Quality Improvement Initiative

Quality Improvement Initiative

In health care systems, the need to address safe patient care necessitates various management responses with regard to the problem in question. Quality improvement initiatives (QI) are actions undertaken by the stakeholders in a health care facility to bridge the gaps in realizing the goals of service delivery (Sadegh et al., 2013). The premise can also entail the implementation of innovative approaches to model and design various strategies aimed at addressing complex care interventions. According to Cullen (2018), assessing quality improvement initiatives is important to measure the performance of a health system to enhance the safety of patients seeking care services. In the institutions of care, quality improvement initiatives also entail an evaluation of the staff capacity and the availability of resources to handle populations seeking medical attention (Mikhail & Langabeer, 2018). Often, nursing population can be used as the yardstick to assess the quality of care since they spend the longest period with the patients (Hickey & Brosnan, 2017).    Thus, the context of safe staffing with respect to nurse-to-patient ratios needs to receive attention.

Quality Improvement Initiative
Quality Improvement Initiative

Selected Quality Measures Identification

Safe nurse-to-patient ratio is a quality initiative that most hospital leaders take into account in a bid to ensure quality care for patients. Health facility administrators often formulate strategies that address safe, effective and efficient approaches that guarantee quality care to patients. Hill and DeWitt (2018) illustrate that one of the most important approaches is to recruit adequate nursing staff and other care professionals to address patient acuity. Certainly, an interplay of many factors concerning nurse-patient ratios has often hampered the efforts to bridge the staffing gap. In many cases, care facilities lack adequate financial resources to implement nursing staff (Shekelle, 2013). Besides, access to competent and experienced nursing staff is a challenge due to the shortage of specialist nurses.

In this regard, the present article delves into the quality measures related to safe nurse-patient ratios in care

Quality Improvement Initiative
Quality Improvement Initiative

setting. The premise is guided by the argument that patient-centered outcomes are compromised by inadequate nursing staff. The present nursing staff in care facilities is also overwhelmed by the high patient population. The occasion of unsafe nurse staffing is also exacerbated by the high rate of nurse turnover most of whom seek further studies or opt for institutions that offer better remuneration packages. According to Shekelle (2013), the recommended rate for nurse to patient ratio is at 1:4. However, the present health facility indicates a ratio of 1:8, which is far below the required standards. The high nurse to patient ratio is detrimental to both the institution and the clients seeking care services. It results to missed care due to untimely administration of medication and poor pain management (Sadegh et al., 2013; Lee et al., 2017). A project on nurse staffing entails addressing nursing skill mix in addition to a response on care hours as a way to look into the working patterns of nurses. Thus, the health facility can also focus on attracting high-quality nurses through redesigning the practice environment to improve patient safety.

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Data Collection Plan

Data collection plan is an important aspect and a straight forward approach to indicate the patterns of nurse staffing in a care facility. The collected data will reflect aspects of patient care, particularly concerning prompt care, increase in falls, bed sores, and other infections (Hickey & Brosnan, 2017). Data on safe nurse to patient ratios can be collected through different approaches and comprises five steps.

The first step entails identifying the perceived speculated results on nurse staffing results and the ways to measure their actual number. The second step relates to developing a data gathering approach to ascertain the problem of the unsafe nurse to patient ratios in a care facility. The third step involves the analysis of the data collected in a bid to reflect on the nurse staffing deficits with respect to patient population seeking health services at the institution. Step four, on the other hand, entails relating the data collected to establish the extent of an inadequate number of nurses when compared to the patient population seeking medical attention. In the final step, the four steps are repeated to ensure the accuracy of the information collected. This also provides information that can be used to compare data from known databases to reflect the pattern of the nurse to patient ratio with recommended standards.

The manual data collection plan will be determined by observing the lifestyle, body and the environment of patient care. This provides qualitative data to gauge on adequate or poor staffing nursing patterns in a care facility (Hickey & Brosnan, 2017). It can be deduced that the behavior and the overall outlook of patients depend on the decisions they make from the information they receive as per the advice of nurses. In the event of inadequate personnel, the quality of life of patients is likely to be compromised due to insufficient education on self-care (Hill & DeWitt, 2018). The environment of care can also be altered and expose patients to hospital-acquired infections as opposed to when there is adequate nursing staff.

The data collection plan is also based on the analysis of diagnosis-related groups (DRGs). The latter denotes a case-mix of patients which categorizes clients as per their diagnoses, demographic characteristics, and treatments administered to them. In a nutshell, the DRGs provide data on the number of doctors, nurses and medical products used to offer given care to patients (Woo, Milworm & Dowding, 2017). Further, the DRGs provides feasible data on the number of care providers required to support prompt as well as quality care. The project on safe nurse-patient ratios will rely on the data from DRGs to provide a measure and indicators on the minimum number of nurse staffing ratios that can affect the quality of patient care in a given facility.

