Sample Essay on Improving Quality Service among Nurses


Delivery of services is one of the paramount principles guiding the existence of any industry that relates directly with clients. In the hospital setting, quality service delivery in health care is vital since it strikes a balance between mortality rates and patient health. Therefore, all medical practitioners have to embody a stringent adherence to professionalism, productivity, and efficacy when dealing with patients since they have the patient’s lives in their hands. Nursing is one among many fields in the medical sector that are mandated to provide quality service delivery to patients regardless of their reservations, or demographical backgrounds.

Purpose of the Research

In the human resource department, the key feature that defines its work output is the enhancement and promotion of workers’ output and rights, respectively. The former will be the focus of this paper, with close relation and analysis of how nurses can increase and manage better quality service delivery for their patients (Institute of Medicine 29). Additionally, aside from this, analysis of the effectiveness of each tool that has been suggested will be performed based on its usefulness to the nursing profession. For instance, in a football match or training, the coach only provides the game strategy, but structures it in a manner that is comfortable and easily applicable to all players’ field position and abilities. This is similar to the nursing field where the director of human resources has to structure his tools in a manner that enhances autonomy among the nurses to manage, implement, and learn these tools being provided based on their inherent abilities (Rodin, Zimmerman, Mayer, Howell, Katz and Sussman 43).

Literature Review

The major theory that defines the content of this research is the goal attainment theory that seeks to provide a framework for how nurses work. Educational and training, competency standards, and performance appraisals are structured in a manner to achieve the goal attainment theory.

In the contemporary world, quality of service in the health industry is esteem to avoid cases of malpractice owing to the open nature of today’s laws. In the United States, for instance, malpractice cases against medical practitioners drawn across different fields have risen by approximately 23% in the past eight years (Anderson & Mangino 121). In effect, medical institutions have changed their modus operandi, policies, and systems to encompass a culture of accountability among its staff. Additionally, they have instigated measures that focus on hiring the most competent and astute professionals in the industry whose work output, productivity, and professionalism is aligned to the institution’s vision, mission, goals and objectives.

One of the major departments tasked with maintaining and creating such an environment is the human resource department. Its powers, duties, and responsibilities have been increased tenfold across businesses and organizations due to the intricate task of employee management and advocacy. This task has become more complex owing to the stringent laws, rules, and regulations that support and promote the right of employees against being prejudiced. Therefore, human resource department have to structure their hiring, selection, recruitment, and management of their employees in a manner that strikes a balance between maintaining the employee’s rights, and promoting the needs of the organization (Peterson & Bredow 121). Therefore, the tools for enhancing service delivery among nurses will be highlighted with consideration of all the pertinent factors that have thus far been highlighted.

Tools for Effective Service Delivery
Education and Training

According to research, this is considered as the most effective for enhancing employee effectiveness in their performance of their duties. Its success rate is pegged at 80% effectiveness across all industries, organizations, and businesses. It entails the education of employees on pertinent sectors of the organizations such as technology, economic development, customer satisfaction, stress management, skill development, knowledge acquisition, cultural values, and legal education, among others. In the nursing field, training and educating the nurses serving in different fields has become an integral aspect in the enhancement of service delivery among them (Anderson & Mangino 118).

The nursing field encompasses a multiplicity of divisions such as informatics, nurse educators, administrators, registered nurses, practicing nurses, anesthetic nurses, among others. All these fields have different subsets that represent each individual nurse’s duties and responsibilities. For instance, among registered nurses, there are those specializing in cancer, heart failure, intensive care unit, operation, and surgery, among others. Therefore, when creating a plan for education and training, the human resource has to factor in all these fields of nursing and structure their education and training to suit the individual needs and specialty of nurses working in particular fields. The education and training can thus be divided equally between general and specialized training and education.

