Addressing nurse-to-patient ratios in the medical surgery department

Planned Change in a Department

Change within the Medical surgery department

There are various factors that occasion change within any organization, some may be due to change in the operations of an organization, some due to expansion, relocation, takeovers, mergers, external forces in economies, internal changes in operation modes or even unprecedented needs as unforeseen at the initial stages. This last one seems to be case within the medical surgery unit in our hospital.

The prevailing condition at the moment that needs a change approach that would improve the conditions within the medical surgery unit and the entire hospital in general is the imbalanced ration between the nurses and the surgery patients currently realized within the unit. The prevailing rate is one nurse within the medical surgery unit handling an average of 6-7 patients which has proven to be too high for a single nurse. The other pertinent problem within the same unit is the availability of only one in charge nurse supervising and acting as the leader.

The challenges occasioned by the imbalance

The high number of surgery patients allocated to each nurse means there is provision of only the bare minimum provisions to the patients. The nurses cannot delve into further enquiring about the patient since there are more patients waiting and limited time. These gaps in information that would be useful to the nurse in aiding the patient have led to increase in mortality rates. The recommended allocation is usually at most 4 patients per nurse and an increase in that to a higher figure, say 8 patients per nurse would be accompanied by a 31% increase in mortality rate as indicated in the National Foundation for American Policy (2007:4). This, unfortunately, is the fatal ratio that exists within the hospital now. A study conducted by Linda Aiken of University of Pennsylvania School of Nursing indicated that on an annual basis, an estimated 20,000 patient died because they visited a hospital that has an acute shortage of nurses hence overworked (American Nurses Association, 2011).

The other significant effects of such high ratios are the nurse burnout cases. This is self evident from the huge number of patients a single nurse has to attend to within the work shift. Bearing that the surgery patents undergo extreme pains and need keener attention and care, the nurse is always up and down trying to ensure the comfort of the patients. This is the followed by heightened stress levels that result in lack of job satisfaction. There have been efforts to counter the lack of satisfaction by offering monetary incentives, yet this has not worked since the workloads are immense (Honor Society of Nursing, 2013).

It is on the grounds of these two compelling reasons among other reasons that it is seen fit to institute changes within the medical surgery unit to avert such eventualities. The changes, as will be indicated, are beneficial to both the patients and the nurse.

Change model

In order for the above changes to be realized, there will be use of the Kurt Lewin 3 Phase Change Theory. This is a model that has the unfreeze, transition and freeze stages (Nursing Theories, 2011). The unfreeze stage involves the introduction of the problem to the people concerned and making people aware of the challenges. Here, the shortage of the nurses and the in charge nurses as will be forwarded to the governing council of the hospital. It will be made clear to them the detriments of such an imbalance as already discussed above.

The second stage is the transition where people will then be looking for the alternative means of doing things within the hospital. Here, there will be suggestions of the increment in the number of nurses with the internationally recommended ration of one nurse for ever 4 patients being the role model. The reasoning behind this ratio will be explained to the various stakeholders and the HR department in particular will come in handy to ensure the implementation of the need to hire more nurses for the facility.

The third step in this model is the freeze step where the positive changes that have been made are solidified and implemented permanently. The positives brought by the more recruitment are recognized and highlighted, barriers to the new changes are tackled, reviews of the change within the department are made and trainings of the new staff is carried out on regular basis. These will ensure the new changes take root for the long run and betterment of the medical surgery unit.