North Mountain Medical is a super sniff facility as they specialized in high acuity level patient. The patient structure is respiratory, with staff trained in tracheostomy care and ventilator management. In house hemodialysis, in house physical therapy. This facility has been in operation since 2004. Patients in this facility do not self-diagnose. Patient diagnoses are from Medical doctors and Nurse Practitioners that work on site. Patient in the facility are cared for by interdisciplinary team. Certified nursing assistants that care for patient will normally report a Change in patient’s condition to the nurse. Nurse completes an assessment and report changes immediately to the doctor. In the event of an emergency patients are send to emergency room for further evaluation and treatment. Health is a right in this facility. Yes, most of the patient’s life style has impacted the health of the patient. Noncompliance with medication regimen and diet changes. Patients in this facility do not believe that health or illness is divinely sent. Most Hispanic and Native American patients tend to be hesitant to sign advance directives and DNR due to their spiritual beliefs. The patient that are diabetic are place on diabetic diet to manage their diabetes. Patient with cardiac issue are place on cardiac diet and patient on dialysis and also have congestive heart failure are on fluid restriction. These are all health promotion methods to improve health of patient. This facility is not a male dominance facility. They have both male and female patients. The mission and values of this facility is reflected in their core values CAPLICO. It stands for celebration, accountability, passion for learning, love one another, intelligent risk taking, customer second and ownership. Employees are encouraged daily to always smile and greet everyone, have a great attitude and work hard. Be polite using please and thank you, do the right thing even when no one is looking. The facility does not have a religious foundation.

The facility operations do reflect the culture of the community. The facility implements a spirit of inquiry and use of evidence based practice in patient care in the following ways. This facility’s patient population is mostly patients that have trach and are ventilator dependent. Research studies have shown that about 10-20% acquires ventilator associated pneumonia and eventually die. This facility follows the guide lines of the institute for healthcare improvement. This measures includes elevation of head of bed 30 to 45 degrees to prevent aspiration. Provision of daily oral care with chlorhexidine and this eliminate the risk of aspirating infectious oral secretions. They also use peptic ulcer disease prophylaxis medication that helps prevent stress ulcers from forming in patients that are critically ill.

This facility also uses evidence base practice to prevent central line associated bloodstream infections, they use the following guide lines on patients with central lines. All Nurses have received an education on how to care and maintain the catheter and this can be found on Point Click Care as standing orders that nurse sign off during their shift. Hubs are disinfected before a Nurse can access the port. Assessment completed daily to ensure that patient still need the central line.    Discontinue immediately when patient no longer in need to reduce the risk of infection. The facility also uses the CDCs guidelines to prevent catheter associated UTIs by assessing daily the need for continuous use of catheter. Hygiene provided to the patient Q Shift and as needed. Measure and empty the urinary drainage bag Q shift and as needed. Hand washing and use of gloves during catheter Care.   Drainage bag kept below the bladder level.  

Another use of evidence base practice is early mobilization of patients...

This patient is seen by therapist within the first 48 hours for evaluation (Nurse.com, 2019).  
An overview of the issue.

The healthcare field in the 21st century is getting bigger and complex. Even though nurses make an effort daily to provide safe patient care, it is often noted that they encounter very stressful situations. This is usually as a result of increased work load, inadequate staff, new technology and the time factor, long shift, mandatory overtime. All of this combined can result in emotional, physical and mental exhaustion to the nurse. If the nurse does not find a way to effectively managed this issue it can lead to nurse burnout (Nurse.org, 2018).

Nurses at North Mountain Medical are suffering from burnout that is attributable to various factors in their workplace. Some of the major contributors to nurse burnout at this facility include inadequate staffing, increased workload for nurses, and the adoption of new technology that nurse may have a hard time learning. The other factors include time constraints since nurses have very limited time to complete a task in an efficient manner, long work hours, and poor working environment. These factors contribute to poor judgment by nurses, which usually leads to poor patient outcomes (Nurse .org, 2018)

The patient population is affected the most. Nurses are equally affected and families are affected. The entire healthcare team is affected. When nurses are not happy with their work environment, they quit. This can be very expensive for the health care organization as they have to hire and train new ones.

Programs that are currently related to this issue.

How has this issue been dealt with in the past? Based on reports from my preceptor who happens to be the director of nursing, the facility has in the past attempted to address nurse burnout by providing adequate staff. Unfortunately, most of the new nurses get overwhelmed and quit. This is thought to be an issue because nurses and certified nursing assistants work for long hours. While nurses are scheduled to work 7am-7pm, most of them end up leaving the facility at 11 or 12 midnight. This is 4 or 5 hours from the time their shift ended. The funding comes from the administrator. There is available funding to hire more staff. There are incentives for employees who refer a new hire. They each get $2000. There is currently a tuition reimbursement program. Nurses that want to further their education at different levels ranging from an LPN studying to become a registered nurse, or a registered nurse pursuing their BSN get reimbursed. However, such nurses need to sign a contract to work for the facility for two years. These are attempts to retain nurses and reduce burnout. Even though North Mountain Medical has been working to address this problem, most of its efforts have remained unsuccessful.

The strength of this facility regarding nursing burnout is that they have an ongoing strategy in place to address the problem. When a nurse is called in to work on their day off, they give that nurse $200 for covering that shift. When nurses feel that they are appreciated for the services they provide, they are motivated to provide quality care to the patient. Thus the saying happy nurse, happy patients.

When called upon, staff from management like unit managers come to the floor to assist in medication pass, accrue checks, start tube feedings, and shower some patients. This prevents the nurses from being overwhelmed with work and allow them to efficiently provide safe client care and no longer experience burn out.

Briefly discuss research-supported recommendations to implement a change process related to this issue.

There are very simple and effective strategies nurses…