Nursing Leadership: Policy Issue of Nurse Staffing Ratio in San Jose Hospital

Running head: NURSING LEADERSHIP 1
Nursing leadership
Name
Institution

NURSING LEADERSHIP 2
NURSING LEADERSHIP
Issue related to the organizational priorities
Policy issue; nurses staffing ratio
The effect of nurses staffing ratio is widely a problem in many hospitals and healthcare
facilities. The San Jose hospital is not an exception. There is a shortage of nurses in the hospital.
Like its known nurse's low staffing leads to the quality of health care of a hospital. Adverse
effects and outcomes are seen in the patients. The patients stay longer in the hospitals than
expected, other related complications and worse enough mortality. Low staffing does not only
affect patients but also affects the few nurses who are in the hospital. Nurses suffer from job
dissatisfaction, fatigue and staff burn-out. The WHO organization standard for nurse ratio is
supposed to be calculated regarding the patient they handle and the standard working time. In a
hospital like San Jose, there has to be the correct staffing ratio for nurses for the hospital to
deliver quality healthcare services (Cho, Sloane, Kim, Choi, Yoo & Aiken, 2015).
Patient to nurse ratio is supposed to be 2-bed patients to one nurse. However, the rule
accepts a team of 5 rotational group nurses to work on 15 patients. That is the acceptable
standard. Concerning working hours, the staffing ratio has a WHO designated formula. This
method is referred to as productive hours method. The productive hours are minus vacation,
illness or continuing education duration (Aiken, Sloane, Bruyneel, Heede, Griffiths, Busse &
McHugh,2014).

NURSING LEADERSHIP 3
The above is the accepted formula for nurse staffing productive hour ratio. The
productive method calculation is the one used in San Jose hospital. It is also the method used for
nurse payment.
2. Investigation of the problem
Recently, San Jose hospital has registered a series of issues regarding quality health
delivery and client satisfaction. The hospital has witnessed medical and medication errors from
nurses. Patient mortality in the past three months has been higher than any duration since the
hospital was fully operational. The hospital has lost about 900 in-patients in the past three
months alone compared to other months (Tsugawa, Jena, Figueroa, Orav, Blumenthal & Jha,
2017). This is an 11% increase according to the hospital database statistics (Tsugawa, Jena,
Figueroa, Orav, Blumenthal & Jha, 2017). These reached the attention of the state government
that visited the hospital to establish the cause (Tsugawa, Jena, Figueroa, Orav, Blumenthal &
Jha, 2017).
Analysis of the current situation using current data
Apart from this alarming mortality rate, there has been an increased re-admissions of
patients like never before. For every 5 discharged in-patient, three were registered for re-
admission. Patient care-related infections are also on the rise among the inpatients. The hospital
finance department is even admitting to having lost the highest amount in the past period due to
readmitted patient- care costs (Ong et al., 2016).
It is from this alarming hospital statistics that something had to be done. Therefore,
prompting an in-hospital research as quickly as possible.
3. Analyze areas that might be contributing to the problem or issue

NURSING LEADERSHIP 4
From the statistics of the hospital, an investigation had to be done to get the cause of the
problem. Considering that the hospital had experienced and dedicated doctors, who had been
serving for more than ten years, the problem did not point to their direction. From the recorded
mortality rate, out of 10 dead patients, five were diagnosed to die due to a medication error, a
role played by a nurse (Makary & Daniel, 2016). Most re-admissions were done because of
inadequate assessment of the nurse on the patient. Other errors that were recorded in the wards
were not accounted for, but they were increasingly on the rise. The inpatient infections could
only be through hygiene or nurse medication error. But since the hospital was not suffering from
a hygiene break-out, the only possible explanation was a problem in the nursing department.
When followed-up through research and detective means, the result was never pleasant.
Nurses who might have lost a patient through medication error ethically should be sent on
compulsory leave while seeing the hospital therapist until the therapist clears them for patient
attendance once more (Van Cott, 2018). However, this was not the case in San Jose. Due to the
nursing staff ratio, it was impossible to send any nurse on compulsory leave. The nurses were
working long hours both night and day shifts. The nursing personnel that comprised of registered
nurses, licensed practical and vocational nurses, unlicensed assistive staff and nursing aides were
only totaling to 183 compared to the number of patient in the inpatient sections when all beds are
occupied which is about 12000. Without admitting the number of out-patients, the nurses were
getting overwhelmed due to staffing ratio, and something had to be done.
4. Proposed solution or innovation for the problem or issue
The perfect solution is to make a nurse-driven workforce quickly and constitute a
committee. The committee top-most goal would be creating staffing plans that will help achieve
patients’ needs while balancing patient population to that of skills and experience of nursing