Organizational Systems and Quality Leadership

Nursing- sensitive indicators are tools used today in the nursing profession that determine the quality of care a patient receives and that provide guidelines for quality improvement initiatives (Hart et al, 2006, p.256). The indicators use is in acute care facilities where they give an insight on specific aspects of nursing care such as structure, process and outcomes. The process of developing these indicators involves identifying hospitals to work with during the activity, doing literature review, consulting with experts and coming up with data collection plans. Others include working with participating facilities to evaluate the feasibility of the data collection plan to use and do pilot studies, announcing a new indicator to participating hospitals, collecting data with the assistance of nurses in the participating hospitals, analyzing data and preparing quarterly reports.

Nursing – sensitive indicators as the name suggests are sensitive to the quality of patient care in a health facility. The following are some of the reasons why they are important; the indicators are empirically tested, they establish a collaborative relationship between hospitals and finally, they provide an avenue to engage nurses in quality-related activities and to educate consumers of nursing care. The indicators include the following outcomes, complications such as urinary tract infections, pressure ulcers, hospital acquired pneumonia and DVT, patient falls and surgical patient complications. The complications include pulmonary failure and metabolic derangement, length of patient hospital stay, restraint prevalence, incidence of failure to rescue which could potentially result in increased morbidity or mortality, patient satisfaction and nurse satisfaction and staffing.

In the case of Mr. J, an understanding of nursing-sensitive indicators can assist the nurses in identifying issues that interfere with his care. First, by understanding nursing-sensitive indicators specific for the hospital, MR. J and his daughter have an insight of patient care in the hospital and are better placed to monitor it thus helping the nurses in identifying shortcomings in their services. Nurses enlightened on nursing- sensitive indicators for the hospital can monitor patient care and easily zero-in on specific patient care services that are according to the indicators likely sources of failing patient care.

The number of falls per patient translates to redressing the number of nurse staff per patient or increasing the total time nursing hours per patient. Increasing staffing or allocating more nursing hours mean the patient receives extra direct care attention. Redress may need putting in place safety measures that prevent or rescue patient from falling, reduce serious injuries after fall as well as ensure suitable environment for the inpatient.

The increased rates of patients put on restraints indicate gives tangible facts for the number of caregivers to be assigned per patient as well the duration of their attention. This has implications on the productive hours allocated by each nurse if the hospital maintains the same number of nurses with increased prevalence of restraints.

Patient satisfaction is indicative of the quality and quantity of care provided by the nursing staff. Dissatisfaction may translate to additional nursing attention per patient or standards of care services are demeaning.

Nurse satisfaction indicates that terms of employment are commensurate with reference to the working environment. Dissatisfaction may lead to declining quality of services delivered. Further Nurse Satisfaction may indicate that the type of contract leading to the employment is better compared to others.

Incidences reported of pressure ulcers will determine the frequency of undertaking the survey. Increased incidences translate to shortening the time taken in undertaking the survey to establish prevalence. This will lead to revising care giving strategies where applicable.

According to Foley, (n.d.) the length of patient stay in hospital premise has a correlation with nurse staffing and their mix. The number of nurses will trickle down to the ability of the hospital to sustain nursing staff at a competitive pay. Thus, better pay would grant better services to the patients thus achieve client satisfaction. Commensurate pay will depend on the workload per nurse, thus nurse satisfaction would determine the quality of services rendered. Length of stay is related to increased complication (Foley, n.d.).

How nurses respond to strict observation of patient cultural or religious attachments is crucial in the healing process of a patient. In an environment where significant numbers of patients have similar special dietary requirements, then the hospital should specialist (Jewish nutritionist) who handles food requirements for such patients. This food should be prepared aside from others to avoid mix-up. Where mix-up is likely then unique cooking and services appliances should set aside. Special meal service staff can handle the food until service to the patient. Staff service chatter should include strict adherence to conditions set for service delivery. Communication should be precise and two-away. The hospital should lay emphases on productive hours for caregivers. Interactive forums between staff and top management could identify problem areas and put mechanisms for redress. An award scheme that recognizes best performing staff could be an additional tool to enhance service delivery.


Foley, M. E. (n.d.). Nurses: Assuring Quality Care for all Populations [PowerPoint Slides]. University of Pennsylvania, Leonard Davis Institute of Health Economics. Web.

Hart, S., Bergquist S. Gajewski B. & Dunton N. (2006). Reliability testing of the national database of nursing quality indicators pressure ulcer indicator: Journal of Nursing Care Quality. Web.