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Discussion: Organizational Policies and Practices to Support Healthcare Issues

NURS 6053 Discussion: Organizational Policies and Practices to Support Healthcare Issues

Discussion: Organizational Policies and Practices to Support Healthcare Issues

Post an explanation of how competing needs, such as the needs of the workforce, resources, and patients, may impact the development of policy

A healthcare policy is reflective of the needs and desires of an organization, and therefore should be transparent as well. Effective leaders and organizations must always engage and practice safe, evidence-based high-quality care Laureate Education (2012). However, that is not always the case as we have witnessed too many times. For example, with the current COVID epidemic, we have seen nothing but patients competing for high-quality care, or a hospital bed in the realm of a shortage of both hospital beds and adequate units and staffing. This is not reflective of any current healthcare policy. An organization can formulate any policy they want, however, if it is not reflective of current policy, staff and patients lose trust, and accidents and errors occur with sicker patients, and staff burnout. Kornownyk, McCormack, Kolber, Garrison, and Allan (2017) described the competing needs of providers where it is estimated that they have upwards of eighteen hours a day of chronic and preventive care management. Coupled with that, are more recommendations of increased preventive and screening primary care is competing to meet the needs of every patient Kornowny et al. (2017). An aging Veteran population, stacked with greater comorbidities, paired with other recommendations for chronic illnesses has added to this already high primary-care turnout rate seen within the facility where primary care providers are losing interest and seeking work elsewhere.

Describe any specific competing needs that may impact the national healthcare issue/stressor you selected. What are the impacts, and how might policy address these competing needs? Be specific and provide examples.

The World Health Organization [WHO], n.da) recommends fair access to quality health care for all, in addition to addressing determinants of health. There are competing needs that would and do impact the development of such policies. For example, who would/will cover the cost of medical care for those who cannot afford healthcare? Would it be government-backed, public will, or basic financing Zieff, Zahary, Moore, and Stoner (2020). More staff would be needed and a significant increase in medical facilities would be merited due to current-day accessibility and availability deficits. Also, more medical supplies and equipment (resources) would be required to implement such care as well as the restructuring and writing of the facility and hospital policies for care for all. The population would then be all patients – those with many unknown comorbidities and providers and nurses would be expected to care for and treat in an already staff deficit workforce where patients’ safety and wellness is in jeopardy and staff error and burnout are riding a fine line. A known concept with care for all is too many patients and not enough providers so long waits occur or people just leave or don’t attend due to the long waits Korownyk et al. (2017).  Policies would need to be implemented regarding order to see patients in and staffing ratios. Quality of care would also be a high competing need depending on the level and depth of staff training, and time.

Presently, for the VA to make an impact on improving health care equity it is critical that they better understand and address the

Discussion Organizational Policies and Practices to Support Healthcare Issues
Discussion Organizational Policies and Practices to Support Healthcare Issues

underlying issues of poor health. Inquiring about social health in a caring, empathetic dialogue and providing patients with resources – be it advice, referring to a group in the community or internal and being a steadfast resource for them as they journey on this new road of knowledge will open a door of opportunity for both the patient and provider WHO (n.db). The competing need is going to be time – will there be ample time and enough providers to see the patient and fulfill this evidence-based care, does the facility have enough staff to allow the time it takes to complete this and follow up Andermann, A., & CLEAR Collaboration (2016)? The impact this can make is large for more patients will become compliant with available resources and credible advice. For example, Fernandez-Lazaro et al., (2019) inform that almost half of the patients who don’t have health insurance that is seen and prescribed a long-term therapy are non-compliant making them sicker.  This can be supported from the top of management down within organizational policy and enforced in the electronic chart for initial and on-going assessment of patient and part of a provider’s dictation regardless of the unit patient is presenting to urgent-care, short-term care, mental health, women’s health, rehab, or long-term care.

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References

Andermann, A., & CLEAR Collaboration (2016). Taking action on the social determinants of health in clinical practice: a framework for health professionals. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne, 188(17-18), E474–E483. https://doi.org/10.1503/cmaj.160177

Fernandez-Lazaro, C. I., Adams, D. P., Fernandez-Lazaro, D., Garcia-González, J. M., Caballero-Garcia, A., & Miron-Canelo, J. A. (2019). Medication adherence and barriers among low-income, uninsured patients with multiple chronic conditions. Research in Social & Administrative Pharmacy, 15(6), 744–753. https://doi.org/10.1016/j.sapharm.2018.09.006

Laureate Education (Producer). (2012). Ethical, Moral, and Legal Leadership [Video file]. Baltimore, MD: Author.

