Leadership conducted on the hospital especially the emergency

Leadership Learning Experience

Problem or Issue

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Nurse staffing is critical to delivery of high quality patient care. In this hospital, nurse staffing seems to be inadequate. This problem jeopardizes the service delivery and high quality patient care. The patients in the emergency department need close monitoring and this duty is often a preserve on the nurses working on this department. The quality of care is linked to nurse staffing which subsequently affects the outcome of hospital care. Staffing ratio is a problem which the leadership of the hospital should always address. It directly affects the service delivery and outcomes of the hospital care. Essence of seeking hospital care is to receive treatment from specialists. However, in the absence of adequate staff, the hospital is incapable of delivering the desired objectives.


An observational study conducted on the hospital especially the emergency department showed that there were two nurses assigned to the emergency department. The quantity of work in the emergency department of this hospital facility seems to overwhelm staff working in this department. The patient population or the nature of care and attention that a patient requires determine the nursing staff for a given department. The emergency department requires close monitoring of the patients in order to attain the desirable results. The observations made in the emergency department showed that at some point the duty nurse could leave one patient to rush and care for another one. Studies indicate that the survival rate of patients in the emergency department hinges on the amount of care (Welton, 2007). Another study attributed survival and mortality rate in the intensive care unit to the staffing ratio within this department (Clarke & Donaldson, 2008). The patients in the emergency department require special treatment which warrants the need to more staffs in the department.

The investigation evaluated the cause of death or readmission in the emergency department verses the staffing ratio and workload. It was established that some patients suffered neglect because of the workload that limited influenced the nurse staff ability to address the concerns of all patients. The patients’ outcomes are sensitive to nursing. The characteristics of the environment in which the care is provided also affects the patient’s outcome. Practice of nursing is sensitive to the conditions within the department. In this case, the emergency department had two nurses and four patients who required high intensive care from them. The efforts made to address the problems of the patients admitted to the emergency department were greatly affected by the nurse staff ratio in this department. Patient B who died in the emergency department suffered some bit of neglect when the nurse J attending to him had to take other assignments of addressing concerns of new patients brought to the emergency department before placing patient B in life support machine.

Analysis of the Investigation

The investigation report seems to suggest that nurse staffing ratio is critical to the patient outcome in emergency and intensive care unit departments. It supports the study on nurse staffing ratio and hospital readmission conducted by Tubbs-Cooley, Cimiotti, Silber, Sloane, and Aiken (2013) which affirmed that hospitals in which nurses care for a small number of patients each are unlikely to report admission between 15-30 days from discharge. The lower patient nurse ratio tends to increase the quality of care the patients receives. Nurses and doctors working in the intensive care unit and emergency department improve patients’ survival chances (West, Barron, Harrison, Rafferty, Rowan, & Sanderson, 2014). High workload for nurses and doctors working in the emergency department tend to distract their attention from pressing concerns. This tends to suggest that the mortality and survival rate in the emergency department is partly influenced by the staffing ratio.  

Areas Contributing to Problem

Hospital policy largely contributes to the staffing issue in the hospital. The leadership of the hospital makes decision concerning the hiring and allocation of staffs in various departments. The leadership of the hospital needs to identify concerns and requirements of each department and align such with the hospital policy. The leadership’s priority also contributes to this problem (Welton, 2007). It is important for the hospital leadership to evaluate the challenges of every department and work towards correcting them.

Proposed Solution

The proposed solution for the problem of staffing ratio is to increase the nursing staff to the emergency department. Studies shows that nurse patient ratio affect the readmission rate of patients. Hospital with low nurse patient ratio records the list rate of readmission (West, Barron, Harrison, Rafferty, Rowan, & Sanderson, 2014). Further, studies show that patient outcome in the emergency department largely depend on the nurse and doctors ratio. It follows that the quality of care especially in the emergency department hinges on the close attention which the doctors and nurses offer to the patient. By increasing the staff in the emergency department, the patients would receive close care and their chances of recovering would greatly increase. Increasing the nursing staff ratio in the emergency department would help in reducing workload for the nurses and enhance attention to the patients.

Cost Benefit Analysis

The cost of implementing the solution is worthwhile because the hospital would record positive patient outcomes and reduced rate of mortality and increased survival chances in the emergency department. The organization would increased cost associated with hiring and salaries of the nurses added to the emergency department to correct the problem of staffing shortage.

Key Stakeholders/Partners

The key stakeholders in this issue are physicians, the leadership of the ambulatory surgery center, and the leadership of the organization (board of management). The input of these partners is critical in ensuring that the organization solves the problem. The support from the organization leadership would permeate the environment for solving the problem. At the same time, engaging the physicians directly in finding the solution to the challenge would promote a positive view towards implementation of the safe harbor provisions. Lastly, the perception of the board of management towards the implementation of the proposed solution would dictate whether the organization solves challenges associated with the emergency department.


The implementation of the proposed solution would involve raising the issue to the board of management and justifying the need to hire more nurse staff to work in the emergency department. It might take one month to hire the appropriate personnel once the board of management has approved the budget. After the implementation, it would be a policy of the hospital to staff the emergency department with adequate staff given the weight given on their role in determining patient outcomes. The success of the proposed solution can be evaluated by examining the readmission rate, patient outcomes, and mortality rate reported in the emergency department.


Role of Scientist

I have learned that a nurse a scientific role of evaluating critical evidence associated with care for the patients. The outcome of such investigation is important in designing, implementing and evaluating research on nursing practice with a view of expanding the science of care. The proposed solution for the staffing problem facing the emergency department was a result of scientific research conducted on how to improve and expand the nursing care practice for patient in the emergency department.

Role of Detective

Nurses offer patient care services and serve as detectives at the same time. I have learned that a nurse uses clinical imagination and science of nursing practice to detect the challenges facing the patients and nursing outcomes. The patients received by the nurse are examined and their reports used in determination of the appropriate treatment. The evaluation of the patient problems is not only a preserve on the doctors and clinicians. The nurse uses the knowledge in clinical medicine to identify the problems of the patients and recommends further examination using such reports.

Role of Manager in the Healing Environment

I have learned that the nurse plays managerial role in the healing environment. The nurse understands how the setting of the patient environment affects the healing process. The environment can induce both positive and negative feelings for the patients. The nurse as manager is responsible for creating a patient care unit that help to support the hospital staff (nurses and doctors) and patients and provide a caring and healing environment. The treatment given to the employees should motivate them to provide utmost patient care.