Saving Lives and Money:
Safe Staffing in Healthcare Saves Lives and Money
by Anne Manchester
There is no doubt. The numbers of health care workers make a difference," said ICN president Hiroko Minami at the launch of this year's IND theme. "Study after study has shown that improved nurse staffing--in numbers and skill-mix--is associated with lower inpatient mortality rates and shorter hospital stays, saving both lives and money. High patient-to-nurse ratios not only have a negative impact on patient outcomes, but also affect the nurses who are at higher risk of emotional exhaustion, stress, job dissatisfaction and burnout." In its Safe Staffing Saves Lives information and action toot kit, ICN states that safe staffing is more than just numbers. Other variables affecting the provision of safe care include workload, work environment, patient complexity, skill Level of the nursing staff, mix of nursing staff, and the links of cost efficiency to patient and nurse outcomes. Preventing adverse events The kit points to growing evidence to support the need for adequate staffing. A Canadian study has shown that a high proportion of adverse events resulting from hospital care (eg falls, drug errors and inappropriate surgeries) were preventable. A higher registered nurse (RN) skill mix corresponded to fewer medication errors and pressure ulcers, and higher patient satisfaction. Medication errors were reduced with a higher proportion of RNs in the staff mix. Another study showed a relationship between full-time-equivalent (FTE) RNs per patient day and urinary tract infections, pneumonia, thrombosis and pulmonary compromise after major surgery. Yet another that the risk of postoperative and pulmonary complications increased if a nurse cared for more than two intensive care esophagectomy patients at night. Most authors have found an inverse relationship between mortality and RNs per patient day, RNs as a percentage of all nursing staff and RNs per hospital. Lower fall rates and higher patient satisfaction levels with pain management have been observed when there were increased RN hours worked per patient. In a 2002 study, more RN hours of care per day were associated with a shorter length of stay in hospital; lower rates of urinary tract infections, upper gastrointestinal bleeding, pneumonia, shock and cardiac arrest; and reduced cases of failure to rescue. In 2005, the Canadian Federation of Nurses Union noted strong empirical evidence demonstrating the Link between inadequate nurse staffing and a range of adverse patient outcomes, including pressure ulcers, urinary tract infections, postoperative wound infections and medication errors. Improving nurses' health Having adequate staff is important because it affects the health of nurses, the ICN kit says. In terms of trying to recruit or retain staff, studies have shown there is a relationship between staffing levels and job satisfaction. A study in the United Kingdom (UK) last year found that high patient-to-nurse ratios were associated with increased risk of emotional
exhaustion and dissatisfaction with current job. Nurses who continuously worked overtime or worked without adequate backup were prone to greater absenteeism and poorer health. Further exacerbating safe staffing is the migration of health care workers from the developing world to the developed. Nurses left behind are faced with very low staffing levels which hinder their ability to provide safe care. Safe staffing is cost effective, says ICN. A Californian study has shown the long-term investment in full-time staff yields cost savings in both recruitment and retention. With good patient outcomes, families and communities benefit and patients are able to return to the workforce, thus contributing to the economy. Recruiting nurses from other countries International recruitment, the kit says, is not an adequate solution to resolving nursing shortages. However, foreign-educated health professionals now make up 25 percent of the medical and nurse workforces of Australia, Canada, the UK and the US. The kit suggests a number of responses to resolving shortages, including: * increasing new nurse supply from pre-registration/training; * improving the retention of current staff; * improving the utilisation of nurses' skills and mix with other staff; * encouraging the return of nurses currently not practising; * examining the scope for ethical international recruitment; * lobbying governments to adequately subsidise the educational system to meet internal demand; and * improving working environments to recruit and retain nurses in challenging work conditions. In the United States (US), particularly among private hospitals, organisations with an adequate number of nurses and physicians are using the size of their staff to increase their competitive edge against other hospitals. Called "magnet hospitals", they are able to use their attractive work environments to recruit and retain staff. Quantifying the work of nurses is an ongoing struggle. "While the tools have been helpful in identifying tasks of nurses, most have not been able to capture the cognitive/intellectual aspects of the role ... thus, while workload measurement tools have been used in safe staffing debate, they are by no means a complete solution to determine safe staffing," the kit states. Safe staffing initiatives can be encouraged in a variety of ways. Legislated nurse-to-patient ratios have been implemented in California and in Victoria, Australia and at least 14 other US states are considering similar legislation. However, the pros and cons for this system are considerable. Instead of legislating safe staffing ratios, some authors suggest that organisations should identify their own definition of safe staffing, based on variables such as acuity of patients, number of ratios and staff mix. The ICN encourages nurses to continue the struggle to achieve safe staffing in their workplaces. Recommended activities include lobbying at work, in communities and nationally for safe staffing levels and healthy working environments; and negotiating safe staffing in collective bargaining agreements. Nurses need to demonstrate why safe staffing is important for their patients' safety and what type of care they can provide when staffed appropriately.
