Identify barriers of implementation of Clinical Guidelines

Identify barriers of implementation of Clinical Guidelines ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Identify barriers of implementation of Clinical Guidelines Name one barrier for each that could impact the implementation of the guideline in practice. And explain how you would work through this issue. Identify barriers of implementation of Clinical Guidelines Additional instruction: Please refer to the peer projects. Please see attached file. Please provide reference within 5 years clinical_guideline_and_implementation_plan_final__red_team.docx work_violence_blue_team.docx chemo_week_7_assignment___yellow_team.docx Clinical Guideline and Implementation Plan Red TEAM November 21, 2017 Clinical Guideline and Implementation Plan Nurses function in high stress environments and may work long hours, while trying to provide safe patient care. Retention of registered nurses becomes problematic when nurses do not receive the support they need to function effectively. This paper addresses retention of registered nurses in the acute care setting. Problem Statement Retention of registered nurses in healthcare poses challenges for an adequate workforce and holistic patient care. Nurses leave or change nursing positions for a myriad of reasons. Among them are inadequate staffing, pay and benefits, stress, and inability to provide care in a way they would like. Interventions need to be taken to retain qualified registered nurses in acute care settings. Nursing retention can cost the hospital between 5.2 to 8.4 million dollars annually (Nursing Solutions, Inc., 2017). Retention of registered nurses is costly and means to improve retention rates should be addressed. Establishing minimum staffing levels can improve nursing retention, save hospitals millions of dollars annually, and improve patient safety. According to the Institute of Medicine’s (IOM) report in 2004, of “Keeping Patients Safe: Transforming the Nursing Work Environment,” patient acuity and skill mix must be considered when creating patient nurse ratios. The American Nurses Credentialing Center (ANCC) reports safe nursing ratios have good patient outcomes reducing nurse overload and burnouts (Buffington, Zwink, Fink, DeVine, & Sanders, 2012). Evidenced-Based Practice Question PICO Question: Do safe nurse-to-patient ratios decrease the risk of nurses leaving positions compared to not having safe nurse-to-patient ratios for registered nurses working in acute care? The population (P) is registered nurses working in acute care.Identify barriers of implementation of Clinical Guidelines The intervention (I) is a safe nurse-to-patient ratio. The comparison (C) is nurses who work without safe nurse-topatient ratios. The outcome (O) is nurses leaving positions. Literature Review The American Nurses Association (ANA) (2015) released an executive summary that looked at optimal nurse staffing and improvement of patient outcomes and quality of care. Appropriate staffing has shown to increase patient satisfaction, safety, and quality, while decreasing mortality rates, readmissions, length of stays, and nurse fatigue (ANA, 2015). Appropriate staffing ratios also improve nurse satisfaction and retention (ANA, 2015). ANA (2017) released evidenced-based key research findings from a literature review on safe staffing. Many research findings were presented supporting safe staffing levels. In a descriptive survey design, factors influencing nurse retention at a Magnet hospital included dissatisfaction of workload and “staffing, nurse-patient ratios, burnout, and stress” (Buffington, Zwink, Fink, DeVine & Sanders, 2012, p. 278). In a correlational, quantitative study by Hairr, Salisburry, Johannsson, and Redfern-Vance (2014), the study looked at links between retention, job satisfaction, and staffing within an acute care environment. The Institute of Medicine (IOM) released a report in 2004, recognizing appropriate staffing levels play a key role in patient safety (Hairr et al., 2014). According to various cited articles in Hairr et al. (2014), literature suggests nurse-patient ratios of 4:1 provide optimal outcomes. Therefore, while patient safety has been documented with appropriate education and numbers of staff, nurse retention is another factor. Although many factors influence retention, nurse satisfaction is a significant component (Hairr et al., 2014). Nurse satisfaction includes appropriate staffing levels. In Hairr et al. (2014), research showed that as dissatisfaction increases, so do thoughts of leaving the workplace. Research Synthesis Nursing retention has become an increasing problem among health care facilities. This can be due to the nurse to patient ratios. Identify barriers of implementation of Clinical Guidelines When there is high nurse turnover, it can cause a financial burden and cost anywhere from $42,000 to $64,000 to replace RNs (Buffington et al., 2012). Nurses who feel overwhelmed in their job or who are facing pressure from not having enough time to get things done, feel unhappy in their job and change jobs (Unruh & Zhang, 2013). The literature recommends three interventions to help improve job satisfaction: autonomy, recognition, and communication (Buffington et