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Nursing Practice: Developing an Implementation Plan

Methods of obtaining necessary approvals

Nursing workload has been a common problem in many hospitals all over the world. This problem leads to numerous effects on the nurses and the patients (Malloch & Porter-O’Grady, 2006). This paper, thus seeks to offer a proposal to implement a plan that will ensure a lasting solution to this problem. However, just like any other change management, necessary support and approval by the concerned authorities is inevitable. For this case, appropriate methods to seek support from the organization’s leadership and staff will be used. Some of such methods include carrying out surveys to assess the willingness of the organization’s personnel and other leaders to adopt the proposed change. Surveys from other areas where such a change was implemented will be submitted to the top management of the organization as proof that a change is needed.

Description of the current problem

According to studies by Malloch & Porter-O’Grady (2006), workload among nurses is a problem that is facing not only hospitals in the United States of America but also the whole world. For this reason, the issue of the amount of work for one nurse remains a global concern. Nurse workload is significantly attributable to over capacity within the hospitals. Usually, the recommended size is 85%. However, numerous hospitals in various parts of the world are operating at a high capacity of 100% with some going past this (Stahl, 2004). Such conditions lead to workload on the side of nurses since they have to provide care to a highly large number of patients despite there being shortage of nurses in most of these hospitals. Due to overcrowding in hospitals, there is a high probability of compromised care, contraction of hospital-acquired infections and readmission rates that are unnecessary.

However, one of the most dangerous effects of such a condition is the high levels of workload on the nurses. From both international and national perspective, it is clear that a relationship exists regarding the subject of lack of enough nurses, outcomes in patient’s care, mortality rates increases, as well as hospital-acquired infections. As such, the relationship between patient safety and nursing workload is available both in acute and long-term care. According to Taylor (2010), the resident outcomes are highly depended on whether the patients receive direct nursing care. If the care is delivered directly to the patients, there is a high possibility of better outcomes, lower mortality rates, improved nutrition, and lower levels of hospital-acquired infections (Taylor, 2010). Usually, cases of overcapacity in hospitals are attributable to the absence of alternative care services at the community levels.

Even though there has been continued campaigns regarding the issue of nurses’ workload, overcapacity and overcrowding in hospitals, little has been done to avert the situation (Stahl, 2004). Patients, in some hospitals, are receiving nurse’s attention from tub rooms, patient lounges, hallways, and in other locations that are ill equipped, exposed and thus unsafe. As such, poor working conditions remain to be a threat to the ability of nurses to offer safe care to patients (Malloch & Porter-O’Grady, 2006). Role confusion, frequent interruptions, lack of sufficient human and technical support, system integration, coordination, and the absence of better ways to make autonomous decisions are some of the factors that adversely affect nurses. As a result, nurses lack job satisfaction and are characterized by incidences of burnout, fatigue, as well as absenteeism (Wells & Wilson, 2009). Evidently, if the working conditions of nurses are improved such that there are policies aimed at safe staffing, the care that patients receive can substantially improve. There is a need to implement a plan that will take care of the working conditions of nurses. A suitable solution for the problem of nurses’ workload would be the implementation of mandated ratios in the hospitals.

Detailed explanation of the proposed change

The problem of workload among nurses has persisted. For this reason, there is a proposal to implement the mandated ratios approach to improve their working conditions. The mandated ratios model is an approach that ensures a well-defined guideline on the number of patients that a particular nurse is entitled. This type of approach is guarantee that nurses do not neglect their duties because of high levels of workload or the lack of satisfaction as far as their work is concerned. The significance of the mandated ratios among nurses is that the nurses can offer better services when the number of patients they attend to is controlled.

According to Wells & Wilson (2009), the adoption of mandated ratios for nurses allows them to have a work schedule that defines one’s boundary as far as time and number of patients is concerned. Usually, this method can adopt a formula based on minimum number of hours that a particular patient spends on one patient. This approach is referred to as the NHPPD. The application of NHPPD can be different depending on a given situation (Taylor, 2010). Usually, this method would adopt 1:4 ratios that are applicable along with shifts for a period of seven days. However, for cases of higher acuity, some differences may exist in the number of patients that a nurse serves.

