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How Competing Needs May Impact the Development of a Policy
Discussion 1
How Competing Needs May Impact the Development of a Policy
For my previous discussion post, I discussed how staffing shortages can lead to burnout due to increased workloads and longer hours. Burnout has been shown to significantly increase medication errors, reduce patient outcomes, and reduce productivity which decreases the quality of patient care overall (Bakhamis et al., 2019). Nurses will also become overwhelmed working in stressful environments, creating lower job satisfaction scores and lower nurse retention (Bakhamis et al., 2019). Because of this need to prevent burnout in nurses, the policy would need to be developed to address having an adequate nurse-to-patient ratio while also balancing budget costs. Despite attempts to develop policies to help healthcare organizations, competing needs related to the workforce and lack of resources make it difficult to address the shortage.
Nursing leaders would need to develop a policy that can create a supportive environment for nurses to care for patients safely. The goal would be to improve patient outcomes and improve retention, decreasing burnout. For example, developing a policy to establish set nurse-to-patient ratios depending on the unit. Adequate staffed units have been shown to result in lower mortality rates, shorter hospital stays, and less risk for adverse risks like medication errors (Saville et al., 2019).
Specific Competing Needs that May Impact Nurse Shortages
For adequate staffing, there needs to be a balance between the funds available and the organization’s available budget so that it is sustainable while also providing the best patient outcomes. In other words, there needs to be staff and funding available for this to happen. Within my healthcare organization, we have used travelers to fill in shifts to help supplement staffing. There have been times when the number of travel nurses outnumbers staff nurses on a given shift. While these travelers provide much-needed help, they also have expensive contracts and will work a few months per their contracts. When discussing this dilemma with hospital leadership, we have been told this process is not sustainable in the long run. Instead, the hospital risks losing more money in paying travelers than losing staff nurses. According to Kelly and Porr (2018), this is an example of how the business model of healthcare can negatively impact nurses and their ability to provide safe, high-quality patient care. Over time this can increase nursing stress due to ethical dilemmas, increase burnout, and ultimately worsen staffing anyway (Kelly & Porr, 2018).
Nurses should recognize these issues as serious ethical dilemmas as patients risk subpar care due to increasing healthcare costs. Milliken (2018) suggests nurses develop ethical awareness, by challenging situations and understanding the outcomes of these actions. For example, in my healthcare organization, we have discussed how the lack of staffing can lead to increased medication errors and our CLABSI/CAUTI rates due to nurses being in a ratio that’s fifty percent or even double what their normal ratio is. For example, in my ICU unit, the standard nurse-patient ratio is 2:1. However, there have been times we are 3:1 or even 4:1 while being expected to provide the same care with more strain on time and resources. Nurses must speak up when they feel they are in an unsafe patient assignment, further developing ethical competence (Milliken, 2018). By speaking up, nurses can be advocates for changes in policy, improving on the current process.
Conclusion
Overall, staffing shortages have created challenges in the healthcare field, leading to increased nurse burnout and poor patient outcomes. Attempting to develop policy to support nurses has been difficult as the organization must also care for its own interests including available funding and budget costs. In other words, the organization must provide funding to staffing, as well as the resources needed to care for patients like the building costs, technology, and other miscellaneous costs. It is recommended that nurses become ethically competent so that they can address moral dilemmas when there is concern that patient care is subpar due to available resources.
References
Bakhamis, L., Paul III, D. P., Smith, H., & Coustasse, A. (2019). Still an epidemic: the burnout syndrome in hospital registered nurses. The health care manager, 38(1), 3-10.
Kelly, P., & Porr, C. (2018). Ethical nursing care versus cost containment: Considerations to enhance RN practice. OJIN: Online Journal of Issues in Nursing, 23(1), Manuscript 6. doi:10.3912/OJIN. Vol23No01Man06. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Nursing-Cost-Containment.html
Milliken, A. (2018). Ethical Awareness: What it is and why it matters. OJIN: Online Journal of Issues in Nursing, 23(1), Manuscript 1. doi:10.3912/OJIN.Vol23No01Man01. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Awareness.html
Saville, C. E., Griffiths, P., Ball, J. E., & Monks, T. (2019). How many nurses do we need? A review and discussion of operational research techniques applied to nurse staffing. International Journal of Nursing Studies, 97, 7-13.
