Promotion for the implementation of mandate for improved nursing-to-patient ratios is important in Florida because there is requirement of ideal nursing ratios and reduction in the overtime job for nurses. In Florida, there is increased apprehension of patient care due to complex diseases and shortage of nursing staff. However, it has been observed that nurses in Florida are not enthusiastic for the implementation of this policy. Nurses in Florida are divided in their ideology and they have belief that such laws and policies would not be proved useful in improving healthcare. Over-working and under-staffing are the main issues evident in the nursing profession in Florida. Mandate nursing-to patient ratio is useful in improving patient advocacy and patient protection (Shekelle, 2013). Due to imbalance in the nursing-to-patient ratio, there is possibility of insufficient provision of medically appropriate care and suffering to the patient which can result in the overall decline in the outcome of the nursing profession. Nurse sensitive measures can be assessed and quality of care can be improved by implementing this policy. Inappropriate nursing-to-patient ratio can lead to unforced medical errors, preventable complications, increased duration of hospital stay, surgical errors and readmissions (Duffin, 2012). Implementation of this policy also proved beneficial in reducing job dissatisfaction and burnout and improving retention of nursing staff in the hospitals. Evidence based nursing staffing is feasible through implementation of this policy. It has been established that augmentation in the nursing staff is proportional to reduction in the mortality and reduction in surgical failures. Job satisfaction for the nurse can be improved by implementing mandatory nursing-to-staff ratio. This can result in better patient outcome and improvement in the overall health status of the community. Improvement in the health status of the community can reduce financial burden on the individuals, community and Government. Implementation of this policy would be more beneficial in long term by reducing burden on the nurses, managing patients in better way, participating in other health promotion activities, keeping record of all health-related activities and improving overall health status and economic status of the community. Financial arrangements for improving nursing-to-patient ratio can be made by raising funds from Government organisations, arranging physicians events and looking for individuals and corporates for donations (Serratt, 2013).
Wages of the nursing staff are the significant contributing portion for the cost of the hospital. Hence, hospital management put an effort to reduce this cost by reducing number of nurses. However, in actual practice it is not true. It is evident that nursing staff are the major contributing factors for the profitability of the hospital. Hence, reduction on the wages of the nurses is not the efficient way of reducing hospital expenditure. It is evident that augmentation in the operational cost of the hospital by increasing staff recruitment can lead to improvement in the profit of the hospital (Kim and Kim, 2015).
Less nursing-to-patient ratio can restrict nurses from performing in more efficient way. There could be mental block due to overburden and pressure from the management. This can result in the loss of autonomy among nursing staff and they can’t perform their nursing interventions in flexible manner. Nursing profession depends on the goodness and kindness of the nurses. However, these beneficences of nurse should not be taken as granted and should not be considered as charity. Nurses should get necessary returns of their efforts. This can be achieved by assigning optimum work to the nurses by mandating nursing-to-staff ratio. Implementation of this policy in Florida hospital would be useful in providing useful information for the policy makers to implement this policy in other hospitals and states. Emerging information by implementing this policy can be beneficial in developing legislation. It can also be useful in identifying nursing-to-staff ratio specific to department, ward and hospitals (Tellez, 2012; Patterson, 2011).
Dr. X, Dean of the hospital would be the key person in implementing mandate nursing-to-patient policy in the Florida hospital. Dr. X would be most suitable person in the organisation to designate as decision maker in implementing this policy because he is having vast experience in working different hospitals and different clinical settings with varied nurse-to-patient ratios. Hence, he is well aware of all the positive and negative aspects of implementation of nurse-to-patient ratios. It is evident that dean of the hospital is well versed with the observable characteristics of the nurses and he is the right person to take decision on assigning work to the nurses. He can make proper decisions on providing healthcare services to the patients based on the number of nurses and their educational and skill status. Hence, he can consider all these aspects in designing policy which would be beneficial for all the stakeholders (Serratt et al., 2011). Implementation of the policy can vary based on the hospital characteristics, size of the patients, size of the nurses and geographical location of the hospital. Dean of the hospital has capability to consider all these aspects while drafting the policy in Florida hospital. Moreover, he is the main connecting link between the management of the hospital and nursing staff. Hence, he should promote the policy implementation and discuss with both management and nursing staff. He should positively consider suggestions made by both the stakeholders and incorporate in the policy for its efficient implementation (Rozdilsky and Alecxe, 2012).
