Application 2: Laying the Foundation for New Approaches to Practice

Application 2: Laying the Foundation for New Approaches to Practice (developed in Weeks 4 and 5)

In a 3- to 5-page paper, include the following:

• A brief summary of the currency of the science underlying the practices used to address your EBP Project issue
• Possible causes of the difference in outcomes from what would be expected according to the research literature
• The effect the EBP Project issue is having in practice
• Current research evidence on new practices for addressing the EBP Project issue
• A summary of the evidence-based practice model (including models from other disciplines as appropriate) and/or change theory or framework you will utilize to systematically integrate new approaches to practice to address the issue

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THIS APPLICATION NR 2 CONTINUE APPLICATION 1 ATTACHED

Identification of a Practice Issue for the Evidence-Based Practice (EBP) Project

The practice issue I have chosen to explore is the nurses are often required to work for the long working hours with extended shifts thereby risking fatigue that could result in medical mistakes. Extended work shifts of twelve and longer hours have become familiar with hospital nurses. Concerns have been raised over performance, fatigue, stress and patient safety as a result of the long working hours. The long hours have been caused because mainly managers believe it is a more cost-effective way of providing care accompanied with lower costs and greater continuity of staffing (Ball., J. et.al., 2017). Some nurses also prefer to work longer daily hours with few shifts. Nurses who work more extended hours are likely to report poor quality care and poor safety when compared to those working shorter hours. To reduce the long working hours causing fatigue hospitals should allow nurses to take short breaks while someone else covers that person’s patients. Policies should be introduced to restrict shifts length and the use of voluntary overtime (Ball.J, et.al.2017) Hospitals should limit the number of consecutive days that a nurse can work.

Summary of the selected practice issue in which the outcome is different from what would be expected according to the research literature

According to survey data from diverse hospitals in the United States, 80% of surveyed nurses admitted to preferring such long working hours whereas hospitals supported such practices via their scheduling behaviors (Stimpfel, Sloane, & Aiken, 2013). Nevertheless, as the percentage of nurses working more than twelve hours has increased, a noticeable decrease in patient dissatisfaction with care has become evident. Moreover, those nurses working for more than 12 hours demonstrate a double propensity to commit medical errors due to burnouts and dissatisfaction as compared to their colleagues working shorter shifts (Dall’Ora et al., 2015). Therefore, the practice of extended working hours in hospitals should become regulated in order to ensure that quality patient care exists. To this end, establishing policies that regulate working hours in a manner akin to those of physicians may become necessary. In addition, other measures such as creation of a workplace culture that respects nurses’ time off and vacations, encourages nurses to promptly leave their workstations upon the completion of their shifts, and permits them to reject overtime work without retribution may be warranted (Ntantana.A, et.al.,2017)

Even as evidence mounts on the disadvantages of long working hours vis-a-vis the quality of care, research has supported the existence of such policies due to their apparent advantages to hospitals. According to scholarship on the issue, the longer working hours leads to reduction in the handing off process as only two nurses are required to complete the procedure as opposed to three in the 8-hour shift. Consequently, nurses will be subjected to less reports and less miscommunication chances hence possible errors. Further, Everhart et al. (2013) postulate that longer working hours will positively impact the financial performance of hospitals due to the reduction of the overall hospital costs. Also, other literature material opines that longer working hours implies better work-life balance for nurses as the flexibility offered may allow them to pursue further education, elect extra shifts and even raise a family.

Nevertheless, whereas the advantages accrued to health care facilities and to a small degree nurses cannot be doubted, the first responsibility of nurses it towards patient care. In this front, long working hours have jeopardized the safety of patients and the welfare of nurses. Rhéaume and Mullen (2018) posit that nurses who work more than 12 hours rate the standard of care delivered in their jurisdictions as poor. These longer working hours also predisposes them to commission of medical errors while the fatigue associated with the culture also influences their performance. Further, the impact of longer working hours on cognition of nurses is negative due to sleep deprivation that they experience (Dall’Ora et al., 2015).

As a result of this, nurses do not perform to their optimal potential thereby affecting the quality of care that they offer. Also, contrary to the evidence adduced in support of this practice culture, extended working hours lead to job dissatisfaction. The existence of this phenomenon has increased the rate of nursing turnover in health care facilities, which defeats the financial motives behind the decision by various facilities to encourage the practice. Evidently, the practice of longer working hours has more disadvantages that advantages. As such, stratagems such as adopting the physical-oriented policies and changing organizational culture need to be operationalized in hospitals in order to address the matter (Ntantana.A, et.al.,2017)

Application 2: Laying the Foundation for New Approaches to Practice

References

Ball, J., Day, T., Murrells, T., DallOra, C., Rafferty, A. M., Griffiths, P., & Maben, J. (2017).

Cross-sectional examination of the association between shift length and hospital nurses job satisfaction and nurse reported quality measures. BMC Nursing, 16 doi: http://dx.doi.org.ezp.waldenulibrary.org/10.1186/s12912-017-0221-7

Dall’Ora, C., Griffiths, P., Ball, J., Simon, M., & Aiken, A. (2015). Association of 12 h shifts and

nurses’ job satisfaction, burnout and intention to leave: Findings FrBMJ Open, 5(9), e008331.

Everhart, D., Neff, D., Al-Amin, M., Nogle, J., & Weech-Maldonado, R. (2013). The effects of

nurse staffing on hospital financial performance: competitive versus less competitive markets. Health care management review, 38(2), 146-55

Ntantana, A., Matamis, D., Savvidou, S., Giannakou, M., Gouva, M., Nakos, G., & Koulouras,

(2017). Burnout and job satisfaction of intensive care personnel and the relationship with personality and religious traits: An observational, multicenter, cross-sectional study. Intensive & Critical Care Nursing, 41, 11-17. doi: http://dx.doi.org.ezp.waldenulibrary.org/10.1016/j.iccn.2017.02.009

Rhéaume, A., & Mullen, J. (2018). The impact of long work hours and shift work on cognitive

errors in nurses. Journal of Nursing Management, 26(1), 26–32. ://doi.org/10.1111/jonm.12513

Stimpfel, A. W., Sloane, D. M., & Aiken, L. H. (2013). The longer the shifts for hospital nurses,

the higher the levels of burnout and patient dissatisfaction. Health affairs (Project Hope), 31(11), 2501-9.

Application 2: Laying the Foundation for New Approaches to Practice