The Leadership Learning Experience

Running Head: THE LEADERSHIP LEARNING EXPERIENCE

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THE LEADERSHIP LEARNING EXPERIENCE 1

NURSE: PATIENTS RATIO

Provision of efficient healthcare to the patients is the most basic primary role of the

nurses. For this to be efficiently delivered upon, nurses: patients’ ratio should be smaller as this

would result in a situation in which a single nurse has a few patients to manage thereby creating

more time a nurse has to see a single patient and take care of all the needs of the patient

(McKinlay, Garrett, McBain, Dowell, Collings & Stanley, 2010).

Explanation of nurse: patients ratio and its timely relevance

With inadequate nursing personnel, healthcare delivery is compromised and would lead

to increased cases of inpatient mortality among other cases such as nosocomial infections that

would jeopardize the health of the patients while in the wards. Ideally, appropriate nurse staffing

is essential as it enhances patients’ satisfaction, it also reduces errors associated with hasty

medications, and it improves safety outcomes by minimizing cases of falls, pressure-associated

ulcers, as well as health-associated infections (McKinlay et al., 2011). Besides it leads to

prevention of nurse fatigue and reduced readmission cost logistics as patients will revisit the

hospital with the same cases if they are not well-managed.

St. Georgina General Hospital that am currently posted as the head of the nurses in

surgery department is faced with overwhelmed nursing staff owing to the increasing ratio of

patients to nurses. At the hospital, this problem has been demonstrated by poor patient outcomes,

reduced nurse motivation among other complications. The topic of policy in nurses staffing is

therefore important to curb these cases and reduce the associated complications at St. Georgina

Hospital. This topic is therefore applicable to the healthcare environment as its adoption would

result in low mortality rates and thus improve the healthcare system at the hospital. A report by

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Altundal (2017) proposed that the best nurse to patient ratio has its computation from the

formula;

Nurses/Patients= Productive Nursing hours/ (patient Days x 24)

The recommended nurses to patient’s ratio vary depending on the concerned department. For

instance, in the emergency room, one registered nurse (RN) must be available for every four

patients in addition to licensed practical nurses, vocational nurses and nurse aids or nurses who

are not registered.

INVESTIGATION OF THE POLICY ISSUE

The primary source of evidence for the deficiency in nurse staffing was a report from an

independent study conducted following five claims by patients in the feedback boxes. The report

also strengthened its findings with the national government’s requirement that the nurse to

patient ratio is narrowed as much as possible a provision that t St. Georgina Hospital yet to

comply with.

Evidence of the problem

The claims were investigated through the administration of questionnaires to random

inpatients and randomly selected nurses within casual wards. On the inquiry, the questionnaires

were both open and close-ended. From the results, 85% of the patients indicated that they were

not contented with the amount of time a nurse spent with them. The nurses stated that they

believed that they were not always at their best when attending to the patients due to fatigue, as

evidenced by the current cases in the nurses’ attendance register in which some nurses had on

occasions left earlier than the stipulated time or intentionally absconded duties.

ANALYSIS OF THE STATE OF THE SITUATION USING CURRENT DATA

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The current data of St. Georgina General Hospital indicates that RNs: Patients’ ratio is

1:25. Every registered nurse is assisted by two other nurses who are either vocational nurses or

licensed practical nurses. For all the eight departments within the hospital, staffing is not done

based on the nature of concerned department regarding demand for more personnel. The

emergency department which is designed to hold up to 9 patients has 1 RN. Even though

mortality cases have recently been on the rise, some less emergency wards had not recorded an

alarming increase in mortality rate. The average mortality rates per wards were two patients per

day.

Areas contributing to the increased Nurse: patients ratio

From the investigation, a post-analysis report was drafted outlining the major causes of

the increased nurse to patients’ ratio. The major causes emanated from the recent closure of a

neighboring hospital, Albertson Medical Centre after it was established it did not comply with

the right procedure during its registration. This, therefore, led to increased number of inpatients

that overwhelmed the current nurses. Other reasons were reduced number of nurses’ employment

over the recent years, stagnating remuneration of nurses resulting in a scenario in which some

nurses opt for private practice. Numerous cases of readmission following poor services in the

previous visit, lack of nurses’ motivation such as team building practices, and low number of

qualified physicians were also identified as the major factors contributing to increased nurses to

patient’ ratio.

PROPOSAL OF A SOLUTION FOR INCREASED NURSE: PATIENTS RATIO

The hospital will have to devise criteria to employ more nurses and employ more doctors

to increase patients’ satisfaction to curb the nurse: patients’ ratio. This is justified based on the

figures from the data gathered in this report with the nurse: patient’s ratio at 1:25 which was very

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high and hovering for its reduction. This is also possible necessary as directly reflected by the

high mortality data gathered from the records register at St. Georgina Hospital.

