Evidence Based Change Practicum Experience

Practicum Experience

The work of advanced practice nurses (APNs) is influenced by many factors that extend beyond their direct reach. At the same time, the influence of APNs is often felt beyond the immediate context within which the serve as the changes they propose influence multiple systems and impact multiple groups of stakeholders. For this reason, APNs are encouraged to promote evidence-based change at all times. This text discusses effective shift-scheduling as the proposed evidence-based change for my practicum setting. It identifies internal and external issues that could affect implementation, and identifies ways in which the proposed change could lead to shifts at levels beyond the practicum.

The Proposed Evidence-Based Change: Shift Scheduling

Hospitals require round-the-clock service, and as such, nurses’ work has to be organized in shifts that are then organized into schedules (Kluger et al., 2020). This is geared at ensuring continuity of care and patient safety (Kluger et al., 2020). Scheduling is the process of providing productive resources to ensure continuity in the production process and help the organization carry out its required function (Kluger et al., 2020). It is a process of assigning the right people to the right jobs (Kluger et al., 2020). In a healthcare setting, scheduling is a process of “planning, organizing, staffing, actuating, and controlling of nurse working hours” (Rizany et al., 2019, p. 2). It involves managing and allocating time to planned tasks by considering nurses competencies equality, flexibility, and skill mix to maximize patient safety without compromising nurses’ job satisfaction (Rizany et al., 2019). The objective of scheduling is to assign an appropriate number of nurses to each shift to ensure high-quality care, enhance the completeness of care, minimize costs, and maximize nurses’ preference (Abd-Al-Aziz & Wahab, 2019).

Effective nurse scheduling has been associated with higher levels of nurses’ job satisfaction and higher levels of patient safety (Rizany et al., 2019; Abd-Al-Aziz & Wahab, 2019). For this reason, I selected nurse scheduling as the proposed evidence-based change for my practicum. The organization may already have a nurse schedule in place. However, my idea is to change the scheduling process to include higher levels of staff participation.

Issues that could affect the Implementation of Effective Nurse Scheduling

Several internal and external factors to the practicum may affect the implementation of effective nurse scheduling. One of the primary internal factors is the organization’s staffing levels (Abd-Al-Aziz & Wahab, 2019). An effective nurse scheduling plan will require the organization to have a certain optimal number of nurses to minimize burnout and work strain during one’s shift. However, staffing decisions are subject to resource availability, which implies that if the organization lacks the capacity to hire additional nurses to meet the optimum number, then scheduling may not be effective. Personnel budgets and staffing plans that cannot flex up and down may limit the APN’s ability to implement and sustain an effective nurse scheduling program.

Lack of financial resources may also hinder effective implementation of a scheduling program, as it would limit the organization’s ability to hire additional staff as well as to enhance the skills set of the current staff. Further, development of a nurse schedule would require the APN to carry out surveys with both patients and nurses to assess their level of satisfaction with the current situation, and to determine their preferences and expectations (Abd-Al-Aziz & Wahab, 2019). These may not be possible if the organization lacks the financial resources.

Another crucial internal factor is the organizational culture. Sources contend that effective scheduling requires high levels of staff participation. The nurse manager needs to actively involve nurses in the scheduling process as a means of ensuring that their preferences and motivators are taken into consideration (Abd-Al-Aziz & Wahab, 2019). However, such involvement of staff is dependent on the organizational culture, including the rules and regulations that govern how staff interact with their superiors and the extent to which they are involved in decision-making (Hagbaghery, Salsali & Ahmadi, 2004).

All the identified factors arise at the organizational level. However, systems at the state and local government allow the APN to respond. For instance, state departments of health may affect an organization’s staffing plan by dictating the minimum number and mix of nursing staff required to obtain accreditation. The APN could thus use the local and state systems to push for staffing changes at the organizational level. Further, the principles for American Nurses Association (ANA) staffing adopted by the association’s board of directors in 1998 require organizations to reflect cultures that value nurses as strategic assets and take care of the needs of nurses like those of patients. These requirements provide leverage for APNs to push for changes in organizational cultures that neglect the needs and views of nurses.

The Proposed Change and Shifts at Other Levels

The change to be implemented at the practicum level is likely to affect practice at several levels outside the practicum level. First, while it was only intended for nurses at the practicum, it may eventually be adopted by human resource for the entire staff base, including physicians, laboratory technologists, and non-medical staff, as a means of reducing burnout and increasing job satisfaction. Further, if the change can help to increase patient safety, satisfaction, and customer ratings; competing organizations could also eventually adopt the same so as not lose their loyal customers.