Rationale for selecting the proposed solution

Although there are other methods that have been suggested by various studies, the adoption of mandated ratios within the nursing sector seemed to be the suitable plan for the problem of workload in nursing units. Other places have tried this approach, and it proved to be working. For example, it was adopted in California and results indicated a reduced level of absenteeism, increased job motivation, and satisfaction among nurses. In addition, the method, according to Wells & Wilson (2009), led to improved health care for patients as well as the reduction in overcrowding and overcapacity cases in institutions providing healthcare.

Following the evidence from both research and actual application of the mandated ratios, there is a high probability that its adoption leads to improved patients’ outcomes (Wells & Wilson, 2009). For instance, a study carried out in Australia to assess the practicality of the mandated ratios in nursing units showed that any form of patient condition linked to nurse-sensitive indicators had decreased. When such results are compared with studies from California, it is evident that both studies report similar outcomes.

Description of implementation logistics

In order to implement the proposed change, there are a few logistics involved. Some of these logistics concern with the time of implementation, the activities involved, as well as issues to do with the actual implementation process. Stahl (2004) asserts that any change implementation is likely to suffer from a number of resistances. The implementation of the proposed change will require a careful approach to avoid resistance, as such may make the implementation process unsuccessful.

For this reason, an implementation committee will be formed to be in charge of all the implementation process including passage of information to staff and organization’s management. For purposes of effectiveness, the implementation committee will comprise of members from all the units in the organization. Such a combination aims to counter any form of resistance that may come up during the implementation process. Since the proposed change will affect all members of staff, it is necessary that they get all the necessary facts about the change. Such facts can include the reasons for implementing the change, as well as how significance the change is to the general working condition of all staff and patients. For this reason, the implementation committee will select a few members of staff who will educate the rest of the staff members and top management of the proposed change and its importance. Since, it is hard to reach all the staff at the same time, the committee will seek permission from all departments in order to make sure that all staff members are contacted.

Resources available for implementation

Any process of change management in an organization is made successful or unsuccessful due to the availability or absence of the necessary resources for implementation. If one considers the implementation of the mandated ratios, it is evident that several resources will be necessary. For instance, the following are some of the resources that are available for the implementation of the mandated ratios in the hospitals.

Staff: The availability of staff members is a crucial thing since they are necessary for offering the necessary support during the implementation process, as well as ensuring its success afterward.

Educational materials: carrying out staff education can never be successful without the incorporation of educational materials. The implementation committee will make use of materials such as flyers, stickers, Ad Campaign, and presentations to educate the staff members.

Assessment tools: it is necessary to carry out an assessment to establish whether the proposed change is required within the institution, as well as measure its success after it has been implemented. Some of the available assessment tools include surveys, questionnaires, and pre-and-post tests. All these tools will be used to establish how knowledgeable the participants are, both at the baseline and after the intervention.

Technology: there has been continued advancement in technology within the nursing sector. Such improvement allows the incorporation of advanced devices in nursing, as well as the use of software. Such technology will be applied in the implementation and operation of the proposed change.

Funds: the process of lobbying for the change, its implementation, and operation will require many finances. The funds will be necessary for educating the staff, printing of educational materials, and for the collection and analysis of data during the implementation process and after the change has been implemented. The implementation committee will lobby for funds to cater for all expense during and after implementation of the proposed change.


From the above, it suffices that poor working conditions for nurses is a significant contributor to poor patients’ outcomes. However, with a clear plan on the number of hours and patients that a given nurse should attend to, such a problem can be eliminated.

References List

Malloch, K. & Porter-O’Grady, T. (2006). Introduction to evidence-based practice in nursing and health care. Sudbury, Mass.: Jones and Bartlett.

Stahl, M. (2004). Encyclopedia of health care management. Thousand Oaks, Calif.: Sage Publications.

Taylor, C. (2010). Nurse satisfaction in relation to mandated nurse to patient ratios. Rockville, MD: Academic Press.

Wells, S. & Wilson, T. (2009). A comparison of the nursing costs associated with the implementation of the mandated nurse-to-patient ratios in California. New York, NY: Springer Publishing Company.

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ApeGrade. 2022. "Nursing Practice: Developing an Implementation Plan." April 18, 2022. https://apegrade.com/nursing-practice-developing-an-implementation-plan/.


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