- 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. (Chapter 9 #3)
How could you calculate whether there is a significant relationship between staffing and medication safety issues?
According to Waxman, 2018 to explore the relationship between two variables, one needs to look at the correlation coefficient. In this scenario, to determine the relationship between the number of temporary RNs to the number of medication errors, a correlation coefficient using the Pearson product moment correlation coefficient would determine the strengths and direction of the relationship.
How would you explain this result to your chief financial officer (CFO) to request additional money to hire more permanent staff RNs?
I would present my chief financial officer with the Pearson product moment correlation coefficient results, showing how the relationships between the medication errors and the hiring of temporary RNs are linked. The calculated results are +0.47 when the temporary RNs are working, which shows the CFO how more medication errors occur with temporary staff. Since the negative correlation shows more errors +0.47 when the temporary RNs are working, this indicates a strong direction that the cause of more medication errors occurs with the use of temporary RNs, and an urgent need to have permanent staff RNs because medication errors can be more costly to the organization.
- 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?
The first action I would take would be to inform and assist low-income individuals with applications for the Mississippi Family Planning Waiver through the Division of Medicaid to continue providing contraceptive services to low-income individuals who qualify. The waiver covers one annual visit and subsequent visits related to birth control methods and family planning services (Mississippi Division of Medicaid, 2022).
Secondly, I would apply for services with Ryan White. Although Ryan White primarily provides services for HIV/AIDS, condoms are provided as a part of the program. Educating the patient and providing condoms would help prevent pregnancy and possible contraction of an STD.
Third, I would explain to the individuals that contraceptives are no longer covered under their insurance, and they will have to pay out of pocket for their contraceptives. I would educate them on prescription cards such as Good RX, and various others that may assist with the cost. Also, I would order the most inexpensive oral contraceptives available as the ordering provider.
How do you justify this action based on legal and ethical guidelines?
Unfortunately, the state of Mississippi has not passed the Affordable Care Act. Therefore, the insurer has every right to reject payment of the claim if they choose to do so without any repercussion.
References:
HRSA Ryan White HIV/AIDS program. Retrieved March 11, 2022, from https://ryanwhite.hrsa.gov/hiv-care/services (Links to an external site.).
Mississippi division of Medicaid. Retrieved March 11, 2022, from https://medicaid.ms.gov/medicaid-coverage/who-qualifies-for-coverage/family-planning. (Links to an external site.)
Waxman, K. T. (Ed.). (2020). Financial and Business Management for the Doctor of Nursing Practice (2nd ed.). New York: Springer.
| Discussion Board Responses Rubric | |||||
| Criteria | Ratings | Pts | |||
| This criterion is linked to a Learning OutcomeNumber of Responses
Students are expected to respond to at least 2 of their peers. |
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30 pts | |||
| This criterion is linked to a Learning OutcomeSubstance of Responses |
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45 pts | |||
| This criterion is linked to a Learning OutcomeGrammar, Punctuation & APA |
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25 pts | |||
| Total Points: 100 | |||||
Peer Response: Calculating Significant Relationships
Pearson correlation coefficient is indeed a good statistical measure for determining whether there is a significant relationship between changes in staffing and medication error issues in the organization. Pearson correlation coefficient helps researchers to establish the strength of association between two variables (Waxman, 2020). Although you have clearly identified the Pearson correlation coefficient as the most appropriate statistical measure for the scenario, calculating it will not help much if you do not know how to interpret the results. According to Schober et al. (2018), it is highly imperative for nurses to understand how to interpret correlation coefficients. It is by so doing that they will be able to estimate how strong the variable that is being tested is in relation to the study sample.
As nurses, we need to know that correlation coefficients are usually interpreted on a scale that ranges from -1 to +1. The strength of association gets stronger as the r value approaches a positive value of +1. When the correlation coefficient is +1, it means that for every nurse that leaves the facility, there is a positive increase in the number of medication errors for the unit by a fixed proportion. Conversely, the strength of association reduces as the r value approaches a negative value of -1. When the correlation coefficient is -1, it means that for every increase in the number of nurses, there is a reduction in medication errors by some fixed proportion. A value of zero (0) indicates that there is no association between the two variables (Alsaqr, 2021). Generally, an association between nurse staffing and medication errors in the given scenario should be confirmed by a positive correlation coefficient. This explains why a Pearson product-moment correlation coefficient of +0.47 means that the number of medication errors continues to rise as nurses continue to leave the organization.
References
Alsaqr, A. (2021). Remarks on the use of Pearson’s and Spearman’s correlation coefficients in assessing relationships in ophthalmic data. African Vision and Eye Health, 80(1). doi:https://doi.org/10.4102/aveh.v80i1.612.
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.
Waxman, K. T. (Ed.). (2020). Financial and business management for the Doctor of Nursing Practice (2nd ed.). New York: Springer.