In Focus: The Nurse to Patient Ratio at USC Medical Center in Los Angeles County - Assignment Example

? Running head: NURSE-TO-PATIENT RATIO In Focus: The Nurse to Patient Ratio at USC Medical Center in Los Angeles County Background Information The problem that the researcher chose to address is the nurse-to-patient ratio in the USC Medical Center. The organisation that the researcher chose is the USC Medical Center in Los Angeles County, located in California, USA. It is usually referred to the Los Angeles County General. It is a public hospital founded in 1878 and is affiliated with the University of Southern California. The hospital provisions general care service and its emergency department is a Level I trauma center. The LAC USC is considered as one of the largest medical training centers and public hospitals across US (USC, 2006). It is also known as the largest provider of healthcare services in Los Angeles County. Its operations involve serving those who are underprivileged, which usually caters to trauma victims and patients suffering from AIDS and sickle-cell anemia (California Nurses Association, 2009). The Management Issue Under Consideration Although the nurse staffing has been considered average to high in the USC Medical Center in Los Angeles County, it hasn't been credited by the American Nurses Credentialing Center as being able to meet exceptional standards in providing nursing excellence. Like most US hospitals, the nurses from the LAC+USC complain that there are too many patients that need to be attended to (California Nurses Association, 2009). The emergency rooms were crowded and the hospital management was over-assigning staff which violates the law concerning safe nurse staffing. There was an instance wherein a shift was covered only by two nurses and they had to deal with 50 patients. As stated by law, 13 nurses should have been present at that particular shift (National Academy Press, 2004). More alarming cases were instances when patients had to wait up to 16 hours before they get medical attention or even have to wait for days for a hospital bed to be available (Nursingworld.org, 2011). At present, the hospital only has 600 beds (USC, 2006).The hospital has approximately 3,500 nurses. In order to be able to comply with the directives mandated, the hospital would need to employ a thousand more (Nursingworld.org, 2011). Apart from the nurse shortage issue, another pressing concern is the turn over. Since nurses across the county are overworked, they experience job dissatisfaction and burnout (National Academy Press, 2000). The California government has mandated that a licensed nurse should accommodate at least 6 medical and surgical patients, which was passed in 2002 and should be put into effect by July 2003. Once the directive is fully implemented, the patient to nurse ratio would shift to 1 nurse per 5 patients (Office of the Governor, 2002). A study showed that despite the legislations passed covering safe staff nursing; almost 85% of hospitals in the United States do not adhere to this because they are low on staff (nursingworld.org, 2011). The problem lies in the availability of staff, that in spite of the hospital management's intention to adhere to the law, they are not able to do so because of the staff shortage (Kovner, Jones, and Zhan, 2007). In essence, the management issue that the researcher intends to focus on is the nurse-to-patient ratio among hospitals. This issue produces inadequate nurse staffing, thus adversely affecting the performance of nurses and the quality of provided to the patients. Concept Map Nurses employed in hospitals that practice a higher nurse to patient ratio most likely generates job dissatisfaction and burnout. It can be noted that although staffing only plays a single aspect of healthcare facilities such as hospitals, it produces a domino effect that affects other facets of the operation (Trafford, 2002). Apart from influencing the degree of performance delivered by reducing mortality rates and ensuring the provision of safe and effective care, it can also affect the hospital itself. Job turnover would result to the need of hospitals to hire new nurses, most of which would have to go through proper training programs. This implies that addressing this issue can help hospitals retain their staff and reduce costs (Nursing Executive Committee, 2000). The previous years have presented an unstable scenario in United States hospitals in reference to nurse staffing. A prevalent issue concerning hospital management is the scarcity of nurses, thus resulting to understaffing (Stolberg, 2002). Across US, pressing concerns regarding nurse shortage entail the inability of hospitals to deliver safe care efficiently towards its patients (Aiken, Clarke and Sloane, 2001). The inadequate staffing level has also been acknowledged by doctors, as this issue hinders the capacity of health care providers to provision exceptional hospital care that is expected of them by their patients (Commonwealth Fund, 2000). Inadequate nurse staffing is considered as a management issue because it can be attributed to impractical