Reflection
The article talks about ba;ancing the baudget and the nursing staffs in a hospital so that total and effective healthcare can be rendered and provided. On the other note, it also tacles the current issue of nursing shortage that has become a serious problem at all levels of nursing. Even at major research and teaching hospitals, chief officers are having difficulty dealing about the issue of scarcity of nursing staff. Unfortunately an overlooked aspect of this nursing shortage is the death of leaders among nurses. Now more than ever, nursing needs competent and dedicated leaders. For some, that is not surprising. However, it is not just the sheer number of nurses at the bedside affecting our leadership problems. The answer is to "develop ones own leadership skills as well as those of ones staff". At nearly every level of nursing, we train nurses on the job to operate complex medical equipment and adhere to administrative procedures. Leadership does not rest merely with administrators and high-level managers, but also can be developed and implemented at the bedside. Nursing has a responsibility to encourage and support new members of the profession, as they become competent clinicians. Nursing must also make them competent leaders. Regarding the leadership theories, the three theories that can be best applied to nursing are the Quantum leadership, Transformational leadership and the Path Goal leadership theory. Quantum leadership is about curiosity to ask questions and discover the process. It requires creativity, flexibility and breakthough thinking to solvethe problem while; Transformational leadership merges ideals of leaders and followers. It promotes change and suites the extremely dynamic health care system. Path Goal leadership theory is about facilitating task accomplishments by minimizing obstructions to the goals and by rewarding folowers for completing their tasks. The leader helps associates to make the most venefcial decisions, reward personnel for task achievement and provides additonal oppotunities for satisfying goal accomplishment. Nurses are often encouraged to take leadership roles. At most nursing schools, there is some type of leadership and management course or lesson in the curriculum. The problem develops that once in the clinical area, there is no follow up. This leadership can come from all levels. With an end to the nursing shortage nowhere in site, nursing does an injustice to itself by not training more leaders.
Comparison of the Three Leadership Theory
Chaos / Quantum Leadership Theory As to power, leadership is about using curiosity to askquestions and discover the process. It requires creativity,flexibility and breakthrough thinking to solve problems. In terms of structure, the system works from the point of service outward. Leadership is about the journey and helping others deal with changes. Leadersneedto do horizontal thinking to develop relationships. As to communications, each worker should add value to the activities. Leaders should plan for errors and manage risks.They should notice changes through interacting with others. Transformational Leadership Theory A style of leadership that promotes change and suites the extremely dynamic health care system. Its focus on change can be directly applicable to nursing. Leaders uses power to unite both manager and employee to pursue a greater good and encourages others to exercise leadership. Its structure stresses on the need for leadership versus management, theimprtanceof values and commitment to service. In relationship, managers can motivate new nurses to submit feedback on how well unit specific procedures are carried out and implemented. The key is to actively listen and institute pertinent suggestions that not only promote client outcomes, but also again help to build a base of leadership with the new nurse. Path Goal Leadership Theory In path-goal relationship and communication, the leader facilitates task accomplishment by minimizing obstruction to the goals and by rewarding followers for completing their tasks. Structure includes planning, organizinnng, directing and contollling through activities such as clarifying expectations of staff associates, scheduling work, making assignments, determining procedures and setting standards.. As to power, leader consideration seems particularly important for routing jobs. The leaders needs to asses needs, explores alternatives, makes the most beneficial decisions and provides additional oppportunities for studying.