Discussion2
Nursing Shortage that leads to Burnout
The nursing shortage is an issue of supply versus demand. The aging workforce and an undersupply of providers and advanced practitioners to take their place is recurrently causing a faculty shortage (Boamah, Callen, & Cruz, 2021). Another reason for the shortage is the shrinking nursing faculty and fewer available seats in the nursing programs.
Competing Needs of the Workforce
It is projected that nursing will be one of the top professions for job growth until the year 2029. It’s expected that the RN workforce will increase by 7%, or 221,900 nurses, in the 10-year period from 2019 to 2029. This is in addition to 175,900 projected RN jobs each year until 2029. Over the last 9 years, we’ve seen approximately 60,000 RNs leave the nursing workforce each year. As of 2018, 55% of nurses working in the US are older than age 50; within the next 10 to 15 years, 1 million RNs will be eligible for retirement (Perkins, 2021).
A variety of factors contribute to the nursing shortage, including working conditions, increased number of patients, violence in the healthcare system, retirement of experienced nurses, difficulty retaining new graduate nurses, a decrease in nursing faculty. Increased workload is negatively affecting the profession by causing nurses to work short-staffed and under increased amounts of stress. This makes many nurses leave the profession. One way that we can address the nursing faculty shortage is to pay them a salary comparable to the salary of other nurses. It’s important to note that the increased cost associated with staffing more nurses is offset by decreased lengths of stay, ICU admissions, infections, and readmissions (Perkins, 2021).
COVID-19
A specific example of a stressor involved with the nursing shortage is COVID-19. Nurses have remained steadfast on the front lines since the beginning of the pandemic, while overcoming challenges and risks to their personal health and safety. Since the start of the pandemic, we’ve seen nurse-to-patient ratios increasing while the number of nurses available to work has decreased. In some organizations, a 1:1 nurse-to-patient ratio is now a 1:4 ratio. It hasn’t been uncommon for up to 10% of nurses in a facility to be out due to COVID-19 related issues, which has put considerable strain on a system that was already strained.
Impact to Policy
Leaders need to create healthy work environments within the healthcare organization, including well-developed policies and procedures that consider the organization, employees, and patients. Multiple studies have shown a correlation between a healthy work environment and job satisfaction. Components of a healthy work environment include effective communication, collaboration, and decision-making in addition to appropriate staffing, transformational leadership, and meaningful recognition. Healthy work environments improve staff performance, satisfaction, and retention. When working to develop healthy work environments, nurse leaders should consult with nurses to determine what works well and what areas can be improved. Positive work environments lead to healthier nurses who perform at high levels and are committed to the organization.
Conclusion
There are many factors that contribute to the nursing shortage. It has been said that enhancing the administrative support might be the most promising facilitator to improving the nursing shortage and retention. The current shortage is not one that nurses alone can solve. It is crucial that administration takes a governmental approach by convening nurses, hospitals, physicians, healthcare personnel, and key stateholders to examine, identify, and then implement real solutions to the nursing shortages (ANA, 2021).
References
American Nurses Association (ANA). ANA’s proposed policy solutions to address the nurse staffing shortage crisis. (2021). South Carolina Nurse, 28(4), 10–11.
Boamah, S. A., Callen, M., & Cruz, E. (2021). Nursing faculty shortage in Canada: A scoping review of contributing factors. Nursing Outlook, 69(4), 574–588. https://doi.org/10.1016/j.outlook.2021.01.018
Perkins, A. (2021). Nursing shortage: Consequences and solutions. Nursing Made Incredibly Easy!, 19(5), 49–54. https://doi.org/10.1097/01.NME.0000767268.61806.d9