This document describes the organizational structure of a 240-bed skilled nursing facility called Buena Vida. It outlines the current leadership and nursing staffing structures, as well as some health outcomes that need improvement such as inadequate staffing, pressure injuries, falls, and patient satisfaction. It analyzes how the current structure with shared unit directors and insufficient nursing staff leads to poor outcomes. Finally, it proposes a plan to improve the organizational system by hiring more nurses and assigning dedicated unit directors, charge nurses, and social workers to better meet patient needs and reduce burnout.

1. C H A N G E O F A H E A LT H S Y S T E M
STRATEGIES FOR ADVANCE
NURSING PRACTICE

2. T Y P E O F O R G A N I Z AT I O N
• Long term and short-term care facility
• Skilled Nursing Facility
• Type of service provided- illness service
• Chronic and long term-> 30 days
• Health promotion- Tertiary healthcare
• Ownership- Nonprofit
• Council type- Family & Resident
• Home-size-240 beds ( 40 pt on 6 Units)
• Demographics – Older Hispanics (majority)
• System Theory- 7 floor, 6 units
• Nursing roles & function-

3. O R G A N I Z AT I O N A L S T R U C T U R E
• 40 Patients on each unit – 7 floors 6 units
• 1st floor: Leadership floor- 1 Director of nursing-
Assistant Director of Nursing- Boss (Administration)
• Floor
• 2nd Unit: 1-unit director: Meetings in regards to the
unit- and emergencies
• 40 patients
• 2 LPNs (1 LPN: Medication Administration) (2ND
LPN: Wound care, Finger Sticks and Insulin
administration, Issues that arises on the unit,
Sending patients to appointments) = Charge Nurse
• 3rd Unit: Same Structure as the 2nd unit- 1-unit
director
• 4th Unit: 1-unit director, 1 RN (Wound care, Finger
Sticks and Insulin administration, Issues that arises on
the unit, Sending patients to appointments, care plans,
progress notes, wound care and Psych notes) =
Charge Nurse/ CNM (Clinical Nurse Manager)
• 5th Unit: Same Structure as 2nd and 3rd unit – 1 social
worker and shares the 4th floor unit director
• 6th Unit Same Structure as 2nd and 3rd unit – 1unit
director
• 7th Critical Care Floor – 1-unit director (Shares 3rd floor
UD), 1 RN (Wound care, Finger ticks and Insulin
administration, Issues that arises on the unit, Sending
patients to appointments, care plans, progress notes,
wound care and Psych notes) = Charge Nurse/ CNM
(Clinical Nurse Manager)

4. L E A D E R S H I P S T Y L E
• Transactional Leadership (current)
• Leadership is responsive
• Contingent reward (quid pro quo)
• Punitive
• Works within organizational structure and
never deviates
• Effects on employees and outcomes
• Error are corrected in a reactive manner
• Limited job satisfaction
• Low to stable levels of commitment
• Transformational Leadership (Aim)
• Leadership is proactive
• Inspiring and motivating
• Intellectual stimulation
• Individualized consideration
• Effects on employee and outcomes
• Coaching and mentoring happens
• A shared vision, feeling valued
• Increased performance
• Increased commitment

5. C U R R E N T P O P U L AT I O N
OLDER
ADULT
SPANISH
70%
AFRICAN
AMERICA
OTHERS

6. H E A LT H C A R E O U T C O M E S T H AT
N E E D S I M P R O V E M E N T
INADEQUATE
STAFFING
PRESSURE
INJURIES
SEPSIS FALLS
PATIENT
SATISFACTION

7. I N A D E Q U AT E S TA F F I N G
BUENA VIDA- Rehabilitation
2LPNs + 1 RN : 40 Patients

8. P R E S S U R E I N J U R I E S
Intrinsic Factors: Immobilization,
 cognitive deficit,
 chronic illness (eg, diabetes mellitus),
 poor nutrition,
 use of steroids, and aging.
Extrinsic factors: pressure,
 friction,
 humidity,
 shear force. Frequent Turning &Repositioning

