Action Plan Summary (Coursework Sample)

Action Plan Summary
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Institution
Action Plan Summary
This Action Plan seeks to engage health institutions, hospital managers, nurse leaders, individual nurses, and policymakers in an effort to revise nurse staff workloads in the Saudi context to address associated problems. The plan will help prevent the occurrence of undesirable patient outcomes caused by strenuous workloads that arise because of high patient-nurse ratios. The plan is premised on the views that (1) nurses are crucial in determining the quality of health care delivery, (2) high nurse workloads have direct implications on quality of care alongside patient outcomes, and (3) organizations can act to mediate sociocultural conditions that cause unfavorable nurse staff workloads.
Multiple scholarly sources indicate that the greater the nursing staff workload, the lower the levels of care quality, leading to undesirable patient outcomes (Gerolamo & Roemer, 2011). The main contributing factor to greater nurse staff workloads is high patient-nurse ratios that lead to long shift durations, burnout, and heightened stress levels, which interfere with nursing focus and ability to address clinical care actions, leading to direct effects on patient safety. In the Saudi context, the unfavorable patient-nurse ratios that cause strenuous nurse workloads arise because of cultural issues such as lack of communication and empowerment alongside uncertainty avoidance (Almalki, Fitzgerald, & Clark, 2012; Hofstede, 2010). These issues create organizational and professional limitations on nurses to engage organizational leadership regarding their working environments, resulting in the aforementioned strenuous nurse workloads and direct effects on patient safety.
The main goal of the action plan is to engage health institutions, hospital managers, nurse leaders, individual nurses, and policymakers in an effort to address the causes of strenuous nurse staff workloads in the Saudi context, which will help prevent associated negative patient outcomes. Four key strategies will help address the organizational and cultural factors that contribute to strenuous nurse staff workloads through sustaining high patient-nurse ratios. The strategies entail addressing nurse- patient ratios, involvement in organization decision-making, policies for ensuring patient mobility and pulmonary hygiene, and linkages between ethical codes and nurse work environment.
The aforementioned actions will help correct nurse workloads through reducing patient-nurse ratios and establishing better working environments for nurses, which will improve quality of care and preclude undesirable patient outcomes in the Saudi context.
Addressing Nurse- Patient Ratios
Strategy and Rationale
Addressing nurse-staffing shortages represents a crucial step in correcting nurse workloads to help preclude the lengthy shift durations, burnout, and heightened stress levels that drive down quality of care. This strategy addresses the direct relationship between nurse workload and patient outcomes. The rationale for this measure arises from scholarly observations relating nurse staffing numbers and quality of care considerations. For instance, Unruh (2008) reviewed literature on nurse staffing and established that adequate nurse staffing and the resultant balanced workloads were crucial in achieving good patient outcomes. In another study, Needleman, et al.(2011) established that staffing of registered nurses below target levels was correlated with increased mortality in hospitals. These findings are consistent with Cho, Hwang, and Kim’s (2008) empirical observations that every additional patient per registered nurse in a hospital led to a 9% increase in patient mortality odds. Further, Shekelle’s (2013) systematic review explored the association between patient outcomes and nurse staffing levels, establishing the existence of a causal relationship between nurse staffing figures in hospitals and inpatient mortality. In addition, patient mortality rates have been proven lower in organizations where ratios are lower than seven patients per one nurse (Liu Lee, Chia, & Chin, 2012).
Implementation
The main activity through which to implement the strategy will entail revising nurse staffing plans to suit best practices in nurse-patient ratios. Twigg, Duffield, Bremner, Rapley, and Finn (2011) review the effectiveness of a bottom-up strategy to planning nurse staffing based on nursing-hours per patient day (NHPPD) practice standard. This approach classifies hospital wards into seven categories based on factors such as patient complexity, high dependency beds, intervention levels, patient turnover, and emergency/elective patient mix, which are then applied in determining nurse staffing distribution. The scholars established that this needs analysis rather than an umbrella approach was effective in reducing strenuous nurse workloads and improving patient safety (Twigg, Duffield, Bremner, Rapley, & Finn, 2011).
