Capella 6030 Assessment 6

Final Project Submission

Name:

Capella University

School of Nursing and Health Sciences, Capella University

NURS-FPX 6030: MSN Practicum and Capstone

Prof. Name:

Date

Final Project Submission

Abstract

The capstone project aims to propose an intervention to address the issue of nurse burnout and its direct link to poor patient outcomes. The proposed intervention focuses on improving the nurse-to-patient ratio in the long-term care units of Minnesota hospitals to enhance nurse well-being and patient care experience. Nurse burnout in the post-COVID era has led to adverse effects on nurses’ physical and mental well-being, decreased job satisfaction, increased nurse turnover, and compromised care quality (Sullivan et al., 2022; Kelly et al., 2020).

The approach adopted for the intervention aligns with the recommendation of the American Nurse Association (ANA), which suggests a nurse-to-patient ratio of 1:4 for long-term care units and 1:2 for emergency departments (Ohbe et al., 2022). The anticipated outcomes of the intervention are a reduction in nurse burnout and an improvement in patient care experience, leading to better patient safety, cost-effective care, and reduced readmission rates.

Organizational Change

The proposed organizational change centers around improving the nurse-to-patient ratio to enhance nurse well-being and patient outcomes. By reducing burnout rates and workload, the intervention seeks to improve the overall health and efficiency of nurses, ultimately benefiting the patients’ care experience, safety, and overall health outcomes.

Introduction

The project will be conducted in Minnesota hospitals, targeting nurses through random sampling. The evaluation of the intervention will involve regular visits to the hospitals and the use of emerging technology, such as dashboards, questionnaires, online forms, and surveys, to collect essential data on the effectiveness of the plan.

Evaluation of the Best Available Evidence

To support the decision-making process, the project incorporates evidence from credible journals and reliable studies. Data from reputable databases like PubMed, Medline, and Google Scholar were utilized. For instance, Ametz et al. (2020) highlighted the urgent need for improving the nurse-to-patient ratio, as excessive workload was found to negatively impact nurses’ mental well-being, leading to traumatic experiences and job dissatisfaction.

Overall, the proposed intervention holds promise in addressing nurse burnout and its subsequent impact on patient outcomes, promoting better healthcare delivery and enhancing the well-being of both nurses and patients.

Problem Statement (PICOT)

Need Statement

The Covid-19 era has exacerbated the issue of nurse burnout, further impacting patient outcomes (Leo et al., 2021). To combat this challenge, this capstone project aims to propose an evidence-based intervention focused on improving the nurse-to-patient ratio in long-care units of Minnesota hospitals. The project seeks to address not only nurse well-being but also patient care experience and associated costs related to burnout.

Rationale for the Intervention

Nurse burnout resulting from an increased nurse-to-patient ratio has far-reaching consequences, affecting nurses’ health, patient outcomes, and overall hospital performance. Notably, nurse burnout leads to reduced job satisfaction, compromised care quality, higher nurse turnover, increased medication errors, and diminished patient satisfaction (Dall’Ora et al., 2020). The evidence by Kelly et al. (2020) highlights the negative impact of burnout on nurse satisfaction and reveals a significant 12% increase in nurse turnover due to burnout. Ryu & Shim (2021) demonstrated a negative correlation between nurse burnout and patient safety management services, resulting in lower care quality. Additionally, Montgomery et al. (2020) found nurse burnout to be a contributing factor to medication administration errors, emphasizing the urgency of addressing this issue. The study by Muir et al. (2021) further highlights the financial burden on hospitals, with an estimated cost of $16,736 per nurse annually due to nurse turnover.

Target Population and Setting

The targeted population for this intervention includes nurses in the state of Minnesota. The rationale behind addressing nurse burnout in this population stems from the serious concerns associated with the problem. During the COVID-19 pandemic, Minnesota hospitals faced resource shortages, including nursing staff, leading to excessive workloads and burnout among nurses. Ruiz-Fernández et al. (2020) highlighted the adverse effects of nurse burnout on mental well-being, resulting in complications such as anxiety, stress, depression, and sleep problems. This not only hampers nurses’ ability to provide compassionate care but also impacts the overall quality of care and health outcomes for patients, making it imperative to address nurse burnout among Minnesota nurses.

