Comment on the posts of two peers. APA citations are required only for the original post.
The person I chose to propose my quality improvement (QI) clinical practice transformation project guided by research was a nurse who works for the Delaware Department of Education. She is the state of Delaware lead school nurse. She creates and oversees the school nurse onboarding process for the state of Delaware.
The specific points that I highlighted in my QI project were topics discovered from qualitative literature review of continuing education needs for school nurses. I proposed that these topics be created into learning modules and an asynchronous new school nurse training program be created. The topics were categorized into five themes (Jordan et al., 2024). Under the standards of practice theme, the topics were: clinical judgement, skill development, legal risks and expectations, competence with technology, time management, state requirements (screenings, medication handling, documentation required. Under the care coordination them the learning needs included: IEP/504 planning, and collaboration with administrators, parent, teachers, and students. Included in the topic of leadership was policy and team development. For continuing education in community health, the topics were cultural sensitivity and infectious disease and exclusion guidelines. And finally quality improvement themes included documentation and outcome measurement.
Alongside with the asynchronous education modules, I also think it would be a good idea to have all school nurses have access to these modules and choose which fits their practice or what they need a refresher on. I also suggested that qualitative research be initiated to determine what nurses in Delaware school districts think they need to learn to feel confident in their practice. I also proposed that the districts each hire a nurse mentor who would spend at least 8 hours a week working side-by-side with the new school nurse to give them guidance and support, help them form a routine, and get their office structured in a beneficial way.
The potential findings will help create a training program that is beneficial for a new school nurse and more specific to the population and area served. It will help new school nurses feel confident in their practice of delivering high quality care to the school children. It could also reduce stress and burden for new school nurses and hopefully promote retention within the districts.
Peer 2 (A.S.):
I would plan to first approach the health care center administrator and director of nursing (DON) to formally propose a quality improvement project guided by my research idea of increasing CNA staffing to resident acuity ratios to reduce CNA staffing turnover, thus improving patient care. Specific points I would highlight for the administrator and DON would be the turnover statistics in a CNA’s first six months. I would also explore CNA facilitator and/or nurse manager efforts and exit interview strategies to better capture data related to the reason behind CNAs resigning from the health care center. Many times, we hear from CNAs that they are overwhelmed by the workload and choose to go find a better opportunity in home health or agency. Other times it is because they feel staff is mean to them which also is likely due to the overwhelming amount of workload for one CNA to give quality care.
When we train new CNAs in our state approved program, the Pennsylvania Department of Education only allow the trainees to have a maximum of three residents to care for while on the clinical neighborhood. It is stressed to them that quality care is the focus, rather than quantity. However, once they graduate, they magically are to provide quality care for approximately twelve residents in the time it was taking them to care for only three. It’s overwhelming to them and all the staff working with them to complete their own assignments plus now also help a new hire with their assignment and also go out of their way to make them feel fully welcomed and emotionally connected with their feelings of anxiety and pressures of the job. The regular staff feel burnt out from training a revolving door of newly trained CNAs.
I would stress to the administrator and DON that what we’ve been doing for at least the last 20 years, is not working anymore, and if we’re being honest with ourselves, it hasn’t been even before the Covid-19 pandemic. We have more staff turnover than ever before. I would stress that our efforts in retention must be studied further so we can find a better change for everyone and most importantly the residents since it is likely their care is suffering because of it. There are countless articles that show a connection between poor staffing and poor patient outcomes. Before more serious issues arise, we should come together rather than make excuses and silence the real reason CNAs are leaving the health care center at a well-known long-term care organization.
“Staffing has largely been built around simple numbers, that is, numbers of patients and numbers of nurses often disregarding factors including patient acuity; family presence and intervention; nurse education, experience, and expertise; hours worked and fatigue; and team composition and development. When these factors are not addressed, the result is often missed care” (Dempsey & Batten, 2022, p 91). Our organizational leaders and stakeholders were proud to learn the mandatory staffing requirements wouldn’t impact our facility since as far as the numbers are concerned, we have been working with the correct staffing ratios. What it seems they are not hearing is the continued turnover and reasons behind it, as well as shortcuts in patient care, thus at times causing reportable injuries. Through continued progression of research, we can lead an industry that seems to be sinking in costs related to injuries of patients, injuries of employees, and poor patient outcomes and readmissions to hospitals possibly through well-established retention efforts. Until we all choose to open our eyes, ears, and hearts to learn more of the cause to find a solution, we will continue to feel the effects of doing things the same way, with the same staffing ratios, in a world of higher acuity patients in long-term care settings. I would also leave them with a final question for thought… how would you feel if your loved one was to be admitted here? Would you feel any concerns whatsoever with the staffing and the morale of the health care center today?