Justification of the proposed solution

The implementation of the solution would entail visiting the hospital’s management offices

so the gathered information could be shared and implore the administration to adopt the solution.

Government health offices, the department of health at the county level would also be visited to

smoothen the process of acquisition of the new nurses. According to Canada (2011) which

considered the major pillars to effective healthcare delivery, the implementation of the report

would also put the hospital high in the ranks among its equals for its effective and efficient

service delivery which will in turn minimize negative feedback. With the changing number of

patients in the wards following new admissions and discharge, the average inpatients per ward is

at 20 patients. The hospital, therefore, need to employ two more nurses per ward resulting into 4

per department and thus 32 nurses (16 RNs and 16 licensed nurses) for the entire health facility.

IMPLEMENTATION RESOURCES

Tools to design and gather the data would include questionnaires and writing pads,

communication and transport logistics as well as typing and printing incurrences. For

implementation of this solution, among the resources to be availed are financial allocations to

pay the new nurses and funds to facilitate construction of more rooms which will serve as the

nurses’ offices. Once implemented, the hospital will reduce its resources such as the drugs,

spaces and foods that are currently spent to facilitate the increasing cases of readmission

following earlier poor healthcare management.

Cost Benefit Analysis

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Considering that an average RN earns a net income of approximately $12,650 per year,

for the 16 RNs, this would be a total of $202,400 per year. The licensed nurses earn a total of

$10,800 which adds up to $172,800 per annum. This would, therefore, necessitate the need for

more offices. To have four RNs share a room, the entire 32 nurses would require four offices.

This construction would cost a total of $150, 000. The total amount required to finance the

project for the first year is therefore $525,200 and a yearly funding of 375,200 as salary of the

nurses. The strength of any hospital is defined by its reputation in terms of services offered and

personal interaction with the staff (MacPhee & Bouthillette, 2008). This plays a key role in

attracting partners and government funding. The hospital is therefore bound to gain more

because the benefits the project will bring are more than the cost of its acquisition.

TIMELINE FOR IMPLEMENTATION OF THE PROPOSAL

Considering that the funding would be from partners and from the government financial

pool for projects, the project will require a minimum of six months to implement. With available

funding, advertisement would be conducted within two weeks after which interviews would be

called for to admit the 32 nurses required. This would happen concurrently as additional offices

are constructed. At the end of the two months, the solution shall have been implemented.

KEY STAKEHOLDERS THAT ARE IMPORTANT FOR THE IMPLEMENTATION OF

THE RESOLUTION.

The main stakeholders are the government, financial institutions, and partners. The

Hospital management, the other staff members and the patients are also key stakeholders. The

hospital administration is a key partner for it is the custodian of the administrative authority of

the hospital.

Engagement with Key Stakeholders and its Success

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In a meeting with the hospital administration, some of the issues to be discussed are

necessity for more nurses and according a space for the construction of the offices. Their input to

the report such as the need to start with a smaller number of nurses and spread employment of

the remaining nurses over a certain duration would be incorporated. Hospital’s permission

would offer an authority to go ahead and make calls for vacancies and contractors. The meeting

with the county government would be essential in availing funds through the Ministry of health.

A meeting with the government would result into a request from the government to have

the project implemented in the next financial year owing to the current financial crisis. With the

government’s full commitment to avail funds in the next financial year, the report solution would

resort to the available sources of funds as it awaits government funding. This would be the same

with state government during a meeting with the relevant health department staff. The other staff

members would be incorporated to seek for their opinion and cooperation in the plan. During the

meeting with the other hospital staff, a request to have a similar project rolled out for the

consultants would be considered in the next research while assessing the situation at the hospital

including constraints due to the shortage of the consultants. The other stakeholders are the

patients who are the major beneficiaries when the policy is fully implemented. Their positive

feedback would improve the ranking of the hospital.

