Staffing Policy Regarding Ratios

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Table of Contents

Introduction
Driving Forces
Restraining Forces
The Action Plan
Lewin Change Model
Reference List

Introduction

When a hospital can identify and maintain an adequate number of RN nurses as staff in a fair ratio of nurse-to-patient is crucial to medical care. It assures quality service delivery. Several studies have been conducted and they reveal that there is a connection between the higher level of registered nurse recruitment and the declining rates of adverse patient outcomes. There is a chasm that exists between those supporting and those opposing the mandated, statute requirement to employ the right nurse-to-patient ratio. Some nursing bodies advocate for the use of ratios while others claim that these ratios are not considerate of patient dependency but cause loss of control at these health facilities.

Driving Forces

The first issue that inspires change is legislation. The 42 code of federal regulation demand that all the hospitals that have been certified to implement Medicare must have adequate numbers of licensed RNs, vocational nurses, and other supporting workers to provide medical care to all the patient needs (Needleman, et al 2002, p. 1716). Considering the weight of such precise statement and the persistent disregard of the congress to enact quality these stringent measures for violation of this staffing act requirement, it is then up to the nurses to push for the appropriate measure to meet the safety needs of the patients (Needleman, et al 2002, p. 1716).

There are notable benefits of having an adequate number of RNs. Every additional RN recruited to work for an average of 8 hours a day will lead to reducing medical expenditure and better health productivity estimated at saving over $60,000. Note that this is just a partial estimation of the economic worth of nursing without mentioning the intangible benefits to the patient like relieving stress in the family or reducing patient pain (Needleman, et al 2002, p. 1717); reducing complicated cost-related issues, reducing malpractice cases and improve working atmosphere that decreases the possibility of turnover or accidents (Needleman, et al 2002, p. 1717).

Nurses are hence requesting the help of the elected officials at the hospital level to the state level to assist in the protection of patients by holding the violating hospital accountable for inadequate staffing rations through statute and other regulatory means (Needleman, et al 2002, p. 1718). The American Nurses Association (ANA) is also fully in support of this rule as it empowers nurses with the authority to initiate staffing plans. This staffing change initiative may be specific to particular healthcare departments and services to their patients. The ANA staffing model is flexible and allows tailored plans to meet certain needs based on the patient factors like severity of sickness, nurse experience, available technology, and supportive medical services (Needleman, et al 2002, p. 1719).

At the state level, some rules seek to enforce punitive measures like suspension of the license or termination when the facility fails to comply. When the nurse-to-patient ratio is unbalanced with one nurse to many patients, the nurses will be overwhelmed by the work and can lead to burnout, stress, and complacency hence poor execution of responsibilities.

Restraining Forces

Because of the economic downturn, there has been decreasing nursing budget resource allocation has caused reduced nurse staff. This means these nurses get to work long hours as they care for the sick or they have to take care of a very big number of patients in a day. This causes great exhaustion and stress. A study by ANA of 550 health facilities with 220, 000 RNs reported that 54% of nurses attending adult medical units and the emergency department did not have adequate time with their patients. There was increased overtime work by 43% because of fewer nurses in comparison to the number of patients. Operations like referrals, transfers, and discharges were greatly affected by these limitations in the workforce (Needleman, et al 2002, p. 1719).

Some professional groups oppose staffing ratios giving reasons like staffing is based on ratio and not client dependency hence unrealistic. Other reasons have been that many hospitals have been forced to close because they could not meet the minimum nursing salaries (Needleman, et al 2002, p. 1721); diversion of emergency department cases hence patients were denied access to care just because the hospital cannot accommodate more patients; increased medical costs to cater for the increased number of nurses to fit staff ration and delayed elective surgeries because of the temporary closure of the surgery rooms.

The American Organization of Nurse Executives is against the staff ratios but support increased evidence-based and outcome-driven study that covers patient acuity when developing staffing guidelines (Needleman, et al 2002, p. 1721). Other restraining reasons have been that the prescriptive approach in the stature requirements of fixed ratios to not take into accounts the change in the needs of clients, preparedness of the staff, and the recent technology.

