Discussing the essentials of Advanced Nursing Practice

Discussing the essentials of Advanced Nursing Practice
Managing workplace change is one of the most difficult parts of the healthcare system today, and it takes good leadership to do it well. Change management is all about dealing with how complicated the process is. This includes planning, implementing, reviewing, and coming up with ways to make the change better. Change is needed in the healthcare system so that healthcare providers can adapt to new ways of doing things, while also pushing best practices and making things better for patients. As nursing education has improved, nurses with the skills to start and manage change in the complicated healthcare system of today have been trained. These nurses come up with ways to care for patients that are planned and work well together. This kind of care is patient-centered and improves quality practices. This talk shows how important it is for nurse leaders to recognize an organizational problem and suggest a change that will improve the level of care for patients.

Why and an Overview

Purpose

The goal of this meeting is to find a patient-centered weakness in the St. Cloud hospital and use that information to suggest a change that will help fix that organizational weakness.

Overview

Leadership and management are important for healthcare groups to grow and expand in the modern world. The health care industry is changing quickly, and the increased use of technology has made it harder to find good service providers. As organizations move toward value-based care, it is important to find weaknesses and ways to improve the level of care given to patients. Leaders in the health care field should realize that the scope and complexity of health care have grown, and that change is now necessary. St. Cloud Hospital, MN is a health care company that has been committed for a long time to giving the people of Central Minnesota kind, personalized care. A meeting with one of the nurse leaders was held to find out what the hospital did well and what it could do better.

Several methods were used to gather information about the organization, including information from the nurse leader, information from the organization’s website, HCAHPs scores from the Medicare and Medicaid Services, and area data from the state website. A nurse supervisor was interviewed face-to-face because it was her job to oversee process change in the facility and because she knew how to find weak spots in the organization. During the interview, well-structured questions were asked about the roles of the nurse leader, the organization’s strengths and weaknesses, quality improvement projects, and evidence-based practices in the hospital. We got secondary data from the Centra Care website, the press and bulletin boards, and the Hospital Compare website, which showed us how well our organizations were doing. From the feedback process, we got enough information and data to do an analysis and make suggestions for how the organization could change for the better.

Description of the Group

St. Cloud Hospital was started by the sisters of the order of St. Benedict in 1886. Its goal is to give the people of Minnesota care that is both individual and kind. People know that this group is the best hospital in the area, and it has even been recognized on a national level. Truven Health has named St. Cloud Hospital as one of the top 100 health care facilities eleven times. (CentraCare, 2020). No other hospital in Minnesota can match the organization’s image, which includes its strong leadership. The organization was named a Magnet hospital because of the standard of the services it provides and the ways it works to improve those services. Magnet recognition has been given to St. Cloud Hospital four times. It is one of 49 hospitals around the world that have won the award four or more times. (CentraCare, 2020). The organization’s good name comes from the prestigious award for nursing excellence and the high-quality care that nurses and other healthcare workers give to their patients.

The services that are given at St. Cloud Hospital rely on the leadership and dedication of the people who work there. About 6,500 people work at St. Cloud Hospital, and more than 550 doctors are on staff. The building has room for 489 beds and cares for tens of thousands of people. The building is a level II trauma center that helps children, adults, and even mental patients who need emergency care. The hospital has improved surgical care services, such as inpatient surgery, outpatient surgery, a surgical care unit, and surgery for people who need intensive care. The organization’s website says that the department has 18 operating rooms where more than 14,000 people get surgery each year (CentraCare, 2020).

Patients can get a lot of services at St. Cloud Hospital, such as emergency care that is available 24 hours a day. Animal-assisted therapy, behavioral health services, birthing services, breast care, cancer care, children’s services, cleft & craniofacial center, diabetes care, digestive care, direct access testing, emergency services, grief & bereavement services, heart & vascular care, home health services, home delivered meals, hospice services, hospital services, hospital services, hospital services, hospital services.