Long-care units were chosen as the setting for the intervention due to the excessive work burdens and responsibilities faced by nurses in these units compared to other areas. Almenyan et al. (2021) emphasized the association between excessive workload, nurse exhaustion, and increased inpatient mortality. Similarly, Kostka et al. (2021) found significantly higher stress levels among long-care unit nurses, contributing to burnout. Addressing nurse burnout in these settings is crucial to improve overall nurse well-being, patient care outcomes, and hospital services.

Nurse burnout has become a significant concern, particularly in the post-COVID era, impacting both nurses’ well-being and patient outcomes (Leo et al., 2021). To address this issue, this capstone project proposes a quality improvement intervention focused on reducing nurse burnout by improving the nurse-to-patient ratio in Minnesota hospitals. Additionally, meditation strategies will be integrated to support nurses’ mental health and well-being.

Intervention Overview

The primary intervention to reduce nurse burnout among nurses in Minnesota is the improvement of the nurse-to-patient ratio. The intervention aligns with the American Nurse Association (ANA) recommendations, such as a ratio of 1:2 in critical care units and 1:4 in emergency units (Chen et al., 2019). Nurses will be selected through a sampling method, and their burnout levels will be evaluated through routine visits before and after the COVID era. The targeted settings are long care units, where nurses often experience excessive workloads and stress, leading to burnout (Eltaybani et al., 2021).

Comparison of Approaches

Another intervention to reduce nurse burnout is the implementation of meditation practices, including yoga, stress-relieving massage, meditation, and mindfulness. This approach is flexible and requires minimal time, making it suitable for nurses to practice amidst their busy schedules. Green & Kinchen (2021) demonstrated the positive effects of mindful meditation on reducing nurse burnout, including work-related trauma, stress, and high workload. While the nurse-to-patient ratio improvement addresses burnout by lessening workload, the meditation intervention focuses on reducing stress and emotional exhaustion (Chen et al., 2019).

Initial Outcome Draft

The intervention aims to reduce nurse burnout in Minnesota by improving the nurse-to-patient ratio. By achieving this, nurses’ mental and physical well-being will improve, resulting in better patient outcomes and overall healthcare service quality (Reith, 2018).

Time Estimate

Developing the intervention is expected to take approximately two months, including literature review and analysis of effectiveness. Implementing the intervention will require one year, allowing sufficient time for activities such as nurse sampling, data analysis, and indicator evaluation (Chen et al., 2019).

Interprofessional Care to Improve Safety and Quality

Interprofessional collaboration will play a vital role in reducing nurse burnout and improving patient safety and care quality (White-Williams et al., 2021). By encouraging mindfulness and meditation practices, nurses can better collaborate and communicate with other healthcare professionals, enhancing interprofessional team performance and overall healthcare outcomes (Kelm et al., 2018).

Literature Review

Existing evidence supports the need to address nurse burnout, with high nurse-to-patient ratios identified as a significant contributor (Reith, 2018). Ametz et al. (2020) highlighted the prevalence of mental well-being issues among nurses, with 40% experiencing trauma and 50% contemplating leaving their jobs. Meditation practices, such as mindful meditation, have shown positive effects on reducing nurse burnout and improving overall well-being (Green & Kinchen, 2021).

Health Policies Impacting the Need

Health policies, such as the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act, play a crucial role in addressing nurse burnout by standardizing nurse-to-patient ratios in different care units (Clipboard Health, 2021). Research conducted in Australia showed improvements in nurse staffing and patient outcomes after the implementation of improved nurse-to-patient ratios (McHugh et al., 2021). Additionally, the Affordable Care Act aims to increase health coverage for patients, putting pressure on nurses to provide high-quality care, which can contribute to burnout (Nurse Journal Staff, 2020). However, studies have shown that addressing nurse burnout through improved nurse-to-patient ratios can be effective in mitigating these effects (Courtemanche et al., 2018).

Intervention Plan for Patient and Population Centered Care

Intervention Plan Components

The major components of the intervention plan are reducing the nurse-to-patient ratio, implementing the intervention, and evaluating its effects. The nurse-to-patient ratio will be reduced to 1:3 in long-term care units and 1:2 in emergency care units (Chen et al., 2019).

