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HE490 Healthcare Capstone Research Studies

HE490 Healthcare Capstone Research Studies

Sample Answer 

HE490 Healthcare Capstone Research Studies

Introduction

As a medical professional, the healthcare environment is a demanding yet rewarding field. The constant day-to-day struggles are far more intricate than one can expect.Even as a healthcare receptionist, the heartbeat of an office, is far more complex and can leave a person feeling worn out. Nurses in hospitals not only worked too hard but also started to regret the decision when they took their Hippocratic oath. Hospital nurses work a thankless job, and hospitals are having more trouble hiring Registered Nurses. Due to a lack of support and long hours, more hospitals are losing quality care (Twigg & McCullough, 2014). The low morale is enough to drive nurses away and further their careers in the medical field outside direct patient care. As a medical professional, I have also decided to leave direct patient care to support the nurses, medical assistants, and staff.

Nurse Shortage, Retention and Job Dissatisfaction

Hospitals are the staple of medical Care. The present shortage of nurses in the United States is expected to continue (Scherman, 2018). Nurse shortage, the nature of the work environment, and employers’ expectations and attitudes, among other factors, influence nurse retention and patient care quality. Improving the workplace for nurses is critical for nurse retention (Cicolini, Comparcini, & Simonetti, 2014). Nurse retention is directly related to nurses in both working conditions and responsibilities. Common reasons nurses give for dissatisfaction with their job are unprofessional behaviour such as verbal abuse, understaffing, the complexity of patients, physically demanding work, and too much paperwork, even with the existence of EMR (Cicolini et al., 2014).

Small rural areas to largely populated cities differ in complexity. Small rural

areas are less busy yet, may lack nurses. Larger cities are packed full of patients with not enough available nurses. California is the only state regulating the nurse-to-patient ratio of 1:1 or 1:2. In the D.C. metro area alone, the nurse-to-patient ratio ranges from 1:6 to 1:10 depending on the available staff (McHugh, Carthon, & Sloane et al., 2012).

Safety in Numbers: Nurse to Patient Ratios and the Future of Health by Suzanne Gordon, John Buchanan Cornell University March 15, 2012, examines arguments for and against ratios. Hospital cost-cutting and layoffs not only create larger deteriorating conditions for both doctors and patients but also increase patient mortality. With at least fourteen U.S. states and other countries considering staffing level regulations, the book offers an understanding of healthcare policymakers handling the implementation of the nurse-to-patient ratios across the nation.

I currently work for a large hospital entity in the D.C. metro area. Focusing on this

important issue by examining the causes of low morale and recommending possible measures to improve the retention rate is of importance. Pairing with a local hospital to implement some of the interventions to see the retention improve over time is also important as well. The top five ways to improve nurse retention in larger cities include reducing overtime and reducing mandatory overtime (Wright & Mahar, 2013), developing shared governance programs that give nurses a voice in scheduling, workflows, and hospital policies  (Brunges & Foley, 2014); ensuring adequate nurse staffing levels and supporting acuity-based staffing tools(West &Sherer, 2009); recognizing nurses’ need for work-life balance (Cortese, Colombo, & Ghislieri, 2010); and encouraging and developing a workplace culture of collaboration between nurses and physicians (Ross, Rogers, & Pearce, 2012).

By using this guideline, I can compare my answers within my hospital and find out if these guidelines are accurate for this area. Utilizing this information from hard-working nurses can open a line of communication with management.

The current problem with nurses is expected to rise within the decade, according to Sherman (2018). The problem, I believe, will not only cause a shortage but will vastly bring down the quality of Care to patients. I have been in the medical field for over 20 years. I started as a receptionist all the way through clinical management and direct patient care. I have experienced firsthand the struggles and hardships on a daily basis, and I strive to change management in a new direction.

Hospitals are constantly struggling to keep nursing staff to full capacity. In the D.C. metro area, where the overpopulated DMV resides, over 300 open nursing positions are available within eight major city hospitals. This does not include Urgent Care facilities or Ambulatory Services. However, the increasing problem of nurse shortages has impacted not only the organization but also the quality of Care.