At St. Cloud Hospital, nursing care is given based on the Professional Practice Model. (PPM). The nurses use this model to give care that is focused on the patient and their family. This care includes things like shared governance, building working relationships, and providing exemplary professional practice. Overall, the company gets 4 stars, while the average for the state is 3.7 and the average for the country is 3.31. (Medicare.gov, n.d.). A large group of registered nurses and advanced practice nurses gives excellent nursing care. The nurse boss says that on average, 140 people live there each day. In order to support care that is focused on the patient and their family, patients can have visitors at any time of the day, with some exceptions. But because of the COVID-19 pandemic, only close family members can come right now, and they have to follow the COVID-19 protocols. The Centra Care System serves areas in Central Minnesota, and St. Cloud Hospital is a part of that system. The center works with places like Long Prairie, Melrose, Monticello, Paynesville, Redwood Falls, Sauk Centre, and Willmar. President Kenneth Holmen is in charge of Centra Care right now. Craig Broman is in charge of St. Cloud Hospital. He is the Chief Operating Officer and is also on the board of directors that runs the hospital. The Chief Information Officer and the area heads work under the Chief Operating Officer. The nurse boss said that the Chief Nursing Officer runs the nursing department and is in charge of all nursing services. The Chief Medical Officer and other medical directors are in charge of the medical services in other areas. There are also the finance, human resources, rehabilitation, psychology/forensics, and rehabilitation units.

Most important needs of people

People from Stearns County, Minnesota, can get medical help at St. Cloud Hospital. Recent numbers show that there are 161,075 people living in the county. 87.5% of them are White, 7.8% are Black or African American, 2.4% are Asian, 3.6% are Hispanic or Latino, and 0.4% are American Indian. (United States Census Bureau, 2019). White people make up 84.6% of the population, followed by Black or African American people. 92% of the people are well-educated and have at least a high school diploma. In terms of health, 7.2% of the people in the county are disabled, and 5.3% of people under the age of 65 don’t have health insurance. In terms of money, the area has a typical household income of $60,606 and 12.4% of the people live in poverty. (United States Census Bureau, 2019). Most of the people who go to the hospital for health care come from St. Cloud, which has a population of 67, 924. The city’s median age is about 8 years younger than the national normal, at 29.9 years. The elderly make up about 5% of the total population, and just as many young people go to the hospital for health care as old people.

5.3% of the people living in St. Cloud are over the age of 65, while 16% are between the ages of 55 and 74. The growing number of people with heart disease is one of the biggest health worries for this group. Heart disease has always been the leading cause of death for people over 65, followed by other long-term diseases like diabetes and high blood pressure. Second, it is clear that most people are affected by fat. In 2016, 14.5% of the population smoked, and 27.6% of the population was obese or overweight, according to sources. Also, drinking is popular in the area, and 21.4% of the people who live there are listed as heavy drinkers.

The number of people with health insurance is a good indicator of how healthy a community is, and it also affects who can get medical care. About 7.3% of people in St. Cloud don’t have health insurance, while only 5.3% of people in the county don’t have it. Most of the people who live there don’t know about the health care services that are available, and most of them don’t use the necessary medical services that are there. People have the same problem when they use community health services. They think that health care is only for people who are sick. The nurse leader said that age, area, and cultural differences are all problems that make it hard for people to get health care. Most of the people who go to the center for health care are White, then Hispanic, and then Black or African Americans.

Most of the people are young adults between the ages of 18 and 34. People in this group have health problems like smoking, drinking too much, and using drugs in other ways. Because of these practices, the city has a number of drug rehab centers where young people can get help and learn how to stay healthy. Reports from the past say that about 11% of the population regularly uses drugs. High school failures are especially likely to abuse prescription drugs. There are a lot of forensic patients who come to the hospital for outpatient care, and it’s always hard to tell who might be abusing drugs or trying to stay out of jail. More people in the area are abusing drugs, which has led to more crime and other problems with public health, such as car crashes. Statistics show that someone gets hurt by a crime in Stearns County every two hours. The most common crimes in the area are theft, burglary, attack, robbery, and rape.

