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Nurse Staffing Shortage Issue
Nursing Staffing Shortage
One of the greatest challenges to the continued development of a high quality health care delivery system is the continued and frequently increasing shortage of qualified nurses active in the profession of nursing. The nursing shortage has waxed and waned for decades but seems to currently be in a state of constant shortage (Fox & Abrahamson, 2009, pp.235-236). In addition the research associated with low levels of staffing and increased adverse patient outcomes has also increased, stating rather starkly that staffing shortages increase the odds that poor patient outcomes are a more frequent result, worse in some settings than others and also dependent on skill mix (Clarke, 2008, p.8). The consensus has and will likely remain that the system must learn to utilize existing practicing nurses in a smarter way by adjusting policy and practice to the situation at hand, i.e. there is…
Clarke, S.P. (2008 Dec) Nurse staffing and patient outcomes: getting to the heart of the matter in research, practice, and policy. Pennsylvania Nurse.;63(4):8-9.
Fox, R.L. & Abrahamson, K. (2009 Oct-Dec) A critical examination of U.S. nursing shortage: Contributing factors, public policy implications. Nursing Forum. 44(4): 235-244.
Flynn, M. McKeown, M. (2009) Nurse staffing levels revisited: A consideration of key issues in nurse staffing levels and skill mix research. Journal of Nursing Management 17: 759-766.
Leadership and Management
In the medical field, the recent topic of debate relates to Nurse Staffing atios where many argue that governments need to intervene in setting minimum staffing laws. Currently, the only state that has enacted a law is California and nurse unions in other states are fighting for the implementation of the same in their workplaces. However, most of the attempts made by other states to implement California's strategy have failed since hospitals fail to participate (Schultz, 2013). The argument of many hospitals is that the laws do not give them the opportunity or ability to make decisions regarding staffing and at the same time be a financial burden (Schultz, 2013, par. 3). As seen from many nursing unions, hospitals have abused the system to the point of employing few nurses and yet the patients are ever increasing. Inappropriate staffing ratios influence the safety of patients, the satisfaction…
Aiken L., Clarke S., Sloane D., Sochalski J., Silber, J. (2002). Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction. Journal of the American Medical Association, 288: 1987-1993.
AONE. Mandated staffing ratios. Retrieved from http://www.aone.org/resources/leadership%20tools/staffingratios.shtml
Curtis, E., Vries, J. & Sheerin, F. (2011). Developing Leadership in Nursing: Exploring Core factors. British Journal of Nursing, 20(5): 306-309.
Hughes, R., Ginnett, R. & Curphy, G. (2006). Leadership: Enhancing the lessons of Experience, (5th Eds.). McGraw-Hill, Boston.
It is critical that NHAs are first qualified nurses, as their ability to relate to other nurses is essential to the organizational success of the nursing home ("Nursing home administrator jobs," 2011). Career paths for an NHA are rooted with education background and nursing experience. Although experience is necessary for being a successful NHA, a career path at minimum requires clinical licensing (Decker, & Castle, 2009).
The NHA is the management body over the facility, and their positions are in high demand. In the U.S. In 2008, approximately 17,000 nursing home administrators were responsible for the oversight of care for 1 million elderly adults and 1.3 million employees (Leister, 2009). Overseeing a large nursing staff, as well as vulnerable residents, are the daily demands of the NHA. The future of NHA field is concerning to researchers and professionals, as the number of licensed NHAs is on the decline. In Maryland,…
Decker, F, and Castle, N. (2009). The relationship of education level to the job tenure of nursing home administrators and directors of nursing. Health Care Management, 34(2), 152-160.
Leister, D. (2009). The vanishing nursing home administrator: stress and intent to leave.
Informally published manuscript, Capella University, Minneapolis, MI. Retrieved from http://gradworks.umi.com/3359575.pdf
Nursing home administrator jobs. (2011). Retrieved from http://www.nursinghomesjobs.org/nursing-home-administrator-jobs/
Nursing profession is among the oldest in history. Currently, there is much debate that surrounds the profession because of the need for more trained nurses. In recent years the nursing shortage has become a major problem for the medical profession and has resulted in poor patient care and slower patient recover. The purpose of this discussion is to provide an in depth examination of the nursing profession. We will discuss the current state of the nursing profession, including the causes for the shortage and the solution. We will also explore the status of the nursing profession in Australia. Let us begin our discussion by providing a comprehensive definition of what is means to be a nurse.
Definition of a nurse
According to the American Heritage Dictionary, a nurse is defined as " a person trained to care for the sick or disabled under the supervision of a physician." (American Heritage…
American Heritage Dictionary. (1982) Second Edition.
Bashford, A. (1997). Starch on the collar and sweat on the brow: self sacrifice and the status of work for nurses. Journal of Australian Studies, (52), 67+. Retrieved August 24, 2003, from Questia database, http://www.questia.com .
Nursing Schedules, Patient Outcomes
The title of this article suffices, although it could stand some improvement to make it even better. It certainly identifies the pivotal variables elucidated within this study, which include nursing scheduling, staffing, and patient morality. It is succinct enough. However, it does not allude to the study population at all. There is also a slight degree of redundancy in the title, as the focus of the research is more on the schedule concerns for nurses than for staffing in general.
The abstract is probably one of the better features of this research study and its ensuing write-up. It certainly is concise in its summary of the primary features of the report. It is also detailed in that it provides the problem, methods used, results, and conclusions -- although it does not not necessarily deploy those particular terms in doing so. It provides a high level synthesis…
Trinkoff, A.M., Johantgen, M., Storr, C.L., Gurses, A.P., Liang, Y., Han, K. (2011). Nurses work schedule characteristics, nurse staffing, and patient morality. Nursing Research. 60(1), 1-8.
Tailoring employment approaches to this group is significant to their continued retention. A lot of the literature suggests that older, more knowledgeable nurses are more likely to expand their work life when the following conditions are present:
Supportive and flexible work arrangements and practices like modified workloads, flexible scheduling options and a reduction in hours of work.
An organizational culture that encourages participation in decision-making and independence over practice.
Work recognition, support and positive feedback from management.
Ergonomically friendly, safe and useful work environments.
Access to professional development actions that target the needs of experienced nurses (An Ageing Nursing Workforce, 2007).
There have been some legislative efforts put into place to battle the current nursing shortage but they have not yet had a noteworthy impact across the nation. The federal Nurse einvestment Act contains promising measures, including inducements to augment the number of nursing faculty. A number of states have…
An ageing nursing workforce. (2007). Retrieved from http://www.ichrn.com/publications/factsheets/Ageing_Workforce-English.pdf
The truth about nursing. (2011). Retrieved from http://www.truthaboutnursing.org/faq/nursing_shortage.html
Staffing shortages in nursing are a consequence of poor nurse retention and nurse satisfaction. Being a nurse requires a lot of dedication, patience, and ability to keep updated in a constantly evolving world. When hospitals and other medical facilities have staffing shortages or shortages in qualified nurses, the healthcare delivery of that particular place dwindles. Nurses are the backbone of any healthcare facility.
