Policy Analysis Project

Answer

Policy Analysis Project

The creation of policies is a constant process necessitated by the changing healthcare needs. The quality of care can only be improved if modifications to existing systems are made to ensure that the patient outcomes are improved. Registered Nurse (RN) leaders should not be satisfied with status quo but should rather interrogate current processes to establish whether they can be changed to ensure improved quality of care (Melnyk et al., 2014). An evaluation of healthcare policies is done to see if they are still relevant and find out any need for changes and modifications to the policies. One of the ways in which the efficiency of systems can be evaluated is by interviewing nursing leaders who provide accurate insights on the policies and their appropriateness for the needs and process of their healthcare organizations.

The presenter of this paper set out to interview Giuseppina Jolie Gaglio, a Senior Staff Nurse at NYU Langone Medical Center. Gaglio has an experience of three years in the Cardiac Cath Lab and Medical-Surgical, Stepdown, Transplant ICU. The interview took place on September 6, 2017, at 1230 (EST) in her office. She has previously been a Staff Nurse for one year in the medical ICU at St. Francis Hospital. Additionally, Gaglio has also served as an Adjunct Instructor-College of Nursing and Public Health at Adelphi University and NYU. Presently, she undertakes her duties at Memorial Sloan Kettering Cancer Center in the Neurology and Neurosurgery Department, a post that she has held for the last four years. On her academic qualifications, she holds a DNP from the Chatham University of New York and an MSN from CUNY Hunter College of New York (Gaglio, 2016). Her BSN is from the Long Island University of New York. The interview was aimed at identifying any current health policy issue in Memorial Sloan Kettering Cancer Center and then make a decision on whether a DNP capstone project could be conducted on the matter identified during the interview. The rationale is that the identification of a policy issue would lead to the evaluation as to the effects of the problem on the patient outcomes in the organization. This paper aims to present the policy issue identified during the interview and apply the policy analysis process proposed by Bardach’s (2012).

Description of Policy Issue

After an assessment of Memorial Sloan Kettering Cancer Center was conducted, it was established that the organization has huge numbers of nurse leaders, supervising the provision of care provided by a healthcare team. Additionally, there were other specialists such as Clinical Nurse Specialist, Advance Practice Registered Nurse (APRN), physician assistants, and Registered Nurses (RNs). However, despite the large-scale assembly of healthcare leaders, a huge number of them lacked skills and competencies to conduct activities such as intravenous blood draws, and IV-line placement because it is not a required institutional competency. As such, there is an overreliance on the RN phlebotomy team to perform these tasks (Gaglio, 2016). Novice nurses who do not possess the necessary skills and competencies to align with their practice environment have caused various patient safety issues. Additionally, the nurse leaders and their followers lack clinical preparedness, experience complex workloads, and high patient to nurse ratios (Gaglio, 2016). The nursing policy issue was, therefore, identified as lack of clinical competencies on the part of the registered nurses as the existing institutional policies and procedures do not delineate specific RN role and responsibilities.

The Nursing Council has set forth standards for continuing competence under Health Practitioners Competence Assurance Act 2003 which places a professional responsibility on all practitioners to maintain nursing competencies (NMC, 2015). Additionally, The Nursing and Midwifery Council (NMC) has published various Standards for pre-registration nurse education which serve to state the competency standards for all nurses. The criteria set out four main areas including professional values, communication as well as interpersonal skills, decision-making in nursing practice and leadership, management, as well as teamwork. The American Nurses Association (ANA) via the Professional Nursing Practice Regulations states that the nursing practice competencies should not only be defined and measured but also be evaluated. The current policy in Memorial Sloan Kettering Cancer Center does not reflect the application of those guidelines as patient health and safety is compromised because of lack of skills and competencies, in particular by the novice nurses.

Interview Examples

In the course of the interview with Gaglio (2016), various examples were provided which proves that there is a lack of delineation of roles and responsibilities as well as lack of skills and competencies on the part of the nurse practitioners. One of those examples is that some of the nurses (and this number is growing) lacked the necessary skills and competencies in areas such as intravenous blood draws and IV-line placement because it not a required institutional competency and there is a reliance on the RN phlebotomy team to perform these tasks. Additionally, the interviewee stated that new nurses are not trained with appropriate skills for blood draws, and IV-line placement, among other exercises.

The other example from the interview which proves the lack of necessary competencies for the RN is the fact that the quality and service matrix in Memorial Sloan Kettering (MSK) is under review by the Nursing Quality Management team because of the length of the average time for waiting during blood draw and delivery of services. According to Gaglio (2016), the health and safety of the patients cannot in some instances be guaranteed as some of the critical individuals in the teams do not possess what is required of them in undertaking their duties. Although the RNs work as teams, some instances arise whereby the skills and competencies of each one of them are needed in the execution of their mandates.

Practice Examples

Various examples from practice were also identified during the assessment hence confirming that lack of nursing competencies is a big issue in Memorial Sloan Kettering Cancer Center. One of the examples is that in 2016, there were one sentinel events involving sepsis on the unit. In this instance, a nurse did not administer prescribed intravenous antibiotics to her neutropenic patient having fevers. She did not know how to draw the needed blood for cultures before giving the antibiotics, and the RN phlebotomy team was unavailable. From these failures, the patient became septic and died 72 hours later in the ICU.

The second practice-related example on the lack of critical skills and competencies was in the situation of sepsis, where a nurse had to do an in-service with another nurse on the implications of sepsis. To learn and improve nursing practice without making the nurse feel at fault or penalized, the nurse was asked what measures can be put into placed improve patient safety. Such incidences are just but some of the examples which show lack of competencies envisioned in the NMC and ANA guidelines on nursing skills.

