Change Process: Nurse Staffing Patterns

Introduction

Understaffing and shortages of nurses is a common issue in health care. Budgets are tight and available personnel are limited. A change to this staffing pattern must be made, however, to ensure a safe and effective healthcare environment for patients. The specific change to the staff that will improve the health care environment for patients is to increase available nursing staff until the nurses on the clock can be dedicated to certain areas which will limit transmission of disease throughout the hospital, risks to nurses who perform procedures in a rush and ensure more attentive and informed care of patients.

Problem identification

Identifying a problem is the first step in the change process. In this case, the problem is too few available nurses. Three major indicators of that problem are the transmission of diseases, injuries from rushing through procedures and diminished attention to patient needs because.

1. Disease transmission threatens patients at least as much as whatever condition brought them into the hospital. Nurses that have to travel to many different parts of the hospital risk spreading diseases they are exposed to (Li et al., 1996, pg. 1048).

2. Needlestick injuries are a serious threat to the health of nurses. Exposure to bloodborne diseases, many without a cure, is a risk nurses deal with every day, but being expected to navigate that risk in a hurry is an invitation to trouble (Clarke, Sloane and Aiken, 2002).

3. When nurses are expected to handle too many patients, each patient receives less careful attention than is safe. Nurse understaffing results in a 7% higher risk of death following surgical procedures and patient mortality is over 30% higher in understaffed hospitals (Aiken et al., 2003).

Unfreezing

Unfreezing the issue of understaffing is a two-pronged task; the status quo is engrained in both budgeting and scheduling. Raising awareness of the problem in hospital administrators is the only way to shift priorities to allow for more adequate nurse staffing.

1. The budget can be addressed by demonstrating the cost incurred by the hospital in the numbers of unnecessary disease transmissions, workplace injuries suffered by overworked nurses, and the increased mortality of patients.

2. Scheduling concerns will be mitigated if more nurses can be hired because it will be possible to more fully staff specific parts of the hospital without requiring crossover of nurses. The higher morale of nurses that are not overextended will also improve the work environment and make management easier.

Moving

The actual changes made will require both increasing nursing staff size and specifically allocating the nurses to particular areas.

1. The ideal number of patients per nurse is shown to be approximately 4 per nurse (Aiken et al., 2003). This is the target for increasing staff size.

2. Focusing nurses to particular areas will increase their familiarity with the risks in that area. Knowing which patients are most vulnerable (such s those with pneumonia) and which pose the greatest risk of transmitting a disease will help prevent these issues. It will also increase nurse familiarity with the procedures required in a particular area, reducing the risk of accidents. For ease of scheduling, nurses could be assigned to units that would always work with each other and those units could be rotated throughout the hospital as needed with a few nurses available for independent assignments. This would increase staff cohesion and help nurses to become more efficient due to a greater familiarity with their coworkers and more focused expectations of their duties on a given day.

Refreezing

The metrics for determining the effectiveness of this change and thus freezing it in place would correspond to the problem areas identified.

1. Rates of new diseases acquired by patients while in the hospital would be compared.

2. Rates of nurse injuries during procedures would be compared.

3. Mortality rates of post-operative patients and general mortality of patients would be compared.

Conclusion

Nurses labor under unreasonable expectations on their time and expertise. Only by increasing the number of nurses on a hospital’s staff and more clearly assigning those nurses specific duties can the process of change in nurse staffing patterns be successfully completed. 

References

Aiken, L. H., Clarke, S. P., Cheung, R. B., Sloane, D. M., & Silber, J. H. (2003). Educational levels of hospital nurses and surgical patient mortality. The Journal of the American Medical Association, 290(12), 1617-1623. Retrieved April 24, 2013, from http://jama.jamanetwork.com/article.aspx?articleid=197345 

Clarke, S. P., Sloane, D. M., & Aiken, L. H. (2002). Effects of hospital staffing and organizational climate on needlestick injuries to nurses. American Journal of Public Health, 92(7), 1115-1119. Retrieved April 24, 2013, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447200/ 

Li, J., Birkhead, G. S., Strogatz, D. S., & Coles, F. B. (1996). Impact of institution size, staffing patterns, and infection control practices on communicable disease outbreaks in New York state nursing homes. American Journal of Epidemiology, 143(10), 1042-1049. Retrieved April 24, 2013, from http://aje.oxfordjournals.org/content/143/10/1042.full.pdf