Case Study 1: Staffing Crisis It’s 9pm on a Saturday evening

Case Study 1: Staffing Crisis It’s 9pm on a Saturday evening in a… Case Study 1: Staffing CrisisIt’s 9pm on a Saturday evening in a small rural hospital where one new nurse, who is only 2 hours into a 12-hour shift, is found by a senior nurse in the break room crying.  The senior nurse looks at the new nurse and says, “whatever got you upset, get used to it honey, the night shift is no walk in the park”, then the senior nurse turns and leaves the room.   For the last year the general medical unit at this 49-bed rural hospital has experienced a 40% increase in staff turnover.  Experienced nurses are leaving for higher paying jobs at larger hospitals and new nurses are given shortened orientations so they can fill the vacant shifts faster.  Four months ago, the hospital hired a new unit director; this is the unit director’s first time in a leadership role with a lassie-fair leadership style.  The medical unit staff was not invited to share their input into this hiring process.  In fact, historically, most of what the staff has to say has gone unnoticed by leadership.  There is no shared governance at this hospital.   The nurses at this hospital are not represented by a union; staffing ratios have been on average 7 patients to 1 nurse on the day shift and 8 patients to 1 nurse on the night shift, with mandatory overtime each week for the past 5 months on both shifts.  There is one nursing assistant for the microsystem per shift.  There are 10 night-shift nurses (LPN and BSN only, no CNL) on staff and only two of these nurses (one LPN one BSN) have worked on the unit for more than 5 years.  On the day shift there are 15 RNs (mix of CNL and BSN), three of whom have worked on the unit for more than 5 years.  The remainder of the nurses were hired within the last 6-9 months, all with no prior nursing work experience.  Only one nurse has worked on the unit for 10 years.  The charge nurse also has a patient assignment during their shift.  With 16 beds on the general medical unit, there are many times when there is no senior staff available as a resource for the newer nurses. At times, this has resulted in jeopardized patient safety.  In the last 3 months there have been 4 falls, 5 medication errors, and 1 hospital-acquired pressure ulcer on this microsystem.  When negative patient outcomes occur the nurses are required by hospital leadership to complete 10 hours of focused in-service training; this training is completed on the nurse’s day off – without pay.  If the nurse does not complete this mandatory training within 3 weeks of occurrence, they risk a documented reprimand and possible termination.   Problem Identification            Mandatory overtime has been a requirement for nurses each week for the last 5 months. During the last 3 months in our microsystem, patients experienced 4 falls, 5 medication errors, and 1 hospital-acquired pressure ulcer and staff turnover rate increased by 40%. Research and studies showed that mandatory overtime for nurses contributes to nurses’ exhaustion, nurses’ errors, poor quality of care for patients, and higher staff turnover rates (Wisconsin Federation of Nurses & Health Professionals, 2012). Describe the evidence-based change you plan to implement as a solution to the problem identified above. Your description must include published evidence that the intervention is likely to improve patient outcomes or process used to deliver care in the health system described in the case study. Health Science Science Nursing NSG 521

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