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Nurse-to-Patient atios in Illinois
For many years the ongoing nursing shortage has required nurses to work longer hours and care for more patients, causing many of them to make fatal and near-fatal mistakes on the job that could have otherwise been avoided. Illinois has attempted to remedy this situation by enacting The Nurse Staffing by Patient Acuity Law on August 24, 2007 ("The Nurse Staffing by Patient Acuity Law," 2012). ather than setting hard numbers for specific nurse to patient ratios, the law instead requires hospitals to enact staffing plans recommended by a committee of their nurses that is comprised of at least 50% direct-care staff nurses. The plans created by these committees must be reevaluated semi-annually so that their effectiveness can be gauged. The nurses on staff are responsible for continually monitoring the plans that have been put in place to ensure that patient needs are properly…
Aiken, L.H., Sloane, D.M., Cimiotti, J.P., Clarke, S.P., Flynn, L., Seago, J.A., Spetz, J., & Smith, H.L. (2010). Implications of the California nursing staff mandate for other states.
Health Services Research, 45(4), 904-921.
Nurse staffing by patient acuity law. (2012). Retrieved September 16, 2012, from:
Dialysis organizations would be another opponent to the change due to the cost. aising the costs of treatment might be necessary to hire new nurses. Dialysis clinics, because of their small size, often have fewer resources than large hospitals and the increased cost of wages of new hires would place a an additional stress on the unit's already limited budget, perhaps if estimates by the American Hospital Association are correct, as much as $270 million dollars a year.
Elaborate on potential negatives that individuals or groups might bring up in discussions and how you would counteract this.
Some nurses, despite their generally strong feelings in favor of the proposal because of their workload, may fear having to take a pay cut, or have overtime hours cut, because of the increased costs and influx of new nurses. Administrators may adopt a different type of change-resistance technique, and simply assert that it…
The American Nurses Association. (2008). ANA.
Retrieved Oct 9, 2008 at http://www.nursingworld.org/
In our hands: how hospital leaders can build a thriving workforce. (May 2007).
American Hospital Association, Commission on Workforce for Hospitals and Health
Nurse-Patient atio on Care Quality
Nurse Patient atio
The Impact of Nurse to Patient atio on Healthcare Quality
The Impact of Nurse to Patient atio on Healthcare Quality
It would be hard to understate the importance of a high nurse to patient ratio (NP) for patient and staff safety, as well as quality of care. While there are a number of different nursing factors that can influence these outcomes, including nursing education, experience, skills mix, contact time, frequency of interactions, and type of inpatient unit, the NP has been the focus of considerable interest in part because it can be easily quantified (reviewed by Sidani, Manojlovich, and Covel, 2010). This review will examine the empirical evidence for the importance of NP in determining patient and staff safety, as well as quality of care. Towards this goal, research articles obtained from the Library of Medicine will be reviewed in detail and…
Aiken, Linda H., Clarke, Sean P., Sloane, Douglas M., Sochalski, Julie, and Silber, Jeffrey H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. Journal of the American Medical Association, 288(16), 1987-1993.
Despins, Laurel A., Scott-Cawiezell, Jill, and Rouder, Jeffrey N. (2009). