Eve Wittlin-Young

1

Leadership Project Power Point

• Eve Wittlin-Young
• University of Central Florida

2
Scenario

• Staff nurse is concerned with the shortage of
  nursing staff present on the unit, as well as the
  effects of short staffing when considering the
  patients safety. Staff nurse decides to present
  ideas to management on ways to promote safe
  staffing with the recruitment and retention of
  nurses.

3
(No Transcript)
4
Background Literature

• The current nursing shortage should be a topic of
  interest to all, not just nurses, as patient
  safety is significantly jeopardized as a result
  of facilities lacking the proper staff to provide
  care to patients.
• Also, with decreased nurse staffing one is
  usually to expect an increase in patient ratios
  and use of unlicensed assistive personnel within
  the hospital environment, creating an even more
  dangerous environment for patients (Maurer
  Smith, 2009).
• Many studies have shown strong correlations
  between nurse staffing levels and patient
  outcomes. The Joint Commission on Accreditation
  of Healthcare Organizations reported that 24 of
  adverse events were related to low nurse staffing
  (Maurer Smith, 2009). A 2005 survey from
  Massachusetts licensed physicians indicated that
  19 of reported patient deaths were directly
  attributable to low staffing levels, 82 believed
  that the patient care suffers from low RN
  staffing levels and 74 supported mandating
  minimal nurse- patient ratios for increased
  patient safety (Cherry and Jacob, 2008).
• A 2002 report, published by the Journal of the
  American Medical Association, found that surgery
  patients are faced with an increased risk of
  mortality and failure-to rescue in hospitals with
  high patient to nurse ratios (Domrose, 2010). In
  2007, a report by the Agency for Healthcare
  Research and Quality, presented that hospitals
  with higher levels of nurse staffing had lower
  hospital-related mortality, decreases in failure
  to rescue, and shorter hospital stays as well
  (Domrose, 2010).

5
Accrediting\ Legislative Mandates

• Politically, much effort has been tried to
  establish minimum staffing level requirements for
  a health care facility in the state of Florida.
• Recently on February 24, 2010, Representative
  Oscar Braynon and Senator Hill filed Florida
  Hospital Patient Protection Act of 2010 (Florida
  House of Representatives, 2010).
• This bill would have established minimum staffing
  level requirements for a health care facility,
  require that the health care facility annually
  evaluate staffing levels and update staffing
  plans as well as prohibiting the facility from
  assigning unlicensed personnel to perform tasks
  that should be performed by a licensed or
  registered nurse (Florida House of
  Representatives, 2010).
• This bill was not passed. Currently, only the
  state of California has implemented mandatory
  nurse staffing in hospitals. As a result of the
  mandatory nurse staffing in California, a study
  released by the state of California Nurses
  Association has stated that the states laws on
  nurse-to-patient ratios has reduced the patient
  mortality (Nursing Standard, 2010).

6
Professional Organizations, Standards/ Position
Statements

• Nursing organizations that support safe staffing
  and have campaigned openly include the American
  Nurses Association and the National Nurses United
• The American Nurses Association (2010) had even
  created the campaign Safe Staffing Saves Lives
  that advocates nationally trying to resolve the
  nurse staffing crises.
• The National Nurses United (2010) created a
  similar campaign supporting the same concept as
  the American Nurses Associations campaign
  however their campaign was titled RN-to-Patient
  Ratios Saves Lives

7
Stakeholders

• It is clear that the stakeholders are not only to
  include all nurses, but the entire nation,
  including the patients, the families, managers
  and administrators.
• We are all involved in some way to our health
  care, whether it is through a hospitalized family
  member or a friend that is receiving care or as
  an employee of the hospital. The entire nation
  should share great interest in the need for safer
  staffing and the current nursing shortage that
  surrounds us and ultimately affects all of our
  safety.

8
Objectives

• My main goal for this project as a staff nurse is
  to present ideas to management on ways to improve
  the staffing levels on the unit by not only ways
  to recruit nurses but to ultimately retain our
  nurses.
• A clear specific and measurable goal is to
  improve the units nurse retention from 92 to
  100 by the end of 12 months as evidenced by all
  newly hired nurses completing a minimum of 12
  months on the unit and remaining with the
  organization. Specifically the organization will
  recruit six nurses to the unit and retain 100 of
  all the newly hired nurses.
• To also include a goal for the retention of
  dedicated staff I would like to add an objective
  of retaining all of our dedicated staff (staff
  that has been with the organization over one
  year) as evidence by 100 of dedicated staff
  remaining with the organization.