General education and training applies to nurses across all the fields, which makes it cheaper, more effective, and having a wide scope of reach on the target employees. Some of the general education and training tools that can be used to improve the service delivery of nurses are such as stress management, technological education, financial management, and newer emerging trends in the service sector (Regnard 99). Tools such as stress management can be essential to improve the nurses’ behavioral trends during their work since it assists in the management of emotional imbalances that they face on a continual basis such as losing a patient, or consoling or counseling a family member or friend. Others such as technological education can be essential in the information management sector and record keeping. It is also important in creating awareness among the nurses on new technological devices being installed in the hospital to enhance service delivery to the patients. For instance, an installation of IT hardware such as iPads for every patient where nurses feed and retrieve medical records, patient treatment, and medication applied to the patient can be instrumental in enhancing service delivery and increasing efficiency in patient care.

Other specialized education and training of nurses applies to knowledge and skill improvement for specific fields. For instance, a recent research on reducing readmissions for patients suffering from heart failure complications showed that one of the strategies of reducing these readmissions for patients could be through education and training of the direct care nurses on how to deal with patients (Bradley 447). The research indicated that educating and training the nurses in this specific field on caring for patients’ and educating them on nutrition, exercise, medication, and other lifestyle choices has a direct effect of reducing these readmissions (Kim 226). In another con-current research, it showed that educating and training nurse administrators on better employee management, record keeping, policy creation and implementation, performance appraisals, research on new medical trends for nurses, and application of organizational mission, vision, goals, and objectives on the nurses was instrumental transferring essential quality service delivery skills and knowledge on their junior staff.

Performance Appraisals

This is another tool that is quickly gaining traction across different service sectors. It entails the employees being constantly assessed on their performance using a set guideline for determining once work output, efficiency, professionalism, and productivity. In the medical field, its application has only recently become a prerequisite for enhancing the performance of its staff ((US Department of Labor). For instance, in the US, the Centers for Medicare and Medicaid Services (CMS) has initiated a program aimed at increasing physician accountability of their performance in providing quality care, as well as observing the usefulness and applicability of Medicare and Medicaid Services. They use a program called Physician Quality Reposting System (PQRS) for assessing their performance, as well as proving monetary incentives to reward quality service delivery. According to research, since the program’s integration into the health care sector, its success rate in enhancing physician performance has been pegged at 45%.

Applying performance appraisals exercises on nurses can also prove effective in improving their level of quality care and service delivery. One of the methodologies that can be used by human resources personnel in this endeavor would be the assessment of each nurse’s strengths and weaknesses when performing their jobs. Once this has been identified, the nurse would then be allocated duties and responsibilities based on her inherent abilities and inabilities. For instance, since the nursing sector has a strict policy on body to mass index (BMI) for their nurses, the hospital can promote equality and humanity for the obese or overweight nurses by allocating them to record keeping and maintenance tasks, rather than stationing them in the ER (Hines, Yu and Randall 86). In this station, there is too much activity, and their health incapacity would be an impediment to their effective execution of tasks allocated that are sometimes extraneous.

The use of performance appraisals on the nurses can be instrumental in rooting out laziness, inefficiencies, poor customer relations, ignorance of work place policy, and poor employee correlations. Identifying these issues in specific nurses can be helpful in isolating these people and providing the necessary advice punishments, education, or management of their work output and behavioral trends. For instance, poor customer relations have been one of the issues facing majority of nurses when dealing with their patients. According to patient feedback regarding their level of care, at least one in five nurses has an ignorant attitude when providing health care to a patient (Lee & Fawcett 98). This can be due to a variety of factors such as stress, long working hours, excess duties allocations, among others.

Once a performance appraisal has been performed on the nurses, the human resource personnel can identify these nurses with poor customer or client treatment, and seek ways and means of addressing their behaviors or frustrations that are causalities for these poor behavioral trends. A performance appraisal is also essential in promoting a culture of accountability for individual nurses. This ensures that blame or poor work output is considered individually and sorted out on that particular nurse. This ensures that all nurses act independently when executing their services in a manner that promotes excellence in service delivery.

