Nurse staffing reductions and communication challenges in hospital settings

Leadership Nursing

Question 2 Response:

Given the fact that these nurses lost their positions due to budgetary constraints, it seems unlikely that other units within the same hospital would have adequate funds to retain these nurses unless there had been a major program shift -- i.e. one department was increased in size and another unit's budget was decreased as a result. This would lead to the creation of more permanent positions and a need for nurses within the expanded unit, and certainly the hospital ought to look to its own staff for reorganization rather than terminating and hiring. This is not really the case, however, and it is hoped that administration is efficient and effective enough to allocate funds to units as befits their needs; if nurses are being cut from one unit for budgetary reasons, there should not be extra room in other units' budgets to hire nurses, and thus there is little likelihood that these nurses will be able to find short-term employment in the hospital after being let go form their own departments.

This does not mean that other short-term employment opportunities are not available while the nurses wait for or engage in longer-term solutions. A number of businesses and institutions hire nurses on a short-term basis for rotating care to patients, many of whom require short-term in-home care due to a recent injury, surgery, or other impermanent debilitation (Simnoazzi 2009). Nurses can also attempt to seek such short-term positions on their own, and if there are not other contractual obligations barring the hospital from recommending their former nurses to patients in need of such care, this could be the basis of an effective limited partnership. Nurses that are able to relocate have even more opportunities in this regard, and will also be able to locate suitable long-term employment sooner.

Day 1

On my first day in the medical-surgical unit, the importance of establishing a clear communications network in high-paced nursing situations quickly became apparent. At times it was very difficult to determine precisely what was necessary to be done, and at other times the same information was communicated by several individuals in a time-consuming and somewhat frustrating manner. While it is of course necessary to ensure that all necessary and relative information is made available to all nurses in the unit on an ongoing basis, to ensure current knowledge and appropriate action, the inefficiencies of this process within the unit seemed to make for a great deal of extra work in communicating that was not entirely necessary. Research has shown that such communication problems can contribute significantly to work stress and burnout among nurses, and it was certainly easy to see why (Heaven & Maguire 2008). Because this was my first day, I did not feel it was appropriate to comment on this situation, but as I begin to feel more comfortable and to have a stronger idea of what is necessary, I definitely plan on approaching the lead nurse.

Day 3

Though falls from hospital beds are more common than might be expected, a fall that occurred in the medical-surgical unit was deemed worthy of calling a meeting of available nursing staff to review fall prevention procedures and stress the importance of maintaining regular and frequent rounds as well as sitting with fall-prone patients whenever possible, even in short and frequently rotating shifts, to ensure that movement can be facilitated when desired. One nurse actually brought up the use of restraints, which were acknowledged to be available as a measure of last resort but which were not to be used except in extreme cases and with the permission of the lead nurse. This is in keeping with current research on the subject, which was actually referenced by the point nurse in this instance, especially when stressing the preferred techniques for mitigating risks of falls and the lack of desirability of the use of physical restraints (Shever et al. 2010). This experience was highly educational both in its specifics and in seeing the dynamics of practice and the influence of research in a practical setting.

Day 4

During a brief one-on-one instigated by the lead nurse during my shift today, I broached the issue of the communication issues I had noticed in the unit. I tried to approach the matter very nonchalantly and in an inquisitive rather than observational mode, but to my surprise the lead nurse cut right to the heart of the issue and acknowledged that there was no really clear or concrete communications system in place, and essentially shrugged off the matter by explaining that the rate at which the actual individuals on the nursing staff changed it would be counter-productive to develop any "rigid, complex communication network." It seemed to me that it would not be all that time consuming to develop a simple hierarchy b which information is distributed, nor would it take nurses new to the unit long to become acquainted with this system, but it was clear such suggestions would have gone unheeded. I was rather disappointed at this display of leadership.

Day 5

Attempting to access part of the hospital database to input information regarding a patient, I found myself increasingly frustrated with the EMR system that had been put into place. Apparently this was a common complaint among the staff; the program was far from intuitive and often froze while trying to complete even relatively simple tasks. I later found that many such systems had been negatively associated with quality of care at many institutions following their implementation, which certainly made me wonder about this particular hospital (Furukawa et al. 2010).