Capstone Change Proposal: Nursing Shortage

Benchmark - Capstone Project Change Proposal
Student’s Name
Professor’s Name
Institutional Affiliations
Course Name and Number
Due Date
Benchmark - Capstone Project Change Proposal
Background
Staffing issues within the healthcare sector have been persistent in the United States. According to Haryanto (2019), nursing is one of the affected sectors, with the problem of nursing shortage emerging as a concerning aspect that influences the quality of healthcare outcomes across the states in the nation. Foli et al. (2021) recognize that an imbalance in the number of nurses against the patients exists, making it challenging for these healthcare providers to deliver services as needed. The primary concern is that the shortage hampers the capability of these professionals to meet the individual needs of all patients in different departments, including the inpatients. Such an aspect raises concern because it compromises the health outcomes of these patients. It also diminishes their satisfaction level, demonstrating the importance of addressing the nursing shortage through appropriate staffing mechanisms to balance the nurse-patient ratio.
Diverse factors interact to trigger the nursing shortage in the U.S. Haryanto (2019) states that these elements are interrelated and complex and that they range from economic and structural to political and social complications. Their presence gradually triggered a worrying staff shortage in the country, which became even more apparent during the COVID-19 pandemic when the human workforce resources suffered extreme pressures due to the workload that overstretched and overburdened these stakeholders. Such recognition has triggered awareness about the need for investigating and finding solutions to this healthcare problem. In this context, Gan (2020) clarified that of the many causative factors, the rapid baby boomers aging illustrates why the U.S. continues to grapple with the nursing shortage predicament. Many healthcare facilities are suffering as these already experienced experts retire, leading to a progressive loss of clinical expertise and tacit knowledge amid an aging population that requires more personalized care. As a consequence, the issue of increasing the number of nurses has become fundamental for the health system’s stability.
Clinical Problem Statement
The nursing shortage issue in the United States has worsened over the years in different states and healthcare facilities. Various researchers have confirmed that it is a significant issue of concern despite the ongoing advancements and policies targeting to improve the overall quality of healthcare delivery within hospitals and in community settings. For instance, Zhang et al. (2018) report that the problem is becoming widespread nationwide because 37 of 50 states will face the nursing shortage challenge by 2030. Many other institutions have thoroughly explored this problem to unearth the underlying issues and their severity. In this context, Foli et al. (2021) indicate that research by the International Council of Nurses found concerning gaps revealing that the U.S. will face a shortage of approximately 10 million in this area by 2030. Such high numbers confirm the gravity of the problem, which many facilities are already decrying since the COVID-19 outbreak.
The fact is that the nursing shortage problem is a public problem of concern. Different departments are feeling the pressure arising from the issue due to the associated ramifications. For instance, Foli et al. (2021) acknowledge that the existing workforce remains overwhelmed by the activities across different departments in a hospital, leading to work-related burnout. Such outcomes have far-reaching consequences on healthcare providers’ motivation, concentration, and sharpness while delivering patient care. According to Drennan and Ross (2019), healthcare providers should remain satisfied without undue pressure to ensure they are alert when caring for patients. This aspect contributes significantly to universal but quality health coverage, which becomes compromised when healthcare providers suffer burnout due to their shortage. This understanding demonstrates the importance of exploring the ongoing nursing shortages in the U.S.
The primary worry is that although all facilities face nursing shortages indiscriminately, the effect is more severe in some regions than others. For instance, Haryanto (2019) notes that graduates prefer to seek work within the urban areas adjacent to their learning institutions. Few express their enthusiasm to relocate and work in remote rural settings, exposing these regions to increased professional environments. Some departments also struggle with the capability to find and compensate specialized nurses due to the unique needs of their patients, aggravating the shortage situation. However, the overall outlook is that the United States finds it tough to replenish the number of nurses as the older ones transition to retirement. According to Haryanto (2019), AACN reported nursing schools’ inability to train more than 56,000 and 80,000 applicants in 2017 and 2012, respectively. This revelation illustrates that the nursing shortage is a systematic challenge influenced by intertwined factors.
Understaffed healthcare institutions lead to increased healthcare complications. For example, Sasso et al. (2019) indicate that increased patients in an understaffed nursing workforce trigger burnout and stress. The working environment becomes unconducive as healthcare outcomes deteriorate because it can cause trauma among the existing practitioners. In this context, Chen et al. (2019) indicate that health-related complications, including medical errors, patient dissatisfaction, and lengthened hospitalization, start manifesting when patients fail to receive appropriate care timely. These results illustrate that adverse outcomes dominate the healthcare sectors without a sufficiently staffed workforce. As a result, this awareness underscores the importance of increasing the number of nurses in affected areas to address the health issues related to the nursing shortage.
Purpose of the Change Proposal about Providing Patient Care in the Changing Health Care System
The current change proposal recognizes gaps in the U.S. healthcare system, and that appropriate alternations are fundamental for improving patient care. The fact is that the nursing shortage poses a concerning threat to patient safety and quality outcomes. There is a need for integrating evidence-based approaches as interventions for the prevailing problem, considering the seriousness and sensitivity of the issue. Studies by Chen et al. (2019) and Foli et al. (2021) prove that understaffing aggravates patient health outcomes in diverse ways, including increasing the rates of medical errors and diminishing the speed of recovery. As a result, this change proposal seeks to stimulate changes in the healthcare system by promoting increased staffing practices to eradicate the understaffing challenge.