al., 2012). With these interventions and safe nurse to patient ratios, nurse retention is increased. Clinical Guideline/Protocol In order to evaluate the patient outcomes on nursing retention and safe patient ratios, data will be collected from patient surveys, quality improvement and safety statistics, nurse exit interviews, and nursing self-evaluations and surveys. The outcomes that will be evaluated will include patient safety, patient and nurse satisfaction, and quality measurements. This data will be collected with support from the Quality and Safety Committee as well as from Human Resources. Implementation Plan The implementation and plan for nursing retention is based upon Maslow’s humanistic needs where safety is the catalyst for (nurse) self-actualization (McEwen & Wills, 2014). Nurses need to feel safe in order to provide quality care as demonstrated by the research. According to Seago (n.d.), when making fundamental changes for provision of safe nursing care, a loss of trust has serious implications for implementation of changes. An inference, based upon Maslow’s hierarchy, is that if a nurse feels safe, the nurse will likely remain in the environment. Like all humans (or animals), when one does not feel safe, one looks to leave to feel safe again. The literature empirically supports how nurse staffing ratios impact the safety of nurses and patients. The leaner the ratios, the higher the medication errors, nosocomial infections, urinary tract infections, and hospital readmissions (Seago, n.d). All of the outcomes consequently result in high dollar fall-outs to a healthcare organization (Seago, n.d.) to include nurses leaving the organization. The plan and implementation for nurse retention in an acute medical-surgical unit is to limit the staffing ratio to no more than four patients to one nurse, with the ability to lower the number of patients to accommodate acuity. Adequate staffing is established by sound methodologies in this case, Maslow, as determined by nursing staff. Once approval is obtained from hospital administration, nursing leadership, and the medical/surgical unit nurses, the proposed plan will be: • Nursing executive support to petition to the Board of Directors the need for safer nurse:patient ratios • Nurse executive to provide the financial implications of higher patient to nurse ratios impacting nursing retention based upon the research • Nursing executives and leadership demonstrate and promote trust in and by nursing staff • Creating a Unit Based Council (UBC) to develop an acuity assignment guide to provide mechanisms to accommodate unplanned variations in patient care workload (Maslow’s respect for others) • Shifting the decision-making process to the direct care nurses thereby empowering and validating the nurses (Maslow’s autonomous thinking) • Identify barriers of implementation of Clinical Guidelines Assign seasoned nurses to precept novice nurses on the medical/surgical unit. This will bridge the gaps in skill sets, thereby, creating a clinically sound commonality of staff. This training period will not impact the nurse:patient assignment (Maslow’s realistic orientation). • Gathering baseline data before and after the dissemination of plan which demonstrates the continuation of assessment in supporting the validity of robust nurse:patient ratios In a controlled environment, the implementation of this proposal will constitute a three-month period. The time frame rationale is based upon 30-day readmissions, hospital reporting for infections, and turnover rate. The time will allow nurse executives, nurse managers, and all key players to gather both human resource retention data and fiscal analysis after the dissemination of the proposed plan. Job satisfaction will consist of a pre-and post implementation job satisfaction survey by all nurses in the medical/surgical unit of interest. The administration will consent to not allowing any float nurses into the unit while the study is occurring. The instrument of choice to measure will be the Assessment of Work Environment Schedule (Edwards et al., 2014). According to Edwards et al. (2014), the instrument has a Cronbach’s alpha of .93. The nurses will access a secure website to take the survey only accessible to the unit’s nurses and only while they are at work. The data will be analyzed using ANCOVA to rule out any preliminary and post implementation unknown variances, one of which to consider is the nurse’s baseline opinion of job satisfaction. A barrier to consider is a nurse finding the time to take the surveys within the allotted time frame both pre-and post. The nursing unit’s managers will ensure the nurses are able to take the on-line surveys at work, only. The completed results of the study will be presented to the hospital’s Board of Directors by the nursing executive, Chief Nursing Officer at the Board of Director’s meeting the month following the finalization of all data. Implementation for this plan will start with evaluating the staffing matrix and dividing care up between discipline specialties. Self-scheduling will be implemented and staffing requirements will be posted for clear understandings of these requirements. Identify barriers of implementation of Clinical Guidelines Decreasing job