Student name

Capella University

NURS-FPX4905

Professor Name

Submission Date

Proposal for Intervention

The Skilled Nursing Facilities (SNFs) have a registered nurse (RN) shortage that needs a systematic staffing intervention. The lack of RNs causes low-quality care provision by increasing the length of timely assessment, reliance on Licensed Practical Nurses (LPNs), and subjecting patients to unfavorable healthcare results, including medication errors and readmissions. The proposed intervention will imply the implementation of an RN flexible staffing model that will include the use of evidence-based scheduling methods, the application of health information technology, and interprofessional collaboration to ensure the maximum utilization of RNs. This approach is premised on the research findings that proper staffing of the RN is related to better patient safety, reduced cost, and better patient care in the long-run in SNFs. This intervention may be helpful to support patient-centered, safe, and efficient care, as it would formulate staffing practices in a strategic manner that would contribute to delivering care to a vulnerable population.

Practice Issue of Concern

The identified practice issue of concern is the RN shortage in the Skilled Nursing Facility, where I can practice during my practicum. Although the facility is a 24-hour care facility, the number of RNs allocated is not sufficient to observe clinical decision-making, thus creating a massive gap in patient safety and quality of care. Currently, LPNs and Certified Nursing Assistants (CNAs) are performing much of the direct care, and RNs usually have more than one resident to attend to in every shift, which implies that they do not have time to provide comprehensive assessment and care planning. Scientific evidence has always existed that the existence of understaffing of RNs is linked to a higher number of falls, infections, and transfers in nursing homes (Harrington et al., 2020). This deficiency is therefore essential in addressing in order to improve the results of the residents as well as delivering safe, efficient, and comprehensive care.

The outlined issue is particularly relevant to the field of leadership-prepared BSN nurses because professional nurses are meant to facilitate the safe staffing rates and pursue quality improvement at the system-wide level. The ANA Code of Ethics pays attention to the responsibility of the nurse to safeguard the welfare of their patients by commenting on the unsafe practice setting (Numminen et al., 2024). Minimal staffing of RN is not an operational issue, but it is a patient safety issue and requires combined solutions. Such a loophole needs a leader, evidence-based policies, and organizational partnerships to ensure that the SNF residents receive the degree of care that they need and deserve.

Current Practice

The current model of staffing in the practicum site is based on the services of LPNs and CNAs under the supervision of RNs, yet there is an insufficient number of staff who would be able to meet the demands of the entire population. Although RNs are expected to administer medication and clinically assess the residents, they are highly understaffed, resulting in a slow response to the changes in the condition of the residents. Staff shortage is also a predisposing factor that may contribute to documentation lapses and lack of continuity of care and adherence to regulations (Bennett et al., 2021). In addition, patients and families do not have a lot of time to see RNs, which causes the lack of informational and emotional needs of the residents and their families to be left unaddressed. The staffing process is usually reactive, and instead of giving the employees their shifts based on their workload, they are given their shifts depending on who is free at any given time.

The facility also has an electronic health record (EHR) system to support the documentation process, but it does not effectively leverage it to analyse workloads and distribute them to staff. Using the case of the intensity of acuity recorded in residents as an example, it is not necessarily used to decide how many staff to shift per shift. This brings in the aspect of inconsistency, whereby high-acuity residents may not necessarily get adequate RN attention (Moy et al., 2023). Unlike in the past, where the agency nurses have been employed to address a shortage in the workforce, this would create a lot of costs and would disrupt continuity of care. As a result, the current practice causes the staff to become burned out, low in morale, and have unpredictable patient outcomes.

Strategy to Improve Current Practice

To address the issue of low RN staffing at the Skilled Nursing Facility, an acuity-based staffing model that is accompanied by scheduling software is proposed. This kind of plan will ensure that the RN assignments are determined by the needs of the residents rather than by the preset ratios, and the actual information about the residents that EHR can provide will be used to prioritize the care of high-acuity residents. Cross-training of personnel and float pools would also provide additional flexibility in case of high demand or unexpected absence, and hiring additional personnel would not be necessary, as it would be very expensive (Apaydin et al., 2022).

The model also focuses on interprofessional collaboration because the nurses, leaders, administrators, and human resources cooperate in their process of aligning staffing with clinical priorities and financial viability. Structured and acuity-based staffing has been discovered to be effective in improving patient safety, adverse events, resident satisfaction, and a more stable and sustainable care environment (Demitria and Stafford, 2021). This strategy will ultimately contribute to the increased output of the labor without hurting the residents, who must always be able to receive quality care in a safe setting.

Changes Needed for People and Processes

In order to accomplish this method of staffing, nurse managers are encouraged to rely on acuity scores of an EHR to make daily assignments to meet the needs of residents with the appropriate amount of RN supervision. Administrators play the key role of advocating the use of the scheduling software, which helps in streamlining the process of staffing and reducing the amount of reactive coverage used in shifts. It will improve delegation, workload allocation, and support provided to the care delivery process by RNs, who will need to accurately record the acuity information, and LPNs and CNAs will have improved and more efficient delegation (Mueller et al., 2024).

To improve on the same, staffing reviews must be done on a weekly basis to identify trends, where gaps exist, and streamline processes. The standardized techniques and processes of using the float pool and unit communication will also be effective in the uniformity and responsibility at inter-team levels. All these transformations lead to the improvement of the quality of care, the increase of the level of resident safety, the reduction of financial resources wasted on inefficiencies, and staff retention.