Work Environment

Another strategy for enhancing service delivery for nurse is the creation of a favorable work environment that addresses not only the needs of the clients or patients, but also those of the nurses working in that environment. A sustainable and effective work environment is a prerequisite that is provided under the laws such as the Employee act. This work environment has to adhere to high safety standards, humanity and equality, tools and equipment provision, effective and unbiased policies, structures, and systems, and consideration of workers’ needs and health. For instance, in the health care industry, one of the mostly contested and neglected work environment policies is in relation to the working hours of the staff. In a majority of hospitals, these staff is forced or is mandated to work for long shifts that could be strenuous to their health and physicality.

Management of working hours among the nurses could ensure that their work is divided or scheduled on time spans that reduce fatigue, and promote better work output (Barbara and Pamela 13). According to psychologists, lack of sleep makes one irritable, frustrated, reduced attention to detail, tense, and constantly having mood swings. This is representative of many nurses working in a variety of hospitals, which some management and human resource personnel mistake for ignorance and lack of professionalism. Therefore, this simple issue can be corrected by making the nurses work in shifts that have been scheduled in a manner that ensures that they have enough rest time. Application of such a system would have an overall increase in improving the nurses’ service delivery and patient care by at least 60%, which could be advantageous for the organization in creating a culture of effectiveness and quality patient care.

Outlining Competency Standards

According to the nursing code of ethics and professionalism, there are assortments of competency standards that the nurses should adhere to in the execution of their duties. These competencies are provided to enhance their level of service delivery for their patients and the organization or institution where they work (Hines, Yu, and Randall 81). The competency standards deal with a multiplicity of fields that assist the nurses in how they act, react, and deal with different aspects of their practice. Some of the things listed in these competency standards are such as research, patient care, education, behavioral trends, legal requirements, institutional and professional conduct, relations with work colleagues, and treatment and counseling of patients and their families.

An adherence of all these competency standards by all nurses would have a collective effective of improving the quality of service delivery and patient care across the institution or hospital (APRN Consensus Work Group & the National Council of State Boards of Nursing APRN Advisory Committee 59). Therefore, as the human resource director, it is paramount that he takes the role of reminding the nurses of their competency standards. This can be achieved by using such strategies as inclusion of these competency standards in the nurse’s contract, which they sign upon their employment. Additionally, setting up of organizational policies that are structured towards promoting and adhering to these competency standards would endear the nurses to practice their professional requirements. Finally, structuring the organizational mission, vision, goals, and objectives around these competency standards would make it easier for the nurses to practice them effectively (Harrison, Young, Price, Butow and Solomon 1122). Additionally, an adherence to these competency standards would automatically translate to better service delivery and patient care, and if implemented effectively could act as the easiest, albeit most effective for enhancing better quality standards among the nurses when executing their duties.

Incentives and Better Remuneration Packages

In today’s contemporary world, economic hardships and increasing cost of basic commodities has resulted in increased expenses, and reduced savings. Therefore, people are constantly either looking for better strategies and tools to improve their earnings through investments, employment, or improving their education. In the nursing field, majority of nurses are faced with similar problems, coupled with the loan payments for the expensive education. In human resource terminology, this could be causality for creating unrest, poor service delivery, and stress among the nurses (Australian Nursing and Midwifery Council 7). One of the methodologies of tackling this issue would be through providing better salaries through promotions, remunerations, bonuses, and incentives.

A cocktail of all these strategies would serve to make the nurses have a sense of belonging within the organization due to an appreciation of their service delivery to both the patients, and the organization. According to statistics, increasing of salaries for employees has a positive of increasing and improving service delivery by the employees by at least 70%. This is similar to the effectiveness of the Physician Quality Reposting System (PQRS), where an assessment of the Jefferson University Physicians (JUP) showed that the incentives paid to the physicians had a 58% success rate for better service delivery (Dowd, Li, Swenson, Coulam and Levy 12).