workloads (Spetz, 2001). The stakeholders concerning this study are the nurses, the hospital and the patients. The key issue mainly focuses on the nurse to patient ratio. However, this issue leads to inadequate nurse staffing, job dissatisfaction, burnout and turn over on the end of nurses (Shindul-Rothschild, Berry, and Long-Middleton, 1996). On the other hand, hospitals are affected by nurse shortage and adverse patient outcomes brought about by inadequate staffing. The patients who require hospital care suffer as they are not provided prompt medical attention and the care they receive could be mediocre as there aren’t enough people to assist them (Friedman, 2002). Aim Nurses are a vital component of a hospital as they serve as a twenty four-hour monitoring system that helps in identifying when the patients' condition begin to decline, wherein intervention could be promptly applied (Stolberg, 2002). The efficiency of the nurses' surveillance process is dependent on the number of nurses available in a specific duration to evaluate the patients’ condition constantly. In that regard, the status of the staffing is significant in maintaining the variation in regards to the mortality rate of a hospital (Silber, Kennedy, and Even-Shoshan, 2000). One of the most important resources in a healthcare facility is the work force, as they are the ones responsible in taking care of the patients (Aiken, Sloane, Lake, Sochalski and Weber, 1999). The low retention among nurses and the predominant nurse shortage is brought about by management issues pertaining to inadequate nurse to patient ratios and burdensome workload which produces job dissatisfaction and burnout (Needleman, Buerhaus, Mattke, Stewart and Zelevinsky, 2002). However, a study conducted by the Audit Commission of England presented that a better staffing condition or a lower nurse to patient ratio does not imply better patient results (Audit Commission, 2001). Performance improvement in health care is based on the following variables: (1) availability; (2) productivity; (3) competencies; and (4) responsiveness. The "availability" factor pertains to turnover, overtime, staff ratios, waiting time and attendance. On the other hand, "productivity" is the interventions provided and the quality of services rendered to patients and "competences" is appropriate compliance to protocol and health care practice. Lastly, the "responsiveness" factor entails the satisfaction of the patients, mortality rates and the proactive quality service. As previously mentioned, these factors can be influenced by poor nurse-to-patient ratio or inadequate staffing. The lack of available nurses reduces the productivity of those rendering services, thus adversely affecting the responsiveness factor (Harris, 2006). At a macro level, one of the most defined means of improving performance in a health care system is improving the planning, deployment and use of available staff. In this particular issue, the staff would be the nurses. Appropriately improving the planning, deployment and utilization of nurses would reduce stress, thus improving job satisfaction and retention. In most cases, a regulatory framework is needed to support such a cause. These frameworks must be supported by government regulations based on institutional capacity (Sheaff, Schofield, Mannion, Marshall and McNally, 2003). Based on the information provided, improving nurse staffing in the USC Medical Center is favorable for the hospital and its stakeholders (Savitz, Jones, and Bernard, 2003). The most significant benefit is how it can address the concern of patient safety and nurse shortage. The degree of care being rendered by a hospital can vary on the rate of preventable deaths of patients upon admission, most importantly for those who manifest life-threatening conditions (Pronovost, Jenckes, and Dorman, 1999). Deaths can be prevented through efficient surveillance of nurses by early detection and prompt interventions. In general, not only deaths can be avoided, but unfavorable patient outcomes, as a whole. Turnover rate can also be addressed because improving the staffing level of nurses would decrease dissatisfaction and burnout brought about by their workloads (Parker-Pope, 2001). Action and Resources An ideal and feasible action to be taken is the proposed solution by the American Nurses Association. The flexible nurse staffing program can help resolve the inadequate nurse staffing, through requiring the USC Medical Center to plan nurse staffing per hospital unit on the basis of its respective conditions. Conditions vary from the severity of the patients' illnesses, the number of patients in a particular unit, the skills and experience of the available nurses, the hospital resources in the form of support staff and technology (ANA, 2011). Managing nurse staffing is supported by the newly passed bill in the United States, which is the Registered Nurse Safe Staffing Act of 2011. It is also referred to as S.58 or H.R. 876. At present, seven states in the United States is following the safe nurse staffing laws resembling that of ANA's. The solution offered by the