Quality of care improvement by changes to workload assignment for safe staffing
1. Quality of care improvement by
changes to workload assignment
for safe staffing
NU420: Leadership and management in the changing health care environment
August 19h, 2015
2. Quality of care
Quality is defined by Merriam-Webster dictionary as 1) how
good or bad something is or 2) a high level of value or
We want to look at quality of care with the second definition in
mind, that quality care is the high level of value of healthcare
and healthcare excellence. If we work at improving the
healthcare we provided to our patients and their family we will
be providing quality care.
Quality care requires support from top-level administration to
bedside clinicians to support staff (Marquis & Huston, p. 517).
3. Quality care measurement
Quality of care affects nursing directly at the bedside as
well as financially. Recent changes to health care laws
under the Affordable Care Act has implemented the need
for quality improvement and patient safety (Brooks,
2014). The American Nurses’ Association’s white paper
report emphasized on the critical role nurses played in
quality improvement due to their direct impact on nursing
sensitive indicators, and encourage nurses to go beyond
the bedside to be leaders of quality improvement changes
system wide (Gallagher, 2010).
4. Research findings
Research shows that clinical nurses at the bedside who
take on additional patients increase the likelihood of
morbidity and mortality of patients, and increases the
rates of burnout and job dissatisfaction for clinicians
(Aiken, Clarke, Sloane, Sochalski, & Silber, 2002).
Increased morbidity and mortality decreases healthcare
quality. It is important for clinical nurses to have a safe
nurse to patient ratio as it is a protection for patients,
improves work condition for clinicians and increases
quality of care.
5. Workload factors
There are many factors that affect the workload of nurses
and a balance must be meet to be productive and
economical yet ensure safe, quality care. There are factors
that affects clinicians specific to certain patient
population. For example a specific patient population
workload factor can be due to a language barrier, which
consumes more time due to the need to find and
communicate through a qualified interpreter. The next
slide displays a list of workload factors.
7. Hourly rounding
A reduction to the nurse to patient ratio provides better
work conditions for staff (Aiken, Clarke, Sloane,
Sochalski, & Silber, 2002), as well as allow staff to engage
more with patients and families. Hourly rounding gains its
full value of improving quality of care when staffing is
done adequately to allow full engagement between nurses
and patients (Cairns, Wolff, Rack & Dudjak, 2010).
8. Patient family engagement
and quality of care
A key to safe quality care, optimization of delivery of
healthcare, and increase patient experience, is engagement
of patients and their family (Lavoie-Tremblay, O’Connor,
Harripaul, Biron, Ritchie, MacGibbon, & Cyr, 2014). The
research done by Lavoie-Tremblay and associates
concluded that bedside teams would benefit from
“involving patients as partners”, and that for this to occur
culture change is required to take patient opinions under
consideration just as equally to those of clinicians
(Lavoie-Tremblay et al., 2014). Such engagement requires
clinicians to spend more time at the bedside, thus
requiring the need for fewer patients per clinicians.
For all these quality care innovations to transpire, nurse
clinicians would be required to spend more time with
individual patients. Under the current system of spreading
nurses thin with high nurse to patient ratios, nurses are
unable to transform healthcare without either cutting
corners or ignoring some patients over others. This is way
it is vital for nurses to have a staffing ratio that takes into
account all workload factors that are required to provide
not only safe, but high quality care that increases the
patient experience and sets a model for other facilities to
Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., Silber, J. H.
(2002). Hospital nurse staffing and patient mortality, nurse burnout, and job
dissatisfaction (p. 1987-1993). Journal of the American Medical
Brooks, J. A. (2014). Quality counts: The new world of health care quality and
measurement (p. 57-59). American journal of nursing.
Cairns, L. L.; Wolff, K. K.; Rack, L. L.; Dudjak, L. A. (2010). From our
readers… Hourly rounding benefits patients and staff. American Nurse
Today. Retrieved from http://www.americannursetoday.com/from-
Connor, J. A., LaGrasta, C. & Hickey, P. A. (2015). Complexity
assessment and monitoring to ensure optimal outcomes tool for measuring pediatric
critical care nursing (p. 297-308). American journal of critical care.
11. Gallagher, R. M. (2010). The impact of nursing care on quality. American
nurses association. Retrieved from
Lavoie-Tremblay, M.; O’Connor, P.; Harripaul, A.; Biron, A.; Ritchie, J.;
MacGibbon, B.; Cyr, G. (2014). The perceptions of health care team members about
engaging patients in care redesign (p. 38-46). American journal of nursing.
Marquis, B. L. & Huston, C. J. (2012). Quality control (p. 517). Leadership
roles and management functions in nursing: Theory and application (7th ed).
Lippincott Williams & Wilkins, Philadelphia, PA.
Merriam-Webster dictionary. (n.d.) Quality. Retrieved from