A number of strategies have been proposed and implemented across different service sectors to enhance the delivery of quality service by employees. The strategies being proposed to enhance the quality of service are performance appraisals, education and training, incentives and better remuneration packages, better work environments, and outlining the nursing competency standards with the organization’s goals and objectives. In the nursing field, the application of these strategies has to be significantly altered to fit into the needs and professional qualifications of the nurses. However, their effect has similar positive outcomes of promoting a culture of professionalism, productivity, and effectiveness, which automatically translate to better service delivery. The strategies are tailored to fit into the goal attainment theory that advocates for service enhancement and goal attainment for the nursing profession. Based on this analysis, the strategies proposed are effective though better and more intricate methodologies have to be employed, such as better management skills, better decision making, among others.


Works Cited

Anderson, Cherri & Mangino, R. Ruthie. Nurse shift report: Who says you cannot talk in front of the patient? Nursing Administration Quarterly, 30. 2 (2006): 112-122.

APRN Consensus Work Group & the National Council of State Boards of Nursing APRN Advisory Committee. Consensus Model for APRN Regulation: Licensure, Accreditation, Certification, and Education. 2008. Print.

Australian Nursing and Midwifery Council. Australian Nursing and Midwifery Council National Competency Standards for the Registered Nurse. Australian nursing council Inc. 2006. Print.

Barbara, R. Lewis and Pamela, McCann, Service failure and recovery: evidence from the hotel industry, International Journal of Contemporary Hospitality Management, 16.1 (2004): 6 – 17

Bradley, H. Elizabeth. Hospital strategies associated with 30-day readmission rates for patients with heart failure. Circulation: Cardiovascular Quality and Outcomes. 6 (2003):444-450

Dowd, Bryan, Li, Chia-Hsuan, Swenson, Tami, Coulam, Robert and Levy, Jesse. Medicare’s physician quality reporting system (PQRS): Quality measurement and beneficiary attribution. Medicare and Medicaid research review. 4.2 (2014): 1-14.

Harrison, D. James, Young, M. Jane, Price, A. Melannie, Butow, N. Phyllis and Solomon, J. Michael. What are the unmet supportive care needs of people with cancer? A systematic review. Support Care Cancer, 17.8 (2009):1117‑1128.

Hines, Patricia, Yu, Kevin and Randall, Michael. Preventing Heart Failure Readmissions: Is Your Organization Prepared? Nursing Economics. 28. 2(2010): 74-86.

Institute of Medicine, The Future of Nursing: leading change, advancing health. Committee on the Robert Wood Johnson Foundation initiative on the future of nursing, National Academy Press: Washington, D.C. 2011. Print.

Kim, M. Sun. Evidence-based Strategies to Reduce Readmission in Patients with Heart Failure. Journal for nurse practitioners. 9. 4(2013): 224-232.
Lee, Rebecca C. & Fawcett, Jacqueline. The influence of the metaparadigm of nursing on professional identity development among RN-BSN students. Nursing Science Quarterly. 26.1(2013): 96-98.

Peterson, Sandra J. & Bredow, Timothy S. Middle range theories: Application to nursing research (3rd Ed.). Philadelphia, PA: Lippincott Williams & Wilkins. 2013. Print.

Regnard, C. Helping the person to share their problems in Regnard, C. Helping the patient with advanced disease:  A workbook. Chapter 2, Radcliffe Medical Press, Oxon. 2004. Print.

Rodin, Gary, Zimmerman, Carmilla, Mayer, Carole, Howell, Doris, Katz, Mark, and Sussman, Jonathan. Clinician patient communication:  evidence based recommendations to guide practice in cancer. Current Oncology, 16.6 (2006):42‑49.

US Department of Labor, Bureau of labor statistics. Tomorrow’s jobs, Occupational Outlook Handbook. 2004. Web.