PLEASE GIVE FEEDBACK ON THE FOLLOWING Time

PLEASE GIVE FEEDBACK ON THE FOLLOWING Time and Resource Allocation Timeline There are examples of hospitals who implemented the proposed change of a nurse-patient ratio within a year (McHugh et al., 2021). This proposed change will be initiated January 1st, 2023 and will be expected to be fully implemented by January 1st, 2024. The first three months will be dedicated to discussions with management and administration in order to obtain their approval for the proposed change. Ideally this approval will be obtained by April 1st, 2023. The next three months will be a trial period of changing from a maximum ratio of six patients to one nurse to a maximum ratio of five patients to one nurse. This will help to gradually decrease the ratio while obtaining more staff including travel nurses. By the end of month nine, on October 1st, the change should be fully implemented. This is in hopes of new graduate nurses, however if none are available then travel nurses will be hired to fill in the gaps on the unit to enable the desired ratio of four patients to one nurse. The last three months will be spent on evaluation of the change proposal and initial reactions and changes that may have to occur. Resource Allocation The resources in terms of technology are already in place with the EPIC staff tracking board the staffing office and managers use. Hospital supplies and computers are already sufficient to staff the required nurse-to-patient ratio. There are travel agencies in contact with the hospital already, and they can be contacted for additional travel nurses that may be required. There are fifty registered nurses coming from the Philippines next year to help with staffing throughout the hospital. In order to fill staffing on the unit, the required number of nurses will be calculated for each shift. The number of patients is going to be assumed to be twenty-four at all times, as there are plenty of transfers and admissions to fill empty beds. If there is an isolation room, then a nurse with fewer patients will expect to assist on the unit and at the desk. If there are only twenty patients then there will be five registered nurses, and additional can be floated. If five remain on the unit then it will be capped in order to ensure no nurse ever has more than five patients. The number of nurses assumed to be on the unit at any time will be six. This will mean eighteen nurses on the unit on a given twenty-four hour day cycle. There are full-time, part-time, and per-diem nurses. For the sake of this change proposal, per diem nurses will not be considered as main staff and will be considered as extra. To fully staff the unit for a week, there can be ten part-time nurses for each shift, which includes day shift, evening shift, and night shift. Each shift will have one full time nurse as well. Travel nurses will not have to fill in many gaps in staffing however may have to at times such as when there are emergencies, bereavement periods, and ill calls that prevent staff from going to work. Each staff nurse makes between $50,000 and $60,000 each year, and travel nurses make about three times that at the institution being analyzed. Conclusion In recent years during the Covid-19 pandemic, the long-present issue of nurse staffing shortages has become even more prominent (Griffiths et al., 2018). Research has shown that staffing shortages are linked to increased adverse events such as patient falls, hospital-acquired pressure injuries, hospital-acquired infections, medication errors, and omissions in care (Kouatly et al., 2018). Staffing shortages also have proven to decrease staff and patient/family satisfaction (Kouatly et al.). A major facet of nurse dissatisfaction is the feeling among nurses that their workload and patient load are too high (Griffiths et al.). The New York State Nurses’ Association as well as the American Nurses’ Association support a ratio of four patients to one nurse on a medical-surgical unit (Furillo, 2022). In order to achieve this proposed change support and buy-in will have to be obtained from the various stakeholders involved in United Health Services, which include patients, family members, nurses, nursing assistants, management, and most importantly administration amongst others. Lippitt’s Phases of Change Theory was utilized in order to achieve the proposed change to a safe staffing ratio of one nurse to four patients. Factors that affect implementation include the number of available staff, finances, acuity, and diversity among other factors. These factors were addressed in a way that would benefit the unit and patient safety first and foremost, as well as in ways that would ensure staff safety by adhering to the one-to-four ratio. When implementing the proposed change, benchmarks were analyzed such as staff retained and patient safety outcomes including the number of adverse events such as falls, pressure injuries, infections, and patient satisfaction. Feedback from staff, administration, and patients will be heavily considered. This feedback will be obtained through pulse and regular monthly surveys. The timeline for the proposed change was laid out, with full implementation expected one year from the start of the change and will result on January 1st, 2024. All of the technological resources are already in place with the recently implemented EPIC system. Human resources will come mainly from home staff and graduate nurses, with travel nurses hired to fill in the gaps. Overall, implementation of the proposed change will primarily depend on staff involvement and will serve its ultimate purpose of making this unit a place where both staff and patients feel safe and accounted for. SCIENCE HEALTH SCIENCE NURSING NUR 490

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