Leadership in Nursing and Healthcare  Strategic Planning for Change—Overview  For this Assignment, you explore one challenge that you would like to see addressed in your organization or one with which you are familiar. You will continue to work on this Assignment over the next several weeks. You will prepare an outline for this assignment due day 7 of week 5. This outline will help organize your work toward this assignment.  This Assignment also serves as your Portfolio Assignment.  To prepare:  • Identify a problem that you would like to investigate for this Assignment. Consider the resources and discussion about strategic planning and models that guide change such as SWOT, Balanced Scorecard, or Six Sigma and lean principles. Review evidence-based literature for data related to your selected problem. You will need to use at least five current (not more than five years old), peer-reviewed articles. If you cannot find adequate evidence, you may need to refine your topic. Your Instructor may provide some guidance for your literature search.   By Day 7 of Week 2, enter your selected problem in the Strategic Planning for Change Forum of the Discussion Board.  Your Instructor will approve your selected problem or provide feedback to help you refine your focus for this Assignment.  While this portion of the Assignment is not graded, it is required.  Once you have received feedback/approval of your selected problem:  • Reflect on the topics you are examining in this course and consider how they relate to your selected problem. Plan to analyze the problem using principles, theories, and concepts related to leadership and management, as well as other pertinent course themes.  • Review evidence-based literature for data related to your selected problem. You will need to use at least five current (not more than five years old), peer-reviewed articles. Your Instructor may provide some guidance for your literature search.  • Synthesize findings from the research literature and/or drawn from other sources of evidence.  • Develop evidence-based recommendations for addressing the problem.   © Laureate Education, Inc. 2  Write a 5- to 6-page paper (not including title page, references, or any appendix) that addresses the following:  • Introduction/Statement of the problem (1/2 page)  • Review of the literature for potential solutions to the identified problem  • Synthesis of the evidence as applied to the stated problem.  • Strategic plan for suggested courses of action based on your evidence and including application of a change theory.  • Conclusion/Summary

Nurse Patient Ratio

1. Introduction and Statement of the Problem

It is projected that by the year 2025, there will be a shortage more than nearly 500,000 registered nurses (RNs). As of 2008, the nursing vacancy rate in the United States was capped at 8%, and much of this observation may be attributed to the fact that the experiences of newly licensed and appointed RNs to have a direct impact on the subsequent perceptions concerning the nursing profession. Moreover, between 30-50% of recently accepted RNs opt to alter their professional positions or completely shift from the nursing profession within the first three years of their appointment to clinical practice (Marquis & Huston, 2015). Hence, the purpose of this study is to highlight the factors that are direct influencers of the decision undertaken by RNs to abandon the clinical nursing practice. Nurses who had opted to leave the nursing profession were interviewed on their reasons for leaving the practices, and a meta-analytic review was also incorporated in the research.

1.1 What is the Problem?

Inappropriate nurse-patient ratio results in adverse health outcomes for patients and this occurrence may be attributed to concerns raised about the safety of patients and the quality of healthcare that is to be delivered (Penoyer, 2010).

1.2 Why is it important to warrant a change?

1.2.1 Striking a balance between the nurse to patient ratio ensures that the workplace environment conditions are optimised thus providing a higher retention capacity within the healthcare organization (Gunnarsdóttir et al., 2009).

1.2.2 In the long run, the unnecessary costs incurred during hiring and recruitment processes is thus averted (Marquis, B. L., & Huston, 2015).

2. Review of Literature

2.1. Aiken et al. (2012) conducted a quantitative study, the purpose of this study was to determine the influence of improved staffing on the outcomes of patient care and nurse workforce stability in European nations. The study comprised of a survey of 418 nurses in 12 European countries and 617 in the United States including a study of 210 patients in European health facilities and 430 in US hospitals.

2.2. Neuraz et al. (2015) conducted a quantitative study that was based on routinely collected data from ICUs of four university hospitals during the year 2013, and it involved a total of 5,718 inpatient stays. The purpose of this study was to match the healthcare staff resources with the needs of ICU patients.

2.3. The objective of the survey conducted by Shang et al. (2013) involves the identification of factors that lead to high turnover and burnout for oncology nurses. This quantitative study incorporated survey data that was collected in 2006 and included 4047 nurses who were drawn from 282 hospitals across three states.

