Critical Thinking Professional Nursing Issue

Critical Thinking Professional Nursing Issue

Nursing work environment and its importance is introduced in this paper. Issues relating to professional nursing work environment are outlined. Further changes required in nursing work environments to achieve primary objective of nursing are given and recommendations for a better nursing work environment are listed. Finally, steps to encourage nursing practice and characteristics of a professional nursing environment are provided.

Introduction to Nursing Work Environment:

Nurses give utmost attention to the patients in hospitals, nursing homes and other health care centers. The work atmosphere plays a major role in the proficient nursing practice. The patient is of major concern in nursing practice. The two aspects that every health care organization must bear in mind are the quality of service and patient safety. In current years a variety of issues have arisen to oppose the work atmosphere of existing nurses. There is a fast growing necessity for knowledgeable and skilled nurses due to the swift developments in biomedical science, enhanced disease prevention and management, mixing of new clinical care technologies and changes in care delivery to a wide range of clinical sites. Moreover, population demographics are varying due to the public ages in growing numbers and are becoming more and more varied in culture and language. (Hallmarks of the Professional Nursing Practice Environment)

The patient safety is defined by the Institute of Medicine as a freedom from accidental injury; and promising patient safety involves the founding of operational systems and procedures that reduces the probability of mistakes and expands the probability of interrupting them when they take place. It is not just enough that the patients leave the hospital or other health care centers with a feeling that they are cured, but also must have a feeling that they had an excellent and high-quality care. The basis of nursing is always the patient's safety. As per the Code of Ethics for Nurses, the nurse helps, supports for and tries hard to look after the health, safety and rights of the patients. It also states that the nurse partake in founding, preserving and humanizing the health care atmosphere and state of employment favorable to the terms of quality health care and coherent with the morals of profession through personal and combined action. If the troubles in the work atmosphere are not tackled, nurses will not be able to adequately look after the patients; the nursing labor force will be mislaid to grievance and burnout; and the profession will never be able to take on the next generation of nurses. (Statement of the American Nurses Association for the Institute of Medicine's Committee on Work Environment for Nurses and Patient Safety)

Issues related to Professional Nursing Work Environment:

With regard to nursing work environment, there are two very important factors. The first factor is to find out the problems in the present days work environment, which makes it so unpleasant for registered nurses and influences the total safety and health of patients. The second factor is to find out what steps are to be taken to create an atmosphere that is conducive in supplying excellent healthcare; that defends patient's safety and enhances the result; and that guarantees the health and safety of the registered nurses and all providers of care. In the past decade, the introduction of managed care and modifications in Medicare Reimbursement has exercised descending pressure on provider margins. Major cost reduction programs have been made use of due to these changes. New models of health care delivery were put into practice throughout the 1990s, and highly skilled, qualified workers were removed or sent. The nurses were the first to sense the pinch through cut back, layoffs and salaries that only kept speed with increase, as registered nurses in general correspond to the largest single expenses for hospitals and health systems. Simultaneously, the removal of nurse manager positions reduced the support, encouragement and funds essential to guarantee that staff nurses can provide the best care. (Statement of the American Nurses Association for the Institute of Medicine's Committee on Work Environment for Nurses and Patient Safety)

As a result, this action also eliminated nursing from management directly disturbing the primary service of 'nursing care' for which consumers are admitted to avail facilities. There is better handling and practice due to the modern advances in medical technology. These advances help in extending the enhancing the quality of lives and also increase the involvedness of health care. Today's hospitals are mostly critical care units; with suppliers in nursing homes, home health agencies, schools and other community settings offering extreme multifaceted services than in the past and operating modern technology in settings that often lack the source like education, training and support to guarantee the proficiency of providers and the security of consumers. These days the registered nurses are busy in the delivery of extremely modern and labor-intensive care for an aging and ever more susceptible patient population. Due to the duration of stay or increasing caseloads, the time fixed for care is shorter than before. Added to this, the nurses work for a long time with lesser support mechanisms and bigger administrative duties. Thus they are facing downsizing to minimize the cost and work for longer hours as labor-intensive technologies are made use of in health care systems. (Statement of the American Nurses Association for the Institute of Medicine's Committee on Work Environment for Nurses and Patient Safety)

