Strategies for advanced nursing practice
- 1. C H A N G E O F A H E A LT H S Y S T E M STRATEGIES FOR ADVANCE NURSING PRACTICE
- 2. T Y P E O F O R G A N I Z AT I O N • Long term and short-term care facility • Skilled Nursing Facility • Type of service provided- illness service • Chronic and long term-> 30 days • Health promotion- Tertiary healthcare • Ownership- Nonprofit • Council type- Family & Resident • Home-size-240 beds ( 40 pt on 6 Units) • Demographics – Older Hispanics (majority) • System Theory- 7 floor, 6 units • Nursing roles & function-
- 3. O R G A N I Z AT I O N A L S T R U C T U R E • 40 Patients on each unit – 7 floors 6 units • 1st floor: Leadership floor- 1 Director of nursing- Assistant Director of Nursing- Boss (Administration) • Floor • 2nd Unit: 1-unit director: Meetings in regards to the unit- and emergencies • 40 patients • 2 LPNs (1 LPN: Medication Administration) (2ND LPN: Wound care, Finger Sticks and Insulin administration, Issues that arises on the unit, Sending patients to appointments) = Charge Nurse • 3rd Unit: Same Structure as the 2nd unit- 1-unit director • 4th Unit: 1-unit director, 1 RN (Wound care, Finger Sticks and Insulin administration, Issues that arises on the unit, Sending patients to appointments, care plans, progress notes, wound care and Psych notes) = Charge Nurse/ CNM (Clinical Nurse Manager) • 5th Unit: Same Structure as 2nd and 3rd unit – 1 social worker and shares the 4th floor unit director • 6th Unit Same Structure as 2nd and 3rd unit – 1unit director • 7th Critical Care Floor – 1-unit director (Shares 3rd floor UD), 1 RN (Wound care, Finger ticks and Insulin administration, Issues that arises on the unit, Sending patients to appointments, care plans, progress notes, wound care and Psych notes) = Charge Nurse/ CNM (Clinical Nurse Manager)
- 4. L E A D E R S H I P S T Y L E • Transactional Leadership (current) • Leadership is responsive • Contingent reward (quid pro quo) • Punitive • Works within organizational structure and never deviates • Effects on employees and outcomes • Error are corrected in a reactive manner • Limited job satisfaction • Low to stable levels of commitment • Transformational Leadership (Aim) • Leadership is proactive • Inspiring and motivating • Intellectual stimulation • Individualized consideration • Effects on employee and outcomes • Coaching and mentoring happens • A shared vision, feeling valued • Increased performance • Increased commitment
- 5. C U R R E N T P O P U L AT I O N OLDER ADULT SPANISH 70% AFRICAN AMERICA OTHERS
- 6. H E A LT H C A R E O U T C O M E S T H AT N E E D S I M P R O V E M E N T INADEQUATE STAFFING PRESSURE INJURIES SEPSIS FALLS PATIENT SATISFACTION
- 7. I N A D E Q U AT E S TA F F I N G BUENA VIDA- Rehabilitation 2LPNs + 1 RN : 40 Patients
- 8. P R E S S U R E I N J U R I E S Intrinsic Factors: Immobilization, cognitive deficit, chronic illness (eg, diabetes mellitus), poor nutrition, use of steroids, and aging. Extrinsic factors: pressure, friction, humidity, shear force. Frequent Turning &Repositioning
- 9. A N A L Y Z I N G T H E E F F E C T I V E N E S S O F T H E C U R R E N T S T R U C T U R E • Shortages of Registered Nurses increases: • > Hospital transfers • > Pressure ulcer development • > Overall increase in poor health outcomes • > Increases nurse burnout
- 10. A N A LY Z I N G T H E E F F E C T I V E N E S S O F T H E C U R R E N T S T R U C T U R E • Shortages of Registered Nurses • Increases nurse burnout • Pressure ulcer development • Hospital transfers • Overall increase in poor health outcomes
- 11. A N A LY S I S C O N T I N . . • LPN AND RN BURNOUT • RESPONSIBILITIES: 40 patients • Medication administration • Wound care • Blood glucose monitoring • Hospital transfers and emergencies • Family members concerns • Weekly psych notes and daily progress notes • Organizing care plans • Daily patient appointments • = Burnout