The first of the stakeholders who would be the first to be consulted was the hospital

management whose positive feedback would commence the policy plan implementation. Then

the Ministry of Health would be contacted on the second week; if they adopt the plan, would

approve it and fund it. After this the patients briefing of the plan and agreement with it, the plan

would be implemented. The other staff members upon seeing the plan will agree with it and their

recommendations implemented in the project upon its execution

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DISCUSSION OF HOW THE SOLUTION WILL BE IMPLEMENTED

First stage would be authorization by the hospital management for a space to construct

the offices and permission to contact the other stakeholders. This would take up to 10 days

following booking of appointments with relevant staff. The current nurses would take part in

orientation of the new nurses assigned to the specific wards. This communication will be made

during the departmental staff meeting and telephone calls made to the head nurses at each

department to effect the same. This will take place during the first week following recruitment of

the new nurses. Communication with the patients would be done through brief and concise

posters outlining the new development. This will be mounted throughout the entire process

which would take approximately six months. The first step in implementation would be to

acquire funds from the government allocation for projects. This would be used to commence

lobbying for funds until adequate fund is available to facilitate construction of the offices. This

stage in acquisition of funds from the both county and state government would consume a total

of two weeks. The partners would then be engaged to provide funds to facilitate monthly

remuneration of the nurses as the project stabilizes to be able to raise more funds to reward the

nurses in the long-term objectives. Upon release of the funds, construction and recruitment

process would start and run for 5 months.

Evaluation

Upon its execution, there would be a research to assess the progress that the

implementation of the report shall have made. Periodical evaluation will be conducted with a

frequency of one evaluation per month. The table below will be filled during the evaluations to

assess whether implementation has bore positive effects or not.

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<2 patients/day

>2-<5

patients/day

>5 patients/day

Mortality rates

Cases of readmission with the

same complication or worse

Negative feedback from the

feedback box

Referral cases due nosocomial

infections

Reports from increased hospital

stay owing to poor services

The table would be filled and the result sampled. Efficiency of the report would be indicated

when the first column is selected. Poor results would be when third column is selected for each

parameter.

Fulfillment of the roles during process of proposal development:

Scientist

The issue of poor nurse staffing was essential to St. Georgina Hospital as the lives of the

patients depends on the presence of nurses and the healthcare quality accorded to them.

Deficiency in nurses to patients’ ratio was of interest to our community as cases of increased

mortality were on the rise. In the surgery unit where I am currently posted, the cases of deaths

arising from inappropriate pre-operative and post-operative management is a menace that should

be resolved. The topic is of particular interest to me as it would enable me develop my leadership

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skills and specifically problem-solving skills. This is manifested in this case as two other nurses

who assisted in administrating and collecting the questionnaires, a staff from the registry and

records department who assisted with data relating to admissions and mortality rates as well as

readmission cases were part of the research team.

Detective

During the investigation, my role as a detective was manifested when my team and I took

it upon ourselves to investigate further into the complaints of the patients citing poor healthcare

services. It was also manifested when we developed an urge to change the increasing nurse to

patients at the hospital which would serve as a solution to the problem. This was unique as the

other departments had not considered investigating the causes of the negative feedback from

patients. Ability to suggest the best possible ways to rectify the situation is another manifestation

of the role of a detective. All these are manifested in the report as nurses took part in

administration of the questionnaires and observations which consumed eight (8) weeks while

four (4) weeks were consumed to prepare the report. Nurses identified a problem and suggested

solutions to revert the situation.

Manager of the healing environment

At the hospital death from causes that are otherwise manageable or preventable is a

nightmare that nurses live with. Ability to create an environment with decreased mortality rates

and improved efficiency ranking in terms of quality service is some dream nurse leaders aim at

achieving. In this study, once implemented, deaths from manageable causes shall have been

tremendously reduced. This manifests the role of a nurse as a manager of the healing

environment. The issue of increased nurse: patients’ ratio is also of interest as it directly impacts

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on the lives of the members of the society as the basic source of information was the feedback

from the patients. Its solution would therefore be of significance to the society.

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References

Altundal, H. (2017). Roles and Responsibilities of Nurses Struggling with Substance

Abusers.doi:10.15405/epsbs.2017.09.23

The Emerging Face of Nursing Leadership in Canada. (2011). Nursing Leadership, 24(1), 3-3.

doi:10.12927/cjnl.2011.22340

MacPhee, M., & Bouthillette, F. (2008). Developing Leadership in Nurse Managers:

TheBritishColumbia Nursing Leadership Institute. Nursing Leadership, 21(3), 64-

75.doi:10.12927/cjnl.2008.20061

McKinlay, E., Garrett, S., McBain, L., Dowell, T., Collings, S., & Stanley, J. (2011).

NewZealand general practice nurses' roles in mental health care. International Nursing

Review, 58(2), 225-233. doi:10.1111/j.1466-7657.2010.00859.x

Smith, K. M., & Crookes, P. A. (2012). The Study of Nursing Care project: back to the future for

contemporary nursing research? Journal of Advanced Nursing, 68(11), 2586-2593.

doi:10.1111/j.1365-2648.2012.05980.x

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