demands by minimizing interruptions and unpredictability, conflicting demands, adverse work schedules and extended work hours (Twigg & McCullough, 2014). Charting will be evaluated for redundancy and will include evidence-based practice charting. Managers will aim to be visible, accessible and responsive to their staff, and will be rounding daily on patients (Twigg & McCullough, 2014). In addition, daily rounds with case management, charge nurse, primary nurse, and the Hospitalist will occur to improve collaboration, flow of work, and patient care while maximizing quality of care cognoscente of the nurse’s time. Conclusion Despite the strong and accumulating evidence that higher nurse staffing levels in hospitals and nursing homes result in safer patient care, there is wide variation in nurse staffing levels across hospitals (Seago, n.d). Healthcare is a business today according to numerous published data and as evidence by Centers for Medicare and Medicaid’s reimbursement policies. Patient satisfaction does impact hospitals, directly, as well as satisfied nurses. The data clearly demonstrates a direct correlation between nursing satisfaction and lower costs to a hospital (Buffington et al., 2012). The state of California has set a mandate to nurse patient ratios with improved documented patient outcomes, increased nurse satisfaction, and a reduction in nurse turnover rates (National Nurses United, 2017). With adoption of nurse-to-patient ratios, hospitals can improve nurse satisfaction, patient safety, and nurse retention. References American Nurses Association. (2015). Optimal nurse staffing to improve quality of care and patient outcomes: Executive study. Retrieved fromIdentify barriers of implementation of Clinical Guidelines http://www.nursingworld.org/DocumentVault/NursingPractice/Executive-Summary.pdf American Nurses Association. (2017). Safe staffing literature review. Retrieved from http://nursingworld.org/SafeStaffing-LiteratureReview Buffington, A., Zwink, J., Fink, R., DeVine, D., & Sanders, C. (2012). Factors affecting nurse retention at an academic Magnet hospital. Journal of Nursing Administration, 42(5), 273-281. doi: 10.1097/NNA.0b013e3182433812 Edwards, N. E., Beck, A. M., & Lim, E. (2014). Influence of aquariums on resident behavior and staff satisfaction in dementia units. Western Journal of Nursing Research, 36(10), 1309-1322. doi:10.1177/0193945914526647 Hairr, D. C., Salisburry, H., Johannsson, M., & Redfern-Vance, N. (2014). Nurse staffing and the relationship to job satisfaction and retention. Nursing Economics, 32(3), 142-147. Retrieved from Ebscohost database. McEwen, M., & Wills, E. (2014). Theoretical basis for nursing (4th ed.). Philadelphia, PA: Lippincott Williams & Wilkins. National Nursing United. (2017). Safe RN-to-patient staffing. Retrieved from https://www.nationalnursesunited.org/ratios Seago, J.A., (n.d). Nurse staffing, models of care delivery, and interventions. (39). University of California San Francisco School of Nursing. Retrieved from http://archive.ahrq.gov/clinic/ptsafety/pdf/chap39.pdf Unruh, L., & Zhang, N. J. (2013). The role of work environment in keeping newly licensed RNs in nursing: A questionnaire survey. International Journal Of Nursing Studies, 50(12), 1678-1688. doi:10.1016/j.ijnurstu.2013.04.002 Work Place Violence: Blue Group CLC Project Grand Canyon University: NUR 504 Work Place Violence Problem Statement Workplace violence (WPV) against emergency department (ED) nurses has become a nationwide problem and can negatively impact a nurse’s physical and psychological well-being as well as patients’. Evidenced Based Practice Question In the ED, is the implementation of clinical safety protocol decreases the prevalence of WPV? Literature Review and Research Synthesis ENA (2008) defines WPV as “any physical assault, emotional or verbal abuse, threatening, harassing, or coercive behavior in the work setting that causes physical or emotional harm”. According to ENA (2008), 54% of ED nurses surveyed had been verbally abused during a oneweek period and 11% had been physically abused. Risk factors includes inadequate staffing and security, overcrowded waiting rooms, long waits, working alone and directly with volatile patients such as drug, alcohol, or with mental health problems, poor hospital design, and lack of policies and training on managing and preventing violence. Negative consequences of WPV against nurses includes acute stress, post-traumatic stress (PTS) symptoms, decreased productivity, physical injury, and even death (Gates, Gillespie & Berry, 2013). Identify barriers of implementation of Clinical Guidelines Gates and colleague (2013) state that PTS symptoms caused by WPV reduces the ability of ED nurses to cognitively focus on their work in comparison to their ability prior to an episode of violence. Therefore, violence can negatively impact a nurse’s physical and psychological well-being as well as other patients’. Unsafe working conditions are resulting in interference with the ability to provide high-quality care (DeNisco & Barker, 2016). Violence can come from patients, families and visitors and often includes intimidation and harassment that can escalate to physical violence (Sharma & Sharma, 2016). Due to this increase