Nursing Risks and How to Mange Them

¶ … high turnover of nursing personnel. The three main risks associated with this issue are 1) poor quality care, 2) unhealthy work environments, and 3) negative financial performance.

The first risk -- poor quality care -- is the result of a high turnover of nurses, which can lead to inadequate staffing. When there are two few nurses on any given shift, patients receive less care and attention because the nurses on shift are stretched in too many directions at once. Patients are required to wait longer, especially in the ER, which can be problematic for patients requiring immediate care. Such is what happened to Edith Rodriguez at King-Drew hospital in L.A: she died in the ER lobby waiting area because of insufficient attention given her by an over-stretched staff (AP, 2007).

The risk management solution to this first issue is to develop a temporary pool of nurses who can work on an as-needed basis. This allows for a contingency of nurses who can fill the gaps in shifts that result from high nursing personnel turnover. Another intervention that can help to mitigate risk is to develop standard operating procedures and a risk management plan that addresses emergency cases. With such a plan in place, nursing personnel can properly assess and handle situations so that the sort of incident described at King-Drew can be avoided.

This risk management solution can be measured and evaluated by tracking the number of patient injuries and deaths that occur prior to and following the implementation of the strategy. A decline in the number of patient injuries and deaths with the stop-gap policies in place would indicate that the strategy is working effectively for the hospital.

The second risk -- unhealthy work environments -- can occur as a result of high nursing turnover as nurses who are filling in for missing personnel become fatigued, stressed, and inefficient. The rate of incidence of injuries such as needlestick can increase as a result of fatigue (Ihan et al., 2006; Smith et al., 2006; Geiger-Brown et al., 2010). Injuries and stress can lead to hostility in the workplace environment, which can impact relations between nurses and patients and lead to health issues for both nurses and patients.

The risk management solution to this issue is to devise and implement focus groups for nurses to allow them to voice their concerns in specific areas of the workplace. This strategy will include allowing nurses to be part of the decision making process on committees that regulate and oversee workplace activity. A second strategy to be implemented is the regulation of the nurse to patient ratio which will ensure that nurse overwork and exhaustion is reduced. A third strategy is the setting of a maximum number of hours of work per week and per day, which will greatly mitigate the risk of nursing fatigue the lower that maximum is set (Geiger-Brown et al., 2012). A fourth and overall strategy to be implemented is the plan to train nurse managers in cultivating and maintaining a productive work environment.

Measurement and evaluation of this risk management solution will be performed by tracking employee satisfaction, noting their intentions to leave the organization (if they are manifested), and recording the actual turnover rate data prior to and post-implementation.

The third risk -- negative financial performance -- results when hospitals that experience high turnover of nursing personnel are forced necessarily to spend more money on recruitment, retention and training. This expenditure subtracts substantially from monetary resources allocated to the various sectors of hospital performance and will create inevitably a budget gap that has to be filled by appropriating funds from some other sector in the hospital's budget. Simultaneously, the hospital sets itself at risk for higher rate of incidence of malpractice suits brought about as a result of poor quality care, which has been described above. Malpractice lawsuits could further drain the resources of the hospital at put it in deep financial stress.