Exploring Leadership and Management Approaches to Nurse Turnover- Impact on Quality of Care and Patient Safety
Leadership and management are key aspects of nursing practice. Leadership entails influencing people towards the achievement of set goals. Management involves a series of steps: planning, organizing, staffing, directing, and controlling. This paper discusses nurse staffing ratios, their influence on delivering appropriate healthcare services, and how to uphold professional standards. Furthermore, it identifies the impact of leaders and managers in the nursing profession on nurse staffing ratios and leadership styles and describes qualities needed to maintain professionalism.
Selected Issue, Setting, and Impact on Patient Safety
Nursing staffing ratios are an important aspect of the healthcare sector. The nurse-to-patient ratio is regarded as the most critical part of health care delivery. These ratios indicate the number of patients that one nurse serves. A low nursing-staff ratio implies that the nursing staff attends to a huge patient population (Haryanto, 2019). Nursing-to-patient ratios should be optimized to ensure that one nurse serves a small population of patients. The optimized ratios differ depending on the department. The optimum ratio of nurses to patients in the critical care unit should be less than or equal to 1:2 (Chowdhury & Chakraborty, 2020). The optimum ratio in the emergency department should not exceed 1:4 for nurses and patients, respectively (Tamata et al., 2021). According to Tamata et al. (2021), the ratio recommended in the general wards is approximately 1:5 for nurses and patients, respectively.
The lack of optimized nursing staff ratios remains a global problem. Poor nursing-to-patient ratios have negative implications on patient care. Ratios higher than the optimized nurse-to-patient ratios indicate that nurses attend to a large population of patients: nurses have to work long-hour shifts, causing staff burnout. This increases the likelihood of medication errors occurring in the healthcare setting (Chowdhury & Chakraborty, 2020), increasing patient morbidity and mortality rates. According to Zhang et al. (2018), studies indicate that a nurse-to-patient ratio of 1:6 in the emergency department increased patient deaths by approximately 6.9%.
The lack of optimized ratios lowers the nursing staff’s morale. Job dissatisfaction hurts the quality of service delivery. Decreased quality of service delivery can be attributed to the huge workload caused by unoptimized ratios or lowered morale. Long working hours and lack of day-offs create fatigue which compromises the quality-of-service delivery (Zhang et al., 2018). Nurses are likely to prioritize specific patients at the expense of others. This impedes the delivery of holistic nursing care services to individual patients. Accordingly, healthcare institutions are likely to experience prolonged patient hospital stays. Prolonged stays have a negative financial impact on the patient and the hospital’s reputation. Therefore, nursing staffing ratios should be optimized to improve the quality-of-service delivery, reduce medication errors and improve patients’ quality of life.
Professional Standards of Practice to Rectify the Issue or Maintain Professional Conduct
The American Nurses Association (ANA) has set up principles and standards that can be used to address the problem of nurse staffing ratios. All nurses in all healthcare settings must play a role in matters concerning nurse staffing (Stievano & Tschudin, 2019). Applying this principle will enable the nurse to participate in formulating policies that uphold optimized nurse-to-patient ratios. ANA stipulates that nurse staffing differs based on the unique task (McClendon & Hurwitz, 2019). Applying this principle will ensure that various departments in healthcare institutions optimize their nursing staff to promote efficient and quality service delivery. ANA directs nurses to be flexible and embrace teamwork (McClendon & Hurwitz, 2019). In this context, nurses should be willing to adjust to low nurse staffing changes. They should be prepared for long-hour shifts and reduced day-offs. They should embrace teamwork with other healthcare providers to ensure that the quality of service delivery is not compromised.
According to McClendon & Hurwitz (2019), the standards of professional practice established by ANA require the nurse to plan, implement and evaluate. This is useful in the cases of low nursing staffing ratios. In this context, the plan should focus on fulfilling the needs of individual patients. This entails scheduling activities to avoid timewasting, further worsening the problem. Communication is the other essential aspect. Nurses should establish open communication with patients and the hospital administration. This will enable them to inform the administration of their grievance and how it affects their performance and patient care. It will also create a good rapport with patients and promote holistic care amid the existing problem of low staffing.
Differing Roles and Approaches of Nursing Leaders and Nursing Managers
Nursing leaders influence their followers to strive willingly toward achieving specific goals. Nursing managers are involved in planning, organizing, staffing, directing, and controlling staff (Amiri et al., 2020). Leaders advocate for transformation and mainly work with people. Conversely, managers rely on transactions and do not promote change (Gandolfi & Stone, 2018). Managers respond to change created by leaders and are interested in the process rather than individuals who bring change.
In this case, nursing leaders should be proactive in motivating other nursing staff. They should guide other nursing staff on being flexible and executing their duties despite the low staffing ratios. This can be achieved by interacting with the staff in their work areas. This exemplifies the role of leaders as motivators. Furthermore, nursing leaders should mobilize and encourage other nursing staff to be active participants in formulating policies that ensure nursing staffing ratios are optimal. Subsequently, they will be upholding a transformational approach. Nurse managers should modify and plan work schedules to ensure that nurses are not fatigued. They should delegate tasks to specific nurses at specific times and check to ensure that they are executed. They should engage with the healthcare facility administration to address the issue of low nursing staff. Accordingly, managers will fulfill their role of staffing and averting conflicts.