When the ratio is reduced, nurses will have less workload and experience less work-related stress or burnout (Chen et al., 2019). The implementation of the plan will focus on ensuring its effectiveness in reducing nurse burnout and its associated health outcomes. The evaluation of the plan will allow the organization to assess the improvement in nurse burnout and patient health outcomes after the intervention. Additionally, the intervention is expected to enhance nurse-patient communication, nurse efficiency, patient-centered care, and overall health outcomes (Wang et al., 2018).

Impact of Cultural Needs on the Intervention

The targeted nurses in Minnesota belong to diverse racial and cultural backgrounds, including White, Hispanic, Black, Non-Hispanic, and Latino populations (MN Compass, n.d.). Additionally, the nurses may include both male and female professionals, some of whom may also be parents. These cultural needs and characteristics of the targeted nurses require attention and consideration during the development of the intervention. Assigning tasks and patients based on cultural needs, beliefs, and values will enhance patient-nurse interaction, performance, and health outcomes (Swihart & Martin, 2021). Cultural competence is also essential in meeting the healthcare needs of patients from diverse backgrounds and ensuring patient-centered care (Lee et al., 2020).

Theoretical Foundation

The Conservation of Resource Theory Model justifies the intervention by highlighting the adverse effects of nurse burnout on nurses’ performance and efficiency (Xia et al., 2019). The reduction in the nurse-to-patient ratio is justified by evidence suggesting that improved ratios enhance clinical and economic outcomes, including patient satisfaction, cost-effective care, and reduced burnout and errors (Sharma & Rani, 2020). The theory also emphasizes the need to protect nurses from burnout to improve patient outcomes and healthcare quality.

The United States Medical Licensure examination recommends strategies such as exercise, relaxation breaks, healthy eating, sleep, and limiting study hours to reduce nurse burnout (Shreffler et al., 2020). These strategies align with the intervention, as an improved nurse-to-patient ratio will allow nurses to take time for self-care and stress reduction, ultimately reducing burnout.

Healthcare Technologies

Healthcare technologies, such as electronic health records (EHR), dashboards, online portals, and forms, will be utilized for data gathering and evaluation during the intervention. EHR will be used to collect patient data before and after the implementation of the plan (Aguirre et al., 2019). Dashboard metrics will assist in monitoring the efficiency of the plan (Helminski et al., 2022). Online forms will be used to gather patient experience feedback and nurse perceptions of the intervention.

Justification of the Components of the Intervention

The Conservation of Resource Theory Model justifies the intervention by explaining the impact of nurse burnout on nurses’ performance and emphasizing the need for an improved nurse-to-patient ratio to protect nurses and improve patient outcomes (Xia et al., 2019). Evidence also supports the effectiveness of an improved nurse-to-patient ratio in enhancing clinical and economic outcomes (Sharma & Rani, 2020).

Stakeholders, Policy, and Regulations

Relevant stakeholders, including patients, nurses, community members, hospital staff, and members of the finance department, have specific needs that will be addressed by the intervention (Karaca & Durna, 2019). The implementation of the intervention aligns with the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act, which emphasizes the importance of nurse-to-patient ratios in different care units (McHugh et al., 2018). The policy aims to improve nurse workload and burnout, leading to enhanced patient outcomes and cost reduction.

Ethical and Legal Implications

Nurse burnout is associated with improper health practices, ethical dilemmas, and reduced decision-making abilities, potentially leading to patient safety and legal concerns (Palazoğlu & Koç, 2019). Addressing nurse burnout through the intervention can help mitigate such issues and improve overall patient care and outcomes (Antonsdottir et al., 2021).

Implementation Plan Management and Leadership

Transformational and Laissez-faire leadership strategies are the most relevant for the implementation of the intervention plan. A transformational leader integrates his/her followers and makes them follow a broad and shared goal toward the betterment of the health organization. Thus, under transformational leadership, all the team members use their time, energy, and efforts toward a single shared goal of the organization. Thus, it helps the professionals provide interprofessional care to the patients for their safety. Increased safety of patients also reduces costs for the organization and the patients (Bachynsky, 2019). All the members of an organization can contribute equally to decision-making through democratic strategies. A democratic leader ensures interprofessional collaboration by engaging all the stakeholders or team members in the process. Under such leadership and strategies, nurses can share their vision and burnout effects with the nurse manager or leader. They can also suggest effective strategies or interventions for reducing the side effects (Heath et al., 2020).

