Capstone Project: Milestone 2: Design Proposal

            A good staffing ratio as a strategy to deliver high-quality care is one of the critical recommendations documented in a landmark report by the Institute of Medicine (IOM). Nursing care process equally influences the quality of care and affects patient health outcomes. Acute care settings require high levels of care, and nurses working within these units are burdened by patients needs with most of them avoiding bedside practice. Health care organizations have initiated various measures to motivate nurses working within acute care settings.  Organizations have also adopted nurse retention strategies to maintain adequate staffs. Adequate staffing can encourage shift-change report to be executed at the bedside to minimize the readmission rates among hospitalized patients.

Change Model Overview

            Health care organizations strive to promote patient safety by addressing various factors that might affect the quality of care patients receive. Frequent bedside reporting and adequate staffs are intertwined. Thus, frequent bedside reporting is a patient-centered approach that can become a routine if nurses are motivated. As such, minimizing workload that might impact on patient health outcomes require good staffing ratio.

The Scope of the EBP

            Offering quality and safe care go beyond staffing; it requires motivated staffs to improve communication during patient hands-off. However, one of the major barriers that might affect patient health is staff shortage in which few care providers work for extended hours than recommended. The Joint Commission recently estimated that 80% of serious medical errors in acute care settings occur due to miscommunication among caregivers, which happens during transfer of patients (Leppin et al., 2014). Staff shortage can compromise patients’ health. Recent reports reveal that the risk of death is likely to increase by 4 percent if patients do not receive adequate care; therefore, high nurse turnover creates a high risk of mortality (Josephson, 2016).  Adequate staffing is closely associated with quality care and better patient outcomes, thus hospital with low staff turnover reports low inpatient mortality.

             Health care organizations can minimize readmission rate by motivating nurses to maintain adequate staff ratio. Motivated staff will experience high levels of job satisfaction and enhance good bedside shift report. Additional benefits of frequent bedside reporting include decreased medical errors and reduction of legal costs associated with cases of negligence filed against the facility (Leppin et al., 2014). A higher nurse staffing ratio would mean offering essential care and addressing patient’s needs; this would lower some of the adverse effects among hospitalized patients.


            Nurses involved in the day to day patient care and the general management will be included in the change process. Their role is crucial in influencing changes to improve patient health. The nurse manager will lead the team, and the hospital management will include it in the implementation process as they make decisions on resource allocation and delegation of duty.


            A recent review by the American Nursing Association emphasized the importance of communication during hands off. Nurses share critical information concerning patient progress and treatment plans; information sharing requires high levels of collaboration and adequate bedside reporting. Leppin et al., (2014) reveals that hospital readmission is a costly occurrence among elderly and high-risk patients. Medicare beneficiaries are readmitted within 30 days after discharge. Improving the quality of care to reduce unnecessary expenses has become a national priority; however, the author emphasizes the need to understand some of the underlying causes of readmission. The author warn that unless sufficient support is given to enhance caregiver’s capacity to carry out their duty effectively, poor patient outcomes and hospital readmission will still occur. Josephson (2016) supports the importance of communication during patient hands off. He emphasizes on the importance of communication between providers during hands-off as the critical method to assure continuity of care. According to the author, incomplete discharge summaries are not useful for outpatient providers.  Poor provider communication, inadequate support by the management, and increased workload affects the quality of patient care.

            Similarly, Josephson, Johnston and Hauser (2013)state that over the years, the main focus has been to reduce the length of stay in hospital as a strategy to reduce costs. Some of the measures include appointing a primary care physician to conduct a follow up for a neurological patient who will probably see a neurologist after a few weeks, and this causes a vulnerable situation for recurrent of neurological illness (Josephson, Johnston & Hauser, 2013). The authors emphasize the need to focus on hands-off rather than rely on discharge summaries which are hastily put together.

            Research studies focus more on understanding the effects of shift report at patient bedside, citing several benefits. However, one of the critical barriers of offering quality care is communication during hands offs, which can affect patient health outcomes. The best solution is to ensure the facility maintains adequate staff.  Poor staffing ratio, increased workload, and high levels of exhaustion among health care providers are the leading causes of poor patient outcomes.

Recommendations for Change Based on Evidence

             Implementing safety initiatives and monitoring their levels of effectiveness should be continuous. Although several benefits of bedside reporting have been recorded within a short period, there is a need to maintain high levels of patient safety by reviewing different strategies and make adjustments where necessary. Patients in acute care units depend on nursing care to improve their health status; therefore, addressing some of the challenges affecting patient care like burnouts and the increased workload can significantly improve patient health.

Action Plan

            The implementation process will involve all care providers offering patient care, including intensive care unit, nursing unit, and high dependency units. The involvement of patients and families after discharge will be important. Conducting an in-house orientation training will be the first activity to reinforce the importance of communication during handoffs. The initiative will advocate for policy change to include specific standard protocols of bedside reporting and hands off procedures to be used in acute care units.

Dissemination Strategy

            Nurses and all health care providers involved in the day to day patient care, including the hospital management, needs to be aware of their roles and how they can influence change to improve patient health. Dissemination process will include evaluating the option of developing a workable solution to minimize rates of readmission. Convincing personnel involved in the process of hiring staffs, allocating of duty, and conduting patient care is important. Sharing with them the proposal will influence  their thinking to see the importance of minimizing hospital readmission by enhancing communication during patient hands offs as a cost effective strategy.  The dissemination process will include meeting the heads of various departments to appeal for their support. Stakeholders include the hospital board, and other sponsors are among the key individuals to be involved in consultative meetings to seek for their support.

            Before convincing the nursing community, consulting the nurse managers to gain their support will help reach out to the entire nursing community. Nurses will be actively involved in every step of the project, right from the planning process, implementation, evaluation, and up to the process of disseminating of the project outcomes.  If nurses and other key stakeholders are convinced of the need to minimize hospital readmissions, they will see the importance of improving communication during hands off and collaborating as a team to improve patient health outcomes.


            A survey will be conducted to evaluate and assess staff attitude and levels of job satisfaction. The evaluation will assess the staff attitude toward the new initiative and ensure the desired changes are achieved. One on one interview with staff will determine how they feel about the new changes. The interview will offer useful information about the staff turnover rate before and after the changes have been implemented. High staff turnover rate before the proposed implementation of the project would mean that there is a need to adopt strategies of retaining staff.


            Health care organizations can improve patient safety by enhancing the work environment and address staff ratio. Nurses can be committed if given adequate support. Adequate resources need to be allocated proportionally to reduce the effects of high nursing turn over that can affect patient safety among hospitalized patients. Although other safety practices can be considered, good staffing ratio is an effective strategy recommended to deliver high-quality care.                                                          


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