Dr. X might face resistance from the management for implementation of the policy because this policy might put extra financial burden on the management. It is the responsibility of Dr. X is to convince management and change their mindset. Management might not aware of the overall impact of the policy implementation because they might be thinking in only one direction which is economic burden due to increase in the number of nursing staff. Dr. X should illustrate management about the profitability of the policy by using evidence based literature. He should explain management different case studies with the beneficial outcome of implementation of nursing-to-patient policy. Few of the nurses might be obstacles for the implementation of the policy because they have belief that improvement in the number of nursing staff would not be beneficial in improving patient care. These nurses might have more self-confidence. Few of the nurses might not wish to have more number of nursing staff because insecurity of their job. Dr. X should address all the challenges by establishing effective communication with the existing nursing staff. He should assure them that those nurses with required skills would be benefited more by implementing this policy because they can diversify their efforts in diverse nursing interventions. It would be more beneficial in improving patient care. Decision on implementation of policy in general for whole hospital or specific to the ward, is one most significant point of concerns for the Dean of the hospital (Spetz et al., 2013). He can take appropriate decision based on patient admission data in general ward and specific ward from the last five years.
Main purpose of this policy is to increase the workforce for more efficient working of the hospital. Dr. X can also look for other alternatives like implementing policy for the recruitment of the licenced vocational nurses (Kim et al., 2012). By implementing this policy, Dr. X can increase number of nurses quantitatively, however quality of work would be negatively affected. It has been observed that vocational nurses are usually associated with lower-skill levels. Dr. X can implement analytical approach for evaluating possibility of recruiting vocational nurses. He can evaluate data related to vocational nurses recruitment and patient outcome in comparison to the regular nurses recruitment and patient outcome. This data would demonstrate advantages and disadvantages of vocational nurses and regular nurses. Dr. X can also collect data from the other hospitals in U.S. with implementation of mandatory nursing-to-patient policy.
There is existence of the law for the adaptation of minimum staff-to-patient ratio in Florida. This law was implemented due to rising issues of safety concerns about the patient’s health. Nurses Association and the Service Employees International Union played important role in establishing this law. Success of the policy implementation can be evaluated by assessing impact indicators and process indicators. Management and Dean of the hospital are mainly responsible for the evaluation of the policy implementation. Impact indicators include positive and negative effects of policy on stakeholders like nursing staff and patients. Impact on the nursing staff include increase in the number of direct-care nursing staff, decrease in the number of vocational staff, nursing staff meeting requirements of staffing standards, reduced burn-out of nurses, reduced staff turnover, improved financial status of the staff and augmentation in the skilled nurses (Coventry et al., 2015). It would be helpful in improving efficiency and financial status of the hospital as compared to the competitor hospitals. Implementation of this policy would be helpful in establishing effective communication among different stakeholders like management, physicians and nurses. Impact on patients include improved quality care, reduced mortality rate, reduced readmissions and satisfaction with the nursing services. It would result in the overall health of the community. Process indicators for the evaluation include assessing generalizability and applicability of the outcomes of the policy implementation. As this policy is designed considering multiple aspects, outcomes of this policy would be implemented in others hospitals also. National and international regulatory requirements would be considered in designing this policy. As these regulatory requirements are accepted worldwide, it is not mandatory to take approval from the hospital management (McNatt et al., 2014). Hence, these outcomes of this policy can be extrapolated worldwide. All the stakeholders from top to bottom like management, physicians and nursing staff would be incorporated in implementation of policy. Hence, there would be successful implementation of the policy. Purpose fulfilment of the policy implementation would be assessed by understanding satisfaction of nurses and patients. Efficiency of the programme will be determined by comparing the nurse job satisfaction and patient outcome prior to and after implementation of the policy. Change in perception of nursing staff about management will be evaluated (Zaragoza, 2014).
Health education and services organisation would be collaborated with the hospital for the implementation of the mandatory nursing-to-patient ratio policy. This organisation would provide skilled nursing staff in sustained manner. Main objective of this organisation is to provide skilled nursing workforce. Future growth of this organisation is mainly based on the recruitment status. Moreover, this organisation is specifically concerned with the quality nursing services to the patients. This organisation is well aware that shortage of nurses would not be able to provide quality services to the patients. Since, objective of quality healthcare to patients is similar between health education and services organisation and hospital, this organisation is ready to collaborate with hospital for implementation of mandatory nursing-to-patient policy. Detailed plan of the policy implementation could be presented to the head of the organisation and other key members. Benefits of the organisation could be specifically highlighted during presentation. Suggestions made during the presentation would be positively considered and incorporated in the policy plan for the mutual benefits (Kleinpell et al., 2015).
