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NUR4837 Health Care Issues, Policy, and Economics Final Examination Fabiola Harman, Jennifer Wingate, Kyla Costello, Melissa Berube , and Michele Moore University of Central Florida

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Jennifer Wingate 1. A "Sentinel Event" has occurred in your facility. Nursing administration and Risk Management are investigating the incident and discuss the principles to be followed in this investigation as well as the evaluation tools that will help them identify all factors that contributed to the event. The Joint Commission was the first to create a standard to a sentinel event in 2000. Their definition to a sentinel event is, an unexpected occurrence involving patient death or serious physical or psychological injury or the risk thereof. Serious injury specifically includes loss of limb or function (Werner, 2011). Joint commission created this standard for when these events occur, that identify the factors that contribute to an event. Administration and risk management will be the ones to step back and look at the full spectrum of circumstances that resulted in the event. The sentinel event is to be reported to the commission after the investigation is complete (The Joint Commission, 2011). The Joint Commission lays out the terms of accepting the root cause analysis that can be used as an evaluation tool for a sentinel event. According to The Joint Commission in 2011, principles to follow when determining a root cause is many. These principles include focusing on processes and standards instead of individuals, digging deeper into the situation and asking the question why, determine processes that possibly contributed which could be prevented in the future, identify the direct factor associated whether human or not, determine potential contributions, and hospital leadership and those closest related to the event are involved (2011). These principles are to be included in the evaluation of a true sentinel event. Processes that can be

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involved in a sentinel event can range from medication management to competency levels of staff, all of which are appropriately evaluated for involvement. Fortunately such measures exists in the medical field such as reporting sentinel events, due to how easy it is for it to occur. But keeping the standards high by continuing to strive for the best quality of care will only improve the future of patient outcomes.

Melissa Berube 2. List and discuss a minimum of 4 factors that are contributing to the current shortage of working Registered Nurses. According to Green, Hatmaker, & Tabone (2008), thousands of job openings in the nursing occupation will open due to a variety of reasons. Many experienced nurses will leave the nursing profession, there will be technologic advances in patient care that cause more patients to access the health care system and cause a need for more specialized care, there will be increasing emphasis on preventive care and there will be a rapid growth in the older population who generally need more nursing care (Green et al., 2008.) The healthcare needs of this older population will begin to intensify at around the same time that experienced nursing staff begin to retire (Fraser, 2011.) Another problem with aging of the current nursing workforce is that there is a decline in younger people choosing nursing as a career (Buerhas et al, 2000 as cited in Glasper, 2011.) As these older nurses retire without sufficient nurses entering the profession to replace them, it will cause a shortage of registered nurses in the future (Glasper, 2011.) Employers need to find innovative ways to keep these experienced workers by making them want to continue nursing (Glasper, 2011.) Another reason there is currently a

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nursing shortage is due to the shortage of nursing faculty to educate them. Vacant nursing educator positions result in an inability to admit a full class of students. This in turn endangers the profession because there is an inadequate supply of nursing professionals to meet the needs of the population (Berent & Anderko, 2011.) The nursing shortage is a worldwide problem. In many countries, the number of nurses who leave the profession every year is more than the number who enter the field (Duffield, OBrien Pallas, & Aitken, 2004a.) Nurses are dissatisfied and leave the profession that leads to an increase in overall workforce turnover and the desire of nurses to return to non-nursing jobs (Aitken et al., 2001 as cited in Gok & Kocaman, 2011.) If we dont do something to solve these problems, there is a projected shortage of 500,000 RNs by 2025 (Buerhas, 2008.)

Fabiola Harman 4. In light of the current nursing shortage, how can organizations ensure their success, patient safety and efficient care provision? Organizations can ensure their success by staffing adequately with the best employees. These employees must be able to plan and schedule tasks accordingly based on their priority. Organizations must be able to stay positive about the goals established. But unfortunately during these dire times of nurse personnel shortage organizations struggle to retain an adequate level of staff. One way that organizations can ensure their success by maintaining an adequate staff level is offer sponsorship programs to nursing prospects. The cost of their school will be paid for if they in turn work for their organization upon graduation. Another way to ensure success and keep

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adequate staff an organization can provide sign on bonuses for nurses who may be thinking of switching organizations. But what can organizations do to ensure patient safety? One way to ensure the safety of patients in the workplace is for the hospital to collaborate with other nursing organizations, for example the Center for American Nurses, or the Association of preoperative Registered Nurses, American Association of Occupational Health Nurses, and even the Emergency Nurses Association and labor unions who represent health care workers. These organizations also work to provide adequate staffing for nurses, decreasing the possibility of on job accidents that provide increased patient safety. Although the health care industry is a dangerous place to work a lot of the pitfalls and perils can be avoided with positive administrative direction. Most of the dangers that effect patients stem back to health care practice. Another way to increase patient safety is for management to enforce safety rules and protocols. This provides a standard for nurses to follow, providing the most efficient care. Decreasing work hours and providing sufficient technology to aid nurses in their task will increase patient safety as well. In order for efficient care to be provided nurses must be capable of quickly diagnosing and assessing a patients condition while providing the appropriate care. Our world is changing rapidly and technology is advancing. In order for nurses to provide efficient care they must be able to keep up with the transformation and adapt to the change. Management can cultivate this and oversee the nurses are keeping up with the progress. But with all this nurses must not lose sight of the core of their profession that is making a connection with the patient and empowering them to recover and lead a

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healthy life. No matter how hectic a workplace can be a nurse must still retain this doctrine and management should in no way jeopardize this relationship.

