NRS 493VN Capstone Project Change Proposal

NRS 493VN Capstone Project Change Proposal

Background

Nursing shortages and nurse burnout have been a continuous concern in healthcare that has existed for years, but now, more than ever, is a time to find a way to improve staffing and retain the nurses at hospitals and clinics. With the current pandemic that we are facing, the need for nurses is of the highest priority throughout the world of healthcare, and the intensity of nurse burnout is rising with every day that passes. The nursing profession gives multiple doors of amazing opportunities and specialties that a nurse may pursue, but for many, it can end up being a door they wish they had never opened due to the overwhelming stress that this profession can bring at times. According to Snavely (2016), 30%-50% of all new RNs either change jobs or leave the profession within the first 3 years of clinical practice. This is very true in both workplaces that I am in at a trauma ICU and at a Dermatology office where I work with other nurses. The amount of turnover has been increasing at alarming rates, especially in the Dermatology clinic, and it is overwhelming for the staff that has stayed with the office, and there needs to be a resolution.

After observing staff and getting feedback from fellow colleagues, one of the most common complaints comes from a lack of support and not feeling appreciated. According to Bong (2019), moral distress is a psychological disequilibrium where one knows the morally right course of action but fails to follow through because of institutionalized constraints. In other words, staff members are feeling hindered in providing efficient care due to the negative work environment they are put in.

Clinical Problem Statement

New graduate nurses and remaining staff in the Dermatology practice deserve and require an integrated support system within the practice to effectively improve the competency levels of new and seasoned nurses and promote retention by adapting strategies to reduce nurse burnout. Due to the high demands in the number of patients, a nurse must see per day at the Dermatology clinic, many nurses can become overwhelmed with stress if there is a lack of assistance or being short-staffed. This not only leads to nurse burnout but also increases the risk of medical error that would negatively impact the patient.

Purpose

In order to provide optimal patient care, staff must uphold a certain level of competency and safety at all times in order to ensure the patient is being treated correctly and safely at all times. In the office, nurses are responsible for treating patients with certain skin conditions such as dermatitis, psoriasis, eczema, and rosacea, to name a few. We are trained thoroughly in several lasers to treat these conditions and require knowledge in settings and how to operate the machines. If the nurse is distracted or overwhelmed, one wrong setting can cause severe burning and blindness to a patient. Not only do we perform laser treatments, but nurses are also trained in the aesthetic portion of dermatology and hold a higher level set of skills for performing these treatments. Patients treated by a nurse who lacks proper skills or is unable to perform at a certain level of quality in care can be greatly impacted by arterial occlusions, blindness, temporary paralysis, etc. The impact that patients can have from nurses being stressed and overwhelmed on a daily basis is dangerous for the patient population. By implementing these meetings and support systems, along with having certain nurses be available as mentors, together we can work on supporting each other to ensure the highest quality of care is delivered to every patient.

PICOT Question

Will the implementation of having mandatory weekly discussions and readily available support groups to staff members over a period of four weeks compared to not having any type of support like current conditions show any difference in retention of staff and help with how staff feels in regards to stress and burnout? Will implementing a Mentor Preceptor program assist with higher retention rates and fewer treatment errors made by staff?

Literature Search Strategy Employed

In searching for literature that pertained to my project proposal, online articles of less than five years were obtained using the GCU library portal. I was able to gather eight articles, all retrieved through an online EBSCO host research platform. The article studies that were evaluated and dissected included qualitative and quantitative data, along with systemic reviews with observational and correlation studies in their research.

