¶ … Mandatory Overtime Policies
Organizational Culture and Readiness Assessment
The results of the Organizational Culture and Readiness for System-Wide Integration of Evidence-Based Practice checklist, which summarizes the survey results, are discussed with regard to the readiness level of the organization, possible project barriers and facilitators, and plans for integrating with clinical inquiry.
The overarching characteristic of the state of readiness of this organization for system-wide integration of evidence-based practice is moderately encouraging, while still indicative of some concern regarding barriers to implementation success. The stakeholders in the organization are aware of the importance of evidence-based practice and they are fundamentally supportive. The organization provides resources to support the integration of evidence-based practice into the institution, however, the availability of skilled staff who can assist with the changes is limited (Battilana & Casciaro, 2012). Two related and high scoring items in the survey have to do with the availability of quality computers and electronic databases for nursing staff to search evidence-based research and the extent to which staff nurses are proficient in computer skills. Also high scoring items are responses to the questions about the extent of the knowledge and skills librarians have about evidence-based practice, and the extent to which librarians are used to search for evidence. And while the extent that advanced practice nurses are available to be mentors for staff regarding evidence-based practice, the survey respondents indicated that there is not a critical mass of nurses who have strong evidence-based practice knowledge & skills nor are there sufficient nurse researchers with doctoral level preparation available to assist in the generation of evidence (Battilana & Casciaro, 2012).
Battilana and Casciaro (2012) explored the impact that the type of organizational change has on the ability of change agents to introduce a new practice in an organization. The contingency theory of organizational change and the structure of networks are supported by the Battilana and Casciaro (2012). Interestingly, when there are breaks or holes in the networks of those who influence change, there seems to be a willingness to initiate bolder organizational change. Moreover, those gaps in the network appear to hinder the adoption of changes that are more similar to the status quo (Battilana and Casciaro, 2012). What this can mean to the use of resources within the organization is that perhaps the divergence across the stakeholders may support a bolder change initiative. Knowing this counter-intuitive finding from Battilana and Casciaro (2012) is a step toward integrating clinical inquiry into the organization, providing strategies that strengthen the organizations weaker areas.
Section B: Problem Description
Background
The practice of mandatory overtime is an issue for the workplace and for patient safety. The literature defines mandatory overtime as, "the practice of hospitals and health care institutions to maintain adequate numbers of staff nurses through forced overtime, usually with a total of twelve to sixteen hours worked, with as little as one hour's notice" ("AACN," 2001). Mandatory overtime is a regular practice and not one implemented in order to address unforeseen emergency situations. Accordingly, mandatory overtime policy does not permit nurses to refuse the additional required hours due to fatigue or out of concern for patient care ("AACN," 2001). Moreover, time that is identified as "on call" is not included in this mandatory overtime requirement unless it falls immediately before or after a scheduled shift and would cause a double shift situation ("AACN," 2001).
Stakeholders
The stakeholders who are involved in the mandatory overtime situation and the issues that result from its implementation include the following: Administrators, advanced practice nurses (APN), nursing staff, nurses with doctoral preparation and librarians to help with evidence-based practice inquiry, patients, and physicians.
PICOT
The theory driving this PICOT is that disallowing mandatory overtime in a hospital or health care institution will result in higher quality patient care, greater job satisfaction by nursing staff, and improvements in institutional reputations, which will translate into greater return on investment (ROI) (Bae, 2010, 2013). Understaffed hospitals are expected to explore strategies that directly and indirectly address the presumed need for mandatory overtime, such as determining how to recruit, hire, and retain more nurses (Trinkoff, et al., 2003). The ANA study, Nurse Staffing and Patient Outcomes in the Inpatient Hospital Setting (3/2000), tracks and reports on five adverse outcomes measures that are associated with staffing. When the patient to nurse staffing ratio is appropriate, the following outcomes can be mitigated: "Length of hospital stay, nosocomial pneumonia, postoperative infections, pressure ulcers, and nosocomial urinary tract infections" ("ANA," 2006).
The therapy / prevention PICOT is based on the belief that sufficient nurse staffing will result in more time being available for more thorough...
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