Especially in recent times, nurses provide prescriptions, treatment protocols, and diagnosis when doctors are away or busy. This literature review is meant to explain such a phenomena and how it relates directly to nurse satisfaction and nursing retention. From here, the connection crosses over to nursing care and healthcare delivery as standards of practice. Things like arrhythmias will be viewed to understand how nursing shortages attribute to lower quality of care. Utilizing Polk's theory of esilience, this review will allow a look into performance improvement concerns and…
Bosch, R., Kirch, W., Theuer, J., Pittrow, D., Kohlhaussen, A., Willich, S., & Bonnemeier, H. (2013). Atrial fibrillation management, outcomes and predictors of stable disease in daily practice: Prospective non-interventional study. International Journal Of Cardiology, 167(3), 750-756. doi:10.1016/j.ijcard.2012.03.053
GIANFERMI, R., & BUCHHOLZ, S. (2011). Exploring the relationship between job satisfaction and nursing group outcome attainment capability in nurse administrators. Journal Of Nursing Management, 19(8), 1012-1019. doi:10.1111/j.1365-2834.2011.01328.x
Hudgins, T. (2015). Resilience, job satisfaction and anticipated turnover in nurse leaders. Journal Of Nursing Management, n/a-n/a. doi:10.1111/jonm.12289
Minhas, R., Vogelaar, G., Wang, D., Almansoori, W., Lang, E., & Blanchard, I. et al. (2015). A prehospital treat-and-release protocol for supraventricular tachycardia. CJEM, 1-8. doi:10.1017/cem.2014.53
739, p=0.009, e?=0.727). This study clearly highlighted that sleep shortage and work fatigue poses a threat to patient safety and that nurse self-care is warranted.[Dorrian et.al, (2006)]
Nurse Support Services
An earlier Australian study by Moore KA (2001) which observed 201 nurses working in three different hospitals had concluded that organizational restructuring policies and the consequent work overload was a high stressor for nurses and this was made worse by the poor communication style (top -- down approach instead of consultative style) that only contributed more to nurse burnout. [Moore KA, (2001)]. Given the high levels of occupational stress and burnout among nurses, it is important that nurse self-care interventions are prioritized. A recent literature review on the subject of work stress and coping methods among Australian nurses revealed that 'work load ', 'role conflict' and 'expression of aggression' were the three main stressors. The literature study also revealed 'seeking…
1) Linda H. Aiken, 'Image of Nursing Global Trends', retrieved Sep 4th 2010, from, http://www.fpnl.co.za/downloads/Presentations/Presentations/Prof%20Linda%20Aiken%20-%20Image%20of%20Nursing%20-%20Global%20Trends.pdf
2) Jillian Dorrian, Nicole Lamond & Cameron Van del Heuvel et.al (Oct 2006), 'A Pilot study of the Safety Implications of Australian Nurses' Sleep and Working Hours', Chronobiology International, Vol 23, Issue 6, pg 1149-1163
3) Lim J, BOGOSSIAN F. & AHERN K. (2010), ' Stress and coping in Australian nurses: a systematic review. International Nursing Review 57, 22-31
4) Moore KA, (2001), 'Hospital restructuring: impact on nurses mediated by social
Nurse Patient atios and Quality of Care
This study reviews the broad level of issues that surround the nurse/patient ratio: a critical shortage of trained and experienced nurses; increased political and fiscal demands from all sectors of society; rising costs internally and externally combined with a rising number of under-insured; and the conundrum of nursing ethics and the ability to foster excellence in care and patient advocacy. We note that there remains an issue about hiring more nurses -- where will these nurses come from if the nursing schools do not increase their recruitment efforts and broaden their curriculum. In addition, we note that the large majority of patients and stakeholders primarily want two things when admitted to a healthcare facility: better paid nurses and more highly-trained professionals who are satisfied with their vocation.
Modern nursing is, by necessity, a mixture of complex balance: patient care vs. staffing; procedures…
More Nurses Make the Difference. (February 2012). The Lamp. 69 (1): Retrieved from: http://search.informit.com/au/documentSummary;dn=045435426132502;res=IELHEA
Safe Nurse Staffing: Looking Beyond the Numbers. (2009). Vantage Point, CNA. Retrieved from: https://www.nso.com/pdfs/db/newsletters/Safe_Nurse_Staffing_-_Looking_Beyond_the_Raw_Numbers_20094.pdf?fileName=Safe_Nurse_Staffing_ -_Looking_Beyond_the_Raw_Numbers_2009-pdf&folder=pdfs/db/newsletters
Aiken, L. (2001). The Hospital Nurse Workforce: Problems and Prospects."Draft
For the Council on the Economic Impact of Health System Change. Retrieved from: http://council.brandeis.edu/pubs/hospstruct / Council-Dec-14-2001-Aiken-paper.pdf
It has been shown through research to be critical that the organization make the provision of support for the nursing staff in terms of their education and provisioning career support as well through making time and financial allocations to provide the necessary support system in which the nursing staff may advance their education and hence their career. (Cook, Horz & Mildon, 2006; paraphrased citing the work of: Robinson, (2001 and Hinshaw (2002) Additionally falling within these provisions of support are time and financial allocations for "research, special projects and publications (Kramer & Schmalenberg, 1988; as cited by Cook, Horz, & Mildon, 2006) the research fact sheet includes the necessity for organizations to "Support a 'bias toward action' (Kramer & Schmalenberg, 1988; as cited by Cook, Horz, & Mildon, 2006); and to "Enhance nurse-staffing rations (Hinshaw, 2002; as cited by Cook, Horz, & Mildon, 2006) and lastly to provide encouragement among…
Cook, a. Hiroz, J. And Mildson, B. (2006) Strategies and Outcomes Associated Magnet Hospitals Fact Sheet II of II - Nursing Health Services Research Unit 2006 September Online available at http://18.104.22.168/search?q=cache:wmmvrr7kMqUJ : www.nhsru.com/factsheets/Magnet%2520factsheet%2520Part%2520II%2520of%2 520II%2520-%2520Strategies.FINAL.pdf+Nursing+Leadership:+Healthcare +organizational+analysis&hl=en&gl=us&ct=clnk&cd=79.
Quality First: Core Values and Concepts for Quality Leadership (2006) American Health Care Association - Provider Guidelines. Online available at http://www.ahca.org/quality/qf_corevalues.htm .
Alexander, Jeffrey; Bloom, Joan; and Nichols, Beverly (1991) Nursing Turnover and Hospital Efficiency: An Organizational Level Analysis (1991) Institute of Industrial Relations University of California Berkley
Nursing Leaderships Role: 'Key' Factors in Organizational Analysis
" (Allen 2008) This means that nursing educators are also a key stakeholder.
Other stakeholders include healthcare facility administrators, corporate trustees and public office holders, who will often have entangled or competing interests relating to the profitability of operations and the political expediency of policy orientation. This will also be true of the various professional advocacy groups, nursing associations and lobby groups that will vie for influence in the discussion on any legislation relating to the nursing shortage.
A primary policy objective is to endorse any legislation that would aggressively enforce better recruitment of nursing students, better training of existing nurses, improvements in working conditions for nurses and mandated nurse-to-patient ratios. These objectives are underscored by evidence of the opportunities to save lives facilitated by mandated ratios. According to the text by Health Services Research (HSR) (2010), "key findings of the study reportedly include that 10-13% 'fewer surgical…
Allan, L. (2008). The nursing shortage continues as faculty shortage grows. Nursing Economics, 26(1), 35-40.
Berkowitz, B. (2012). The Policy Process. .
Cullen, E.; Ranji, U. & Salganicoff, A. (2010). Addressing the Nursing Shortage. Kaiseredu.org.
GovTrack. (2010). S. 1031: National Nursing Shortage Reform and Patient Advocacy Act. govTrack.us.
Clearly, since the focus of these articles are based on an institutional economics point-of-view of healthcare quality, a limitation of the study is that it does not take into consideration other variables that might influence the efficiency of nursing homes in providing quality healthcare. Among these unaccounted variables are the politics behind healthcare, specifically federal laws and policies related to the provision of healthcare. Apart from policies and laws, another variables unaccounted for in this study is a thorough look or analysis of the relational dynamics between patients and nurses, as well as other healthcare practitioners and professionals. This variable is vital in understanding the concept of quality healthcare because it provides an in-depth look at the 'experiential" dimension or perspective healthcare -- that is, healthcare quality as assessed by patients and healthcare professionals/practitioners.
In terms of socio-demographic characteristics, the literature collated regarding nursing home care does not…
Modern nursing has become a multi-disciplinary career that encompasses a number of roles and requires more expertise than ever before. In modern nursing, there are a number of stakeholders: patients, families, the community, insurance companies, governmental agencies, administrators, colleagues, staff and physicians. Healthcare solutions in the 21st century require a collaborate effort that remains focused on continual progress towards customer service satisfaction. The key is to understand the overall paradigm of healthcare and nursing management -- even through the terms "manager" and "leader" are often used interchangeably, they are not. In general, management organizes affairs, projects, and people -- therefore subordinates are involved. The manager is in charge, but not necessarily leaders in that they do as directed and then direct tasks. Leaders do not have subordinates, rather they have followers. Leaders motivate, challenge, coach and inspire vision, enable others to act and encourage (Carrroll, 2005; Kouzes and…
cute care facilities try to maintain low costs and employ quality nurses. Within this statement is a double standard. How can we have quality nurses and cut costs at the same time? This is where the skill mix comes into play. In the skill mix, there are Registered Nurses (RNs), Licensed Practical Nurses (LPNs), and unlicensed staff. If the lesser skilled staff free RNs they can be better able to perform their nursing duties and assessments. If acute care facilities can agree on an appropriate number of each type of staff member within the facility, they might be better able to accomplish safe patient outcomes while keeping costs down.
Determining nurse-to-patient ratios is a complex issue where one solution is not sufficient to cover all circumstances. The merican Nurses ssociation assembled a panel of nursing and health professionals to research appropriate staffing levels. The panel developed the following Matrix for…
Aiken and colleagues have been pioneers in studying nurse patient ratios and their relationship to patient outcomes.
