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GET WRITING HELP!Assignment: Identify barriers of implementation ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Assignment: Identify barriers of implementation Name one barrier for each that could impact the implementation of the guideline in practice. And explain how you would work through this issue. Assignment: Identify barriers of implementation Additional instruction: Please refer to the peer projects. Please see attached file. Please provide reference within 5 years attachment_1 attachment_2 attachment_3 Clinical Guideline and Implementation Plan Red TEAM November 21, 2017 Clinical Guideline and Implementation Plan Nurses function in high stress environments and may work long hours, while trying to provide safe patient care. Retention of registered nurses becomes problematic when nurses do not receive the support they need to function effectively. This paper addresses retention of registered nurses in the acute care setting. Problem Statement Retention of registered nurses in healthcare poses challenges for an adequate workforce and holistic patient care. Nurses leave or change nursing positions for a myriad of reasons. Among them are inadequate staffing, pay and benefits, stress, and inability to provide care in a way they would like. Interventions need to be taken to retain qualified registered nurses in acute care settings. Nursing retention can cost the hospital between 5.2 to 8.4 million dollars annually (Nursing Solutions, Inc., 2017). Retention of registered nurses is costly and means to improve retention rates should be addressed. Establishing minimum staffing levels can improve nursing retention, save hospitals millions of dollars annually, and improve patient safety. According to the Institute of Medicines (IOM) report in 2004, of Keeping Patients Safe: Transforming the Nursing Work Environment, patient acuity and skill mix must be considered when creating patient nurse ratios. The American Nurses Credentialing Center (ANCC) reports safe nursing ratios have good patient outcomes reducing nurse overload and burnouts (Buffington, Zwink, Fink, DeVine, & Sanders, 2012). Evidenced-Based Practice Question PICO Question: Do safe nurse-to-patient ratios decrease the risk of nurses leaving positions compared to not having safe nurse-to-patient ratios for registered nurses working in acute care? The population (P) is registered nurses working in acute care. The intervention (I) is a safe nurse-to-patient ratio. The comparison (C) is nurses who work without safe nurse-to-patient ratios. The outcome (O) is nurses leaving positions. Literature Review The American Nurses Association (ANA) (2015) released an executive summary that looked at optimal nurse staffing and improvement of patient outcomes and quality of care. Appropriate staffing has shown to increase patient satisfaction, safety, and quality, while decreasing mortality rates, readmissions, length of stays, and nurse fatigue (ANA, 2015). Appropriate staffing ratios also improve nurse satisfaction and retention (ANA, 2015). ANA (2017) released evidenced-based key research findings from a literature review on safe staffing. Many research findings were presented supporting safe staffing levels. In a descriptive survey design, factors influencing nurse retention at a Magnet hospital included dissatisfaction of workload and staffing, nurse-patient ratios, burnout, and stress (Buffington, Zwink, Fink, DeVine & Sanders, 2012, p. 278). In a correlational, quantitative study by Hairr, Salisburry, Johannsson, and Redfern-Vance (2014), the study looked at links between retention, job satisfaction, and staffing within an acute care environment. The Institute of Medicine (IOM) released a report in 2004, recognizing appropriate staffing levels play a key role in patient safety (Hairr et al., 2014). According to various cited articles in Hairr et al. (2014), literature suggests nurse-patient ratios of 4:1 provide optimal outcomes. Therefore, while patient safety has been documented with appropriate education and numbers of staff, nurse retention is another factor. Although many factors influence retention, nurse satisfaction is a significant component (Hairr et al., 2014). Nurse satisfaction includes appropriate staffing levels. In Hairr et al. (2014), research showed that as dissatisfaction increases, so do thoughts of leaving the workplace. Research Synthesis Nursing retention has become an increasing problem among health care facilities. This can be due to the nurse to patient ratios. When there is high nurse turnover, it can cause a financial burden and cost anywhere from $42,000 to $64,000 to replace RNs (Buffington et al., 2012). Nurses who feel overwhelmed in their job or who are facing pressure from not having enough time to get things done, feel unhappy in their job and change jobs (Unruh & Zhang, 2013). The literature recommends three interventions to help improve job satisfaction: autonomy, recognition, and communication (Buffington et al., 2012). With these interventions and safe nurse to patient ratios, nurse retention is increased. Clinical Guideline/Protocol In order to evaluate the patient outcomes on nursing retention and safe patient ratios, data will be collected from patient surveys, quality improvement and safety statistics, nurse exit interviews, and nursing self-evaluations and surveys. The outcomes that will be evaluated will include patient safety, patient and nurse satisfaction, and quality measurements. This data will be collected with support from the Quality and Safety Committee as well as from Human Resources. Implementation Plan The implementation and plan for nursing retention is based upon Maslows humanistic needs where safety is the catalyst for (nurse) self-actualization (McEwen & Wills, 2014). Nurses need to feel safe in order to provide quality care as demonstrated by the research. According to Seago (n.d.), when making fundamental changes for provision of safe nursing care, a loss of trust has serious implications for implementation of changes. An inference, based upon Maslows hierarchy, is that if a nurse feels safe, the nurse will likely remain in the environment. Like all humans (or animals), when one does not feel safe, one looks to leave to feel safe again. The literature empirically supports how nurse staffing ratios impact the safety of nurses and patients. The leaner the ratios, the higher the medication errors, nosocomial infections, urinary tract infections, and hospital readmissions (Seago, n.d). All of the outcomes consequently result in high dollar fall-outs to a healthcare organization (Seago, n.d.) to include nurses leaving the organization. The plan and implementation for nurse retention in an