Ensuring Professionalism Through Diverse Health Care Settings
Leaders and managers can adopt various aspects to enforce professionalism. Training of staff should be conducted regularly. Nursing staff should receive additional skills that will enable them to manage the large patient population. This can involve emphasizing proper communication, using new medical technology, or handling patients’ complaints. Regular feedback should be provided: daily, weekly, monthly, or performance appraisals (Ingwell-Spolan, 2018). Feedback should correct any deviation from the norm. The other aspect is discipline. Failure to incorporate feedback warrants discipline. This should follow a specified order such as verbal warning, written warning, suspension, and termination. Discipline as a tool will make all staff comply with established guidelines and maintain professionalism.
Rewards can be used to encourage professionalism. Staff who demonstrate exemplary practices should be rewarded. Rewards motivate other staff and make them adhere to the established professional standards. Leaders and managers should develop and circulate and emphasize standard professional practices. Existing policies such as the ANA professional standards of practice should act as the template for those policies. Furthermore, managers and leaders should uphold high professional standards and ethics. This will increase the probability that their subordinates and followers will uphold professionalism.
Leadership Style to Address the Issue
A transformational leadership style can help address the problem of nursing staffing ratios. Transformational leadership entails motivating and inspiring followers (Amiri et al., 2020). This awakens the intrinsic drive of the employees to fulfill a specific task. This type of leadership strengthens leader-employee bonds and lowers staff turnover rates (Gandolfi & Stone, 2018). Nursing leaders should inform employees of the nature of the problem and guide them on how to cope. Motivating nursing staff will make them strive willingly towards ensuring quality care delivery to the patients. Also, staff with an innate drive to uphold nursing ethical standards and maintain professionalism throughout their work. Furthermore, by reducing the staff turnover rate, transformational leadership prevents the existing problem from worsening. This is in contrast to authoritarian leadership, which would have increased staff turnover rates and exacerbated the problem.
Conclusion
Nursing staffing ratios are an important aspect of the healthcare sector. The nurse-to-patient ratio is regarded as the most critical part of health care delivery. These ratios indicate the number of patients that one nurse serves. Transformational leadership style can help address the problem of nursing staffing ratios by motivating, inspiring, inducing the intrinsic drive, and reducing the staff turnover rate.
References
Amiri, N. Al, Rahim, R. E. A., & Ahmed, G. (2020). Leadership styles and organizational knowledge management activities: A systematic review. Gadjah Mada International Journal of Business, 22(3), 250–275. https://doi.org/10.22146/gamaijb.49903
Chowdhury, S., & Chakraborty, P. pratim. (2020). Nurse‑to‑patient ratio and nurse staffing norms for hospitals in India: A critical analysis of national benchmarks. Journal of Family Medicine and Primary Care, 6(2), 169–170. https://doi.org/10.4103/jfmpc.jfmpc
Gandolfi, F., & Stone, S. (2018). Leadership, Leadership Styles, and Servant Leadership. Journal of Management Research, Vol. 18,(No. 4, Oct.-Dec. 2018,), 261–269. https://www.researchgate.net/publication/340940468
Haryanto, M. (2019). Nursing shortage: Myth or fact? Orthopaedic Nursing, 38(1), 1–2. https://doi.org/10.1097/NOR.0000000000000535
Ingwell-Spolan, C. (2018). Chief Nursing Officers’ Views on Meeting the Needs of the Professional Nurse: How This Can Affect Patient Outcomes. Healthcare, 6(2), 56. https://doi.org/10.3390/healthcare6020056
McClendon, S., & Hurwitz, J. (2019). American Nurses Association Releases Updated Principles for Nurse Staffing. https://www.nursingworld.org/news/news-releases/2019-newsreleases/staffing/#:~:text=ANA’s%20%E2%80%9CPrinciples%20for%20Nurse%20Staffing,patient%20status%
Stievano, A., & Tschudin, V. (2019). The ICN code of ethics for nurses: a time for revision. International Nursing Review, 66(2), 154–156. https://doi.org/10.1111/inr.12525
Tamata, A. T., Mohammadnezhad, M., & Tamani, L. (2021). Registered nurses’ perceptions on the factors affecting nursing shortage in the Republic of Vanuatu Hospitals: A qualitative study. PLoS ONE, 16(5 May), 1–17. https://doi.org/10.1371/journal.pone.0251890
Zhang, X., Tai, D., Pforsich, H., & Lin, V. W. (2018). United States Registered Nurse Workforce Report Card and Shortage Forecast: A Revisit. American Journal of Medical Quality, 33(3), 229–236. https://doi.org/10.1177/1062860617738328
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Question 
In this assignment, you will write a 1,000-1,250-word paper describing the differing approaches of nursing leaders and managers to issues in practice. To complete this assignment, do the following:
Select an issue from the following list: bullying, unit closers and restructuring, floating, nurse turnover, nurse staffing ratios, use of contract employees (i.e., registry and travel nurses), or magnet designation.
Exploring Leadership and Management Approaches to Nurse Turnover- Impact on Quality of Care and Patient Safety
Describe the selected issue. Discuss how it impacts the quality of care and patient safety in the setting in which it occurs.
Discuss how professional standards of practice should be demonstrated to help rectify the issue or maintain professional conduct.
Explain the differing roles of nursing leaders and managers in this instance and discuss the approaches they take to address the selected issue and promote patient safety and quality care. Support your rationale by using the theories, principles, skills, and roles of the leader versus manager described in your readings.
Discuss what additional aspects managers and leaders would need to initiate in order to ensure professionalism throughout diverse healthcare settings while addressing the selected issue.
Describe a leadership style that would best address the chosen issue. Explain why this style could be successful in this setting.