Contribution of Leadership Theorists to Nursing
Leadership theorist has their variety of thought and different kind of approaches as to what leadership is all about. It influences a wide range of people that maybe ruling a country, businessman managing his company and in any kind of people under professions requiring organization and management. One of them is nursing. As we all know, nurses also do have leaders in his profession in the form of a chief nurse, head nurses, etc. The leadership theory, a nurse chooses, should reflect her ideals and be one she can most effectively use. Once aware of the existing theories, a nurse can subscribe to whichever fits her personality best. One theorist that influence the nursing practice is Susan O. Valentine writes that nursing can best take advantage of current medical knowledge and recent technological advancements by adopting a "transformational leadership approach." Through this approach, the nurse becomes instrumental in leading the charge toward more effective care in the clinical setting. They are often called upon to make instant life-saving decisions before a doctor can be called on scene. Furthermore, they are also often in charge of deciding how best to approach a patient when it comes to sensitive issues revolving around care. On the other hand, Porter-OGrady (1997), who developed the thought of worker knowledge rose vertically as the worker moved up the chain of command and knowledge bases increase as position increases, concluded that leadership and the knowledge associated with it has shifted. According to him, by permitting some autonomy in their decision-making, we lay the foundation of leadership. New nurses decide appropriate times to call a physician, choose applicable care plans and pertinent interventions. Nurses can be effectively train in this manner by evaluating their decisions with corresponding patient outcomes. During the 1950s, House revealed that leaders who have structures activities for staff associates, generally, had more productive work groups and got higher perfromance evaluations from superiors. This concept of the path-goal theory may be based on the principle of reward system towards the workers from their employers. It is now reflected on the workers over time pay and bonus. Leader consideration seems particularly important for routine jobs wherein workers perform variety of tasks which they may find satisfying and less need for social support.
Chris Argyris (1923), under thesituational leadership theory, intoduced the idea of immaturity maturity continuum which indicates that as people mature, they progress from a passive to an active state and fromdependence to independence. The progression is not always smooth that is why the leader needs to adapt leadership styles accordingly. In the nursing field, maturity towards the profession is an important aspectof being a leader to the group. The leader should have a wide range of experience and theres this requred number of years to be praticing the professionto be competent and proficiently enough to fit the position. Frank Gilbreth (1868-1924) and Lillian Gilbreth (1878-1972) emphasized the benefits of job simplification and the establishment of work standardsas well as the effects of incentive wage plans and fatigue on work performance. In the nursing profession,we understand how important the standards are. They are the guiding principle of thenursing practice that is why the idea has greatly influence the development of the profession. Henri Fayol (1841-1925) had studied the functions of managers regardless of the type ofthe organization ortheir level in the organization, they all ahve essentially the same taskswhich are planning, organizing, issue in orders, coordinatingand controlling. He defined and organizes a the leaders tasks and responsibilities wherein he belives that the managements areall universal. Abrahan Maslow (1908-1970) who conceptualizes the thought of having hierarchy of needstheory, is one ofthe theorist a nurse can neverforget. His theory which outlined a hierarcal structure for human needs is classified into categories. It has been widely used by nurses, especially student nurses, as basis for prioritizing care tothe client when creating a nursing care plan. These theorists are some of the minds reflected by nurses in developing their leadership skills. Studies showed that nurse managers with positive leadership styles, who develop, stimulate, and inspire followers to exceed their own self-interests for a higher purpose and are based on interactions between leader and followers, had moresatisfied staff. As an outcome, patient satisfaction was higher on units where managers used a positive leadership style.