Since, this organisation is working towards developing skilled nurses, it has nurses equipped with skills and innovative approaches. In case of requirement of specific type of skills for providing care to the patients, this organisation is ready to provide resource nurse for curing that particular patient. This type of support from the organisation would be helpful in solving problem of recruiting each and every type of skilled nurses. This organisation would also be useful in capacity building of the hospital for providing care to each type of patient. Providing care to the patients due to lack of skilled nurses would not be stopped in the hospital (Aiken et al., 2011).
Goals of the hospitals are mainly focused on the quality healthcare services to the community. Community also aimed at receiving quality healthcare services from the hospitals. Hospital can be helpful in achieving the goal of the community by achieving by its own goal. Mandatory nursing-to-patient ratio is one of the most efficient way to achieve the goal of quality healthcare to the community. For the implementation of bottom up approach, there should be education, training and shared benefits for all the stakeholders. Stakeholders like nurses and patients should be aware of the benefits of the policy. Community based health and economic benefits should be demonstrated to nurse and patients. Efficient communication of the benefits of the policy to the nurses and patients would be helpful in smooth implementation of the policy.
Strengths and resources within the community, research and action for the mutual benefit of all partners and long-term process and commitment to sustainability are the three Community-based participatory research (CBPR) principle useful for the implementation of the mandatory nursing-to-patient ratio. Strengths and resources within the community include skills of the nurses for providing quality care to the patients, establishment of social relationship with the patients, building faith of patients in nursing staff and hospital and working in collaboration with family members and community members for providing quality care to patients (Sofolahan-Oladeinde, 2015; Burke, 2013). Research and action for the mutual benefit of all partners includes potential benefits to both nurses and patients. Nurses can get necessary job satisfaction and patients can receive quality nursing services from the nurses. Research evidence demonstrating mutual benefits of mandatory nursing-to-staff ratio should be implemented in the hospital setting. Long-term process and commitment to sustainability include sustained supply of skilled nursing staff. For this collaboration should be strengthened with public health agencies and educational institutes. Collaborative evaluation plan will be designed based on the sustainability of the collaboration, mutual benefits of the collaboration, strengths of the organisation in providing resources. If organisation is strong enough to provide sustained resources in terms of skilled nurses, there would be mutual benefit for the organisation and hospital also. Hospital can implement policy in efficient way and organisation can get good opportunity to recruit their candidates. These mutual benefits of hospital and health education organisation would be beneficial in maintaining sustained collaboration.
Advantage Bottom-up Approach
Bottom-up approach would be more beneficial in improving adaptability of new policy because this policy is mainly designed for people at the bottom like nurses and patients. Identification of the success of the policy implementation is possible in the initial phase.
Disadvantage Bottom-up Approach
In Bottom-up approach a lot of organisational changes are required for the implementation of the policy. Due to immediate changes in the organisational structure, it would be difficult for all the stakeholders to adapt to these changes. This strategy is mainly driven by the human resources available and not the goals and objectives of the hospital. Hence, more human resources, time and money required for implementation of policy.
Advantage Top-Bottom Approach
Focused use of human resources is feasible using this approach for implementation of the policy. First draft of policy implementation will be model copy and based on this model copy further policy copies can be prepared. Hence, there is possibility of improvement in the policy at each stage. In contrast to bottom-up approach, there would not be much damage to the organisational structure.
Disadvantage Top-Bottom Approach
It would be difficult to assess outcome of the policy implementation in the initial phase. Minimum number of stakeholders will be considered in the initial phase of the policy implementation. (Stewart et al., 2015)
In bottom-up approach, people at the micro level plays significant part in the implementation of the policy. In top-bottom approach, people at the macro or top level are mainly responsible for the implementation of the policy. In mandatory nursing-to-patient ratio policy implementation, top-bottom approach will be more beneficial because multiple factors need to be considered prior to implementation of this policy. People at the macro or top level are mostly aware of the all the factors in the hospital.
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