American Nurses Association is favorable towards the nurses but it does not adversely affect the hospital as the guidelines presented are flexible (ANA, 2011). The program can be easily adjusted based on the conditions in the hospital. This approach protects the interests of nurses while effectively managing the staffing process as opposed to the customary strategy following mandatory nurse-to-patient ratio (ANA, 2011). This system can be best implemented through complying with the provisions advised by the American Nurses Association. It mandates the requirement among hospital administration to practice public reporting of the information pertaining to nurse staffing. Daily updates must be posted per shift, inclusive of the information regarding the number of the unlicensed and licensed staff that would offer direct patient care. More importantly, it would note the number of available registered nurses per shift (ANA, 2011). For better analysis and evaluation of varying conditions, it has also been required to collect and submit data that can be utilized to identify the correlation between patient acuity and nurse staffing. The researcher chose to adopt two workforce methods that can be utilized in the application of the flexible nurse staffing program. First is the workforce-to-population ratio method. Basically, it involves projecting the availability of health workers based on the workforce density. This approach does not require rigorous data aside from the number of patients expected to come in and the number of available nurses. The downside of this approach is that it wouldn't be able to address other variables that could affect the provision of health care services as it only focuses on population growth. The premise established in this approach is that there must be a sufficient number of health workers to address the needs of the patients. This approach is similar to the Historic Allocation method, or is commonly known as the personnel-to-population method. The second approach is the service targets method. This method enables the flexibility of the staffing program as it specifies targets for the production or services that would be most utilized in a given duration. This approach categorizes the time frame or shifts, the type of health services required and the number of available nurses that are able to provision effective care. Through these variables, the management would be able to project the size of the patients and plan a staffing program that is in accordance with the productivity requirements (Chen, et al, 2004). The hospital administration would be able to maximize its resources by constantly assessing the conditions of each hospital unit and allocating adequate nurses for each (nursingworld.org, 2011). This approach requires the management to evaluate the staffing level of nurses each shift per unit. In that way, the staffing level would be in accordance with the patients' needs and the nurses' welfare. The management must not overlook such pressing concerns as nurse staffing must not be reduced in order to minimize costs, rather, it plays a critical factor in generating exceptional quality in reference to patient outcomes (ANA, 2011). The RN Safe Staffing Act requires hospitals to be responsible in investigating complaints presented by the patients (nursingworld.org, 2011). Hospitals that fail to follow the guidelines mandated by the S. 58/H.R. 876 would receive civil monetary penalties as imposed by the United States' Secretary of Health and Human Services. In addition, nurses are protected by the government as they can complain directly in regards to staffing issues (ANA, 2011). Responsibility The hospital management would take the lead in implementing the flexibility staffing program of nurses. They are the ones who would monitor and evaluate the number of available nurses per shift and per unit. After evaluating the availability of resources and the projected condition per unit, the hospital management would formulate a strategy or a plan that would efficiently carry out the tasks needed to be delivered. They would assign the available nurse per patient that would not cause a burdensome workload. This would allow the nurse to work efficiently and the patients to be provisioned prompt medical attention. The management is the one responsible in the overall flexibility system that would be adopted, in order to avoid inadequate staffing thus preventing adverse patient outcomes and job dissatisfaction among nurses. In order to deliver the most efficient care, a comprehensive approach in health workforce planning can be adopted as a means to address the poor nurse-to-patient ratio. The flexible nurse staffing program suggested by the American Nurses' Association can be utilized as a means to implement workforce projections, in line with effective health workforce planning. This method would imply that the healthcare management would have to rationalize policy options on the basis of a scenario that is financially viable on a long-term period, wherein the projected supply of human resources for health in line with the needed staff