NURS 8100 Agenda Setting
I am the head of the Nurse Peer Review Council at my workplace. We look at problems that come up from clinical practice issues that haven’t been solved. In the first two months of 2022, we’ve looked at clinical practice issues like how nurses hand over their work to the next nurse, not having enough staff, and not following the chain of command when things go wrong.
I’ve been in charge of perinatal services for more than 10 years. During my time as a leader, I’ve noticed that the number of patients per nurse in perinatal services doesn’t match the guidelines from the Association of Women’s Health and Neonatal Nursing (AWHONN). These guidelines were made in 2010 to make sure patients in the perinatal period get the right care depending on how sick they are (Simpson et al., 2019). But the people who manage the hospital’s money don’t get why this is important, and they often ignore these guidelines to save money.
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These guidelines look at different kinds of medical conditions and how sick patients are and put them in different groups. They also say how many nurses should take care of each group. For example, a patient pushing during labor should have one nurse just for them, but three patients in triage can have one nurse. The problem is that patients can get sicker or less sick during labor, and this is hard to plan for if you want to use nurses effectively. This is even harder if the hospital has to make a certain amount of money and the number of nurses doesn’t match what patients really need. This means patients don’t get the best care, and it’s bad for mothers, babies, and the nurses taking care of them (Simpson, 2016).
Right now, I’m working with a specialist to test a program in the healthcare system. This program checks if we have enough nurses based on the AWHONN guidelines. We’ve collected data for eight months and made a presentation for the leaders of the hospital. This presentation tells them when we need more nurses to make sure mothers and babies get safe care.
I’ve used some strategies from an agency for healthcare and research quality toolkit (AHRQ). These strategies include having a good plan and getting the right people on the team, finding someone who really believes in the project, talking regularly with the people involved, and moving through the steps of the project in an organized way (www.ahrq.gov). When you do this, you end up with a clear presentation that shows why we need to make a change. It’s important to show why the change is needed for safety but also for the hospital’s money and how things work day-to-day.
References:
Agency for Healthcare Research and Quality. (October, 2014). Designing and Implementing Medicaid Disease and Care Management Programs. Retrieved from https://www.ahrq.gov/patient-safety/settings/long-term-care/resource/hcbs/medicaidmgmt/mm2.html
Simpson, K. R., Lyndon, A., Spetz, J., Gay, C. L., & Landstrom, G. L. (2019). Incorporation of the AWHONN Nurse Staffing Guidelines into Clinical Practice. Nurse Women’s Health, 23(3), 217–233. https://doi.org/10.1016/j.nwh.2019.03.003
Simpson, K. R., Lyndon, A., & Ruhl, C. (2016). Consequences of inadequate staffing include missed care, potential failure to rescue, and job stress and dissatisfaction. Journal of Obstetric, Gynecologic & Neonatal Nursing, 45(4), 481–490. https://doi.org/10.1016/j.jogn.2016.02.011
Clinical Practice Issue: Frequent Admissions due to Poor Discharge Nursing Education
Reducing the number of times patients have to come back to the hospital after being discharged is a significant goal in healthcare. To make this happen, patient discharge education is becoming increasingly important. According to Polster (2015), almost 20% of Medicare patients go back to the hospital within 30 days of leaving, and 34% go back within 90 days.
The quality of the education patients get when they leave the hospital is connected to how often they end up back in the hospital. Nurses are usually the ones responsible for teaching patients and their families (Luther et al., 2019). But there are problems. There isn’t always enough time, and patients and families can get overwhelmed. Sometimes, patients have more than one health problem, which makes taking care of them at home even harder (Luther et al., 2019). We need a structured way to help hospitals get better at this and reduce the number of patients coming back to the hospital (Luther et al., 2019).
