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A quality improvement project that evaluates the wait times from the time patient arrives
at clinic, the actual scheduled time of appointment, and the time the patient is taken to treatment
room by nurse can determine the cause of the patient dissatisfaction of wait times. The National
Database of Nursing Quality Indicators (NDNQI) is a survey nurses take to assess the safety in
their work environment, delivers evidence to support the importance of nurse sensitive
measures in overall patient experience strategy (Press Ganey NDNQI, 2016, para. 1). Using
these evaluation tools, can determine which interventions would be best to trial before making
any definitive changes. The NDNQI is used by nurse managers in assessing the needs of the
nursing staff and can ask for more nurses based on those needs.
Nursing professional practice implications leads to burnout syndrome and high nurse
turnover rate. Job retention is used by some as a measure of patient safety (Amer, 2013, p.
53). Burnout syndrome is generally defined as exhaustion, depersonalization, and reduced
satisfaction in performance (Weber & Jaekel-Reinhard, 2000, p. 512). Nurses that are
chronically under stress due to high patient volume and discharge/admission of patients per shift
experience greater turnover and burnout. The observation made in the infusion center is high
patient turnover rate and the acuity of the patients can require significant amount of a nurses
time. More patients with higher acuity and rapid turnaround with discharges and admissions,
make nursing practice more stressful than ever (Amer, 2013, p. 25). New patients require
almost double the amount of time then established patients. Nurses provide much needed
education to patient and family about medications, discharge instructions, signs/symptoms when
to call MD, and self-care/maintenance until next appointment. When the nurse to patient ratio is
great, education cannot be addressed nor time allotted.
Improving nurse to patient ratios has been researched and found to show care is safer
when nurse-to-patient ratios are reasonable (Amer, 2013, p. 25). Higher nurse to patient ratios
have been documented to improve outcomes such as lower mortality rates, fewer pressure sores,
and less antibiotic use (Amer, 2013). Increasing the number of nurses would help alleviate the
immediate need and help with the nurse to patient ratio. The infusion center is adding five more
chairs/beds for the increased patient volume in the last two years. Retention of current and
experienced nurses would increase morale and job satisfaction among current nurses working in
the infusion center. Amer states, an optimal work environment has adequate staffing, a positive
collaborative environment or supportive nursing culture and resources that encourage life-long
learning (Amer, 2016). Retention of current nurses is cost-effective measure for hospitals. It is
expensive for a health care facility when there is high nurse turnover (Unruh, 2008).
The dashboard below, for BSHSI, shows that the target is not being met which effects
reimbursement from Center for Medicare Services: Medicare and Medicaid.
79%,
90%
2.10,
n/a
42.86%
75.00%