Nurse staffing Ratio contributes to nurse safety

Application of Theory: Nurse staffing Ratio contributes to nurse safety

  1. Introduction to the paper includes a few general statements on the idea of nursing
    theory being applied to solve problems/issues in nursing practice, regardless of the specialty area
    of practice. For example, why would one pick a nursing theory to solve a practice problem?
    Would a grand, middle-range, or practice theory be best? Does the writer have any experience in
    using nursing theory this way? In addition, a brief one-paragraph summary of a specific nursing
    theory and information on the sections of the paper are provided. The selected nursing theory can
    be a grand theory, a middle-range theory, or a practice theory.
  2. Description of the problem/issue for which strategies will be developed. The problem
    to be resolved must be in nursing leadership, nursing education, nursing informatics, or health
    policy. Scholarly evidence (in the form of a literature review) supporting the issue is included.
    The problem/issue could be local to one’s specific practice setting. For example, the setting
    might be a nursing unit, a nursing-education program, an informatics department, or a health-
    policy unit of a consulting firm. The problem/issue needs to be something that a nursing theory
    can impact, whether it solves the actual problem/issue or enables people affected by the
    problem/issue to deal with it. It is best if the problem/issue is from real life something the writer
    of the paper has dealt with or is currently engaged in.Introduction
    Barr and Welch (2012) suggest that leading change in health care has become more rampant
    among the nurse leadership. Strong leadership in partnership facilitates smooth transformational
    change. Nursing theory shape nurse practice in a myriad ways, and provides considerable
    positive impact. Nursing theory provides a framework, which support nursing practice and offers
    solutions to nursing ethical dilemmas, thereby ensuring delivery of quality care. Nursing
    theories assists the nurse discipline in the clarification of beliefs, goals, and values. This

Running Head: Application of Theory Paper
facilitates proper definition of the unique nurse contribution to the concept of care. In fact,
nurse clinical practice standards are derived from the nursing theories. The nursing theory
resolves challenges in educational, leadership and research as well as practice settings.
Depending on the health issue under investigation, there are three major types of nursing
theory. Grand nursing theory is the broadest, but provides generalized propositions. This level of
nursing theory reflects on the nurse practice, thereby offering very insightful solutions. Theories
in this level include conceptual frameworks. The middle range theories scopes are narrower than
Grand nursing theory. The importance of this level of nursing theory is that it acts a bridge
between the grand nursing theory and nursing practice. The nursing practice theories have very
limited scope. These theories are developed within a specific nursing practice. The nursing
theories at this level offer intervention for nursing practice, and predict outcomes of nursing
practice. The advantages of nursing theory will be demonstrated by Jean Watson’s theory (Clark,
Zickar & Jex, 2013).
Identification of practice problem
The main issue in the health care facility I work at is staffing ratio. Literature indicates
that nurse-staff ratio ensures quality of care. However, high turnover rates and reduced number
of nurse graduates has been an ongoing challenge of nurse managers as well as administrators.
Blignaut, Coetzee & Klopper (2013) argue that challenge is associated with negative patient
outcome, reduced safety in work place and reduces patient satisfaction. The high turnover rates
are attributable to nurse overwork, burnout, and fatigue. This affects nurse’s practice because the
nurse lacks compassionate working.
Witges & Scanlan, (2014) state that the staffing ratio has been associated with reduced
patient and nurse safety. The availability of health as nurses who have had ample rest is

Running Head: Application of Theory Paper
important in providing quality and empathetic acer. However, most work places are described
with innumerable stressors, which often result to disease or even injuries. The stressors occur in
various forms such as, characteristics of the facility’s leadership, internal and external changes
the organization. Some of these changes includes lean contracts, use of advance technology
without refresher courses, increased population of older workforce and high number of aging
population seeking care in the healthcare facility have been associated with reduced patient
safety.
The hazardous working condition can impair nurse’s health. This includes health
complications such as musco-skeletal disorders, infections, mental discomfort, cardiovascular
diseases, and other complications such as neoplastic diseases. Working for longer shift affects
nurse sleep pattern and gastro-intestinal system. This results to psychological response such as
stress and depression. Long hour shifts also increases rate of exposure to harmful chemicals and
infectious agents. Long hour working can increase smoking and alcohol consumption rate, and
caffeine use with the aim of fighting fatigue (Blignaut, Coetzee & Klopper, 2013).
According to Lievens and Vlerick (2013), the traditional approach of addressing the
nurse staffing issues has not been very successful. The paper suggests that by applying the theory
of human caring will help solve this challenge. This is because the model points out on nursing
leadership solutions, which can help the administrators and the healthcare management by
guiding them on how to solve this issue amicably.
Proposition of Jean Watson’s theory
Thomas-Hawkins & Flynn (2015) study indicates that the main concepts of the Jean
Human caring theory assume that the foundation of nursing and its essence resides in provision
of care. According to this theory, quality care provision is enhanced through interpersonal