Aiken, Sochalski, and Lake (1997) demonstrated that nursing presence, whether measured as RN ratios or as RN hours relative to other nursing personnel hours, is significantly correlated to mortality. When studying patient outcomes in specialized AIDS units,
Aiken, Sloan, Lake, Sochalski, and Weber (1999) found that at 30 days post admission, mortality rates were 60% lower in magnet hospitals, and 40% lower in dedicated AIDS units than in conventional scattered bed units. The researchers concluded that higher nurse patient ratios were a major factor in these lower
This is a legislator information sheet on nurse-patient ratios (as adapted from Aikan et al. 2010) for a busy legislator who will only have time to read bullet points:
The ratio of nurse patient is lower in California than in other states with nurses in CA having at least one patient less than nurses have in other states (as for instance in New Jersey and in Pennsylvania as mentioned in Aikman et al. (2010))
California nurses had lower nurse-patient ratio on medical and surgical units when compared to other states. The average amongst CA nurses was 2 patients less than those in other states.
The lower the nurse-patient ration, the lower the level of mortality amongst patients
When nurses' workloads paralleled those of workloads of Californian nurses, the following results occurred:
a. nurses' burnout decreased
b. nurses' job dissatisfaction decreased
c. nurses reported consistently better quality of care…
Abood, S. (2007). Influencing health care in the legislative arena. Online Journal of Issues in Nursing, 12(1), 12 pp.
Aikan, L.H., Sloane, D.M., Cimiotti, J.P., Clarke, S.P., Flynn, L., Seago, J.A., Spetz, J., & Smith, H. (2010, April 9). Implications of the California nurse staffing mandate for other states. Health Services Research. Retrieved from http://www.nursing.upenn.edu/chopr/Documents/Aiken.2010.CaliforniaStaffingRatios.pdf
Nursing Staff Levels Affect Patient Mortality
Managing unnecessary variability in patient demand to reduce nursing stress and improve patient safety.
Litvak, E., Buerhaus, P.I., Davidoff, F., Long, M.C., McManus, M.L. & Berwick, D.M.
Date of publication: June 2005
Examination of the operational issues affecting health care delivery, including patient driven peaks in demand and effects of nursing shortages or inadequate staffing on clinical outcomes for patients.
esearch question and/or hypothesis:
In this study the researchers propose that increases in adverse clinical outcomes occur when hospital nurse staffing is inadequate. Further the researchers suggest that increases in census rates increase the potential for serious stresses for patients and nurses working in the field. Lastly the researchers suggest that if hospitals reduce unnecessary variability of staff levels in a hospital, the hospital can reduce the probability of negative patient outcomes, improve safety for patients and improve the overall quality of care.
Aikan, L.H., Clarke, S.P., Sloane, D.M, Sochalski, J. & Silber, J.H. (2002 -- Oct).
"Hospital nurse staffing and patient mortality, nurse burnout and job dissatisfaction." JAMA, 288(16): 1987-93.
Halm, M., Peterson, M., Kandels, M., Sabo, J., Blalock, M., Braden, R., Gryczman, A.,
Krisko-Hagel, K., Larson, D., Lemay, D., Sisler, B., Strom, L., Topham, D. (2005 -- Sept). "Hospital nurse staffing and patient mortality, emotional exhaustion and job dissatisfaction." Clin Nurse Spec, 19(5): 241-5.
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…
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
ecause this is true, it is critically clear that the nursing leadership manager's role is one of a vital nature and that support for nurses in their role is the primary component that must necessarily be integral to leadership in nursing in dialysis units if the turnover of nurses is reduced to the lowest possible level. The nursing leadership manager's role is one that must proactively deal with burnout of these dialysis unit nurses instead of attempting to address these as they occur. Prevention is 'key' toward this end. As the demands grow for quality and competent nursing staff so does the need grow for competency in leadership nursing manager roles. ecause the dialysis unit nurse is very closely involved in their patient's care and because these patients are required to report for treatment several days a week for several hours a day the nurse's mental, physical and emotional state…
Aiken, L.H., & Patrician, P. (2000). Measuring organizational traits of hospitals: The Revised Nursing Work Index. Nursing Research, 49, 146-153.
Aiken, L.H., & Sloane, D.M. (1997). Effects of organization innovation in AIDS care on burnout among urban hospital nurses. Work Occupation, 42, 453-477.
Aiken, L.H., Clarke, S.P., Sloane, D.M., Sochalski, J., & Silber, J.H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction [Electronic version]. JAMA, 288, 1987-1993.
Aiken, L.H., Clarke, S.P., Sloane, D.M., Sochalski, J.A., Busse, R.A., Clarke, H., Giovanetti, P., Hunt, J., Rafferty, a.M., & Shamian, J. (2001). Nurses' reports on hospital care in five countries [Electronic version]. Health Affairs, 20, 43-53.
What causes staffing shortages in the field of nursing? Staffing shortages can be the result of many variables—turnover, unmet demand for services due to a lack of RNs, overwork (nurses calling in sick), and so on. Buchan (2002) identified the problem of staffing shortages in nursing as having an underlying cause in the nature of the health system itself as well as a social one: “Nursing in many countries continues to be undervalued as women’s work, and nurses are given only limited access to resources to make them effective in their jobs and careers” (p. 751). This is especially true in countries like Saudi Arabia, where nursing is viewed as woman’s work but is not valued highly by society—though it is recognized as being highly needed (Alyami & Watson, 2014). To address the issue of staffing shortages, the Institute of Medicine (IOM, 2012) has called for more nurses to…
The shortage of nursing staff remains a major challenge in the U.S. According to the American Association of Colleges of Nursing (AACN) (2014), the shortage is expected to be even greater in the next one decade or so. The shortage has been fuelled by factors such as reduced enrolment into nursing schools, increased retirement of the nursing workforce, as well as higher demand for healthcare due to population ageing and greater incidence of lifestyle diseases (AACN, 2014).
The shortage of nursing staff has severe implications for the nursing workforce. A high number of patients relative to nursing staff often translate to increased workload for nurses. Indeed, nurses continue to grapple with unhealthily lengthy work shifts, often stretching up to 12-13 hours. It is an issue that has sparked a great deal of debate given the connection between excessive workload and nurse outcomes. Literature extensively demonstrates that excessive workload as a…
Nursing Doctoral Business Proposal
The benefits of staffing Advanced Nurse Practitioners (ANP) as ANP Case Managers
A Nurse Practitioner (NP) is a registered nurse educated and certified to operate autonomously and collaboratively in an advanced and comprehensive medical responsibility. The practitioner has several additional roles under which they are to conduct diagnostic investigations, prescribe medications and undertake referrals to specialist clinical medications. esearch suggests that when nurses undertake prescription roles, it can result to increased efficiency, maximization of resources, and improve patient access to medicines and enable nurses to provide timely and extensive care packages (Cashin, Buckley, Newman & Dunn, 2009). In the advanced practitioner context, the roles that exist include the Clinical Nurse Specialist, the Certified Nurse Midwife, the Nurse Anesthetist and the Nurse Practitioner.
On the other hand, an Advanced egistered Nurse Practitioner (ANP) is also a registered nurse who possesses professional knowledge base, intricate decision-making skills and…
Cashin, J.A., Buckley, T., Newman, C., & Dunn, V.S. (2009). Nurse practitioner provision of patient education related to medicine. Australian journal of advanced nursing, 27(2), 12-
Carter, N. et al. (2010). The role of nursing leadership in integrating clinical nurse specialists and nurse practitioners in healthcare delivery in Canada. Nursing leadership, 167-185, doi:
Lowering the Nurse/Patient atio: A simple Step for Improving Care
Nursing is far from a static profession or discipline, and is in fact in a constant state of progression and change. Not all of these changes are necessarily for the better; increased healthcare demands, decreased abilities to pay for many patients and institutions, and a host of other factors can contribute to negative changes in the nursing work environment. When such factors arise it becomes all the more important for effective nursing researchers and practitioners to identify and advocate positive changes to the practice and the profession of nursing that can help combat the negative factors and ensure a consistent quality of care. In the current era of an ongoing shortage of nurses n the face of increasing demand and the approaching depletion of available nurses due to the aging population of nurses themselves, addressing the nurse-to-patient ratio…
Adomat, R., Dip, P. & Hewison, A. (2004). Assessing patient category/dependence systems for determining the nurse/patient ratio in ICU and HDU: a review of approaches. Journal of Nursing Management 12(5): 299-308.
Hassan, Z., Pryor, E., Autrey, P. & Turner, J. (2009). Hand Hygiene Compliance and Nurse-Patient Ratio Using Videotaping and Self Report. Infectious Diseases in Clinical Practice 17(4): 243-7.
Kane, R., Shamliyan, T., Mueller, C., Duval, S. & Wilt, T. (2007). The Association of Registered Nurse Staffing Levels and Patient Outcomes: Systematic Review and Meta-Analysis. Medical Care 45(12): 1195-204.