Korownyk, C., McCormack, J., Kolber, M. R., Garrison, S., & Allan, G. M. (2017). Competing demands and opportunities in primary care. Canadian family physician Medecin de famille canadien, 63(9), 664–668.

World Health Organization. (n.d.a). Social determinants of health. Retrieved from https://www.who.int/health-topics/social-determinants-of-health#tab=tab_2

World Health Organization. (n.d.b). 10 Global Issues to Track in 2021. Retrieved from https://www.who.int/news-room/spotlight/10-global-health-issues-to-track-in-2021

Zieff, G., Zachary., Y. K., Moore, J. B., & Stoner, L. (2020). Universal Healthcare in the United States of American: A Healthy Debate. Medicina (Kaunas), 56 (11), 580. doi: 10.3390/medicina56110580

The one issue of science-based advice I would advocate for would be to address staffing. We have most of the tools to do our jobs but not the most essential resource – low staff and the inability to retain them. Without adequate and properly trained staff – care, safety, and standard are playing a dicey hand and failing miserably in other areas.

Nurses are natural leaders and as the American Nurses Association has alluded to over and over – Nurses as valued professionals must be at the front line of health care, for they are the voice and advocates for themselves and the very individuals they care for. When people are placed into positions where they feel valued, respected, and empowered, evidence indicates they perform better, with fewer errors and with passion and desire. In the article by Quek et., (2021), when leadership is distributed more among applicable and pertinent staff, the staff becomes engaged with a sense of need with an increased desire to stay.  Furthermore, in a study by Hasselgren, Dellve, and Gillberg (2021) distributed leadership is a collaborative and collective effort between managers and their employees where trust is the foundation. These relationships when productive are beneficial for they are reinforcing each other in a positive fashion Hasselgren, Dellve, and Gillberg (2021). It is equally relevant to inform you that this study did not address associations between distributed leadership and support or collaborations from senior management Hasselgren, Dellve, and Gillberg (2021). As known, dependent on the type of leadership that is portrayed and utilized within the organization, this approach could prove challenging. For example, I work for the federal government and the type of leadership within our organization is authoritative where all the decisions are made among the senior team. As the American Nurses Association (2021), and Agency for Healthcare Research and Quality (2012) indicate, nurses must be utilized to their full capacity. The (American Nurses Association, 2021) further pledges that the Department of Health and Human Services must “provide resources for the recruitment and retention of nurses within organizations.”

To reach the objective and goal of no patient left behind, staffing must be addressed and satisfied so that safe-evidence care can be demonstrated and sustained. After all, Rosa Parks did not get on the bus silently but adhered to what was right and just in her eyes.

References

American Nurses Association. (2021, September 1). ANA Urges US Department of Health and Human Services to Declare Nurse Staffing Shortage a National Crisis. Retrieved from nursingworld.org

Agency for Healthcare Research and Quality. (2012, December). The Role of the Nurse Manager module of the CUSP Toolkit addresses the role of nursing leaders for your quality improvement initiative. Retrieved from https://www.ahrq.gov/hai/cusp/modules/nursing/nursing-notes.html#slide8

Hasselgren, C., Dellve, L., & Gillberg, G. (2021). Conditions for distributed leadership practices among managers in elder- and disability care organizations: A structural equation modeling approach. International Journal of Nursing Studies Advances, 3. https://doi.org/10.1016/j.ijnsa.2021.100049

Quek, S. J., Thomson, L., Houghton, R., Bramley, L., Davis, S., & Cooper, J. (2021). Distributed leadership as a predictor of employee engagement, job satisfaction and turnover intention in UK nursing staff*. Journal of Nursing Management (John Wiley & Sons, Inc.), 29(6), 1544–1553.

RE: Discussion – Week 3

COLLAPSE

How competing needs may impact the development of polices to address that issue 

For years the healthcare system in the United States has relied on a fee-for-service payment system whereby each medical service and procedure is paid for separately. However, this payment model created several limitations, including fueling health care costs, overtreatment, and overutilization at the same time leaving others underserved and undertreated. In an attempt to counter these perverse incentives, the legislation of payment reforms which focuses on methods that reflect providers’ performances, primarily quality, safety, and patient experience, has been put in place to replace the traditional system of fee-for-service (Palumbo et al., 2017). The new healthcare payment reform has been designed to spur provider efficiency, reducing unnecessary spending subsequently reducing healthcare costs. However, competing needs such as the use of 12-hour shifts as employees’ retention strategy, workforce, and resources have affected the development and adoption of this critical policy following the necessity that surrounds competing needs to align with the agenda of payment reform.  

