Outline

1. Executive Summary
2. Problem Statement
3. Deficiencies and Current Status in the Current NM Model
4. Desired State of the System
5. Benchmarks and References
6. Hypothesis
7. Assumptions
8. Strategic Values
9. Proposal including Staffing, Costing, and Quality Audits
10. Conclusions and Recommendations
11. References

Executive Summary

In most healthcare facilities, Nurse Managers are expected  to maintain a very high level of quality care and  maintain patient safety while juggling both financial and human resources in a prudent manner. Currently, little research on how best to juggle those goals has been provided within any given healthcare facility. Thus, little is understood about the limits to effective management for a single Nurse Manager.

In the academic healthcare environment which is the subject of this project, the standard for making such determinations has been  derived primarily on an historical basis—“that’s how we’ve always done it”—with little real evidence on whether such decisions have been appropriate and efficient for the facility. This paper attempts to remedy that by describing an evidence-based study to determine the effectiveness of a single Nurse Manager in coping with two 28-bed units in separate facilities.

The organization under study currently comprises only one Nurse Manager, who oversees three other technical staff , and 70 other employees at the line level. The method used in this study will include a literature review of healthcare industry and Nurse Managers to determine the problems and advantages of the current model.  That in turn provides a mode of providing recommendations on whether the existing model is adequate to maintain appropriate standards of patient care, patient safety, employee resource management, and fiscal responsibility. Based on these results, recommendations will be presented for either continuing the existing model or specific suggestions on how best to modify the  model to achieve the goals specified.

Specific issues that will be considered in this assessment include peer-reviewed literature from both healthcare and management disciplines, management measures such as span of management, span of control, fiscal management, inventory management and quality assurance programs will be included.  These will identify any deficiencies in the existing model and will help determine the need, if there is one, to modify the model. Other critical issues include stress and its effect on competency and the decision-making process, and the long-term effect of all issues on overall image of the institution. Finally, financial measures will assess the result of any model changes on the financial bottom line of the organization, if any human resources changes, or employee staffing needs are discovered.

The end result of this project will be to present an evidence-based proposal with an appropriate staffing suggestions and span of control determination that, if implemented, would better position the institution as a going concern in the eyes of its stakeholders, and enable to continue to be the facility of first choice among all competitors.

Problem Statement

This project is based on a study of an academic environment healthcare system that consists of two units, currently managed by a single Nurse Manager. These two units are

1. An Acute Care Medicine Unit, which is a 28-bed medical surgical unit in which telemetry is located in the critical hospital. This unit currently is budgeted with 54.2 full time employees (FTE), but currently has only 49.2 FTE, with a -5 variance. Included within these FTE are 3 clinical coordinators  (CCs) and a Nurse Manager Assistant. A Nurse Manager (NM) and Nurse Clinician (NC) are included in the FTE count.
2. An Admitting Unit, which is expanding to be a 28-bed  unit with telemetry, and using the same NM and NC as in the Acute Care  Unit, plus one CC. This unit is currently budgeted at 39.49 FTE, but has only 20.2 actual FTE with a -19.29 variance.

This project seeks to investigate whether modern management principles along other financial and scientific evidence support using a single NM for this facility.  In particular, the study assesses whether a single NM in this environment can be effective at achieving these key goals:

• Excellent patient quality of care in both units
• Excellent patient safety in both units
• Efficient use of staff resources in both units
• Prudent financial management of the two units
• Avoiding excessive stress in the NM to ensure quality decision-making and effective management of the units

After assessing these issues in the current model, a determination will be made on appropriate changes to the NM model for these two facilities, in particular to determine if adding a second NM would improve overall measures of performance for both facilities.  Once this determination is made, the project will conclude with a recommendation of an appropriate mode that will facilitate the mutual achievement of the hospital goals and objectives as well as that of its technical and line workers.

Deficiencies and Current Status in the Current NM Model

Currently, several problems have been identified in these two units that project recommendations will seek to remedy.  Reported problems include: high levels of stress, poor servicing rates for patients, the possibility of increases in the medication and other error rate and staff attrition rate, poor inventory management, low morale and  threats to the corporate image of the institution.

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