Stearns County is the eighth healthiest place in Minnesota and the 124th healthiest place in the United States as a whole. But the health worries of the people in St. Cloud and the hospital as a whole are very important. For example, many people come to the hospital for emergency care because they have been drinking, have been in crashes, or have been arrested. Most of these people don’t have health insurance, which costs the hospital and the community a lot. The cost of treatment and follow-up programs shows that chronic diseases cost the company and the community a lot of money. Even though there are enough people working at St. Cloud Hospital, the amount of work and number of people treated is so big that more nurses and other health care workers are needed. There needs to be more healthcare providers in the neighborhood, especially for those who don’t know how important it is to get regular care. Most of the people in the area are getting older, which is likely to hurt the region’s economic growth in the future.

Nurse Leader’s Roles

The nursing supervisor is an important link between the hospital’s management and the care team. These people are leaders in patient care because they have learned how to do their jobs through practice and training. During the meeting, an interview was done with a nursing supervisor at St. Cloud Hospital who had been a nurse for more than ten years. The interview was mostly about the formal and informal roles of the nurse leader in the school and how those roles match up with MSN essentials. As a formal leader, the supervisor makes sure that nurses follow the rules and policies of the company. These include keeping track of the work done during shifts, working with other professionals when giving care, and using the full range of their nursing practice. The supervisor said that she works closely with the staff nurses and nursing helpers to give them advice and ideas when they are giving regular nursing care.

Instead of caring for patients directly, nurse managers work directly on administrative tasks. The nurse leader said that she is involved in hiring and teaching new employees, which includes giving clear instructions. Also, the supervisor is involved in the ongoing teaching of staff when quality improvement areas are found. Budgeting and scheduling staff to make sure shifts are fully staffed for patient safety is another part of an administrative job. Nursing managers also have to make sure that rules are followed and that staff members are safe. The nurse said that she is an active part of writing and changing policies and procedures to make nurses safer and to lead by example. The nurse leader stressed that part of her job as a supervisor is to enforce rules, which she does by using positive methods.

To learn more, she was asked about her job and responsibilities in the organization, such as her informal duties as a nurse supervisor. She said that she gives clinical leadership, sets up processes, and examines how care is given to make sure that nurses are working to reach organizational goals. She stressed the importance of working together to care for patients and get the best results for them. She trains people from different fields on teamwork and interprofessional collaboration. In her informal jobs, she talked about how important it was to keep a positive work environment, keep people motivated, and find ways to solve problems. She goes out of her way to help new workers get started, make sure they have a good balance between work and life, and give them the support they need during the transition period.

The roles of the nurse supervisor that have been described are the same as the roles that are discussed in the Essentials of Masters Education in Nursing. Essential III talks about the nurse’s role in improving safety and quality. In this job, a nurse with a master’s degree is expected to be able to explain the methods, tools, performance measures, and standards related to quality, as well as be ready to put quality principles into practice within an organization. (AACN, 2011). The nurse supervisor is a good fit for this job because she actively works to improve and promote safety in the healthcare organization. She said that she goes around every day to make sure things like paperwork, taking medications as prescribed, and following rules are done to keep patients safe. She is also a team player in the organization’s quality improvement projects, especially those that have to do with patient and healthcare worker safety.

The nurse supervisor knows how important it is for professionals from different fields to work together to improve patient and public health. Essential VII says that a nurse with a master’s degree is a member and leader of interprofessional teams who talks to, works with, and gets advice from other health professionals in order to manage and organize care. (AACN, 2011). The nurse leader makes sure that the collaborative practice is used in the hospital by encouraging nurses and doctors to get along well with each other. She said that it was her job to make sure that both nurses and doctors took part in daily rounding, which included continuing medical education that was set up by either team.

Nurses who have a Master’s degree must show that they can care for patients at the Master’s level. Master’s level nursing includes using a nursing intervention that changes how people, groups, or systems get health care. (AACN, 2011). The nurse must show that she knows about nursing science and be able to put this knowledge to use right away. To show how this job is used, the nurse supervisor uses clinical reasoning and decision-making skills to help make sure patients get good care. For example, the nurse said that punishing workers is always a good idea because it encourages them to change their behavior instead of making staff members dislike each other. Also, the nurse encourages the institution to use methods that have been shown to improve quality.

