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Background
The ultimate goal of healthcare delivery is to ensure patients receive quality, timely, and sustainable medical services. Unfortunately, this goal has been hindered by several barriers that affect many medical institutions. Statistics indicate that around 2 percent of patients admitted in hospitals will receive inadequate care or get injured due to the problem of understaffing (Wise, Fry, Duffield, Roche, & Buchanan, 2015). Corchia et al. (2016) observed that burnout, poor patient outcomes, lack of motivation, and exhaustion were associated with the current problem of the nursing shortage.
The number of people joining the profession within the past two decades has remained low. The aging population needs complex and timely health services. The baby boomers leaving the profession are not being replaced. Medical institutions have been looking for new strategies to deal with the current problem. The absence of adequate resources in many health institutions is a major challenge making it hard for many professionals to support the changing needs of their patients. A new change would be needed to address this predicament.
Problem Statement
Patients who fail to receive exemplary medical support might not record positive health outcomes. The situation can be worse for premature infants in neonatal care. Infants require uninterrupted attention from medical practitioners and nurses. Unfortunately, the absence of nurse practitioners in different healthcare settings makes it impossible for such infants to receive the required medical support and care. Lake et al. (2015) observed that the nursing shortage was associated with increased levels of dissatisfaction and burnout. The situation also explains why more practitioners tend to be dissatisfied with their jobs.
Understaffing in neonatal settings has been associated with premature deaths, poor infant outcomes, and risk-adjusted mortality (Wise et al., 2015). This issue has been observed to pose a major challenge in the global healthcare sector. That being the case, strategies aimed at resolving this problem such as positive nursing relationships and collaboration will enhance the quality of care available to more neonatal patients, ensure practitioners are satisfied with their roles and streamline the healthcare delivery process.
Purpose of the Change Proposal
The purpose of this proposal is to recommend various strategies that can be embraced by medical institutions to address understaffing. In neonatal settings, understaffing is associated with infant mortality and poor health outcomes. The proposal suggests that adequate workplace planning, collaboration, and positive relationships will transform the situation.
Nurses can result in inadequate education to balance their work schedules and establish meaningful relationships that can promote performance. The recommendation will encourage more practitioners and nurses to collaborate, address workplace concerns, and focus on the best practices that can eventually ensure more infants receive timely care. The idea will be applied in different healthcare settings to tackle the challenge of understaffing and maximize the quality of services available to many surgical and neonatal patients.
PICOT Statement
The PICOT question that will be used for the final paper is: Does organizing different kinds of collaborative events and functions for nurse practitioners (I) for three months (T) improve the quality of care delivery (O) by decreasing mortality rates among surgical and neonatal patients (P) when comparing these rates to those present in facilities that lack collaborative events (C)?
Literature Search Strategy
A powerful literature search approach presents adequate insights and ideas that can be used to support the intended research study. Several articles focusing on the relationship between patient outcomes and patient-nurse ratios were considered for the study. To come up with a powerful study, the approach focused on the discussions focusing on the quality of care and medical support in neonatal intensive care units (Shang, Stone, & Larson, 2015). Several keywords were considered and used to select appropriate articles for the study. Some of the keywords included nurse-to-patient ratio, neonatal intensive care, surgical patients, nurse collaboration, understaffing, skill mixes, and evidence-based nursing practice.
Several websites and databases providing information on nursing were considered for the study. Some of these databases included ScienceDirect, ProQuest, EBSCOhost, and CINAHL. The targeted articles for the literature review were published within the past five years. Several strategies were embraced to ensure the articles supported the targeted topic. For instance, the targeted researches presented samples of nursing in neonatal care units (Twigg, Gelder, & Myers, 2015). The selected studies utilized data from a wide range of reports, documents, and populations. This fact explains why the completed study will offer quality information and discussions that can be used to improve the quality of services available to more communities.
Evaluation of the Literature
The identified literature supports the fact that many healthcare institutions are affected by the problem of nurse understaffing. As a result, more patients find it hard to receive evidence-based and timely care (Hughes, Bobay, Jolly, & Suby, 2015). The targeted articles focused on the issue of nurse-to-patient ratio and how it impacted healthcare delivery (Lake et al., 2015). The selected articles used data from different populations and administrative documents thus making the presented information reliable and appropriate for the study.
