III. Institution/Organizational Related
Organizational policy should reflect an organizational climate that values registered nurses and other employees as strategic assets and exhibit a true commitment to filling budgeted positions in a timely manner. In addition, personnel policies should reflect the agency's concern for employees' needs and interests (McClure, et al./1983).
All institutions should have documented competencies for nursing staff, including agency or supplemental and traveling RNs, for those activities that they have been authorized to perform (JCAHO/1998). When floating between units occurs, there should be a systematic plan in place for cross-training of staff to ensure competency (JCAHO/1998). Adequate preparation, resources and information should be provided for those involved at all levels of decision-making. Opportunities must be provided for individuals to be involved to the maximum amount possible in making the decisions that affect them. (Williams and Howe/1994). Finally, any use of disincentives for reporting near misses and errors should be eliminated to foster continuous quality improvement (Leape/1994).
In addition, the organizational policies should recognize the myriad needs of both patients and nursing staff and provide the following:
- effective and efficient support services (transport, clerical, housekeeping, laboratory, and so forth) to reduce time away from patient care and to reduce the need for the RN to engage in "re-work" (Prescott et al./1991);
- access to timely, accurate, relevant information provided by communication technology that links clinical, administrative and outcome data;
- sufficient orientation and preparation including nurse preceptors and nurse experts to ensure RN competency;
- preparation specific to technology used in providing patient care;
- necessary time to collaborate with and supervise other staff;
- support in ethical decision-making;
- sufficient opportunity for care coordination and arranging for continuity of care and patient and/or family education;
- adequate time for coordination and supervision of UAP by RNs;
- processes to facilitate transitions during work redesign, mergers and other major changes in work life (Bridges/1991);
- the right for staff to report unsafe conditions or inappropriate staffing without personal consequence; and,
- a logical method for determining staffing levels and skill mix.