- 12. C O N C L U D I N G A N A L Y S I S Shared Unit Directors (UD’s) leads to: Patients being sent to the hospital unnecessarily Patients getting readmitted back to nursing home shortly after Decrease in patient satisfaction Lack of organization in the system
- 13. A P L A N T O I M P R O V E T H E O R G A N I Z A T I O N A L S Y S T E M • The recent framework of the Buena Vida’s nursing home prohibits the facility from obtaining its greatest potential and inhibits the delivery of care to elderly patients. • 240 patients • 54 nurses • 3 shifts • Six patient units/ 40 patients per unit. • There are not a serviceable number of nurses per shift. • Critical unit (7th floor) has one RN and one charge nurse • There are less than 3 nurses per shift • Nursing shortage • Employee burnout • Safety issues for patients if needs are not being met adequately • Increased number of pressure injuries • Increased in sepsis rates
- 14. A P L A N T O I M P R O V E T H E O R G A N I Z A T I O N A L S Y S T E M C O N T . • Plan to subdue nursing problem is to hire adequate staff • 12 Registered Nurses • 10 Licensed Practical Nurses • 6 Social Workers • 2 Unit Directors • Each patient unit will now have/per shift • 3 LPNs • 2 RNs • 1 Unit Director per unit • 1 Social Worker per unit • In floors without charge nurses (unit directors) , the RNs will serve as charge nurses for their respective floors (Holley, Jennings & Wolters, 2009).
- 15. A P L A N T O I M P R O V E T H E O R G A N I Z A T I O N A L S Y S T E M C O N T. • Roles • 3 LPNs on each shift will split duties with one another • Wound care • Finger sticks/Insulin administration • Medication administration • pressure injury checks • vital signs • Duties can also be split between 3 LPNs by each taking charge of 14 patients. • These results will be reported and/or electronically logged for the patient assigned to the LPN to the covering RN. • RNs will be available to focus more on patient assessments, care plans, progress notes, wound care. • Unit directors can exclusively focus on signing off patients for appointments, issues that arise on the unit, and meetings. • Sepsis screening/protocol to assess the need for a hospital transfer • Two nurse skin checks prior to discharge, transfer, and admission with signed documentation.
- 16. A P L A N T O I M P R O V E T H E O R G A N I Z A T I O N A L S Y S T E M C O N T. • This plan will aid in the improvement of the health of the patients • It will help ease the management of the units • Safer environment • More staff available for crisis and emergency situations. • Reduces burnout amongst employees • Easier supervision and task assignments for directors and charge nurses (Mehdaova, 2017). • Patients in the critical units will be given the close observation they need for recovery.
- 22. R E F E R E N C E S • Andersson, Å, Frank, C., Willman, A. M., Sandman, P., & Hansebo, G. (2017). Factors contributing to serious adverse events in nursing homes. Journal of Clinical Nursing,27(1-2). doi:10.1111/jocn.13914 • Björn, C., Rissén, D., Wadensten, B., & Josephson, M. (2017). The opportunities and obstacles nurses have in carrying out their work–A case study in an operating department in Sweden. Perioperative Care and Operating Room Management, 6, 1-6. https://doi.org/10.1016/j.pcorm.2016.12.002 • Buchanan, P. R., & Grunstein, R. R. (2011). Positive-pressure treatment of obstructive sleep apnea syndrome. Handbook of Clinical Neurology, 98, 421-439. Retrieved fromhttps://doi.org/10.1016/B978-0-444-52006-7.00028-9 • Buckley, L., Berta, W., Cleverley, K., Medeiros, C., & Widger, K. (2020). What is known about paediatric nurse burnout: a scoping review. Human Resources for Health, 18(9), 1-23. https://doi.org/10.1186/s12960-020-0451-8 • Buena Vida. (2019). Some of our quality services. Retrieved from http://buenavidarehab.com/ • Centers for Medicaid and Medicare Services. (n.d.) Find and compare Nursing Homes. Https://www.medicare.gov/nursinghomecompare Choi, Y. G., Choi, B. J., Park, T. H., Uhm, J. Y., Lee, D. B., Chang, S. S., & Kim, S. Y. (2019). A study on the characteristics of Maslach Burnout Inventory- General Survey (MBI-GS) of workers in one electronics company. Annals of Occupational and Environmental Medicine, 31, e29. https://doi.org/10.35371/aoem.2019.31.e29 •