Nurse’s Role in Correct Data Collection

Nurses are integral in providing information related to patient safety in a care facility. The professionals avail data that can be used in the analysis of staffing by acuity indicators. In other words, nurses are the health professionals that have close proximity to patients, and as such, they provide actual information on the number of patients under their care. They can inform hospital administrators if the number of patients they attend to are more or less based on their ability to provide the service. Acuity in a care setting is ranked as per the severity of illness rated based on minor to major and extreme conditions. A nurse ratio of 1:4 is the recommended scale to solve thrilling severity of patient conditions. The measure indicates the level of flexibility of a hospital to provide care to patients with complicated illnesses. Studies by Hill and DeWitt (2018) and Lee et al. (2017) affirm that nurse leaders and advanced registered nurses use aggregate data to measure as well as monitor the trends in quality care to patients. The information gathered is incorporated into data collected from administrative and multiple clinical databases from the facility, which will further be used to analyze the trends or to support research in the given health facility.

Professional, Ethical, and Regulatory Standards Implementation

The project implementation requires quality improvement actions based on the ethical and regulatory standards of nurse staffing. Related standards and criteria need to conform to the federal regulations on a number of health professionals required in care facilities (Woo, Milworm & Dowding, 2017). The safe nurse-to-patient ratios program as well addressing the number of licensed registered nurses and practical nurses that conforms to the regulatory requirement of health facilities of a state become necessary. The effectiveness of a quality improvement initiative depends on the employment of nurses with competency in their area of specialty to optimize patient outcomes (Mikhail & Langabeer, 2018). However, confidentiality of the sensitive information reported by nurses on the administrative practices of a given facility must be guaranteed as a remedy to victimization.

The American Nurse Association (ANA) recommends specific rates of nurse-to-patient ratios in different departments of a health facility. In the critical unit, a ratio of 1:2 is recommended while at the emergency department the regulatory body expects 1:4. Further research by Lee et al. (2017) suggests that the standard criteria of the ANA guide on the implementation of the quality initiative. The stipulated recommended ratios will guide nurse staffing.

Communication to Stakeholders

Implementation of the quality improvement initiative can be well achieved through effective communication to stakeholders. The initial process will require the provision of accurate and adequate information for justification on the implementation of safe nurse-to-patient ratios (Wong, 2015). Stakeholders will be informed on the current state of the nurse-to-patient ratios so that they evaluate the need for quality improvement. As part of the quality improvement team, I will schedule a meeting with the stakeholders where the facts and figures related to the safe patient care will be availed. I will also collect feedback from key stakeholders regarding the program and compile a report that will steer the implementation process.

Interprofessional Collaboration

The implementation of the safe nurse-to-patient ratios will depend on the leadership skills emulated by the stakeholders in the given health facility. According to Laureani, Brady and Antony (2013), nurse leaders and the project management team must display leadership skills to inspire other nurses as they strive to improve patient care. Besides, the leaders need to create a staffing plan that aims to respond to unpredictable nursing turnover as part of the improvement initiative to address patient acuity. The stakeholders will also be expected to communicate progress to all team members and highlight areas where the program should be given priority (Laureani, Brady & Antony, 2013). However, as part of stakeholder engagement, leaders must portray interprofessional collaboration so that the program is accepted within the care facility. Cullen (2018) posits that successful implementation of the program depends on how the leaders define the financial requirement, emulate time management skills and address potential challenges that might impede achievement of safe patient care.


In conclusion, the need to improve quality in healthcare necessitates the introduction of systematic approaches to prioritize on actions required for care delivery. Safe nurse staffing in health facilities is essential in improving the well-being of patients. However, in addressing the nurse staff deficit, the stakeholders will need to employ skilled and competent professionals. Further, it will be vital to assess the acuity in the selected hospital and allocate nurses based on the severity of patients’ illnesses. All these approaches are aimed at minimizing medication errors as well as to improve the quality of health outcomes.





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Hickey, J. V., & Brosnan, C. A. (2017). Evaluation of health care quality in for DNPs (2nd ed.). New York, NY: Springer Publishing Company.

Hill, M., & DeWitt, J. (2018). Staffing Is More Than a Number: Using Workflow to Determine an Appropriate Nurse Staffing Ratio in a Tertiary Care Neurocritical Care Unit. Journal of Neuroscience Nursing50(5), 268-272.

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Lee, A., Cheung, Y. S. L., Joynt, G. M., Leung, C. C. H., Wong, W. T., & Gomersall, C. D. (2017). Are high nurse workload/staffing ratios associated with decreased survival in critically ill patients? A cohort study. Annals of intensive care7(1), 46.

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Sadeghi, S., Barzi, A., Mikhail, O., & Shabot, M. M. (2013). Integrating quality and strategy in health care organizations. Burlington, MA: Jones & Bartlett Publishers.

Shekelle, P. G. (2013). Nurse-patient ratios as a patient safety strategy: a systematic review. Annals of Internal Medicine158(5_Part_2), 404-409.