Running Head: Application of Theory Paper
interaction. The main and basic assumptions of the theory include the fact that caring is
effectively practiced through interpersonal interaction. The theory suggests there are a set of
carative factors, which increase patient satisfaction. The theory also suggests that effective care
promotes health of the patient, family and the community at large. Additionally, the theory
suggests that caring responses accept a person as what she is currently and what she may become
in the future. The nursing theory concept suggest that a caring environment is important as it
provides an opportunity for a person to choose the best care plan for themselves at any given
point of care.
Witges and Scanlan (2014) research indicates that a caring leadership is more
healthogenic, this makes caring an integral concept to nursing practice. The theory has ten
carative factors including the establishment of humanistic-altruistic leadership system. This
factor is mediated through experiences and exposures to various healthcare challenges. This
factor is paramount for maturation of nurse leadership and management skills. This nursing
theory suggests that an effective leadership is one that cultivates sensitivity to others and to
oneself. The nurse leader must ensure that the nurses are more sensitive and authentic. Moreover,
the nurses should be encouraged such that self-actualization and self-growth is sustained. This in
turn ensures that those people the nurse interacts with are empowered, thereby promoting health.
Empowered nurses will ensure that they build a strong relationship through effective
communication. Effective communications is associated with good work place rapport and
strengthen the aspects of human caring. The theory outlines that a good leadership is
characterized by empathy, congruence, and warmth. These feelings foster a caring relationship
between healthcare facility management and their staff as it improves the organizations
awareness. The human caring theory enables the nurse leader to solve problems following

Running Head: Application of Theory Paper
systematic scientific approach of problem solving. This is the only approach to control, predict
and to find the best solution. The human caring science should always be neutral and objective.
The human caring theory focuses on the learning-teaching process. This will help the nurse
understand the situation better, enabling them have a cognitive plan (Clark, Zickar & Jex, 2013).
Blignaut, Coetzee, and Klopper (2013) argue that for quality delivery of services, the
model suggests that nurse must work in a safe environment. Tis will help the nurse to offer
supportive and protective care adequately. The human caring theory recommends that both the
internal and external environments should be at equilibrium as both environment are
interdependent. The model as is grounded in a hierarchy of human demands similar to that of
Maslow’s, and each need or demand is as important as the principles of nursing. Therefore, to
provide an optimal care, the needs should be valued and attended. Lastly, the model has some
allowance for existence of phenomenological forces. Phenomenology in this case refers to the
way people understand and value this i.e. people’s opinion. The model allows the integration of
psychology in nursing leadership. This helps the nurse and the organization management to
mediate the concept of holistic nursing practice, and identify the best approach, which will
empower nurses, improve staff ratio, lower nurse workloads and strengthen the quality of care.
Application of Watson’s theory
Witges and Scanlan (2014) reveals that Nurse Leaders can use this theory to address
nurse safety issues associated with reduced nurse-staff ratio. Using the ten caritas, the health care
facility can address the issue of nurse staffing and by enable the staff engage in holistic nursing
practices, and making the uses engage in self-care. Additionally, the organization can plan on
policies, which will ensure nurses do no work for long hours. The organization leadership should
ensure that the nurses have enough time to rest so that they can rejuvenate. Incorporating this

Running Head: Application of Theory Paper
theory into practice, provides a great impact to the work environment as well as positively
impact on the nurse’s perception. The theory enables the nurses to incorporate a caring practice
in their practice; caring to patients and to their health’s. This indicates that there is connectedness
between nurse leadership, nurse and the patients.
Strategy Rationale
Nurse safety is an integral component in any health care facility; however, the concept is
overlooked. There are limited resources on the role of nurse leadership in enhancing staffing
ratios. With the shortages of nurses in the country, it is high time that for leadership to explore
other options such as the adoption of new technology such as robotics, telehealth, use of sensors
in beds, motion sensors and thermos-sensors to help the nurse in delivering their services. Other
options such as employing of unregistered nurses as staff assistance, more volunteers, and interns
could be other options, which can be applied to reduce nurse workloads (Blignaut, Coetzee &
Klopper, 2013).

