Final Project Submission

Abstract

The goal of the capstone project is to suggest a solution to lower the rate of nursing burnout, which is closely associated with subpar patient outcomes. Additionally, the capstone project’s suggested solution will help Minnesota nurses, the target demographic, achieve better results. In light of the negative health consequences linked to nurse burnout in the post-COVID age, it is critical to address this issue (Dall’Ora et al., 2020). Therefore, improving the nurse-to-patient ratio in Minnesota hospitals’ long-term care units is the suggested remedy. Additionally, it seeks to enhance patient outcomes, such as care experience, and the wellbeing of nurses. Reduced nurse burnout will result in fewer medication errors, which will lower the expense of errors and readmissions.

Addressing this issue is justified by the detrimental effects that burnout has on nurses’ physical and mental health. Poor care quality, a rise in nurse turnover, and a lack of job satisfaction are some other effects of nursing burnout. In particular, I used the tactic of improving the nurse-to-patient ratio throughout the hospital to achieve this goal (Green et al., 2021). The American Nurse Association (ANA) recommended this method, and it was used. The recommendation states that the ratio in the emergency room should be one to two and in the long-term care unit, one to four. The main conclusions of this capstone project are a decline in nurse burnout and an improvement in the quality of care received overall.

Organizational Change

The project’s recommended organizational modification relates to nursing staffing where the number of nurses taking care of the patients needs to be increased. The purpose of the scheme is to enhance nurses ‘quality of life by explaining the burnout ratio due to the rising proportion of nurses per patient (Suleiman et al., 2020). In addition to the enhancements, The intervention for nursing burnout will improve other outcomes like patient safety, effective care delivery, and patient experience.

Introduction

Professional stress or burnout is becoming a major concern to health in the United States particularly among nurses. In this project, I am seeking to solve the problem of high nurse turnover in the long-care units of hospitals. The nurses employed by Minnesota State are the target audience for this capstone assignment. Thus, the capstone project will be executed in long-care units of Minnesota hospitals (Khatatbeh et al., 2022). The subject of this study is the nurses and this population is targeted through a process of random sampling while the process of intervention assessment entails visits to the hospital on a routine basis. Overall, it is mandatory to pursue the intervention in the context of the burnout of the nurses since it has severe consequences on the state of the health outcomes as well as the efficiency of the nurses. Furthermore, according to The National Academies of Medicine, the problem poses a threat to the influence that health organizations have (Melnyk et al., 2020). Among all the elements of the plan, the most significant is the change in the ratio of the number of nurses to patients. Other components include; stakeholder consultation; implementation activities; action plans; and performance to enhance the patient and nursing outcomes. To assess the intervention, new technologies such as dashboards, questionnaires, online forms, and surveys will be used to collect vital information regarding the success of the plan.

Evaluation of the Best Available Evidence 

To ensure that there were credible sources of information to support clinical and organizational decision-making, several actual journals and valuable studies were chosen. The data used in the intervention plan of decreasing the ratio of the number of nurses to the number of patients involved was sourced from real databases of PubMed Medline and Google Scholar (Dincer et al., 2020). One study explains why the nurse-to-patient ratio has to be improved because the following three problems in nurses stem from excessive workload. The problems identified were emotional health (34 percent), adverse events (40 percent), and job satisfaction (50 percent).

Problem Statement (PICOT)

Need Statement

It is crucial to understand that the era of COVID-19 saw a significant rise in the level of nurse burnout; however, this is not an exclusive challenge of the most recent period. This was especially true after the COVID era due to the overload of patients. With this issue in mind, the project is attempting to respond to the shortage of nurse-patient ratios as an evidence-based intervention to decrease the risk of nurse burnout (Peters et al., 2022). It is also aimed at honoring patient experience, care, nurse’s health, and the cost of burnout-related concerns. To obtain a more detailed analysis of the intervention results, it was decided to select a team of nurses for the project.

Fulfilling the need is essential since an increase in the nurse-to-patient ratio that leads to nurse burnout is bad for the patients’ and the hospital’s health as well as the nurses’. The major effects that are linked to nurse burnout include job dissatisfaction, compromised patient care quality, nurse attrition, increased rate of medication errors, and dissatisfied patients (Peters et al., 2022). Also, the issue makes a hospital spend more financially due to the high likelihood of turnover among nursing personnel. The drive also points to burnout and exhaustion as having an impact on the turnover of nurses. The given body of the research work includes the results of the survey that was carried out in three healthcare facilities. Using data collected for only one year (2018-2019), the authors discovered that nurse burnout influences unsustainability by impacting nurse satisfaction. The findings indicated that burnout led to an increase in the nursing staff turnover rate by 12%. Research evidence indicated that there was an inverse relationship between nurse burnout and patient safety management service (PSMA) (Renner et al., 2023). If burnout increases, PSMA quality decreases and general care quality is impacted poorly. Studies were conducted in Alabama and revealed that medication administration errors stemmed from aspects such as nurse burnout. These were work burnout, job satisfaction, years of experience on the job, and patient burnout of the nurses in the ICU. Each of these points of evidence contributes to the realization of the necessity of the intervention. This work reveals that due to the turnover of nurses, a hospital has to spend a substantial sum per nurse in a year. 