within the entire overall plan. Through this approach, the supply and requirements among nurses and patients would be balanced. In that light, the models used for the health workforce would be utilized as the basis in projecting the following: (1) supply; (2) requirements; (3) work activities; (4) workload; (5) staff development, (6) and movement (Hall, 1998). Timeframe The adoption of the flexibility program can be initiated within a 12 month period on chosen medical units. This will be practiced in units that amass the largest number of patients, such as the emergency and trauma divisions. Within this duration, daily assessment would be applied in order to identify if there are any improvements in regards to the nurses and the patients’ conditions. Data would be documented on a day to day basis. If the 12 month period proves to be successful, then the full implementation and adoption of this program can be established throughout the whole hospital. Monitoring The tools that can be utilized by the hospital management in monitoring and tracking the implementation of the flexible nurse staffing program is the Workforce Projection Tool (WWPT) and the Workload Indicators of Staffing Needs (WISN).The WWPT is a workforce instrument intended aid in the process of comparing and assessing daily and summary reports that can be used for projecting the health workforce and the cost implications. However, it only utilizes a restricted amount of variables, which include population growth, availability of health workers, salaries, and cost rates. The results produced by this tool can be used as a guideline by hospital managements as a means to continuously produce staffing plans on a daily basis. On the other hand, the WISN is another tool designed to program the appropriate time and activities designated per nurse, which can then be translated into workloads. The utilization of this tool can help hospital managements apply a rational method in regards to planning staffing levels. The inadequate staffing produced by the imbalance between staffing and workload is an error based on facility capacity, not service utilization (Duckett, 2005). The progress can be monitored through weekly evaluation. Since the data would be documented on a daily basis, the information collected can be collated which allows the hospital management to assess if the new flexibility program is producing better results. Random short interviews can also be conducted after three months of the new program’s implementation. Nurses would be asked regarding any improvements they have experienced and if they believe that the new staffing program has been applied effectively for the welfare of the stakeholders involved. In addition, data pertaining patient outcomes would also be assessed to determine if there were any improvements. Risks and Strategies The possible risks that can hinder the effective implementation of the flexible staffing program are as follows: (1) failure of the hospital management to document daily data; (2) failure of the hospital management to plan and publicly report nurse staffing. If these two risks are present, then the flexible staffing program would be ineffective. The strategies that can be employed to address these risks is to assign a group in the hospital administration to be responsible in documenting the data, as categorized by nurse staffing or availability of licensed and unlicensed nurses, inclusive of the number of patients and patient acuity per unit. In addition, a group assigned to monitor the documentation would also be held accountable in ensuring that all the necessary information is publicly posted and updated. In lieu with this, another group would be assigned to cascade the daily staffing plan to the available nurses per shift. Through following this process, the hospital management would be able to fully document all the necessary data and analyze it to formulate a plan that can be applied per shift and unit. The monitoring group would ensure that all the necessary information has been collected so that the next group would be able to cascade the information to the nurses. This would then create a systematic method that enables the nurses to deliver effective care. Such limitations can be brought about by the limitations of the tools and instruments used in assessing the supply and demand of health care service. Bibliography Online Articles ANA. (2011). Study confirms ANA goal to match nurse staffing levels to patients’ needs. American Nurses Association. Henry, J. Kaiser Family Foundation. Survey of physicians and nurses. Retrieved on September 8, 2011 from http://www.kff.org/content/1999/1503 . Nursingworld.org, (2011). Safe staffing saves lives. Retrieved on September 8, 2011 from http://nursingworld.org USC. (2006). "Los Angeles County Hospital USC Medical Center" Keck School of Medicine, University of Southern California. Retrieved on September 8, 2011 from http://www.usc.edu/schools/medicine/patient_care/hospitals_clinics/lacusc_medical.html. Journals Aiken, L.H., Clarke, S.P. and Sloane, D.M. (2001). 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