The successful implementation of a plan requires management strategies at the organization’s end. Management strategies transform the objective of the organization into a proper plan. The strategies will include the training of nurses and the implementation of democratic values. Such strategies will help nurses better understand their roles and responsibilities. Nurse training will acknowledge the need to fulfilling the gaps in their work and adopt new strategies and skills to meet the needs. It will improve their decision-making ability through a better consensus. Trustworthiness will integrate the target nurses; humility will provide them with opportunities for learning along with their practice and accountability will make them responsible for their duties and roles.

Delivery and Technology

One of the delivery methods for the plan implementation is the action plan. The action plan will decrease the nurse-to-patient ratio according to the hospital settings’ needs. For example, in the long-term care units, the ratio will be 1:3 while in urgent care units it will be 1:2. The nurses will discuss the action plan through arranged workshops. After that, the plan will be presented to other stakeholders for approval. The target nurses will be managed by nurse managers who will keep a check on nurse performance and training. Nurses, patients, and other stakeholders will be involved in decision-making to ensure project quality and effectiveness (Fernando et al., 2019).

Evaluation of Current and Emerging Technology

The use of current and emerging technology will make the plan more effective and useful for the target population, patients, and the healthcare unit. The technology has the potential to enhance communication among the involved stakeholders through tools like e-mails, phone calls, electronic health records, et cetera. The management can use the technology of a Learning Management System (LMS) to enhance the knowledge of nurses and patients as well. It can be used to improve nurse training and practice by providing them easy and instant knowledge database. Users can use technology even for financial purposes like transactions. The use of emerging technology will also impact the delivery method by providing nurse management opportunities via online portals. For example, nurses can get their tasks and other important information on the portals through online systems (Ko et al., 2018). It will reduce their burden of managing tasks and related burnout. When the burnout will be less, patients will get better care quality. It will also reduce the cost of the healthcare system by reducing the rate of errors and readmissions.

Artificial Intelligence (AI) is another emerging technology that can improve delivery methods. The technology of AI is developed according to human intellect and it copies the intellect for using the data in it. Different types of AI tools include chatbots (to solve customer problems), intelligent assistants (to improve user scheduling), and recommendation engines (to provide the best available solution to a problem). The most relevant AI tool for the need in this project is the use of intelligent assistants as they can help nurses and managers to improve task schedules (Saraswat et al., 2022).

Stakeholders, Policy, Regulations

Nurses, members from the finance department, managers, patients, and community members. Patient needs include better communication, safety, information, support, self-care, and health education. The nurse’s needs consist of involvement in decision-making, team collaboration, better communication with patients and other professionals, and having a healthy work-life balance. The needs of managers are leadership, team-making, communication, and problem-solving ability. The needs of all the stakeholders will get improved with the implementation of the intervention plan.

The two most relevant health regulation policies impacting the plan implementation are the Affordable Care Act (ACA) and the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act. The former policies address the chance of high nurse burnout with the increase in health coverage. Increased health access will increase the patient population that nurses will have to attend to, increasing the nurse-to-patient ratio in settings. To overcome the issue, ACA provided a solution by separating inpatient and outpatient care facilities. 

The Quality Care Act endorses certain nurse-to-patient ratios in different healthcare facilities. For example, the medical care units should have a ratio of 1:4 while the emergency unit will require the nurse-to-patient ratio to be 1:3. The implementation of the plan can be improved by following the discussed policies.

Timeline

The timeline estimation for the plan implementation is one year, including the assessment of the target population before and after the COVID era. The time is realistic and sufficient for managing all the implementation processes like surveys, sampling of nurses (2 months), analysis of key performance indicators (4th month), and evaluation of the results (six months). Three potential challenges can affect the process i.e., government policies, nurses’ motivation, or lack of availability for the sampling. 