Population and Setting

The population on which the proposed intervention is to be implemented is the nurses of Minnesota State. The reason for identifying the extent of nurse burnout in the mentioned population group is the existing issues linked to the problem. There is a concern since some of the hospitals in Minnesota went on strike during the COVID period, thus, health resources became scarce (inclusive of nurses) (Renner et al., 2023). Minnesota Nurse Association also supported the assertions of availing more resources to address the challenge. However, the list affected the score because poor nurse staffing resulted in nursing burnout due to increased workload during the pandemic. Nurse burnout alludes to exhaustion experienced by nurses physically and psychologically. For instance, internationally-based nurse burnout was found to negatively impact their psychological health; they experienced more difficulties such as anxiety, stress, depression, and sleep disorders. Furthermore, the lack of proper physical and mental conditions in nurses results in denying the patient care, compassion, kindness, and affection besides the treatment (Immonen et al., 2019).  These are some of the causes of poor quality of service delivery in organizations and all healthcare facilities are not an exception. Therefore, burnout in Minnesota State nurses was damaging the nurses as well as the health results of patients. Each of these elements also impacts the health quality in a community as well as the services from hospitals. That is why the problem of Minnesota’s nurses’ burnout shall be solved for all the nurses working in this region.

I want to increase the amount of staffing on the nurse-patient ratios in long-care units. I selected this environment because nurses working in long-care units are often overworked and receive more responsibilities than most nurses (Immonen et al., 2019). Fatigue also poses other challenges such as physical or mental exhaustion and other factors that may lead to the death of patients. For instance, research also noted in their discussion section that high workload, nurse fatigue, and higher mortality rates among patients. A study conducted a study which revealed that nurses who work in long-care units have listening feelings such as feeling sad and hopeless. 

Quality Improvement Methods

The intervention of adjusting the number of patients served by a nurse is proposed for the facilitation of enhancing nurse burnout in Hospitals. This intervention aims at lowering nurse burnout levels in hospitals as well as implementing strategies of lowering the nurse patient ratio and teaching nurse meditation.

Intervention Overview

For instance, one of the interventions that can be implemented to reduce the rate of nurse burnout among the nurses in Minnesota are increasing the ratio of nurses to patients. The intervention will include the increase in the ratio according to the ANA recommendations for example, a critical care unit 1:2, and an emergency unit 1:4 (Pollock et al., 2021). The selection of the nurses will be done in accordance with the sampling technique. To assess the improvement in burnout, I will also examine the changes in nurse performance during my routine visits, before and after the COVID period. The intervention is appropriate for the target population of nurses in Minnesota as it will assist them in decreasing burnout and its impacts on patients. This means that due to the increased ratio of the number of nurses to the number of patients, the nurses will not be under immense pressure and thus, they will feel calm and focused. Consequently, it will decrease the burnout rate among them. 

The intervention also very well fits with the target long-care units because nurses practicing in the units require a break from stress most (Pollock et al., 2021). They are overworked because their duties involve prolonged caregiving which can be very demanding, both psychologically and physically thus wearing them out. Thus, the Intervention can minimize their concern since the ameliorated ratio will decrease work-related strains. The target need is decreasing nurse burnout and the overall evidence-based discussion well supports this goal.

Comparison of Approaches

Besides increasing the ratio of nurses to patients An intervention has taken place that can be used in the nurses of Minnesota namely meditation for nurses, for example, mindful meditation, exercise and or therapy, and or yoga for purposes of reducing nurse burnout. The complementary intervention is assisting the nurses to go through meditational procedures to minimize burnout (Wang et al., 2021). Activities that will be practiced include yoga, stress-reducing massage, meditation, and mindfulness. Interference best suits the targeted nurses in the way that they can practice these exercises at any time anywhere without any additional effort. They don’t need to carve out too many hours from their tight schedules as such exercises do not consume much time yet give considerable positive outcomes. Several research has established the impact of such exercises on the decrease of burnout. For example, the research work demonstrates the impact of mindful meditation on the various dimensions of nurse burnout, including work trauma, suffering, stress, and workload (Chen et al., 2024). Compared to the enhancement of the nurse-to-patient ratio, this intervention will only take a little more time from the nurses as they will have to practice the exercise or meditation. Thirdly, the workload will not be affected by the meditation intervention proposed for the nurse. The meditation intervention also enriches the long-term care settings as the nurses in such settings are more stressed and burnt out. The meditation intervention will enhance their status via exercise, meditation, positive thinking, and emotional control; whereas the nurse-to-ratio improvement intervention will decrease burnout by decreasing workload.

Initial Outcome Draft

In general, the intervention of lowering the nurse-to-patient ratio is expected to lessen Minnesota’s nursing workforce’s burnout. The nurse-to-patient ratio addresses nurse decision-making capacity and hospital services (Khatib et al., 2020). Reducing nurse burnout also has a positive effect on stress and anxiety levels in nurses as well. The finding shows that I am interested in enhancing nurses’ emotional and physical health and benefiting the patient. Nurse burnout can also have positive impacts on healthcare services in a specific setting by its reduction.

Time Estimate

It takes approximately 2 months in total to develop the intervention. The time frame is reasonable as it will also incorporate the improvement analysis and the literature review of the situation’s effectiveness. Identifying information or data on the matter of nurse burnout and its impact on patient outcomes and nurses themselves will pose one of the challenges, which may hinder the timeline.