Evaluation of Literature

Most of the literature and research questions that I have reviewed and have seen will relate most to my proposal and consist of a comparative analysis of the proposed solution that I plan to present. An example of this can be seen in whether or not there will be a difference in retention rate amongst staff in this time period compared to our monthly retention rates. The Institute of Medicine recommends nurse residency programs, especially since the cost to recruit and train one nurse is between $62,100-$67,000 (Cochran, 2017). This is valuable in relation to analyzing and comparing how much staff we hire and train just to have them quit two months later. Another example is comparing the data of incident reports of mistakes of treatments from nurses within the time frame of my implementation. The literature that was reviewed was very insightful and beneficial in creating the platform for the outline of how I wanted the mentor preceptorship to be implemented in the practice. There are many different structures of how preceptor programs are created, so I gathered information from each article that I felt would benefit the practice in relation to improving the competencies of staff members.

Applicable Change

The focus of my project was on identifying the relationship between nurse burnout and high turnover and how it is related to the lack of a good support system in the work environment. In reviewing nursing theories, I feel the one that my proposal relates to the most would be the Explanatory Theory. It can be seen as relatable to this theory because you can see how the correlations between different concepts relate to one another. Research has proven time and time again the effects and correlations there are between having new grad programs and its effects on retention and higher competencies.

Proposed Implementation With Outcome Measures

My proposed implementation was to have meetings with staff and create a mentor preceptorship program. My plan included all nursing staff along with the medical assistants who assisted the nurses with treatments. These meetings took place once a week, and we provided lunch for volunteering to partake in my project. This hour of time allowed for anyone to speak freely on their emotions, current stressors or if there has been something positive. The main idea was to have a judgment-free zone and for staff to feel heard and appreciated for their hard work. Nurses need to have the opportunity to be heard and allowed to voice their concerns and feelings because it helps to promote change where it’s needed. Because of the high amount of new nurses we constantly hire at the office, I want to be able to implement some sort of mentorship for new nurses so they have the added support they require, and it can assist them in furthering their skills and building their autonomy. By implementing a support group and a mentor preceptor program, staff will feel supported and attain the knowledge and skills they require to work effectively and safely, but most of all, the patients will receive the best care, and the staff will be able to provide efficient care. When I first began this implementation of holding weekly meetings, we had all staff on board; unfortunately, a few were not consistent with staying in the meetings, but we were still able to gather data by creating surveys and questionnaires for all staff to gather equal information and review if there was any improvement on staff’s feelings of the practice and what improvements they saw or still needed improvement.

Evidence-Based Practice In Creating The Intervention Plan

According to Maryniak (2017), new nurse strategies include didactic education, the use of simulation, dedicated preceptors, and a planned program that assists with the transition of new nurse practice. By utilizing the eight articles of evidence-based research in regards to nurse burnout and short staffing along with how leadership affects the way nurses work, I implemented some of the strategies into my project and evaluated with my preceptor how my project has affected our staff in the four weeks. Reviewing the articles on research and evidence-based practice, we were able to create our own version of a new graduate program for dermatology, which also allowed seasoned staff to utilize the mentor nurse as a resource nurse in learning new skills. In the beginning, it was a bit challenging because so many evidence-based research articles focus on hospital settings and not clinical private practices, but I gathered information from each article that I felt would be useful, and it has thus far not just benefited the staff but also has helped the management in improving their leadership skills with the staff.

Evaluating Proposed Nursing Intervention

One of the most important steps in implementing an EBP proposal is ensuring that the change we want to happen actually occurs and you have the evidence to prove it. After a proposal has been implemented, it’s important to find a method to gather information to prove that the outcome was achieved and that the data is consistent. When there are time constraints for a study of evaluating if your EBP proposal shows a positive outcome, one must be organized and consider all options of methods in evaluating results. Urgent action is needed to rapidly accelerate EBP in order to reduce the tremendously long lag between the generation of research findings and their implementation in clinical settings. My preceptor, physician, management and I have evaluated all the data we have compiled thus far in a short meeting we have had on Fridays at the end of the day. This information has been valuable for the practice and my project because we have seen a difference in how the staff is working, morale has improved, and fewer treatment errors are being made. Since the implementation, we have only lost one staff member. Along with this, staff have expressed that the support they feel is helping them gain new knowledge and skills for the way they do their treatments, thanks to the resource nurse we have as a mentor for the new nurses.

