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Gillian Scott, Case Study Example
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Gillian Scott is an experienced nurse on a medical/surgical floor at a community hospital. She arrives at 6:45 PM for her 12-hour night shift concerned about the impending blizzard that is forecasted to bring 2-3 feet of snow and damaging winds during the next 12-18 hours. At 9:00 PM several nurses begin to ask Gillian if she is going to contact the nursing supervisor to seek strategies to ameliorate probable staffing shortages in the morning in order to secure safe patient care.
When is the optimal time to secure a contingency plan to address potential issues with safe patient care due to the storm?
An effective contingency plan is one that is developed 24-48 hours before an emergency event (Veenema, 2013). Gillian Scott is in an unfortunate situation because at the beginning of her shift at 6:45 P.M., which is forecasted to hit peak intensity in 12-18 hours, she is unable to account for many of the factors that would prevent staffing shortages and discontinuity in patient care. As a consequence, a contingency plan that is made 12 hours prior to a potential disaster isn’t an optimal situation, although it does allow enough time for quick decisions and procedures to be enacted. The longest that the nursing staff should wait before developing a contingency plan is 8 hours prior to the storm. However, it is necessary to emphasize that in this situation, 8 hours prior to the storm is the middle of the night, and the hospital may not be able to contact a majority of the staff to inform them of the plan. Therefore, in this particular case, 12 hours prior to the storm is the most acceptable time to develop the contingency plan.
What are the potential challenges?
In this situation, the main challenge is that the contingency plan is being developed late at night. After 5 P.M., many hospitals typically have a smaller amount of staff than they would during normal business hours in order to keep costs down (Beresford, 2008). As a consequence, Gillian Scott and the other nurses on duty must find a way to balance their regular responsibilities to their patients while determining how to ensure that patient care is not diminished as a consequence of the storm. In addition, it is essential for all of the nurses to cooperate and determine the best possible way to handle the patients during the storm. Since there are fewer nurses staffed at this hour, the plan that is developed is least likely to be representative of the entire nursing staff.
Another consideration that should be made is that patient load may be increased as a consequence of the storm due to weather related accidents. Furthermore, an assumption of snow storms is that it takes a longer time for the ambulance and emergency medical technician to reach a patient. As a consequence, the nursing staff and physicians need to see the patients immediately upon their arrival to the hospital to make up for the time lost during travel. One of the only ways to account for increased patient load and decreased patient wait time is to ensure that the hospital is adequately staffed (University Hospitals Birmingham, 2010). This required ensuring that the healthcare team scheduled to work the shifts that occur during the time in which the snow storm is expected to occur to arrive at the hospital early, preferably before the storm begins. In addition, the nursing supervisor should reach out to members of the nursing staff that were not scheduled to work to call them in as well. It is unlikely that all of the staff members that were scheduled for work will be able to come in even after generating this plan, but this method will ensure that there are enough healthcare professionals available for the hospital to be functional.
Another challenge of this situation relates to the time at which the contingency plan is being developed. Since Gillian Scott recognized the potential problems that the snow storm could bring at 6:45 P.M., it may be difficult to contact many of the nurses about the contingency plan and to inform them that they should report to work. By the time that Gillian Scott is able to speak to the nursing supervisor and have a conversation about what should be done, it will be 8 or 9 P.M. At this time, many members of the healthcare staff may be sleeping or otherwise occupied. Therefore, it is important to make repeat phone calls to ensure that everyone gets the message.
Who should be involved in the development of the plan?
The entire nursing staff should be involved in the development of the plan, although it will not be easy to have the whole team meet to develop the plan at once. Therefore, it should be done in shifts, led by the nursing supervisor and Gillian Scott. Half of the nursing staff on duty should be asked to remain with the patients while the other half will be asked to discuss reasonable options for a contingency plan. After the discussion is complete with this group, they will be asked to return to work and the other half of the nursing staff will be questioned. The nursing supervisor and Gillian Scott will note the most popular opinions, which will be enacted as a part of the contingency plan if the nursing supervisor and Gillian Scott agree that the plans are helpful and necessary. Although the entire nursing staff will be allowed an opinion, Gillian Scott and the nursing supervisor will be allowed to make the final decision due to their authority and experience in emergency situations.
When should the contingency plan be implemented?
The latest that the contingency plan should be implemented is at 10:00 P.M., the night before the storm. This will ensure that the nursing staff has adequate time to develop a contingency plan and to determine whether their proposals are reasonable and helpful. However, even though it is important to develop an effective plan, it must be developed before off-duty members of the nursing staff become impossible to contact. As a consequence, the nursing staff and reception should begin making calls regarding staffing and altered arrival time at 10:00 P.M. Since the snow storm is expected to begin at 6:45 A.M., the nursing staff will be expected to begin their shifts at 5 A.M. to ensure that they arrive safely. At all times between 10:00 PM and 5 A.M., the hospital should be making preparations to ensure that patients are responded to quickly. This includes preparing the EMT staff and ambulance drivers for the conditions they will face.
How will leaders evaluate the effectiveness of the plan?
To evaluate the effectiveness of this plan, it is essential to keep track of EMT response time in addition to how quick the patient is seen after they enter the hospital and how long the treatment takes. If the total time it takes for the patient to reach the hospital and receive treatment is comparable to the time it takes when there is no snow storm, then the contingency plan can be deemed effective. If this is not the case, it will be necessary to increase emergency staffing by creating a contingency plan further from the start of the snow storm in future emergencies. Furthermore, the leadership team should ask for nurse feedback concerning the contingency plan in order to gain a full understanding of where the staff believed the plan was lacking or was strong (Wagner, n.d.).
How will the nursing team evaluate the effectiveness of the leadership team in assessing, planning, implementing, and evaluating a plan to provide patient care during the emergency?
While the leadership is necessary to develop and implement the final contingency plan, it is essential for the nursing team to provide feedback in order to assist the development of effective plans in the future. The first component of this experience that the nursing team should review is the effectiveness of developing the contingency plan using the whole nursing staff. While it is effective to get an opinion from the whole staff, it is essential to determine whether this was worth the time it took and whether the opinions of the staff were actually enacted in the creation of the plan. To determine this, the nursing staff should either meet or issue a survey in which they gather all opinions on this topic. Next, the implementation of the plan should be reviewed to determine whether they believe the manner in which the plan was carried out was effective or not. This includes an evaluation of whether calls to the off-duty nursing staff were made in the most time efficient manner and whether repeat attempts were made to reach non-responders. Furthermore, this review includes a delegation of responsibility to various staff members and whether these jobs were assigned in a manner that is maximally effective. Lastly, the plan to provide patient care during the emergency should be evaluated on the basis of the number of patients seen compared to those seen on a regular day, response time, the availability of nurses per patient compared to regular staffing numbers, and the ability to correctly diagnose and treat patients.
References
Beresford L. (2008). Weekend Effect Persists. The Hospitalist. Retrieved from http://www.the-hospitalist.org/details/article/186014/Weekend_Effect_Persists.html
University Hospitals Birmingham. (2010). Inclement Weather Plan. Retrieved from http://www.uhb.nhs.uk/Downloads/pdf/InclementWeatherPlan.pdf
Veenema TG. (2013). Disaster Nursing and Emergency Preparedness. New York: Springer Publishing Company.
Wagner N. (n.d.). A Disaster Plan for Nursing Homes. Chron. Retrieved from http://smallbusiness.chron.com/disaster-plan-nursing-homes-71145.html
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