Literature Review

Hassmiller, S. B., & Cozine, M. (2006). Addressing the nurse shortage to improve the quality of patient care. Health Affairs25(1), 268-274.

According to a study from the Health Affairs article, nurses are “burned out” much faster due to the clerical and non-nursing duties that must be performed besides clinical duties. EMR (Electronic Medical Records) is problematic due to lacking or dull computer network services. Robert Wood Johnson Foundation’s (RWJF) work in nursing focuses on improving the hospital work environment to attract and retain high-quality nursing staff, with the ultimate goal of improving patient Care and outcomes in hospitals.

According to the article, 43 percent of nurses plan to leave their job within the first three years. The average age for a nurse is 40 years. It is a rare occasion for a nurse to retire from a hospital at age 65. Without immediate action, the nurse shortage will continue to worsen. By 2020, estimates suggest that the United States will have at least 400,000 fewer nurses than today when baby boomers are in their seventies and eighties. The RWJF has continued to support experienced nurse leaders through the Robert Wood Johnson Executive Nurse Fellows program, advanced leadership and mentoring program for nurses in senior executive roles in health services, public health, and nursing education. The RWJF has invested $29.7 million in this program, which has supported more than 125 executive nurses, to give nurses a more influential role in transforming the U.S. healthcare system.

Transforming Care at the Bedside (TCAB) is a collaborative project between the RWJF and the Institute for Healthcare Improvement (IHI), which involves thirteen hospitals in a pilot program for medical/surgical nurses to identify and implement changes that will improve in their units. The organization is researching ways to make it easier for nurses to spend more time with patients and less time on administrative tasks. In most cases, these innovations have been cost-neutral or have even saved money. In 2006, when the pilot phase of TCAB is complete, the foundation expects to develop a demonstration phase of the program that would reach a broader spectrum of U.S. hospitals.

Another innovative idea which features equipment and functionality to allow

patients to remain in the same room, even when their condition changes during their

hospital stay. This capacity is particularly important, given the risk of medical errors and

infections, as well as the resources and staff time required, when patients are transferred

from one room to another.

The RWJF is not alone in its support for programs to address the nurse shortage and improve the quality of nursing care. Public and private organizations across the country are investing in nursing at the local, state, and national levels. The state, as well as the federal governments have taken measures to decrease shortages. In 2004 the Health Resources and Services Administration’s (HRSA’s) Division of Nursing received appropriations for nearly $142 million in support of nursing education, student scholarships, nurse retention, workforce diversity, and faculty development. The CMS also is working to develop more requirements for nursing homes to release public reports on their staff training, retention, and use of non-nurse staff to provide patient Care.

One of the largest corporate supporters of nursing in the past several years has been Johnson and Johnson. J&J has invested more than $30 million in Nursing’s Future. Working with Johnson and Johnson, the RWJF plans to release a resource guide to help local funders understand the national issues related to the nurse shortage and identify efforts to improve the recruitment and retention of skilled nurses. As a healthcare industry across the nation, nurse retention has been a problem in all parts of the country. Since the 90s, studies to keep nurses have been implemented and has been a long and tedious process but necessary in order to keep healthcare quality.

 

Schroyer, C. C., Zellers, R., & Abraham, S. (2016). Increasing registered nurse retention using mentors in critical care services. The health care manager, 35(3), 251-265.

In today’s fast-growing healthcare industry, many studies have been conducted regarding Nurse Retention. Mentors have been researched in hopes of slowing down retention rates. A study at Bethel College was done by Sam Abraham DHA, R.N.

by adding mentors to new nurses as well as overworked experienced nurses to gain wisdom, provide support and encourage individuals to maximize skills and performance. The purpose of this study was to calculate retention rates of R.N.s of a 325-bed community hospital in Northern Indiana. The novice nurse had many frustrations while engaging in overworked environments, reality shock, and lateral violence led to high turnover rates. Mentors of new nurses are allowed for safely voice concerns, ask for advice and feel confident with their work environment

Meraviglia, M., Grobe, S. J., Tabone, S., Wainwright, M., Shelton, S., Yu, L., & Jordan, C. (2008). Nurse-friendly hospital project: enhancing nurse retention and quality of Care. Journal of nursing care quality23(4), 305-313.