2.4. Tubbs-Cooley et al. (2013) conducted a quantitative study examining the relationship between staffing ratios and all-cause readmission in pediatric. The research involved 194 nurses and 459 children who had been admitted with typical conditions in 225 hospitals.

2.5. The study conducted by West et al. (2014) is aimed at investigating whether the size of the nursing workforce has a direct impact on the survival chances of critically ill patients both in general wards and the ICU. The research incorporates a quantitative study involving a survey of 38, 168 patients from 65 ICUs.

3. Synthesis of Evidence

3.1. Summary of Potential Actions

The ultimate function of ensuring a proper nurse to patient ratio is embedded in the fundamental purpose of instituting approaches that are directed towards patient safety. As such the typical potential actions would include establishing the practice of evidence-based leadership and management; adequate staffing; provision of clinical decision-making support and lifelong learning structures for nursing staff; implementing mechanisms that facilitate interdisciplinary collaboration and a feedback system that alternates with training sessions geared towards patient safety.

3.2. Comparing and Contrasting Recommendations

The healthcare organization ought to invoke nursing participation in the executive decisions undertaken and achievement of effective communication between clinical leadership and nursing. Other practices may include the education of board members on the link that exists between management practices and patient safety and emphasizing financial goals and productivity as components that warrants the well-being of patients.

3.3 Determination of Best Action

An ideal approach would involve the reconciliation of the factors that perpetuate active nurses participation in leadership while taking into consideration the cost-effectiveness of the measures to be undertaken.

4. Suggested Courses of Action

4.1. The model approach that ensures patient safety in a healthcare institution is dependent on the involvement of the nursing staff in effective leadership stratagems.

4.2. Process of Implementing Change

The process of implementing change would involve enhancing ongoing vigilance on patient safety while balancing the efficiency of nurses; demonstrating trust in workers, active management in the process of change and the engagement of employees in non-hierarchical decision-making.

4.3. Leadership Theory

There exists a correlation between nursing leadership and patient outcomes

4.4 Who, what, when and where?

The research aims at improving the general patient outcomes through the optimisation of nursing staff and equipping them with the ideal resources that would guarantee efficiency in the delivery of quality care in a health institution.

5. Summary and Conclusion

5.1. The ideal nurse to patient ratio has been correlated with factors such as projected workforce shortages, testing the proficiencies of healthcare leaders and improvements on the quality of care. As a result, nursing leaders have the mandate of ensuring that appropriate staffing and other resources have been put in place to optimise positive patient outcomes.

References

Aiken, L. H., Sermeus, W., Van den Heede, K., Sloane, D. M., Busse, R., McKee, M., … & Tishelman, C. (2012). Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States. Bmj, 344, e1717.

Gunnarsdóttir, S., Clarke, S. P., Rafferty, A. M., & Nutbeam, D. (2009). Front-line management, staffing and nurse–doctor relationships as predictors of nurse and patient outcomes. A survey of Icelandic hospital nurses. International journal of nursing studies, 46(7), 920-927.

Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management functions in nursing: Theory and application (8th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins

Neuraz, A., Guérin, C., Payet, C., Polazzi, S., Aubrun, F., Dailler, F., … & Schott, A. M. (2015). Patient mortality is associated with staff resources and workload in the ICU: a multicenter observational study. Critical care medicine, 43(8), 1587-1594.

Penoyer, D. A. (2010). Nurse staffing and patient outcomes in critical care: a concise review. Critical care medicine, 38(7), 1521-1528.

Shang, D. J., Friese, D. C. R., Wu, M. E., & Aiken, L. H. (2013). Nursing practice environment and outcomes for oncology nursing. Cancer nursing, 36(3), 206.

Tubbs-Cooley, H. L., Cimiotti, J. P., Silber, J. H., Sloane, D. M., & Aiken, L. H. (2013). An observational study of nurse staffing ratios and hospital readmission among children admitted for common conditions. BMJ Qual Saf, 22(9), 735-742.

West, E., Barron, D. N., Harrison, D., Rafferty, A. M., Rowan, K., & Sanderson, C. (2014). Nurse staffing, medical staffing and mortality in intensive care: an observational study. International journal of nursing studies, 51(5), 781-794.