Communication is one of the most important aspects of nursing, as the case study of the student and the instructor indicates. The student nurse failed to communicate to the instructor the patient's abnormal oxygen saturation reading -- a reading that could have had very serious consequences for the patient. An entire week going by before this information is relayed to another nurse is highly unacceptable, considering how much emphasis is placed upon preventing medical errors from occurring (Cimiotti, Aiken, Sloane, Wu, 2012). Thus, it is imperative that student nurses appreciate the ramifications of failures in communication -- ramifications that could be potentially fatal for patients and, by extension, legally adverse for the health care facility. Stressing the crucial importance of nurse to nurse communication is vital to the well-being both of the health care organization and the well-being of the patient.
Importance of Nurse to Nurse Communication
Cimiotti, J., Aiken, L., Sloane, D., Wu, E. (2012). Nurse staffing, burnout, and health care -- associated infection. American Journal of Infection Control, 40(6): 486-490.
Dall'Ora, C., Griffiths, P., Ball, J. (2016). 12-hour shifts: burnout or job satisfaction?
Nursing Times, 112(12/13): 1-2.
Dall'Ora, C., Griffiths, P., Ball, J., Simon, M., Aiken, L. (2015). Association of 12 h shifts and nurses' job satisfaction, burnout and intention to leave: findings from a cross-sectional study of 12 European countries. BMJ Open, 5(9): e008331.
Nursing: Theory and Nursing Practice Issues
Theory and Nursing Practice Issues: Nursing
The modern-day staff nurse faces a variety of challenges in the work environment. These include inadequate staffing, the authority gradient, and issues related to changing models of care. The nurse leader has a duty to aid staff nurses working under him in addressing the challenges posed by these, and other issues facing the nursing profession. Leadership theories provide effective guidelines by which nurse leaders can address issues inherent in the nursing profession. In so doing, they accord staff nurses adequate opportunities to make meaning out of their lives. Leadership theories such as the situational leadership theory, the transformational leadership theory, role theory, and path-goal theory provides crucial insights from which nurse leaders could draw reference when seeking solutions for problems facing subordinate staff nurses. This text explores how leadership theory can be applied to nursing practice issues, and…
Barker, A. (1992). Transformational Nursing Leadership: A Vision for the Future. New York NY: Jones & Bartlett Company.
Department of Health and Human Services. (2010). Addressing New Challenges Facing Nursing Education. The Department of Health and Human Services. Retrieved from http://www.hrsa.gov/advisorycommittees/bhpradvisory/nacnep/reports/eighthreport.pdf
Early, G. (2005). Leadership Expectations: How Executive Expectations are Created and Used in a Non-Profit Setting. London, UK: OCMS Publishers.
Edmonson, C. (2010). Moral Courage and the Nurse Leader. The Online Journal of Issues in Nursing, 15(3), Manuscript 5.
Nursing Leadership and Management and Field Experience
Nursing Leadership and Management Field Experience
The problem identified concerns about patient safety and satisfaction arising out of shortage in nurse staffing. In the contemporary times, staffing has become a major issue concerning nurses, generally, and in this paper we attend to the issue in outpatient clinical settings. This problem of under-staffing of nurses has assumed significant importance and needs to urgent attention, as it has an influence on the satisfaction of the patients and more significantly their safety. An outpatient clinic cannot run if the patients have no desire or wish to go there. In addition, it becomes hazardous in risking the lives of the patients. The purpose of this research is to research the cause of understaffing on outpatient clinics together with the influences it has on patient safety and care. Additionally, the project encompasses examining the perspective of…
Gardner, J., & Walton, J. (2011). Striving to Be Heard and Recognized: Nurse Solutions for Improvement in the Outpatient Hemodialysis Work Environment. Nephrology Nursing Journal, 38(3), 239-253 15p.
Haas, S. A. (2016). Developing Staffing Models to Support Population Health Management and Quality Outcomes in Ambulatory Care Settings. Nursing Economic$, 34(3), 126-13
Halbesleben, Jonathon, Bonnie Wakefield, Douglas Wakefield, and Lynn Cooper. "Western Journal of Nursing Research." Western Journal of Nursing Research. 30(5) (2008): 560-577.
Kalisch, B., Tschannen, D., & Hee Lee, K. (2012). Missed nursing care, staffing, and patient falls. Journal of Nursing Care Quality, 27(1), 6-12.
eview On Nurses Shortage
The supply of professional nurses relative to the increase in demand for their services has been on a general decline over the years. As a career choice, nursing has been facing perennial shortage of professionals. Most healthcare organizations will affirm that their daunting tasks were recruiting fresh nurses and retaining the ones already in practice. The 2008 projections from the Bureau of Labor Statistics showed that the demand for professional nurses would increase from the then two million to three million, which represents sixty percent increment. In ideal situations, the number of those who have enrolled in nursing will be sufficient to supply the rise in their number. Nevertheless, this would not be the case if nothing were done to salvage the worrying trend of most students not graduating or resorting to other careers. According to Benjamin Isgur of PWHC Health and esearch Institute,…
American Association of Colleges of Nursing. (2009, September, 28). Nursing Shortage Fact Sheet. USA: AACN.
Buerhaus, P.I., Staiger, D., & Auerbach, D.I. (2009). The future of the nursing workforce in the United States: Data, trends, and implications. Boston: Jones and Bartlett Publishers.
Blakeley, J., & Ribeiro, V. (2008). Early Retirement among Registered Nurses: Contributing Factors. Journal of Nursing Management, 16(1), 29 -- 37
Cummings, G., et al. (2008). The Relationship between Nursing Leadership and Nurses' Job Satisfaction in Canadian Oncology Work Environments. Journal of Nursing Management, 16(5), 508 -- 518.
espect in Personal and Professional Consideration
espect is defined by one author as "a concept used to connote dignity, reverence, and regard" (Milton, 2005). This concept is not confined by what an individual does toward others, but also how they treat themselves and other treat them (Nursing World, 2010). The ethics involved speak mainly to the first part, how nurses treat patients, but there is also much ethics literature that suggests that people will give respect if they receive it and feel it for themselves. This short paper discusses how nurses view respect in its different forms and how these different forms compare and contrast.
The fact that respect for other stems from respect for self is not just a platitude that is thrown around to ensure that nurses remain mentally healthy; it is a statement with regard to proper ethics within the nursing community. It…
Hanford, J. (2001). Bioethics for nurses from a faith-based perspective. Ethics & Medicine, 17(2), 69-73.
Milton, C.L. (2005). The ethics of respect in nursing. Nursing Science Quarterly, 18(1), 20-23.
Nursing World. (2010). Code of ethics for nurse with interpretive statements. Retrieved from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthics forNurses/Code-of-Ethics.aspx
Paris, L.G., & Terhaar, M. (2010). Using Maslow's pyramid and the National Database of Nursing Quality Indicators ™ to attain a healthier work environment. Online Journal of Issues in Nursing, 16(1).
Staffing Shortage: Clinical Management Issue
The United Kingdom is facing a serious nursing shortage that seems destined to get much worse before it gets better (othcock, 2000). Clinical managers are finding it increasingly difficult to find qualified, experienced nurses and much interest is being given as to how to hire and retain nurses for hospital facilities.
It is important to understand why a nursing shortage exists. The nursing shortage is basically a product of supply and demand (othcock, 2000). The majority of nurses today are over the age of 30. The average practicing nurse is in his or her mid-40s. These nurses will begin to reach retirement age (65) around 2010, leading the nursing retirement wave, and half of the nurse workforce will be eligible to retire over the next two to three decades. In addition, numbers show that nursing school enrollments have been dropping. In a nutshell, this means…
McKee, Louise. (October 31, 1998). Nurse shortage threatens UK care. BMJ 1998;317:1176.
Rothcock, J. (January/February, 2000). How to Beat the OR Nursing Shortage. Outpatient Surgery Magazine.
BBC News. (September 5, 2001). 'My battle to find nurses'. Retrieved from the Internet at: http://news.bbc.co.uk/1/hi/health/1527176.stm .
BBC News. (October 31, 2002). Half of nurses 'consider quitting'. Retrieved from the Internet at: http://news.bbc.co.uk/2/hi/health/2375725.stm .
Technology-based teaching strategies can greatly accelerate the how both teaching and learning occur and therefore often reduce traditional issues and concerns faced by students and instructors. This approach changes the conventional way of thinking about how quality nursing programs are assessed and changes the levels of requirements to better suit student learning with better access to libraries, counseling and tutoring services, computing equipment, tuition, and financial aid to name a few.