The change suggested in this project is to introduce acuity-based staffing to address the problem. Such an approach considers other diverse components, including nurse availability and facility-based resources for supporting the change proposal. As a result, Juvй‐Udina et al. (2020) emphasize that the employed approach is consistent with the current problem because it shifts from the traditional staffing techniques to a more focused method that prioritizes patients’ needs in different departments. In this context, the proposal aims to eradicate the nursing shortage to promote the health outcomes of inpatients within the hemodialysis department. Thus, the approach targeted the appropriate goal and considered the available resources to determine the process of achieving the objectives.
PICOT Question
This project uses a PICOT question to inform its strategies for searching for the appropriate evidence for answering the nursing shortage question. According to Foli et al. (2021), this problem has far-reaching consequences beyond disrupting the quality of care to affecting the well-being of healthcare providers. As a result, there was a need to approach the issue with precision informed by the right tools because designing PICOT questions plays a significant role in ascertaining the values the department would draw from increasing nurse staffing. In a PICOT question, the population is the patients facing various health-related risks due to the nursing shortage. The project considers inpatients in the hemodialysis department vulnerable because of their increased need for immediate care and monitoring throughout their treatment process. The intervention based on the needs and risks associated with the population is expanding nursing staffing levels through an appropriate strategy. In such a process, it will be critical to compare the effects of the intervention in the target group with other patients in the hospital without the treatment. The final consideration is evaluating the outcome of the intervention through aspects such as medication error changes and length of hospitalization within a set timeline.
The various components identified in the formulation reveal that this project PICOT question states, in inpatients in hemodialysis centers, does an increased number of nurses, compared to nursing shortages in the units, lead to improved health outcomes within 14 days? A breakdown of the various components illustrates that:
P - inpatients in hemodialysis centers
I - increased number of nurses
C – nursing shortages
O – improved health outcomes
T – 14 days of hospitalization
Identifying this question is critical for directing the search strategy fundamental for literature review and influencing project implementation.
Literature Search Strategy Employed
The researcher employed a desk review approach to search for appropriate evidence to support the change proposal. The method incorporates extensive online-based research for relevant health-related resources, especially journal articles from reputable databases. The title and the PICOT questions were critical for influencing the search strategy employed in this activity. Moreover, the process only considered materials within a specific timeline and accessible online.
It was fundamental for the investigator to explore different databases to increase the probability of identifying relevant journals that fit the change proposal. In this context, it explored diverse databases, including Cochrane, Google Scholar, PubMed, ProQuest, and EBSCOHOST. Using informed literature search tactics improved the ease of drawing only the ideal materials related to the PICOT question. As a result, some of the options employed in this project comprise the use of specific search phrases such as “nursing shortage in inpatient,” “nursing shortage and patient outcomes,” “increased nursing staffing and patient outcomes,” and “nursing shortage in hemodialysis centers.” Since the search results presented hundreds of related journals, the year of publication filter tool made it easy to scale down the number of results slightly by ensuring that all the listed resources comply with a specific parameter. The next step was to manually scan the titles and the abstract to determine the most relevant journals accessible for use in the literature review. This process led to the identification of several qualitative and quantitative-inclining journal articles published in 2018 and beyond for use in this study.
Evaluation of the Literature
The literature evaluation process was thorough and meticulous. It followed a structured approach using a literature evaluation take that listed different evaluation criteria for each article used in the literature review. For instance, the assessment required the identification of the peer-reviewed journal and its permalink, the title and publication date, research questions, purpose, design, sample, analysis, key findings, recommendations, and explanations of the mechanisms for using each article to support the EBP project. This approach demonstrates that it was a comprehensive process.
The first step of determining the applicability of literature in this study was assessing whether the researched article was peer-reviewed. All eight articles used satisfied this criterion, being published in a recognized journal, including the journal of nursing management, advanced nursing, advanced practices in nursing, and the health care manager. Their titles and year of publications also demonstrated that they related to the PICOT question and are recent, respectively (Jarrar et al., 2018; Foli et al., 2021). Such elements were critical to ensuring that the materials used had pertinent and the most updated evidence in the change process.
The evaluation process also considered the research questions used by the researchers in the different articles. Research questions are fundamental in determining the direction of a study, making this aspect critical when evaluating the suitability of other materials in this change process. Since the proposal investigates the issue of the nursing shortage and the effect that increasing nursing staffing would trigger on patient health outcomes, it was critical to assess the findings of researchers approaching the same issue from diverse perspectives (UzunhasanoДџlu & Ozkan, 2021). Although some of the eight articles did not explicitly outline their research questions, the data collection and analysis section implied them. These elements revealed the different viewpoints of researchers in the context of nursing shortages, the consequences, and suggested solutions.
Other critical components applied in the literature evaluation comprised the aim of the study or the purpose and the study designs. These aspects are fundamental because they contribute to the strength of the findings in a study, informing the utilization of the results by other researchers. In this context, the evaluation determined that the different journal articles have a purpose related to nursing shortage within the clinical settings. Their various study designs also contributed to selecting the most influential articles with generalizable findings in different locations. As a result, these aspects notably affected the literature review and the four materials chosen for comparison in the section.
The research also included other features, such as determining the presence or absence of an intervention in the literature evaluation process. These considerations are critical because they also influence the strength of the evidence emerging from different studies, as illustrated by the hierarch...