- 23. • Choi, Y. G., Choi, B. J., Park, T. H., Uhm, J. Y., Lee, D. B., Chang, S. S., & Kim, S. Y. (2019). A study on the characteristics of Maslach Burnout Inventory-General Survey (MBI-GS) of workers in one electronics company. Annals of Occupational and Environmental Medicine, 31, e29. https://doi.org/10.35371/aoem.2019.31.e29 • Comondore, V., Devereaux, P., Zhou, Q., Stone, S., Busse, J., Ravindran, N., . . . Guyatt, G. (2009). Quality of care in for-profit and not-for-profit nursing homes: Systematic review and meta-analysis. BMJ (Clinical Research Ed.), 339(Aug04 2), B2732 • Dyrbye, L. N., Meyers, D., Ripp, J., Dalal, N., Bird, S. B., & Sen, S. (2018). A Pragmatic Approach for Organizations to Measure Health Care Professional Well-Being. NAM Perspectives, 8(10).doi:10.31478/201810b • Ejere, E., & Abasilim, U. (2013). Impact of transactional and transformational leadership styles on organisational performance: Empirical evidence from Nigeria. Journal of Commerce, 5(1), 30-41 • Griffiths, P., Saville, C., Ball, J., Jones, J., Pattison, N., & Monks, T. (2020). Nursing workload, nurse staffing methodologies, and tools: A systematic scoping review and discussion. International Journal of Nursing Studies, 103, 1-11. https://doi.org/10.1016/j.ijnurstu.2019.103487
- 24. • Gyang, E., Shieh, L., Forsey, L., & Maggio, P. (2015). A Nurse-Driven Screening Tool for the Early Identification of Sepsis in an Intermediate Care Unit Setting. Journal of Hospital Medicine, 10(2), 97-103. https://dx.doi.org/10.1002%2Fjhm.2291 • Holley, W. H., Jennings, K. M. & Wolters, R. S. (2009). The Labor Relations Process. • Cengage Learning. • Kapu, A. N., & Kleinpell, R. (2012). Developing nurse practitioner associated metrics for outcomes assessment. Journal of the American Association of Nurse Practitioners, 25(6), 289-296. doi:10.1111/1745-7599.12001 • Kelly, R. J., & Hearld, L. R. (2020). Burnout and Leadership Style in Behavioral Health Care: a Literature Review. The Journal of Behavioral Health Services & Research, 1-19. https://doi.org/10.1007/s11414- 019-09679-z • Kleinpell, R. (2017). Promoting early identification of sepsis in hospitalized patients with nurse-led protocols. Critical Care, 1-3. https://dx.doi.org/10.1186%2Fs13054-016-1590-0
- 25. • Mehdaova, E. A. (2017). Strategies to Overcome the Nursing Shortage. Walden University • Scholarworks. • Michael, M., Schaffer, S. D., Egan, P. L., Little, B. B., & Pritchard, P. S. (2013). Improving Wait Times and Patient Satisfaction in Primary Care. Journal for Healthcare Quality, 35(2), 50-60. https://doi.org/10.1111/jhq.12004 • Monegro, A. F., & Regunath, H. (2020). Hospital-acquired infections. Startpearls. https://www.ncbi.nlm.nih.gov/books/NBK441857/ • Pun, J., Chan, E. A., Eggins, S., & Slade, D. (2020). Training in communication and interaction during shift-to-shift nursing handovers in a bilingual hospital: A case study. Nurse Education Today, 84, 1-9. https://doi.org/10.1016/j.nedt.2019.104212 • Salyers, M. P., Bonfils, K. A., Luther, L., Firmin, R. L., White, D. A., Adams, E. L., & Rollins, A. L. (2016). The Relationship Between Professional Burnout and Quality and Safety in Healthcare: A Meta-Analysis. Journal of General Internal Medicine,32(4), 475-482. doi:10.1007/s11606-016- 3886-9 Saville, C. E., Griffiths, P., E.Ball, J., & Monks, T. (2019). How many nurses do we need? A review and discussion of operational research techniques applied to nurse staffing.
- 26. T H A N K Y O U ! ! ! !