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...
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…
