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Case Study, Chapter 10, Mandatory Minimum Staffing Ratios (DQ6)

June 3, 2023/in Uncategorized /by SK

Case Study, Chapter 10, Mandatory Minimum Staffing Ratios

A nurse manager is attending a national convention and is attending a concurrent session on staffing ratios. Minimum staffing ratios are being discussed in the nurse manager’s own state. The nurse manager has a number of questions about staffing ratios that the session is covering. The nurse manager knows that evidence exists that increasing the number of RNs in the staffing mix leads to safer workplaces for nurses and higher quality of care for patients.

1. What are the three general approaches recommended by the American Nurses Association (2017) to maintain sufficient staffing?

2. Summarize the findings that are often cited as the seminal work in support of establishing minimum staffing ratio legislation at the federal or state level.

3. Analyze what proponents and critics say about whether mandatory minimum staffing ratios are needed.

Chapter 10 Mandatory Minimum Staffing Ratios

RN Skill Mix

Economics as the driving concern for changes

Trend: reduction in RNs in staffing mix; replacement with less expensive personnel

Research: number of RNs in staffing mix directly affecting quality of care and patient outcomes

National movement to mandate minimum staffing ratios

As of 2017, 14 states addressed nurse staffing in hospitals in law/regulations

California is the only state that stipulates in law; regulations for required minimum nurse-to-patient ratios to be maintained at all times by unit

Staffing Ratios and Patient Outcomes

Research findings (see Table 10.1)

Questions about cost-effectiveness of statewide mandatory nurse staffing ratios

Greater RN skill mix and fewer cases of sepsis and failure to rescue

Benchmark research

Needleman et al. (2002)

Aiken et al. (2002)

Direct link between nurse-to-patient ratios and mortality from preventable complications

Mandatory Minimum Staffing Ratios: Needed? #1

ANA with concern related to effect of poor staffing on nurses’ health and safety and patient outcomes

Proponents

Absolutely essential for patient safety and outcomes

Use of standardized ratios for consistent approach

Critics

Exponentially increased cost with no guarantee of quality improvement or positive outcomes

AONE agrees and does not support mandated nurse staffing ratios

Question #1

Is the following statement true or false?

Few states have enacted staffing laws.

Answer to Question #1

False

As of 2017, 14 states addressed nurse staffing in hospitals in law/regulations.

Mandatory Minimum Staffing Ratios: Needed? #2

Evidence of benefits mixed, contradictory

No accounting for education, experience, and skill level

Risk of actual decline in staffing—used as a ceiling or absolute criteria without accounting for patient acuity or RN skill level

Cost as the major deterrent—not financially attractive to hospitals

Mandate for specific staffing ratios and current shortage leading to reduction in hospital services, increased emergency room diversions, increased unit closures, increased expenses

Mandatory Minimum Staffing Ratios: Needed? #3

Ohio Hospital Association: benefit of staffing ratios is mixed and sometimes contradictory

Corbridge (2017): argues that mandating inflexible nurse staffing ratios or stringent meal and rest break requirements do not improve patient care or outcomes

Silber et al (2016): better-staffed facilities had a formula for excellent value as well as better patient outcomes (see Box 10.2)

California Prototype #1

First state to implement mandatory minimum staffing ratios

Maximum number of patients an RN could be assigned to care for under any circumstances (see Table 10.2)

Issues in determining appropriate ratios

Lack of data about nurse staffing distribution

Patient classification system (PCS) data problematic

Unknown cost

California Prototype #2

Recommendation: 1 nurse to every 6 patients in med/surg units

Delays in implementation

Problems with interpreting the meaning and intent of language related to “licensed nurses”

Issues related to cutting nonlicensed staff

Questions if adequate number of RNs available to meet ratios

Emergency regulation in 2004; overturned in 2005

Hospitals and nursing unions’ responses

California Prototype #3

Struggle to implement

Mandate effective 1/1/2004

Larger hospitals versus smaller hospitals to meet mandate

Need for legal clarification for “at all times” (i.e., breaks, lunches)

Question #2

Is the following statement true or false?

California implemented mandatory minimum staffing ratios fairly quickly.

Answer to Question #2

False

There were significant delays in implementing the California mandatory minimum staffing ratios.

