Posted: January 21st, 2023

The Application of Data to Problem-Solving Discussion

The Application of Data to Problem-Solving Discussion

I am going to choose a topic for this discussion that hits home for me. I currently work on an inpatient psychiatric ward in a hospital. Our unit can fit 30 patients. As per our nursing union contract, we are to have 4 Registered Nurses (RN) per shift. Very rarely does our census fall below 25, therefore there is no reason to justify having less nurses. We are currently having a staffing crisis on my unit for night shifts. We never have 4 RNs. We consistently have 3 RN, which puts the ration to 10 patients to 1 RN, which is a dangerous ratio. Most recently, we have experienced unacceptable staffing. Three times this month we were left with 2 RNs due to sick calls. Day shift nurses did not offer to stay and help out. On these nights are ratio was 15 patients to 1 RN. This is unacceptable and dangerous for staff and for the patients themselves. According to the Journal of Nursing Management, the number of nurses has been shown to have a significant effect on patient‐safety outcomes, but the structure of the nursing staff has received little attention. There are safeguards in place to help protect us nurses The Application of Data to Problem-Solving Discussion. Our union has a form that allows us to fill out if our staffing is not sufficient, which is called a Protest of Assignment. According to Sullivan, in the state of California, the RN is not responsible for something if the ratios are too high.

So the data that can be used by management is how patient outcomes are affected by poor staffing ratios. Also the higher risk of mistakes made by RN’s when their workload is too heavy. If management were to do this research, maybe they would have a better understanding of how important better ratios are. In another study it is actually shown that RN staffing ratios have a relationship to patient mortality (Sasichay-Akkadechanunt, Scalzi & Jawad, 2003). It is clear that nursing management should use this data to ensure their units are sufficiently staffed The Application of Data to Problem-Solving Discussion.

Sasichay-Akkadechanunt T, Scalzi CC, & Jawad AF. (2003). The relationship between nurse staffing and patient outcomes. JONA: The Journal of Nursing Administration, 33(9), 478–485. https://doi-org.ezp.waldenulibrary.org/10.1097/00005110-200309000-00008

Sullivan GH. (2004). Advice of counsel. When staffing ratios aren’t met, is the nurse responsible? RN, 67(11), 64–51.

Wang, L., Lu, H., Dong, X., Huang, X., Li, B., Wan, Q., & Shang, S. (2020). The effect of nurse staffing on patient‐safety outcomes: A cross‐sectional survey. Journal of Nursing Management (John Wiley & Sons, Inc.), 28(7), 1758–1766. https://doi-org.ezp.waldenulibrary.org/10.1111/jonm.13138

response

The topic of staffing and the lack thereof has hit home to me, and I feel very passionate about how unsafe it is for patients and nurses when working in unsafe patient-to-nurse ratios. Currently, there is a campaign through the National Nurses United for safe RN-to-patient staffing ratios. Currently, some of those proposed staffing ratios are ICU 1:2, PACU 1:2. L&D 1:2, pediatrics 1:3, ER 1:3, telemetry 1:3, med/surg 1:4, and psychiatric 1:4 (National Nurses United, n.d.) These ratios seem fair, reasonable, and safe, yet, I have not seen them in my current hospital. Our ICU is currently 1:2-3 patients, ER anywhere from 4-10 (ranging from inpatient holds, ICU, and ER patients), and most recently from this weekend; our tele floor was 1:7. It has been studied and proven through multiple research the dangers of unsafe patient-to-nurse ratios. There are several consequences to unsafe workloads: adverse patient safety, high nursing turnover, and nursing shortage, and nursing is expected to do nonprofessional tasks such as delivering meal trays, housekeeping, transporting, and coordinating ancillary cares (Hughes et al., 2008) The Application of Data to Problem-Solving Discussion. 