According to Clark, Zickar & Jex, (2013) the strategy intends to reform the healthcare
facility policies and protocols, which acts as barriers to improving, nurse safety through
increasing nurse-staff ratio and reducing overworking the nurses. The exact model, which will be
applied in this strategy, is Continuous Quality Model commonly referred to as FOCUS-PDSA.
The Strategy rationale includes searching and seeking the underlying concept, which cause high
turnover rates and increased workloads for the employees. This includes exploring options of
integrating computerized health care devices such as Tele-health concept. Organization
committee comprising of relevant stakeholders will be formed. These people (including nurses,
managers, head of departments and community representatives) will preside over the barriers and

Running Head: Application of Theory Paper
facilitators of working; analyze the discrepancies and to establish the most effective
interventions.
Expected outcome
The evaluation of the expected outcome will be done after one year. However, this should
not be limited within this time because interventions outcomes may take a while before they are
realized. The expected outcome includes improved and safe working environment. The nurses
should not act for long hours. The turnover rate should decrease as well as the number of work
injury or ailment related complication. The benefits of improving working environment for the
nurses are manifested through increased quality of care. This includes reduced number of
hospital acquired infections, hospital falls and postoperative infections. This is because the
nurses will be in a position to deliver quality care, with minimal confusion or error. Relaxed and
nurses with adequate rests manifest proper communication and interpersonal skills. This implies
that there will be a reduction in medical errors, improved quality of life, and patient’s
satisfaction.
The main challenges with this nursing theory is that it does not rely on the
conventional mechanism of ensuring that only qualified people are employed, which are still
being applied in most of the healthcare facility. Additionally, the theory lacks mechanisms to
motivate nurse work force to ensure that they are retained. This implies that the theory is
somewhat too abstract that the leaders may become reluctant to integrate into practice (Blignaut,
Coetzee & Klopper, 2013; Witges & Scanlan, 2014).
Conclusion
Nurse staffing and nurse safety is a major issue, which need to be addressed. For a long
time, these challenges have been solved using shortsighted interventions such as additional

Running Head: Application of Theory Paper
incentives and recruitment bonuses. These interventions solve the problems temporarily, and
introduce fiscal difficulties to the organization. This calls for the integration of nursing theory to
address this issue more amicably, through practical interventions. This implies that the nurse
leaders must be involved, and must apply nursing theory to identify the underlying mechanism.
The nursing theory should be applied when exploring available options. It should also be applied
when making long-term changes that will shape the health care facility in to a safer environment
for both the service user and service provider. Using theoretical framework, the nursing
leadership as well as organizations will record higher employee retention rate, and
simultaneously improve the quality of care and patients outcome.

Reference list
Barr, J., & Welch, A. (2012). Keeping nurse researchers safe: workplace health and safety issues.
Journal Of Advanced Nursing, 68(7), 1538-1545. doi:10.1111/j.1365-2648.2012.05942.x
Blignaut, A., Coetzee, S., & Klopper, H. (2013). Nurse qualifications and perceptions of patient
safety and quality of care in South Africa. Nurs Health Sci, 16(2), 224-231.
doi:10.1111/nhs.12091
Clark, O., Zickar, M., & Jex, S. (2013). Role Definition as a Moderator of the Relationship
Between Safety Climate and Organizational Citizenship Behavior Among Hospital Nurses.
J Bus Psychol, 29(1), 101-110. doi:10.1007/s10869-013-9302-0
Lievens, I., & Vlerick, P. (2013). Transformational leadership and safety performance among
nurses: the mediating role of knowledge-related job characteristics. J Adv Nurs, 70(3), 651-

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    Thomas-Hawkins, C., & Flynn, L. (2015). Patient Safety Culture and Nurse-Reported Adverse
    Events in Outpatient Hemodialysis Units. Res Theory Nurs Prac, 29(1), 53-65.
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    Witges, K., & Scanlan, J. (2014). Understanding the Role of the Nurse Manager: The Full-Range
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