Part 5: Recommending an Evidence-Based Practice Change Mandatory overtime

Answer

1. • Outstanding patient services translate to high levels of patient satisfaction.
   • The low number of nurse professionals results in a need for mandatory overtime.
   • 12 hour shifts impact nurse performance.
   • Readiness for change is triggered by the concern raised on nurse performance.
   • Determine how to improve nurse performance.

   The current organization aims at providing outstanding patient services so as to lead to high levels of their satisfaction.

   However, due to the low number of nurse professionals, the organization has adapted a culture where nurses have to work on mandatory overtime.

   This has led to poor performance among the nurses who are expected to work for atleast 12 hours per shift .

   The organization is ready for change since there are adverse effects on nurses’ job satisfaction, well-being, and intention to leave their job which have raised concern.

   The management needs to determine ways to improve the performance of nurses since it also impacts the kind of outcomes experienced by the patients.

    

   Current Problem

   • Nurses who work overtime tend to showcase poor performance (Son et al., 2019).
   • There is a cause for concern since negative patient outcomes are experienced (Banakhar, 2017).
   • Inadequate nurse staffing encourages mandatory overtime policies.
   • The stakeholders involved in this problem include nurses, the human resource team, as well as the management of the institution.
   • The risks are; resistance to change and increased levels of turnover.
   • The current problem revolves around the fact that nurses who work overtime tend to showcase poor performance (Son et al., 2019).
   • Therefore, rather than the act of working overtime being beneficial, it becomes a cause for concern since negative patient outcomes are experienced (Banakhar, 2017).
   • Many institutions struggling with inadequate nurse staffing will end up establishing mandatory overtime policies which overworks the nurses and interferes with their work-life balance.
   • The stakeholders involved in this problem features the nurses, the human resource team, as well as the management of the institution.
   • The risks that can be experienced during change implementation is the resistance to change and increased levels of turnover.

    An Evidence-based Idea For a Change In Practice

   • A shift of the usual 8 hours enhances nursing outcomes and improves nurses’ job satisfaction (Dall'Ora et al., 2015).
   • Working long hours triggers adverse nurse outcomes and work-related hazards (Son et al., 2019).
   • Long working shifts impact the nurse’s ability to complete important “ancillary” work (Emmanuel et al., 2020).
   • Improve the current staffing so that the nurses do not have to work for more than 8 hours.

   According to research, longer working hours of 12 or more hours impact nurse’s health and wellbeing, including their level of job satisfaction (Banakhar, 2017).

   However, a shift of the usual 8 hours does not impact nurse performance, but rather enhances the outcomes and improves their job satisfaction (Dall'Ora et al., 2015).

   Working long hours triggers adverse nurse outcomes and work-related hazards (Son et al., 2019).

   Long working shifts also impacts the nurse’s ability to complete important “ancillary” work (Emmanuel et al., 2020).

   Thus, it is clear that the best alternative for the current organization is to improve the current staffing so that the nurses do not have to work for more than 8 hours.

   Knowledge Transfer of the Change

   • Conducting research on various databases so as to identify specific themes (Johnson, 2016).
   • Dissemination through organization level presentations.
   • Communication of findings through presentations conducted in the meetings.
   • Kurt Lewin’s three step change model so that change resistance is avoided.
   • Stakeholders will be informed and given an opportunity to react.
   • Knowledge on the topic will be created by conducting research on various databases so as to identify specific themes (Johnson, 2016).
   • After the information has been collected, dissemination will take place through organization level presentations.
   • Here, the findings will be communicated to the target audience through presentations conducted in the meetings.
   • The adoption and implementation will take into account the Kurt Lewin’s three step change model so that change resistance is avoided.
   • Therefore, the change process will be smooth as the stakeholders will be informed and given an opportunity to react before the change is implemented.

   Measurable Outcomes

   • Outcome 1: Increase the current nurse staffing by 50% by hiring more professionals in the next one
     • Hiring more nurses will reduce the workload per nurse.
     • The time spent with each patient will be productive.
   • Outcome 2: Reduce the nurse turnover rates in the organization by 90%, by improving the nurse   work environment within the next three months.
     • The work environment impacts the level of nurse job satisfaction.
     • If the environment is favorable, the nurses will be able to enjoy their jobs.

   These outcomes are interrelated. When nurse performance is improved through a focus on the areas that impact their satisfaction, then the patient outcomes will also be promoted.

   90

   Measurable Outcomes

   • Outcome 3: Improve patient outcomes by 50% by focusing on the improvement of                                nurse performance in the next three
     • When nurse performance is improved, the kind of service offered to patients is outstanding.
     • When patients experience great services, their overall outcome improves upon discharge.

   A Summary of the Critical Appraisal

   • Level I evidence articles.
   • Overworking of nurses is discouraged (Dall'Ora et al., 2015).
   • It impacts their wellbeing that eventually affects the kind of service offered to patients (Son et al., 2019).
   • Hence, higher adequate staffing is needed.
   • Overall, both patients and nurses will experience improved outcomes.
   • All the articles that were appraised feature level I evidence.
   • All the resources argue against the overworking of nurses (Dall'Ora et al., 2015).
   • That is because it impacts their wellbeing that eventually affects the kind of service offered to patients (Son et al., 2019).
   • Hence, higher adequate staff are needed to ensure that each professional will only handle the required number of patients per shift.
   • Overall, the findings ensure that both patients and nurses will experience improved outcomes.

   What I Learned from Completing the Evaluation Table 

   • The level of evidence determines validity.
   • Peer reviewed articles are the most accurate.
   • The theoretical background of an article links to current practice.
   • The inclusion and exclusion criteria determine the conclusions drawn.
   • The type of database used is also of great importance.

   The level of evidence determines the validity of a research article.

   Peer reviewed articles are the most accurate research articles to use in evidence based practice.

   The theoretical background of an article helps to establish the current research and how it relates to current practice.

   The inclusion and exclusion criteria should be analysed to determine whether the conclusions drawn are reliable.

   The type of database used is also of great importance when determining the reliability and validity of research articles.

   What I Learned from Completing the Evaluation Table Cont’d

   • The study design should be aligned with the methodology used.
   • The right methodology leads to accurate results.
   • The right sample size must be considered.
   • The strengths and limitations of a study affect study results.
   • The study design should also be analyzed to determine whether it aligns with the methodology used.
   • The right methodology must be used to promote accurate results.
   • The right sample size should also be used to ensure the findings of a study can be related to the actual population.
   • The strengths and limitations of a study need to be analyzed to determine the extent to which the findings may be affected.

   Conclusion

   • An evidence based practice is important in determining the right course of action for an organization.
   • Decision making should be supported by data from research studies that are peer reviewed and accurate.
   • The current organization should increase nurse staffing and reduce working hours to ensure job satisfaction and outstanding performances.