Presentation of Policy Analysis

There should be a particular guide to be used in the identification of the areas that the current policy in the institution needs improvement or changes. According to Bardach (2012), the eight-step process can be used in the evaluation of policies as well as shifts in those policies. Such a process starts with the definition the particular problem, gathering evidence about the problem, constructing alternative solutions, selecting criteria, projecting the outcomes, confronting existing tradeoffs, deciding on the best policy, and finally telling a personal story (Bardach, 2012). These eight steps will be deployed to analyze a system in Memorial Sloan Kettering Cancer Center.

Definition of the Problem

The problem identified during an interview with Gaglio (2016) is a failure of the policies and procedures of the institution to delineate the roles and responsibilities of the RNs. Additionally, it was also noted that the novice nurses were the people who lacked essential skills and who threatened the health and safety of the patients. Key areas where the RNs required competencies are those of intravenous blood draw and IV-line placement. The recommendation that was made by the interviewee is that Nursing Education Department needs to develop, for the nurse residency program, updated curricula of nursing competencies and skills required to deliver safe and efficient nursing care (Gaglio, 2016). However, in the meantime, lack of critical skills can result in the loss of lives due to improper intravenous blood draws and IV-line placement.

Assembly of Evidence

The American Nurses Association (2013) states that nursing competencies should not only be defined, but also measured, and evaluated. If skills of the nurses cannot be defined with ease, then it follows that they do not exist. Additionally, the Nursing and Midwifery Council (2015) provided that RNs should embrace professional values in the conduct of their work. Despite those provision being in place, RNs in Memorial Sloan Kettering Cancer Center do not possess those skills, and the healthcare facility has not delineated the various roles and responsibilities that each of the RNs should undertake. As such, the current policy requires some changes which would improve the training options for the novice nurses to ensure that RNs are well prepared for their practice.

Construction of Alternatives

If Memorial Sloan Kettering Cancer Center does not make changes to its current policy, then the health and safety of the patients in the facility will be compromised. The option that can be taken without revising the policy is providing nurse training and refresher courses which will ensure that novice nurses and RNs are equipped with skills and competencies required of them in accordance with NMC (2015) and ANA (2013) guidelines. In the Institution, a need arises for the training of the RNs on how they can conduct intravenous blood draws and IV-line placement without causing any adverse impact on the patients. As such, the alternative to the change in policy is offering nurse training in the Institution to ensure increase staff competencies.

Selection of Criteria

Memorial Sloan Kettering Cancer Center current policy affects all RNs in the facility. As such, changes in the policy would have an impact on the ability of the RNs to do intravenous blood draws and IV-line placement (Gaglio, 2016). RNs are required to have BSN for them to conduct such activities. The irreducible minimum required of the RNs is to hold a diploma from nursing done in two years. However, the mandatory two years training are not long enough to equip RNs with the principal competencies for their tasks.

Projection of Outcomes

If changes to the current policy are made, and nurses trained on how to conduct intravenous blood draws and IV-line placement, the expected results were that the quality of care would be improved and patient outcomes would be better (Manoochehri et al., 2015). Additionally, such changes can be used by researchers to assess the impact of increased training and refresher courses. Evaluating the outcomes of the project can provide foundational data which can be deployed in making further changes and health quality initiatives in future instances (Cheng et al., 2014).

Confronting Trade-Offs

The proposed changes to the current Institutional policies and procedures will ensure increased competencies for the RNs and improve patient quality and safety. The teams with the roles and responsibilities of intravenous blood draw and IV-line placement will have the opportunity to identify learning opportunities and area which require training (Gaglio, 2016). The second trade-off apparent from the interview is that the time used for the training and refresher courses could affect working hours. As such, the program and courses should be flexible to allow for any changes if need be.

Decision

The ultimate decision that changes should be made to the current implementing institutional standards of nursing practice and competencies in the nurse residency program will ensure increased competencies and skills for nursing practice. The final decision will be made by different stakeholders including the novice and RNs, Quality Control Department, Human Resource (HR) Department, among others. The changes will experience some resistance which should be overcome through consultations. The ultimate impact of the changes will increase competencies and hence better quality regarding patient outcomes.

Telling the Story

Despite the decision to change the current policy of implementing institutional standards of nursing practice and competencies, novice RNs are eagerly waiting for programs which will make them better prepared for their practice. Additionally, they want to know how they can appropriately conduct intravenous blood draws and IV-line placement. Gaglio (2016) was categorical in the interview that changes to the current practice standards are a matter of necessity as opposed to luxury as the health and safety of patients are at stake. Ensuring quality of care is a bare minimum which should be the goal of any healthcare organization. As such, the training opportunities proposed are well timed.

In conclusion, modifications in institutional policies are critical to improving the quality of care and better patient outcomes. In Memorial Sloan Kettering Cancer Center, the current practice guidelines do not have clearly delineated roles and responsibilities for the RNs. Additionally, novice nurses lack key competencies and skills required of their job. The current practice is, therefore, not in line with ANA and NMC guidelines on professional competencies. The proposed policy changes are the provision of training opportunities to the RN is that they can be better prepared and equipped with skills on how to perform intravenous blood draws and IV-line placement. Such changes will ensure successful handling of customer issues and guarantee the quality of care for the patients. Nurse leaders should interrogate current policies and if need be to make changes which would make their institution an epitome of quality care.