The Role of Staffing in Care

Critical Review
The article by Swickard et al considers the role of the American Association of Critical-Care Nurses Synergy Model for Patient Care in relation to transporting patients between hospital settings for increased levels of care. It reveals the fact that the aforementioned synergy model is a patient-centric one in which providers attempt to match a patient’s characteristics with a particular nurse’s competency to achieve patient goals (Swickard et al, 2014, p. 16). The article was insightful because it demonstrated the need for such an approach in situations in which the care provider may or may not be aware of each of the factors influencing how successful transporting the patient is.
The article by Montgomery et al focuses on the applicability of the synergy model of care in rural settings. It deconstructs the theory behind this care model, rural theory, and rural nursing practices. Analysis of “the four major concepts of the metaparadigm” (Montgomery et al, 2017, p. 87) associated with these concepts revealed that they were congruent to one another, and appropriate to be used in conjunction with one another. The article utilized this analysis to determine that although the synergy model is designed for critical care, it is worthy of expansion to rural nursing practices in general.
The information contained in this article and that by Swickard et al is a testament to the utilitarian nature of this care model. It is adequate for use in rural settins and for determining modes of transportation between hospitals.
The article by Shearer considers the variation in the mixture of skills for nurses in various states in Australia. Specifically, this work evaluates the influence of nursing assistants when paired with registered nurses in acute settings. The basis of the article is an open forum in which registered nurses discussed the merit of nursing assistants in the context of different facets of this profession. Some of the findings revealed that the work load of each of these groups was incommensurate. Registered nurses actually wanted nursing assistants to perform more tasks. The article also detailed the phenomenon of placing registered nurses with nursing assistants, and largely cautioned against it because of the latter’s circumscriptions in education and stipulations about their job functions.
The article by Stimpfel et al focuses on the length of nurses’ shifts. The article reveals that it is not uncommon for nurses to work longer than eight hours; during the most cases, nurses are satisfied with their scheduling (Witowski et al, 2012, p. 2501). However, this article also alludes to the numerous drawbacks realized over the long term of nurses routinely working 12 hours shifts—or longer. These lengthy shifts directly correlate to career dissatisfaction and burnout, disadvantageously affecting both nurses and their employers in the long run. Obviously, nurses working 12 hour shifts or longer have less shifts scheduled during a pay period than those working eight hours or shorter.
The article by Dricoll et al indicates that there is a correlation between nurse to patient ratios and patient outcomes. This literary work denotes that in certain instances, lower nurse to patient ratios leads to decreased mortality rates (Driscoll et al, 2018, p. 6). The findings of the article were based on a review of the existent literature from 2006 to 2017. The authors were attempting to discern the effects of nurse to patient ratios on both patients and nurses. It was determined that higher staffing levels—resulting in lower nurse to patient ratios—contributed to decreased numbers of “medication errors, ulcers, restrain use, infections, and pneumonia” (Driscoll et al, 2018, p. 6).
A synthesis of the information gathered from each topic reveals that it is possible to amalgamate this information into a series of best practices regarding nursing in acute care settings. Perhaps the focal point of the amalgamation of the findings uncovered in the critical review of this literature is the model of care apropos to acute care settings—the synergy model. In order to best acquaint patients with the nurses whose traits yield the most value, it is necessary to provide those nurses what they need in terms of scheduling and patient ratios. It seems nurses should not work 12 hours shifts or regularly exceed 10 hours in a row, nor should there be a nurse to patient ratio so high that nurses cannot focus on those patients who are best suited to their qualities. Additionally, the sufficiently staff nurses for this particular care model, it is necessary to also utilize nursing assistants as a vital resource to keep those ratios low and prevent nurses from working over 10 hours in a row.
