Good example of essay on care environment

The Effect on Job Satisfaction and Adverse Patient Event in Full Time Registered Nurses with Unit Float Assignments Compared With Those Whose Unit Assignment Are Fixed In an Acute

Chamberlain College of Nursing
NR451 RN Capstone Course
Term and Year
Increasing Nursing Job Satisfaction
The work environment for a registered nurse is very significant to their turnover and job satisfaction. In addition to this, the work environment is also influential in the patient outcomes (Ulrich et al., 2006). In recognition of this fact, this paper looks at the utilization of registered nurses in float assignments. The job satisfaction of a registered nurse is determined by many factors. One of the factors that is relevant to this topic is the use for float assignments. Float assignments can be a significant source of job dissatisfaction for registered nurses.
This problem can be solved through a variety of ways. Firstly, float assignments can be abolished altogether so that registered nurses are in fixed positions. However, this might not be sustainable, especially because of the shortages in nursing staff. Alternatively, registered nurses can be given more autonomy to decide whether they want to be on float assignments, and the departments in which they would prefer working. However, the most sustainable solution given the shortage of nursing personnel, and the solution advanced in this paper is cross training of nurses in other units where gloat assignments are used.

Change Model Overview

The John Hopkins Nursing Evidence-Based Practice Process is composed of three elements. The elements include the practice question, evidence and translation. The practice question is the most important element of the John Hopkins Nursing Evidence-Based Practice Process. This is because the manner in which the question is coined determines the other steps of the process. After the practice question is posed, the next activity involves looking for evidence pertaining the question. The appraisal of the evidence raise determines whether the practice should be changed altogether or improved. In the case the appraisal of the evidence supports changes in the practice, the evidence is translated and the planning and implementation of the action plan to achieve the changes is done (NewHouse et al., 2007). This guide to facilitating change is appropriate for nurses because it considers the evidence available in determining whether changes or improvements are necessary. As such, the approach chosen is evidence based, and therefore sustainable.

Practice Question

Step 1: Identify an EBP question
In an acute care environment, what is the effect on job satisfaction and adverse patient event in full time RNs with unit float assignments compared with those whose unit assignment are fixed The problem identified is that nurses are utilized for float assignments and some of the nurses are not trained in the unites to which they are assigned. The proposed intervention is the cross training of nurses in the various units where float assignments are used. This proposed intervention is comparable to the present where no cross training in the various units where float assignments are used has been offered. The expected outcome from the interventions is that there will be an increase in the job satisfaction for the registered nurses.

Step 2: Scope of practice question

Float assignments means that nurses are assigned to other unit for two primary reasons; either because of their units have a low census or to fill in due to a shortage of nursing personnel. This presents a problem. According to Alspach (2003), an increase of one patient to the average workload of a registered nurse is associated with a 7% increase in the probability of death for the patient within a month of admission. An increase in the workload of a registered nurse by 2 and four patients was shown to increase patient mortality by 14% and 31% respectively. Although the results in this study were preliminary, they speak of a significant problem within health care. The impact of the problem in the broader sense is that float assignments lead to increased workload for registered nurses, an element that has been shown to affect the patient outcomes, more precisely through increased probability for patient mortality.

Steps 3, 4, and 5: Team

The implementation of this project required the input of various stakeholders. This is because the identified problem affects different units in a health facility. Additionally, the planned intervention and the expected outcomes will have a bearing on many members of the health care team. This makes these people relevant stakeholders in the team. The people who make up the team include nursing managers, nursing supervisors, administrative nursing shift supervisors and frontline staff (McKenna et al., 2011). These members are very crucial to the implementation of this project. Their input is important because these are members of the nursing productivity team

Evidence

Steps 6 and 7: Internal and external search for evidence
According to Alspach (2003), an increase of one patient to the average workload of a registered nurse is associated with a 7% increase in the probability of death for the patient within a month of admission. An increase in the workload of a registered nurse by 2 and four patients was shown to increase patient mortality by 14% and 31% respectively. The findings from this study were preliminary. Nonetheless, the methods used in the study were reliable and valid, making the findings credible. Ulrich et al., (2006) argued that the work environment was an influential element in the job satisfaction of registered nurses.