9
Implementation
10
Involvement of Stakeholders and others who may be
involved

• To successfully obtain the goals of recruiting
  and retaining nurses to prevent a shortage in
  staffing, as a staff nurse I would involve the
  stakeholders that are mainly composed of the
  units managers and administrators.
• Our goals and objectives can be open to and
  shared with the public as well, as it is nursing
  care that we are providing to the people and
  their families and they have every right to know
  the actions management is taking to ensure
  patient safety in the facility.
• Also creating awareness and publishing our
  efforts to the public on what the organization is
  currently doing to ensure a safe environment to
  their patients would be a positive effort on the
  organizations part.

11
Timeline

• Implementation length of this plan is truly
  continuous, however for the purpose of this
  project it will specifically be one year, as I
  will be examining and analyzing data one year
  from initiating the recruitment of nurses.
• In order to retain the committed nurses of the
  unit as well as the newly recruited nurses,
  management must be creative in expressing to
  staff how they are truly and continuously
  appreciated. Throughout the year, management can
  dedicate several days to show staff appreciation
  management may even consider having a short
  morning meeting upon nurses arrival to offer
  words of encouragement and acknowledgement of
  their excellent work.
• In order to recruit nurses to the unit, managers
  will offer a tea and tour, where the organization
  welcomes new nurses to have some light snacks and
  beverages and tour the hospital. It would give
  the nurses a great opportunity to see the
  hospital and the unit specifically also it would
  allow the interested nurses an opportunity to
  interact with the unit managers and ask detailed
  questions.

12
Education

• The unit will educate all staff members of our
  goals and objectives by having assistant nurse
  managers create posters and provide in-services
  to all nursing staff members to ensure awareness
  of the units goals of improving patient safety
  with nurse retention and recruitment.

13
Budget
14
Staff Budget

• As a staff nurse, I will discuss with management
  the number of nurses that is needed to
  appropriately staff the unit. Based upon the 112
  bed facility and the current number on nurses
  that are employed with the organization that the
  unit requires six new nurses to maintain
  appropriate safe staffing.
• I would first like to seek the approval for
  hiring additional nurses for the unit, preferably
  the six nurses. Once the unit manager gains
  approval to hire and depending on the positions
  approved, we can then estimate a basic budget for
  start- up costs.
• For instance, if the request to hire six new
  nurses were to be approved then we can think
  about costs for orientation. The nurse educators
  of the unit can then set the nurses up in an
  orientation plan that consists of a schedule of
  unit specific classes and job training for a
  period of six to twelve weeks, depending on the
  success/ comfort level of the individualized
  nurse. Two nurse educators will be teaching the
  necessary classes, such as the NICU course, to
  the new nurses in one of the organizations
  classrooms receiving their base pay of 22.00 an
  hour for six hours a day, for eight days, for a
  total cost of 2,112.00. The new nurses will
  receive their base pay of 19.00 an hour for six
  hours, for eight days with the cost of 912.00
  per nurse for their eight day course orientation.
  Providing the total cost of course orientation of
  7,585.00. Then to estimate that all of the six
  nurses that were hired work three twelve hour
  shifts a week with a preceptor for a total of six
  weeks 19.00 an hour would cost the unit 4,104
  per nurse over the six weeks of orientation.
  Providing a grand total of both course and unit
  orientation for the six nurses of 32,209

15
Supply Budget

• Supplies that will be needed for the tea and tour
  event in the hopes of recruiting new nurses to
  the organization would include signs that
  announce and direct the tea and tour, tables and
  chairs for both the managers and interested
  guests, pens, paper, assortment of tea, and light
  snacks such as shortbread cookies to entertain
  our guests. This event is to be hosted by our
  administrative staff that will be receiving their
  salary pay during this time. Estimating costs for
  supplies include 5.00 a sign for four signs
  (20.00), tables and chairs (25.00 a set
  includes four chairs and one table) for four sets
  totals 100.00. Pens and paper total cost 25.00,
  tea and snacks created by the organizations café
  30.00. Total of estimated supplies cost for the
  tea and tour event 175.00.
• Supplies needed in order to retain our dedicated
  nurses would include small chocolates to give out
  to staff provided by the organizations café on
  special occasions throughout the year (38.00,)
  having pizza days for the nurses (once a month
  for 12 months, five dollars a pizza for five
  pizzas total 300.00), small gifts from the
  organization such as pens or tote bags can also
  show great appreciation of their excellent work
  (2.00 an item for 72 items totals 144.00).
  Estimated total of costs for retention of nurses
  project 482.00.

