Introduction
Policy implementation in the healthcare administration system is critical to ensuring commitment to providing patients with the best services in a health facility. More precisely, the nursing profession requires proper monitoring since nurses interact more with patients than any other professional in healthcare services (Fjørtoft et al., 2020). As such, an effective policy becomes necessary to mitigate potential cases of negligence and laxity at work, which may result in catastrophic outcomes for critically ill patients.
A policy document may be locally adopted within a particular facility or region or a national policy encompassing an entire country. The primary purpose of the nursing policy is to provide relevant guidelines for nursing care and ensure strict adherence to professional performance expectations (Fjørtoft et al., 2020). It indicates the standard procedures that nurses must follow when dealing with different medical cases at any given time. As a result, the chances of erroneous nursing care provision become minimal.
Most of the standards in a nursing policy draw from a standardized code of conduct and professional guidelines. In the USA, nursing policy has been based on the 3rd edition of the American Nurses Association (ANA) Scope and Standards of Practice (Chan et al., 2021). Whereas the local nursing policy covers almost every aspect of care provision by nurses, there are several areas where it can be improved to ensure more efficiency and minimize errors in treatment. In particular, the policy comprehensively talks about the requirements of nurses in all stages of treatment, providing directions in different scenarios.
However, under the patient assessment guidelines, the nurse must complete the physical assessment within four hours of admission and four hours of beginning a new shift. At the same time, the policy requires that vital signs must be obtained within 30 minutes of admission and monitored in not more than 8-hour intervals after that (Biggins et al., 2021). These guidelines may raise controversy regarding the entire assessment process, leading to misreporting and possibly incorrect medication. Therefore, the policy needs revision to allow for a procedural assessment that covers patient details comprehensively at the earliest possible time.
Assessment Stages
Patient assessment is a complex process that requires an empathetic approach to the patient to avoid missing key details. Furthermore, it is essential to note that patient assessment can be categorized into four areas, each requiring the participation of different stakeholders to ensure proper healthcare. Beginning with the triage and the initial assessment, the nurse engages the patient to understand the nature and origin of the illness or problem (Lee & Kim, 2022). This stage gathers primary information about the patient to use during the subsequent focused assessment stage. At this stage, the patient’s data is analyzed to try to identify the existing problem.
At the next stage, called time-lapsed assessment, more details about the patient are analyzed if the second assessment stage was unsuccessful (DeNisco, 2019). At this stage, the nurse may send patient samples for detailed laboratory tests to identify the existing problem. Finally, a treatment scenario may require emergency assessment where the patient is presented with high-risk and possibly life-threatening conditions. Such injuries may include physical injuries like concussions and internal bleeding.
Stakeholders Involved
During the assessment stage, key stakeholders include patients, caregivers, doctors/nurses, guardians, insurance companies, and government agencies. Patients are often the primary focus of any medical assessment (Lee & Kim, 2022). They present themselves at the healthcare facility seeking medical attention.
When the patients cannot present themselves at the facility, caregivers and guardians become the other party of interest during the treatment process. These individuals become responsible for the patients and are resourceful when nurses obtain patient information. They answer all patient questions, helping nurses gather accurate information during assessments.
Medical practitioners, including doctors and nurses, play a key role during assessment and treatment. According to DeNisco (2019), nurses have been key players in patient care, providing care to vulnerable populations in both rural and urban areas since the 1960s. They accompany the patient from admission to recovery and discharge from a healthcare facility. Employers are also vital stakeholders who need to be notified about the patient’s condition, especially if it is serious. However, this group becomes relevant when the patient is unable to act on their own behalf.
Another vital stakeholder group during the patient assessment is the insurance companies. The information about a patient’s insurance is vital for the clearance of medical bills that may accrue (Qin et al., 2023). Nevertheless, this information should not be a priority before addressing the patient’s condition.
Finally, the government is also a vital stakeholder in medical assessment. However, most cases do not require government involvement in a patient’s data. However, some instances require immediate reporting to authorities for advanced attention. Such cases include physical assault, gunshot injuries, and medical issues that may raise security concerns.
Use of Human Mortality Database (HMD)
The Human Mortality Database (HMD) is a leading scientific data resource that provides detailed and harmonized mortality and population estimates for developed countries. For nursing policy, the HMD offers essential data on life expectancy, age-specific mortality rates, and historical mortality trends. Those are vital in policy development.
Additionally, it provides a comparative analysis among developed nations and details the impact of healthcare interventions. These valuable insights aid nursing policymakers in understanding health patterns, making evidence-based decisions, and improving healthcare delivery and population health outcomes. According to HMD, there were 39506 infant deaths in USA between 2020 and 2021 (Human mortality database, n.d.). This information is vital to developing nursing policies that would reduce the number in future.