California Prototype #4

Improvement in RN staffing and patient outcomes?

Reduction in number of patients per licensed nurse

Increase in number of worked nursing hours per patient day in hospitals

No significant impact on measures of nursing quality and patient safety indicators

No increase in adverse outcomes despite increasing patient acuity

Lower risk-adjusted mortality (Aiken, 2010)

No improvement in quality of care (HC Pro, 2009)

Similar Initiatives: Other States

Minimum standards for licensed nursing in certified nursing homes but not in acute care hospitals

Several attempts, but none enacted

Adequate numbers requirement for Medicare-certified hospitals

Many states actively pursuing minimum staffing ratio legislation

Other Alternatives

Pursuit of alternatives to improve nurse staffing without legislated minimum staffing ratios

Lack of support for legislated minimum staffing ratios

The Joint Commission

ANA against fixed nurse–patient ratios; recommendation of three general approaches (see Box 10.3)

Question #3

Is the following statement true or false?

The ANA supports legislation for fixed nurse–patient ratios.

Answer to Question #3

False

The ANA does not support fixed nurse–patient ratios but advocates for a workload system that takes into account the many variables that exist to ensure safe staffing.

End of Presentation

Educational Program On Risk Management – Part One: Outline Of Topic

June 3, 2023/in Uncategorized /by SK

The purpose of this assignment is to create an educational program that supports the implementation of risk management strategies in a health care organization.

In this assignment, you will develop an outline for an “in‐service”‐style educational risk management program for employees of a particular health care organization that will then form the basis for a PowerPoint presentation in Topic 5. Select your topic for this educational session from one of the proposed recommendations or changes you suggested in the Risk Management Program Analysis – Part One assignment to enhance, improve, or secure compliance standards in your chosen risk management plan example.

Create a 500‐750-word comprehensive outline that communicates the following about your chosen topic:

Introduction: Identify the risk management topic you have chosen to address and why it is important within your health care sector.
Rationale: Illustrate how this risk management strategy is lacking within your selected organization’s current risk management plan and explain how its implementation will better meet local, state, and federal compliance standards.
Support: Provide data that indicate the need for this proposed risk management initiative and demonstrate how it falls under the organization’s legal responsibility to provide a safe health care facility and work environment.
Implementation: Describe the steps to implement the proposed strategy in your selected health care organization.
Challenges: Predict obstacles the health care organization may face in executing this risk management strategy and propose solutions to navigate or preempt these potentially difficult outcomes.
Evaluation: Outline your plan to evaluate the success of the proposed risk management program and how well it meets the organization’s short-term, long-term, and end goals.
Opportunities: Recommend additional risk management improvements in adjacent areas of influence that the organization could or should address moving forward.

You are required to incorporate all instructor feedback from this assignment into Educational Program on Risk Management Part Two ‐ Slide Presentation assignment in Topic 5. To save time later in the course, consider addressing any feedback soon after this assignment has been graded and returned to you. It may be helpful to preview the requirements for the Topic 5 assignment to ensure that your outline addresses all required elements for submission of the final presentation.

You are required to support your statements with a minimum of six citations from appropriate credible sources.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

Discuss three areas in which health problems or barriers to health were identified.

June 3, 2023/in Uncategorized /by SK

Family Health Assessment Part I

Understanding family structure and style is essential to patient and family care. Conducting a family interview and needs assessment gathers information to identify strengths, as well as potential barriers to health. This information ultimately helps develop family-centered strategies for support and guidance.

This family health assessment is a two-part assignment. The information you gather in this initial assignment will be utilized for the second assignment in Topic 3.

Develop an interview questionnaire to be used in a family-focused functional assessment. The questionnaire must include three open-ended, family-focused questions to assess functional health patterns for each of the following:

Values/Health Perception
Nutrition
Sleep/Rest
Elimination
Activity/Exercise
Cognitive
Sensory-Perception
Self-Perception
Role Relationship
Sexuality
Coping

Select a family, other than your own, and seek permission from the family to conduct an interview. Utilize the interview questions complied in your interview questionnaire to conduct a family-focused functional assessment. Document the responses as you conduct the interview.

Upon completion of the interview, write a 750-1,000-word paper. Analyze your assessment findings. Submit your questionnaire as an appendix with your assignment.