Payment reforms such as Medicare, which pushes for bundled payment, whereby patients are required to use only one payment method covering all episodes of care, have to address nursing shortages. With the aging population steadily rising, Medicaid has been burdened with being the primary payer of healthcare for many Americans. Nurses play a critical role in driving system change because of their sheer numbers (Miller et al., 2017). It is estimated that as of 2019, over 3.8 million registered nurses were integrated into the American workforce, a lower number compared to the health care needs of the American people. As a result, the available nursing workforce is forced to register more hours in their workplaces, reducing quality, safety, and quantity of care service (Rivers & Glover, 2008). There are numerous severe ramifications associated with shortages of nurses, such as work overload of available healthcare personnel, which results in burnout and subsequently compromise patient safety and long waiting, which may cause more harm, including preventable deaths.  

References: 

Miller, B., Ross, K., Davis, M., Melek, S., Kathol, R., & Gordon, P. (2017). Payment reform in the patient-centered medical home: Enabling and sustaining integrated behavioral health care. American Psychologist, 72(1), 55-68. https://doi.org/10.1037/a0040448 

Palumbo, M., Rambur, B., & Hart, V. (2017). Is health care payment reform impacting nurses’ work settings, roles, and education preparation?. Journal Of Professional Nursing, 33(6), 400-404. https://doi.org/10.1016/j.profnurs.2016.11.005 

Rivers, P., & Glover, S. (2008). Health care competition, strategic mission, and patient satisfaction: research model and propositions. Journal Of Health Organization And Management, 22(6), 627-641. https://doi.org/10.1108/14777260810916597 

REPLY QUOTE EMAIL AUTHOR

RE: Discussion – Week 3

Competing Needs

A significant competing need that is impacting the way that advanced practice registered nurse (APRN) practice is physician influence. In 2014 the American Medical Association (AMA) adopted a resolution 214 opposing the planned APRN Compact. Allowing the APRN multistate license to practice in states that are in the compact (Sofer, 2018, p. 12). In 2015, the AMA opposed the APRN to practice independently at Veterans Affairs facilities. Arguing that nurses cannot take the place of trained physicians (Sofer, 2018, p. 12). With every study done that points to APRN providing safe, effective care, it is a wonder that APRN faces opposition from physicians (American Assosciation of Nurse Practioners, n.d.).

Policy Influence

Collaborating with policymakers and physicians to give APRN independent practice is beneficial. Those benefits include elimination of physician supervision time freeing up more time for patient care and increased access to primary care which would reduce the need for hospitalization (Unruh, Rutherford , Schirle , & Brunell, 2018, p. 541). Also, direct and indirect economic benefits result in wages, taxes, increased spending in the economy. In 2012, The Perry Group found that expanding the role of the APRN could produce $8 billion in revenue and 97,205 in permanent jobs(Unruh, Rutherford , Schirle , & Brunell, 2018, p. 545).

Policy Considerations

 Legislators, physicians, and APRN need to collaborate to create policies that provide optimal patient-centered care. Reminding everyone that the goal is to place the attention back on patients getting access to healthcare. As well as implementing procedures that allow the APRN to practice at the full potential so patients can have access cost-effective and timely healthcare. Recommendations would include creating national standard rules and regulations of the APRN rather than state by state. Having a national standard would clearly define scope of practice guidelines for the APRN to adhere to.

References

American Assosciation of Nurse Practioners. (n.d.). https://www.aanp.org/advocacy/state/state-practice-environment

Sofer, D. (2018, March). AMA Resolution Opposes Independent Practice by APRNs. American Journal of Nursing118, 12. Retrieved from https://ovidsp-dc2-ovid-com.ezp.waldenulibrary.org

Unruh, L., Rutherford , A., Schirle , L., & Brunell, M. L. (2018, November-December). Benefits of Less Restrictive Regulation of Advance Practice Registered Nurses in Florida. Nursing Outlook66, 539-550. http://dx.doi.org/https://doi.org/10.1016/j.outlook.2018.09.002

RE: Discussion – Week 3

Hi Dalila. One of the reasons that NPs are not given full practice authority is that physicians oppose this policy. Moore, et al. (2020) of Policy, Politics, and Nursing Practice did a study where participants were actively or passively involved in legislative actions for NP full practice authority. Each of the participants said that those who had the most opposition to NPs having full practice authority were organized medicine. The opposition is especially strong from specialists. However, participants said that not all physicians may be opposed to NPs having full practice authority. Some believe it is medical professional organizations more so than individuals (Moore, et al., 2020, p. 225). Those who are not opposed to NPs having full practice authority have probably recognized the benefits of having NPs associated with their practices. Some may be opposed to NP full practice authority if they are the physicians who oversee NPs because they make a great deal of money for very little effort doing that.

