One major safety concern of a unit I worked on in my clinicals was the prevalence of falls. Falls are the most common cause of nonfatal injuries in patients older than 65 (Currie, L., 2008). Due to large patient-to-nurse ratios, the nurses and the techs on the floor were unable to get all of their tasks done and also help with ambulating patients to the restroom and/or helping them do whatever it is they were trying to do when they got up from the bed and fell. With patients being left to wait for assistance and wait so long they feel as though they are on their own – this is when people are injured more severely due to falls.
As a leader in this unit, I would first investigate the causes of the increased fall rate. As the staff had mentioned, the staffing to patient ratios was a large part of the increase in falls. In this case, I would implement – as best as I could – a lower patient ratio to better allow nurses to keep tabs on their patients’ needs. If the patient ratio wasnt a variable factor, I would do my best to assign patients to nurses in a way that is evenly distributing the workload. For example, if one nurse was given four patients and each was very complicated and had years of chronic illnesses that needed constant management and another nurse had four patients that were basically waiting on discharge papers and a taxi home, I would swap two of the higher maintenance patients with the lower maintenance patients in order for the workload to be more even. Outside of this, I would use the tried and true methods of fall prevention: screening tools and risk assessment usage, door/bed/patient fall-risk alerts, changes in environment and equipment modifications, safety education, and proactive toileting (Spoelstra, S., et. al, 2011). Confirmation is the fifth and final step of the theory, where the change is reinforced throughout the unit to ensure a seamless and long-term change. If the change in patient ratios and the added fall prevention methods work, then the change will be solidified throughout the unit. If not, then it is right back to the drawing board (Murray, 2017). If the change was implemented long-term, I would track the success of the change by monitoring the fall rates within the unit.
When dealing with nurses who have experienced adverse patient outcomes due to falls, I would look at the overall picture – figure out what contributed to the incident and work to fix those problems. I think most hospitals and nurse leaders understand that when a safety incident occurs, the nurse assigned to that patient ends up feeling a lot of guilt, and being immediately reprimanded and told they are to blame can be unfair. If I were the manager, I would try to reassure the nurse and look at the whole picture to find where the mistakes were made and how we could fix them. I believe transformational leadership would be the most helpful leadership theory to implement in this case – it allows for the creation of stronger relationships throughout the unit. It would be the best leadership theory to provide a motivated and cohesive unit to help change the unit for the better (Murray, E., 2017).