But where this Associates Degree approach will benefit the profession most is in the healthcare system where it is needed most. New nurses will be better acclimated to the needs of sophisticated logging processes, medical billing and inventory as well as scheduling and other tasks now all handled via digital processing and computer. A modern day nurses are more technologically sophisticated, the overall patient care process also gets better as more available free time is offered back to the…
One need only read the newspaper "Classified" ads to realize that employers are trying many clever marketing tactics to attract prospective nurses into their organizations. Many are offering sign-on bonuses, extra benefits and other amenities to attract a limited supply of nurses. As both the general population and the elderly population grow, the number of nurses needed to care for them increases proportionally as well. The number of people choosing to pursue nursing as a career has been on the decline, mainly due to long working hours, low pay, high job stress and other factors. These factors will not resolve themselves if the nursing deficit continues to increase. In addition, graduate nurses find it difficult to enter the workforce due to their lack of experience and a shortage of mentors to teach them. The solution is simple, more nurses are needed, and soon. Novice nurses are fresh graduates who…
Durkin, Barbara.(2002) Reliving Hospital Mistake: Mom recalls overdose case February
24, 2002. Newsday, Inc.
Lang, Susan. (1996) Lack of nursing assistants is an impending crisis, says Cornell gerontologist. Cornell University. Cornell University. http://www.news.cornell.edu/releases/May96/nursingassistants.ssl.html . Accessed June, 2002.
National League for Nursing (NLN). (2000). Unpublished Data. New York, NY. http://nursing.about.com/gi/dynamic/offsite.htm?site=http%3A%2F%2Fwww.nln.org%2Faboutnln%2Fnews_tricouncil2.htm. Accessed June, 2002.
The overall health care profession is undergoing fundamental change due in part to new laws and regulations. These laws and regulations, although well intended may result in unintended consequences for the nursing profession overall. Turnover, in particular is a critical aspect of the health care profession. Turnover creates added costs to the firm, while also sacrificing both care and service. In the future, the role of a nurse will be fundamentally altered. For one, regulation such as the Affordable Care Act will result in an entire population of insured patients needing care. As such, the role of a nurse will ultimately be predicated on a more individualized basis with specialization in certain aspects. Reducing turnover therefore will now become paramount to overall viability of the healthcare firm. The population at risk, due in part to regulation, is now society as a whole. Nurses due in part to this…
eport on Conditions at Brighton and Sussex University Hospitals NHS Trust
The following report is based on extensive observation of the conditions for patients living at the Brighton and Sussex University Hospitals NHS Trust. While some patients received moderate care, overall, the quality of care in this facility was appalling. All patients -- all people -- deserve to be treated with dignity, and this was far from the case. The conditions were especially distressing given that in general they could be fixed or at least ameliorated relatively easily. Not all of the ills of old age or disability can be remedied, of course. Pain and fear will be present even with the best possible care. Given that this is true, all possible efforts must be made to reduce fear, anxiety, and pain to the greatest degree possible.
The facts that this report is based on were documented by…
Grant, P. (2010). Ethical lessons from the 'undercover nurse': implications for practice and leadership. Medical Ethics 36: 469-472.
Margaret Haywood's diary. Retrieved from http://news.bbc.co.uk/2/hi/programmes/panorama/4701651.stm .
Online bulletin. Retrieved from http://www.southerneditorial.co.uk/bulletin/july05/breaknews.htm.
Reasons for the substantive hearing of the Conduct and Competence. Retrieved from http://www.nursingtimes.net/Journals/1/Files/2009/4/17/haywood_NMCruling.pdf
Nursing is one of the most important professions in the world today. It involves not only physical healing, but also healing on a deeper level, where the care giving extends to the patient's environment and relationships to speed the healing process. The nursing environment then often also concerns politics and political involvement. As caregivers who operate in an inclusive environment and relationships, it is often necessary for nurses to be aware of political processes and policies. In this way, nurses can ensure an optimal environment for their patients and the healing process in general.
Des Jardin (2001) defines politics as "a means to an end." Nurses who are concerned with policy formation outcomes must involve themselves in politics. There are a number of ways in which this can be accomplished. Mainly, the author notes that nurses can affect the development of institutional policies by becoming involved in politics…
Des Jardin, K.E. (2001, Oct.). Political involvement in nursing education and empowerment. AORN Journal. Retrieved from: http://findarticles.com/p/articles/mi_m0FSL/is_4_74/ai_80159541/
("Summary of the LPN Declaratory Ruling, 2003)
The selected tasks and shared responsibilities of the licensed practical nurse define such nurses as responsible for being adequately prepared for the nursing responsibilities they assume because they have obtained the validation of completion of an approved preparatory program and have evidence of the successful completion of a nursing licensing examination. A registered nurse, however, as the title conveys, must be registered as a specific health care professional, within a professional organization, rather than merely possess evidence of having a license, and has passed the necessary coursework to obtain his or her master's in the nursing profession. The LPN's validation documents state that he or she has reached the achievement of mastering all theoretical and nursing skill competencies required of an entry level practical nurse in caring for individuals in any age group. It states that the licensed practical nurse has the sufficient…
Carter, Melodie R. (Jun 2004) "ABCs of Staffing Decisions." Journal of Nursing Management. Retrived 2 Sept 2005 at http://www.findarticles.com/p/articles/mi_qa3619/is_200406/ai_n9425719
Nurse Practice Act. (2004) Retrived 2 Sept 2005 at http://www.arsbn.org/pdfs/practice_act/2004/nursepracticeact_2004.pdf
Summary of the LPN Declaratory Ruling." (Feb 2003) Connecticut Nursing Journal. Retrived 2 Sept 2005 at http://www.findarticles.com/p/articles/mi_qa3902/is_200212/ai_n9305171
Bar code medication administration (BCMA) is one of the keys to minimizing medical errors in a manner consistent with evidence-based practice (Poon et al., 2010). However, universal embrace and utilization of BCMA remains stagnant. easons for resisting the transition to BCMA include nurse perceptions. Holden, Brown, Scanlon, & Tzion-Karsh (2012), for instance, found nurses reporting low perceived usefulness of BCMA in spite of the wealth of evidence supporting the technology. Perceived ease of use of BCMA was moderate, suggesting that it is mainly attitude factors preventing nurses from implementing BCMA in their institutions. When perceptions of the usefulness of BCMA increase, then compliance with BCMA standards can become more widespread. Any program that attempts to increase the utilization of BCMA must focus first on human factors including attitudes. This requires that all nurse leaders, as well as nurse educators, prepare advance practice nurses for using BCMA as a matter…
Duffield, C.M., Roche, M.A., Blay, N., & Stasa, H. (2011). Nursing unit managers, staff retention and the work environment. Journal of Clinical Nursing, 20(1-2), 23-33.
Roberts, B.R. (2013). Doctor of nursing practice: Integrating theory, research, and evidence-based practice. Clinical Scholars Review, 6(1), 4-8. doi: http://dx.doi.org/10.1891/1939-2095.6.1.4
According to the Joint Statement on Delegation produced by the American Nurses Association (ANA) and the National Council of State Boards of Nursing (NCSBN) "the N assigns or delegates tasks based on the needs and condition of the patient, potential for harm, stability of the patient's condition, complexity of the task, predictability of the outcomes, abilities of the staff to who the task is delegated, and the context of other patient needs" (Joint Statement).
In this particular case, it is easy to determine the frustrating aspects affecting Ms. W. It can also be a relatively simple matter to correct the situation in order to ensure effective care for Ms. . The nursing supervisor in this case would sit down with Ms. W. And map out a strategy for the patient's care, remembering of course that the key to successful delegation "depends on the quality of N and NAP working…
Joint Statement on Delegation, American Nurses Association and the National Council of State Boards of Nursing (NCSBN).
Potter, P.; Deshields, T.; & Kuhrik, M.; (2010) Delegation practices between registered nurses and nursing assistive personnel, Journal of Nursing Management, Vol. 18, Issue 2, pp. 157-165
Nursing Workforce Issues and Concerns
The article, "Nursing Workforce Issues and Trends Affecting Emergency Departments" by obinson and colleagues (2004) looks at the range of contemporary issues which directly impact the quality of care which is received in America's emergency rooms (E).The authors argue that looking at the most pertinent issues which impact the nation's Es is a sound way of taking the temperature of the general healthcare climate as a whole. Examining things like workforce issues, staffing issues and the ratios of patients to nurses can help all individuals involved get a better sense of the challenges that this professional arena faces when it comes to delivering a high quality of care. One of the strengths of this research article is that a host of strategies are engaged in to better improve the quality of care for patients while bolstering the number of qualified nurses and other staff team…
Robinson K.S.; Jagim, M.M.; Ray, C.E. (2004). "Nursing Workforce Issues and Trends
Affecting Emergency Departments" Retrieved from nursingcenter.com:
All managers would be full-time employees with benefits and salaries ranging between $35,000 to $40,000 with benefits and the opportunity for business equity.