Care Model and Staffing Plan Connections
As alluded to in the preceding synthesis section, the care model selected for a 24-bed, general medical unit in an acute care hospital will revolve around the synthesis model. It seems imperative to pair patients with nurses who have the sort of characteristics that are most beneficial to their attainment of patient objectives. To successfully implement this model, however, one must account for the staffing needs required to ensure nurses are able to function at their maximum capacity to ameliorate their patients. The primary considerations of the staffing plan for this care model are the mixture of nursing professionals involved, the length of shifts these professionals work, and the number of patients assigned to each nurse (nurse to patient ratio). The synthesis model is best suited to a staffing situation in which there are relatively low patient to nurse ratios, simply so those patients can optimize their experiences with their nurses and best achieve their patient goals. To that same end, it is critical that those nurses are able to work shifts of modest length (specifically not exceeding 10 hours, and ideally no more than eight hours at a time) in order to most effectively maintain their stamina, professionalism, and capability of providing tailored care to their patient groups. Additionally, by augmenting the numbers of registered nurses with nursing assistants, this care model can provide optimum utility by ensuring that nurses are not overworked.
Total Number of Staff and Skill Mix Needed
In order to adequately staff this 24-bed acute care facility, there are 16 registered nurses required. Eight of these nurses will work at a time. This number of nurses keeps the nurse to patient ratio low at that of one to three. Moreover, these registered nurses should ideally be supported by eight nursing assistants. Four of these should work at a time. This way, the total ratio of nursing professionals to patients is two to one. Therefore, the numbers of registered nursing staff and nursing assistant staffs required for each shift include six of the former and two of the latter. This way, these staff members can readily be rotated to support the additional shifts.
Congruence with Care Model and Staff Structure
The considerations of the number of staff and skill mix necessary for the aforementioned use case is congruent with the overall staffing structure and care model described herein. Although the synergy model is not necessarily predicated on individualized care, it is based on the personalization in which specific attributes of nurses are aligned with those of their patients and the objectives of those patients. As such, it is pivotal to have numbers of registered nurses and nursing aids that allow for them to be designed for specific types of patients who exhibit certain traits that are aligned with those of the foregoing care providers. 16 registered nurses ensures that at all times there are nurses who can provide for patients with a wide range of care needs and styles most beneficial to their goals. Furthermore, by augmenting those nurses four assistant nurses per eight hour shift, there should never be a dearth of care personnel to attend to patients’ needs in as specific a way as possible.
Safe Staffing Procedures
There are a few safe staffing procedures that are advisable to implement to produce the desired care results for patients via the synergy model and staffing stipulations outlined in this document. Foremost of these procedures is an orderly mechanism for eliciting feedback from nursing staff regarding their experiences and concerns with serving the patient population. Therefore, schedules will be created two weeks in advance and issued for one week at a time. Moreover, nurses will have an email address with which to readily interact with administration regarding their opinions of the scheduling. Also, nurses should be allotted sick days and generous vacation packages so they have adequate time to recover from the vicissitudes of their daily work—so they can ideally perform better on the job and engage at this care facility for longer time periods.
References
Driscoll, A., Grant, M.J., Carroll, D., Dalton, S., Deaton, C., Jones, I., Lehwaldt, D., McKee, G., Munyombwe, T., Astin, F. (2018). European Journal of Cardiovascular Nursing. 17(1), 6-22.
Montgomery, S.R., Sutton, A.L., Pare, J. (2017). Online Journal of Rural Nursing and Health Care. 17(1), 87-99.
Stimpfel, A.W., Sloane, D.M., Aiken, L.H. (2012). The longer the shifts for hospital nurses, the higher the levels of burnout and patient dissatisfaction. Health Affairs (Millwood). 31(11), 2501-2509.
Shearer, T. (2013). Getting the mix right: assistants in nursing and skill mix. Australian Nursing & Midwifery Journal. 21(5), 24-27.
Swickard, S., Swickard, W., Remier, A., Lindell, D., Winkelman, C. (2014). Adaptation of the AACN synergy model for patient care to critical care transport. Critical Care Nurse. 34(1), 16-28.