acute medical-surgical unit is to limit the staffing ratio to no more than four patients to one nurse, with the ability to lower the number of patients to accommodate acuity. Adequate staffing is established by sound methodologies in this case, Maslow, as determined by nursing staff. Once approval is obtained from hospital administration, nursing leadership, and the medical/surgical unit nurses, the proposed plan will be: Nursing executive support to petition to the Board of Directors the need for safer nurse:patient ratios Nurse executive to provide the financial implications of higher patient to nurse ratios impacting nursing retention based upon the research Nursing executives and leadership demonstrate and promote trust in and by nursing staff Creating a Unit Based Council (UBC) to develop an acuity assignment guide to provide mechanisms to accommodate unplanned variations in patient care workload (Maslows respect for others) Shifting the decision-making process to the direct care nurses thereby empowering and validating the nurses (Maslows autonomous thinking) Assign seasoned nurses to precept novice nurses on the medical/surgical unit. This will bridge the gaps in skill sets, thereby, creating a clinically sound commonality of staff. This training period will not impact the nurse:patient assignment (Maslows realistic orientation). Gathering baseline data before and after the dissemination of plan which demonstrates the continuation of assessment in supporting the validity of robust nurse:patient ratios In a controlled environment, the implementation of this proposal will constitute a three-month period. The time frame rationale is based upon 30-day readmissions, hospital reporting for infections, and turnover rate. The time will allow nurse executives, nurse managers, and all key players to gather both human resource retention data and fiscal analysis after the dissemination of the proposed plan. Job satisfaction will consist of a pre-and post implementation job satisfaction survey by all nurses in the medical/surgical unit of interest. The administration will consent to not allowing any float nurses into the unit while the study is occurring. The instrument of choice to measure will be the Assessment of Work Environment Schedule (Edwards et al., 2014). According to Edwards et al. (2014), the instrument has a Cronbachs alpha of .93. The nurses will access a secure website to take the survey only accessible to the units nurses and only while they are at work. The data will be analyzed using ANCOVA to rule out any preliminary and post implementation unknown variances, one of which to consider is the nurses baseline opinion of job satisfaction. A barrier to consider is a nurse finding the time to take the surveys within the allotted time frame both pre-and post. The nursing units managers will ensure the nurses are able to take the on-line surveys at work, only. The completed results of the study will be presented to the hospitals Board of Directors by the nursing executive, Chief Nursing Officer at the Board of Directors meeting the month following the finalization of all data. Implementation for this plan will start with evaluating the staffing matrix and dividing care up between discipline specialties. Self-scheduling will be implemented and staffing requirements will be posted for clear understandings of these requirements. Decreasing job demands by minimizing interruptions and unpredictability, conflicting demands, adverse work schedules and extended work hours (Twigg & McCullough, 2014). Charting will be evaluated for redundancy and will include evidence-based practice charting. Managers will aim to be visible, accessible and responsive to their staff, and will be rounding daily on patients (Twigg & McCullough, 2014). In addition, daily rounds with case management, charge nurse, primary nurse, and the Hospitalist will occur to improve collaboration, flow of work, and patient care while maximizing quality of care cognoscente of the nurses time. Conclusion Despite the strong and accumulating evidence that higher nurse staffing levels in hospitals and nursing homes result in safer patient care, there is wide variation in nurse staffing levels across hospitals (Seago, n.d). Healthcare is a business today according to numerous published data and as evidence by Centers for Medicare and Medicaids reimbursement policies. Patient satisfaction does impact hospitals, directly, as well as satisfied nurses. The data clearly demonstrates a direct correlation between nursing satisfaction and lower costs to a hospital (Buffington et al., 2012). The state of California has set a mandate to nurse patient ratios with improved documented patient outcomes, increased nurse satisfaction, and a reduction in nurse turnover rates (National Nurses United, 2017). With adoption of nurse-to-patient ratios, hospitals can improve nurse satisfaction, patient safety, and nurse retention. References American Nurses Association. (2015). Optimal nurse staffing to improve quality of care and patient outcomes: Executive study. Retrieved from http://www.nursingworld.org/DocumentVault/NursingPractice/Executive-Summary.pdf American Nurses Association. (2017). Safe staffing literature review. Retrieved from http://nursingworld.org/SafeStaffing-LiteratureReview Buffington, A., Zwink, J., Fink, R., DeVine, D., & Sanders, C. (2012). Factors affecting nurse retention at an academic Magnet hospital. Journal of Nursing Administration, 42(5), 273-281. doi: 10.1097/NNA.0b013e3182433812 Edwards, N. E., Beck, A. M., & Lim, E. (2014). Influence of aquariums on resident behavior and staff satisfaction in dementia units. Western Journal of Nursing Research, 36(10), 1309-1322. doi:10.1177/0193945914526647 Hairr, D. C., Salisburry, H., Johannsson, M., & Redfern-Vance, N. (2014). Nurse staffing and the relationship to job satisfaction and retention. Nursing Economics , 32 (3), 142-147. Retrieved from Ebscohost database. McEwen, M., & Wills, E. (2014). Theoretical basis for nursing (4th ed.). Philadelphia, PA: Lippincott Williams & Wilkins. National Nursing United. (2017). Safe RN-to-patient staffing. Retrieved from https://www.nationalnursesunited.org/ratios Seago, J.A., (n.d). Nurse staffing, models of care delivery, and interventions . (39). University of California San Francisco School of Nursing. Retrieved from http://archive.ahrq.gov/clinic/ptsafety/pdf/chap39.pdf Unruh, L., & Zhang, N. J. (2013). The role of work environment in keeping newly licensed RNs in nursing: A questionnaire survey. International Journal Of Nursing Studies , 50 (12), 1678-1688. doi:10.1016/j.ijnurstu.2013.04.002 Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10
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