In sum total, the facility would employ 30 nurses. The distribution of schedules and shifts amongst nurses would be shaped by what Ozcan & Hornby (2011) call activity measurement. According to Ozcan & Hornby, "as health service organizations began to emerge from the traditional approaches to determining staffing requirements, they increasingly adopted methods for determining staffing needs, which were based on some form of activity measurement (9). The staffing norms that emerged are all intended to be specific for the type and location of staff being considered." (Ozcan & Hornby, p. 212)
These are factors which would contribute to the breakdown in roles and responsibilities among the aforementioned 30 nursing professionals. Of these, 12 would be senior Registered Nurses earning roughly $35,000 per annum with benefits. These…
Malloch, K. (2006). Expert Nurse Estimation Patient Classification System (ENEPCS). Kathy Malloch & Associates
Ozcan, S. & Hornby, P. (2011). Determining Hospital Workforce Requirements: A Case Study. World Health Organization.
Nursing Fiscal Plan
The author of report is asked to assess a budget framework and compare what has happened to what is set to happen through the rest of the year and ascertain how best to close out the year. The author is asked to assess budget line item requests for the duration of the year as well as what expenses can and should be deferred until the new fiscal year. The budget projections that were accurate are to be labeled as well as what factors have caused the inaccuracies. As to the latter, it is asked if those inaccuracies were controllable or predictable.
The author is asked to do a bit of research on patient acuity symptoms and to ascertain the best approach for that process vis-a-vis quality patient care. The author is asked what strategies pertaining to motivation, communication, care delivery and so forth need to be implemented…
Brennan, CW, and BJ Daly. "Patient Acuity: A Concept Analysis." Journal of Advanced
Nursing 65.5 (2009): 1114-1126. CINAHL with Full Text. Web. 29 Apr. 2013.
Ekwall, A, M Gerdtz, and E. Manias. "The Influence of Patient Acuity on Satisfaction
With Emergency Care: Perspectives of Family, Friends and Careers." Journal Of
Nursing and Issue of Falls
Falls are responsible for considerable morbidity, immobility, and mortality among older persons, especially those living in nursing homes. Falls can occur in a home, community, long-term rehabilitation, or acute care Setting (Laurence Z.. et.al, 1994). The risk of falls can be related mostly to mobility status, exposure to hazardous environments and risk-taking behaviors such as climbing ladders for seniors living in the community setting. Factors for a fall in hospitalized adults are greatly influenced by acute illness that often has a marked, albeit temporary, impact on physical and cognitive function compounded by care provided in unfamiliar surroundings in the long-term care setting, the risk factors for falls are influenced by impaired cognition, wandering or impulsive behavior, use of psychotropic medications, incontinence and urgency, lack of Exercise, unsafe environments, and low staffing levels. Patient falls are serious problems
In acute care hospitals and are used as…
Anuradha Thirumalai, (1998). Nursing Compliance with Standard Fall Prevention
Protocol Among Acute Care Hospital Nurses. Retrieved September 26, 2012 from http://digitalscholarship.unlv.edu/cgi/viewcontent.cgi?article=1191&context=thesesdissertations&sei-redir=1&referer=http%3A%2F%2Fwww.google.co.ke%2Furl%3Fsa%3Dt%26rct%3Dj%26q%3Dnursing%2520compliance%2520with%2520standard%2520fall%2520preventionprotocol%2520among%2520acute%2520care%2520hospital%2520nurses%26source%3Dweb%26cd%3D1%26ved%3D0CCAQFjAA%26url%3Dhttp%253A%252F%252Fdigitalscholarship.unlv.edu%252Fcgi%252Fviewcontent.cgi%253Farticle%253D1191%2526context%253Dthesesdissertations%26ei%3Dg-NiUPW8CuLB0QW_r4DgAw%26usg%3DAFQjCNE6__5zNu8vjRxc-jIFBXbBfKVIng#search=%22nursing%20compliance%20standard%20fall%20preventionprotocol%20among%20acute%20care%20hospital%20nurses%22
Dykes, P.C., Carroll, D.L., Hurley, A.C., Benoit, A., & Middleton, B. (2009). Why do patients in acute care hospitals fall? Can falls be prevented? Journal of Nursing Administration, 39(6), 299-304. doi:10.1097/NNA.0b013e3181a7788a
Laurence Z. Rubenstein, Karen R. Josephson & Alan S. Robbins, (1994). Falls in the Nursing
Nursing Problem: Shortage of Nurses in Healthcare
The researcher works at Phoebe Memorial Hospital, where there is an extreme nursing shortage. Without an adequate amount of nurses, patient care and safety may turn out to be compromised, while nurses themselves may be stunned, upset, and dissatisfied. At the researcher's workplace, high patient-to-nurse ratios has been displaying that there is a lot of frustration and job burnout, which is linked to higher yield. At Phoebe, there is an inadequately staffed nursing force which has been discovered to play a negative part in patient results. In difference, studies have confirmed that hospitals like Phoebe Memorial Hospital with low nurse turnover are the ones that have the lowest rates of risk-adjusted death and severity-adjusted span of stay.
There is no very exact way of describing the concept of nursing shortage at the Phoebe Memorial Hospital Phoebe, but a report of this…
NURSING PROBLEM: SHORTAGE OF NURSES
They also need to research how much increasing the staffing levels will increase costs, and where funding will come from to cover those costs.
There is another aspect of the argument that must be addressed, as well. There is a nursing shortage, and even if staffing levels are increased, there may not be enough nurses to bring the staff up to the mandated levels, and then health care facilities would be in non-compliance. The union proposal to adopt mandated staffing levels should also address implementing new training and recruiting techniques to help health care entities meet the staffing challenges that a mandate would bring. Without the nurses and other trained professionals to work in these areas, staffing mandates do not do much good, and if the union wants to be successful, they must recognize that.
Atkins, Siegel & Slutsky. (2005). Making policy when the evidence is in dispute. Health…
Atkins, Siegel & Slutsky. (2005). Making policy when the evidence is in dispute. Health Affairs, 24(1), 102-113.
Feilding & Briss. (2006). Promoting evidenced-based public health policy: can we have better evidenced and more action? Health Affairs, 25(4), 969-978.
Wharam & Daniels (2007). Toward evidenced-based policy making and standardized assessment of health policy reform. JAMA 298(6): 676-690.
Nursing profession is a complex and important field of human care. In addition to the challenge of high workloads and long hours, nurses are also faced with the challenge of caring for persons who are often hostile or otherwise difficult to handle as a result of the conditions they suffer from. In such cases, nurses must provide care with professionalism and friendliness, regardless of their personal feelings. To be able to perform their work effectively over the long-term, it is vital for nurses to receive as much support as possible from their leaders and peers. In addition to leadership systems such as the transformational paradigm and the synergy model, there are also technical support systems that nurses can benefit most profoundly from.
The nurse's relationship to the information systems and technology department, for example, is of optimal importance. According to the Biohealthmatics.com Website (2010), this relationship is currently tragically underutilized…
Bigelow, B. And Arndt, M. (2005, Spring). Transformational Change in Health Care: Changing the Question. Hospital topics: Research and Perspectives on Healthcare. Vol. 83, no. 2.
Biohealthmatics.com (2010). Nursing Information System. Retrieved from: http://www.biohealthmatics.com/technologies/his/nis.aspx
Polifroni, E.C. (2007, Jan.). Guest Editorial: Ethical Knowing and Nursing Education.
Ryan, M.K. And David, B. (2003, Dec). Gender Differences in Ways of Knowing: The context Dependence of the Attitudes Toward Thinking and Learning Survey. Sex Roles, vol 49, Nos. 11/12.
The budgeting process at CHOMP is varied and requires that nursing managers and department heads keep a close eye on the daily activities of staff. It is described as a structured process that begins with planning meetings in August with the financial services department. The department director and the Vice President sign off on the budget in December, and then all budgets are reviewed by the President's Advisory Committee which includes the CEO and the Vice Presidents.
Department directors also have to sign off on their budget in November or December. Budgeting decisions are made by each nursing department. The budget is generally two to three million dollars, including wage and non-wage budgets. The budget is flexible. Nurses need to stay between 95-105% for productivity with an aim of 100%. The budget is averaged so on days when full time employees exceed the hours budgeted based on patient numbers they…
About Us." (2005). Available:
Schmaedick, G.L. (1993). "Cost-effectiveness in the nonprofit sector: Methods and examples from leading organizations." Westport, CT: Quorum Books.
