Root-Cause Analysis of Nursing Staffing Shortages and Safety
School
Capella University**We aren't endorsed by this school
Course
NURS 4020
Subject
Nursing
Date
Dec 10, 2024
Pages
7
Uploaded by SuperSparrowMaster1229
1Root-Cause Analysis and Safety Improvement PlanCapella UniversityNURS4020: Improving Quality of Care and Patient Safety
2Root-Cause Analysis and Safety Improvement PlanNursing staffing shortages are an issue that has been effecting healthcare globally for many years, and will continue to be an issue unless addressed. The way to address this issue is toget to the root-cause of the issue and determine what factors are causing the issue to occur. This paper will outline the elements of a successful quality improvement initiative, for this example the root-cause analysis approach will be used. The paper will also analyze the factors which lead to the patient safety risk of staffing shortages and identify organizational interventions to promote patient safety. Analysis of the Root CauseThe goal of the root-cause analysis model is to determine the why of an issue or sentinel event. Instead of focusing on a single sentinel event as the basis of this paper, the focus will be on the events and concerns that arise as a result of the nursing staffing shortage. In this scenario, the events take place on a 25 bed medical-surgical unit in a critical access community hospital. The unit has an average daily census of 20.4 and an average acuity, caring for post-surgical, medically stable patients requiring only rehab but also patients with acute illnesses like pneumonia, sepsis, COPD, etc. The ideal nurse to patient ratio is 1:5 unless the unit experiences a call out or another reason for short staffing and then the ratio becomes 1:6 or 1:7. The nurses and nursing assistants are scheduled for 12-hour shifts and typically work 3 or 4 shifts per week. This unit had 4 nurses who resigned in a short time and could not hire replacements before their last days. Because of the short staffing there were many errors that occurred. A higher number ofmedication errors were reported because of nurses increased workload and the number of patients needing medications administered. Multiple patients developed hospital acquired pressure injuries because of a reduced number of staff members present to assist with turning and
3repositioning. The number of patient complaints related to missed care or poor nursing care increased. The rate of falls and falls with injury on the unit increased because the fall risk interventions usually put into place for patients were missed. Bed alarms and ensuring the patient’s bed is in the lowest position were forgotten due to staff being rushed. Staff morale plummeted and staff illness and call outs also increased. These issues were recognized by nursing leadership and all of the staff members on the unit and negatively affected not only the patients but the nurses and nursing assistants as well. The patients were effected by receiving a decreased quality of care, some experienced adverse effects from receiving the wrong treatments and medications, prolonged hospital stays as a result of additional hospital acquired illnesses or worsening of their existing illnesses. The staff were negatively affected by having an increase in burnout and mental health issues, an increase in health-related issues from physical exhaustion and a decrease in staff morale (Capella University, 2024).In an ideal situation, when the 4 nurses gave their resignation, the organization would have been able to recruit 4 new hires to replace thenurses leaving. The replacement nurses would have been experienced and would not have needed an extended period of orientation.Application of Evidence-Based StrategiesTo identify the root-causes of the nursing staff shortages, it is best to start with the cycle of staffing shortages creating more staffing shortages and higher turnover rates. According to Costa et al. (2024), the main concern from a group of surveyed registered nurses is chronic understaffing. The nurses who are showing up day in and day out and managing an increased workload for a 12-hour shift are becoming burned out at faster rates. The burnout then causes staff to leave their current employment to find another organization who is not suffering from such high nursing shortages, making the issue at their current employer worse. A professor Linda
4Aiken, cited by Suran (2023) does not feel that the nursing shortage is the issue, that the issue is the burnout that is caused by nurses working in understaffed conditions. Another root-cause of the nursing staffing shortage is the supply of nurses to replace those who are retiring and leaving the workforce and the demand of an increased need for nurses as inpatient and outpatient settings are facing rapid growth (Buerhaus, 2021). A concern with hiring new graduate nurses is that the experience level, judgement and critical thinking skills are lacking to where they cannot replace the experienced nurses in the workforce. Additionally, with the senior nurses retiring, the available preceptors and trainers who are orienting the new graduate nurses do not have the expertise in training as they are newer nurses themselves. This isalso exacerbated by the fact that patients are becoming sicker and