Explanation of Servant Leadership and its application to a student nurse
Servant leadership was developed by Robert K. Greenleaf (1970). It is a philosophy which supports people who choose to serve first, and then lead as a way of expanding service to individuals and other institutions. Servant-leadership encourages collaboration, trust, listening, and the ethical use of power and empowerment. Its concept is like, from being a servant to being a leader or being both at the same time. Some of their duties is to devote themselves to serving the needs of organization members, focus on meeting the needs of those they lead, develop peers to bring out the best in them, listen and build a sense of community, facilitate personal growth in all who they are in contact with and coach others and encourage their self expression. It is as if their giving so much efforts and so much of the doings for the benefit of the group,not thinking just about himself but for the sake of the whole members of the group. From Greenleafs philosophy comes the different ideas and supporting principles like on Larry Spearss work wherein he identified ten characteristics of a servant-leader which are; listening, empathy, healing, awareness, persuasion, conceptualization, foresight, stewardship, commitment to the growth of people and building community. The concept of servant - leadership is very applicable to a student nurse in a way that they somewhat have the ability to lead the group and all of them should have a fair of the responsibilities for the group. Another one is the students leading their clients which is done through health teaching. In that way, we, student nurses, was able to serve others. Serving others, thus, comes by helping them to achieve and improve health. Another good example is the upcoming community immersion of our batch where in,we are tasked to form and train a core group to be able to serve as next leader of health in their community. This activity falls exactly under the criteria of a servant leader which the people served grow as individuals, becoming 'healthier, wiser, more autonomous and more likely themselves to become servants and; the extent to which the leadership benefits those who are least advantaged in society. These only show how great the responsibility of a student nurse, who thought to them as just simple task, can brought about huge change and improvement to the lives of so many people who are in need of our service.
Hardest part of experience as a student leader and how leadership framework might offer ways to reframe a problem and sugggest solutions
Aside from being a leader of our group, Im also a part of a student organization, especifically the Nursing Student Council, for two consecutive terms. I can say that I had a hard time defining my role to the said organization. Being a secretary, I should, basically, be the one working on the records of meetings, filling important documents and arranging the schedule but what is happening is that we do almost all the work that is why it is difficult to prioritize the studies because of the need to attend the responsibilities, same as the other officers. Also, personally, the hardest part is to disseminate the information or tasks to the students or even to the other members of the council; and the responsibility of making decisions for the whole group thats why the ending is that, we took most of the tasks to be done. Having read the different leadership theories and framework, I can say that I can relate through some of the principles that I think can give me solutions to those problems. One of them is the path goal theory wherein it says that the leaders needs to asses needs, explores alternatives, makes the most beneficial decisions and provides additional oppportunities for studying. In that way, I can minimze my problem on schedule and maximize my time for my other priorities like studies. Also, Contingency theory somewhat discusses some of my issues in terms leadership. According to this theory, leadership style will be effective or ineffective depending on the situation. Fred Fiedler identified three aspects of a situation that structure the leaders role: oneis the leader - member relations, task- structure and position power. It somehow fits the probelm but again, this theory can be used to select the proper leadership style based on the given situation. Being a leader, whether in a small group or in a huge organization, is a very hard responsibility especially when youre a student at the same time. Sometimes, you forgot being a student for while just to attend the needs of your group, that is why I, personally, can relate to the thought of servant leadership, most especially when I read what Greenleaf said which goes, True leadership emerges from those whose primary motivation is a deep desire to help others." I can say that servant leadership is a very moral position, putting the well-being of the followers before other goals. Its so true. I know the duty is hard and the problems are tough ans stressing but it becomes fullfiling especially when you finally see the outcome and you hear peoples appreciation of your hardship. Its truly rewarding.
Submitted to:
Dean Liberty E. Alcarion, RN, MAN
Submitted by:
Eloise M. Pateo
NR 41
December 2011