Ward Jr., W.J. (1994). "Health care budgeting and financial management for non- financial managers." Westport, CT: Auburn House.
Moreover, I feel that patients must empower themselves to become healthier. New technologies and access to a wealth of information on the Internet is helping patients learn more about their bodies so that health care becomes accessible to everyone. As nurses, we need to listen to what the patient's priorities are. If the patient prefers alternative medicine to what the doctor recommends then we should be willing to let the patient choose as long as we inform them of all possible outcomes. Instead of expecting the health care system to rescue them from destructive lifestyle choices, patients need their nurses to counsel them on improving their eating and exercise habits and reducing stress. To reduce stress in our own lives, we nurses need to learn how to remain positive and life-affirming. At the same time, we need to learn how to address sensitive issues related to death and dying, grief…
Next, the amount of legal and ethical hoops that electronic health records must jump through is substantial and no doubt overwhelming to someone who is new to it. With the advent of laws like HIPAA and even general ethical concerns that are not technically codified in law, that can be a tall order for anyone to adjust to. Lastly, the work that these electronic health records people do is indispensable and it truly is a job oriented to serving the sick and infirmed even if there is a significant career and financial incentive to doing the job well.
In a day where health care is always in the headlines and on people's minds, electronic health records continue to evolve and improve and this shall also be true of people's mindsets and adeptness with technology as the generations move on. Even so, we are not yet at a point where…
Middleton, Blackford & Bloomrosen, Meryl & Dente, Mark a & Hashmat, Bill & Koppel,
Ross & Overhage, J Marc & Payne, Thomas H & Rosenbloom, S Trent & Weaver, Charlotte & Zhang, Jiajie. (2013). Enhancing patient safety and quality of care by improving the usability of electronic health record systems:
recommendations from AMIA. Journal of the American Medical Informatics
Association: JAMIA, . Retreived from http://www.biomedsearch.com/nih/Enhancing-patient-safety-quality-care/23355463.html
Of course, as Medicare beneficiaries increase because of the number of baby boomers, the Medicare program may adjust. However, current hospice figures demonstrate that only about twenty percent of all elderly individuals that die are enrolled in hospice programs.
Implementation and Monitoring
The needs of this new program will require thorough training and once implemented, precise monitoring. "When you approach a problem in the way your work group functions, you're implementing an organizational change. By taking a critical look at your process, and using some theories from organizational design, you can fix the problem -- and change your organization to make quality more likely." (Derby, 1999) The training will be a key because of the potential requirements associated with the Hospice program that may require completely new skill sets for the majority of our staff. The fact is that many of our nurses may not have acquired the necessary skills…
Derby, Esther. (2002). Modeling Organizational Change. Retrieved on February 12, 2005, at http://www.estherderby.com/writings/modeling.htm
Hospice Benefits and Utilization in the Large Employer Market. Ed. Beth Jackson, Teresa Gibson, Joline Staeheli. March 2000. U.S. Department of Health and Human Services. Retrieved on February 12, 2005, from http://aspe.os.dhhs.gov/daltcp/Reports/empmkt.htm.
Rubenfeld, M. Gaie, & Scheffer, B.K. (1995). Critical Thinking In Nursing. Philadelphia: JB Lippencott.
Social Security Administration. (1993) "Social security programs in the United States." Social Security Bulletin 12/22/1993.
Third, lack of attention to evidence-based practice can lead to inconsistent delivery of care services.
Evidence-based practice relates to almost every aspect of health care at every stage of a client's relationship with the institution. For example, evidence-based practice informs the types of questions asked during the diagnostic procedures and might even impact the diagnosis itself (Bennett & Bennett, 2000). Evidence-based practice impacts the methods by which infections are prevented (Cantrell, 2009). Evidence-based practices impact the extent to which nurses are empowered to make sound, safe, and effective decisions (Scott & Pollock 2008). Evidence-based practice has the potential to transform the structure of a health care organization like MMH. This is because evidence-based practice changes the hierarchical structure in the organization due to the increased responsibility of nurses for conducting their own research. Alternatively, evidence-based practice can be an extension of organizational change. Health care organizations reducing the hierarchical nature…
Artinian, B.M., West, K.S., & Conger, M.M. (2011). The Artinian Intersystem Model. New York: Springer.
Bennett, S. & Bennett, J. (2000). The process of evidence-based practice in occupational therapy: Informing clinical decisions. Australian Occupational Therapy Journal (2000), 47, 171-180.
Burns, N. & Grove, S.K. (2009). The Practice of Nursing Research. St. Louis, MO: Saunders.
Cantrell, S. (2009). Performing under pressure: Caring for decubitus ulcers. Healthcare Purchasing News. Aug 2009.
Human esource Standards and Staffing
The times when there was high vacancy rate in both public and private hospitals and clinics across the United State have come and gone, but the shortage of nurses is evidence. However according to 2002 report by the workforce commission of America Hospital Association, nursing shortage is reflects fundamental changes in population demographic. It shows clearly the demands of staffing in nursing professional (Mark W. Stanton, 2010). Therefore, what is staffing? And what are great challenges to staffing and requirement when doing staffing?
Staffing can be defined as the method of determining and providing the acceptable number and mix nursing personnel to produce a desired level of acre to meet the patients demand (Mike. ichard, 2009). It's purposely to provide the nursing unit with an appropriate and an acceptable number of workers in each unit to perform the nursing task as required. The unit requires…
Florence. Nightingale, (2010). International Council of Nurses
Krista Sheehan (2009) Ethical Standards of Nursing Education
Andragogy Nursing Education
1). This is a problem that needs to be addressed by adding more training to the budget. The problem is, most hospitals' budgets are already spread too thin. Therefore, hospital administrators need to work harder to find sources to help fund their activities.
Nurses have more power and responsibility than ever before to ensure that they are making honest reports about their patients. They may be in a rush to get home and not feel like entering all of the proper data into the computer. Or, they may take shortcuts in the use of other technologies. It is a nurse's ethical responsibility, however, to ensure honesty in all that she does. This includes 'blowing the whistle' when she sees that other nurses are not being honest or are misusing technology.
This can be extremely difficult, however, considering that nurses often suffer negative repercussions for 'whistleblowing'. A study conducted…
Birdi, K., Clegg, C.W., Patterson, M.A., Robinson, A., Stride, C.B., Wall, T.D., & Wood, S.J. (2008). The impact of human resource and operational management practices on company productivity: A longitudinal study. Personnel Psychology, 61, 467-501.
Bodenheimer, T., MacGregor, K., and Stothart, N. (2005). Nurses as leaders in chronic care. British Medical Journal, 330(7492), 612-613.
Carver, L. & Candela, L. (2008) Attaining organizational commitment across different generations of nurses. Journal of Nursing Management, 16 (8), 984-991.
Charette, R. (2006, June) EHRs: Electronic Health Records or Exceptional Hidden Risks? Communications of the ACM, 49(6),120.
Nurse Staffing Levels Through a Legislative Process
Despite arguments from critics who argue that mandated nurse staff levels will adversely affect the skill mix of nurses, the experiences of states that have implemented this solution clearly indicate that this alternative represents a timely approach to a nationwide issue. To determine the facts, this paper reviews the literature to identify the respective pros and cons of mandating nurse staffing through a legislative process, followed by a discussion concerning whether public reporting would be effective in achieving safe levels of staffing. Finally, a summary of the research and important findings concerning the pros and cons of mandating nurse staffing levels through a legislative process are presented in the conclusion.
eview and Discussion
Today, the low nurse-to-patient staffing levels in many states has been found to be threatening the quality of health care services and adversely affecting job satisfaction and morale levels of…
Furillo, J. & Mcewen, D. (2012, October 3). State-mandated nurse staffing levels lead to lower patient mortality and higher nurse satisfaction. National Nurses United. Retrieved from http://www.nationalnursesunited.org/news/entry/state-mandated-nurse-staffing-levels-lead-to-lower-patient-mortality-and-hi/ .
Glazer, G. & Alexandre, C. (2009, January). Legislative: The nursing shortage: A public health issue for all. Online Journal of Issues in Nursing, 14(1), 37.
Experience and good performance can result in promotion to better positions. In management, nurses have the opportunity to become assistant head nurses or head nurses and, from there, to assistant directors, directors, and vice presidents. Many of today's management-level nursing positions require a degree in nursing or health services administration.
As floor supervisors, a BSN graduate oversees care for an entire unit of patients while mentoring and training new nurses. Other RN to BSN degree holders put their liberal arts skills to work as entrepreneurs, running temporary nursing staffing agencies, home care services, and other health care-related small businesses.
