NUR 621 Topic 7 DQ 1 What are some of the key differences for a staffing model in a skilled nursing facility as compared to a medical-surgical unit in the hospital

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Topic 7 DQ 1

Jan 27-29, 2022

What are some of the key differences for a staffing model in a skilled nursing facility as compared to a medical-surgical unit in the hospital?

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Feb 2, 2022, 5:11 AM

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Knowledge Check

What are some of the key differences for a staffing model in a skilled nursing facility as compared to a medical-surgical unit in the hospital?

TF

Jan 29, 2022, 11:54 PM

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Healthcare workers are the backbone of any healthcare organization. “Staffing is the cornerstone of human resource management” (Theriault et al., 2019). For healthcare organizations to thrive and function at their best, adequate, qualified employees must provide continuous, high-quality, safe patient care. Competent and adequate staffing in healthcare facilities increases and promotes positive patient outcomes, decreases readmissions, decreases errors and safety events, improves the patient experience, and improves facility ratings. “Healthcare is labor-intensive, requiring the expertise and efforts of nurses and other health care providers to assess and manage the care of consumers needing health care services” (Penner, 2017). Staffing and scheduling sometimes present as a complex issue due to the challenges faced by different healthcare organizations, such as short staffing, patient acuity, patient capacity, budgeting, and lack of adequate finances.

Staffing varies between a skilled-nursing facility versus a medical-surgical unit in a hospital. Both units require staffing for twenty-four hours per day for seven days per week, but the medical-surgical unit is an acute setting with more rapid patient turnover while the nursing facility is more chronic and long-term. Based on the acuity and services required, an acute inpatient hospital unit requires more nurses, such as RNs, while a skilled-nursing facility requires fewer nurses and more support staff such as nurses’ aides.

There are three types of staffing models budget base, nurse-patient ratio, and patient acuity (My American Nurse 2014). Some facilities use a combination of staff models depending on the unit’s needs or the facility. Staffing has been and continues to be a considerable challenge for many healthcare facilities and organizations worldwide. Quality patient care and patient safety should be one of the top priorities when staffing is considered. Other factors to be considered when addressing staffing needs are call-offs, sick leave, emergencies, admissions, discharges, patient capacity, and patient acuity.

References How would you monitor these indicators?

My American Nurse. (2014). What every nurse should know about staffing. https://www.myamericannurse.com/what-every-nurse-should-know-about-staffing/amp/

Penner, S. J. (2017). Economics and Financial Management for Nurses and Nurse Leaders (3rd ed.). Springer Publishing Company. ISBN: 978-0-8261-6001-0

Theriault, M., Dubois, C., Silva, B. and Prud’homme, A. (2019). Nurse staffing models in acute care: A descriptive study. Nursing Open, 6(3). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6650648/#_ffn_sectitle

Jan 30, 2022, 9:10 AM

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Replies to Tameka Foster

Hi Tameka!

I enjoyed reading your posts but was wondering what your thoughts are regarding the regulation of nurse-to-patient ratios? This has always been a dicey subject since I have been in nursing. As nurses, we know the type of facility, level of care, and patients determine the nurse-to-patient ratios. However, all patients are not the same. I have been assigned to patients that were so complex that it was very difficult to sufficiently meet all their needs. Although healthcare facilities have nurse-to-patient ratios or some type of staffing plan in place, the pandemic has caused some organizations, including mines, to forgo adhering to these staffing guidelines. Nevertheless, the importance of having optimal staffing levels cannot be underestimated. Research has repeatedly shown the positive relationship that exists between adequate nursing staffing levels and improved patient outcomes. Moreover, Qureshi et al. (2019) highlighted how understaffing can lead to nurse burnout, stress, and other negative effects.

References How would you monitor these indicators?

Qureshi, S. M., Purdy, N., Mohani, A., & Neumann, W. P. (2019). Predicting the effect of nurse–patient ratio on nurse workload and care quality using discrete event simulation. Journal of Nursing Management, 27(5), 971-980. https://doi.org/10.1111/jonm.12757

Jan 31, 2022, 11:37 PM

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Hi Angela, thank you for your response!