The rough implementation time will be one year which is also reasonable since it should be enough time to complete all the foreseen activities (Ozdemir et al., 2023). The assessment of burn rates will be conducted before the COVID period and after the application of the intervention. Other activities will include sampling of nurses for the two months, analysis of the indicators for the 4th month, and collection of data on Excel sheets for the six months. Those factors that may affect the timeline include a shortage of nurses, policies, and the likelihood of low motivation amongst the nurses.

Interprofessional Care to Improve Safety and Quality

The issued interprofessional collaboration will further decrease the costs of readmissions while enhancing the health of patients. Nurses are a vital component of healthcare systems due to factors such as patient care and safety that are hinged on the existing healthcare resources nurse staffing, and the nurse-to-patient ratio Among the proposed solutions to enhance the care and safety of patients, any intervention that seeks to address nurses’ needs will automatically result in enhancing the quality of healthcare and the safety of patients (Çelik et al., 2022). The techniques outlined on the mindful mediation for nurses especially those working in critical or long-term care units ensure that their stress levels resulting from strong emotions and demanding work schedules are well managed. Hence, through worked examples of assessment, nurses improve their interprofessional teamwork and communication skills.

Literature Review

These findings reveal the importance of focusing on the problem of nursing staff exhaustion. I found that the author said that the cause of nurse burnout is a high nurse-to-patient ratio. He further backs the importance of addressing the issue by explaining the harm it has on the patient’s best interest. A research study says that there are three Organisational factors associated with nurses’ mental health and burnout (Harnett et al., 2024). For instance, 34% of the nurses were not mentally healthy; 40% reported experiencing one or the other form of trauma; and 50% of the nurses stated that they wanted to leave the job. Further, the study exposed that the reasons related to the current nurse burnout include the young age of nurses, lack of social support, and their unpreparedness to tackle the COVID-19 pandemic. The findings revealed that 31 percent of the nurses involved in the study were fatigued mentally.

Analyzed studies on the effects of nurse burnout on the handling of patient safety and presented the finding of an inverse relationship between nurse burnout and management. Therefore, the authors recommended enhancement of the nurse environment and additional research to obtain more information (Estrada et al., 2022). The outcomes of the evidence highlight the importance of increasing the number of staff nurses in the patient care setting. Another supporting evidence confirms that workload has a positive relationship with nurse burnout. undefined Besides stating the relation existing between the two factors, they proposed a solution to the problem which was meditation. The study shows that mindful meditation helps to decrease stress levels and consequently, burnout rates among nurses. Research targeted the emergency departments in North India.

Health Policies Impacting the Need

The Hospital Patient Safety and Quality Care Nurse Staffing Standards Act was presented in 2019. to promote a standard in various health facilities so that the Public Health Services can control the nurse staffing ratios in various health establishments. It does not set an equal ratio across various environments rather the nurse-to-patient ratio is set depending on the requirements of several departments. Concerning staffing, the policy established concerning the nurse-patient ratio is 1:1 for long-term care units, 1:3 for emergency services, and 1:4 for surgical services (Li et al., 2022). This policy is directly connected to what HMO faces concerning high levels of nurse burnout. The research demonstrated that the reduction of the nurse-to-patient ratio positively influenced nurse staffing and patients’ health results. The study was done in Australia to monitor the health sector productivity after the increasing number of nurses per patient.

For making connection with the Nurse-to-Patient ratio, the Affordable Care Act links the fact that expansion in the health coverage of patients will call for substantial numbers of nurses. Since ACA aims at improving patient health access, it will increase the pressure on the nurses to give quality services to many people hence leading to burnout (Cai et al., 2021). However, the research indicated that ACA brought solutions to the issue of nurse burnout and led to a rise in the ratio of nurses and patients due to enhanced health insurance. They split the outpatient and inpatient care intending to lower the number of patients attended by a nurse.

Intervention Plan for Patient and Population

Centered Care

Intervention Plan Components

The major components of the intervention plan are to decrease the facility’s ratio of nurses to patients, to implement the intervention, and to assess the impacts. In long-term care units is planned to be 1:3 and in emergency care units 1:2 of nursing staff to patients. It will take one year to implement the plan implementation. The effects will then be seen with the target population and patients as the following subheading From there suggests (Bernardes et al., 2020). A decrease in the nurse-patient ratio will also help in minimizing the level of burnout in the nurses being served in the long-term care units.

When that ratio is slashed, the nurses will have less workload and less work stress or burnout. The plan implementation will make it easier for the providers to find out each part of the intervention to make it effective in addressing nurse burnout as well as related health impacts. The assessment of the plan will aid the organization in determining changes in nurse burnout and the general health of the patients within the health records after the plan has been put in place (Kawar et al., 2023). Besides the aforementioned benefits on the target group, the intervention will enhance the communication between the nurses and patients, and nurses’ productivity which will enhance patients’ centeredness and overall health. All the components of the intervention are the best given that it will effectively reduce nurse burnout as they will compare outcomes before and after the intervention and enhance patient and population-centered care hence improving overall health outcomes.