Evaluation Plan Defining Outcomes

Improvement in the nurse’s well-being and patient outcomes are the primary outcomes of the intervention. The purpose of the intervention is to provide nurses with a better environment u reducing burnout so that they can have sound mental and physical health. Thus, the patient outcomes related to nurses will get better. The accomplishment of the intervention means better health outcomes and reduced nurse burnout. When the nurse-to-patient ratio will be reduced, it will decrease nurse burnout and enhance patient outcomes and care quality. Patient safety will be enhanced as the implementation of the intervention will reduce the occurrence of medication errors (Driscoll et al., 2018). The alternative outcomes will be the increased efficiency of nurses due to less work burden and overall improvement in the health services of the hospital (Rosenberg, 2021). An increase in salary expenditures can be another outcome of the intervention as the hospital will have to hire more nurses for reducing the nurse-to-patient ratio.

Evaluation Plan

The main component for the evaluation of the plan is nurse surveys. In these surveys, the evaluation will be done by taking feedback from nurses, patients, and their families through interviews and questionnaires (Story & Tait, 2019). The survey will help management know the effectiveness and areas of improvement in the plan. The data that can give complete insights into the effectiveness of the plan includes the new nurse-to-patient ratio, nurse perspective, and patient health records. The data will be recorded in electronic health records and the dashboards of the hospital for easy tracing. Data collection will be done through surveys, questionnaires, online forms, dashboards, and electronic health records. The management will analyze the data by setting a local benchmark for the health outcomes of the patients and after 15 days the data will be evaluated from the dashboards. The nurse perspective, patient experience, and health records will be compared before and after the implementation which will show the accomplishment of the goals. The evaluation plan is based on some assumptions. For example, questionnaires are considered a reliable form of the data collection method. Additionally, hospital dashboards are effective tools that can tell the progress of key performance indicators in a setting (Helminski et al., 2022). 

Discussion

Advocacy

Nurses are a vital part of any change in health organizations as they make the frontline workforce. They can lead any change by playing a role as a leader i.e., transformational leader. Through transformational leadership roles, they can motivate, integrate, and lead the followers in the direction of the shared goals of the organization. Being the most interactive workforce with patients, they can play role in interprofessional collaboration too. The practices to enhance collaboration can include safety huddles and interprofessional communication. These techniques can improve care quality and patient outcomes. The intervention in improving the nurse-to-patient ratio will also have positive effects on the overall nursing profession and role. When the intervention will get positive results related to patient experience, nurse well-being, and hospital outcomes, it will be adopted on a larger scale, enhancing the chances of improving the nursing profession. Also, the leadership role in the intervention for nurses advocates for the enhancement of the nurse role from care delivery to other areas like change management and leadership in health organizations (Wood, 2021).

Improvement in the nurse-to-patient ratio will reduce nurse workload. The initiative will also decrease nurse burnout and improve related outcomes like efficiency and focus, and better health results. Nurses will be able to better collaborate with other professionals and leaders due to a balanced work burden. As nurses will be able to work efficiently with better focus, the chances of medication errors and readmissions will reduce, thus benefiting the hospital in financial and health contexts. 

Future Steps

The intervention project can be amended by including the cultural aspect in the plan. As the patients can be from various cultural backgrounds, they should be attended to by nurses according to their cultural needs. Nurses can be trained and educated to enhance their cultural competence. Moreover, the amendment in the project will enhance the health outcomes of the hospitals in time for culturally sensitive care. The technologies like dashboards and electronic health records will help management keep records in a better and safe way. They can easily track the record needed for the evaluation. These technologies will help them get real-time data for the evaluation process. Nursing models like Team Nursing (TN) model endorses a team of nurses working under a leader. It ensures efficient work and patient outcomes by the team led by transformational leadership.

Reflection on Leading Change and Improvement

I felt improvement in my ability to lead changes and manage projects in hath organizations. The project also enhanced my leadership knowledge and skills. Also, I got to know the role of a leader in team collaboration and change management. I can say that this knowledge will help me in my future practice as I will be able to manage the team collaboration, decision-making, and communication. It can also transform into my future practice as it enabled me to propose and lead the charge related to improvement in the nurse-to-patient ratio for the reduction of nurse burnout. I can also play the role of a nurse leader in my future practice. It will also improve the outcomes of patients and enhance the healthcare services of the hospital.

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