Open Systems Theory Nursing Staff Shortages

According to Meyer & O’Brien-Pallas (2010), to address organizational problems such as staff shortages, a systemic perspective is demanded, one which integrates “clinical, organizational, financial, and outcome variables from a nursing perspective” (p. 2829). All too often, staffing is merely addressed from an individual, closed systems perspective. For example, nurses are encouraged to join an organization through the use of an introductory bonus, or to remain with a retention bonus. This only skims the surface of the problem, which is rooted in deeper and more systemic problems within the healthcare system, including a shortage of nursing faculty, high levels of nursing burnout, and low levels of support for nursing and nurses on an administrative level.
The Problem: Nursing Shortage
Within my own institution, there is a clear nursing shortage. Nurses are being forced to care for patients at a higher ratio of caregivers to patients, even though this has been shown to result in higher rates of medical errors, due to nursing fatigue. There is also the issues of horizontal violence, or nurses bullying other nurses, which can be exacerbated due to tensions on staff. Looking through the problem through a systems perspective of inputs, throughput, output, cycles of events, and negative feedback, according to Meyer & O’Brien-Pallas (2010) can be useful. Inputs, in the case of studying a human relations issue, take the form of both patients and nurses; it can also include institutional personnel outside of the immediate environment. With this problem, addressing input-related problems by increasing staff numbers is critical, although the other elements of open systems theory must likewise be addressed.
Open System Concepts: Problems and Solutions
For example, according to the American Association of Colleges of Nursing (AACN) (2017), “faculty shortages at nursing schools across the country are limiting student capacity at a time when the need for professional registered nurses continues to grow” (par.1). Nursing schools are actually turning away qualified students because there simply are not adequate amounts of faculty to educate all students who wish to be nurses. Without being able to expand the available roster of openings to educate new nurses, the prospects for improving the shortage seem dim. On an institutional level, organizations can make it easier for nurses on staff to teach at hospitals. They can also offer tuition reimbursement to make it cheaper for students to study and continue on to baccalaureate level preparation, in exchange for agreeing to remain at the institution for a specific amount of time. These types of remedies target inputs of human resources more holistically.
Throughput in regards to the nursing shortage includes services or interventions. For example, new nurses may be driven away due to experiencing fatigue, overwork, and horizontal violence triggered by poor work conditions. The institution can improve on this aspect of care by targeting such issues in a meaningful way; attempting to reduce the most burdensome overscheduling with fair, clearly defined policies about who must work overtime and holidays and when. It can also engage in a review of services and interventions to determine which ones are the most difficult for nurses to provide. Output or patient volume must likewise be managed with a focus on the human factors and stressors of nursing. For example, nurses during busy times in the ICU may be given more than one unstable patient to monitor at a time; this leaves the nurse open to stress and the risk of making more errors.
Viewing the problem as a result of systems or cycles in the wider environment is, of course helpful, to understand how and why the problem cannot be remedied in a single day. Of course, more aggressive recruiting of new nurses from nearby campuses is important as is communicating to older nurse that engage in bullying that such attitudes are unacceptable. But constructive negative feedback is often necessary to initiate change, as people are unwilling to change unless there is a sense of urgency. But if there is negative feedback, in the form of poor performance reviews, it must be in the form of measurable data, such as patient satisfaction or poor retention of staff.
Change Plan
The change plan to address the nursing shortage must therefore consist of both micro and macro level changes. On a micro level, this includes making working conditions more pleasant (reducing unfair shift burdens and orienting all nurses so they are aware of what constitutes horizontal violence, know how to report it, and know how to avoid perpetrating it themselves). On a macro level this includes supporting continuing and future nursing education financially and with appropriate institutional policies. It may also include encouraging nurses to engage in professional collaboration with universities and associations to take proactive actions to reduce the faculty as well as the overall nursing shortage.
Professional, Mission, and Values-Based Nursing Standards
One helpful aspect of addressing the nursing shortage on an institutional level is that it is so widespread, and professional organizations such the AACN (2017) have come to set standards and guidelines to address it. For example, the AACN (2017) noted that it has made it a priority for nurses to attain at least baccalaureate -level, and if possible, master’s-level educations, due to evidence based research that education results in superior patient care, yet it found that in 2016,  9,757 qualified applicants were turned away programs at the master’s level; 2,102 at the doctoral programs. The organization called upon both healthcare institutions and educational institutions to remedy this issue by increasing faculty salaries and enrollment.
The AACN has also kept track of evidence-based research on the nursing shortage pertaining to both nurse and patient safety. For example, the AACN reports that in the journal BMJ Quality & Safety (2013) higher patient loads are directly correlated with higher hospital readmission rates; the American Journal of Infection Control (2013), higher patient-to-nurse ratios were strongly correlated with both nursing burnout and infections (“Nursing Shortage Fact Sheet,” 2018). Even as much as a single patient added to a nurse’s burden of patient care increased infection rates.
Conclusion
It is commensurate with the mission of my institution to promote patient welfare and safety. The demand to cut costs also makes lowering readmission rates a serious priority. Upholding the mental and physical welfare of staff, as well as compensating nurses fairly is likewise essential. An open systems approach means working with surrounding universities to enable nurses to engage in fruitful relationships, both working as fairly compensated assisting faculty to increase enrollment of qualified applicants as well as supporting the tuition of nurses wishing to continue their educations. It also means instituting fair policies regarding staffing, so nurses are not forced to shelve professional concerns or endure excessive fatigue to give the patients the care they deserve. Finally, it means creating a friendly workplace environment where nurses are subjected to fair and unbiased performance reviews and are oriented in appropriate behavioral expectations to other nurses as well as patients.


Resources
Meyer, R. M., & O’Brien-Pallas, L. L. (2010). Nursing services delivery theory: An open system
approach. Journal of Advanced Nursing, 66(12), 2828–2838. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3017742/
Nursing faculty shortage. (2017). American Association of Colleges of Nursing (AACN).
Retrieved from: http://www.aacnnursing.org/News-Information/Fact-Sheets/Nursing- Faculty-Shortage
Nursing shortage fact sheet. (2017). American Association of Colleges of Nursing (AACN).
Retrieved from: http://www.aacnnursing.org/News-Information/Fact-Sheets/Nursing- Shortage