Impact of Cultural Needs on the Intervention

The target nurses are also from different racial or cultural backgrounds since the setting of Minnesota is culturally diverse. The population it has includes Whites, Hispanics, Blacks, Non-Hispanics, and Latinos who also have diversity in cultures and languages (MN Compass, n. d. ). Furthermore, the nurses comprised both males and females and also some of the nurses were parents (Toles et al., 2021). Thus the cultural needs and characteristics of the targeted nurses have influenced the development of the intervention. These are the needs that have to be addressed and solved as the intervention is being constructed. For instance, the work that a nurse is supposed to do and the patients they are supposed to attend to should be something that suits the cultural inclination of the two parties involved. There are several reasons why some nurses might not feel comfortable in some practices ranging from cultural beliefs. Therefore, the management should be aware of that. This will enhance patient-nurse interaction, performance as well as the general health of the patients (Danno et al., 2021).

It is also important to know that the long-term care units will have cultural needs and certain characteristics as well. For instance, such a facility offers standard care to patients with chronic or emergency health complications in the said long period.

Theoretical Foundation

Conservation of Resource Theory is a model through which the interaction between nursing and burnout is explained and the effects of the theory as experienced in the profession. They define burnout and how it influences the efficiency of workers, especially nurses. In the same theory, burnout decreases the performance of the nurses by loading them up with a pile of work (Andrews et al., 2020). Regarding the distinction made between the objects, conditions, and traits that lead to burnout, it points to four what causes nurse burnout i. e. energy, objects, conditions, and personal traits. Therefore, the theory influences the plan because it stresses the prevention of nurses from fatigue and advancing safety, care, and cost for patients. It also presents a solution to the problem as a change of the nurse-to-patient ratio as a remedy. The theory has a weakness whereby the theory cannot define the role of nurse performance as a moderator between burnout and outcomes.

According to the United States Medical Licensure examination, the following are some strategies to prevent the occurrence of nurse burnout: exercising, having breaks for relaxation, eating healthy and sleeping, having limited study hours, and taking time off work (Eggli et al., 2023). These strategies affect the layout of the plan in a manner that would imply that a decrease in the ratio of nurses to patients will allow the nurses to step down from the nursing practice long enough to practice more of such strategies towards the reduction of burnout.

The technological solutions related to the intervention plan are EHR, Dashboards, Online Portal, and Forms. These technologies will come in handy in the evaluation part of the plan. For instance, EHRs will be employed in collecting data on the patients before and after the plan’s enforcement (Spaulding et al., 2021). Likewise, the variables included in dashboard metrics before and after the plan will assist the managers in monitoring the performance of the plan. Some of the tools that will be used include online forms that can be used to find out about the patient’s experience and the nurse’s impression of the intervention.

Justification of the Components of the Intervention

The Conservation of Resource Theory Model provides the rationale for the intervention itself by painting a picture of how, due to nurse burnout, the performance and production of the nurses suffer. One of the elements of this plan is the improvement of the ratio of nurses to patients for instance 1 nurse to serve 3 patients especially those in long-term care facilities. Increase in the nurse-to-patient ratio is warranted in the evidence who argues that the increase in the nurse patient ratio brings about clinical and economic benefits (Rojo et al., 2022). The positive effects are patients’ satisfaction, reduced cost of delivered healthcare services, and minimized nurse fatigue and mistakes. The strategies such as exercise, meditation, and others to enhance nurse burnout are justified by research which is the main component of the intervention. The findings show that EHR and dashboards aid patient and hospital data acquisition and tracking.

Stakeholders, Policy, and Regulations

Patients, nurses, other members of the community that will be affected by the implementation of the new measures, the hospital staff, and members of the finance department will be considered as the relevant stakeholders. The patient’s needs include knowledge satisfaction, Information regarding the treatments, Education on health, and quality care. Such needs affect the health of the nurses if there is no good relationship between the number of nurses to the number of patients (Hidayat et al., 2023). Managing several patients and satisfying their unique needs in LTCUs will be challenging for nurses and deserve a better ratio to lessen nurses’ fatigue. An efficient ratio of the number of nurses to the number of patients will enhance the well-being of the patients by offering the proper care that they need from the nurses. Some of the nursing needs include work-life balance, participation in decision-making processes by seeming to balance work, and having sound mental and physical health standards  (Hidayat et al., 2023). Managers are required to adopt efficient management strategies, collaboration with team members, and improve communication and managerial skills. All of the stakeholder’s needs require the optimal allocation of the nurse-to-patient ratio high because of the role of a nurse in patient care and other stakeholders’ needs.

The Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act focuses on the ratios of nurses to patients with consideration to the kind of care units. For instance, the policy provides a framework on staffing that the facility should have I emergency and long-term care units be 1:2 and 1:3 respectively. The policy matches the project as it will light the nurse’s workload and fatigue by enhancing the number of patients attended by a nurse (Rojo et al., 2022). Therefore, the performance of the nurses will be enhanced and there will be a decrease in the cases of medication errors and readmission. Therefore, it would be possible to reduce the cost linked to readmissions and mistakes. The ratio of implementing the standard ratio the hospitals is guided by the Public Health Services Act which aims at the right proportion of the patients to the number of nurses in the health facilities.

Ethical and Legal Implications

The study proves that there is a positive correlation between the level of burnout in nurses’ incorrect health practices and ethical issues of nurses in the emergency departments. Incompetency destabilizes their decision-making capability, patient’ quality, and general health services (Eggli et al., 2023). Therefore there is a greater likelihood of readmissions and errors hence making it costly to both the hospital and the patient. A higher burnout rate is also associated with moral distress plus high turnover in organizations. It affects the general productivity of nurses and health organizations hence the increased chances of being liable for legal matters such as incorrect prescriptions or unethical decisions.

