Resolving the Challenge of Nurse Staffing Ratios

¶ … Leadership and Management

In the medical field, the recent topic of debate relates to Nurse Staffing Ratios where many argue that governments need to intervene in setting minimum staffing laws. Currently, the only state that has enacted a law is California and nurse unions in other states are fighting for the implementation of the same in their workplaces. However, most of the attempts made by other states to implement California's strategy have failed since hospitals fail to participate (Schultz, 2013). The argument of many hospitals is that the laws do not give them the opportunity or ability to make decisions regarding staffing and at the same time be a financial burden (Schultz, 2013, par. 3). As seen from many nursing unions, hospitals have abused the system to the point of employing few nurses and yet the patients are ever increasing. Inappropriate staffing ratios influence the safety of patients, the satisfaction of nurses, and contribute to the further deterioration of work environment due to job stress and burnout. Nursing staffing ratios is a debate, and the only way to improve the situation is to use effective approaches for leading and managing the hospital environment. Thereby, avoiding negative effects that are inappropriate for nurse-to-patient ratios.

According to Aiken et al., a positive relationship exists between nurse-staffing ratios and preventable patient death (2002). Arguments raised consider legislations to be having a high potential of leading political and economic devaluation of the nursing profession due to the fixed ratios. Therefore, failure to deal with nursing staffing ratios will be rampant. The mandatory proponents for staffing ratios argue that it will improve quality of care. Since the satisfaction of patients and nurses is enhanced, the nursing work environment will be improved. Improvement in the work environment attracts new nurses and licensed nurses who are not working currently. Staffing critics argue that by mandating specific staffing ratios in environments where the shortage is on the high, leads to the reduction of hospital services, increased unit closures, increased diversions in the emergency room, increased hospital expense due to additional costs related to labor for temporary agency nurses and overtime.

The American Organization of Nurse Executives (AONE) has a responsibility to manage patient care and give them an assurance of having a focused environment that looks at quality and safety in their operations. Staffing ratios are complex with multiple variables and using the mandated staffing ratios approach does not guarantee a healthy working environment for nurses. Additionally, the safety and quality levels are not sufficient in preventing the adverse patient outcomes. AONE's position on mandatory staffing ratios asserts that it serves only to increase stress on systems in the health care as it is overburdened with escalating shortage of professionally registered nurses both nationally and internationally. Thus, the mandatory staffing ratios approach has a potential of creating greater risks to the safety of the public (AONE, par. 4).

Leadership and Manager Approach Comparison to the Issue

According to Hughes et al., the distinction between leaders and managers is as follows (2006):

Leaders develop, managers maintain

Leaders originate, managers initiate

Leaders innovate; managers administer

In terms of status quo leaders' challenge, managers accept it

Leaders view is long-term, managers use short-term view

Leaders inspire, managers control

Leaders ask why and what, managers ask when and how.

However, a leader is not made from an individual's job title only, but rather his/her behavior is the determinant. It is always expected that a leader can inspire, innovate, challenge and, guide as stated above. However, the underlying question is whether these behaviors and practices are present in today's nursing leaders (Curtis et al., 2011, p. 307).

Nursing staffing ratios impacts manager's responsibility since a shortage of nurses increases the chance of error due to the improper treatment accorded to patients and nurses being burned out. Additionally, nurses are easily overworked or discouraged as they handle a large number of patients. It is here that skills become tested and not the financial and technical abilities of nursing leaders and managers. It is also evident that demonstrated leadership in nursing fosters leadership in others in the work environment. Characteristics and traits that promote leadership are extroversion, openness, and motivation in terms of management. Further still, leadership is facilitated by experience and age. Effective leaders in healthcare settings are those who are in contact with caregivers. Leadership training programs are also effective in bringing both short-term and long-term change in the health care setting (Curtis et al., 2011, p. 308).

Managers assess work environments and determine better assignment and management of nurses. For instance, by using working schedules, burnout is reduced and those with longer shifts are given enough time to replenish their strength in preparation for the next one. When managers apply these approaches in instances when nurse-to-patient ratios are on the low, the work environment will be balanced and cost reduced. Hence, quality and safety is enhanced towards the attainment of organizational goals and objectives (Hughes et al., 2006).

In nursing, the role of leadership is different from that of managers because they are found in any health care personnel irrespective of their current position. Leaders inspire and motivate those around them in achieving organizational goals and personal goals. Research conducted showed the existence of a relationship that is positive "between relational leadership style model and patient outcomes" (Wong & Cummings, 2013, p. 709).

In the nursing environment facing the issue of nursing staffing ratios, leaders can take the relational leadership approach. Relational Leadership implies a relational process of "people who come together and attempt to accomplish change by making a difference to benefit the common good" (Uhl-Bien, 2006). The inclusive type of leadership embraces all backgrounds and viewpoints: the approach will help them gather feedback from nurses concerning problems faced concerning nursing staffing ratios. The approach also empowers personnel to become more involved in finding solutions to existing and upcoming issues. The willingness of leaders and managers to incorporate nurses' ideas will improve the work environment.

My Personal Approach

My take on the issue leans towards the relational model because it involves all stakeholders when making decisions as leaders. Since the approach gives focus to inclusivity, empowerment, purposeful, ethics, and process-orientation (Uhl-Bien, 2006) as its primary factors, it is possible to work with others in a given organization. My approach to nursing staffing ratios would be interacting with the staff and gathering information on their job specialization. After that, the collected information will be helpful in making work schedules considering the nurses preferences and fostering job rotation. Through this, the work environment will be enjoyable and interesting for all parties hence, burnout is reduced and job stress minimized or abolished. The main thing that I would ensure is present in my workforce is high motivation levels to increase productivity in the health care setting.