In conclusion, by learning more about the nursing field, nurses discover new options for solving day-to-day problems in a way that can improve the practice environment (Barry, 2000). The BSN provides a solid foundation for specialized study to prepare for teaching new nurses, or being a resource nurse specialist.
Barry, Mark. (2000). More Letters: Entry Into Practice. AJN, American Journal of Nursing, Volume 103 Number 3, 69-70.
Leonard, Teresa. (March, 2003). RN to BSN -- advice on returning to school - registered nurses pursing baccalaureate degree. AORN Journal.
Mattera, M. (May, 2005). BSN on your terms. Registered Nurse, 63, 7.
Rosseter, R. (1997). As Demand for RNs Climbs, Bachelor's-Degree Enrollments
nurse to patient ratios within large clinical settings has been well document. The data gathered from this somewhat obvious problem has created avenues of research that delve into many different aspects of knowledge and understanding. The clinical problem discussed in othberg et al. (2005) is based on the idea that there are harmful patient to nurse ratios that negatively affect the way a hospital is successful in healing with patients. Their research article sought to find relationships between nurse to patient ratio data and cost effective safety interventions.
The authors of this research article established significance to this study by premising their argument on the fact that new state laws are mandating certain patient to nurse ratios. The reader should be interested in this study because the simple act of under or over-staffing a clinical setting is breaking the law. The authors wrote " some advocates propose that lower PTN…
Rothberg, M.B., Abraham, I., Lindenauer, P.K., & Rose, D.N. (2005). Improving nurse-to- patient staffing ratios as a cost-effective safety intervention. Medical care, 43(8), 785- 791.
First, nursing schools must be able to compete with clinical employers because there is little incentive to pursue a teaching career when first-year nurses can earn as much as their professors. Second, it will likely be impossible to eliminate the nursing shortage as long as American nursing schools are unable to accommodate thousands of qualified students annually. Finally, because FENs are likely to continue playing such a large role in American nursing, the accreditation system of their institutions or their degrees must be adjusted to ensure that FENs who intend to practice in the U.S. are fully prepared for their careers and not just trained in the technical aspects of nursing. Ultimately, the U.S. nursing shortage is probably capable of reversal, but not without a concerted effort in at least those specific areas.
Albaugh JA. "Resolving the nursing shortage: legislative issues." Urologic Nursing
(June 1, 2004). Accessed January 27,…
Albaugh JA. "Resolving the nursing shortage: legislative issues." Urologic Nursing
(June 1, 2004). Accessed January 27, 2010 from:
Gordon S., Buchanan J., and Bretherton, T. (2008). Safety in Numbers: Nurse-to-Patient
Need for Operating Room Nurse Residency Program
A Review of Literature
Previous studies have indicated that in other specialties, nurse residency programs have been largely successful in seeking to stem nursing shortages. However, very few studies have attempted to evaluate as well as assess the effectiveness and success rate of nurse residency programs in relation to operating room nurses. It is important to note that there is a looming crisis in the horizon in relation to the shortage of operating room nurses (Brown, Belgard, Washington, and Grueso, 2017). The effects this continued shortage could have on perioperative nursing could be dire. Towards this end, the relevance of assessing the relevance of nurse residency programs in seeking to address this concern cannot be overstated.
In the words of Zinn, Guglielmi, Davis, and Moses (2012), “as experienced nurses leave the workforce, new graduate nurses are the supply pipeline to acute care hospitals”…
Responsibilities of Nurses to Patients
Why is it important
The role of nurses has a direct implication on the patients. For example, nurses observe and provide direct care to the patients. The physicians give orders and thus are the role of the nurses to implement (Aiken et al., 2014). Often, the work of the physicians is not complete without the help of the nurses. The nurses are responsible for changing clothes and giving the medications to patients. Often, the patients are unable to do basic tasks, and therefore the roles of nurses become very important. Nurses keep medical records for the patients and therefore give medications to the patients in time and monitor their progress.
Another important role of the nurse is assessing the response of the patients to medications. Keep the records for the progress of patients is an invaluable practice. The records help the nurses to monitor how…
This really helped me to remember why it was I became a nurse, and demonstrates the true needs of patients that I was helping to care for and not simply trying to cure. These moments also made the more mundane and laborious elements of the job seem more worthwhile, and I was definitely feeling less stress and more satisfaction upon the completion of my shift than I had the previous day, when such patient connections has not seemed possible.
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…
Furukawa, M., Raghu, T. & Shao, B. (2010). Electronic Medical Records, Nurse Staffing, and Nurse-Sensitive Patient Outcomes: Evidence From the National Database of Nursing Quality Indicators. Medical Care Research and Review 67(11):77-89.
Heaven, C. & Maguire, P. (2008). Communications Issues. In Psychological Issues in Palliative Care, Lloyd-Williams, M, ed. New York: Oxford University Press.
Shever, L., Titler, M., Mackin, M. & Kueny, a. (2010). Fall Prevention Practices in Adult Medical-Surgical Nursing Units Described by Nurse Managers. Western Journal of Nursing Research 32(9): 17-24.
Simonazzi, a. (2009). Care regimes and national employment models. Cambridge Journal of Economics 33(2): 211-32.
It is necessary and important for any professional to understand the differences and applications of theory, practice and research. Within the nursing profession these concepts are highly regarded and the AACN has identified this process of distinguishing between as Essential #3. The purpose of this essay is to explain and indentify practice discrepancies that may adversely affect patient outcomes. This essay will suggest that leadership and purpose are necessary in order to truly understand the synthesis of these concepts.
Theories are simply theories and not laws and it is possible to accept theories as infallible. This is not ideal for the nursing profession. Theories are used to guide and model behavior and not replace it. Such ideas as the theory of gravity or the nuclear theory of the atom are often accepted as true fact but in reality there are many problems with those theories that prevent them…
Hall, L.M., Doran, D., & Pink, G.H. (2004). Nurse staffing models, nursing hours, and patient safety outcomes. Journal of Nursing Administration, 34(1), 41-45.
TITLER, M.G., Kleiber, C., STEELMAN, V., GOODE, C., Rakel, B., BARRY-WALKER, J.E.A.N., ... & BUCKWALTER, K. (1994). Infusing research into practice to promote quality care. Nursing Research, 43(5), 307-313.
The decade-old system that specifies least standards for staffing in nursing homes need to be restructured, the report says. The U.S. Department of Health and Human Services must call for nursing homes to have at least one N within the facility during all times. Based on the departments' 2001 report to Congress on minimum staff-to-patient ratios for nursing homes, the HHS should mention the staffing levels that increased with the number of patients. Central and state report cards on nursing homes should give information on levels of nursing staff, and measuring of staffing levels should be developed for hospital report cards. The healthcare facilities should avoid using nurses from temporary agencies to fill the vacancy. (Substantial Changes equired in Nurses Work Environment to Protect Patients from Health Care Errors)
Working for long hours on the part of the nurse's makes them fatigue since it decreases their energy and reduces their…
ANA Commends IOM Report Outlining Critical Role of Nursing Work Environment in Patient Safety" (November 5, 2003) Retrieved at http://www.nursingworld.org/pressrel/2003/pr1105.htm . Accessed on 11 February 2005
Hallmarks of the Professional Nursing Practice Environment" (January, 2002) AACN White Paper. Retrieved at http://www.aacn.nche.edu/Publications/positions/hallmarks.htm . Accessed on 11 February 2005
Statement of the American Nurses Association for the Institute of Medicine's Committee on Work Environment for Nurses and Patient Safety" (September 24, 2002) Retrieved at http://www.nursingworld.org/pressrel/2002/iom924.htm . Accessed on 11 February 2005
Substantial Changes Required in Nurses Work Environment
Many advocates of the move feel that lower patient to nurse ratio would lead to additional savings because it would reduce nurse turnover rate, lawsuits, complications and length of stay. Nursing unions in the state of California have asked for a PTN ratio of 3 to 1. The health association however agreed on 5 to 1 which sound more reasonable than the originally proposed 10 to 1. (othberg, 2005)
Patient to nurse ratio when it is too high can definitely adversely affect care. And with baby boomers aging and needing healthcare, we know that number of people looking for healthcare will continue to rise in the coming years. However staff shortage continues to pose a serious problem. And unfortunately, the problem doesn't always lie with cost control. While it is true that most of the problems with staff shortage can be attributed to hospitals cutting down their costs and hence…
Michael Rothberg, 2005. Improving Nurse-to-Patient Staffing Ratios as a Cost-Effective Safety Intervention Med Care 2007;45: 571-578)
Patricia W. Stone, PhD,* Cathy Mooney-Kane,
Nurse Working Conditions and Patient Safety Outcomes.