Nurse Leaders: Facilitating Change in the Healthcare Setting - Essay Sample

Introduction

Nurses play a pivotal role in ensuring the delivery of quality healthcare services to patients. Today, the healthcare industry faces a myriad of problems such as the lack of enough hospital beds, patient dissatisfaction, and nurse shortage. Nurses with leadership skills can facilitate the desired change in their working environment. With the right skills, the nurse leader can plan and implement the change in the hospital without any problems. The purpose of this paper is to discuss a change proposal for the problem of a low nurse to patient ratio. Parts of the paper scrutinize the identified problem, assessment of the planned change, the planning and implementation of the change including the resisting forces, and evaluation of the change itself. There is a need for a strategy and collaboration between interdisciplinary teams to ensure that the proposed change works.

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Definition of the Problem

Low nurse to patient ratio has been a problem in most hospitals across America. As a registered nurse in the acute care unit, there is an identifiable problem of a low nurse to patient ratio. The unit has five registered, nurses and the number of patients who visit the hospital daily is high. On most occasions, the nurses have to work extra hours and shifts to ensure that they serve the patients. At the end of the day, the nurses are overwhelmed with work, which creates burnout and dissatisfaction among nurses. On many days, nurses have had to work more than twelve hours a day because the number of patients was high. Also, in 24 hours, only seven registered nurses are available. Over the same period, the number of nurses per patient beds is low. On an average day, one nurse serves about seven patients. Some patients have often complained of dissatisfaction with services. Also, some nurses at the unit had to quit because of the burnout and dissatisfaction they have experienced because of the problem. In hindsight, such problems omit the possibility of patient safety and critical care. The problems discussed are indicators for a low nurse to patient ratio at the unit level. Due to that, there is a need for change. Balancing the nurse to patient ratio will undoubtedly result in an improved working environment, better unit nurse staffing, increased patient and nurse satisfaction, low mortality rates, and low burnout among nurses.

Research has shown that low nurse staffing to patient ratio has a significant effect on the patient ratio. Rebecca (2018) asserted that the number of nurses available to attend to patients in a day and the number of hours they work affect patient mortality. According to the author, staffing targets need to be met to decrease patient mortality rates. Additionally, in her research, the author noted that the right balance of nurses to meet the needs of patients defines fiscally responsible staffing. For instance, a study in 2016 found that 62% of nurses in American hospitals work with a median salary of $68,450 per year (Rebecca, 2018). The author mentioned that since salaries make half of the country’s nurses pay, there is the need to exert changes in issues such as staffing to meet the financial outcomes. Patient outcomes are sensitive to nursing variables. The author indicated that the Affordable Care Act as well as the Centers for Medicare and Medicaid services usually withhold payments to hospitals if patients’ quality is unmet. The research calls for the need for a nurse leader at the unit level to predict and monitor the staffing variables that relate to patient outcomes. Furthermore, Griffiths et al. (2018) discussed the aspect of missed care as it relates to nursing staffing. In the results of their systematic review, the researchers established that more than seventy nurses reported that they omit some level of care to patients because of the low nurse to patient ratio. More so, an observational study by Bridges et al. (2019) revealed that there is the need for an increasing nurse to patient ratio because failure to do that results in changes in quality and quantity of staff-patient interactions. The authors indicated that when registered nurses staffing is low, then there are inadequate interactions between patients and nurses. Maintaining staffing levels will help to meet financial outcomes, improve patient outcomes, and avoid missed care.

The organizational structure of the hospital facility will help to facilitate the proposed change. The hospital has a vertical organizational structure. At the top, there is the hospital manager. Across the vertical level, there are unit managers. All unit nurse leaders report to the top-level management concerning issues the nurses’ experience. More so, the registered nurses at each level communicate with the unit managers about the issues they experience. The type of organizational structure at the facility creates informed and inspired leadership, decision-making, as well as accountability. It is expected that the organizational structure will help to ease the change process through encouraging communication and collaboration between interdisciplinary teams. Additionally, the organization structure will help in establishing the vision and direction of the change process. Also, the organization structure will play a significant role in monitoring and measuring the outcomes as well as problems that arise due to the change to ensure it has fulfilled its purpose.

