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Critical care or intensive care units in hospitals are required to be staffed with nurses who are trained to work in these units and who are able to perform their duties in a stressful environment. However, staff shortages in these units are typical because of specifics of responsibilities and the lack of effectively trained professionals (Ayed, Thulth, & Sayej, 2015). As a result, this factor influences the quality of provided care to critically ill patients. The purpose of this paper is to discuss the problem of the quality of care in the intensive care unit of the selected hospital and describe the quality improvement plan to address this problem.
Description of the Process That Needs Improvement
Staff shortage in hospitals is a problem that is related to many areas in health care, and for the purpose of this paper, it is important to focus on a specific process that needs to be improved in the critical care unit in relation to nursing staff shortages. The problem is that the lack of trained personnel is mostly observed in the critical care unit at night when registered nurses are expected to perform a range of duties and monitor many patients. Inappropriately planned schedules and the lack of qualified staff create a situation when one nurse can monitor more than three patients at night without the assistance of other personnel, and the quality of provided care decreases significantly.
The Quality Improvement Model
To address the identified problem, it is important to utilize a certain quality improvement model that is usually applied in hospitals. The model appropriate in this case is the Plan-Do-Study-Act (PDSA) Cycle. The first stage of this model is planning that involves designing steps to complete in order to address the problem and implement a change. The second stage is doing, and it is associated with testing the intervention. At the stage of studying, the results of the implemented strategy are examined and evaluated. The stage of acting involves implementing the quality improvement strategy in the selected unit (Cohen et al., 2015). Several cycles associated with this model usually help develop the most effective intervention to cope with the issue and improve the quality of provided care.
Organizational Knowledge and Possible Insights
Currently, administrators of the critical care unit understand that the used schedule for night shifts is ineffective, and it does not address the problem of staff shortages. The number of patients in the unit is different every day, and this number can change during shifts. As a result, it is problematic to predict the number of patients who should be cared during each night shift. In spite of the presence of a weekly schedule, certain corrections can be made each day to guarantee that enough staff works a night shift to address the needs of all patients. Still, staff shortages lead to a situation that some nurses can work several night shifts in sequence. Consequently, the quality of provided care decreases. This knowledge helps identify the problem. However, the present insights regarding improving the situation seem to be ineffective. Thus, administrators are focused on trying different variants of schedules to address staff shortages at night and prevent nurses fatigue. Nevertheless, little attention is paid to filling in nursing vacancies in order to overcome the general problem of staff shortages.
The Process Breakdown
It is important to note that the process breakdown regarding the provision of high-quality care at night is associated with the fact that the overall number of critical care registered nurses who can work during night shifts is not appropriate to address the number of patients served in the hospital. The nurse-to-patient ratio does not address norms in order to guarantee high-quality care during night shifts because of nurses fatigue, lack of sleep, and delays. In addition, trying to address staff shortage, administrators also attract those nurses who lack training to work in intensive care units. As a result, the quality of proposed services can be low.
The Inter-Professional Team
While working on improving the process, it is necessary to organize an inter-professional team, the members of which will have certain duties and roles. Thus, it is important to involve administrators, nurse leaders, critical care registered nurses, and physicians as key actors. Administrators should organize schedules in such a way that these professionals will collaborate in the most effective manner while sharing information and responsibilities at night. Nurse leaders should become responsible for educating registered nurses regarding approaches to working with protocols and evidence and improving the quality of care (Momennasab, Karimi, Dehghanrad, & Zarshenas, 2017). Critical care registered nurses and physicians should become responsible for working as the part of small teams whose duties during night shifts are clearly stated.
Current Evidence
The evidence-based literature on the problem of quality improvement due to staff shortages provides several practices to overcome the situation. According to Ayed et al. (2015), night shifts are viewed by nurses as stressful, and an effective approach to eliminating pressure is based on reducing work hours during these shifts with the focus on conducting additional motivational training for nurses. Another evidence-based strategy depends on the study of the number of required and available nurses for each shift and the staff allocation depending on these data (Momennasab et al., 2017). These strategies allow for improving the quality of care during night shifts.
The Plan for Improving the Process
In order to improve the identified problem in the selected critical care unit, it is possible to apply the intervention related to planning the nurse workload for each shift. Changes in the staff allocation should also be associated with reducing working hours for shifts. In the selected unit, it is important to apply four six-hour shifts (morning, day, evening, and night) to decrease pressure on nurses. According to the PDSA model, at the stage of planning, possible working hours and the number of nurses for performing in each shift will be determined (Ayed et al., 2015; Momennasab et al., 2017). At the stage of doing, the critical care unit will test a new schedule during ten days. At the stage of studying, nurses feedbacks and the quality of provided care will be evaluated. If some changes are required, a new cycle will begin involving nurses from a test group. When the results of the evaluation are positive, it will be possible to shift to the stage of acting and implementing the change for the whole unit.
Conclusion
The process that requires improvement in the selected critical care unit of the hospital is the staff allocation during night shifts. The problem is that, currently, available nurses cannot provide high-quality care because of the lack of human resources. The proposed plan is based on the PDSA quality improvement model, and it guarantees effective, step-by-step implementation of a specific evidence-based intervention in order to guarantee positive changes in the discussed process.
References
Ayed, A., Thulth, A. S., & Sayej, S. (2015). Impact of night shift and training development factors on performance of professional nurses in North West Bank governmental hospitals. Journal of Education and Practice, 6(27), 50-60.
Cohen, R. I., Kennedy, H., Amitrano, B., Dillon, M., Guigui, S., & Kanner, A. (2015). A quality improvement project to decrease emergency department and medical intensive care unit transfer times. Journal of Critical Care, 30(6), 1331-1337.
Momennasab, M., Karimi, F., Dehghanrad, F., & Zarshenas, L. (2017). Evaluation of nursing workload and efficiency of staff allocation in a trauma intensive care unit. Trauma Monthly, e58161.
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