The article focuses on improving the workplace for nurses directly related to satisfaction in terms of both working conditions and responsibilities. According to the authors, nurses get burnouts due to verbal abuse, the complexity of patients, physical demands, understaffing and too much paperwork. Its main focus was the Nurse-Friendly Project, which was incorporated into the hospital’s policies to create a positive environment. Thirty rural or small hospitals enrolled in the project. Of the 1150 nurses, 68 percent of R.N.s’ reported their usual workday was over 12 hours long, while the rest of the 32 percent were either part-time nurses or temporary contracted nurses.

The NF hospital project improved nurses’ perception of their work environment, creating a positive practice setting, nurse staffing and quality of patient care. Improvement in the work environment enhanced nurse retention as measured by changes in nursing care hours, skill mix and nurse turnover rates over time. Since the start of retention, government-commissioned studies focus on nurse staffing to improve patient safety, health outcomes, and quality of Care.

Berry, L., & Curry, P. (2013). Nursing workload and patient Care: Understanding the value of nurses, the effects of excessive workload, and how nurse-patient ratios and dynamic staffing models can help — Canadian Federation of Nurses Unions.

The main focus of this article is on the insignificant amount of action taken to ensure safe nurse staffing and quality of Care. The policy was intended to advise policymakers, elected officials and healthcare executives to carefully review their staffing and patient outcomes in hopes of taking action and do better. A mandatory report review of employee satisfaction must be studied monthly to track problem areas and find innovative ideas to improve staffing issues. A research study was conducted to determine the association between the patient-to-nurse ratio and failure to rescue (deaths following complications).

Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., & Silber, J. H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. Jama288(16), 1987-1993.

In the article, the authors state that registered nurse staffing ratios were found to be an important factor in explaining hospital mortality. Nurses are described as having “round-the-clock care” by detecting early signs and symptoms of patient deterioration and to act immediately to prevent harm and or death. It was found that R.N. surveillance is directly influenced by the number of R.N.s available to assess a patient’s health on a daily basis. Staffing ratios were found to be important in explaining hospital mortality. Nurse staffing legislation represents a credible approach to reducing mortality by implementing a float pool of Nurses and decreasing the administration workload to focus on the clinical workload for nurses.

Pappas, S. H. (2008). The cost of nurse-sensitive adverse events. Journal of Nursing Administration38(5), 230-236.

The author described ways to determine the cost of adverse events and adequate levels of nurse staffing to efficiently provide quality patient care. The effect of the cost associated with quality outcomes must be monitored and repeatedly studied. Nursing cost is a target as a potential source of cost saving with most hospitals. It was proven that the appropriate quality and quantity of nurse staffing are essential to achieving high-quality patient outcomes. By decreasing nurses, there was a significant increase, and patient mortality and the cost of end-of-life care increased. More patients needed emergency surgeries, and the overall cost of patient care increased. Hospital staffing in large major cities on the east coast, a survey was conducted in regard to employee satisfaction.

Zelvis, K., Duran C., & Swenson, K. (2015). Consequences of Hospital Nurse Staffing. Available at https://www.ropclip.com/GPx2XN_7atw/consequences-of-hospital-nurse-staffing.html

In the video, the authors found that the lack of resources was a leading cause of retention, and mistreatment behaviour by physicians was one of the top three causes of nurse retention. It was also found that mistreatment by the patient’s family members was also one of the top five causes of retention. This raises a flag with hospitals because such incidences are hard to monitor and cause low self-esteem among nurses. With actual physicians adding to the problem, it is difficult to resolve since most physicians are headstrong and stubborn or, in other words, “set in their ways.” The hospital is faced with possibly losing a physician, especially if he or she has high credibility among patients.

Patients’ causing abusive or verbal problems is also another issue that must be

monitored, but usually, the saying “the customer is always right” in healthcare is policy.

A hospital cannot lose patient Care, especially when involved with high-paying insurance such as Blue Cross Blue Shield.