The Centers for Medicare and Medicaid Services (CMS) want nurses and the healthcare team to do things that can stop patients from coming back to the hospital. These things include not sending patients home too early, making sure they get the right follow-up care, giving them the right treatments, making sure they don’t have problems with their medicines, and making sure the handoff from one healthcare provider to another goes smoothly (Polster, 2015). The policy I’m interested in focuses on making sure the handoff goes smoothly and that patients get the right education before they leave the hospital. Bad handoffs and poor education are linked to problems with individual healthcare providers, patients, how providers work together, and the support they get from their organization (Hesselink et al., 2014). Healthcare providers can reduce how often patients come back to the hospital and have bad outcomes by giving patients the right information when they leave, making sure care is well-coordinated, and talking to their colleagues in a timely way (Hesselink et al., 2014).
Strategies to Inform and Persuade Stakeholders
There are several strategies to inform stakeholders about the importance of the clinical practice issue I’m interested in. First, we need to establish the policy we want and who the stakeholders are. These stakeholders include clinical nurses, doctors, patients, pharmacists, quality and safety people, nursing managers and directors. Once we know what policy we want and who the stakeholders are, we should listen to what the stakeholders have to say. What they think is important should be considered. Knowing what to expect from our changes can help us make our plan better and get new ideas. Sharing our ideas with key stakeholders can make us more united in our goal to improve discharge education and reduce frequent admissions (Hyder et al., 2010). Having stakeholders involved in all stages of our research and policy-making is really important.
We also need to build connections between different people and groups who are involved. This helps make a strong link between research and policy (Hyder et al., 2010). Another strategy is to use policy briefing to show why this is important. This way, we can use research evidence to explain why we need to make a change (Lavis et al., 2009). We need to show that good education when patients leave the hospital can really help reduce how often they come back. This will help our patients and our hospital in the long run.
Employee Satisfaction and Retention
In any organization, the happiness of the employees is a big factor in how well the organization does. Nurses and other healthcare workers are the heart of the healthcare system. Right now, many nurses are looking for new jobs because they want better pay, a better work-life balance, more flexibility, and safer staffing levels. Healthcare systems are losing lots of nurses while the need for them is going up. The turnover rate in healthcare is around 8.8% to 37.0%, depending on where you are (Haddad et al., 2022). According to The American Nurses Association (ANA), there will be more nursing jobs available by 2022 than any other profession in the United States. The US Bureau of Labor Statistics says we need more than 275,000 nurses from 2020 to 2030 (Haddad et al., 2022).
Dr. Kathleen White and Dr. Joan Stanley talk about the theory of setting an agenda. They say that making a formal policy to deal with important issues is important (Laureate Education, 2011). Dr. Kathleen also talks about how to get a policy accepted and what to think about before making a policy (Laureate Education, 2011). Getting people to work together is key to making changes. You can’t make a new policy without getting the people who do the work every day to help make it. In this case, the staff are the ones who do the work. Stakeholders are people and groups who are part of an activity because they help make, use, manage, regulate, or check it (Hyder et al., 2010). What they think is really important because it can help with making policy.
Listening to the people who do the work every day is really important for making the hospital better. At my hospital, we ask the nurses what they think every year. This helps us know what they need and want. Sometimes, we make changes to our policies based on what the nurses say. Last year, nurses and patient care technicians said they needed more flexible scheduling to help them do their jobs better. They said they couldn’t leave work on time and had trouble planning their lives because of the way the schedule worked. Hospital leaders talked about how to make the nurses’ voices heard. They changed the schedule to have shifts that were 4 hours long, which helped them have more people working. The nurses said that this made them happier and healthier. It didn’t cost any extra money, but it helped keep the nurses at the hospital and made them want to work there. It also made the hospital look better for people who wanted to work there.
References
Haddad LM, Annamaraju P, Toney-Butler TJ. Nursing Shortage. [Updated 2022 Feb 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK4931
Hyder, S. Syed, P. Puvanachandra, G. Bloom, S. Sundaram, S. Mahmood, M. Iqbal, Z. Hongwen, N. Ravichandran, O. Oladepo, G. Pariyo, D. Peters, Stakeholder analysis for health research: Case studies from low- and middle-income countries, Public Health, 124 (3), 159-166
Walden University, LLC. (Executive Producer). (2011). Healthcare policy and advocacy: Agenda setting and the policy process. Baltimore: Author.
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