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Applicable Nursing Theory
Although medicine is a holistic and humanitarian science, in hospital management systems nurses are viewed as human resources. The majority of nursing theories are typically patient-focused and are based either on utilitarian or Kantian ethics. Thus, they are unfit for being implemented as frameworks to support the intervention aimed at restructuring and rationalizing existing schedules. However, Hobfolls theory of Conservation of Resources is capable of addressing the matter of effective nursing management as well as the psychological effects of burnout and turnover, which lead to understaffing in hospitals. The theory considers four resources, which are as follow (Prapanjaroensin, Patrician, & Vance, 2017):
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Objects. In this scenario, objects are instruments, equipment, and facilities. Rationalizing and simplifying hospital logistics in order to reduce travels between offices would reduce the overall number of hours nurses spend without attending to patients.
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Conditions. In this scenario, conditions are defined by schedules, workload, the number of patients served, and the environment. Our intervention is aimed at affecting two of the major conditions, which are scheduling issues and effective workloads.
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Personal characteristics. These are defined by the skills, endurance, psychological resilience, resistance to burnout, adaptability, and other characteristics that individual nurses have.
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Energy. Is defined by physical and emotional energy spent by nurses during work.
The proposed intervention, though affecting only one of the four types of resources directly, has the potential of affecting the rest indirectly, as each of the factors mentioned above is interconnecting, forming a holistic nursing framework.
Proposed Implementation Plan
The proposed intervention involves developing a flexible Excel-managed schedule for nurses, which can be altered and modified by managers based on the necessity, the number of patients, and the estimated workload (Tuominen, Lundgren-Laine, Kauppila, Hupli, & Salanterä, 2016). Implementing such a schedule would require analysis and cooperation with one of the local healthcare facilities. It is likely that the attempt to introduce flexible scheduling would first be made on a smaller scale, involving one or several departments within a single hospital setting.
The proposed scheduling intervention would manage the number of active nurses based on the number of patients attending daily. It would mean that the hospital would not be overstaffed when the number of patients is low nor would it be understaffed when the number of patients is high. Nurses would be allowed to have more time to rest and less-intensive schedules. The number of effective patient-hours is expected to grow while the overall number of working hours for nurses would drop, as they would not be expected to stay at work idly. The effectiveness of the intervention can be measured with empirical data (patient-hours and work-hours) as well as indirect variables, such as burnout rates, general satisfaction, and other psychological indicators that can be measured via questionnaires.
Potential Barriers to Plan Implementation
One of the greatest potential barriers to the plan is that the healthcare organizations would not allow implementing the intervention in their own setting, out of fear of disruption to their day-to-day operations. One of the possible ways to avoid rejection is to send participation requests to numerous healthcare facilities, both large and small. Small facilities with low workflow can be used to test out the proposed intervention without risk. Another issue is related to the adoption of fluid schedules. Some nurses would be unable to adapt to the ever-changing schedules, even if the shifts become shorter, as it makes daily planning difficult (Rochefort, Buckeridge, & Abrahamowicz, 2015). This issue can be avoided by offering different schedules to different nurses some would be able to retain their regular schedule and form the backbone of the department, while the rest would be subjected to different shifts, depending on the number of patients and the workload.
References
Prapanjaroensin, A., Patrician, P. A., & Vance, D. E. (2017). Conservation of resource burnout and nation safety. Journal of Advanced Nursing, 73(11), 2558-2565.
Rochefort, C., Buckeridge, D., & Abrahamowicz, M. (2015). Improving patient safety by optimizing the use of human resources. Implementation Science, 10(89), 1-11.
Tuominen, O. A., Lundgren-Laine, H., Kauppila, W., Hupli, M., & Salanterä, S. (2016). A real-time Excel-based scheduling solution for nursing staff reallocation. Nursing Management, 23(6), 22-29.
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