Nurses play a very important role in the provision of the quality of care in healthcare organizations. However, this is not one of the easiest jobs, explained by the high level of stress and burnout among the members of the nursing staff. The problem is made worse by the fact that the majority of the health care organizations are facing the challenge of shortage of the nursing staff. Based on this reality, the safety and quality of care of the patients is jeopardized (Mancino, 2013). Use of the systems theory can come in handy in providing a comprehension of the problem and the potential solutions for the leaders to implement. Using the theory, the discussion will include the identification of the problem that leads to the desired outcomes and potential solutions to the problem.
Jackson Memorial Hospital
JMH is a tertiary care and teaching hospital situated in the Miami neighborhood of the Civic Center. The hospital provides treatment in a wide range of specialties, including emergency services, surgery, oncology, pediatrics, radiology, pathology, and breast health among many others. The hospital caters for the health needs of diverse populations, including children, adolescents, and adults from different backgrounds and with diverse health problems. The health care organization is one of the many that operates under an open system theory, which is founded on an energy system with input and output, as well as operating within an environment that has an impact on its operations. Within the environment, the inputs undergo a processing activity that leads to the generation of outputs (Meyer & O’ Brien, 2010). The processed information is obtained from the environment within which the external organization operates.
The input is the system of the health care facility, including those operating within it to generate results. JMH has over 1,550 licensed beds, making it a major referral hospital in the region. Among the departments within the hospital, include the Geriatric Mental Health and Detox unit. The geriatric unit is a 20-bed unit with 2 nurses on the floor, a Charge nurse, two mental Health technicians (MHTs) on every 12- hour shift, and a unit secretary from 0800hrs to 1600hrs for both units Geriatric and Detox. After the secretary leaves at 1600hrs, the charge nurse is responsible to do the secretarial job on both units, plus hers. The geriatric floor has one Attendant Doctor from University of Miami, two Fellows MD, and six MD students from University of Miami who are present Monday to Friday from 07:00 Am to 1700. The unit also has three community Doctors with their students who come every day to see their patients. If a patient has a problem, minor issues after 1800hrs the Charge nurse will contact the ER MD that are available 24/7 in the hospital. The Geriatric unit also has a social worker and a case manager Monday to Friday from 0800 to 1700hrs. The Detox unit has one secretary, one nurse, and one mental health technician. In addition, there is one Attendant MD and one fellow with five students from University of Miami.
Throughput refers to the processing activity where the input is processed into output using the energy and information within the environment (Giachetti, 2016). The nurses within the departments have to play an important role beginning from the initial contact with the patient. Among the duties of the nurses include the assessment of the patient coming in for treatment, recording of patient information, taking of the vitals such as the weight and BP, administration of drugs, and provision of different kinds of therapy and interventions. Quality of care offered to patients depends on the quality of the nursing staff. The nurses are also responsible for ensuring that the patients are comfortable while receiving care.
Output is the outcome or product of the processing of the input using the energy and information (Saurin, Rooke & Koskela, 2013). The outcome of the contact between the nurse and the patient is the focus in this case. When the patient enters the health care institution, he/she has expectations to receive safe and quality health care. The outcomes of the health care organizations are an ongoing process given that there are always input as well as the energy and information to process them into outputs (Meyer & O’ Brien, 2010). When the patient comes into the hospital, the experience following the contact with the nurse determines the quality of service and the level of satisfaction. In case the patient is admitted, the continued presence of the nurse is critical. The nurse continues to offer the services until when the patient is discharged. The patient outcome is important for continued service provision by the hospital.
Negative feedback (or balancing feedback) results from some form of disturbance or a change in the input, which causes the output to be fed back into the processing process (Meyer & O’ Brien, 2010). The process causes reduction of the output fluctuations. In the cycle, this occurs in the event that the patient completes a review of the services and gives it back to the nursing staff. The review becomes an important source of information for another cycle of service. The surveys completed show the level of satisfaction and can be used for future improvement of the services provided to the patient.
