Geneva Guadalupe is a new manager on the busiest medical and surgical unit in a tertiary hospital. There are 39 beds on 9 Tower, which has a high volume of diabetes patients. She is excited to improve the quality and outcomes on this unit. During her interview, she learned that under the previous leadership the quality was deteriorating, as reflected in Hospital Consumer Assessment of Healthcare Providers and Systems (HCHAPS) scores and absenteeism and turnover rates. It was costing the unit between $42,000 to $65,000 to replace a nurse.

While making rounds, Nurse Guadalupe observed complaints about missed nursing care from all shifts and decided to make staff accountable for ensuring that patient care is completed. She asked a CNL to monitor the types of patient care activities that were being omitted. After 1 week, the CNL stated that it was difficult to make that determination because everyone had a different opinion on which interventions were being omitted. Additionally, staffing was an issue. The manager’s initial response was, “What’s wrong with staffing? Why would you blame staffing for omitting patient care?”

In your own words:

1. What is your first approach to showing a link between missed nursing care and staffing?

2. What questions could you pose to frontline nurses to understand how their staffing experience related to missed care?

3. Whom will you engage institutionally to understand the issue fully? Why them?

4. Which data elements may be required to build a case for staffing and missed nursing care?

5. What ideas would you propose to the administration to reverse the financial effects and improve HCHAPS scores?