The articles were observed to analyze and describe the impact on nursing practices and responsibilities on patient outcomes. The scholars indicated clearly that the problem of the nursing shortage was affecting every aspect of the healthcare sector (Rogowski et al., 2013). The problem was observed to influence patient outcomes negatively. Although most of the articles did not offer adequate information on the role of collaboration towards bolstering performance, they presented adequate recommendations that can be embraced in an attempt to promote patient outcomes.
Change Theory
A powerful theory was required to ensure the proposed change was viable and appropriate for the healthcare sector. Change models offer adequate strategies that can be embraced to implement and make the part of the new practice of the targeted institution. Change is something that should be embraced in every sector to acquire new behaviors and practices that have the potential to improve the level of performance (Hughes et al., 2015). After considering the proposed practices such as collaboration within the workforce, it was agreed that a proper model would make it possible for different healthcare institutions to embrace the idea and make it part of their healthcare delivery models.
The first stage of the model is known as unfreezing. During this phase, institutions create the best environment through constant communication (Twigg et al., 2015). More people in the organization are informed about the importance of new workplace behaviors whereby nurses collaborate in an attempt to meet the changing needs of the targeted clients. The second phase is implementing the change. During the stage, the individuals will be informed about the benefits of the change and how it will transform their experiences. Adequate time should be allocated to ensure the change is implemented successfully (Rogowski et al., 2013). The refreezing stage (also the last) encourages members of staff to accept the new behaviors implemented in the institution. With proper support and guidance, the collaboration will become a new norm that boosts performance and care delivery.
Implementation Plan: Outcome Measures
To make nurse collaboration a reality, an implementation plan will be necessary. A competent team led by a supervisor is needed to support the implementation process. The first stage is using a powerful campaign or educational program aimed at informing the nurses about the needed change. The educational process will encourage the nurses to come together, address their differences, and form teams (Corchia et al., 2016). The teams will be guided by the supervisors and leaders to promote the new practice. Several outcome measures will be used. For instance, the outcomes recorded by the neonatal and surgical patients will be used as benchmarks to determine the success of the implementation plan (Lake et al., 2015). The levels of collaboration and job satisfaction will be key indicators for the success of the implementation plan.
Potential Barriers and Solutions
Every new change stands a chance to encounter some kind of resistance. This means that some of the nurses and workers in the targeted institution might be against the suggested behaviors and practices. The use of the above implementation plan and change model will address this potential barrier. Financial constraints might affect the success of the plan. That being the case, the targeted institution will be encouraged to allocate adequate funds to support the agenda. Lack of adequate time is another potential challenge capable of affecting the process (Twigg et al., 2015). Proper planning will be done to address this potential barrier. Such solutions will ensure the new practice becomes part of the healthcare institution.
References
Corchia, C., Fanelli, S., Gagliardi, L., Bellu, R., Coscia, A., Zangrandi, A., & Zanini, R. (2016). What we talk about when we talk about NICUs: Infants acuity and nurse staffing. The Journal of Maternal-Fetal & Neonatal Medicine, 29(18), 2934-2939. doi:10.1186/s13052-016-0247-6
Hughes, G., Bobay, L., Jolly, A., & Suby, C. (2015). Comparison of nurse staffing based on changes in unitlevel workload associated with patient churn. Journal of Nursing Management, 23(3), 390-400.
Lake, T., Staiger, D., Horbar, J., Kenny, J., Patrick, T., & Rogowski, A. (2015). Disparities in perinatal quality outcomes for very low birth weight infants in neonatal intensive care. Health Services Research, 50(2), 374-397. doi: 10.1111/1475-6773.12225
Rogowski, A., Staiger, D., Patrick, T., Horbar, J., Kenny, M., & Lake, T. (2013). Nurse staffing and NICU infection rates. JAMA Pediatrics, 167(5), 444-450. doi:10.1001/jamapediatrics.2013.18
Shang, J., Stone, P., & Larson, E. (2015). Studies on nurse staffing and health careassociated infection: Methodologic challenges and potential solutions. American Journal of Infection Control, 43(6), 581-588. doi:10.1016/j.ajic.2015.03.029
Twigg, E., Gelder, L., & Myers, H. (2015). The impact of understaffed shifts on nursesensitive outcomes. Journal of Advanced Nursing, 71(7), 1564-1572. doi:10.1111/jan.12616
Wise, S., Fry, M., Duffield, C., Roche, M., & Buchanan, J. (2015). Ratios and nurse staffing: The vexed case of emergency departments. Australasian Emergency Nursing Journal, 18(1), 49-55. doi:10.1016/j.aenj.2014.08.001
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