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Geneva Guadalupe is a new manager on the busiest medical and surgical unit in a tertiary hospital.

Geneva Guadalupe is a new manager on the busiest medical and surgical unit in a tertiary hospital. There are 39 beds on 9 Tower, which has a high volume of diabetes patients. She is excited to improve the quality and outcomes on this unit. During her interview, she learned that under the previous leadership the quality was deteriorating, as reflected in Hospital Consumer Assessment of Healthcare Providers and Systems (HCHAPS) scores and absenteeism and turnover rates. It was costing the unit between $42,000 to $65,000 to replace a nurse.

While making rounds, Nurse Guadalupe observed complaints about missed nursing care from all shifts and decided to make staff accountable for ensuring that patient care is completed. She asked a CNL to monitor the types of patient care activities that were being omitted. After 1 week, the CNL stated that it was difficult to make that determination because everyone had a different opinion on which interventions were being omitted. Additionally, staffing was an issue. The manager’s initial response was, “What’s wrong with staffing? Why would you blame staffing for omitting patient care?”

In your own words:

  1. What is your first approach to showing a link between missed nursing care and staffing?

  2. What questions could you pose to frontline nurses to understand how their staffing experience related to missed care?

  3. Whom will you engage institutionally to understand the issue fully? Why them?

  4. Which data elements may be required to build a case for staffing and missed nursing care?

  5. What ideas would you propose to the administration to reverse the financial effects and improve HCHAPS scores?

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Sample Answer

 

 

 

Addressing Missed Nursing Care and Staffing Issues on 9 Tower

1. Demonstrating the Link Between Missed Care and Staffing:

  • Review HCAHPS Data: Analyze HCAHPS scores related to pain management, communication with nurses, and responsiveness to call lights. Low scores in these areas can correlate with missed nursing care.
  • Track Omission Rates: Collaborate with the CNL to define core nursing interventions for diabetes patients on 9 Tower. Track the omission rate of these essential tasks across different shifts and staffing levels.

Full Answer Section

 

 

 

 

  • Benchmark Staffing Ratios: Compare nurse-to-patient ratios on 9 Tower with industry standards and similar units within the hospital. This helps identify potential understaffing issues.
  1. Questions for Frontline Nurses:
  • Specific Missed Care Examples: “Can you share specific examples of patient care activities you’ve had to omit due to staffing limitations?”
  • Impact on Patient Care: “How do these omissions affect your ability to provide quality care to your patients with diabetes?”
  • Safety Concerns: “Have there been any instances where missed care due to staffing led to patient safety concerns?”
  • Ideal Staffing Levels: “In your experience, what nurse-to-patient ratio would allow you to deliver optimal care to all patients on your shift?”
  1. Engaging Institutional Stakeholders:
  • Director of Nursing (DON): The DON oversees nursing operations and can provide insights into staffing models, workload management strategies, and potential solutions.
  • Human Resources (HR): HR can share data on nurse vacancy rates, turnover costs, and recruitment efforts. This helps understand the financial burden of understaffing.
  • Finance Department: Collaborate with finance to calculate the cost of missed care based on potential complications and readmissions. This strengthens the case for improved staffing.
  1. Data Elements for Building a Case:
  • HCAHPS Scores: Track trends in HCAHPS scores related to missed care experiences.
  • Omission Rates of Core Interventions: Monitor the percentage of missed essential care activities for diabetes patients.
  • Nurse-to-Patient Ratios: Compare staffing levels on 9 Tower with benchmarks and analyze the correlation with missed care rates.
  • Nurse Turnover Rates: Track nurse turnover costs and their impact on the hospital budget.
  • Cost of Missed Care: Estimate the financial burden of potential complications arising from missed care due to understaffing.
  1. Proposals to Reverse Financial Effects and Improve HCAHPS Scores:
  • Targeted Recruitment and Retention Strategies: Develop programs with competitive salaries, sign-on bonuses, and career advancement opportunities to attract and retain qualified nurses.
  • Skill-Mix Optimization: Explore options for deploying nursing assistants or certified nursing aides (CNAs) to assist with basic care tasks, freeing up nurses for more complex interventions.
  • Improved Workload Management: Implement strategies to distribute patient assignments more equitably and avoid nurse overload, ensuring quality care delivery.
  • Staff Education and Development: Provide ongoing training on best practices for diabetes management and time management skills to optimize workflow.
  • Patient and Family Engagement: Empower patients and families to participate in their care plans and report any missed care concerns, fostering collaboration.

By demonstrating the clear link between missed nursing care and staffing, advocating for evidence-based solutions, and collaborating with key stakeholders, Geneva Guadalupe can create a positive impact on patient care, staff satisfaction, and the hospital’s financial health.

 

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