Joanne is a newly graduated nurse working on a general medical floor in a large urban teaching hospital. She is typically assigned between four and six patients during her shift depending on the acuity mix. Many of her patients are direct admit patients or are transferred from the emergency department. Joanne has recently noticed a significant delay on weekend shifts with room turnover and new patient admittance.

Joanne voiced her concerns regarding the delays to her unit manager. Her manager agreed that room turnover delays on the weekend have significantly increased in recent months. She reported that she will investigate the delays further. A few weeks pass and Joanne’s manager reports back that there have been staff reductions in the organization’s environmental services staff on the weekend shifts. As a result, room cleaning has been delayed significantly. Joanne’s manager has voiced her concerns regarding the delays, but administration has been reluctant to hire additional staff. Joanne and her manager both feel strongly that investment in staff is needed.

Reflective Questions

1. What strategies might Joanne and her manager utilize to reflect the significance of these staff shortages?
2. How might they gather and present information to demonstrate the need for additional environmental services personnel?
3. What stakeholders would be important to engage in this discussion?
4. Create a PICOT question for this scenario.

When considering the impact of care delays in a health care organization, it is important to gather data to substantiate the significance of delayed care. Joanne and her manager might begin to look at organizational throughput or transfer data to determine how long patients are being held in emergency rooms or other settings during the weekend shifts compared to weekday shifts. Additionally, it would be important for the organization to determine if these delayed admits impeded the ability of the emergency department to accept patients and if the organization was subsequently placed on patient divert due to an inability to care for patients in the emergency room setting. Engaging house supervisors, charge nurses, informatics specialists, etc., may be helpful in determining the significance of the delay and potential quality implications. An example PICOT question to help examine this scenario may be structured as: What is the impact of one additional environmental services FTE compared to existing staffing patterns on organizational throughput times over a three-month period?