Effective Approaches in Leadership and Management

Over the last decades both public and private hospitals have been experiencing severe financial situations (Everhart, Neff, Al-Amin, Nogle, & Weech-Maldonado, 2013). The financial shortage is associated with delay or even lack of governmental sponsorship and competition from their rivals. Enacting the policy will mount financial pressure on these hospitals that are on cost-cutting strategies. The salaries and wages of nurses are dominating the costs of operation in the hospitals and therefore adding more staff to correct the understaffing will be like creating another problem (Goddard, 2003). Contrary, Empirical studies prove that adequate nurse staffing produces better outcomes for both the staffs and the patients (Donaldson & Shapiro, 2010). These do not mean that the financial performance of the health centers will be at stake. Quality is associated with profitability. Understaffing leads to increased workloads, fatigue and job dissatisfaction. These situations that can be corrected on the implementation of proper staffing policies (Everhart, Neff, Al-Amin, Nogle, & Weech-Maldonado, 2013). The policy aims at offering quality service, reasonable patient-doctor ratios, reducing high mortality rates, improving the health of patients through proper examination and disease diagnosis among other

Staffing needs affect the nursing department’s budget, staff productivity, the quality of care provided to patients and even the retention of nurses (Jooste, 2013). The nurse manager has to explain to the management of the benefits of change in providing adequate staffing all the time. Adequate staffing helps staff retention. Staff retention saves a lot of money in terms of orienting new people to the unit. Safe staffing always helps in the reduction of falls, infection rates, pressure ulcers, decrease hospital stays and death. Flexible and creative scheduling is essential for retaining staff and promoting a positive work climate (Grohar-Murray & Langan, 2011). Adequate staffing with good staffing ratio will help nurses to concentrate on their patient care which may help in a reduction in medical errors and lawsuits to the hospital.

Nurse staffing and how it relates to the quality of patient care has been an important issue in the field of nursing for quite some time. This topic has been particularly popular recently due to the fact that there is an increasing age among those who make up the Baby Boomer era in the United States. There will be a greater need for nurse staffing to increase to help accommodate the higher demand of care. Although nursing is “the top occupation in terms of job growth,” there are still nursing shortages among various hospitals across America today. The shortage in nurses heavily weighs on the overall quality of care that each individual patient receives during their hospital stay (Rosseter, 2014).

This paper aims to address and discuss about the leadership and management of the nurse leader interviewed. This experience was a great opportunity to witness first hand how a nurse leader cultivate and manage their staffs in real life setting. Moreover, it provides a great access to gain insight and knowledge about nurse leaders’ vital responsibilities and role diversities in the organizations they work with. Nurse leaders pay more specific and close attention in handling the staffs and most importantly, patient care.

The purpose of this article is to discuss appropriate nurse staffing and staffing ratios and its impact on patient care. Although the issue is just not about numbers as we discuss staffing we begin to see how complex the issue has become over the years. Many factors can affect appropriate nurse staffing ratios. As we investigate nurse staffing ratios we can see the importance of finding the right mix and number of nurses to provide quality care for patients.

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.

The Master of Science Nursing student with the collaboration of my nurse executive mentor Mrs. Darville created a project that is valuable for the facility and a rewarding experience for me as a graduate student.

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.

Nursing shortages in the United States have left practicing registered nurses (RNs) with strenuous workloads. Such heavy workloads can lead to poor patient outcomes, decreased satisfaction among both patients and nurses, and questionable quality of care, among other things (Cimiotti, Akien, Sloane, & Wu, 2012; Department for Professional Employees, 2014; Duffield et al., 2011). Realizing the potential for error that accompanies such circumstances, efforts are being made to decrease the workload of nurses in hopes of improving quality of care. One such effort, and the focus of this paper, is the implementation of mandated nursing staff ratios. Mandated nursing staff ratios would restrict the number of patients a nurse is allowed to care for at one time (Tevington, 2011). While this idea seems to be a fitting solution, there has been much debate about the effectiveness of mandated nursing staff ratios. This paper will discuss arguments for mandated nursing staff ratios, arguments against mandated nursing staff ratios, and the impact of mandated nursing staff ratios on the profession of nursing as a whole.

In recent years, the healthcare industry has seen a significant decline in the quality of patient care it provides. This has been the result of reduced staffing levels, overworked nurses, and an extremely high nurse to patient ratio. The importance of nurse staffing in hospital settings is an issue of great controversy. Too much staff results in costs that are too great for the facility to bear, but too little staffing results in patient care that is greatly hindered. Moreover, the shaky economy has led to widespread budget cuts; this, combined with the financial pressures associated with Medicare and private insurance companies have forced facilities to make due with fewer

Healthcare changes occurring today along with shrinking budgets and reimbursement rates for hospitals has forced institution CEOs to do more with less. Changes and restructuring of various health facilities require nursing leaders with flexibility and adaptability. Nurse leaders must also consider budgetary constraints, cost effectiveness, patient safety, and quality care while maintaining focus on improved patient outcome. The responsibility of ensuring patients receive safe and high quality care belongs to every employee in the hospital, including support staff such as IV therapy. In this hospital, this led to the development of a nurse director position to oversee the

The current and growing shortage of nurses is posing a real threat to the ability of hospitals, long-term care facilities, and others to provide timely access to quality care. Nurse staffing shortages and nurse turn-over contributes to the growing reduction in the number of staffed patient beds available for services, increasing costs, and rising concerns about the quality of care. Health care organizations highly depend on nurse managers and leaders to reverse this trend. This paper discusses the reasons for nursing shortage and turn-over, different approaches to solve this issue, and my personal philosophy about this issue.

Management is the key players in engaging their staff into what is happening in their environment and giving them the ability to make much needed changes. Engaging and encouraging the staff can allow for more open discussions and also being more satisfied with their position because they know they have the ability to input any needed information. Finding the gaps in communication and understanding between leaders and their staff can help recruit and retain newer nurses into leadership

Managers, according to Dwyer and Hopwood (2013, p. 4), are ‘organisational members who are responsible for the work performance of other organisational members’. No matter on what level of management, managers are utilizing organisational resources to make decisions and take actions when performing their management role and responsibilities with their formal authority. As today’s healthcare landscape has brought many changes, challenges, and even turmoil for nurse managers, supervisors, and team leaders, now, more than ever, nursing needs energetic, committed and dedicated managers with leadership capacity to meet the enormous demanding of the healthcare climate and unpredictable challenges (Tomey 2009). McKee, Kemp and Spence (2013, p. 4) agree that: ‘in organisations today, everyone needs to be a leader’. The leadership skills and abilities of nurse managers have long been acknowledged as the fundamental strengths to make critical contributions to the smooth operation of hospital care (McGuire & Kennerly 2006). Effective use power by leaders and the role of managers can stimulate and engage staff members and followers in a more creative problem-solving process and “out of the box” thinking (Dignam et al. 2012). Managers implement leadership role can produce results that are far more likely to provide the

Share Our Strength’s leadership style is based on shared leadership (Crutchfield & McLeod Grant, 2012). From the start the leadership has been a joint effort. The founders are a brother and sister team, Bill and Debbie Shore (Crutchfield & McLeod Grant, 2012). This style of management has continued through the development of the organization. The leadership is divided between the founders, president, CFO, executive vice president, multiple offices, multiple senior directors, the board, and a leadership counsel (Share Our Strength n.d.). The leadership being divided between a wide variety of people helps to provide varied opinions and ideas when approaching the goals of the organization.