This writer is all in favor of nurse-to-patient ratio regulations. California is one of the only states that has officially established laws and regulations regarding the nurse-to-patient mandate. Because of the lack of federal mandate regarding nurse-to-patient ratios, registered nurses (RNs) are consistently required to care for more patients than is safe, compromising patient care and outcomes (National Nurses United, n.d.). Safe patient care has shown positive outcomes for the patient, the nurse, and healthcare organizations. Patients have a right to receive the best care every time; care should be safe, high-quality, patient-centered, and holistic. How can patient care be all of the above when sometimes a nurse is required to care for up to 8 and more patients in an acute care setting? Presently this writer’s facility’s maximum nurse-to-patient ratio on any shift on a medical/surgical/telemetry floor is seven patients; this can be unsafe for both patient and nurse, especially when there is not enough or no support staff to assist. Short staffage has been a chronic issue in healthcare, and the present pandemic has put an even further strain on the situation. The nurse-to-patient ratio continues to be a concerning topic for nurses across the USA.

Reference How would you monitor these indicators?

National Nurses United. (n.d.). National campaign for safe RN-to-patient staffing ratios. https://www.nationalnursesunited.org/ratios#:~:text=There%20are%20no%20federal%20mandates,and%20negatively%20impacting%20patient%20outcomes.

Jan 30, 2022, 6:29 PM

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A hospital’s medical-surgical unit is more resourced than a skilled nursing facility. The auxiliary nurses and nurse aides are essential in a medical-surgical unit because of the acuteness of the patient’s problems (Thériault et al., 2019). The number of care providers present in a nursing facility meets the patient’s needs because the patients do not need extra care unless their health deteriorates. Therefore, it is more appropriate to schedule all the nurses in a nursing facility according to their shifts. Furthermore, a skilled nursing facility will likely take more graduate nurses to meet the rising demand for patient care (Harrington et al., 2020). On the other hand, a

medical-surgical unit in a hospital may take most of the experienced care providers to meet the critical care needs of patients. This move ensures that patients receive quality care in the surgical units. Each unit has other care providers to help if they need help or their conditions exacerbate.

NUR 621 Topic 7 DQ 1 What are some of the key differences for a staffing model in a skilled nursing facility as compared to a medical-surgical unit in the hospital

References How would you monitor these indicators?

Harrington, C., Dellefield, M. E., Halifax, E., Fleming, M. L., & Bakerjian, D. (2020). Appropriate Nurse Staffing Levels for U.S. Nursing Homes. Health services insights, 13, 1178632920934785. https://doi.org/10.1177/1178632920934785

Thériault, M., Dubois, C. A., Borgès da Silva, R., & Prud’homme, A. (2019). Nurse staffing models in acute care: A descriptive study. Nursing open, 6(3), 1218-1229. https://doi.org/10.1002/nop2.321

