Safety, Quality, and Informatics

Running head: STAFF SHORTAGE 1

STAFF SHORTAGE 2

Staffing Shortages in the World of Nursing

Samantha M. Tallarine

Capella University

Organizational and Systems Management for Quality Outcomes

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 performance

Weaknesses · 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 depth

Opportunities · 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. In Leadership & nursing care management (pp. 1-36). St. Louis: Elsevier.

Huber, D., & Workman, L. L. (2018). Confronting the Nursing Shortage. In Leadership & nursing care management (pp. 339-366). St. Louis: Elsevier.

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 http://library.capella.edu/login?qurl=https%3A%2F%2Fsearch.proquest.com%2Fdocview%2F1929679336%3Facc

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 https://www.silive.com/news/2015/05/nurse_staffing_issues_result_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. doi:http://dx.doi.org.library.capella.edu/10.1016/j.jen.2016.09.003