Nursing Ratios Based on Acuity - Weebly



center30000630555Nursing Ratios Based on AcuityAshley YotkoisMcLaren Bay Region Critical CareAshley.yotkois@1050000Nursing Ratios Based on AcuityAshley YotkoisMcLaren Bay Region Critical CareAshley.yotkois@rightbottomWhy Ratios &Patient AcuityMatter33000100000Why Ratios &Patient AcuityMatterSummary centercenterResearch has shown that poor staffing among nurses increases adverse events among patients, poor quality care, decrease satisfaction in care, decrease in job satisfaction, and increase in burnout rates. 00Research has shown that poor staffing among nurses increases adverse events among patients, poor quality care, decrease satisfaction in care, decrease in job satisfaction, and increase in burnout rates. The shortage of nurses and poor staffing is not an occurrence that plagues one state or one country. This is an international problem among the nursing profession. Research has shown that poor staffing among nurses increases adverse events among patients, poor quality care, decrease satisfaction in care, decrease in job satisfaction, and increase in burnout rates. Statewide ratios were mandated in California and many other states to ensure safe and quality patient care. “The strategies that have been em-ployed include: improving the health care system, improving work cultures for increased retention through policy and regulation, making greater investments in nursing education to build sustainable nursing education infrastructures, and enhancing the image of the nursing profession”(Yun, Jie, & Anli,2010). Recommendations are for increased legislative follow up with health care facilities quarterly in order to ensure that patients receive safe, quality care and are satisfied with it as well as, improve retention of the Registered Nurse workforce through various suggested resolutions. BackgroundIn this brief, the focus is going to be on the utilization of staffing tools in accordance with recommended patient to nurse ratios, as well as, to also make equal patient assign-ments in all units based on acuity of patient population. Mandating ratios will not solve the problem of the shortage of nurses. Utilization of the nurses available for the patient population is more important. leftcenterA poor work environment is one that is, “lacking in adequate resources , strong nurse leadership, collegial relationships between nurses and physicians, ardent nurse participation in hospital affairs, and a solid nursing foundation for quality of care-also appears to negatively affect both nurses and patients,” (Cho et al., 2015). 00A poor work environment is one that is, “lacking in adequate resources , strong nurse leadership, collegial relationships between nurses and physicians, ardent nurse participation in hospital affairs, and a solid nursing foundation for quality of care-also appears to negatively affect both nurses and patients,” (Cho et al., 2015). Appropriate ratios are still important and having a policy in place that determines staffing levels depending on unit type, as well as, filling open positions and retention of nurses is also crucial. An emergency process or “backup plan” needs to also be part of the policy if nurse to patient ratios are significantly short. Poor staffing or shortages are often due to poor work environments, lateral violence, poor staffing ratios, and decreased job satisfaction that results in decreased retention, decreased patient and family satisfaction, poor patient outcomes, and decreased safety for patients and staff. These results are costing healthcare facilities large sums of reimbursements because of the decreased satisfaction, poor outcomes, and increased length of stay. Description & AnalysisPoor staffing levels are often an issue in facilities across the United States and internationally. Approximately 13 states have mandated staffing ratios. They are having good results from the mandates, but are they feasible considering the national shortage of nurses we currently have and will continue to have? “Recent patient safety initiatives have motivated various stakeholders-including health care providers, researchers, payers, legislators, regulators, accreditors, and consumers-to focus their efforts on understanding the best methods for minimizing errors and maximizing safety in order to achieve high quality, cost-effective care,”( Brennan et. al, 2012). It is important for nursing units to have the appropriate number of staff per number of patients. However, making assignments equal in acuity is important whether the appropriate numbers of nurses are available or not. Assignments are quite often uneven and certain patient loads are heavier than others