INITIAL QUESTION

Put yourself in the role of an advanced practice nurse leader working at a community health clinic in a rural setting. Two of the nurses assigned to home health visits have recently left the practice, resulting in an understaffed clinic office. As the advanced practice nurse leader in this office, it is your responsibility to ensure that patient care is not compromised during this staff shortage. As you answer the discussion questions for this week, select a rural setting in your state. Answer the questions as though you are working at the location you identify.

Discussion Questions

1. Briefly describe the rural area you have selected. Considering the scenario, identify negative outcomes related to quality of care and patient safety that could occur. What are the first three facets of this problem that you will need to address? Provide rationale for your decision.

2. Based on your findings from question one, consider the resources available to your selected area, including at the state and national level, and formulate potential solutions. Discuss two solutions that you feel would address the facets of the problem. Consider cost, feasibility, policy compliance, and other resources, including staff availability, specific to the rural area you have identified. Provide rationale for your decision.

3. Evaluate the potential impact of your proposed solutions on this healthcare setting. What leadership principles are necessary to create a positive outcome for change? Provide rationale for your decision.

RUBRIC

20 pts

Exceptional

One post written in response to fellow learners’ post and are each between 100-150 words. Response is substantive insightful and contain at least one reference.

STUDENT POST

The selected rural area with an understaffed clinic office is Immokalee, located in Collier County, Florida. Immokalee is an unincorporated city and census-designed with a population of around 24 thousand residents. Their annual income per capita is 12 thousand. The percentage below the poverty level is 37.9%, significantly below the national poverty level (Immokalee, Florida (Fl) Poverty Rate Data – Information About Poor and Low-Income Residents Living in This City, 2019). Therefore, the advanced practice nurse leader in this rural office must keep in mind that inadequate nurse staffing is linked to various negative implications such as missed or delayed care, adverse patients’ outcomes, poor patient experience, high nurse turnover rates, and increased cost of care (Gonzales et al., 2018).

Although the Bureau of Labor Statistics data has reported that in May 2015, the annual median wage for registered nurses was $67,490, The American Association of Colleges of Nursing has reported that new positions that have been created for registered nurses are not being filled (American Association of Colleges of Nursing 2013). Therefore, the practice leader must consider this gap when dealing with Home Health Nurses shortage to make home visits possible.

Horizontal violence, generational diversity, and healthy work environments are three facets of the nursing shortage to be addressed. Horizontal violence is one phenomenon that influences nurse retention and, thereby, the nursing shortage. Nurses that face horizontal violence have to decide between staying at that particular job or depart altogether (Armmer, 2017). Health care and nurse administrators must consider the significant construct of generational diversity as a potential contributing factor to horizontal violence. The perspective of generational diversity provides insight into decisions associated with the professional nurse’s intent to leave or not to leave. The nurse leader has to analyze the composition of the nursing staff: are they baby boomers, generation X, or Millenials? Each outcome from individual decisions made by each professional nurse will culminate in nurse retention or nursing shortage (Armmer, 2017). A healthy working environment, which is the third facet to be addressed, according to The American Association of Critical-Care Nurses (2013), has eight standards. These standards are authentic leadership, skilled communication, true collaboration, appropriate staffing, meaningful recognition, effective decision making, genuine teamwork, and physical and psychological safety. In contrast, unhealthy work environments are characterized by abusive behavior, disrespect, lack of trust, rigidity to change, poor communication, and weak leadership with no vision (Huddleston et al., 2016).

The first solution directly related to this particular rural clinical office situation is reaching out to a nursing school in Naples, 45 minutes away from Immokalee, and recruiting new nursing graduates, offering them competitive pay. In addition, educators and recruiters for nursing practice should accept/hire culturally diverse students/nurses to expand the ethnic diversity of the nursing workforce to meet the needs of culturally diverse clients (Condon et al., 2013).

Second, the clinic can emphasize funding and support for residents of Immokalee from rural backgrounds to get them enrolled into nursing programs with a work commitment of 2 years at the clinic after graduating from nursing school. By supporting nursing educational opportunities in underserved rural areas, the office clinic will produce nurses where they live and create a healthy future for these communities (Condon et al., 2013).

Many foundations provide financial resources to healthcare needed in Immokalee at the local level, such as the Field Museum and the Sarah Siddon Society. At the National level, there are grants from the U.S. Department of Health and Human Services. HRSA provides health care to geographically isolated and economically or medically vulnerable populations (HHS Grants, 2014). Immokalee is a community that meets all the qualifying requirements for such a financial grant.

The impact of such an intervention proposal will be a positive change, taking into consideration the empowerment of nursing staff, and will display a direct impact on this rural community. Not just it will support education, but will also employ the nurses who are resident of Immokalee.

Such empowerment and a sense of belonging will be vital for a positive outcome. By addressing intersecting characteristics of a nursing shortage, horizontal violence, generational diversity, and healthy work environment, the clinical leader will have an outcome with increased nurse retention, increased response to nurse recruitment efforts, and sustained quality of patient care (Condon et al., 2013).

References

American Association of Colleges of Nursing. 2013. Talking Points. Impact of the Economy on the Nursing Shortage. Washington: American Association of Colleges of Nursing.

Armmer, F. (2017). An inductive discussion of the interrelationships between nursing shortage, horizontal violence, generational diversity, and healthy work environments. Administrative Sciences, 7(4), 34. https://doi.org/10.3390/admsci7040034 (Links to an external site.)

Condon, V. M., Morgan, C., Miller, E. W., Mamier, I., Zimmerman, G. J., & Mazhar, W. (2013). A program to enhance recruitment and retention of disadvantaged and ethnically diverse baccalaureate nursing students. Journal of Transcultural Nursing, 24(4), 397–407. https://doi.org/10.1177/1043659613493437 (Links to an external site.)

Gonzalez, E. W., & R. Esperat, M. (2018). The clinical scholar role in doctoral advanced nursing practice. In Dnp role development for doctoral advanced nursing practice. Springer Publishing Company. https://doi.org/10.1891/9780826171740.0009 (Links to an external site.)

HHS grants. (2014, December 30). HHS.gov. https://www.hhs.gov/grants/grants/index.html (Links to an external site.)

Huddleston, Penny, and Jennifer Gray. 2016b. Describing Nurse Leaders’ and Direct Care Nurses’ Perceptions of a Healthy Work Environment in Acute Care Settings, Part 2. JONA 46: 462–67

Immokalee, Florida (fl) poverty rate data about poor and low-income residents living in this city. (2019). http://www.city-data.com/poverty/poverty-Immokalee-Florida.html (Links to an external site.)

Neill, J., & Taylor, K. (2008). Undergraduate nursing students‘ clinical experiences in rural and remote areas: Recruitment implications. Australian Journal of Rural Health, 10(5), 239–243. https://doi.org/10.1111/j.1440-1584.2002.tb00038.x (Links to an external site.)

Seo, S., & Spetz, J. (2013). Demand for temporary agency nurses and nursing shortages. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 50(3), 216–228. https://doi.org/10.1177/0046958013516583 (Links to an external site.)

U.S. Bureau of Labor Statistics. 2015a. Registered Nurses: Occupational Outlook Handbook. Work Environment. December 17. Available online: www.bls.gov/ooh/healthcare/registered-nurses.htm#tab-3 (accessed on 06 September 2021)