Potential Barriers

One of the biggest barriers that we have dealt with since implementing this research project, which my preceptor and I have tried to tackle, is the lack of attendance among some of the staff members. To see results, we have to be consistent, and not having everyone involved definitely puts limitations on the study. It has also been hard because many staff members are having to leave during their lunch break to pick up their children due to COVID-19, and many daycares are closing in our area. What we decided to do for those who cannot attend is gather data using online questionnaires that allow them to answer the questions and send it to me via e-mail. This allows me to connect with everyone and collect data to evaluate if there has been any improvement or change since this new implementation. Another limitation to our study at the beginning of all of this was the lack of support we had from management due to the issues brought up by staff regarding how there is poor leadership in the office. We were able to turn this into a positive change by providing the management with some of the resources I have gathered from research articles that I am using for my project so that they can also utilize it as a resource and make their leadership skills stronger. It is important for a leader to reflect on how their staff feels and is performing because it reflects a lot on how you manage a group of people.

Data Collection

In talking with my preceptor and brainstorming ideas, we concluded that the best method is to collect data by having staff that participating complete surveys and questionnaires. We formulated a questionnaire on treatments on how to properly perform certain treatments, and this was designated to the group of new nurses who have been getting the training from the preceptor that the physician-approved. We did this to review if they are retaining the information being taught and if there is new knowledge on procedures they are yet to complete. We also developed a survey to evaluate how staff feels towards the small changes and want feedback on how they feel about the weekly meetings and having a resource nurse. Collecting data by surveys and questionnaires for certain staff members gives valuable information that is useful for determining if there is a difference in patient outcomes and if there are improvements in the practice. Another form of data collection has been in evaluating patient incident reports of treatment errors made by staff, and I have been inputting all information in an Excel file to formulate a graph that I plan to present to the practice at the end of my project intervention.

References

Bong, H. E. (2019). Understanding Moral Distress: How to Decrease Turnover Rates of New Graduate Pediatric Nurses. Pediatric Nursing, 45(3), 109–114. Retrieved from http://search.ebscohost.com/ login.aspx?direct=true&db=tfh&AN=137059027&site=eds- live

Cochran, C. (2017). Effectiveness and Best Practice Of Nurse Residency Programs: A Literature Review. MEDSURG Nursing, 26(1), 53–63. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=c9h&AN=121353515&site=eds- live

Maryniak, K. (2017). Enhancing the New Nurse Experience: Creation of a New Employee Training Unit. Nursing Economic$, 35(6), 322–326. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=c9h&AN=126865183&site=eds-live

Snavely, T. M. (2016). Data Watch. A Brief Economic Analysis of the Looming Nursing Shortage In the United States. Nursing Economic$, 34(2), 98–100. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=asn&AN=114616391&site=eds- live

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In this assignment, students will pull together the change proposal project components they have been working on throughout the course to create a proposal inclusive of sections for each content focus area in the course. At the conclusion of this project, the student will be able to apply evidence-based research steps and processes required as the foundation to address a clinically oriented problem or issue in future practice.

Students will develop a 1,500-word paper that includes the following information as it applies to the problem, issue, suggestion, initiative, or educational need profiled in the capstone change proposal:

1. Background
2. Problem statement
3. Purpose of the change proposal
4. PICOT
5. The literature search strategy employed
6. Evaluation of the literature
7. Applicable change or nursing theory utilized
8. Proposed implementation plan with outcome measures
9. Identification of potential barriers to plan implementation and a discussion of how these could be      overcome
10. Appendix section, if tables, graphs, surveys, educational materials, etc. are created

Review the feedback on the Topic 3 assignment, PICOT Statement Paper, and Topic 6 assignment, Literature Review. Use the feedback to make appropriate revisions to the portfolio components before submitting.