Include the following in your paper:

Describe the family structure. Include individuals and any relevant attributes defining the family composition, race/ethnicity, social class, spirituality, and environment.
Summarize the overall health behaviors of the family. Describe the current health of the family.
Based on your findings, describe at least two of the functional health pattern strengths noted in the findings. Discuss three areas in which health problems or barriers to health were identified.
Describe how family systems theory can be applied to solicit changes in family members that, in turn, initiate positive changes to the overall family functions over time.

Cite at least three peer-reviewed or scholarly sources to complete this assignment. Sources should be published within the last 5 years and appropriate for the assignment criteria.

Prepare this assignment according to the guidelines found in the APA Style Guide. An abstract is not required.

Reflection Discussion – COURSE: PATHOPHYSIOLOGY

June 3, 2023/in Uncategorized /by SK

Week 8 Reflection Discussion – COURSE: PATHOPHYSIOLOGY

Purpose

The purpose of this discussion is to reflect over the past 8 weeks and describe how the achievement of the course outcomes in this course have prepared you to meet the MSN program outcome #1, MSN Essential I, and Nurse Practitioner Core Competencies # 1 Scientific Foundation Competencies

Activity Learning Outcomes

Through this discussion, the student will demonstrate the ability to:

1. Provide evidence of meeting the achievement of course outcomes (CO 1, 2, 3, 4, 5)

2. Provide evidence of meeting MSN program outcome 1 (CO 1, 2, 3, 4, 5)

3. Provide evidence of meeting Nurse Practitioner Core Competency 1 (CO 1, 2, 3, 4, 5)

Total Points Possible: 50

Requirements:

Reflect over the past 8 weeks and describe how the achievement of the course outcomes in this course – PATHOPHYSIOLOGY, have prepared you to meet the MSN program outcome #1, MSN Essential I, and Nurse Practitioner Core Competencies # 1 Scientific Foundation Competencies Program Outcome #1: Provide high quality, safe, patient-centered care grounded in holistic health principles. (holistic health & patient-centered care)

MSN Essential I: Background for Practice from Sciences and Humanities:

Recognizes that the master’s prepared nurse integrates scientific findings from nursing, biopsychosocial fields, genetics, public health, quality improvement, and organizational sciences for the continual improvement of nursing care across diverse settings.

Nurse Practitioner Core Competencies # 1 Scientific Foundation Competencies

1. Critically analyzes data and evidence for improving advanced nursing practice.

2. Integrates knowledge from the humanities and sciences within the context of nursing science.

3. Translates research and other forms of knowledge to improve practice processes and outcomes.

4. Develops new practice approaches based on the integration of research, theory, and practice knowledge.

DISCUSSION CONTENT
Category	Points	%	Description
Program Outcome Achievement	15	15%	1. The reflection specifically identifies and addresses the pre-determined program outcome; AND 2. Provides two (2) or more examples of how the student specifically achieved or had exposure to this outcome during this course.
MSN Essential Competency Achievement	15	15%	1. The reflection specifically identifies and addresses the pre-determined MSN Essential Competency; AND 2. Provides two (2) or more examples of how the student specifically achieved or had exposure to this competency during the course.
NP Competency Achievement	15	15%	1. The reflection specifically identifies and addresses the pre-determined NP core Competency; AND 2. Provides two (2) or more examples of how the student specifically achieved or had exposure to this competency during this course.
	45	90%	Total CONTENT Points= 45 pts
DISCUSSION FORMAT
Category	Points	%	Description
Grammar, Syntax, Spelling, & Punctuation	5	5%	Grammar, spelling, and/or punctuation are accurate, or with zero to one error. Direct quotes in discussions are limited to one short quotation (not to exceed 15 words). The quote adds substantively to the discussion. (*) APA style references and in text citations are required; however, there are no deductions for errors in indentation or spacing of references. All elements of the reference otherwise must be included.
	5	10%	Total FORMAT Points= 5 pts
			DISCUSSION TOTAL=50 points

Case Study, Chapter 10, Mandatory Minimum Staffing Ratios (DQ6)

Educational Program On Risk Management – Part One: Outline Of Topic

Discuss three areas in which health problems or barriers to health were identified.

Family Health Assessment Part I

Reflection Discussion – COURSE: PATHOPHYSIOLOGY

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