treatment judgments on the part of
the practitioner (Griffith, 2018). Nurses are human, and with
that comes imperfections. It is very possible that a nurse can
have underlying biases that they may not even be conscious of.
This can come through when they are treating patients who may
be homeless, or have mental illness. This is why there should be
more than one nurse that is in charge of doing triage.
Health care policies directed towards the care of uninsured
patients
Health care across different nations provides little priced safety
nets, which include free clinics, community health centers, as

well as public hospitals. Here, the uninsured patients receive
medical attention at a low price irrespective of their differences.
Whether the uninsured patients are low-income earners or high-
income earners, they are always aware of the existence of low
cost and high price medical centers respectively.
There are also policies that exist to allow any patient to receive
medical attention in the event of an emergency. There is no
valid reason to discriminate an individual based on their
financial condition during a crisis (Christakis, 2014). The
responsibility for uninsured patients is also widely recognized
through offering high-class major safety nets, which include
educational health centers and free clinics. It can, therefore, be
concluded that in the event an uninsured person falls sick, there
are many places to receive medical attention.
Moral and ethical challenges faced by nurses when enacting
hospital protocols and policies.
In every country of the world, nurses have encountered ethical
difficulties in the pursuit of patient’s health care. It is also by
the nursing profession that they should uphold principles, moral
virtues and duties which have become increasingly sophisticated
in the face of immense pressures and moral choices incurred in
the line of duty (Jones, 2016). The demand for nurses to meet
the multifaceted requirements for the patients creates a very
complex nursing environment. The nurses must ensure that the
rights of the patients are upheld irrespective of the
multidimensional differences.
Unethical practices in emergency rooms and other areas should
be avoided at any cost to maintain the image of the firm. It is
also a moral obligation to ensure that end of life concerns are
well taken care of, alongside preserving the confidentiality of
the patients towards health care. These honest and ethical
obligations result in more stress among nurses. There is also a
conflict of interest that arises if an uninsured patient comes
along. Although nurses have the obligation to treat each patient
fairly regardless of race, sex or income, they may receive
pressure from the organization to treat insured patients first,

regardless of acuity.
Strategies for managing the care of the uninsured and indigent
population
The number of uninsured patients has been on the rise for a few
decades as a result of the premiums paid for life insurance,
which is far beyond the budgets or natural population. Their
governments through the public health sector can support the
non-working, uninsured patients.
The funds to finance medical activities are raised from taxes,
and this results in high fees amongst the employed as well as
the business sector. General tax revenues which may include
income tax, import duties and sales tax can be preferred. The
medically uninsurable population comprises of a small group of
the general population. Their health care demands can be met
through incentives or taxes or both (Kolodner, 2014). The
uninsured working group can be mandated to take insurance
policies since they can afford them. The employers should
ensure that their employees pay a regular amount towards their
insurance policy.
In conclusion, it is therefore clear that many steps are involved
in triage nursing. There already exists health care policies and
protocols that have to be adhered to in case of an emergency.
The general nursing environment is also a major factor that
affect the treatment decisions made by nurses. Conflicts of
interest and maintaining confidence of patients are some of the
ethical challenges faced by nurses. However , the uninsured
patients can be taken care of through numerous strategies which
can be adopted by the various states.

Resources
Aacharya, R. P., Gastmans, C., & Denier, Y. (2011). Emergency
department triage: An ethical analysis. BMC Emergency
Medicine, 11, 16.
doi:http://dx.doi.org.library.capella.edu/10.1186/1471-227X-11-
16
Asch DA, Jedrziewski K, Christakis NA. Response rates to mail
surveys published in medical journals. Journal of Clinical
Epidemiology. 2014;50(10):1129–1136.
Burns JP, Mitchell C, Griffith JL, Troug RD. End-of-life care in
the pediatric intensive care unit: Attitudes and practices of
pediatric critical care physicians and nurses. Critical Care
Medicine. 2015;29(3):658–664.
Butz A, Redman BK, Fry ST, Kolodner K. Ethical conflicts
experienced by certified pediatric nurse practitioners in
ambulatory settings. Journal of Pediatric Health
Care. 2014;12(4):183–190.
Domagala, S. E., & Vets, J. (2015). Emergency nursing triage:
Keeping it safe: JEN JEN. Journal of Emergency Nursing,
41(4), 313-316.
22
Grady C, Soeken KL, Danis M, O'Donnell P, Taylor C, Farrar
A, Ulrich CM. Does ethics education influence moral action of
practicing nurses and social workers. American Journal of
Bioethics. 2018; 8(4):4–11.
Jones TM. Ethical decision-making by individuals in
organizations: An issue-contingent model. Academy of
Management Review. 2016;16:366–395.

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