Case Study Questions
In this scenario, the problems and issues faced by Jennifer Broadwater in her position as the women’s health director of a non-profit healthcare system in the region are examined. Although Broadwater’s department has had a flawless history with a highly effective reputation, some concerns over staff retention and an unwelcoming work environment have arisen. She, therefore, has the challenge of tackling these obstacles while keeping in mind staffing patterns, patient care requirements shared control procedures, and financial considerations.
Question One
As mentioned before, the department employs a decentralized process in terms of budgeting in its operations. Therefore, the same method can tackle the department’s current challenges. According to Roussel et al. (2022), decentralized budgeting incorporates eight significant steps to unify the process’s managers and staff. The first six steps demonstrate the labor-intensive nature of nursing services. In comparison, the last two steps of the budget planning process entail non-labor expenses (Roussel et al., 2022).
Essentially, the first two steps of this process entail determining the productivity goals of the department and forecasting the workload to align with these goals (Roussel et al., 2022). In order to incorporate this, Broadwater ought to take a deep dive into the current state of her department through a thorough examination. This should involve scrutinizing the combination of various issues affecting the department, such as the staff max, demands for patient care, and how the shared governance method affects the department’s daily operations. In addition, employing the evaluation, Broadwater should establish precise objectives for enhancing the department’s effectiveness. Such objectives need to tackle the challenges of employee attrition, a toxic workplace, and maintaining high standards of patient care.
Additionally, the next two steps entail budgeting, which incorporates budgeting for patient care hours and staffing schedules (Roussel et al., 2022). In order to successfully implement this stage, Broadwater needs to set aside funds in her budget to support the various initiatives identified in the analysis and forecasting stages. These resources may be directed towards addressing various challenges identified, including procedures aimed at improving the morale of the staff, employee training, skills development, and incentives that specifically target BSN RNs. However, it is imperative to remember that Broadwater must maintain a high level of communication throughout the budgeting process. According to Li et al. (2021), transparent corporate communication allows employees to use a control coping technique to manage changes proactively and minimizes workers’ apprehension about change. Furthermore, open communication and a control coping approach promote good connections between employees and their employers (Li et al., 2021). Therefore, Broadwater must communicate her budgeting intentions and objectives to her staff straightforwardly, emphasizing the importance of the shared governance model and the need for change.
The last four steps, which complement all these other stages, are incorporated into Broadwater’s plan’s implementation and monitoring phase. These steps include planning and charting for both productive and non-productive hours in addition to the labor-intensive phases like estimating costs of supplies and services and anticipating capital expenses (Roussel et al., 2022). Therefore, Broadwater and her team should collaborate to introduce the allocated initiatives, such as revamping the nursing care delivery system, improving orientation programs, and tackling productivity concerns. It is imperative to track and assess the enhancements regularly. Gathering data on staff retention rates, patient care results, and general employee satisfaction will aid Broadwater in evaluating the efficacy of her plans. These performance evaluations will furnish an opportunity to make adjustments where necessary. Ultimately, she must communicate progress and reports to the CNO and leadership team.
Question Two
In order to optimize her professional nursing capacity while expanding the BSN RN pool, Broadwater can explore several strategies. First, implementing cross-training programs can help enhance the capabilities of patient care technicians, unit secretaries, and ADN RNs. These groups can carry out additional tasks through this measure, decreasing the need for BSN RNs in certain positions. Moreover, establishing mentorship programs would better support ADN RNs pursuing BSN degrees. According to Kachaturoff et al. (2019), peer mentorship is important in reducing employee turnover and engagement and promoting skill competency among nursing staff. In order to implement this, one option could be to facilitate online courses to assist with their professional development, in addition to promoting peer-to-peer networking and other tailored initiatives. It would also be wise for Broadwater to scrutinize patient acuity levels and assign nurses accordingly based on their skill mix and experience to guarantee safe and efficient patient care. Adjusting nurse-patient ratios to align more closely with departmental requirements may also be necessary. The idea is that matching employees with their skills allows them to tackle tasks and jobs that they are more comfortable with and can handle competently.
Reflective Questions
Question One
Amidst recent publications in nursing journals, the nursing profession’s future may be altered by pay-for-performance initiatives. One effect of these initiatives is the stimulation of healthcare providers in providing top-notch care. For example, healthcare providers may feel more enticed to allocate extended periods with patients (Asadi-Aliabadi et al., 2022). Moreover, pay-for-performance programs also bolster contentment among nurses. Pay-for-performance, for example, instills confidence among nurses and other healthcare professionals, making them more satisfied with their jobs (Martin et al., 2020).
