Staffing Impact on Care Quality in Nursing Homes

Change Theory Utilized

The proposed intervention involves a significant change in the workplace, which requires the use of an effective theoretical framework to guide the transformations. Lippitt’s theory will be employed to implement the intervention in question. Mitchell (2013) argues that this theoretical paradigm is the most applicable in the nursing practice as it “uses similar language to the nursing process” (p. 33). This theory involves such phases as the diagnosis, assessment of motivation, assessment of the capacity of change, selection of change objectives, appropriate roles of change agents, maintenance of change, and termination of the helping relationship.

Implementation Plan and Outcome Measures

The implementation of the intervention will be divided into seven major stages (see Appendix A). These phases are consistent with Lippitt’s phases of change. The first part will involve the diagnosis of the problem. During this stage, the problem will be researched, and the hospital’s nursing staff will be notified about the problem and its outcomes. The exact number of professionals needed in each department will be estimated.

During this phase, regular meetings will be held to come up with the exact number of nurses that will be hired. Hudson and Shen (2015) note that it is important to estimate the exact number of nurses needed in each department of the hospital, which can be implemented after an extensive discussion. Therefore, certain meeting time should be devoted to the discussion of this topic. Nurses’ perspectives on the matter can help come up with the most optimal number of new nurses that should be hired.

The intervention will also include the implementation of several surveys including the investigation of nurses’ satisfaction and performance, as well as their motivation to participate in the program (for example, in the role of mentors). One of the initial stages will involve the negotiations with the hospital’s management concerning the allocation of the necessary funds. It is important to have the necessary statistics, survey results, external research results to persuade the hospital’s management. It is also vital to make sure that new nurses will have mentors and will receive certain training as Hudson and Shen (2015) claim that chronic understaffing requires this approach. At the Palmetto Hospital Miami, the understaffing problem is chronic so effective training and mentoring are essential.

The final phases of the intervention imply the development of internal policies and standards as well as the facilitation of the change in the state or even nation-wide. Hospital standards can be developed quite easily based on the intervention evaluation. To contribute to the development of state- or nation-wide standards, it is necessary to share the experience through participation in conferences and publication of the results in peer-reviewed journals. Finally, it is also important to collaborate with nursing organizations (such as American Nurses Organizations) to make the public and officials involved in the process of new standards development. The major measurement of this stage will be new standards and increased nurse-patient ratios.

Potential Barriers and Solutions

Any change is often associated with a certain resistance. Backhaus, Verbeek, van Rossum, Capezuti, and Hamers (2014) claim that understaffing is often regarded as a negative but quite common feature of the nursing practice. In simple words, stakeholders (nurses, other healthcare professionals, officials, patients, and so on) have got accustomed to nursing understaffing. This trend can be regarded as a barrier since it can be difficult to create the need for change.

People (even nurses) can be unwilling to participate in the program as they can have doubts concerning its effectiveness and be reluctant to mentor or train new staff. To overcome this barrier, it is necessary to communicate with the stakeholders and reveal the benefits of increased nurse-patient ratio. Importantly, it is important to provide particular details of the program to make people understand that the goals of the intervention are achievable.

Clearly, the hospital’s management can also become quite resistant to the change as it requires the allocation of quite significant funds that are scarce. Harrington, Schnelle, McGregor, and Simmons (2016) state that financial concerns tend to be the major factor contributing to understaffing. To address this barrier, it is important to develop a detailed report concerning the outcomes (with the focus on financial losses) associated with understaffing at the Palmetto Hospital Miami and the benefits of the increased nurse-patient ratio. It is also vital to provide the number of new nurses needed.

Finally, policy-makers can be reluctant to introduce new federal standards as they will require the allocation of additional funds. However, politicians may be motivated to implement certain changes to win votes for the next elections. Therefore, the most effective way to address the barrier mentioned is to draw the public’s attention to the problem. It is important to share successful experiences and make other hospitals willing to implement the change. Patients, healthcare professionals, scholars, politicians, educators, media should all be involved in the discussion, which can be achieved through participation in conferences, the publication of articles in peer-reviewed journals, and collaboration with nursing organizations.


Backhaus, R., Verbeek, H., van Rossum, E., Capezuti, E., & Hamers, J. (2014). Nurse staffing impact on quality of care in nursing homes: A systematic review of longitudinal studies. Journal of the American Medical Directors Association, 15(6), 383-393.

Harrington, C., Schnelle, J., McGregor, M., & Simmons, S. (2016). The need for higher minimum staffing standards in U.S. nursing homes. Health Services Insights, 9(1), 13-19.

Hudson, C., & Shen, W. (2015). Understaffing. Organizational Psychology Review, 5(3), 244-263.

Mitchell, G. (2013). Selecting the best theory to implement planned change. Nursing Management, 20(1), 32-37.

Appendix A

Proposed Plan Implementation: Timeline.

Stage Intervention Time Measures
Diagnosis Estimation of the number of nursing professionals needed that involves surveying, discussions during regular meeting and meetings with the hospital’s management Week 1 Reports containing the number of nurses that will be hired in each department
Motivation Assessment Surveys regarding particular nurses’ motivation to participate Week 1 A list of change agents motivated to implement the intervention
Resources Assessment
  • Estimation of the resources needed
  • Negotiations with the hospital’s management concerning the corresponding funds allocation
Week 1-2 Estimated funds needed to implement the intervention, the management’s agreement to allocate the necessary funds
Change Objectives (Plan) The development of the plan with timetables, responsibilities (including training and mentoring) Week 3 The developed plan
Roles of change agents
  • The developed plan is reviewed and approved by the stakeholders (hospital’s management, change agents)
  • The major details of the plan are provided to the staff
Week 3 The developed plan is provided to the stakeholders
  • New nurses are hired
  • New nurses receive on-job training and mentoring
  • A survey is implemented
Week 4-9

Week 11

  • The nursing staff is increased
  • New nurses have mentors
  • Nurses complete performance reports
  • Nurses complete satisfaction and performance surveys
  • The intervention is evaluated
  • The corresponding standards (concerning nurse-patient ratio) are developed
  • The experience is shared with other healthcare professionals
  • Communication with nursing organizations involves the discussion of the change of the standards
Week 10-12
  • Report concerning nurses’ performance and satisfaction is developed
  • Policies and standards concerning nurse-patient ratio are developed
  • A peer-reviewed article is published, the report is provided during conferences
  • Some nursing associations and organizations are addressed (the experience is shared and the standards developed are introduced for further discussion)

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