Nursing Practice Of The Acute Care Arena

In the past two decades, there has been a push for appropriate staff to client ratios. However, measuring client needs and nursing efforts have been around since 1922 (Lewinski-Corwin, 1922, pp. 603-606). The earliest recorded effort was by the New York Academy of Medicine. Superintendents and nurses from ten training schools documented the time spent providing bedside care. From complied information, the researchers revealed each client required an average of five hours and four minutes of care in a 24-hour period. From these observations, they evaluated staffing issues in New York City. At that time, none of the hospitals were sufficiently staffed (Lewinski-Corwin, 1922, pp. 603-606).

In the traditional health care model, formal learning is not complete when a physician receives their medical degree and white coat at the end of their academic program. Medical school graduates are required to complete an accredited hospital residency program to become licensed to practice medicine, (Jolly, Erikson, & Garrison, 2013). However, acute care nurse practitioners (ACNPs) are not afforded, nor expected to complete, the same educational requirements. The current expectation that a new graduate ACNP learn their advanced nursing role “on-the-job” is unacceptable and leads to decreased job satisfaction and preparedness. In the every-changing climate of health care, the development of required residency programs for ACNPs should be maintained as a priority.

For over a decade researchers have been performing studies examining the effects patient-to-nurse ratios have on adverse outcomes, mortality rates, and failure-to-rescue rates of patients and on job dissatisfaction and burnout experiences of nurses. Aiken, Sloane, Sochalski, and Silber (2002) performed a study which showed that each additional patient per nurse increased patient mortality within 30 days of admission by 7% and increased failure-to-rescue by 7% as well. This same study also showed that each additional patient per nurse resulted in a 23% increase in nurse burnout and a 15% increase in job dissatisfaction. Additionally, Rafferty et al. (2007) performed a study in which the results showed that patients in hospitals with higher patient-to-nurse ratios had a 26% higher mortality rate and nurses were twice as likely to have job dissatisfaction and experience burnout. Blegen, Goode, Spetz, Vaughn, and Park (2011) performed a study where results showed that more staffing hours for nurses resulted in lower rates of congestive heart failure morality, infection, and prolonged hospital stays. The same study also showed that increased nursing care from registered nurses resulted in lower infection and failure to rescue rates and fewer cases of sepsis.

While uncertainty about the role of an Adult-Gerontology Acute Care Nurse Practitioner (AG-ACNP) persists, what research has found about the role is that AG-ACNP’s provide advanced nursing care to those who are acutely, critically or chronically ill in both traditional and nontraditional healthcare settings (Kleinpell et al., 2012). Standard of scope differs between all types of scopes and nurse practitioners alike. The scope of practice (SOP) for an Acute Care Nurse Practitioner (ACNP) is not based on practice setting, but rather what type of care the patient will need, for example, someone who needs ventilator management in either the home or hospital environment (Kleinpell et al., 2012).

The results of the study showed that significant increase in patient satisfaction scores, decreased call light usage, and reduction in patients fall rates. One-hour rounding shows higher satisfaction than two hour- rounding. Hypothesis supported the study because the research shows rounding can reduce patient call light usage (Meade, Bursell, Ketelsen , 2006). The theoretical framework that forms the basis of the research is that consistent nursing rounds can meet the basic needs of patient and ultimately reduce call light use and [pic]improve management of patient care while also[pic] increasing [pic]patient satisfaction and[pic] safety.

Hourly rounding, also known as “intentional” or “comfort” rounding is essentially when the nurse or tech routinely checks on a patient at scheduled times to anticipate individual needs prior to the activation of the call bell alarm (Harrington et al., 2012). In a recent study, authors imply that hourly rounding is an effective process for improving patient satisfaction and clinical outcomes (Brosey and March, 2015). I feel that the implementation of hourly rounding will improve multiple aspects of care, including patient and nurse

The American Association of Critical-Care Nurses, state that there are several factors that lead to successful, healthy work environments. “The ingredients for success — skilled communication, true collaboration, effective decision making, appropriate staffing, meaningful recognition and authentic leadership” (American Association of Critical-Care Nurses, 2016, para. 4). However, I have to disagree to the idea that the nurses’ work environments are totally at blame. What are the main causes of unhealthy work environments? There are several elements that lead to unhealthy work environments such as job stressors, different work environment perceptions, and unique employee characteristics.