Policy Options/ Viable Alternatives
Revising the provisions of the nursing policy on patient assessment would be a vital process to ensure efficiency in patient management (Jarva et al., 2022). The policy requires a nurse to conduct a focused assessment of the chief complaint within 30 minutes of admission. While this time is okay for most conditions, it is important to note that some patients require immediate assessment in emergency cases. The policy also directs nurses to obtain vital signs like temperature, heart rate, breathing rate, blood pressure, and pulse oximetry within the first thirty minutes of patient admission. Likewise, this provision is okay since the timeframe provided can be considered urgent.
Nevertheless, the policy should limit this time to a lower limit in emergencies. It would be better to indicate the different response speeds for different classes of conditions. Additionally, the policy requires that nurses identify admission history within 24 hours. Sometimes, a patient’s admission history may be vital in determining the right treatment procedure. This information reveals vaccinations and the current medication used for a particular patient.
Obtaining this information also helps to ascertain whether the patient is allergic to some medicines. Moreover, it is also a perfect way to determine the medicine to administer to the patient, guided by previous or current medications. Therefore, a patient’s admission and treatment history should be a priority piece of information obtained as soon as the patient is admitted.
Furthermore, according to the nursing policy document, a physical assessment should be completed within four hours of admission and four hours of the start of each shift. This timeframe may induce laxity among healthcare providers, especially nurses. Instead, while this time may work perfectly for most conditions, it needs to be revised to promote speedy test completion and reporting.
Notably, the policy indicates that the nurse has sixty minutes to report critical results from lab analyses to the licensed practitioner (LP). Again, this time allocation for critical lab results is unnecessarily long and may result in the escalation of a condition that could have been controlled (Jarva et al., 2022). This situation implies that a nurse would not be liable even in a catastrophic event if they received the results and held them for 59 minutes before reporting them. This part needs an amendment to indicate that a nurse should report such findings as soon as they are released from the lab. Overall, reviewing these sections of the nursing policy would improve the general handling of a patient’s condition and facilitate speedy treatment.
The Role of APRNs in Promoting Change to the Policy
As the primary stakeholders in healthcare provision, advanced practice registered nurses (APRNs) play a central role in ensuring the smooth operation of a healthcare facility (DeNisco, 2019). Fundamentally, they are responsible for caring for patients around the clock, even without LPs. Therefore, their importance cannot be overstated.
One of the key roles of nurses in ensuring the transformation of nursing policy is embracing a positive mindset that compels them to act with urgency. In so doing, the nurses would attend to patient care more promptly, regardless of the maximum allowed time by the policy. In particular, they can be keen to identify critical patients who need urgent attention from assessment to treatment or management of the existing condition.
Working collaboratively would also go a long way to save much of the lost time when a particular nurse has to attend to several patients in different departments. Proper division of labor among the available nurses would ease the burden of congestion and time wastage during patient assessment and healthcare provision. Such collaboration goes hand-in-hand with effective communication across different healthcare departments and professions within a facility.
Influencing Factors for Policy Change
Effective implementation of policy changes in nursing faces a considerable challenge due to various factors affecting the entire health sector (Iwu et al., 2021). Firstly, reducing the time allowed to assess and report a patient’s condition would require additional staff in the nursing profession. This move implies an additional budgetary requirement for recruiting and remunerating these individuals, which may be burdensome for the governments. Moreover, it may take a long time for the nurses to acclimate to new regulation recommendations, resulting in a backslide to the original situation.
Nevertheless, reducing the patient-nurse ratio would effectively ensure prompt healthcare provision in the long run. Government regulations on the nursing profession may also affect the rate at which the recommended changes are implemented. In particular, local authorities should enact policies that promote an upward development of the nursing profession to ensure a sufficient supply in every hospital.
Likewise, there are several socioeconomic factors whose impact on policy changes remains significant. The level of education is one key element affecting policy changes in nursing care. Whereas a patient’s education does not affect the quality of service, having the best-educated nurses on the job would facilitate effective policy changes when necessary. Similarly, employment and income affect most individuals’ social welfare. It also extends to healthcare expectations, where good income and stable employment facilitate the implementation of policies that enhance better nursing care to patients.
Conclusion
The nursing policy is an effective tool for governing how nurses attend to patients. It helps in saving time consumed by patient admission and condition assessment and promotes better healthcare outcomes. Nevertheless, a closer review of the policy’s guidelines on time for assessment and report submission to LPs may indicate possible areas for improvement.
While there is nothing wrong with the allowed timeframes, it is vital to note that some conditions may be more critical, requiring urgent attention than the time indicated in the policy. Therefore, the document needs to provide a clear guideline to nurses on how to respond to urgent emergencies rather than rely on the indicated number of hours for virtually every condition. Consequently, the healthcare system would improve and help save many lives lost due to nurses’ laxity.
References
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