Developing an Implementation Plan A Policy for Partnership with Nursing

Developingan Implementation Plan: A Policy for Partnership with Nursing Schoolsto Lower the Nurse-Patient Ratio

Developingan Implementation Plan: A Policy for Partnership with Nursing Schoolsto Lower the Nurse-Patient Ratio

Ahigh nurse-patient ratio is an issue of concern to all stakeholdersin the health care industry. This is because it affected the image ofthe hospital and the wellbeing as well as the recovery of patients,especially those who have undergone surgery. This paper will discussthe process of implementing a project that will help the hospitalpartner with the nursing schools in order reduce the nurse-patientratio by providing nursing students with internships and employmentafter graduation. The project will help the hospital enhance thetreatment outcome, reduce mortality and morbidity, nurse turnover,and improve the satisfaction of patients as well as the registerednurses. The paper will discuss the method of obtaining an approval, adescription of the current problem, explain the proposed solution,rationale for the solution, evidence from literature review,implementation logistics, and resources required for a successfulimplementation.

Methodsof obtaining approval

Anyprojects that involve human subjects require the approval of theInstitutional Review Board, IRB. To this end a written proposalindicating the purse, the process, the possible outcome of thepresent project will be submitted to the hospitals IRB for approval.The main role is to ensure that the proposed project will not harmhuman beings and it complies with all ethical guidelines (Moon &ampMaung, 2009). In addition, the project will require a lot ofresources and the support from the top management. This will beachieved by making a formal application for approval from thehospital’s board of directors. Most importantly, the current bodyof nurses will be involved from the start to the end in order toacquire their support. Research has shown that resistance to changeamong employees result from the lack of participation in the designand the implementation stages, which make them feel that they are notpart of the project (Kamel, 2012). Registered nurses will rerequested to give their opinions, take part in the process ofdeveloping a training program, and review the success of the project.


Thenurse-patient ratio has been associated with a high rate of mortalityamong the hospitalized patients, a decline in treatment outcome, andclient satisfaction. A high nurse-patient ratio implies that thenumber of hospitalized patients exceeds the number of nurses who areavailable to administer to them. Consequently, nurses are overworked,which leads to their burnout, an increase in treatment errors, morechances of adverse events, and the mortality rate of hospitalizedpatients. The current situation of a high nurse-patient ratio can beattributed to a recent increase in the rate of nurse turnover,shortage of registered nurses in the labor market, and a deliberatedecision by the hospital to recruit additional nurses in order toavoid inflating the cost of delivering care to clients.

Proposedsolution: Reforming the HR policy to facilitate partnership with thenursing schools

Mostof the solutions that have been suggested may not fit in allsituations. However, establishing a stable relationship between thehealth care facility and the nursing schools guarantees a regularsupply of qualified nurses and reduce the cost of hiring. Accordingto Larkin (2015) health care facilities can partner with nursingschools in different ways, but the most common methods include theprovision of internship opportunities for the nursing students,staffing the nursing classes with qualified trainers, and providingscholarship loans and grants to nursing students. A partnership thatis established between a health care institution and the nursingschool is a mutually beneficial program. This is because the nursingschool gets the opportunity to enhance the skills of its studentsthrough a real life practice of the knowledge learned in class whilethe health care facility increases the number of staff per bed. Thehospital will then employ the most competent students aftergraduation. This will give the hospital a continuous supply ofcompetent nurses.

Rationalefor partnering with the nursing schools

Apartnership between the health care facilities and the nursing schoolcan address the issue of a high nurse-patient ratio in two ways.First, nursing students who are undertaking their internship in agiven health care facility increases the number of staff per bed,which helps to fulfill the objective of partnering with the nursingschools (Larkin, 2015). Although nursing students may not have equalskills to graduate nurses, their contribution to the nursing servicescan be maximized when they work under the instructions of registerednurses. A higher number of staff will increase patient satisfactionand treatment outcome, while reducing the mortality rate among thehospitalized patients. Secondly, a partnership that results in theaward of scholarship to students and the supply of experiencedtrainers to the nursing schools increases the recruitment of nursingstudents while motivating those who are already undertaking theirstudies to complete school and join the workforce (Larkin, 2015). The shortage of nurses is caused by the decline in the number ofstudents who are joining the nursing schools and an increase in thenumber of students who drop out or change the course before theygraduate. An internship will play a critical role in reversing thecurrent situation. The nursing student will increase the nurse percapita. Therefore, a partnership between the nursing school and thehealth care facility will offer both a long-term and a short-termsolution to the issue of a high nurse-patient ratio. This is becausenursing students will reduce the workload of the registered nurses,which is a short-term solution, while the most competent student willbe recruited after graduation, which is a long-term solution to theissue of a high nurse-patient ratio.