Outcomes
Given that the strategy will help address strenuous nurse workloads, the outcomes expected include heightened post-implementation nurse satisfaction with workloads alongside reduction in undesirable patient outcomes associated with nurse functions. Such outcomes will underpin how correcting nurse-patient rations reduces strenuous work volume and allows nurses to offer better care to patients. Measurement of these outcomes will entail pre- and post-implementation evaluation of nurse satisfaction with workload alongside assessment of shifts in undesirable patient outcomes directly attributable to nurse workload. In the latter case, Twigg, Duffield, Bremner, Rapley, and Finn’s (2011) study indicates that it is possible to measure patient outcomes regarded as nursing-sensitive outcomes.
Operations and Resources
This strategy will require the concerted efforts of nurse leaders, the HR department, and individual nurses in determining the needs analysis per ward and establishing the required number of nurses for each ward, as Fitzpatrick and Brooks (2010) notes the importance of the nurse leader in acting as a logistician to guide other stakeholders in planning human capital usage. Implementing the strategy will take six weeks, within which the stakeholders will undertake planning, simultaneous needs review, and planning nurse human capital distribution per ward. The necessary resources will include best practice standards on nurse staff planning, nurse staffing planners, and IT resources for data analysis, storage, presentation, and distribution.
Involvement in Organization Decision Making
Strategy and Rationale
Involving nurses in organization decision making can contribute to addressing the nurse staffing problems that lead to strenuous workloads and their implications on quality of nursing care provided. Measures that may help integrate nurses and nurse leaders into organizational decision-making processes contribute to overall patient outcomes issue by addressing the organizational and cultural causes of heavy nurse workloads. Scholarly observations such as Jaafarpour and Khani (2011) indicating that low nurse involvement in aspects such as deciding unit staffing affects their work environment and contributes to negative patient outcomes constitute the rationale of this strategy. Jaafarpour and Khani (2011) established that involving nurses in decision-making processes led to positives such as lower levels of job strain and burnout, which contributed to higher quality of patient care leading to desirable patient outcomes such as fewer complications and lower patient mortality. Graham-Dickerson, et al.(2013) also indicate that involving nurses in organizational decision making in areas such as adequate staffing and balanced workloads is an important determinant of nurse satisfaction or dissatisfaction and resultant implications such as burnout, turnover, and patient outcomes. In the Saudi context, scholars note social-cultural factors that constitute barriers to nurse involvement in decision-making processes, including lack of autonomy by nurses, general undervaluation of the nursing profession, lack of communication and empowerment, and uncertainty avoidance (Al-Ahmadi, 2009; Hofstede, 2010). Such Saudi social-cultural barriers preclude transparent communications, shared decision-making, and non-hierarchical structures, which explain the lack of involvement of nurses in making decisions about staffing.
Implementation
The activities in this strategy include sensitizing institutions to include nurse leaders in organizational decision making, empowering and affording nurses opportunities to air views on their working environment, and establishing supportive two-way communication models and feedback collection. Providing evidence from institutions that implement the best practice Magnet strategy that underscores the importance of staff nurse involvement in decision making, staffing, and scheduling will contribute to influencing Saudi hospitals to include nurses and their leaders in decision-making aspects such as nurse staffing (Magnet Monday, 2013; Roussel, 2011). Such scholarly and best practice evidence may help address the Saudi social-cultural barriers to nurse involvement in making decisions, as they concern areas such as nurse autonomy, value of the nursing profession, and the importance of communication and empowerment (Roussel, 2011).
Outcomes
The main outcome entails heightened involvement of nurse leaders and nurses in making decisions about nurse staffing and nurse-patient ratios. Such involvement will be evidenced by inclusion of nurse leaders in deciding staffing requirements alongside the collection of nurse staff feedback about their workloads. Measurement of these outcomes will entail post-implementation surveys of nurse involvement in organizational decision-making and evidence of nurses using ...