How the organization is made up

The goal of St. Cloud Hospital comes from CentraCare, and every day it works to improve the health of every patient. During the interview, strong leadership was named as one of the group’s strengths. The leaders of the company are focused on the mission and vision, which makes it possible for employees to be committed and for personalized care to be given. The nurse supervisor said that St. Cloud is a healthcare partner that knows the patient and is ready to help them through their most happy or difficult times. Also, the institution has been trying to make changes from the top down lately so that they can focus on patient care and cut costs. This is a way for managers to deal with the problems caused by the COVID-19 pandemic and to change the old structure of the company. Because of its strong leadership, the organization is now one of the top 100 hospitals in the US and has won several awards for being the best hospital in St. Cloud, Minnesota.

The nurse supervisor found a few problems with the system that make it hard to give good care. She talked about problems with staffing on the weekends, which have led to problems like more people falling and longer wait times in the emergency room. The center doesn’t have enough float pool to handle all of the calls, and the few staff members who are there are overworked. There are already plans to hire more registered nurses and nursing aids. The biggest worry is that there are more patient falls in the hospital units. This problem has a big effect on older people, and since COVID-19 rules limit the number of family members who can stay in the wards, something needs to be done right away.

The center is working on a number of projects to improve quality and use evidence-based practices. EBP was just started by the department of psychiatry and forensic services to help people get back into the community after they are released. Practices like assertive community treatment, family psycho-education, and integrated care for psychiatric patients with multiple disorders have been put into place. Also, each intervention uses treatment methods that have been proven to work based on the patient’s situation. For example, present-centered therapy is used in family psychoeducation for people with post-traumatic stress disorder (PTSD). SBAR communication is the other evidence-based practice used in the facility. It helps nursing teams and other health care workers talk to each other better. Six months ago, the SBAR checklist was used to improve conversation in the emergency room. Right now, the project managers are asking for feedback on how well the practice is working.

A quality improvement program is a set of activities that work together to keep an eye on, analyze, and improve the quality of processes so that a company can provide better healthcare. Several projects to improve quality have been put in place in different parts of St. Cloud Hospital. A hand hygiene measurement method is in place in the ICU and operating rooms to help cut down on patient and healthcare worker infections. The method, which is run by computers, compares how well the two departments clean their hands to the goal set for the end of the year. Using a board-level committee to improve safety, communication, and transparency is another way to improve quality that has been shown to work. The commission, which is made up of chosen healthcare professionals, takes the place of important leaders in the organization who don’t have enough time to keep an eye on how things are going in the institution.

Changes to the organization are suggested

The nurse boss says that staffing problems are causing more patients to fall, especially on the weekends. This is a problem in health care. As the administration keeps making the changes that are needed to improve staffing, hourly rounds can help reduce the number of falls in the school. I think that nurses should use an hourly rounding plan to help find patients who are at risk and meet their needs on time. Falling while in the hospital is still a regular problem, and it can lead to serious injuries or even death. Walsh et al. (2018) say that people, especially those in medical and surgical units, fall about 3.5 times per 1000 patient days, and about 26.1% of them get hurt seriously. Educating the staff, using wristbands, setting up times to go to the bathroom, and putting in bed alarms have not been enough to solve the problem. But hourly counting, which includes assessing and reducing the risk of a fall, has been shown to work.

The PDSA cycle will be used to plan activities to make sure that the proposed strategy is carried out well. In order to prepare for the change, the administration will choose a group to start hourly rounds in the hospital. The AHRQ protocol will then be used to teach employees about the new plan. The procedure includes things that are done for every patient, like pain, medication, going to the bathroom, and checking the hospital bed. (AHRQ, 2013). In the second part, hourly rounding will be put into place during shifts. Special attention will be paid to the needs of each patient and to finding out what makes them more likely to fall. During the study phase, nurses and helpers will be asked to serve as “champions” on the floor. Each department’s leaders will keep an eye on the number of falls and give feedback to the nursing teams. In the last step, changes will be made to the intervention, the number of falls will be analyzed, and company policies will be made about the new change.