Implementation Plan

Management and Leadership

Therefore, the two suitable Leadership styles for the execution of the intervention plan are Transformational and Laissez-faire Leadership styles. A transformational leader incorporates his/her followers and gets them to pursue a wide and universal objective for the improvement of the health organization. Hence, under transformational leadership, all the team members act and contribute in terms of time, energy, and effort to one particular goal of the organization. Therefore, it supports the professionals in giving the interprofessional care needed to the patients to avoid risks. Safety of patients also saves the costs which may be both for the organization and the patients. Every employee in an organization is capable of participating in the decision-making process in an organizational democratic manner. Thus, a democratic leader who would like to maintain and encourage interprofessional collaboration must include all the stakeholders or all members of the team in the process. In such leadership and strategies, the nurses can present their vision, and such consequences of burnout affect the nurse manager or leader. They could also recommend ways of minimizing the effects or maybe coming up with the best techniques for handling them.

For a plan to be implemented effectively, there must be management strategies at the end of the organization. Management strategies refine the goal of the organization into a great strategy. Some of the strategies that are likely to be adopted include the training of nurses and the advocacy for the promotion of democracy. Such strategies will go a long way in helping the nurses understand their roles and responsibilities. Nurse training will recognize the need to address these gaps in their work and implement new approaches and knowledge to address them. It will also enhance their decision-making of the subjects through a preferable consensus. Trustworthiness will enable the integration of the target nurses into the workplace; humility will give them a chance to learn as they practice and, accountability will help them assume full responsibility for their practice and duties.

Delivery and Technology

The action plan is one of the delivery methods used in the implementation of the plan. The action plan will reduce the ratio of nurses to patients depending on the requirements of the hospital setting. For instance, in the low complicated long-term care units, the ratio will be one nurse to three patients, while in the highly complicated urgent care units, it will be one nurse to two patients. The nurses will elaborate the action plan through organized workshops. From there, the plan will be submitted to other relevant authorities for endorsement. The target nurses will be under the supervision of the nurse managers who will monitor the performance and training of the nurses. The project will entail the suggestion, direction, and involvement of nurses, patients, and other stakeholders in the decision-making process of the project to guarantee quality and efficiency.

Evaluation of Current and Emerging Technology

The incorporation of current and evolving technology will enhance the applicability and feasibility of the plan for the target population, patients, as well as the healthcare unit. It could also improve the communication between the key stakeholders including e-mailing, telephone, electronic health records, and other related forms of communication. The management can make the use of a Learning Management System (LMS) functional in increasing the knowledge of nurses and patients as well. It can be used to enhance the training and practice of nurses by offering them quick and easy access to a vast collection of knowledge.

In the case of delivery methods, Artificial Intelligence (AI) is another recent technology that can enhance the delivery methods. AI is a technology created about human intellect and it mimics intellect for utilizing the data in it. Some examples of AI tools are chatbots to address problems faced by customers, intelligent assistants to enhance a user’s schedule, and recommendation engines to give the best possible solution to a problem. The most appropriate AI tool to support this need in this project is intelligent assistants since they can assist both nurses and managers in enhancing task schedules.

Stakeholders, Policy, Regulations

Nurses, finance department people and managers, patients, and common people from the community. The identified patient needs are communication, protection, information, assistance, independence, and clarification of health literacy. The nurse’s needs are in decision-making, teamwork, better communication with the patients and other related professionals, and proper working conditions. Managers’ needs are the need to lead, build a team, communicate, and have problem-solving skills. All the needs of stakeholders will be enhanced with the reformation of the intervention plan to be implemented.

The two main health regulation policies that relate to this plan implementation include the Affordable Care Act and the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act. The former policies relate to the probability of high nurse turnover over the expansion of health coverage. Improvement in the aspects of health access means that there would be a larger number of patients that nurses will be expected to handle in different settings, thus augmenting the nurse-to-patient relationship. To surmount the mentioned problem ACA offered a solution that consisted of the distinction between the establishments that delivered inpatient and outpatient services.

The Quality Care Act supports some specified staffing of nurses for patients in diverse centers of medical care. For instance, the medical care units should recommend the nurse-to-patient ratio of 1:4 while the emergency unit needs it to be 1:3. To enhance the plan the following created policies can be helpful during its implementation.

Timeline

The time required to implement the plan is one year considering the target population before and after the COVID era. They postulate the time as realistic and adequate for handling all implementation processes such as surveys, sampling of nurses (two months), analysis of KPIs (fourth month), and assessment of the outcomes (six months). Three potential threats are possible to influence the process i.e., government policies, the motivation or unavailability of nurses for sampling.

Evaluation Plan

Defining Outcomes

Enhancement in the nurse’s health status and improvements in the patient’s condition are the measures being sought in a given direction of the intervention. The goal of the intervention is to enable nurses to work in a better environment without getting burnt out to have good mental and physical health. Therefore, the performance related to the patient outcomes of the nurses will improve. The success of the intervention translates into improved health for the patients and decreased nurse burnout (Kang et al., 2022). Qualitative improvement of the patients, as well as care quality, will be realized when the number of patients per shift per nurse is reduced. It will improve patient safety as the execution of the intervention will minimize medication errors. The other consequences will be enhanced efficiency in the performance of nurses because of reduced workload, and a general enhancement of the health services of a hospital. Another implication of the intervention is that there will be an increase in salary expenditures because the hospital will need to employ more nurses to decrease the number of patients per nurse.