Evidencefrom a literature review

Mostof the previous studies have established a positive associationbetween a high nurse-patient ratio and poor quality of patientoutcome. In a literature review conducted by Shekelle (2013) all 15studies that were considered confirmed that patient outcome reduceswhen the nurse-patient ratio is high and improves when the ratio isreduced. A cross sectional study conducted in Netherland and Finlandrevealed a high nurse-patient ratio increase cases of adverse eventsamong the hospitalized patients (Hinno, Partanen &amp Julkunen,2011). Based on the findings of the two studies, it can be confirmedthat reducing the nurse-patient ratio is among the most viablesolution to a high rate of mortality among the hospitalized patientssince it will enhance patient safety, increase their satisfaction,and the overall treatment outcome. However, other studies haveconfirmed that most of the stakeholders in the health care sector areaware of the significance of the nurse-patient ratio, but they failto recruit more nurses with the objective of avoiding the high costthat is associated with the compensation of registered nurses(Garretson, 2004). This implies that the stakeholders should takeaccount of the cost implications of implementing a given solution. Byallowing the nursing students to assist the registered nurses througha hospital-college partnership, the hospital will increase the nurseper capita without increasing the salary expenditure. This willreduce burnout among the registered nurse, increase theirsatisfaction, reduce the treatment errors, and enhance the patientoutcome (Cimiotti, Aiken, Sloane &amp Wu, 2012).


Theproposed plan for partnering with the nearby nursing schools will belaunched in January 2016. Before then, the human resource managerwill identify and contact potential nurse schools to confirm theirwillingness to participate in the program. The human resource managerwill collaborate with the nurse leaders to determine the level ofeducation and the number of nursing students who can be accommodatedby the hospital at any academic year. A formal proposal will bewritten to the hospital’s director for approval before it is sentto selected colleges. The human resource manager will review thefeedback from the colleges to ensure that the desired number ofnursing students has been obtained. The human resource manager willthen collaborate with the nurse leaders to design a training programfor interns. This will equip them with basic skills that they need todeliver quality services to clients. Resources for the trainingprogram will be obtained from the departments of procurement and thedepartment of finance. Once the resources are acquired, the humanresource manager will invite students from selected colleges, wherethey will be trained for two weeks, and deployed to their respectiveplaces of work. The HR manager and the nurse leaders will oversee theimplementation of the program and review its success. This processwill be repeated every academic year.


Theprocess of implementing the entire program will require five types ofresource. First human resources (including the nurse leaders andregistered nurses) will be requested to offer training to the newinterns, oversee, and evaluate the program. Secondly, the trainingprogram will require training materials, including PowerPointPresentation. In terms of technology, laptop and PowerPointpresentation software will be procured. The fourth type of resourceis the survey tool that will be used to assess the satisfaction ofregistered nurses and treatment outcome before and after theimplementation process. Fifth, the procurement of the trainingmaterials and allowances for registered nurses who will train internswill be required.


Thehigh nurse-patient ratio has a negative impact to the nurses,patients, and the health care facility. The high nurse-patient ratiois caused by different factors, but the most common ones include adeliberate decision by the hospital administrators to reduce thenumber of nurses in order to control the cost of delivering healthcare. However, the high ratio in some hospitals results from the lackof registered nurses in the labor market. The high nurse-patientration has been associated with poor quality of treatment outcome, adecline in patient satisfaction, a high mortality rate among thehospitalized patients, and nurse burnout. The increase in thetreatment errors and a decline in the quality of care tarnish theimage of the hospital. Establishing a partnership between thehospital and the nursing schools can provide the health care facilitywith a reliable supply of interns and graduate nurses who arefamiliar with the operations of the hospital.


Cimiotti,P., Aiken, H., Sloane, M. &amp Wu, S. (2012). Nurse staffing,burnout, and health care-associated infection. AmericanJournal of Infection Control,40, 486-490.

Garretson,S. (2004). Nurse to patient ratios in American health care. NursingStandards,19, 14-37.

Hinno,S., Partanen, P. &amp Julkunen, V. (2011). Nursing activities, nursestaffing and adverse patient outcomes as perceived by hospitalnurses. Journalof Clinical Nursing,21, 1584-1593.

Kamel,B. (2012). Reasons for resistance to change in the national companyfor the distribution of electricity and gas. InternationalJournal of Management and Strategy,3 (5), 1-10.

Larkin,S. (2015). Solutions for the current nursing shortage. NursingCommunity.Retrieved November 14, 2015, from

Moon,R. &amp Maung, K. (2009). The history and role of institutionalreview boards. AMAJournal of Ethics,4, 311-321.

Shekelle,G. (2013). Nurse-patient ratios as a patient safety strategy. Annalsof Internal Medicine,158 (5), 404-409.