Fluent Essays

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 Complexity and Leadership Healthcare delivery within rural settings is considerably different from that in urban settings especially because of a wide range of challenges faced within community health centers and a higher percentage of a geriatric population in the countryside. Accordingly, there is a higher demand for critical care and patient-based care for those with chronic and acute conditions, albeit with lesser resources to handle the rural populations (Woo et al., 2017). Steelville is a rural town in Crawford County, Missouri that is characterized by a rural community health setting. Recently, the local community health clinic faced a challenge with two of the advanced nurse practitioners (ANPs) responsible for regular home health visits leaving the practice, leaving a staff shortage for the ANP leader to deal with. Three prominent facets of the staff shortage issue are imminent: ensuring continuity in the provision of quality care to the patients previously served by the ANPs, safeguarding patient safety with prompt response during emergencies such as limb-threatening or life-threatening situations especially for acute and chronic patients, and guaranteeing autonomy in service delivery for the home health visits. Therefore, the ANP leader needs to realign the community clinic’s resources to cover the gaps left by the departing nurse practitioners (NPs) while ensuring utmost patient safety and quality of care for the rural population served by the health center. The local community health clinic is faced with a similar challenge like most other healthcare centers across the United States, that is, staffing shortages. According to Woo et al. (2017), critical care physician shortage was predicted to grow by 22% in 2020, rising to 35% by 2030. Firstly, the APN leader at the clinic should utilize the advanced practice capabilities at his or her disposal, such as strategic planning/scheduling of home health visits, to enhance the effectiveness of workforce utilization to alleviate the challenges resulting from the current and possible future staff shortages. Such an approach is foundational towards ensuring cost-effective but high-quality service delivery through strategic cost containment measures, which is crucial particularly for the local geriatric population (Ozcan et al., 1995). Secondly, given the high ratio of NPs and ANPs to physicians, the ANP leader should adopt or push for policy adjustments that allow for greater autonomy in critical care and emergency situations, thereby permitting them to oversee various medical tasks that are traditionally conducted by physicians (Maier & Afentakis, 2013; Maier et al., 2016). The higher level of workforce utilization will help the APN leader fill in the staff shortages without any additional hiring and placement costs through better utilization of the current APNs’ clinical competencies, complex decision-making skills, and expertise in managing a wide range of chronic and acute conditions affecting the local population. The proposed solutions could have various impacts on the local healthcare setting. For example, while strategic planning of home health visits could improve patient outcomes significantly since patients receive care promptly and according to a specific schedule, the current workforce may become overworked and overwhelmed easily with the extra work, which ultimately affects the delivery of quality care (Woo et al., 2017). Additionally, APN autonomy might be a strategic management decision for the APN leader but some conditions still require the full attention of specialty physicians, meaning that the approach might not solve the staff shortage issue in the long-term. However, the APN leader could implement various leadership principles that are foundational in running and motivating small but effective teams. For instance, the nurse leader should possess advanced knowledge of the local healthcare delivery system, how to develop and maintain collaborative teams across and within disciplines, effective patient advocacy, a high level of ethical care approaches, and the tenets of safety and quality care improvement (Shalala et al., 2011). The adoption and implementation of these core leadership principles will be pivotal in maintaining a highly motivated APN and NP workforce at the community health clinic, thereby working as an effective short-term solution for the apparent staff shortages. Nurse leadership is a complex and multifaceted discipline that requires a high level of competency in various fields. Advance nurse practitioner and nurse practitioner shortages are increasingly becoming common in diverse healthcare settings, especially in rural areas with a higher geriatric population in need of constant quality care because of their chronic conditions and comorbidities. Therefore, APN leaders must adopt innovative mechanisms that effectively utilize the currently available workforces by leveraging on their competencies and improving the effectiveness of service delivery. Adopting such mechanisms will ensure better cost effectiveness and improvement of quality care delivery in the long-term within local community clinics and health centers.       References Maier, C. B., Barnes, H., Aiken, L. H., & Busse, R. (2016). Descriptive, cross-country analysis of the nurse practitioner workforce in six countries: Size, growth, physician substitution potential. BMJ Open, 6(9), 1-12. http://dx.doi.org/10.1136/bmjopen-2016-011901 Maier, T., & Afentakis, A. (2013). Forecasting supply and demand in nursing professions: Impacts of occupational flexibility and employment structure in Germany. Human Resources for Health, 11(1), 24-36. https://link.springer.com/content/pdf/10.1186/1478-4491-11-24.pdf Ozcan, S., Taranto, Y., & Hornby, P. (1995). Shaping the health future in Turkey: A new role for human resource planning. The International Journal of Health Planning and Management, 10(4), 305-319. https://doi.org/10.1002/hpm.4740100406 Shalala, D., Bolton, L. B., Bleich, M. R., Brennan, T., Campbell, R., & Devlin, L. (2011). The future of nursing: Leading change, advancing health. The National Academy Press. Woo, B. F. Y., Lee, J. X. Y., & San Tam, W. W. (2017). The impact of the advanced practice nursing role on quality of care, clinical outcomes, patient satisfaction, and cost in the emergency and critical care settings: a systematic review. Human Resources for Health, 15(1), 1-22. https://doi.org/10.1186/s12960-017-0237-9    Reply