 At what point will administrations look at this like the national crisis it is and start staffing hospitals adequately? How many patients have to be harmed or, worse, die before action is taken? And why must it come to that? Nurses risk their license to take care of an unmanageable number of patients for administration to receive yearly bonuses and no risk to any license they may hold. Healthcare has turned into a business and has strayed away from patient-centered care. I hope in my healthcare time, I see a shift in direction, and we go back to the model of true patient-centered care.

National Campaign for Safe RN-to-Patient Staffing Ratios. National Nurses United. (n.d.). https://www.nationalnursesunited.org/ratios.

Hughes, R., Gurses, & Pascale, C. (2008). In Patient Safety and Quality: An Evidence-Based Handbook for Nurses. essay, Agency for Healthcare Research and Quality. Chapter 30. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK2657/

sample response 2

Staffing is essentially a concern in all health care facilities worldwide. When legislatures determine the patient-to-nurse ratio, they do not consider the acuity of the patients. The hospital where I work has telemetry and med surg combined. Being able to monitor the tele units while taking care of the other 6 or 7 patients is unsafe. ICU is also responsible for overlooking the tele units, however often times the alarms are ignored because “that person is probably getting up to the BR again” or “I am tired of listening to room 112’s alarm” The Application of Data to Problem-Solving Discussion.

It is extremely difficult to staff facilities with the nursing shortage, but changes need to be made. Nurse-to-patient ratios have become one of the most controversial topics in health care (Tung, L., 2019) and understandably so. Patients are not receiving quality care which affects satisfaction surveys and results in poor publicity and a decrease in reimbursement from insurance companies due to rehospitalizations.

“Studies show that when RNs are forced to care for too many patients at one time, patients are at higher risk of preventable medical errors, avoidable complications, falls and injuries, pressure sores, increased length of stay, and readmissions.1 In addition, RNs experience higher burnout rates, and job dissatisfaction”(Aiken, L., et al.).

Relying heavily on informatics with evidence-based staffing, patients would receive high-quality care efficiently and safely while minimizing negative incidences and mortality within the healthcare system (Hyun, S., et al., 2008). Many studies are provided that the outcomes are much improved with a higher level of RN staffing The Application of Data to Problem-Solving Discussion.

Resources

Aiken, L., et al. “Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction.” Journal of the American Medical Association. 2002; 288(16): 1987-93, 1990. (43 percent of RNs surveyed had high burnout scores, and a similar proportion were dissatisfied with their current job. Both burnout and job dissatisfaction are indicators of turnover.)

Hyun, S., Bakken, S., Douglas, K., & Stone, P. W. (2008). Evidence-based staffing: potential roles for informatics. Nursing economic$. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4440797/.

Submitted by ADonahue on May 10. (2021, May 12). National Campaign for Safe RN-to-Patient Staffing Ratios. National Nurses United. https://www.nationalnursesunited.org/ratios.

Tung, L. (2019, November 29). Why mandated nurse-to-patient ratios have become one of the most controversial ideas in health care. WITF. https://www.witf.org/2019/11/29/why-mandated-nurse-to-patient-ratios-have-become-one-of-the-most-controversial-ideas-in-health-care/ The Application of Data to Problem-Solving Discussion.

Discussion: The Application of Data to Problem-Solving

In the modern era, there are few professions that do not to some extent rely on data. Stockbrokers rely on market data to advise clients on financial matters. Meteorologists rely on weather data to forecast weather conditions, while realtors rely on data to advise on the purchase and sale of property. In these and other cases, data not only helps solve problems, but adds to the practitioner’s and the discipline’s body of knowledge.

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When preparing to begin a new class of student nurses, the process is always one of much preparation and collaboration. Processing the application, scheduling the entrance exam, and reviewing all necessary data. The only thing missing is the standards by which students should be admitted. Although criteria are suggested by the exam developer, the same criteria are not considered when choosing the next class. What would the retention and board pass rate look like if there was data to show statistics of the entrance exam scores, test scores and student pass/fail ratio? Would board pass rates improve if students were accepted based on the recommended criteria of the exam developer? Would students be successful and able to complete their education if the entrance process were followed correctly and based on entrance exam scores? Could disappointments of failure be eliminated by not accepting students that are not prepared for the demanding requirements of the nursing profession?

