• Patients receiving less attention

• Patients receiving less attention

Increased pressure on existing staff to cover and pick up the extra work often leading to burnout

• Patients receiving less attention

• Pressure on current staff to train and then gel with the new employees

• Lack and lag of knowledge with new employees concerning institutional practices, workplace norms, team behaviors, and patient knowledge, familiarity, and care experience

Clinical aspect – unit cohesiveness/patient care

Many nurses leave their positions because of negative experiences with heavy or unrealistic workloads and due to feeling unheard and undervalued. Clinical nurses’ sense of disempowerment can be related to lack of leadership interventions. Clinical nurses may feel that managers are insensitive to their staffing needs, don’t support employee well-being, and don’t invest enough in staff education or clinical advancement according to Linnen and Rowley (February 2014).

Proposal direct impact – nurses will see themselves as stewards for their unit. “Nurses are leaders by virtue of their responsibilities; for them, empowerment isn’t a privilege, but a professional necessity” (Linnen and Rowley, 2014).

Proposal indirect impact –

– Nurse advancement

– Staff participation in policy and governance

– Leadership support

– Adequate staff and resources

– Nurse/physician relations

Comment 2

My mentor is a wound care nurse and my proposal is about quality improvement and how it affects pressure ulcers. After discussing with my mentor, we discussed that a financial aspect for developing an evidence-based practice project would be a reduction in billing for treatment, such as special ointments, creams, and dressings that are billed to the patient, patient’s payer source, and facility. A quality aspect would be an improvement of the quality of care. Evidence-based practice would prevent the development of pressure ulcers and/or improve the healing of current pressure ulcers. A clinical care aspect would be understanding who the target population is and what type of facility they are in.

My proposal would directly impact all of these aspects because treating these types of wounds can be very costly to not only the patient or patient’s payer, but also the facility. The facility usually has a house supply of basic dressings and wound care supplies, such as calcium alginate with and without silver, different types of dressings, collagen, etc. Over time, this can become very costly because dressing changes need to be done on a daily basis and as needed. To improve healing and prevent wound development, evidence-based studies have proven that turning patients at least every two and keeping them clean and dry significantly decreases the development of pressure ulcers. The use of preventive materials (types of mattresses, positioning devices, etc.), characteristics of the residents (personal preference of preventive materials, presence of existing ulcers, and positioning), protocols based on four themes (observation of the skin, frequency of repositioning and postures, use of support surfaces, and elevation of heels also helps as well (Beeckman, Clays, Van Hecke, et al., 2013).