Nursing Leadership and Management and Field Experience Nursing Leadership and Management Field Experience

Problem Identification

The problem identified concerns about patient safety and satisfaction arising out of shortage in nurse staffing. In the contemporary times, staffing has become a major issue concerning nurses, generally, and in this paper we attend to the issue in outpatient clinical settings. This problem of under-staffing of nurses has assumed significant importance and needs to urgent attention, as it has an influence on the satisfaction of the patients and more significantly their safety. An outpatient clinic cannot run if the patients have no desire or wish to go there. In addition, it becomes hazardous in risking the lives of the patients. The purpose of this research is to research the cause of understaffing on outpatient clinics together with the influences it has on patient safety and care. Additionally, the project encompasses examining the perspective of the existing personnel on patient care as regards the problem of under-staffing. Subsequently, the paper seeks to suggest practical ways to remediate patient safety concerns by working on conceptual themes that address under-staffing issues in nurses.

Rationale for Change, Quality Improvement, or Innovation

The lack of adequate nursing staffing in the outpatient setting stresses the existing nurses, who now experience fatigue, as an outcome, quite regularly. As such, nurses are barely capable of putting in their best effort and attempt in rendering health care of the highest quality at all times during their working shifts. More so, they might fail to detect any errors or mistakes in treatment procedures. The rationale for change is that overstressed/fatigued nurses barely ever report or give an account of mistakes and errors. The key basis is time. The nurses might have the sense that they do not have the time to report such mistakes or any erroneous events. Instead, they continue rendering the follow-up clinical care to the patient. In addition, these sorts of nurses also have a more adverse thinking methodology to their work. As a result, they might not shed light on an error that fortunately, did not cause any harm to the patient's overall health (Halbesleben et al., 2008). In a clinical sense, the problem is that patients are not receiving the suitable and fitting treatment and care they need and deserve, in clinics that are understaffed. This is because when the nurses are busy, they have to attend to too many formal tasks related to nursing care.

Causes of the Problem

Owing to the change in the healthcare system of the United States, there are is an increase in the jobs and duties undertaken by the nurses in the outpatient setting. In the contemporary times, outpatient units and clinics are undertaking procedures that in the past used to be done in the hospital. Thus, the increase in workload is not matched by a proportional increase in staff, resulting in fatigue, under-reporting and ultimately loss of quality in healthcare.

Secondly, financial issues play a role in causing nurse (staff) shortages. Outpatient clinics and healthcare institutions do face and operate on a strict and stringent budget. As an obvious outcome, financial restrictions have given rise to increased pressure for the clinics to operate with limited resources in the provision of healthcare. Such clinics resort to the choice of operating with minimal staff. The decrease in personnel can in fact bring about a large saving for the outpatient clinics. However, the question is, is this move a safe one for the patients?

In a clinical sense, the problem is that patients are not receiving the suitable and fitting treatment and care they seek and need when such clinics are understaffed. This is because the nurses are burdened with many additional tasks, other than providing care within the same duty hours; such tasks might encompass treatment and dispensation of medication as directed by the physician, charting everyday records, teaching patients how to administer their own medication and the communication of healthcare instructions to nursing aides to ascertain appropriate patient care. It is not surprising for nurses to begin their shift and start caring for as many as eight patients.

Identification of Stakeholders

The different stakeholders that have a key interest in, and also a substantial influence on the proposed change include patients, nurses, physicians and doctors, administrators and ancillary care staff.

Stakeholders' interest, power, and influence

Outpatient unit administration have a predominantly reputational and financial interest in any sort of alteration made within the setting and also have the authority and power to espouse and implement or reject any suggested proposals. The nurses have a personal, direct-effect interest in the proposed changes for obvious reasons -- they are affected directly by the number of hours they have to work as also...

Thirdly, physicians are also important stakeholders in the project; the physicians are responsible, though indirectly, for dealing with any adverse problems that come about from any mistakes and errors made by the nurses. For instance, if medication is dispensed erroneously, it implies that the patients will have to be rushed to the intensive care unit and the physicians are the people who have to deal with such consequences. Another important stakeholder is the patient, who is also directly influenced by the issue of understaffing of the nurses, as their safety becomes a risk.
Purpose of Project

The main purpose of the project is to attain a better understanding of the impact of having insufficient nursing staffing, developing an effective plan that stimulates and encourages patient safety and satisfaction, and lastly, to come up with proposed solutions that enhance nursing staffing.

Proposed Solution

Studying several journal articles reveals that, there are a number of solutions proposed to rectify the staffing problem at the outpatient units. Amongst the most notable and the most common themes, revolve around two suggestions. The first proposed solution would be to institute a mandated nurse staffing ratios. The second proposed solution is to apportion nurse staffing in relation to patient acuity.

Evidence Summary

In accordance to the research article by Vortherms et al. (2015), there is a lack of dependable, consistent, and effective outpatient oncology acuity-based staffing systems. In particular, the article encompassed the prevailing staffing model in a Midwestern cancer center that indicated inadequacies and ineptitudes associated to irregular patient low, treatment course of therapy intricacy, and physician practice discrepancy (Vortherms et al., 2015). In accordance to the article, proof shows that nursing assignments and duties have a direct contribution to patient low efficiency. Subsequent changes encompassed scheduled nurse time, brushed up acuity-based patient arrangement, and a reviewed nursing care delivery model. Carrying out of the acuity-based system delivered dependable staffing, enhanced efficiency, decreased overtime, and value-added patient and staff satisfaction. Vortherms et al. (2015) recommended the espousal of the acuity-based system to other outpatient environments and development of staffing level standards.

In accordance to a research study undertaken by Kalisch et al. (2012), it was ascertained that because of understaffing, there comes about missed nursing care. In particular, the study examined nursing care and 'patient falls', in relation to safety. The different aspects examined consisted of patient assessment and reassessment, ambulation and dispensation of medication. The results of the study indicated that there was an existing relationship between staffing and missed patient care. It was perceived that lesser amount of time disbursed directly with the patient, the greater the risk of falls. This was especially apparent in relation to ambulation. When the outpatient unit is understaffed, the nurse might not have the capacity to get to the patient in time for different aspects of care and are unable to respond to patient demands for attention in time (Kalisch et al., 2012).

The other proposed solution is the development and staffing models that are purposed to provide support for quality results in the outpatient settings and also in the management of population health. This is evidenced by the article by Haas (2016), which delineated the manifold demands and difficulties intrinsic in establishing staffing models in outpatient health care settings in the United States. The author asserts that health care administrators in such outpatient settings ought to institute a supportive physical and social health care setting, and develop interprofessional groups and staffing models that are high performing as well as electronic systems for documentation that follow performance (Haas, 2016). This is because patients will have better prospects to obtain safe, high-quality evidence-based care that emboldens patient participation in decision making together with the provision of their care (Haas, 2016). Therefore, it is recommended that the outpatient unit be aligned and receptive to the community within which it is located, completely devoted to population health management, and constantly looking over the environment for competitive, supervisory, and external environmental risks (Haas, 2016). All of these tests necessitate extremely knowledgeable providers enthusiastic to alter outlooks and culture, for instance movement in the direction of concerted practice amongst the interprofessional group together with the patient (Haas, 2016).

Some of the solutions recommended include maintaining competency, which include enhancing hiring practices, improving the hiring process, and involving the registered nurses in hiring and interviews.…