Evaluation Plan

Nurse surveys make up the bulk of the components used in the evaluation of the plan. In these surveys, the evaluation will involve administering structured interviews and questionnaires to the nurses, the patients themselves, and their families. The survey will play a vital role in helping the management understand the extent of efficiency and gaps in the plan (Van et al., 2021). The data that may provide overall information on the effectiveness of the plan is a new nurse-to-patient ratio, the perspective of the nurse, and the medical records of the patient.

 The data will be managed by the management by defining a local rate for the patient’s health status then the data will be reviewed from the dashboards after 15 days. The findings will be gathered by comparing the pre and post-implementation for the goal progress of the project in terms of the nurse perspective, patient experience, as well as, the health records (Jannati et al., 2022). The evaluation plan made in the course of this work is based on several assumptions. For instance, questionnaires are regarded as an effective type of data collection technique. Also worth mentioning are the hospital dashboards which are efficient devices that can narrate the progression of identified KPIs in a given environment.

Discussion

Advocacy

Nurses are at the center of any change in health organizations since they make the frontline workforce. As role makers, they can be at the forefront of any change as a transformational leader. He or she will be able to inspire, coordinate, engage, and direct the follower towards the vision of the organization. As the most patient interactive caregivers, they can also contribute to interprofessional relations. The practices that can promote collaboration can include safety huddles and communication practices (Kang et al., 2022). All these techniques can help a health facility to enhance the quality of care as well as the patients’’ outcomes. The improvement of the nurse-to-patient ratio will also have implications that will benefit both the nursing field and the role of nurses. When the intervention is applied and will get positive results in patient experience, nurse well-being, and hospital, it will be used on a larger scale, increasing the odds of positive change for the nursing profession (Abbasinia et al., 2020). Also, the leadership role in the intervention for nurses suggested the expansion of the role of the nurse from care delivery to other domains such as change agents and leadership in health organizations.

An increase in the nurse-to-patient ratio means that the workload among the nurses will be reduced. It will also reduce the rate of burnout rate among nurses, as well as other attributes associated with it such as efficiency focus, and health results (Scott et al., 2021). The gains achieved by employers and employees will allow nurses to have a balanced work burden while effectively collaborating with other professions and leaders. When nurses can work without worrying so much about distractions, they will not be likely to make mistakes and least likely to make medication mistakes or the patients will be readmitted to the hospital; these will benefit the hospital in both the financial and health aspects.

Future Steps

The cultural aspect is important and including it in the intervention project can help amend the plan. Due to the culture sensitivity analysis done earlier, this implies that patients can be from diverse cultural backgrounds and as such should be attended by nurses according to their cultural preferences. Culturally competent training and education are possible and can be implemented for nurses (Deliktas et al., 2019). Furthermore, concerning the project amendment, the health status of the hospitals will improve at the right time in terms of culturally competent care. Technologies like dashboards and electronic health records will assist the management to have better and safer records. They can easily monitor the records required for the assessment. These technologies will assist them in obtaining real-time data for the evaluation process. Nursing models such as the Team Nursing (TN) model endorse a team of nurses working under a team leader. Healthcare outcomes are improved due to the efficient work of the team led by transformational leadership.

Reflection on Leading Change and Improvement

I observed that my ability to lead changes and manage projects at hath organizations has been enhanced. They also helped me improve my leadership know-how and experience throughout this project. I also learned about leadership duties in collaboration and change management within a team (Whitehouse et al., 2022). As for me, I can state that such knowledge will be useful in my future practice, as it will allow me to manage the collaboration of the team, making decisions, and the communication process. It can also transform into my future practice as it allowed me to introduce and spearhead the campaign regarding the improvement in the nurse-to-patient ratio for the elimination of nursing burnout. I can also act as a nurse leader in my future practice. It will also increase the quality of patient care and develop the hospital’s services.

Conclusion

In conclusion, there is considerable promise for lowering nurse burnout and increasing patient outcomes in Minnesota hospitals by implementing the suggested intervention of raising the nurse-to-patient ratio in long-term care units (Jannati et al., 2022). This strategy meets the vital requirement for improved nurse well-being by adhering to ANA recommendations, which enhances care quality and lowers expensive errors and readmissions. The results highlight the significance of tackling burnout to promote a more robust staff and enhance the general quality of patient care, particularly in the aftermath of the COVID-19 pandemic.

