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NURS 6053 DQ Organizational Policies and Practices to Support Healthcare Issues

NURS 6053 DQ Organizational Policies and Practices to Support Healthcare Issues

NURS 6053 DQ Organizational Policies and Practices to Support Healthcare Issues

Discussion: Organizational Policies and Practices to Support Healthcare Issues

In this discussion, I am to explain how competing needs in the workforce, in our resources, the needs of the patients, may impact the development of our policies. We have 12-hour shifts in our unit, and this works quite well, except when someone calls off, which is frequent. We recently added 8-hour shifts for some employees, this gives us an overlap, which does help some. We have 4-hour shifts available as a fill-in, especially during mealtimes, shift change, but we never seem to have adequate staffing. We do not have an on-call staff, and our supervisors work during the day, so if there is a call-off in the evening or night they rely on the call list. We work in a very violent acute crisis unit, if staffing is already inadequate and we end up placing a patient in seclusion, we now have that patient as a 1:1. Safety is an issue and will always be an issue in our units. Our resources are very limited, we rely on each other, and when there is a call-off, where do we turn? Ultimately the patient care is going to suffer, errors can increase, staff gets frustrated, annoyed, and others can see this frustration. Our goal should always be to provide positive patient care and have positive patient outcomes. Nurses are challenged daily to continue to provide excellent quality patient care, even in poor conditions, even when we are exhausted, even when there are no atta girls, and we do it without judgment (Kelly, 2018). In my opinion, leaders should lead. They should lead by doing, for example, if someone is a supervisor their job should be to have an on-call role, come in and work the unit. I love the video by Laureate Education, 2012, stating leaders should be teaching positive morals, be professional, and provide strong ethical principles. The leader should assist their staff with needs, and be the one to make the calls when the call-offs come flowing in. According to Milliken, 2018, ethical awareness is often not recognized by the nurse in his/her busy day, for example, taking simple vital signs, assessing the patient, asking questions. Nurses are responsible for being aware of any potential ethical risks to the patients. The nurse must look outside of their usual routine and be attentive to the patient’s needs, concerns, and situation, and that every nursing action can impact the patient in a negative or positive way.

My organization offers premium pay if they call you in, but we all have been doing this, and it gets old fast. It is great to make the extra money, but you cannot take the money with you. The stress of working in a violent unit is not safe, and the stress is ongoing. I understand in nursing we will always have our moments of a staffing shortage, call-offs, working overtime, and sometimes working in poor conditions, but when it is all the time, this is unacceptable. Upper management at this moment should be restructuring the policies and finding some solutions. They should re-evaluate the pay scale, and the school reimbursement tuition policy. Many employees are paying back large loans, although the hospital has a tuition reimbursement program, it is not high enough to cover the costs, causing the employee financial strain. We need to work on the policy staffing ratio, the Patient-Nurse Ratio (PNR), and the CMS reimbursement scale. We have what is called frequent flyers, these are patients that get discharged and come back repeatedly, my question would be, what is the reimbursement to the hospital when this occurs, is the hospital making money or losing money on this? All these topics impact the development of a policy, after the policies are developed and before they are implemented and put into place, there should be employee input before the policy is finalized.

 

 

 

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Discussion: Organizational Policies and Practices to Support Healthcare Issues

Restructuring the staffing policy, would decrease errors, increase patient and employee satisfaction, keep retainment of staff high, decrease escalated patients, decrease in seclusion and restraint use, and increase positive patient outcomes. Suggest Supervisors a total of (4), 2 would rotate so that every weekend is covered, 2 rotate so every week is covered. PCNA should do the vital signs and the Accu- checks. If we had appropriate staffing, certain patient behaviors may have been de-escalated quicker, maybe with the conversation, medication, a snack, instead of violence, seclusion, and 4 points restraints. If we end up with patients in seclusion or restraints, we now have an escalated patient, frustrated staff, angry family members, and even a worse staffing situation because now we have a 1:1 and we must pull someone to watch this patient in an already inadequate unsafe situation. The ones calling off all the time are utilizing FMLA, but I know they are not using it correctly and this must be managed by Human Resources. The nurses are now doing their meds, taking turns doing 1:1, trying to keep an eye on the rest of the patients, and ethically we should not be doing this all at once because this is unsafe, can lead to errors, or even more escalation. Security has also been scarce; they have a shortage as well. We used to have 2 security officers on each unit, now there is 1 officer, and he comes and goes, of course, we always have an emergency when he is gone.

