Nursing: Developing Organizational Policies and Practices

Nursing is a challenging profession where nurses take care of patients dealing with mental or physical illness. Nurses are the primary contact points for the patients since they are the ones who check patients' vital signs before giving them appointments to the physician or professional doctor. In this paper, the healthcare stressor would be discussed in detail so that its competing needs are determined, and a policy should be recommended to reduce the stressor. Moreover, the ethical considerations would also be debated for the policy application and its strengths and issues.
The two competing needs that impact nurse's burnout are increased demand for patient care and administrative procedures. The physical health problems in the form of anxiety, depression, insomnia, etc., adversely affect the nurse's health and cause burnout (Salyers et al., 2017). Nurses' functioning is negatively affected as they are forced to take frequent breaks due to tiredness, lethargy, staying absent from work, or exhibit signs of low commitment towards their job. These symptoms directly affect their performance, and patient satisfaction levels are low. These factors collectively become a source for national concern as it has become a national health stressor because nurses are an indispensable part of the healthcare workforce.
The relevant policy that can be developed for reducing healthcare stressor, which is nurse burnout, is adequate staffing. The patient-nurse ratio is a powerful strategy to reduce nurse burnout, as there is a reverse correlational relation between staff hiring and nurse burnout (Chen et al., 2019). Certain burnout constituents such as emotional fatigue, reification, and reduced personal achievement are the causes of nurses' less commitment towards the job. Emotional exhaustion was deducted to be contributing the most out of these components. The service quality becomes poor as satisfaction is regarded as a major benchmark for performance results. Customer retention can also be a part of policymaking since patients would return to the same clinic or hospital where they know they would be served with personalized care, and that is only possible if a dedicated healthcare workforce, prominently including the nurses, are active and determined towards their job. The policy should encompass the patient-nurse ratio adjustments in the form that there should be nurses who could attend to him within the day and night shifts for one patient. The increased number of patients would be attended by a sufficient number of nurses, conducive to maximized patient health outcomes. If there are fewer nurses and more patients, it can be dreadfully thought that the circumstances would be stressful for the nurse, resulting in errors, fatigue, absenteeism from work, etc.
The policy of adequate staffing and making adjustments for patient-nurse ratio has ethical implications such as having a sufficient number and assortment of staff in alignment with the hospital's recruitment plan, the presence of clinical screening and human resource indicators for ensuring competitive staffing that should be effective, and establishment of nursing principles and policies by the nursing executive for smooth functionality of procedures within the clinical setting (American Nurse, 2016). The ethics of adequate staffing also involves aspects like not harm the patient since it is the sole responsibility of the hospital's HR department that unskilled nurses should not be hired that might be inexperienced about patient safety. Public safety should not be risked at the hand of unsafe staffing as the nurses should be registered and licensed. It would be considered fraud and unethical on the hospital's part to have inexpert labor. Another ethical implication for staffing would incorporate sharing new and updated medical information with the nursing personnel to make them aware of the innovative technique for taking care of them. They would then be able to perform at their best and protect the patients from adverse health outcomes.
There have been some set standards for nurse ratios inside wards in the US and Australia that require minimum staffing levels based on the ward type (Griffiths et al., 2016). Benefits have been deduced from this policy that could induce fewer hospital staff costs for new nurse staff hiring. However, there have been debates about increased nurse staffing so that nurse fatigue and burnout could be reduced and the patient satisfaction level should be improved. The net economic benefits of increased nurse hiring would be automatically offset by improved patient satisfaction and retention. This could be considered its strength and a challenge since the HR professionals have to think of a perfect mix of skilled nurse practitioners and the amateurs ones who are hired at low costs. This can prove a cost-effective approach at a cross-sectional level within carious hospital wards by considering the baseline staffing needs. The uniform rationing of the patient with the patients should be managed efficiently.
The balance of competing needs of resources, workers, and patients should be maintained for the medical center's structured functionality. Resource allocation and rationing play a crucial part in adequate nurse staffing and maintaining a balanced patient-nurse ratio for reducing nurse burnout. The meaning of rationing in a healthcare setting can be inferred as the reasonable action-taking about medical interventions for addressing scarcity that might affect patient health services (Scott et al., 2018). Rationing should justify the resource distribution so that the overall allocation's ethical acceptability is observed, and the restriction should not raise ethical and moral concerns. The healthcare authorities should be able to reason if there is a restrictive provision of staff. It should be morally unjust so that the overall outcomes, especially in terms of patient satisfaction and health results, should be satisfactory. The resource distribution should be done so that procedural fairness is maintained and the demands are met by optimizing the outcomes so that the goal of equal distribution of resources across all hospital departments should be achieved. The resources, workers, and patients' competing needs would be balanced and justified based on cost-effectiveness. Still, the distinction should be made if the restrictive allocation and rationing of nursing staff hurt patients' health outcomes. It would bring ethical considerations to healthcare hiring staff and their policies. There are recruitment pressures in staff shortages that have raised international eyebrows; however, it does not minimize the role of skilled nurses, even in staff shortages, so that they are fully attentive towards the patient's needs, no matter how much pressure this poses on them mentally and physically. The resources become scarce in such a situation where nurses are forced to meet the patient's expectations, even if they make errors in prescribing wrong suggestions or medications. Therefore, it puts the nurses under intensified stress to prioritize patients' needs even in times of scarcity.
Healthcare policymakers and staff hiring specialists should consider adequate staffing to reduce nurse burnout to observe less absenteeism or job quittance. Ethical concerns would be included in adequate staffing so that resource allocation of proficient, registered, and licensed nurses and proper rationing should amplify net economic benefit for the hospitals and the patients.
References
American Nurse. (2016, April 7). A conversation about the ethics of staffing. Retrieved from https://www.myamericannurse.com/conversation-ethics-staffing/
Chen, Y., Guo, Y., Chin, W., Cheng, N., Ho, J. & Shiao, J. (2019). Patient-nurse ratio is related to nurses' intention to leave their job through mediating factors of burnout and job dissatisfaction. International Journal of Environmental Research and Public Health, 16(23), 4801. DOI: 10.3390/ijerph16234801
Griffiths, P.D., Ball, J.E., Drennan, J., Dall'Ora, C., Jones, J., Maruotti, A., Pope, C., Recio, A. & Simon, M. (2016). Nurse staffing and patient outcomes: Strengths and limitations of the evidence to inform policy and practice. A review and discussion paper based on evidence reviewed for National Institute for Health and Care Excellence safe staffing guideline development. International Journal of Nursing Studies, 63. DOI: 10.1016/j.ijnurstu.2016.03.012
Salyers, M.P., Bonfils, K.A., Luther, L., Firmin, R.L., White, D.A., Adams, E.L. & Rollins, A.L. (2017). The relationship between professional burnout and quality and safety in healthcare: A meta-analysis. Journal of General Internal Medicine, 32(4), 475-482. DOI: 10.1007/s11606-016-3886-9
Scott, P.A., Harvey, C., Felzmann, H., Suhonen, R., Habermann, M., Halvorsen, K., Christiansen, K., Toffoli, L. & Ppastavrou, E. (2018). Resource allocation and rationing in nursing care: A discussion paper. Nursing Ethics, 26(5), 1528-1539. https://doi.org/10.1177/0969733018759831