Problem
The leading problem in my unit is inadequate staffing, leading to challenges in the provision of quality of care to the patients. The ratio of patient to nurses is not adequate, with 20 patients with only two nurses, two mental health technicians, and one secretary operating from 0800 to 1600 in Geriatric mental health units where 95% of the patients are at high risk of falls. After the secretary has left, the charge nurse has to perform the duty of the secretary for both units, plus her duties. In some cases, the nurse fails to notice that the break is long past because of the workload. Taking even one hour of the break means that they can fail to complete the workload. The issue of inadequate staffing is an identifiable problem within my unit. The Detox unit has only one nurse for 10 patients. Those patients can be very critical and should be monitored frequently for alcohol, benzo, and cocaine withdrawn. The same nurse has to meet with the attendant MD, the students MD, social worker, and case manager every morning to discuss the care plan for the patients, and their discharges. Burnout of the nurses becomes a reality because of the huge workload. By the time the nurse has finished the work, she has no energy left to drive home and has to be picked by someone else.
Desired Outcome
The desired outcome is to provide adequate staffing for the units to function optimally (Carayon, Wetterneck, Rivera-Rodriguez, Hundt, Hoonakker, Holden, & Gurses, 2014). One way to resolve the problem is to hire two full-time secretary for both units (geriatric and Detox) to answer the phone calls, schedule appointments, answer the doorbell, order supplies needed for the unit, and address the overwhelming paperwork handled by the Charge nurse. Another solution would be to hire two more MHT. In this case, one extra MHT can assist the nurse with the patients to conduct vital signs, blood sugar and perform activities of daily living. The policies and procedures for the entire facility are to have staffing matrix, which dictates the nurse to patient ratios for each shift depending on patient’s acuity levels. The staffing matrix stipulates that for a certain number of patients, there should be a specified number of nurses, MHTs, unit secretary among others. However, this is the required standard, which has not been achieved in the unit because of the nursing shortage.
Goals, Objectives, and Professional Standards
Among the goals that should be achieved in the unit is to increase the nursing staff for the unit to achieve the standard patient-nurse ratio. Another aspect is to improve the quality of care as a function of the adequacy of the nursing staff. The objective is to ensure that the patients are filling positive surveys after receiving the services at the hospital (Carayon et al., 2014). The nursing leader at the hospital has the role of coming up with policies that enhance increased recruitment of nurses and training of the current nurses to improve performance and the quality of care in the units. Safety and quality of care provided to the patient is one of the standards that should guide the proposed solution. Diversity notwithstanding, all the patients have the right to quality care (American Nurses Association, 2010). The change is in line with the mission of the hospital, which is “To build the health of the community by providing a single, high standard of quality care for the residents of Miami-Dade County” (Jackson Health System, 2017. p, 1). Providing adequate nurses is an important step towards achieving this mission. The nurses will work more effectively to maintain the values of the hospital and build a culture and climate of safe and quality care.
Conclusion
JHS is a health care facility committed to providing high standards of quality health care to the community that they serve. However, this is achievable in the event that there are adequate nurses to provide the care. Hence, increasing the number of the nurses is the definite way of moving towards achieving the vision and mission of the hospital. Application of the systems theory has effectively pointed out the problem leading to the proposal of the solution. Provision of superior services is only possible if the proposed solutions are implemented.
References
American Nurses Association. (2010). Nursing: Scope and Standards of Practice (Second ed.). Silver Spring, Maryland: American Nurses Association. Retrieved from www.nursingworld.org/Nursing-Scope-Standards
Carayon, P., Wetterneck, T. B., Rivera-Rodriguez, A. J., Hundt, A. S., Hoonakker, P., Holden, R., & Gurses, A. P. (2014). Human factors systems approach to healthcare quality and patient safety. Applied ergonomics, 45(1), 14-25.
Giachetti, R. E. (2016). Design of enterprise systems: Theory, architecture, and methods. CRC Press.
Jackson Health System [JHS]. (2017). Mission and vision. Retrieved from www.jhsmiami.org
Mancino, D. J. (2013). Recalculating: the ‘nursing shortage’needs new direction. Dean’s Notes, 34(3), 1-3.
Meyer, R. M., & O’Brien-Pallas L. L. (2010). Nursing services delivery theory: An open system approach. Journal of Advanced Nursing, 66(12), 2828–2838. Retrieved from www.onlinelibrary.wiley.com.ezp.waldenulibrary.org
Saurin, T. A., Rooke, J., & Koskela, L. (2013). A complex systems theory perspective of lean production. International Journal of Production Research, 51(19), 5824-5838.
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