Moreover, improving patient outcomes is one of the other benefits of pay-for-performance. According to Aghajani et al. (2019), it motivates employees to enhance both the quantity and quality of services provided while prioritizing the health system goals and improving patient health outcomes. Nevertheless, there are some potential challenges that this type of reimbursement system presents. For instance, it may blur precise and equitable performance measurement, which is essential, and neglect non-measurable aspects of nursing care. It is in line with this reasoning that Loomer et al. (2023) argue that pay-for-performance reimbursement harms the development of quality care, especially for the elderly in nursing homes.
Question Two
Three core financial dilemmas arise in the realm of nursing. Firstly, there is the concern about how we compensate our nurses. Benefits and salaries continue to soar, making it expensive for healthcare organizations to find and retain staff. According to Dillard-Wright and Shields-Haas (2021), as healthcare prices increase and inequality expands, nurses strongly need to build alternative healthcare delivery models unattached to traditional employment and profit-driven systems. This mandate stems from the disciplinary emphasis of nurses, which stresses social justice as a social and moral good related to the human services nurses deliver (Dillard-Wright & Shields-Haas, 2021). Therefore, studies frequently emphasize the importance of proper nurse staffing for optimal outcomes regarding patient safety.
Furthermore, implementing leading healthcare technology requires a heavy monetary contribution. It necessitates supporting nurses’ education to master these cutting-edge tools. According to Rutledge et al. (2021), the situation is so bad that even basic standardized nursing competencies in areas such as telehealth are missing. There is an ever-increasing need to match financial investment put towards technological advancement skills development and reimbursement in nursing.
Finally, within the nursing profession, financial complexities and opportunities are extensively discussed in existing literature. An essential area of concern is workforce development, which involves funding for ongoing education, career progression, and training. For instance, measures such as fellowship schemes, among others, can be employed to promote career progression funding. According to Trusson et al. (2019), additional clinical educational positions are needed to allow nurses to continue to apply their knowledge and skills post-PhD; otherwise, the full degree of their worth will not be recognized. Cultivating a skilled nursing workforce hinges on adequate support for advanced practice and BSN education programs.
References
Aghajani, M. H., Manavi, S., Maher, A., Rafiei, S., Ayoubian, A., Shahrami, A., Ronasiyan, R., & Maziar, P. (2019). Pay for performance in hospital management: A case study. International Journal of Healthcare Management, 1–7. https://doi.org/10.1080/20479700.2019.1664029
Asadi-Aliabadi, M., Karimi, S. M., Tehrani-Banihashemi, A., Mirbaha-Hashemi, F., Janani, L., Babaee, E., Nojomi, M., & Moradi-Lakeh, M. (2022). Effectiveness of pay for performance to non-physician health care providers: A systematic review. Health Policy. https://doi.org/10.1016/j.healthpol.2022.03.007
Dillard-Wright, J., & Shields-Haas, V. (2021). Nursing With the People. Advances in Nursing Science, Publish Ahead of Print. https://doi.org/10.1097/ans.0000000000000361
Kachaturoff, M., Caboral-Stevens, M., Gee, M., & Lan, V. M. (2019). Effects of peer-mentoring on stress and anxiety levels of undergraduate nursing students: An integrative review. Journal of Professional Nursing, 36(4). https://doi.org/10.1016/j.profnurs.2019.12.007
Li, J.-Y., Sun, R., Tao, W., & Lee, Y. (2021). Employee coping with organizational change in the face of a pandemic: The role of transparent internal communication. Public Relations Review, 47(1), 101984. https://doi.org/10.1016/j.pubrev.2020.101984
Loomer, L., Kim Nichols Dauner, & Schultz, J. (2023). Association of Pay-for-Performance Reimbursement With Clinical Quality for Minnesota Nursing Homes Residents. 107755872311700-107755872311700. https://doi.org/10.1177/10775587231170064
Martin, B., Jones, J., Miller, M., & Johnson-Koenke, R. (2020). Health Care Professionals’ Perceptions of Pay-for-Performance in Practice: A Qualitative Metasynthesis. Inquiry: A Journal of Medical Care Organization, Provision and Financing, 57. https://doi.org/10.1177/0046958020917491
Roussel, L. A., Thomas, P. L., & Harris, J. L. (2022). Management and Leadership for Nurse Administrators. Jones & Bartlett Learning.
Rutledge, C. M., O’Rourke, J., Mason, A. M., Chike-Harris, K., Behnke, L., Melhado, L., Downes, L., & Gustin, T. (2021). Telehealth competencies for nursing education and practice. Nurse Educator, 46(5). https://doi.org/10.1097/nne.0000000000000988
Trusson, D., Rowley, E., & Bramley, L. (2019). A mixed-methods study of challenges and benefits of clinical academic careers for nurses, midwives, and allied health professionals. BMJ Open, 9(10), e030595. https://doi.org/10.1136/bmjopen-2019-030595
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