Increase quality care with staff involvement with workload assignment

Roberto Rivera-OlmoNU420: Leadership and management in the changing health care

environmentBarbara FindleyJuly 30th, 2015

Research findings Each additional patient a nurse care for increases

the the “likelihood of dying within 30 days of admission” and increase failure to rescue odds by 7%, as well as increase the odds of burnout by 23% and causing in increase of job dissatisfaction by 15% (Aiken, Clarke, Sloane, Sochalski, & Silber, 2002).

Higher nurse to patient ratios have a significant association with lower quality of care, increase in patient exposer to avoidable adverse outcomes and healthcare cost (Stanton, 2004).

Staff and quality findings

Study findings show that nursing workload is affected by “factors other than the patient’s clinical condition” (Carayon & Gurses, 2008).

Increasing registered nurses while decreasing unlicensed staff by requiring nurses to take on more responsibilities while having a slight decrease of patients to care for does not improve patient satisfaction or quality of care (Martin, 2015).

Current nursing assignments are based upon a patient acuity/classification scores or nursing care hours.

High workload

Cost of high workload

In a literature review study on nursing turnover costs and rates, Li and Jones found reported turnover rates “ranging from a low of 9.49% to a high of 250%”, dependent on hospital retention practices and staffing (2013). A report from The Robert Wood Johnson Foundation found estimated replacement cost per RN at about $22,000 to $64,000 (2007), with cost being higher for new nurse turnover due to the higher level of orientation involvement required.

As staff are required to take care of more patients increase chances of in hospital traumas like falls and quality of care indicators like pressure ulcers. Falls can cost as high as $86,00 per incident and ulcers cost the US $11 billion (Gallagher).

Workload factors Nursing care hours do not differentiate for nurses and

unlicensed staff, nor for the different levels of acuity. Use of NCH for workload factoring may allow incomplete patient care to occur (Marquis & Huston, p. 385).

Patient classification systems assist making nursing assignment by classifying patients into a acuity level to determine the right amount and mix of nursing and unlicensed staff (Marquis & Huston, p. 385).

Although PCS allows for a better assessment of staffing needs than NCH, it only factors in the clinical aspect of the patient and does not address other factors that may take addition time from staff to provide to other patients, thus reducing quality of care.

Workload factors Factors to consider when making assignments

include care areas like feeding, activities of daily living, and general health. Other factors that need to be considered in staffing assignment is required treatment, treatment complexity, medication and there route of administration.

Other factors that should be considered in workload assignment due to time consumption are factors like infection control (time of PPE donning and removal), anticipatory interventions from disease process, cognitive workload (intellectual information processing), admission/discharge paperwork, and family support (Connor, LaGrasta & Hickey, 2015).

Department based staffing

Due to the complexity of healthcare and the uniqueness of each department and unit, department based staffing and workload measurement tools implementation is more beneficial than hospital wide-blanket staffing and workload measurement tool implantation. Departmental based staffing can be logistically implemented by having unit/departmental nursing committees for workload measurement tool creation and implementation.

Workload measurement panels

Departmental staff nurses may form a panel to discuss unit based patient population complexity. Each panel can be include experienced bedside nurses, charge nurses, clinical nurse specialist, clinical coordinators and other nursing staff (Connor, LaGrasta & Hickey, 2015).

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Appropriate staffing By developing workload measurement tools for that

are specific to patient population complexities per unit, staffing can be provided accordingly to anticipated workload factors. This method would save each department money while addressing adequate staffing unlike a hospital wide staffing ratio with the required staff which would understaff some units and over staff others.

Unit based measurement tools can identify the required need of nurse to patient and axillary staff to patient/nurse. In units where patients are more self reliable, the use of axillary units would be less, while more complex patient population units would require small nurse to patient and axillary staff to patient ratios.

Quality care from appropriate staff workload As nurses and unlicensed staff are staffed to

appropriate workload, patient’s quality of care can improve due to improved safety, decrease waiting times and increased health care deliverance.

Cost savings Insuring quality of care improvements while keeping

expenditures low is important to any health care facility success. By using available staff to create unit based workload measurement tools, health care facilities remove the need to hire outside consultants. Along with quality improvement, the reduction of nursing turnover due to understaffing can save the hospital hundreds of thousands of dollars annually.

Improving quality of care measures also saves health care facilities money by anticipating issues (e.g. falls) common to unit based patient population complexities and staffing accordingly to prevent these issues from occurring.

Implementation

Attractiveness Health care facilities that can improve the

quality of care for patients, increase nursing retention, reduce nursing turnover, and safe money, all by staffing to a safe workload becomes an desired place for patients to seek treatment and professionals (unlicensed staff, nurses and providers) to seek employment.

References Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., Silber,

J. H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction (p. 1987-1993). Journal of the American Medical Association.

Carayon, P. & Gurses, A. P. (2008). Nursing workload and patient safety: A human factors engineering perspective (Ch. 30). Patient safety and quality: An evidence-based handbook for nurses. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK2657/#ch30.r25

Connor, J. A., LaGrasta, C. & Hickey, P. A. (2015). Complexity assessment and monitoring to ensure optimal outcomes tool for measuring pediatric critical care nursing (p. 297-308). American journal of critical care.

Gallagher, L. G. (2011). The high cost of poor care: The financial case for prevention in American nursing homes. The national consumer voice for quality long-term care. Washington, DC.

Martin, C. J. (2015). The effects of nurse staffing on quality of care (p. 4-6). Academy of Medical-Surgical Nurses.

Marquis, B. L. & Huston, C. J. (2012). Staffing needs and scheduling policies (p. 385). Leadership roles and management functions in nursing: Theory and application (7th ed). Lippincott Williams & Wilkins, Philadelphia, PA.

Li, Y. & Jones, C. B. (2013). A literature review of nursing turnover cost (p. 405-418). Journal of nursing management.

Robert Wood Johnson Foundation (2007). Assessing the direct costs of RN turnover. Evaluation of the Robert Wood Johnson Foundation wisdom at work initiative. Retrieved from www.rwjf.org/content/dam/files/legacy-files/article-files/2/revlewinevalrnturnover.pdf

Stanton, M. W. (2004). Hospital nurse staffing and quality of care (p. 7). Agency for healthcare research and quality: Research in action.