In the recent years the significance for nurse care is lost. Major drivers of this alteration have been economic restrictions resulting from changes in repayment for care, quick progress in clinical technologies and care modalities, and corporatism of health care systems. Hospitals and health systems have been compelled to concentrate on cost control and reorganizing of operations to attain utmost efficiencies. At the cost of direct caregivers, like downscaling of the professional nursing labor force, reorganization of nursing services, alterations in employment mix, quick movement of patients to different care settings, and reduced support services for patient care, many cost savings in health care have been achieved. In the present days' health system, poor teamwork among health care providers also hinders the efforts to offer quality care. The nurses feel that the present work atmosphere to be highly hectic and professionally unsatisfactory. Intensifying the challenges to the work environment for nursing practice is the nationwide scarcity of nurses and other allied health professionals.

Major government agencies and professional nursing organizations have given details of the problems related to the national nursing workforce. It is proposed that if the nurse's problem is left uncared, then the problem may rise into a major national health care problem by the year 2010. Several factors like demand, supply, and the aging employees have added to the problem of inadequate numbers of nurses available to care for the growing needs of the American public. Though there is a rise in the actual supply of nurses, it has not kept up with the considerable increase in demand for nurses. (Hallmarks of the Professional Nursing Practice Environment)

Changes required in nursing Work Environment:

As per the new report given by the Institute of Medicine of the National Academies, the work atmosphere of the nurses who are the major section of the nations' health care workforce must be significantly changed to better protect patients from health care errors. The report calls for variations in how nurse staffing levels are set up and compulsory limits on nurses' working hours as part of a complete plan to alleviate problems that intimidate safety of patients by increasing the work atmosphere in four areas: deployment of workforce, management, design of jobs, and organizational culture. Donald M. Steinwachs, chair, of the department of health policy and management at the Bloomberg School of Public Health of the John Hopkins University in Baltimore and chair of the committee that wrote the report says that no one or two actions by themselves can keep patients safe. Instead forming work atmosphere that minimizes mistakes and enhanced patient safety will need basic changes in how nurses work, how they are positioned and how the very basic culture of the organization understands and promotes actions on safety. We give a complete plan to tackle all these areas. The country's 2.2 million registered nurses - RNs, 700,000 practical and vocational nurses who are licensed, and 2.3 million nursing assistants represent 54% of all providers of health care. Nurses are the health professionals who interrelate most regularly with patients in all environments, and their activities like continuous screening of patient's health status are directly connected to improved patient results. (Substantial Changes Required in Nurses Work Environment to Protect Patients from Health Care Errors)

There are studies, which show that improved infections, bleeding and cardiac and respiratory arrests are connected with insufficient number of nurses. Nurses also shield against medical errors. For instance, a study in two hospitals was of the view that nurses interrupted 86% of medical wrongs before they reached the patients. Some nurses in health care facilities are overstrained in spite of the fact that improved nursing staff levels result in safer patient care, for example, in some hospital nurses are allocated up to 12 patients per shift. The decade-old system that specifies least standards for staffing in nursing homes need to be restructured, the report says. The U.S. Department of Health and Human Services must call for nursing homes to have at least one RN within the facility during all times. Based on the departments' 2001 report to Congress on minimum staff-to-patient ratios for nursing homes, the HHS should mention the staffing levels that increased with the number of patients. Central and state report cards on nursing homes should give information on levels of nursing staff, and measuring of staffing levels should be developed for hospital report cards. The healthcare facilities should avoid using nurses from temporary agencies to fill the vacancy. (Substantial Changes Required in Nurses Work Environment to Protect Patients from Health Care Errors)

Working for long hours on the part of the nurse's makes them fatigue since it decreases their energy and reduces their attention to the patient and thereby poses to be a serious danger to the patients. Most of the nurses work for 8-12 hours per shift and some work for more hours. Those concerned regulatory bodies of the state should disallow nursing staff from working longer than 12 hours per day and more than 60 hours every week. In addition to changes in staff levels and working hours, the plans of restructuring of the hospital which began in the mid-1980s brought about considerable changes in how nurses function. As a major step in humanizing nurses work atmosphere and bringing back trust, the report advises health care organizations to involve nurse leaders at all management levels and to seek input from nursing staff regarding decisions about work design and execution. Nurses are in major positions to help identify unproductive work processes that could lead to mistakes, recognize reasons of nursing staff turnover, and find out suitable staff levels for each unit.