Another reason why some physicians are opposed to NPs, according to Peterson (2017) of the Journal of Advance Practice Oncology, having full practice authority is the misconception that NPs want to broaden their scope of practice. The reality is that NPs want to practice within the extent of their licensure. Some Boards of Nursing define what the scope of nursing practice is. For example, Texas says that APRNs act independently and collaboratively with “the health team in observation, assessment, diagnosis, intervention, evaluation, rehabilitation, care and counsel, and health teachings of a person who are ill, injured or infirm” (Peterson, 2017, p. 76). However, Texas requires NPs to be overseen by physicians. Peterson (2017) says that this may be because medical boards have lots of money behind them to push their agenda (Peterson, 2017, p. 76). The opposition by physicians needs to stop so that health care can be delivered better to everyone.

References

Moore, C., Kabbe, A., Gibson, T., & Letvak, S. (2020). The Pursuit of Nurse Practitioner Practice Legislation: A Case Study. Policy, Politics, and Nursing Practice, 21(4), 222–232. Retrieved from https://journals.sagepub.com/doi/pdf/10.1177/1527154420957259

Peterson, M. E. (2017). Barriers to Practice and the Impact onHealth Care: A Nurse Practitioner Focus. Journal of Advance Practice Oncology, 8, 74-81. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5995533/pdf/jadp-08-074.pdf

RE: Discussion – Week 3

Discussion Module Two

The healthcare workforce is one of the most complex industries that has ever existed. The system is made up of many different components and details that must work together to maintain the health and wellbeing of society (Broome & Marshall, 2021). The needs of a workforce, resources, and patients are only some of the components that make up the healthcare industry. While each element is its own entity, they all must be attended to so they can work together to help healthcare run smoothly. Unfortunately, the needs of each entity often compete, making the balance of healthcare challenging to maintain. This is where policy development comes into play; policy development is often enacted after assessing the needs of each healthcare component. Based on what the needs are and how they can be attained is what policy is based upon (Wieckowska, 2019).

As mentioned above, the different needs of healthcare components are often in competition with one another, making a healthy balance very difficult to achieve (Wieckowska, 2019). Such competing demands can be easily detectable when it comes to the issue of a lack of access to primary healthcare. For example, for primary healthcare to achieve its mission of keeping the health of society in check through health promotion, preventative health, education, and screening, the workforce requires an adequate amount of primary care clinicians. However, there is a shortage of primary healthcare clinicians making the resources limited and competitive. Additionally, the global population has grown tremendously, leading to a limited number of resources and increased healthcare financial needs. These issues manifest in an increased lack of access to primary healthcare (Ward et al., 2018).

The competing needs of healthcare that contribute to a lack of access to primary care can cause ethical conflict. Nurses are often faced with ethical and moral dilemmas due to the standards of care that they are expected to maintain together with the competing needs and limited resources (Kelly & Porr, 2018). To ease such ethical conflicts, policies are put in place to help balance needs to a state of equilibrium. Specifically, in connection to the issue of a lack of access to primary healthcare, there are quite a few policies that have been focused on to help create a better balance. An example of one policy is giving nurse practitioners more autonomy and credential of practice. Through such a policy, nurse practitioners can provide primary care, thereby creating more resources and points of access (Xue et al., 2018). Another policy to address the issue of primary care is insurance policies. Many organizations have made policies that focus on accepting all insurance types, enabling more patients to access primary healthcare (World Health Organization, 2019).

References

Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). New York, NY: Springer.

Kelly, P., & Porr, C, (2018), Ethical nursing care versus cost containment: Considerations to enhance RN practice. OJIN: Online Jpournal of Issues in Nursing, 23(1), Manuscript 6, doi: 10.3912/OJIN.Vol23No01Man06. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Nursing-Cost-Containment.html

Ward, B., Lane, R., Mcdonald, J., Powell-Davies, G., Fuller, J., Dennis, S., . . . Russell, G. (2018). Context matters for primary health care access: A multi-method comparative study of contextual influences on health service access arrangements across models of primary health care. International Journal for Equity in Health, 17(1). doi:10.1186/s12939-018-0788-y

Wieckowska, B. (2019). Healthcare needs maps-evidence informed healthcare policy. Social Insurance Department, Warsaw School of Economics, 15-20. doi:10.7365/JHPOR.2017.1.2

World Health Organization. (2019). Report of the Global Conference on Primary Health Care: From Alma-Ata towards Universal Health Coverage and the Sustainable Development Goals. Retrieved December 13, 2021, from https://apps.who.int/iris/bitstream/handle/10665/330291/WHO-UHC-IHS-2019.62-eng.pdf