The Planned Change Assessment

Staffing levels are necessary to ensure the safety and provision of quality care to patients. The U.S Bureau of Labor Statistics (2020) indicated that there will be a 12% increase in the demand for registered nurses between 2018-2028 because of the demand for healthcare services. This increase in demand compounds the existing low nurse to patient ratio in various hospitals across America as well as our facility. Inadequate staffing, without a doubt, endangers the safety of both nurses and patients. Introducing new practices to new staff and increasing the number of registered nurses in the unit will help in alleviating the problem. Regarding patients, for example, the planned change will increase the safety and quality of care given to patients. Driscoll (2018) affirmed that increased nurse staffing in hospitals results in increased nurse-sensitive increased outcomes in acute settings. In their systematic review and meta-analysis, the authors found that a higher level of nurse staffing is associated with a decreased risk of in-hospital mortality and nurse-sensitive outcomes. With a balanced or higher patient to nurse ratio, patients can receive quality care and nurses can attend to the patient’s need keenly. Regarding nurses, the issue of burnout because of heavy workload has a detrimental effect on the safety of nurses. Gustan et al. (2018) asserted that burnouts related to low nurse to patient ratio result in mental exhaustion and stress levels among nurses, which results in medication errors and malpractice suits. Furthermore, McPhee et al. (2017) asserted that heavy nurse workloads results in interruptions between the nurse and patients. At the facility, nurses often leave other tasks unfinished because of the rush to attend to patients. Also, there is the issue of dissatisfaction due to low nurse to patient ratio. Chen et al. (2019) asserted that burnout creates dissatisfaction among nurses, which eventually makes them quit their jobs. The literature review has shown broad findings related to the proposed change.

The incorporation of change theory will be significant in the change process. The change theory incorporated will be the force field model and the unfreezing change refreezing model. Using the theory, the management at the facility will need to have sufficient information about the change. The two types of forces in the model are the driving and resistant forces. The force-field model forms the basis of Lewin’s three stages of change. Figure 1 shows the force field model and the unfreezing change refreezing model. The three steps of change theory include the following,

Unfreezing – involves the process of communicating to personnel about the proposed change. This stage is facilitated by increasing the driving force and decreasing the resistant forces. In the proposed changes, the driving forces include higher nurse satisfaction rates and low burnouts as well as patient satisfaction and improved quality of care. The resisting forces might include interference with autonomy and other uncertainties such as job loss and loss of self-determination.

Moving – this step involves the change itself. In the stage, the interdisciplinary team will be informed of the benefits of the change and connecting with leaders to get perspectives of the change.

Re-freezing – this step involves making the change a new habit. The step ensures that the change is implemented.

Figure 1: Force Field Model and the Unfreezing Change Refreezing Model

The Change Planning and Implementation

The change planning and implementation is often a tiring process because some employees resist change. To overcome the resistance to planning and implementation of the change, strategies such as in-service training and education will be significant to ensure that the nurses at the unit embrace the change process. As mentioned earlier, the change process entails introducing unit nurses to new practices and the addition of more registered nurses in the unit to reduce the workload, increase patient and nurse satisfaction, and reduce burnout. The training and education will help the staff to understand the need for change, gain the support of the change, and minimize barriers to new practices within the organization. some of the new practices that registered nurses at the unit level will include working collaboratively with the existing nurses to ensure that by the end of the shift, they have finished their workload successfully. Also, before adding new nurses, nurses will be assigned the number of patients they should serve in a day to reduce mental exhaustion.

The Planned Change Evaluation

As a change agent, the steps for evaluating for change include the following,

• Step 1: Forming a team with the registered nurses at the unit. Forming the team will enable it to define the problem and find the best possible solution.
• Step 2: Collecting data on how the problem affects registered nurses. The use of questionnaires and focus groups will be significant among unit nurses to establish how the low nurse to patient ratio affects them. Also, during the data collection process, measuring outcomes such as the expected results after the change will be evaluated.
• Step 3: Analyzing the data. After the data collection, data analysis will be significant to determine whether the change is viable.
• Step 4: Sharing results with registered nurses in the unit as well as the unit managers through group meetings will help to get more input on the change process.

As a change agent, my roles include an advocate, communicator, problem solver, and advisor.