References

Andrews, H., Tierney, S., & Seers, K. (2020). Needing permission: The experience of self-care and self-compassion in nursing: A constructivist grounded theory study. International Journal of Nursing Studies, 101, 103436. https://doi.org/10.1016/j.ijnurstu.2019.103436

Abbasinia, M., Ahmadi, F., & Kazemnejad, A. (2020). Patient advocacy in nursing: A concept analysis. Nursing Ethics, 27(1), 141–151. https://doi.org/10.1177/0969733019832950

Bernardes, A., Gabriel, C. S., Cummings, G. G., Zanetti, A. C. B., Leoneti, A. B., Caldana, G., & Maziero, V. G. (2020). Organizational culture, authentic leadership and quality improvement in Canadian healthcare facilities.https://doi.org/10.1590/0034-7167-2019-0732

Çelik, M. Y., & Kiliç, M. (2022). Family relationship of nurses in COVID-19 pandemic: A qualitative study. World Journal of Clinical Cases, 10(19), 6472–6482. https://doi.org/10.12998/wjcc.v10.i19.6472

Chen, P., Bao, F., Pompeo, E., Zhang, X., & Xu, T. (2024). Summary of the best evidence for the prevention and management of myasthenic crisis after thymectomy. Gland Surgery, 13(4), 540–551. https://doi.org/10.21037/gs-24-90

Cai, S., Yan, D., & Intrator, O. (2021). COVID-19 Cases and death in nursing homes: The role of racial and ethnic composition of facilities and their communities. Journal of The American Medical Directors Association, 22(7), 1345–1351. https://doi.org/10.1016/j.jamda.2021.05.002

Danno, C. H., Esteves, L. S. F., & Bohomol, E. (2021). Quality improvement programs and the professional nursing practice environment: an integrative review, 74(1), e20200108. https://doi.org/10.1590/0034-7167-2020-0108

Dincer, B., & Inangil, D. (2021). The effect of emotional freedom techniques on nurses’ stress, anxiety, and burnout levels during the COVID-19 pandemic: A randomized controlled trial. Explore (New York, N.Y.), 17(2), 109–114. https://doi.org/10.1016/j.explore.2020.11.012

Dall’Ora, C., Ball, J., Reinius, M., & Griffiths, P. (2020). Burnout in nursing: A theoretical review. Human Resources for Health, 18(1), 41. https://doi.org/10.1186/s12960-020-00469-9

Deliktas, A., Korukcu, O., Aydin, R., & Kabukcuoglu, K. (2019). Nursing students’ perceptions of nursing metaparadigms: A phenomenological study. The Journal of Nursing Research: JNR, 27(5), e45. https://doi.org/10.1097/jnr.0000000000000311

Eggli, Y., Halfon, P., Zeukeng, M. J., Kherad, O., Schaller, P., Raetzo, M. A., Klay, M. F., Favre, B. M., Schaller, D., & Marti, J. (2023). Potentially inappropriate medication dispensing in outpatients: comparison of different measurement approaches. Risk Management and Healthcare Policy, 16, 2565–2578. https://doi.org/10.2147/RMHP.S427516

Estrada, L. V., Harrison, J. M., Dick, A. W., Luchsinger, J. A., Dhingra, L., & Stone, P. W. (2022). I am examining regional differences in nursing home palliative care for black and hispanic residents. Journal of Palliative Medicine, 25(8), 1228–1235. https://doi.org/10.1089/jpm.2021.0416

Green, A. A., & Kinchen, E. V. (2021). The effects of mindfulness meditation on stress and burnout in nurses. Journal of Holistic Nursing: Official Journal of the American Holistic Nurses’ Association, 39(4), 356–368. https://doi.org/10.1177/08980101211015818

Hidayat, A. A. A., Uliyah, M., & Haryanti, T. (2023). Mobile nursing care plan information system for nursing service in hospitals. European Review for Medical and Pharmacological Sciences, 27(1), 13–19. https://doi.org/10.26355/eurrev_202301_30848

Harnett, G., & Collins, M. (2023). Nursing in rural, remote and isolated settings: A literature review. Rural and Remote Health, 23(1), 8159. https://doi.org/10.22605/RRH8159

Immonen, K., Oikarainen, A., Tomietto, M., Kääriäinen, M., Tuomikoski, A. M., Kaučič, B. M., Filej, B., Riklikiene, O., Flores Vizcaya-Moreno, M., Perez-Cañaveras, R. M., De Raeve, P., & Mikkonen, K. (2019). Assessment of nursing students’ competence in clinical practice: A systematic review of reviews. International Journal of Nursing Studies, 100, 103414. https://doi.org/10.1016/j.ijnurstu.2019.103414

Kang, E., Kim, M. Y., Lipsey, K. L., & Foster, E. R. (2022). Person-centered goal setting: A systematic review of intervention components and level of active engagement in rehabilitation goal-setting interventions. Archives of Physical Medicine and Rehabilitation, 103(1), 121–130.e3. https://doi.org/10.1016/j.apmr.2021.06.025

Khatib, R., Lee, G. A., Marques-Sule, E., Hopstock, L. A., O’Donnell, S., Svavarsdóttir, M. H., Andreae, C., Vellone, E., Goossens, E., Strömberg, A., Kjellström, B., Jaarsma, T., & Stewart, C. (2020). They are evaluating the extent of patient-centered care in a selection of ESC guidelines. European Heart Journal. Quality of Care & Clinical Outcomes, 6(1), 55–61. https://doi.org/10.1093/ehjqcco/qcz025

Kawar, L. N., Aquino-Maneja, E. M., Failla, K. R., Flores, S. L., & Squier, V. R. (2023). Research, evidence-based practice, and quality improvement are simplified. Journal of Continuing Education in Nursing, 54(1), 40–48. https://doi.org/10.3928/00220124-20221207-09

Khatatbeh, H., Pakai, A., Al, T., Onchonga, D., Amer, F., Prémusz, V., & Oláh, A. (2022). Nurses’ burnout and quality of life: A systematic review and critical analysis of measures used. Nursing Open, 9(3), 1564–1574. https://doi.org/10.1002/nop2.936