How would you monitor these indicators? Grading Rubric Guidelines

Performance Category	10	9	8	4	0
Scholarliness Demonstrates achievement of scholarly inquiry for professional and academic decisions.	Provides relevant evidence of scholarly inquiry clearly stating how the evidence informed or changed professional or academic decisions Evaluates literature resources to develop a comprehensive analysis or synthesis. Uses valid, relevant, and reliable outside sources to contribute to the threaded discussion	Provides relevant evidence of scholarly inquiry but does not clearly state how the evidence informed or changed professional or academic decisions. Evaluates information from source(s) to develop a coherent analysis or synthesis. Uses some valid, relevant, reliable outside sources to contribute to the threaded discussion.	Discusses using scholarly inquiry but does not state how scholarly inquiry informed or changed professional or academic decisions. Information is taken from source(s) with some interpretation/evaluation, but not enough to develop a coherent analysis or synthesis. Little valid, relevant, or reliable outside sources are used to contribute to the threaded discussion. Demonstrates little or no understanding of the topic.	Discusses using scholarly inquiry but does not state how scholarly inquiry informed or changed professional or academic decisions. Information is taken from source(s) without any interpretation/evaluation. The posting uses information that is not valid, relevant, or reliable	No evidence of the use of scholarly inquiry to inform or change professional or academic decisions. Information is not valid, relevant, or reliable
Performance Category	10	9	8	4	0
Application of Course Knowledge – Demonstrate the ability to analyze, synthesize, and/or apply principles and concepts learned in the course lesson and outside readings and relate them to real-life professional situations	Posts make direct reference to concepts discussed in the lesson or drawn from relevant outside sources; Applies concepts to personal experience in the professional setting and or relevant application to real life.	Posts make direct reference to concepts discussed in the lesson or drawn from relevant outside sources. Applies concepts to personal experience in their professional setting and or relevant application to real life Interactions with classmates are relevant to the discussion topic but do not make direct reference to lesson content	Posts are generally on topic but do not build knowledge by incorporating concepts and principles from the lesson. Does not attempt to apply lesson concepts to personal experience in their professional setting and or relevant application to real life Does not demonstrate a solid understanding of the principles and concepts presented in the lesson	Posts do not adequately address the question posed either by the discussion prompt or the instructor’s launch post. Posts are superficial and do not reflect an understanding of the lesson content Does not attempt to apply lesson concepts to personal experience in their professional setting and or relevant application to real life	Posts are not related to the topics provided by the discussion prompt or by the instructor; attempts by the instructor to redirect the student are ignored No discussion of lesson concepts to personal experience in the professional setting and or relevant application to real life
Performance Category	5	4	3	2	0
Interactive Dialogue Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts a minimum of two times in each graded thread, on separate days. *(5 points possible per graded thread)*	Exceeds minimum post requirements Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts three or more times in each graded thread, over three separate days. Replies to a post posed by faculty and to a peer Summarizes what was learned from the lesson, readings, and other student posts for the week.	Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts a minimum of two times in each graded thread, on separate days Replies to a question posed by a peer Summarizes what was learned from the lesson, readings, and other student posts for the week.	Meets expectations of 2 posts on 2 different days. The main post is not made by the Wednesday deadline Does not reply to a question posed by a peer or faculty	Has only one post for the week Discussion posts contain few, if any, new ideas or applications; often are a rehashing or summary of other students’ comments	Does not post to the thread No connections are made to the topic
	Minus 1 Point	Minus 2 Point	Minus 3 Point	Minus 4 Point	Minus 5 Point
Grammar, Syntax, APA Note: if there are only a few errors in these criteria, please note this for the student in as an area for improvement. If the student does not make the needed corrections in upcoming weeks, then points should be deducted. Points deducted for improper grammar, syntax and APA style of writing. The source of information is the APA Manual 6th Edition	2-3 errors in APA format. Written responses have 2-3 grammatical, spelling, and punctuation errors. Writing style is generally clear, focused, and facilitates communication.	4-5 errors in APA format. Writing responses have 4-5 grammatical, spelling and punctuation errors. Writing style is somewhat focused.	6-7 errors in APA format. Writing responses have 6-7 grammatical, spelling and punctuation errors. Writing style is slightly focused making discussion difficult to understand.	8-10 errors in APA format. Writing responses have 8-10 grammatical, spelling and punctuation errors. Writing style is not focused, making discussion difficult to understand.	Post contains greater than 10 errors in APA format. Written responses have more than 10 grammatical, spelling and punctuation errors. Writing style does not facilitate communication. The student continues to make repeated mistakes in any of the above areas after written correction by the instructor
	0 points lost				-5 points lost
Total Participation Requirements *per discussion thread*	The student answers the threaded discussion question or topic on one day and posts a second response on another day.				The student does not meet the minimum requirement of two postings on two different days
Early Participation Requirement *per discussion thread*	The student must provide a substantive answer to the graded discussion question(s) or topic(s), posted by the course instructor (not a response to a peer), by Wednesday, 11:59 p.m. MT of each week.				The student does not meet the requirement of a substantive response to the stated question or topic by Wednesday at 11:59 pm MT.

NUR 621 Topic 7 DQ 1 What are some of the key differences for a staffing model in a skilled nursing facility as compared to a medical-surgical unit in the hospital