These are all questions that could be answered by utilizing data from previous classes enrolled at the nursing education facility where I work. Considering the initial application, essay, healthcare experience, and entrance exam prior to admission would assist with poor retention and failed board rates. If students are not prepared, dedicated, and compassionate about the journey of nursing, maybe another career choice would benefit them. Critical thinking and communication are both important aspects of nursing, potential students will be tested on this criterion as well as comprehension and some core subjects related to healthcare (Nursing entrance exam). It is imperative that you excel in more than one subject matter to score well on the exam. If unable to reach the recommended score, entrance should not occur and remediation on the given material should be a requirement before reapplication to the program. Reading, writing, math, science, and critical thinking are basic testing subjects and should be reviewed prior to the exam. This shows dedication and initiative and will assist with a successful score. Collecting data on those students that have prepared for the entrance exam would be an asset as well to the program and future students The Application of Data to Problem-Solving Discussion.

Nursing informatics would benefit the nursing education program by providing information on the success of potential students to the success of graduating nurses. This information would carry through the potential employers with information of progression and excelling in their education. The decision support system (DSS) and/or the executive support system could be implemented to input admission criteria while the informatic system would analyze the information and provide staff with the best candidate for admission (McGonigle & Mastrian, 2017).

By utilizing the data that is collected through the admission process, the program would be able to mitigate the stress of selecting future students and improve the student body as well as the education facility. The process would be more effective, accurate and improve the admission process (Laureate Education, 2018). The admission process would be strictly based on testing scores and unbiased.

Resources

Laureate Education (Producer). (2018). What is Informatics? [Video file]. Baltimore, MD: Author.

McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning

Nursing Entrance Exams–Which One is Right for You. All Nursing Schools. (2021, March 22). https://www.allnursingschools.com/how-to-get-into-nursing-school/entrance-exams/.

response

I thought your topic that you chose was very unique. I presume that you work as a nurse educator or on the staff in a nursing school? I live in the tri-state area (New Jersey, New York, Pennsylvania) and I can tell you that it is extremely competitive here to get into a nursing program. I had to wait 2 years to get into mine. Some schools are extremely selective and some have really long waitlists. My friend is trying very hard to get into a nursing program, has mostly all A’s in the prerequisites, but got one C, and was not accepted into the nursing program because of that one grade. It is discouraging to many students. I agree with you that data can definitely help the decision makers when it comes to admission, but I believe that there should be more that is taken into consideration when deciding a students fate.  Previous studies suggest that Grade Point Average (GPA) from previous academic studies (in schools or at tertiary level) provides a good predictive power for achievements in undergraduate health profession programs (Shulruf, Wang, Zhao & Baker, 2011). I believe that total GPA is a great indicator for future outcomes, although it should not be only factor. A nursing school in Indiana made a revision to their admission process to add more factors to their decision making process, like an interview, a writing sample and a service requirement (McNeilis, Wellman, Hrisomalos, McElveen & South, 2010). I believe that adding more criteria will only help students’ chances to gain admission to nursing programs and help bridge the gap in the nursing shortage we are experiencing in the United States The Application of Data to Problem-Solving Discussion.

References

McNelis AM, Wellman DS, Krothe JS, Hrisomalos DD, McElveen JL, & South RJ. (2010). Revision and evaluation of the Indiana University School of Nursing baccalaureate admission process. Journal of Professional Nursing, 26(3), 188–195. https://doi-org.ezp.waldenulibrary.org/10.1016/j.profnurs.2010.01.003

Shulruf, B., Wang, Y. G., Zhao, Y. J., & Baker, H. (2011). Rethinking the admission criteria to nursing school. Nurse Education Today, 31(8), 727–732. https://doi-org.ezp.waldenulibrary.org/10.1016/j.nedt.2010.11.024 The Application of Data to Problem-Solving Discussion