Nurse Ratios and HAI

Nursing Theory

A large body of nursing research has identified a correlation between staffing aspects and patient outcomes. Managing the quality of care and patient safety is important as failure to do so may result in significant expenses. On average, the cost of an individual central line-associated bloodstream infection (CLABSI) exceeds $45,000 (Paulsen, 2018). Furthermore, the federal government withholds payouts to hospitals when quality indicators such as HAIs are not met.

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Practical change occurs by achieving the optimal nurse-to-patient ratio. The federal regulation 42CFR 482.23(b) requires medical facilities to maintain adequate levels of nursing staff in order to receive Medicare benefits. Although exact figures are not provided, the American Nurses Association recommends that the ratios be established through legislative means. It is recommended for the ratio to not exceed 1:2 in critical care or 1:4 in emergency departments (Paulsen, 2018). Staffing levels should be established to be flexible to account for unpredictable adverse events, but also to predict and account for admissions, patient needs, and shift availability of nurses.

Modern nursing theorists have developed a specific contingency model for nurse staffing. It is based on a contingency leadership theory which ensures management utilizes critical thinking and flexibility to optimize nurse-patient ratio assignments. The contingency approach focuses on the aspect that different scenarios may require a varying approach to leadership and management. Therefore, nursing staffing will change accordingly, but will not increase past 1:5 based on flexible utilization guidelines.

This requires a shift in utilization guidelines by adding a permanent charge nurse and a full-time admission nurse to the clinical staff. Instead of a traditional nurse manager, there is now a triad leadership which consists of a clinical manager, clinical coordinator, and unit educator as well as wide staffing reviews every 12 hours (Mahoney, 2016). Furthermore, a combination of multidimensional econometric models can be used to accurately calculate nurse staffing for the hospital needs in a cost-effective manner.

Plan of Implementation

Hospital managers should collaboratively work with the nursing staff to develop and review any formal staffing plans and rotations at the organizational and ward levels. The staffing plans should not only consider available budgeting but the varying needs within the organization and a mix of competencies that nurses can provide. These staffing plans should address various scenarios and issues such as critical shortage and should be individually tailored to specific units with their unique patient demands and nurse responsibilities.

The plan should clearly identify various core components. First, staffing qualifications are a requirement, outlining the number of licenses and unlicensed nurses on shift as allowed by legislation, as well as the presence of shift manager and other supporting staff. All personnel should have competency documentation and be under supervision. The next aspect is coverage ratios. This includes minimum staffing needs for each unit as well as the skill level of nurses. nurse-to-patient ratio guidelines are established to ensure that during any time of day the coverage does not exceed or strongly deviate from a preset amount.

Staffing levels should be adjusted based on a workload assessment of the facility that commonly remains relatively consistent over time. Scheduling limitations should be in place to ensure that nurses do not experience fatigue and burnout as this may compromise safety and increase the risk of errors. Nurses should not work more than 16 consecutive hours and extended shifts must be pre-approved and not be a regular occurrence (Koethe, 2018).

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The plan implies the development and introduction of HAI prevention guidelines as well. This includes staff training and periodic reminders about the importance of preventive factors. Furthermore, visual and auditory reminders should be given to staff on following procedures and preventive hygiene techniques to avoid errors that may lead to the prevalence or transmission of HAIs. Outcome measures should include an evaluation of staffing regulations, nurse-to-patient ratios, and levels of HAIs prevalence over time.

Staffing would be evaluated through random audits to ensure that adequate nursing rations of 1:5 at maximum are maintained as well as the presence of various types of nurses and supervisors. HAI levels are regularly measured as a health performance indicator and would provide data to correlate whether staffing has addressed the issue.

Barriers to Implementation

A number of barriers may arise during the plan implementation in a health facility. First, there are structural barriers, such as employee turnover which leads to difficulty in maintaining proper staffing levels and leadership structures for scheduling. The facility cannot maintain any staffing directives in terms of scheduling or FTE budgeting if there is a consistent turnover. Another risk factor is a lack of engagement from staff. The staffing issues and nurse ratios require active participation and candid discussion from the majority of employees. However, disinterest may lead to inconsistencies, violation of regulations, and further structural collapse.

A final barrier continues to be budget constraints which may prevent hiring additional nurses to decrease nurse ratios and budgetary practices pose numerous challenges to nursing leaders while attempting to lower ratio levels (Annis et al., 2017). Overall, these barriers are common in implementing most evidence-based practice changes. However, they can be overcome with competent leadership, creative approaches, and advocacy for nurses.

References

Annis, A. M., Robinson, C. H., Yankey, N., Krein, S. L., Duffy, S. A., Taylor, B., & Sales, A. (2017). Factors associated with the implementation of a nurse staffing directive. JONA: The Journal of Nursing Administration, 47(12), 636–644. Web.

Koethe, L. (2018). Nursing department staffing plan. Web.

Mahoney, D. (2016). Breakthrough solutions: A contingency model for nurse staffing. Web.

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Paulsen, R. A. (2018). Taking nurse staffing research to the unit level. Nursing Management, 49(7), 42-48. Web.

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