Hourly rounding is a strategy involving nurses and other health care staff to regularly “check in” on patients every hour. Because nursing staff is not reacting to call lights, patients are more content and happy; therefore nurses feel they are doing a better job helping their patients (Studer, 2007). Research has shown that rounding every hour lowers patient’s use of call lights and resultantly decreases the workload of the nurse (Leighty, 2007; Meade, Bursell, & Ketelsen, 2006; & Tipton, 2008). Performing hourly rounds has contributed to 20% less walking per shift

A change that a nurse manager could implement that would help improve patient care is hourly rounding. In order to implement this change successfully, the nurse manager needs to clearly communicate the expectations, and then follow up with good monitoring. When the nurse manager sees the staff meeting the expectations the staff should be acknowledged rewarded/recognized and celebrated. On the other side, if the staff is not meeting the expectations they should be reminded, coached, and counseled. Sticking to the communicated expectations can have powerful results when the nurse manager diligently and consistently puts the plan into practice.

Inconsistent nurse-patient ratios are a concern in hospitals across the nation because they limit nurse’s ability to provide safe patient care. Healthcare professionals such as nurses and physicians agree that current nurse staffing systems are inadequate and unreliable and not only affect patient health outcomes, but also create job dissatisfaction among medical staff (Avalere Health, 2015). A 2002 study led by RN and PhD Linda Aiken suggests that "forty percent of hospitals nurses have burnout levels that exceed the norms for healthcare workers" (Aiken, Clarke, Sloane, Sochalski & Silber, 2002). These data represents the constant struggle of nurses when trying to provide high quality care in a hospital setting.

Hourly rounding can be defined as proactive nursing intervention, at regular intervals in order to ensure patients needs have been met. Nurses attending to patients’ comfort, safety and

Patient satisfaction has been identified as a key determinant of quality care under the Centers for Medicare and Medicaid (CMS) value-based purchasing program. Hospital Consumer Assessment of Healthcare Providers and Systems (HCHAPS) is a publicly reported survey providing a national standard for collecting and reporting data. HCHAPS has become an important determinant for satisfaction of care received in hospitals. Frankfort Regional Medical Center (FRMC), a 170-bed tertiary care hospital located in central Kentucky, is acutely aware of the importance of maintaining high quality care reflected in patient satisfaction scores. In an effort to improve patient satisfaction scores related to nursing specific indicators, bedside reporting was introduced in 2012. Despite its introduction, HCHAPS scores showed no improvement. Harrington et al. (2013) established that nurses more often react to patient problems rather than focusing on preventing problems. Brosey and March (2014) proposed that “hourly nurse rounding is an effective method to improve patient satisfaction and clinical outcomes” (p.1). This paper would propose the implementation of a structured process of intentional rounding (IR) in an effort to improve patient satisfaction, patient safety, and quality of care.

Barry Hill (2017) performed studies related to the quality of care that patients receive and what factors are associated with those perceptions. One area that was noted to be of importance and directly related to quality of care provided to patients is staff dissatisfaction and burnout. This study also found that longer shifts contributed to increased amounts of emotional exhaustion leading to decreased quality of care for patients. Addressing staffing needs early and intervening can decrease the amount of nurse burnout and dissatisfaction that is often seen. This study has shown that hiring additional competent nurses reduces medication errors, falls, infections, wounds, and decreases hospital litigation costs, while improving staff morale, patient experience and care, and cost-effectiveness for the hospital.

Hourly rounding contributes in several key areas to achievement of high levels of patient satisfaction, including quality of care and patient safety. This puts patients at the center of care by building on the fundamental aspects of care, which are so important. Thus by checking in on patients in wards regularly to see whether they are comfortable and have everything they need can produce a number of positive results. Nurses

According to Barton (2013), establishing an acuity-based core staffing model is a delicate balance between enhancing patient safety and provider productivity while also optimizing organizational costs (Barton, 2013). According to Barton (2013), the true benefit of an acuity-based, data-driven staffing management system is flexibility enabled by real-time information. Barton argues that more than mandatory staffing, nurses with adequate support and manageable work levels report increased satisfaction; and patient care, quality, and safety is optimized (Barton, 2013). I agree with Barton’s view of nurse staffing. Having worked in the intensive care unit for 18 years, I have seen how appropriate staffing improved the quality of patient care.