Why it’s suggested to make a change

Falls are a regular problem in healthcare, and they have a big effect on both the patient and the organization. They cost the patient a lot of money and can lead to longer stays in the hospital. Patients who get major injuries from falls stay in the hospital 6.9 days longer and pay $13,806 more than patients who don’t get hurt in falls. (Walsh et al., 2018). When older people are involved, these prices become a problem for the community as a whole. It makes people less productive because they have to stay at the hospital to take care of loved ones. For Medicare patients, the hospitals pay for the costs of falls, which means that the level of care is lower. Patients can be directly hurt by falls, but healthcare organizations also lose a lot because their reimbursements rest on quality measures like the number of falls. Also, injuries that are very bad, like death, can lead to probes by regulators or legal claims.

The change that is suggested is to use an hourly rounding plan with ways to prevent falls to find patients who are likely to fall. Hourly rounds are a practical way to show that the patient-centered care approach is being used. During these rounds, important things like pain, personal needs, position, and placement are checked on. (AHRQ, 2013). The hourly review ties fall prevention activities into the rest of the care for the patient and helps the patient and their family be more aware of the risk. Fall prevention in a hospital can help save money and make patients happier in a number of ways. For example, patients will be able to understand their care when they leave the hospital, and the HCAHPS results will go up in areas like getting care quickly when asked. Because of this, more patients will be happy with the level of care they get at the hospital and tell their friends and family about it.

Measures to Check

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey will be used as a national standard to measure how the company is changing. Some of the things that will be looked at are whether or not patients say they got help as soon as they wanted and whether or not they would suggest the hospital to other people. Based on the previous scores, patients who said they “always” got help as soon as they wanted had a score of 71%, while the average for the state was 76% and the average for the country was 70%. (Medicare.gov, n.d.). The goal is to get the scores to go from 71% to 75% in six months.

After the new change is made, the study part of this evaluation will compare the scores seen after the change was made to the organization’s quarterly HCAHPS scores. To act successfully, an increase in scores after the second quarter will show that the program is working, and this will lead to the change being incorporated into the way the organization works. If the scores won’t go up, the suggestion will be looked at again, and any changes that need to be made will be made before the cycle starts all over again.

References
Agency for Healthcare Resaerch and Quality. (2013). Preventing falls in hospitals: Tool 3B. Scheduled rounding protocol. Retrieved from

https://www.ahrq.gov/patient-safety/settings/hospital/fall-prevention/toolkit/rounding-protocol.html

American Association of College of Nursing (AACN). (2011). The essentials of master’s education in nursing. Retrieved from

CentraCare. (2020). Caring for you in St. Cloud: St. Cloud Hospital. Retrieved from https://www.centracare.com/locations/centracare-st-cloud-hospital/

http://www.aacnnursing.org/portals/42/publications/mastersessentials11.pdf

Medicare.gov. (n.d.). Hospital profile: Survey of patients’ experiences: St Cloud Hospital. Retrieved from

https://www.medicare.gov/hospitalcompare/profile.html#profTab=1&ID=240036&state=MN&lat=0&lng=0&name=ST%20CLOUD%20HOSPITAL&Distn=0.0

United States Census Bureau. ( 2019). Quick facts: Stearns County, Minnesota. Retrieved from https://www.census.gov/quickfacts/stearnscountyminnesota

Walsh, C. M., Liang, L. J., Grogan, T., Coles, C., McNair, N., & Nuckols, T. K. (2018). Temporal trends in fall rates with the implementation of a multifaceted fall prevention program: Persistence pays off. Joint Commission Journal on Quality and Patient Safety, 44(2), 75–83. https://doi.org/10.1016/j.jcjq.2017.08.009

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