Kyla Costello 5. The Institute of Medicine (IOM) has produced several reports on the state of the United States' Health Care system. Cite two recommendations from these reports and discuss their potential impact to your practice if they were to be implemented. Also discuss the implications to your practice if they are not implemented. Recommendation 3: Implement nurse residency programs. State boards of nursing, accrediting bodies, the federal government, and health care organizations should take actions to support nurses completion of a transition-to-practice program (nurse residency) after they have completed a prelicensure or advanced practice degree program or when they are transitioning into new clinical practice areas. If nurse residency programs were implemented for every nurse entering professional practice they would enter much more prepared. The clinical experience and textbook information from nursing school cannot compare to real world knowledge. In addition, nurses who moved to a different area of clinical practice would be adequately prepared for the new patient population they are working in. In my practice a uniform nurse residency program would consistently prepare the new nurses, or those new to the unit, to care for our patients. In my current practice the orientation process varies unit to unit and is not a specified nurse residency program. If this was not implemented the nurses

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entering into clinical practice could be using unsafe practices and patients may not receive the best possible care. Nursing skills come from practice and experience, when a new nurse is not given the opportunity to learn hands on the patient outcomes could suffer. Recommendation 4: Increase the proportion of nurses with a baccalaureate degree to 80 percent by 2020. Academic nurse leaders across all schools of nursing should work together to increase the proportion of nurses with a baccalaureate degree from 50 to 80 percent by 2020. These leaders should partner with education accrediting bodies, private and public funders, and employers to ensure funding, monitor progress, and increase the diversity of students to create a workforce prepared to meet the demands of diverse populations across the lifespan. Increasing the proportion of BSN prepared nurse would improve my current practice by giving nurses more knowledge to provide the best possible care to patients and improve outcomes. Furthermore, the recommendation includes organizations to provide tuition reimbursement that would encourage nurse who may not return to school because of financial restraints. Finally, salary differential for a bachelors degree is recommended and would also encourage those hesitant to get their BSN degree, money is a good motivator. This recommendation would foster the idea always learning and staying current with evidence-based practice. Without implementation of this recommendation nurses could get complacent. Nursing would not evolve, care would remain the same and new ideas and practices would not be introduced. Encouraging education to improve individual nurses would benefit the entire nursing profession.

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Michele Moore 7. It is said that there is strength in numbers. Such "Solidarity" even helped break the grip of communism in Poland several years ago. List and discuss at least 2 methods or resources nurses can use to stand together and bargain for collective change. Which option would you consider being the most professional and why? As I was researching solidarity in nursing, I found there has been a movement in place to bring unions into the nursing profession. A group called Service Employee International Union, or SEIU, is pushing for nurses to join unions to ensure a safer working place for nurses ( SEIU.org). SEIU is joining with the American Nurse Association, the National Federation of Nurses, the National Nurses Union, and the American Federation of Nurses as well as other unions to stop the taking of service employee rights and pensions. These organizations are trying to stand up for quality patient care while protecting the public services, like nurses, right to work in an environment with the proper tools, staff and equipment to safely do their job. Wisconsin, for example, is one state that is cutting pensions of service workers to give others tax breaks. This directly affects nurses. Unions are one way to protect us, as nurses. Another way to is to stay informed and involved in groups, discussion boards, magazines and committees within your organization. If you join committees within your hospital, you can voice your concerns; provide feedback to management on what is working and what isnt working. This is also a very professional way to bring up your concerns, praise things that are working and bring information to those who might not

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be aware of what is going on. I find that staying informed on any issues, joining clubs and reading journals is the best way to stay involved. Solidarity comes with knowledge and using that knowledge to protect and benefit your career choice as a nurse. The future of nursing is dependent on the establishment of unions for a safer, more productive work environment. Unions will help with nurse to patient ratio, set salaries based on years of experience across the board and provide a voice for nurses. This person would represent the majority and ensure issues are brought to the attention of the proper parties. This would provide Solidarity in Nursing!!!

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References Berent, G. R., & Anderko, L. (2011). Solving the nurse faculty shortage. Nurse Educator, 36(5), 203-207. doi:10.1097/NNE.0b013e3182297c4a Buerhaus Pl. Current and future state of the U.S. nursing workforce. JAMA. 2008;300 (20);2 Fraser, S. (2011). Are your nurses happy at work? Why it

matters. OR Nurse, 5(3), 6. Glasper, A. (2011). Can older nurses still provide care? British Journal Of Nursing (BJN), 20(18), 1206-1207. GK, A., & Kocaman, G. (2011). Reasons for leaving nursing: A study among Turkish Profession, nurses. Contemporary Nurse: A Journal For The Australian Nursing 39(1), 65-74.

Green, A., Hatmaker D.D., Tabone, S. (2011). Workforce Advocacy and the Nursing Shortage. In B. Cherry & S. Jacob (Eds.), Contemporary nursing: Issues, trends & management (5th ed.), (pp.254-281). St Louis, MO: Elsevier Mosby. KaiserEDU.org Health Policy Explained. (2010) Addressing the Nursing Shortage. Retrieved on December 7,2011 from http:// www.kaiseredu.org/

Issue- Modules/Addressing-the-Nursing-Shortage/Background-Brief.aspx Negri, Richard. SEIU.org, Nurses + Union Solidarity.(7 March, 2011). Retrieved on December 5, 2011 from http://www.seiu.org/2011/03/ nurses-union-solidarity.php

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The Institute of Medicine of the National Academies. (2010). The future of nursing: leading change, advancing health. Washington DC: National Academies Press. The Joint Commission. (2011). Sentinel events. Retrieved from
http://

www.jointcommission.org/assets/1/6/2011_CAMH_SE.pdf

Warner, K. (2011). Quality improvement and patient safety. In B. Cherry & S. Jacob (Eds.), Contemporary nursing: Issues, trends & management (5th ed.),

(pp442-463). St Louis, MO: Elsevier Mosby.