16
Evaluation
17
Time/ frequency- markers for evaluation, data
collection and measurement

• My markers for evaluating whether the
  organization was successful in their efforts of
  recruiting and retaining nurses would include
  working with the organization to analyze the
  statistics and data obtained from human
  resources.
• Specifically, I will be looking at the number of
  nurses that were newly hired and compare that to
  the number of newly hired nurses that had left
  the organization within a year and the number of
  newly hired nurses that had remained with the
  organization. I would like to determine if we had
  met our goal of retaining all of the newly hired
  nurses for at least one year. I would also
  examine the number of dedicated staff that had
  stayed with the organization and look at their
  years of loyalty in order to determine, if we had
  met our goal of nurse retention of our dedicated
  staff as well. Another option would be to present
  surveys to the nursing staff to determine their
  satisfaction with the organization and offer a
  section for the employees to offer input
  anonymously on ways to improve the unit and
  whether they are satisfied with serving the unit
  and if they have plans to leave the organization
  due to dissatisfaction.

18
Data Analysis

• In order to analyze whether my ultimate goal of
  attaining appropriate staff to ensure patient
  safety was met, I would work with our unit
  management and risk management to gather
  statistics and data.
• Specific data that includes all of the errors and
  injuries that had resulted in patient harm/
  injury throughout that year on our unit and then
  examine the number of nurses that were working
  during these adverse events to determine if there
  was a correlation between short staffing and
  patient errors and injuries. Hopefully, I would
  then find that there were very few errors, if any
  that had resulted in patient harm, as the
  objectives of recruitment and the retention of
  nurses were successfully met and had ensured
  safety to our patients. This would also then
  satisfy my concerns as a staff nurse and justify
  that safe and appropriate staffing does in fact
  prevent patient injuries and errors from
  occurring.

19
Thresholds and corrective action to be taken if
thresholds not met

• Multiple statistics and studies have shown strong
  correlations between nurse staffing levels and
  patient outcomes. The Joint Commission on
  Accreditation of Healthcare Organizations reports
  that 24 of patient adverse events were related
  to low nurse staffing (Maurer Smith, 2009). You
  can clearly understand how being inappropriately
  staffed with registered nurses, does in fact,
  lead to poor patient outcomes and places all of
  our patients safety at risk. This is what leads
  me to believe that this plan of retention and
  recruiting nurses will promote and ensure patient
  safety. Also take onto consideration that in
  2007, a report by the Agency for Healthcare
  Research and Quality, published that hospitals
  with higher levels of nurse staffing had lower
  hospital-related mortality, decreases in failure
  to rescue, and shorter hospital stays (Domrose,
  2010).
• I personally would work with management and
  administration to discover the numbers of adverse
  events that had taken place on our unit during
  that year and examine the nurse to patient ratios
  and compare them to the previous years to see if
  the plan of staff retention and recruitment had
  made a particular difference. If The Joint
  Commission on Accreditation of Healthcare
  Organizations reports that 24 of patient adverse
  events were related to low nurse staffing (Maurer
  Smith, 2009) I would then compute what
  percentage of our units adverse events were due
  to low nurse staffing and hopefully find that it
  is less than ten percent, as we have improved our
  staffing on the unit with our objectives being
  met.
• However, if I was to discover that our goals were
  not met after gathering all of the data and that
  we were not successful in retaining our nurses
  and not successful in our recruitment which had
  then lead to adverse events and patients harmed,
  I would then turn to our staff directly. I would
  like to meet with them all and discuss what
  changes they believe should be made in in order
  to promote the safest environment possible to our
  patients and then report ideas to management.

20
Plan to Maintain Stakeholder Buy-in and How to
Sustain the Improvement

• It is with the belief that with this particular
  plan and with our objectives being met, the
  statistics of improved patient safety, as well as
  increased patient satisfaction with a full staff
  of delighted nurses, the stakeholders will be
  incredibly content and continue supporting our
  organization.
• Sustaining this change will definitely be a
  challenge, however, a challenge that the
  organization will have great interest in
  supporting and willing to maintain, especially
  with gathered statistical evidence that supports
  our goals and objectives for this project.

21
Anticipated Obstacles
22
Actions to Prevent and Methods to Address if
Encountered

• Anticipated obstacles would include inadequate
  staff that results from call offs and call
  sick, as well as, a low nurse satisfaction that
  would lead to a high turnover rate and an
  increase in adverse events.
• In order to prevent inadequate staff resulting
  from nurses who are not satisfied with the unit,
  I would suggest having meeting s with the
  dissatisfied nurses and speak with them about
  their unhappiness and their specific reasons for
  dissatisfaction and possible ways improvements
  can be made for the future.
• Although, I would be unable to prevent nurses
  from calling out sick or calling off from work
  due to personal reasons we would have alternative
  plans to maintain appropriate staff to ultimately
  decrease the risk of adverse events. For example,
  we would have the option to call pool staff into
  work, follow an on-call list or possibly borrow
  nurses from other similar units that are fully
  staffed and utilize their presence safely.
• With utilization of alternative plans our unit
  will be adequately and safely staffed with
  registered nurse to promote the most absolute
  safest environment to our patients at all times.

23
References