Steps 8 and 9: Summarize the evidence

The fact that the work environment is influential in the job satisfaction of a registered nurse (Ulrich et al., 2006) and patient outcomes (Alspach, 2003) has been documented. It has also been documented that the use float assignments is a source of job dissatisfaction. This is because the registered nurses lack autonomy in the determination of if they will and what float assignments they take. The problem identified in the paper relates to a lack of cross training in the various units where float assignments are used. This can be correlated to the findings by Alspach (2003) that an increase of one patient to the average workload of a registered nurse is associated with a 7% increase in the probability of death for the patient within a month of admission. An increase in the workload of a registered nurse by 2 and four patients was shown to increase patient mortality by 14% and 31% respectively. Through the stakeholders suggested by McKenna et al., (2011), the proposed intervention can be implemented in order to achieve an increased job satisfaction among the registered nurses.

Step 10: Recommendations for change

Based on the appraised evidence, it is recommended to improve on nursing practices. As identified earlier, the most sustainable solution considering the fact that there is a shortage in nursing personnel is to carry out cross training in all the units where float assignments are used.

Translation

Steps 11, 12, and 13: Action plan
Before the planned intervention can be rolled out on a broader scale, there is a need to carry out a pilot study in order to further evaluate the appropriateness of the intervention. The pilot study will be carried out on nurses in acute care units. They will be cross trained on five other units where float assignments are used within the health facility. The mechanisms through which registered nurses are allocated float assignments will be maintained. The aim is to assess the effect of cross training on the job satisfaction of registered nurses in the acute care units. The outcomes will be evaluated through a survey issued periodically to the registered nurses in float assignment (Bratcher & Madrid, 2008). The presentation of the results will be done in stakeholder meetings.

Steps 14 and 15: Evaluating outcomes

The desired outcome for this project is an increase in the job satisfaction for the registered nurses. The outcomes will be measured using surveys that will be administered periodically. The results of the project will be presented to the key stakeholders during the review meetings.

Steps 16, 17, and 18: Implementation

After the pilot study is complete and the appropriateness of the intervention determined, the project will be rolled out to all the units in the facility. Nursing managers are some of the members of the stakeholders. As such, they are kept abreast of the progress of the project through the periodic reports. It is expected that they will recommend for the rolling out of the project to the entire health facility. The findings of the project will be communicated internally through a report presented to the administrator, nursing managers at the unit level and the front level staff. The findings will also be communicated externally through entries in relevant journals. In order to ensure that the project is permanently rolled out in the facility, a task force will be established to monitor the program and also recommend for evidence based changes.

Conclusion

The problem identified in the paper is the job dissatisfaction because of the float assignments. The problem is relevant because it not only affects the turnover of the registered nurses, but also affects the patient outcomes. Evidence has shown that an increase in the average workload of a registered nurse leads to an increase in the probability for patient mortality. In recognition of the significance of this problem, the project recommended a change model that will culminate in the improvement of nursing practice. This will be affected through a pilot study that will involve training of registered nurses from the acute care unit. The nurses will be trained in five other units that use float assignments.

References

Alspach, G. (2003). Nurse staffing and patient outcomes. This is news? Critical care nurse 23(1): 14-15
Bratcher, L. & Madrid, P. (2008). 2008 National teaching institute creative solutions abstracts. Critical care nurse, 28(2): e1-e54.
McKenna, E., Clement, K., Thompson, E., Haas, K., Weber, W., Wallace, M., Stauffer, C., Frailey, J., Anderson, A., Deascenti, M., Hershiser, L. & Roda, P. (2011). Using a nursing productivity committee to achieve cost savings and improve staffing levels and staff satisfaction. Critical nurse care, 31(6): 55-65
NewHouse, R., Dearholt, S. Poe, S., Pugh, L. & White, K. (2007). Johns Hopkins Nursing Evidence-Based Practice Model and Guidelines. Indianapolis, Honor Society of Nursing
Ulrich, B., Lavandero, R., Hart, K., Woods, D., Leggett, J. & Taylor, D. (2006). Critical care nurses’ work environments: A baseline status report. Critical care nurse. 26(5): 46-57.