 

We do have training for our staff that is mandatory. The WELLE training is for the de-escalation of violent patients (Policy and Procedures, 2019). We are now doing what is called Cross Training for the hands-on staff, this way someone from my psych unit can go work in the covid unit and vice versa. This has not been working very well so far as the staffing member that fills in only does it occasionally and the confidence is not there, which can pose a risk for errors. Balancing work, school, and life is hard enough to accomplish, add a job that is stressful, demanding and add inadequate staffing, poor leadership, you get burnout, errors, and negative results (Laureate Education, 2015).

 

 

 

Quite often, nurse leaders are faced with ethical dilemmas, such as those associated with choices between competing needs and limited resources. Resources are finite, and competition for those resources occurs daily in all organizations.

For example, the use of 12-hour shifts has been a strategy to retain nurses. However, evidence suggests that as nurses work more hours in a shift, they commit more errors. How do effective leaders find a balance between the needs of the organization and the needs of ensuring quality, effective, and safe patient care?

In this Discussion, you will reflect on a national healthcare issue and examine how competing needs may impact the development of polices to address that issue.

To Prepare:

  • Review the Resources and think about the national healthcare issue/stressor you previously selected for study in Module 1.
  • Reflect on the competing needs in healthcare delivery as they pertain to the national healthcare issue/stressor you previously examined.

By Day 3 of Week 3

Post an explanation of how competing needs, such as the needs of the workforce, resources, and patients, may impact the development of policy. Then, describe any specific competing needs that may impact the national healthcare issue/stressor you selected. What are the impacts, and how might policy address these competing needs? Be specific and provide examples.

By Day 6 of Week 3

Respond to at least two of your colleagues on two different days by providing additional thoughts about competing needs that may impact your colleagues’ selected issues, or additional ideas for applying policy to address the impacts described.

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The healthcare environment is significantly growing and improving the quality of clinical services is essential. Healthcare policies and practices provide regulation in daily operation and ensure uniformity for all employees so that there are no discrepancies (Rosa et al., 2020). For a policy to be developed in nursing, the competing needs must align with the agenda the strategy is advocating for. Competing needs arise when the healthcare workers want to meet the set goals and objectives. For example, the workforce needs may be adequately addressed but the resources required are not sufficient enough to facilitate policy development (Anderson et al., 2020).

The competing needs that may impact the national healthcare issue/stressor under study in this discussion is the multi-morbidity. Multi-morbidity is steadily increasing across the world and poses a major challenge to healthcare systems around the world (Franklin et al., 2017). According to the healthcare providers, the reasons for the rise in multi-morbidity is lifestyle choices in which most Americans live a sedentary life, leading to obesity, cardiovascular disease, and diabetes. In Medicare population, 65% of patients have two or more chronic illnesses, therefore, Multi-morbidity is related to ageing and it is also socially patterned being common and occurring at an early age in areas of high socio-economic deficiency (Sacha et al., 2020).

To address the competing needs, the healthcare organization has to implement major changes in the workforce issue, managing patients, and distribution of resources (Figueroa et al., 2019). Managing chronic illnesses reduces the cost of healthcare because the rate of chronic diseases is higher especially in the US compared to other nations. The population affected by chronic illnesses requires special attention, therefore, the government should get sufficient nurses to help the people. Through the process of expansion of the affordable treatment programs, discouraging sedentary lifestyle, improving the medication adherence, and providing grants and funds to support healthcare, the health organization in America can play its role in the reduction health care cost (Crowley et al., 2020).

In conclusion, managing chronic illnesses, increasing resources, and advising people to live a healthy lifestyle leads to achieving the set goals in healthcare. Reduction in workforce can be achieved through gathering enough resources. Managing the competing needs have impacted before setting organizations policies and practices.

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 3 Discussion Rubric

 

Post by Day 3 and Respond by Day 6 of Week 3

To participate in this Discussion:

Week 3 Discussion

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RE: Discussion – Week 3

Week 3 Response #1

Rachel,

As you mentioned, one significant healthcare problem is medication nonadherence due to cost.  This problem leads to adverse patient outcomes.  The Institute of Healthcare Improvement identified four goals to improve healthcare’s overall state within their Quadruple Aim.  These goals included increasing healthcare accessibility, decreasing healthcare costs, improving clinical outcomes, and improving healthcare providers’ practice environments (Broome & Marshall, 2021; Laureate Education, 2018).  Decreasing medication cost leads to improved outcomes.