Assumptions

The strategy assumes that nurse managers, RNs, and the support staff members are prepared to adopt an acuity-based staffing strategy and are well-trained. It is based on the assumption that the EHR and scheduling facilities of the facility can be adjusted to offer in-the-moment staffing options. Sufficient administrative support and collaboration with human resources support, float pools, and cross-training programs are also the basis of the strategy. It also assumes that the participation of the staff will be promoted in case of an even distribution of the workload. Finally, it makes the assumption that the residents will experience better results when better staffing based on the acuity needs is put in place.

Enhancing Quality, Safety, and Cost-Effectiveness

A staffing model based on acuity, supported by the application of scheduling technology, can significantly improve the quality of care in the Skilled Nursing Facility. The facility will manage to allocate RNs to residents based on the acuity of residents and therefore offer patients with more complicated care requirements more timely evaluation and intervention, which will eradicate the chances of complications, which can be prevented (Apaydin et al., 2022). This habit contributes to safety as it will diminish the absence of care, drug errors, and reluctance to respond to changes in resident situations. Greater continuity of RN oversight also helps to facilitate improved resident satisfaction and improved clinical patient outcomes, which is quality patient-centered care.

On the cost part, the system will reduce the expenses spent on recruiting expensive agency nurses by simplifying internal staffing and employing cross-trained workers and float pools. The advantages of the improved allocation of work are that it will decrease the burnout and turnover of the nurses, which is costly in long-term care facilities. Long-term cost savings are also the outcome of the reduction of adverse events, patient readmission, and emergency transfers (Grant et al., 2020). The short-term expenses may contain certain investments in scheduling software and employee training, yet the advantages of the strategy in the long-term, increased efficiency, safety of care delivery, and sustainable staffing solutions, outweigh the expenses, which is why the strategy will be not only viable but also economically viable.

Application of Technology in the Strategy

The suggested staffing plan is based on the close interconnection of the technological tools, in particular, EHR systems and scheduling software, to streamline the decision-making process and resource distribution. Acuity scores used in EHR offer real-time data of the clinical needs of residents, thus allowing nurse managers to allocate RNs more efficiently and balance the workloads (Sequeira, 2022). This is facilitated by scheduling software that automatically schedules the availability of the staff to the acuity of patients, and it also provides flexibility in the form of alerts, reminders, and features of shift adjustment. A combination of them forms a clear and evidence-based system that minimizes variability and enhances the consistency of care.

The technology implementation is suitable in that it directly resolves the staffing shortage, which undermines safety and quality in the Skilled Nursing Facility. The use of EHRs makes it possible to be accurate when capturing patient conditions, and the use of scheduling platforms simplifies the process of communication, reducing the number of errors and avoiding excessive dependency on agency staff (Sequeira, 2022).

Implementation of the Improvement Strategy at the Clinical Site

The Skilled Nursing Facility will start the implementation of the acuity-based staffing strategy by training the staff on the way to document correct patient acuity data in the EHR and scheduling software in order to match the staff with the needs of the residents. Daily assignments would be assigned by nurse managers in accordance with the actual acuity scores at the moment, and administrators and human resources would guarantee the availability of float pool and cross-training programs (Stephens, 2024). Staffing trends, resident outcomes, and workflow changes would be discussed each week in interdisciplinary meetings to ensure uniformity. This is a staged method that will enable employees to familiarise themselves with new procedures, yet patient care is not compromised, which will eventually result in a technology-driven model of safe and effective staffing that is sustainable.

Site-Specific Challenges and Solutions

The difficulties in the Skilled Nursing Facility are resistance of staff, lack of acquaintance with the scheduling tools, inconsistent use of EHR, high patient acuity, and budget constraints. Gradual adoption will be facilitated by phased training, starting with the nurse managers. Mentorship and referencing tools can facilitate the transition process in the long run (Morgan, 2023). The scalable scheduling systems that are installed on the current EHRs assist in minimizing financial pressure. A compliance staffing coordinator will manage the compliance, and the adoption will be smooth with minimal interruption to the resident care.

Interprofessional Collaboration to Support Strategy Implementation

The success of acuity based staffing strategy at the Skilled Nursing Facility depends on interprofessional collaboration. When nurse managers, administrators, and frontline nurses collaborate, it can be ensured that they can coordinate the staffing assets with the needs of residents (Blake et al., 2024). The disciplines introduce new skills- nurse managers are in charge of acuity-based assignments, administrators assist with financial planning, and human resources are in charge of float pools and staff scheduling. As these roles are aligned, the facility will be able to develop a consistent, fair, and sustainable staffing procedure that reinforces the general care delivery.

The collaboration is also applied to the field of clinical practice in a way that allows communication between RNs, LPNs, and CNAs regarding the needs of care to be provided to residents, as well as workload balance. Periodic interdisciplinary meetings allow to analyze the acuity data, discussing the challenges, and creating preemptive solutions to staffing shortages. In my practicum, I found out that understaffing of RNs frequently put pressure on other personnel in the team and also influenced the promptness of care to residents.

Conclusion

The proposed strategy of staffing plans via the acuity approach is a direct solution to the problem of RNs shortage in the Skilled Nursing Facility, as it will match the assignments and the needs of the residents based on the acuity data provided through the EHR and scheduling programs and float pools. The given approach helps improve the quality and safety of care and minimize delays in interventions, as well as helps retain staff by balancing workloads. The local issues like staff resistance, training requirements, and budget limitations can be relieved with step-by-step education, technology that can be expanded, and a staffing organizer, which makes staff comply. The strategy facilitates sustainability, saves expenses through turnover and readmission, and, ultimately, enhances patient-centered results to the vulnerable population of the facility because of the excellent interprofessional collaboration.