Hiring more nursing assistants to assist during registered nurses'(RNs) shortage can be very challenging. Currently, I am working in the critical care unit (CCU), where we always used total patient care delivery assignments. The staff work 12-hour shifts, and each nurse is assigned for two patients, depending on the patients’ acuity. According to Marquis and Huston (2017), total-patient-care (TPC) nursing is the oldest patient-delivery model. With this model, one bedside nurse oversees the total care of patients during the assigned shift. The total responsibilities of the bedside nurse for a patient’s care include bathing, bed making, administering medications, vital signs, carrying out all ordered treatments, dressing changes, patient teaching, discharge planning, and updating patient care plan, etc (Marquis & Huston, 2017). We do not have nursing assistants in the CCU to help our nurses with all these responsibilities. Unfortunately, two months ago, we have about six nurses who resigned due to professional advancement and relocation.
Since we have a nurses shortage and hiring nurses is a long process, we (CCU leaders and the senior executive leadership) decided to collaborate with other departments to give us task nurses or nursing assistants which we called clinical partners (CP). Since both task nurses and the CPs will work under the supervision of the supervisor or the charge nurse, this delivery care model will fall under the functional-care model. A task nurse is a medical-surgical or telemetry nurse who is responsible for giving medications according to her job descriptions, checking blood sugar, etc. The nursing assistants’ tasks are to help CCU nurses in bathing the patients and foley care, changing linens, answering call lights, etc.
Marquis and Huston (2017) noted that functional-care model (FCM) was found to be more cost-efficient due to the lower number of RNs required per shift. FCM involves assigning tasks to various team members based on the patients’ complexity or acuity of care needed. Generally, routine tasks are done by persons who are not RN, and the RN oversees more complex patients’ needs. With this model, the unit charge nurse makes the patients’ assignments for the team because she/he has more knowledge of all the patients’ needs (Marquis & Huston, 2017). However, switching from TPC to FCM has a significant impact on the patients’ quality of care in our unit. Our patients’ satisfaction dropped this month by 30%. Marquis and Huston (2017) outlined that the FCM quality of care was found to be less than with the total-patient-care model (Marquis & Huston, 2017). In my experience, hiring more nursing assistants to assist during nurses shortage will help to lessen the nurses’ workload in the CCU temporarily. On the other hand, having more certified critical nurses improve patients’ safety and outcomes.
Meanwhile, hiring more nursing assistants to assist during nurses’ shortage can impact patients’ quality of care and staff satisfaction on St. Louis Medical Center (SLMC). As a nurse administrator at SLMC, I will use evidence-based practice, current literature, and scientific research to analyze proposed changes in nursing care delivery models. I will also make changes in work design to facilitate meeting organizational goals. Also, I will arrange a departmental meeting involving staff-led representatives from all nursing departments to ensure that everyone has a voice. Finally, I will empower each unit-based practice councils/members to be involved in unit problem solving such as short staffing and develop action plans to resolve the issues. During the meeting, I will seek feedback from my direct reports and the staff and ask them “what’s working well and what is not?” and to know what I can offer for them.
One of the mechanisms used to promote employees’ growth and development in an organization’s long-term plan is empowerment and to support staff during times of difficult transitions (Choi, Goh, Adam, & Tan, 2016). Johnston and Villa (2018) outline that the Chief Nursing Officer should ensure successful engagement by integrating a shared governance council (SGC). SGC involves monthly meetings with bedside nurses to express issues, share best practices, develop action plans, and raise specific challenges to administration (Johnston & Villa, 2018).
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application. (9th ed.). Philadelphia: Lippincott Williams & Wilkins.
Choi, S. L., Goh, C. F., Adam, M. B. H., & Tan, O. K. (2016). Transformational leadership, empowerment, and job satisfaction: the mediating role of employee empowerment. Human Resources for Health, 14(1). doi: 10.1186/s12960-016-0171-2
Johnston, D., & Villa, J. (2018). Shifting culture: A new CNO leading to nursing excellence. Journal of Nursing Administration, 48(9), 422. Retrieved from https://search-ebscohost-com.chamberlainuniversity.idm.oclc.org/login.aspx?direct=true&db=edb&AN=131663203&site=eds-live&scope=site