The Action Plan

The appropriate strategy to effect change in healthcare delivery will be the empirical–rational strategy. This strategy is based on the fact that human beings are rational and they act according to reasoned self-interest. This, therefore, means that people would be ready to adopt change as long as it is justifiable and when they are made to understand the benefits that would come as a result of the change (Marquis & Huston, 2009, p. 67).

Therefore nurses are better placed to use this chance to influence the management by highlighting the benefits of a proper nurse-to-patient ratio. As a consequence, the managers will be able to include these suggestions in the recruitment and selection to employ more staff to fill the required ratio. Some of the developments can entail in-service education, formal professional studies, and ongoing training and education. The plan will follow four steps as below;

Recognize The Need For Change

This is the step that involves being aware that restructuring in nursing is necessary and possible (Marquis & Huston, 2009, p. 67). It also entails awareness that the organization is facing some shortages and change is needed. To increase awareness, nurses will take self-studies and retreats to help perceive these needs

Identification Of The Existing Problems

This step entails the actual diagnosis of the problems in the organization and it may need professional or expertise contribution. The nursing workforce identifies their duties and responsibilities through daily interactions but formal methods like official inter-departmental meetings are employed when the response is to be taken by several people (Marquis & Huston, 2009, p. 67). The structured group techniques can then be used for clarification of issues like routine procedures, challenges, and so on

Selection And Modification Of The Model

This step entails the development of methods that would be used for carrying out the implementation process. Selection of a model from several alternatives based on the patient care duties and responsibilities that need to be addressed is at this stage (Marquis & Huston, 2009, p. 68). This offers a realistic analysis of the attitude and needs of the supporting staff and takes into consideration the organization’s constraints. Professionals are to be involved at this stage for their expert contribution and decision-making skills.

Systematic Implementation And Evaluation

This is when the managers begin to execute the plan right from abstraction to a solid actualization of the plan. The managers conduct a staffing process based on the needs identified and work in concert with the nursing workforce to get the most talented and enthusiastic workers for the job (Marquis & Huston, 2009, p. 69). This is also where the expert RNs takes supportive roles like mentorship roles and preceptor jobs to assist new nurses to adapt to the system. The implementation process is divided into steps and resources allocated for each. This step is not a one-time event but an incessant process.

Following implementation, there is evaluation. This is the stage that involves measurement of the impact that the change had on the staff, the entire facility, and largely on the patient services. The measures must be selected to reflect the intended objectives of the job redesign initiative (Marquis & Huston, 2009, p. 70). This stage also offers objective standers that justify the need to continuously implement the change and identify elements that need continued modification.

Lewin Change Model

The Lewin Theory entails three stages; unfreezing, Moving, and Refreezing. Unfreezing is the problem awareness stage where the willingness to change is inspired by the nurses from within but not by coercion (Burnes, 2004, p. 978). It also involves convincing people to change the attitude from the old beliefs by employing punishment and reward motivations. Stress is a major problem in nursing and plays an important role and necessitates the need for change (Burnes, 2004, p. 978). Effectiveness is highly dependent on the involvement of the nurses

The moving phase is when the staff begins to work to effect this change. It entails identification of the problem, finding alternative solutions, goals and planning the accomplishment of these objectives. Staffing ratios change aims at attaining quality care for patients and nurse satisfaction. The way to accomplish the required ratio is to recruit more experienced nurses (Burnes, 2004, p. 978).

Refreezing involves the incorporation of the change into the system including personalities and stabilization of the process. Sometimes people tend to revert to old habits shortly after the transformation has been made (Burnes, 2004, p. 978). This process of integration helps to build momentum and perpetuate the change. The implementation group makes necessary framework adjustments to support the recruitment of new nurses to meet the mandated staffing ratios.

Reference List

Burnes, B. (2004). Kurt Lewin and the Planned Approach to Change: A Re-Appraisal. Journal of Management Studies, 41 (6), 976-1002.

Marquis, B.L., & Huston, C.J. (2009). Leadership Roles and Management Functions in Nursing: Theory and Application (6th Ed.). Philadelphia: Lippincott Williams & Wilkin.

Needleman, J., et al. (2002). “Nurse Staffing and quality of care in hospitals in the United States,” N Engl J Med; 346 (22):1715-1722.

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