9. A N A L Y Z I N G T H E
E F F E C T I V E N E S S
O F T H E C U R R E N T
S T R U C T U R E
• Shortages of Registered Nurses
increases:
• > Hospital transfers
• > Pressure ulcer development
• > Overall increase in poor health
outcomes
• > Increases nurse burnout

10. A N A LY Z I N G T H E E F F E C T I V E N E S S
O F T H E C U R R E N T S T R U C T U R E
• Shortages of
Registered
Nurses
• Increases
nurse
burnout
• Pressure
ulcer
development
• Hospital
transfers
• Overall
increase in
poor health
outcomes

11. A N A LY S I S
C O N T I N . .
• LPN AND RN BURNOUT
• RESPONSIBILITIES: 40 patients
• Medication administration
• Wound care
• Blood glucose monitoring
• Hospital transfers and
emergencies
• Family members concerns
• Weekly psych notes and daily
progress notes
• Organizing care plans
• Daily patient appointments
• = Burnout

12. C O N C L U D I N G
A N A L Y S I S
Shared Unit Directors (UD’s) leads
to:
Patients being sent to the hospital
unnecessarily
Patients getting readmitted back to
nursing home shortly after
Decrease in patient satisfaction
Lack of organization in the system

13. A P L A N T O I M P R O V E
T H E
O R G A N I Z A T I O N A L
S Y S T E M
• The recent framework of the Buena Vida’s nursing home prohibits the facility from
obtaining its greatest potential and inhibits the delivery of care to elderly patients.
• 240 patients
• 54 nurses
• 3 shifts
• Six patient units/ 40 patients per unit.
• There are not a serviceable number of nurses per shift.
• Critical unit (7th floor) has one RN and one charge nurse
• There are less than 3 nurses per shift
• Nursing shortage
• Employee burnout
• Safety issues for patients if needs are not being met adequately
• Increased number of pressure injuries
• Increased in sepsis rates

14. A P L A N T O
I M P R O V E T H E
O R G A N I Z A T I O N A L
S Y S T E M C O N T .
• Plan to subdue nursing problem is to hire adequate staff
• 12 Registered Nurses
• 10 Licensed Practical Nurses
• 6 Social Workers
• 2 Unit Directors
• Each patient unit will now have/per shift
• 3 LPNs
• 2 RNs
• 1 Unit Director per unit
• 1 Social Worker per unit
• In floors without charge nurses (unit directors) , the RNs will
serve as charge nurses for their respective floors (Holley,
Jennings & Wolters, 2009).

15. A P L A N T O I M P R O V E
T H E O R G A N I Z A T I O N A L S Y S T E M C O N T.
• Roles
• 3 LPNs on each shift will split duties with one another
• Wound care
• Finger sticks/Insulin administration
• Medication administration
• pressure injury checks
• vital signs
• Duties can also be split between 3 LPNs by each taking charge of 14 patients.
• These results will be reported and/or electronically logged for the patient assigned to the LPN to the covering RN.
• RNs will be available to focus more on patient assessments, care plans, progress notes, wound care.
• Unit directors can exclusively focus on signing off patients for appointments, issues that arise on the unit, and meetings.
• Sepsis screening/protocol to assess the need for a hospital transfer
• Two nurse skin checks prior to discharge, transfer, and admission with signed documentation.

16. A P L A N T O I M P R O V E T H E O R G A N I Z A T I O N A L
S Y S T E M C O N T.
• This plan will aid in the improvement of the health of the patients
• It will help ease the management of the units
• Safer environment
• More staff available for crisis and emergency situations.
• Reduces burnout amongst employees
• Easier supervision and task assignments for directors and charge nurses (Mehdaova,
2017).
• Patients in the critical units will be given the close observation they need for recovery.

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26. T H A N K Y O U ! ! ! !