Orientation programs for newly appointed nurses and ongoing education programs are being held back due to cost factors, though surveys point out that many licensed nurses who are newly permitted do not have the overall thorough preparation to offer care for present days' patients. Many RNs are not getting continuing education and training to accommodate themselves with the current growth of latest technology and medical knowledge. Health care organizations should devote financial funds to support nursing staff in the current attainment and preservation of knowledge and skills. The committee's suggestions are given at a time when there is a high turnover of nursing staffs, as well as a nursing scarcity that is expected to deteriorate in the future. The health care organizations are helped in employing and maintaining nurses by executing the suggested changes in nurses' work atmosphere. As the supply of nurses is unluckily made thin right now, they must be encouraged by work processes, work space, working hours, staffing practices and a culture that increasingly protects against mistakes and eagerly spots and alleviates mistakes when they take place. If the recommendations suggested by the report are followed, then nurses will like to stay in health care organizations. (Substantial Changes Required in Nurses Work Environment to Protect Patients from Health Care Errors)

Recommendations for a better nursing Work Environment:

The American Nurses Association - ANA highly praised the Institute of Medicine (IOM) for a report, which shows a clear relation between the nursing work atmosphere and patient safety, and advises improvements in health care working conditions that would lead to safer patient care. Based on a survey released in 2000 by to Err is Human IOM study, which shows that 98,000 patients die yearly due to medical errors, a study Keeping Patients Safe: Transforming the Work Environment of Nurses, were made on these recommendations. ANA has long asserted that better patient safety and quality of care cannot be attained without spending in and appraising nursing, said ANA President Barbara Blakeney, MS, APRN, BC, ANP. The study gives proof that immediate steps are to be taken to make better the nurses' working conditions and by doing so the patients can be prevented from mistakes. Blakeney noted that Congress should take immediate action on several awaiting legislative measures that would improve the nursing work atmosphere. (ANA Commends IOM Report Outlining Critical Role of Nursing Work Environment in Patient Safety)

These include proposals that 1) authorize safe nurse/patient ratios, 2) strictly control the insecure practice of compulsory overtime, and 3) offer adequate funding for nursing workforce development. Blakeney says that the nurses and patients across America are asking Congress to take steps that will enhance nursing care in the country and hold health care facilities responsible for the staffing decisions they take. The study notes frankly that the typical nurse's work environment creates a serious threat to patient safety in all four of the basic workings of all organizations like organizational management practices, workforce operation practices, work plan, and organizational culture. Major among these changes are that a culture of safety in nursing is required to be created and maintained. ANA agreed unreservedly with the study's finding that many hospitals do not have sufficient numbers of nurses, a practice that jeopardizes patients, and the finding that insecure work practices and workspace plan create fear to patient safety. It also agreed that piecemeal approaches are not enough and that further study is required and this study must be an integral part of the continuing process. Actually, ANA supported the report's proposal to reduce the number of hours a nurse can work to 12 hours in any 24-hour period and 60 hours in any seven-day period - the same limits being proposed by the Safe Nursing and Patient Care Act of 2003.

In other words, banning compulsory overtime for nurses is necessary for safe patient care. And compulsory overtime could be abolished if Congress were to pass the Safe Nursing and Patient Care Act. It is ANA's agreement that nurse leaders must also vigorously ask for direct-care nursing staff and sponsor them to have a greater voice and additional chances to take part in decision-making. In short, anywhere and every time possible, vanguard nurses must be engaged in any decisions that disturb their work life and patient care. Blakeney was mainly firm about the requirement for a greater connection between management practices, the work environment and safety. One probable solution which has been pointed out that was also stressed in the IOM report was the American Nurses Credentialing Center - ANCC Magnet Recognition Program, which concentrates on excellence in nursing services for attaining safer patient care. (ANA Commends IOM Report Outlining Critical Role of Nursing Work Environment in Patient Safety)