Thieman, L. (2013). Nurse Retention: Wellness Programs Growing Steadily. Available at https://www.youtube.com/watch?v=hBRhoBiEa-Q

Due to the many downside results of numerous studies, more and more hospitals

are now taking the initiative to create wellness programs for nurses and employees. In the video, the scholar explained new and innovative ways of engaging employees by providing workshops in their institute, such as Reiki Healing, group discussions and” burnout” courses. These workshops are provided for all employees, such as team building exercises, group fun activities, private group discussions and learning stress relieving techniques.

Anne Arundel Medical Center in Annapolis,  Maryland, created a ball pit room in the hospital where employees can literally throw themselves in a ball pit and relieve stress. This small but yet effective support can vastly improve employee morale. This book describes hiring and exit interview strategies when hiring nurses and watching them leave their employment. The in-depth interview process of new nurses, as well as nurses who are leaving their employment, allows management to study the process from finish to end. Utilizing this book in a hospital or healthcare office setting allows management to engage in the process of monitoring patient and employee satisfaction.

Nurses Workforce Turnover

Turnover regularly leads to a shortage of nursing staff that adversely affects patient satisfaction and outcomes. Kelly, Runge, & Spencer (2012), found that patients who were attended to by nurses who found their work meaningful experienced higher levels of satisfaction with the Care they received than those who had nurses who expressed concern about quitting their job. Hall (2005) also conducted research that found that higher rates of employee turnover were directly linked to higher patient mortality. Hospitals with sufficient staff record minimal adverse patient outcomes such as urinary tract infections, pneumonia, falls, post-operative complications, medication errors, and death. In fact, patient infections are argued to increase by roughly 30% with each loss of a nurse (Hall, 2005).

High employee turnover results in low employee morale in hospitals. This stems

from the fact that overworked staff typically are given increased responsibilities and

workloads following the loss of a key figure in a trained or active workforce (Clark, 2007). New staff members are not immune. They similarly suffer from reduced morale as they fight to learn new job procedures and duties. If such a work environment continues, it may lead to the hospital’s experiencing serious challenges in attracting and retaining

high-quality talent (Parker, Giles, & Lantry et al., 2014). In turn, this negatively affects the hospital’s daily operations.

Conclusion

Dedicated resources and targeted activities can make a difference in outcomes for both nurses and patients. Keys to success included engaging staff, having high expectations coupled with high support, providing data to unit-level staff to measure improvements emphasizing renewed accountability and maintaining the focus on quality patient care. A great deal of information has been written regarding compassion fatigue and burnout. These concepts are directly related to engagement with an organization and the profession. There is no question that nurses are bombarded with distressing and complex physical and emotional challenges every day, in addition to dealing with personal issues they may face in their own lives.

When the goal is to provide the highest level of quality patient care, the professional development of staff and managers is important to meet performance expectations and achieve the target clinical goals. Improving registered nurse retention and vacancy rates while also improving patients’ outcomes had significant human resource and financial benefits for the organization and contributed to achieving Magnet Recognition.

Just as we must acknowledge that patients suffer and then respond accordingly, we must acknowledge that the work caregivers do is complex, important, and both physically and emotionally challenging. In addition, leaders and colleagues must recognize these efforts in tangible and intangible ways that demonstrate appreciation for the caregiver. This need not always be in monetary or tangible rewards. In fact, the images were not focused on compensation in any shape or form. Indeed, simply acknowledging efforts and praising good outcomes and behaviour in a genuine and unscripted way is meaningful.

References

Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., & Silber, J. H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. Jama288(16), 1987-1993.

Berry, L., & Curry, P. (2013). Nursing workload and patient Care: Understanding the value of nurses, the effects of excessive workload, and how nurse-patient ratios and dynamic staffing models can help. Canadian Federation of Nurses Unions.

Brunges, M., & Foley‐Brinza, C. (2014). Projects for increasing job satisfaction and creating a healthy work environment. AORN journal100(6), 670-681.

Cicolini, G., Comparcini, D., & Simonetti, V. (2014). Workplace empowerment and nurses’ job satisfaction: a systematic literature review. Journal of Nursing Management22(7), 855-871.

Clark, T. N. (2007). The relationship between job satisfaction and turnover in large insurance companies: A survey analysis. Capella University..