One study by Khera et al. (2019) surveyed individuals with atherosclerotic cardiovascular disease and discovered one out of eight patients were non-adherent because of medication cost, representing 2.2 million adults (p. 2073). Cost-related nonadherence not only accounts for not purchasing the medication but also for patients purposely missing doses, taking less than the prescribed dose, and postponing medication refills because of cost (Khera et al., 2019, p. 2068).  With cardiovascular disease being the leading cause of death in the United States, medications to prevent further complications, worsening outcomes, and hospital readmissions should be more affordable and accessible.

Eliminating financial barriers to assess necessary medications would improve adherence and reduce disease morbidity and mortality.  Policy interventions targeting drug costs would also improve compliance and minimize further healthcare costs due to nonadherence. Within the United States population, particularly the elderly, disabled, chronically ill, and poor, should have access to affordable prescription medications.

References

Broome, M. E. & Marshall, E. S. (2021). Transformational leadership in nursing (3rd ed.). Springer Publishing Company. DOI: 101891/9780826135056

Khera, R., Valero-Elizondo, J., Das, S. R., Virani, S. S., Kash, B. A., de Lemos, J. A., Krumholz, H. M., & Nasir, K. (2019). Cost-related medication nonadherence in adults with atherosclerotic cardiovascular disease in the United States, 2013 to 2017. Circulation, 140(25). 2067-2075. https://doi.org/10.1161/CIRCULATIONAHA.119.041974

Laureate Education (Producer). (2018). The healthcare environment [Video file]. Walden University.

NURS_6053_Module02_Week03_Discussion_Rubric

Excellent Good Fair Poor
Main Posting
Points Range: 45 (45%) – 50 (50%)

Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.

Supported by at least three current, credible sources.

Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

Points Range: 40 (40%) – 44 (44%)

Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module.

At least 75% of post has exceptional depth and breadth.

Supported by at least three credible sources.

Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

Points Range: 35 (35%) – 39 (39%)

Responds to some of the discussion question(s).

One or two criteria are not addressed or are superficially addressed.

Is somewhat lacking reflection and critical analysis and synthesis.

Somewhat represents knowledge gained from the course readings for the module.

Post is cited with two credible sources.

Written somewhat concisely; may contain more than two spelling or grammatical errors.

Contains some APA formatting errors.

Points Range: 0 (0%) – 34 (34%)

Does not respond to the discussion question(s) adequately.

Lacks depth or superficially addresses criteria.

Lacks reflection and critical analysis and synthesis.

Does not represent knowledge gained from the course readings for the module.

Contains only one or no credible sources.

Not written clearly or concisely.

Contains more than two spelling or grammatical errors.

Does not adhere to current APA manual writing rules and style.

Main Post: Timeliness
Points Range: 10 (10%) – 10 (10%)
Posts main post by day 3.
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 0 (0%)
Does not post by day 3.
First Response
Points Range: 17 (17%) – 18 (18%)

Response exhibits synthesis, critical thinking, and application to practice settings.

Responds fully to questions posed by faculty.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Communication is professional and respectful to colleagues.

Responses to faculty questions are fully answered, if posed.

Response is effectively written in standard, edited English.

Points Range: 15 (15%) – 16 (16%)

Response exhibits critical thinking and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.

Points Range: 13 (13%) – 14 (14%)

Response is on topic and may have some depth.

Responses posted in the discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed.

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.

Points Range: 0 (0%) – 12 (12%)

Response may not be on topic and lacks depth.

Responses posted in the discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited.

Second Response
Points Range: 16 (16%) – 17 (17%)

Response exhibits synthesis, critical thinking, and application to practice settings.

Responds fully to questions posed by faculty.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Communication is professional and respectful to colleagues.

Responses to faculty questions are fully answered, if posed.

Response is effectively written in standard, edited English.

Points Range: 14 (14%) – 15 (15%)

Response exhibits critical thinking and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.

Points Range: 12 (12%) – 13 (13%)

Response is on topic and may have some depth.

Responses posted in the discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed.

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.

Points Range: 0 (0%) – 11 (11%)

Response may not be on topic and lacks depth.

Responses posted in the discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited.

Participation
Points Range: 5 (5%) – 5 (5%)
Meets requirements for participation by posting on three different days.
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 0 (0%)
Does not meet requirements for participation by posting on 3 different days.
Total Points: 100
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