Week 7 Discussion Board
Discuss the following:
1. The oncology inpatient unit has experienced a great amount of nursing staff turnover. In the last 6 months, five of the 22 permanent RN staff have left. In addition, the number of medication errors for the unit has risen from an average of two per month to a high of 11 errors last month.
• How could you calculate whether there is a significant relationship between staffing and medication safety issues? (Chapter 9 #3)
You complete the calculation of the Pearson product-moment correlation coefficient to determine the relationship of the number of temporary RNs to the number of medication errors. Remember that correlation does not indicate cause and effect, but only that there is a quantifiable, directional relationship between these two variables. The calculated result is r = +0.47.
• How would you explain this result to your chief financial officer (CFO) to request additional money to hire more permanent staff RNs? (Chapter 9 #4)
2. You are the chief nursing executive for a small rural clinic that provides contraception services to low-income individuals. An insurer, providing care under the Affordable Care Act (ACA), has rejected paying the claims, stating that they are a not-for-profit religious organization and are not obliged to cover these services. You check your records and find that nonpayment for contraception places a significant financial burden on the clinic. These individuals do not have access to any other health care services in the region. (Chapter 10 #3)
• What are your first, second, and third actions according to priority?
• How do you justify this action based on legal and ethical guidelines?
Reference:
Waxman, K. T. (2018). Financial and business management for the Doctor of nursing practice. 2nd ed. Springer Publishing Company.
Discussion Board Initial Posting Rubric
Criteria Ratings Pts
This criterion is linked to a Learning OutcomeRelevance to the topic or problem 20 pts
Exemplary
18-20 points. The posting directly addresses key issues, questions, or problems related to the text and the discussion activity. The posting applies course concepts well, connecting them to the actual activity. 17 pts
Satisfactory
15-17 points. The posting addresses key issues, questions or problems related to the text and the discussion activity, but in some cases only indirectly or obliquely. It does not always apply course concepts fully. 0 pts
Unsatisfactory
0-14 points. The posting does not directly address the question or problem posted by the discussion activity.
20 pts
This criterion is linked to a Learning OutcomeInsight and application of course concepts 40 pts
Exemplary
37-40 points. The posting offers original or thoughtful insight, analysis, or observation that demonstrates a strong grasp of concepts and ideas pertaining to the discussion topic. 36 pts
Satisfactory
30-36 points. The posting does offer some insight, analysis, or observation related to the topic, but may not demonstrate a full understanding or knowledge of concepts and ideas pertaining to the discussion topic. 0 pts
Unsatisfactory
0-29 points. The posting does not offer any significant insight, analysis or observation related to the topic. No knowledge or understanding is demonstrated regarding concepts and ideas pertaining to the discussion topic.
40 pts
This criterion is linked to a Learning OutcomeUse of evidence and support 25 pts
Exemplary
23-25 points. The posting supports all claims and opinions with either rational argument or evidence. Evidence is documented with appropriate citations. 22 pts
Satisfactory
19-22 points. The posting generally supports claims and opinions with evidence or argument, but may leave some gaps where unsupported opinions still appear. 0 pts
Unsatisfactory
0-18 points. The posting does not support its claims with either evidence or argument. The posting contains largely unsupported opinion.
25 pts
This criterion is linked to a Learning OutcomeGrammar, Punctuation & APA 15 pts
Exemplary
14-15 points. The posting has less than 3 errors in grammar, Punctuation, and/or APA. 13 pts
Satisfactory
11-13 points. The posting has 3-5 errors in Grammar, Punctuation, and/or APA. 0 pts
Unsatisfactory
0-10 points. The posting has more than 5 errors in Grammar, Punctuation, and/or APA.
15 pts
Total Points: 100
Week 7 Discussion: DNPs on Research and Ethics
Question One
- Calculation of Significant Relationship
Nurse practitioners undertaking their Doctor of Nursing Practice (DNP) programs should be able to collect relevant data to guide decision-making in clinical practice. To be able to obtain relevant information from the collected data, DNP nurses must first analyze the collected data, either quantitatively or qualitatively, before interpreting it (Waxman, 2018). In the given scenario, the oncology department has recorded an increase in the rate of medication errors in the past month following a great amount of nursing staff turnover. In order to calculate whether there is a significant relationship between medication safety issues and nurse staffing, the DNP nurse should conduct a retrospective longitudinal study. A longitudinal study is a type of correlational research involving a backward observation of variables over a certain period of time like weeks, months, or years, depending on the nature of the problem (Musy et al., 2021). It is an appropriate design for understanding the relationship of variables like those presented in the given scenario. Using the approach, the DNP nurses will be able to study how changes in the number of nurses, (from the time they started to leave the organization to date), have affected the number of medication errors in the facility (Musy et al., 2021). When using this approach, the nurse practitioner should choose a significance level that will be used to interpret whether there is a significant relationship between staffing and medication safety issues. In most statistical studies, the confidence level is set at 95% with the level of significance being tested at p-values of < 0.05 (Waxman, 2018). Values that fall below 0.05 are considered to be statistically significant.
- Interpretation of Statistical Results
The DNP nurse can also calculate a Pearson product-moment correlation coefficient to determine the relationship of the number of temporary RNs to the number of medication errors. An r value of +0.47 shows that there is a directional relationship between the number of nurses and the rates of medication errors (Schober et al., 2018). When explaining these results to the chief financial officer (CFO) to request additional money to hire more permanent staff RNs, the nurse should help the CFO to understand that there is a slightly linear positive correlation between changes in nurse staffing and medication errors. Precisely, rates of medication errors increase as the number of nurse decrease. Therefore, it is highly imperative that additional funds be provided to hire more permanent staff RNs.
Question Two
DNP nurses should take legally and ethically-appropriate actions when making decisions regarding issues that are affecting their organizations. In the given scenario, an insurer, providing care under the Affordable Care Act (ACA), has rejected paying the claims, stating that they are a not-for-profit religious organization and are not obliged to cover these services. There is an existing law in the United States exempting organizations or insurers with moral or religious objections from providing insurance coverage of contraception services (The Commonwealth Fund, 2020). The best actions to take in the order of importance include; (1) convincing the insurer to pay insurance claims, (2) looking for an alternative source of funds to address the financial burden caused by the non-payment for contraception, or (3) developing guidelines based on private insurance to be followed in the future when proving contraception services. These actions are justified based on ethical and legal guidelines (Waxman, 2018). They are legal in that they follow the law and are ethical in that they increase healthcare access for low-income individuals who need contraception services.
References
Musy, S. N., Endrich, O., Leichtle, A. B., Griffiths, P., Nakas, C. T., & Simon, M. (2021). The association between nurse staffing and inpatient mortality: A shift-level retrospective longitudinal study. International Journal of Nursing Studies, 120, 103950. doi: 10.1016/j.ijnurstu.2021.103950. Epub 2021 Apr 25. PMID: 34087527.
Schober, P., Boer, C., & Schwarte, L. A. (2018). Correlation coefficients: appropriate use and interpretation. Anesthesia and Analgesia, 126(5):1763-1768. doi: 10.1213/ANE.0000000000002864. PMID: 29481436.
The Commonwealth Fund. (2020). Supreme court excuses organizations with religious or moral objections from covering workers’ birth control. https://www.commonwealthfund.org/blog/2020/supreme-court-excuses-organizations-religious-or-moral-objections-covering-workers-birth
Waxman, K. T. (2018). Financial and business management for the Doctor of nursing practice. 2nd ed. Springer Publishing Company.