needing more specialized care which requires specialized training for nurses. Improvement Plan With Evidence-Based and Best-Practice StrategiesThere are a few strategies available to ensure that the unit can provide safe nursing care even given the nursing shortages and increased workload. The first strategy is to determine the maximum safe workload for each nurse on the unit. Nursing leadership and frontline nurses should work together to create a staffing tool that outlines the workload for each nurse. The sameshould be done for the nursing assistants on the unit. When possible, a primary nursing model should be used where nurses and nursing assistants work together to provide the care to the patients as a team and maintain continuity of care during their work schedules. The use of lay health workers has also been shown to offload the workload for nurses andnursing assistants which allows those individuals to focus on nursing-related tasks (Basnight et al., 2023). Delegating the tasks that take a lot of time away from the nurse specific care can help to improve patient outcomes as well as ensure the nurse can complete their work in a timely
5manner. Toileting, repositioning, feeding patients and re-stocking supplies on the unit are all tasks that are necessary but that do not need to be completed by a registered nurse or a licensed nursing assistant. The goal of the improvement plan at this time is to restructure the staffing in a way that meets patient needs and the needs of the staff to ensure high-quality patient care without increasing the number of nursing staff on the unit. By restructuring the staffing model to reflect aprimary nursing care model and the addition of lay health workers, the unit will better accommodate the average census on the unit safely. Caring for the patients as a team instead of trying to complete everything individually can lighten the workload for each individual nurse. The current nursing staff will need to be educated on the primary nursing care model before implementation. They will need to understand and be able to demonstrate the ability to work as a team and ensure they know how to delegate appropriately. The unit will also need to determine if there are current staff members in the organization who are interested or willing in being trained for the lay health worker position. If not, recruitment for these positions will be needed. The education and training phase for this implementation plan will last roughly 3-6 months once the lay health workers are identified or hired. Existing Organizational ResourcesInstituting the lay health worker position may create opportunities for staff who are currently employed in other areas of the organization. Sometimes at hospitals there are staff members who work in departments such as culinary or environmental services who are interestedin healthcare fields, but do not have the resources to attend nursing school. In these instances, these staff can feel fulfilled in the patient care attendant role to provide support to patients with no additional schooling.
6The organization will need to invest time in training and educating the patient support staff on the tasks they will be required to complete. According to Basnight et al. (2023), training with competency-based learning using the teach back method and observation was successful in their study. The education department will also be instrumental in training and educating the existing staff on the primary care nursing model. ConclusionStaffing shortages are an issue in the healthcare field that will take time and creativity to combat. A root-cause analysis on the staffing shortage of nurses was conducted at a critical access hospital inpatient unit. Being understaffed, having a high workload and low supply/high demand of nurses were found to be factors that contributed to the staffing shortages. This paper reviews the evidence-based strategies such as instituting a primary care nursing model and the addition of lay health workers to help solve this issue. An improvement plan was developed to help improve the quality of care provided with the current nursing staff on this unit. The plan helps to spread the workload out with the existing staff to help reduce nursing burnout as well as improve patient care.
7ReferencesBasnight, R., Berry, P., Capes, K., Pearce, S., Thompson, J., Allen, D. H., Granger, B. B., & Reynolds, S. S. (2023). Evaluation of lay health workers on quality of care in the inpatient setting. PLoS ONE, 18(11), Article e0293068. https://doi.org/10.1371/journal.pone.0293068Buerhaus, P. I. (2021). Current Nursing Shortages Could Have Long-Lasting Consequences: Time to Change Our Present Course. Nursing Economics, 39(5), 247–250.Capella University. (2024). NURS4020 Assessment 01 - Enhancing Quality and Safety. http://courseroom.capella.edu/courses/32966/pages/assessment-1-instructions?module_item_id=1652813Costa, D. K., Valley, T. S., & Friese, C. R. (2024). Addressing the Nursing Workfoce Crisis Through Nurse-Physician Collaboration. JAMA Intern Med, 184(5), 463–464. https://doi.org/10.1001/jamainternmed.2024.0183Suran, M. (2023). Overworked and Understaffed, More Than 1 in 4 US Nurses Say They Plan to Leave the Profession. JAMA, 330(16), 1512–1514. https://doi.org/10.1001/jama.2023.10055