Jannati, Y., Babajani, A., Kolaei, M. G., Mohsenipouya, H., Mousavinasab, N., Gorji, M. A. H., & Mamun, M. A. (2022). Evaluating patient satisfaction with nursing services before and after implementation of the health system transformation plan in iran: A cross-sectional study. Health Science Reports, 5(4), e710. https://doi.org/10.1002/hsr2.710

Li, Y., Cai, X., Mao, Y., Cheng, Z., & Temkin-Greener, H. (2022). Trends in racial and ethnic disparities in coronavirus disease 2019 (COVID-19) outcomes among nursing home residents. Infection Control and Hospital Epidemiology, 43(8), 997–1003. https://doi.org/10.1017/ice.2021.246

Melnyk, B. M., Kelly, S. A., Stephens, J., Dhakal, K., McGovern, C., Tucker, S., Hoying, J., McRae, K., Ault, S., Spurlock, E., & Bird, S. B. (2020). Interventions to improve mental health, well-being, physical health, and lifestyle behaviors in physicians and nurses: A systematic review. American Journal of Health Promotion: AJHP, 34(8), 929–941. https://doi.org/10.1177/0890117120920451

Ozdemir, H., & Kilicarslan, E. (2023). The effect of technology-based interventions on child and parent outcomes in pediatric oncology: A systemic review of experimental evidence. Asia-Pacific Journal Of Oncology Nursing, 10(5), 100219. https://doi.org/10.1016/j.apjon.2023.100219

Peters, M. D. J., Godfrey, C., McInerney, P., Khalil, H., Larsen, P., Marnie, C., Pollock, D., Tricco, A. C., & Munn, Z. (2022). Best practice guidance and reporting items for the development of scoping review protocols. JBi Evidence Synthesis, 20(4), 953–968. https://doi.org/10.11124/JBIES-21-00242

Pollock, D., Davies, E. L., Peters, M. D. J., Tricco, A. C., Alexander, L., McInerney, P., Godfrey, C. M., Khalil, H., & Munn, Z. (2021). Undertaking a scoping review: A practical guide for nursing and midwifery students, clinicians, researchers, and academics. Journal of Advanced Nursing, 77(4), 2102–2113. https://doi.org/10.1111/jan.14743

Rojo, E., Maestre, J. M., Piedra, L., Esteban, J., Sánchez, B., Hoz, V., & Del Moral, I. (2022). Entrenamiento de equipos interprofesionales con simulación in situ para mejorar la calidad de la reanimación cardiopulmonar [Interprofessional team training with in situ simulation to improve the quality of cardiopulmonary resuscitation]. Journal of Healthcare Quality Research, 37(2), 92–99. https://doi.org/10.1016/j.jhqr.2021.10.001

Renner, C., Jeitziner, M. M., Albert, M., Brinkmann, S., Diserens, K., Dzialowski, I., Heidler, M. D., Lück, M., Nusser-Müller-Busch, R., Sandor, P. S., Schäfer, A., Scheffler, B., Wallesch, C., Zimmermann, G., & Nydahl, P. (2023). Guideline on multimodal rehabilitation for patients with post-intensive care syndrome. Critical Care (London, England), 27(1), 301. https://doi.org/10.1186/s13054-023-04569-5

Spaulding, E. M., Marvel, F. A., Jacob, E., Rahman, A., Hansen, B. R., Hanyok, L. A., Martin, S. S., & Han, H. R. (2021). Interprofessional education and collaboration among healthcare students and professionals: A systematic review and call for action. Journal of Interprofessional Care, 35(4), 612–621. https://doi.org/10.1080/13561820.2019.1697214

Suleiman, N., Gomez, J. L., Aguayo, R., Cañadas, G. A., De La Fuente, E. I., & Albendín, L. (2020). The effect of mindfulness training on burnout syndrome in nursing: A systematic review and meta-analysis. Journal of Advanced Nursing, 76(5), 1124–1140. https://doi.org/10.1111/jan.14318

Scott, S. M., & Scott, P. A. (2021). Nursing, advocacy, and public policy. Nursing Ethics, 28(5), 723–733. https://doi.org/10.1177/0969733020961823

Toles, M., Colón-Emeric, C., Moreton, E., Frey, L., & Leeman, J. (2021). Quality improvement studies in nursing homes: A scoping review. BMC Health Services Research, 21(1), 803. https://doi.org/10.1186/s12913-021-06803-8

Van, G. H., Huisman-de Waal, G. G. J., Vermeulen, H., & de van der Schueren, M. A. E. (2021). Effects of nursing nutrition interventions on outcomes in malnourished hospital inpatients and nursing home residents: A systematic review. International Journal of Nursing Studies, 117, 103888. https://doi.org/10.1016/j.ijnurstu.2021.103888

Whitehouse, C. L., Harris, C., Charlton, P., & Hare, N. (2022). The changing paradigm of research delivery during a pandemic – a reflective account. Nurse Researcher, 30(2), 12–17. https://doi.org/10.7748/nr.2022.e1832

Wang, M., Jiang, Y., Han, W., Jiang, L., & Mao, C. (2021). Summary of the best evidence for the prevention of intraoperative unplanned hypothermia in patients undergoing laparoscopic surgery. Gland Surgery, 10(9), 2790–2798. https://doi.org/10.21037/gs-21-578