prevalence, many ED nurses have or considered transferring to another department or facility or have even left the profession altogether (ENA, 2008). “Maintaining a safe work environment is a legal and ethical responsibility of health care administrators and nursing leaders” (Copeland & Henry, 2017, p. 65). To increase patient and staff safety, satisfaction, retention and to avoid more violence, stress, and turnover, ED management need to implement stronger policies, provide adequate staffing, increase security, consider structure redesign, and provide staff with proper violence training (Gates, Gillespie & Berry, 2013). Encouragement of staff to report any episodes of violence, advocate for their staff, and to communicate openly about issues and needs related to violence is imperative. Administration needs to educate their staff about the state laws against WPV and the resources available to nurses (ENA, 2008). If nurses are responsible for taking care of others, then they need to be able to take care of themselves. To conclude, WPV and lack of healthcare worker safety is a significant problem in health care and needs to be further addressed because of its impact on patient care and safety, as evidenced by the numerous research articles. Clinical Protocol The following clinical protocol should be followed to make a reasonable effort to prevent WV of any kind and have a safety atmosphere. To be a high reliable organization it is imperative to utilize various Highly Reliable Organization (HRO) tools. To keep an atmosphere which is free from WV when any employee feels concerned they can utilize the following tools: STAR, Stop Think Act Review & CUS, I am Concerned I am Uncomfortable this is a Safety issue. Leaders must immediately respond and investigate any suspicions or knowledge of a current or potential threatening situation. It is appropriate to convene a Threat Assessment Team to include Human Resources, Employee Health, Security and the next level of management. Identify barriers of implementation of Clinical Guidelines Any employee with concerns may be referred to the Employee Assistance Program for further evaluation and assistance regarding counseling and certified treatment. All reports of violence will be taken seriously. The environment is a non-punitive one for those who report, in good faith, any threatening or disruptive behavior. Implementation Plan The implementation plan begins with designing a confidential pre-test, of ten structured questions, to be administered via email to RNs at a Level 1 Trauma Center as a baseline study. Only RNs is to receive the questionnaire. Questionnaires will be emailed, and involvement is voluntary. Results are to be collected and logged by educators. The facility has in place 24- hour security, mandatory de-escalating training for all staff, panic buttons, and controlled badge access to the department. The purpose of this implementation plan of cross- sectional survey is to establish RN exposure to WPV in the ED, barriers to reporting violence, and perceptions of safety, in addition to improve workplace safety related to violence. Implementation plan goal is to improve workplace safety, understand the culture of tolerance and exposure, and identify and reduce barriers to reporting of violence experienced. Timeline The questionnaire will be emailed to all RNs on a Monday. Request to respond is set to two weeks and results will be tallied by ED educators over 1-2 days. Results will be transcribed and reported to ED leadership directors for appropriate follow-up within 1-2 weeks. An appreciation email and results will be sent to RNs for their participation. An action plan will be developed for identified risk, barriers, and areas for immediate action within 2 weeks following department head review. Criteria for Evaluating Outcomes The Centers for Disease Control and Prevention [CDC] outline four types of evaluation techniques; formative, process/ implementation, outcome/ effectiveness, and impact evaluation (CDC, n.d). The criteria for evaluating outcomes of the pre-test structured survey will use the impact evaluation. The criteria for using the evaluation technique, is the results of the survey will be used to provide evidence for policy or funding that can be implemented in the institution related to the action plan goals. Identify barriers of implementation of Clinical Guidelines Barriers, Obstacles, and Drivers for change Barriers to this study include non- participation, single institution assessment, and institutional culture of perceived safety regarding terminology of WPV. Obstacles to getting staff participation could include those on medical leave, vacation, or not willing or able to respond to emailed survey. Other obstacles may be interpreting results in a measurable manner, as some responses may be subjective. To recruit drivers for change, sending an email requesting staff involvement or interest in improving safety in the ED as a team champion, would gain access and cooperation of those that would be implementing change. Requesting ED leadership involvement would also serve as a benefit for drivers of change, as they would provide daily reminders, guidance, and suggest … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10