Cortese, C. G., Colombo, L., & Ghislieri, C. (2010). Determinants of nurses’ job satisfaction: the role of work–family conflict, job demand, emotional charge and social support. Journal of nursing management18(1), 35-43.

Gordon, S., Buchanan, J., & Bretherton, T. (2008). Safety in numbers: Nurse-to-patient ratios and the future of health care. Cornell University Press.

Hall, L. M. (2005). Quality work environments for nurse and patient safety. Jones & Bartlett Learning..

Hassmiller, S. B., & Cozine, M. (2006). Addressing the nurse shortage to improve the quality of patient care. Health Affairs25(1), 268-274.

Hassmiller, S. B., & Cozine, M. (2006). Addressing the nurse shortage to improve the quality of patient care. Health Affairs25(1), 268-274.

Kelly, L., Runge, J., & Spencer, C. (2015). Predictors of compassion fatigue and compassion satisfaction in acute care nurses. Journal of Nursing Scholarship47(6), 522-528.

McHugh, M. D., Carthon, M. B., Sloane, D. M., Wu, E., Kelly, L., & Aiken, L. H. (2012). Impact of nurse staffing mandates on safety‐net hospitals: Lessons from California. The Milbank Quarterly90(1), 160-186.

Meraviglia, M., Grobe, S. J., Tabone, S., Wainwright, M., Shelton, S., Yu, L., & Jordan, C. (2008). Nurse-friendly hospital project: enhancing nurse retention and quality of Care. Journal of nursing care quality23(4), 305-313.

Pappas, S. H. (2008). The cost of nurse-sensitive adverse events. Journal of Nursing Administration38(5), 230-236.

Parker, V., Giles, M., Lantry, G., & McMillan, M. (2014). New graduate nurses’ experiences in their first year of practice. Nurse Education Today34(1), 150-156.

Ross-Walker, C., Rogers-Clark, C., & Pearce, S. (2012). A systematic review of Registered Nurses; experiences of the influence of workplace culture and climatic factors on nursing workloads. JBI Database of Systematic Reviews and Implementation Reports10(49), 3080-3145.

Scherman, J. (2018). Nursing Shortage in America: What You’ll Need to Know in 2019. Nursinghttps://www.rasmussen.edu/degrees/nursing/blog/nursing-shortage/

Schroyer, C. C., Zellers, R., & Abraham, S. (2016). Increasing registered nurse retention using mentors in critical care services. The health care manager35(3), 251-265.

Thieman, L. (2013). Nurse Retention : Wellness Programs Growing Steadily. Available at https://www.youtube.com/watch?v=hBRhoBiEa-Q

Twigg, D., & McCullough, K. (2014). Nurse retention: A review of strategies to create and enhance positive practice environments in clinical settings. International journal of nursing studies51(1), 85-92.

West, S., & Sherer, M. (2009). ISO: The “right” nurse staffing model. Oncology Issues24(6), 26-30.

Wright, P. D., & Mahar, S. (2013). Centralized nurse scheduling to simultaneously improve schedule cost and nurse satisfaction. Omega41(6), 1042-1052.

Zelvis, K., Duran C., & Swenson, K. (2015). Consequences of Hospital Nurse Staffing . Available at https://www.ropclip.com/GPx2XN_7atw/consequences-of-hospital-nurse-staffing.html

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Question 


HE490 Healthcare Capstone Research Studies

Assignment 05

HE490 Healthcare Capstone: Research Studies

Directions: Be sure to save an electronic copy of your answer before submitting it to Ashworth College for grading. Unless otherwise stated, answer in complete sentences, and be sure to use correct English, spelling, and grammar. Sources must be cited in APA format. Your response should be double‐spaced; refer to the “Format Requirementsʺ page for specific format requirements.

HE490 Healthcare Capstone - Research Studies

HE490 Healthcare Capstone – Research Studies

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Submit the First Draft of your research paper. At a minimum it should include:

  1. Title Page
  2. Introduction
  3. Review of Relevant Literature (minimum five)
  4. Body
  5. Conclusion
  6. Unannotated Bibliography

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