Xue, Y., Kannan, V., Greener, E., Smith, J. A., Brasch, J., Johnson, B. A., & Spetz, J. (2018). Full Scope-of-Practice Regulation Is Associated With Higher Supply of Nurse Practitioners in Rural and Primary Care Health Professional Shortage Counties. Journal of Nursing Regulation, 8(4), 5-13. doi:10.1016/s2155-8256(17)30176-x

Competing needs arise within any organization as healthcare workers seek to meet their targets and leaders seek to meet hospital goals. Either targets or goals require establishing priorities and allocating resources. For example, a policy addressing adequate nurse staffing is essential to meet the patient and workforce needs while minimizing hospital cost. However, utilizing in more nursing staff might result in economic inefficiencies along with misallocated resources.

The shortage of staff is connected with negative impacts; including lower quality and quantity of care because there are few resources to offer. Work overload to the existing nurses lead to burnout, and eventually compromising patient safety. Nursing shortage policies are constantly supported by current literature and they vary from country to country. However, there is continuous effort to modify certain aspect such as pay agreements, emergency hiring plans and RN residency programs to improve working environment for nurses (Park & Yu, 2019). Nurses should also voice their opinion on ways to resolve competing needs; the culture of silence creates a culture of acceptance and continues to suppress nursing professional knowledge (Kelly & Porr, 2018).

Competing needs that may impact nursing shortage is aging population in which baby boomer entering the age of increased need for health services. Which would require more students to enroll into the nursing program today and hire more educators to provide students with proper training. Another contributing factor is nurse burnout, statistics shows a national turnover rates is 8.8% to 37% (Lisa et al., 2020). Nurses are experiencing burnout daily and leaving the profession for better opportunities or advancing in their career. Ensure an optimal nurse to patient ratios to improve nurse staffing and improve quality of care delivered. Lastly, workload and work environment has forced hospitals to reduce staffing and implement mandatory overtime polices to ensure nurses would be available to work when the number of patients admitted increased unexpectedly. Furthermore, increase the workload to decrease on health care costs.

A policy might address these competing needs by ensuring an optimal nurse to patient ratio which can improve care outcomes for patients and ensure patient safety. Healthcare policymakers’ involvement in developing a staffing policy in every organization to improve working conditions (such as working hours, violence in workplace, managing workload) for the nurses staff to improve competencies and better job satisfaction. Ensure adequate government funding to allocate resources for training and clinical skills without causing strains on the government and organization budget. Also, devote resources toward increasing nurses wages; a token of appreciation for their dedicated and hard work.

References

Haddad, L.M., Annamaraju, P., & Toney-Butler, T.J. (2020). Nursing Shortage. Retrieved June 15, 2021, from https://www.ncbi.nlm.nih.gov/books/NBK493175/

Kelly, P., & Porr, C. (2018). Ethical nursing care versus cost containment: Considerations to enhance RN practice. OJIN: Online Journal of Issues in Nursing, 23(1), Manuscript 6. doi: 10.3912/OJIN. Vol23No01Man06. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Nursing-Cost-Containment.html

Park, H., & Yu, S. (2019). Effective policies for eliminating nursing workforce shortages: A systematic review. In Health Policy and Technology, 8(3), 296-303. https://doi.org/10.1016/j.hlpt.2019.08.003

Organizational Policies and Practices to Support Healthcare Issues

Quite often, nurse leaders are faced with ethical dilemmas, such as those associated with choices between competing needs and limited resources. Resources are finite, and competition for those resources occurs daily in all organizations.

For example, the use of 12-hour shifts has been a strategy to retain nurses. However, evidence suggests that as nurses work more hours in a shift, they commit more errors. How do effective leaders find a balance between the needs of the organization and the needs of ensuring quality, effective, and safe patient care?

In this Discussion, you will reflect on a national healthcare issue and examine how competing needs may impact the development of polices to address that issue.

Resources

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES

To Prepare:

  • Review the Resources and think about the national healthcare issue/stressor you previously selected for study in Module 1.
  • Reflect on the competing needs in healthcare delivery as they pertain to the national healthcare issue/stressor you previously examined.

By Day 3 of Week 3

Post an explanation of how competing needs, such as the needs of the workforce, resources, and patients, may impact the development of policy. Then, describe any specific competing needs that may impact the national healthcare issue/stressor you selected. What are the impacts, and how might policy address these competing needs? Be specific and provide examples.

By Day 6 of Week 3

Respond to at least two of your colleagues on two different days by providing additional thoughts about competing needs that may impact your colleagues’ selected issues, or additional ideas for applying policy to address the impacts described.