and have the same number of patients. righttop00 Charge nurses or team leaders often make assignments based on objective information that did not take medications, psychological disturbances, spiritual care needed, family issues, ordered procedures or other components that can increase the time it took to take care of a patient (Powel & Fogel, 2013). “The nurses were vital in modifying the tool because they were able to recognize the important components missing from the original tool that were necessary for our patient population,” (Powel & Fogel, 2013). The buy in of nurses is absolutely vital in the implementation of this tool as well as “Go Live” of the tool. The strategy I am advocating is the formation and use of an acuity tool that “would enable the charge nurse to more evenly distribute patient assignments based on specific and consistent measures, Minimum Nurse to Patient RatiosType of UnitMinimum RatioCritical Care1:2Operating Room1:1Labor and DeliveryPerinatalAntepartum1:21:4Pediatric1:4Emergency Department1:2 or 1:1Stepdown1:4Telemetry1:5Med/Surg1:6 or 1:5Table derived from Serrat, 2013which would be reevaluated each shift,”(Powel & Fogel, 2013). The hypothesized advantages of the creation and implementation of an acuity tool definitely outweighs the disadvantages. This may not be the answer to the nurse to patient ratio issues, but if the current practice continues and nothing is done, we can continue to anticipate increased rates of nurse dissatisfaction and burnout, decreased retention, poor patient satisfaction, patient outcomes, increased length of stay, decreased and decreased reimbursements. We know this to be true because it is what is currently happening.RecommendationIn order to combat some of the issues caused by short staffing and nursing shortages, some recommendations are toleftbottomPros of Acuity ToolEasy to use Efficient Even distribution of patient population among available nurses Identifies severity of illness and intensity of care needsCons of Acuity ToolAcuity is equal but number of patients per nurse may not be.Resistance to change is inevitable00Pros of Acuity ToolEasy to use Efficient Even distribution of patient population among available nurses Identifies severity of illness and intensity of care needsCons of Acuity ToolAcuity is equal but number of patients per nurse may not be.Resistance to change is inevitable implement policy that plainly states staffing ratios according to unit type, have a staffing crisis definition and plan, and implement an acuity tool. The table above is the staffing levels recommendations for safe based on unit type. The table above is a staffing acuity tool developed for an oncology unit (Brennan et. al, 2012). Multiple tools were graded with grades A through F. The table below shows satisfaction (HCAHPS) and the improvements in them after a staffing acuity tool was implemented but staffing ratios were unchanged (Powell & Fogel 2013).-118110551116500ConclusionThe nursing shortage and decreased staffing levels are predicted to affect healthcare for many years to come. By getting staff nurses involved in facility and unit decision making processes and developing a guiding policy reflecting recommended staffing ratios, a staffing crisis protocol for all unit types, and developing an acuity tool to help make appropriate patient assignments with equal acuity, nurses will be empowered to have a voice in strategies to help improve patient care, safety, and satisfaction. These interventions have also shown to improve employee satisfaction and work environment, which directly effects retention. ReferencesBrennan C, Daly B, Dawson N, Higgins P, Jones K, Madigan E, Van Der Meulen J. (2012). The oncology acuity tool: a reliable, valid method for measuring patient acuity for nurse assignment decisions. Journal of Nursing, 20(3), pp. 155-85. ., Sloane, D.M., Kim, E.Y., Kim, S., Choi, M., Yoo, I.Y., Lee, H.S., & Aiken, L.H. (2015). Effects of nurse staffing, work environments, and education on patients mortality: An observational study. International Journal of Nursing, 52, pp.535-542. DOI: , H. & Fogel, M. P. (2013). The triad of excellence: acuity, accuracy, approval. Nursing Management, 44(4), p.15-19. DOI: 10.1097/01.NUMA.0000428193.22013.3f Serratt, T. (2013). California’s nurse-to-patient ratios, part 1: 8 years later, what do we know about nurse-level outcome. The Journal of Nursing Administration, 43(9), pp. 75-480. DOI:10.1097/NNA.obo13e3182a23d6f.Yun, H., Jie, S., & Anli, J. (2010). Nursing shortage in China: State, causes, and strategy. Nursing Outlook, 58(3), pp.122-128. doi:10.1016/j.outlook.2009.12.002., ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download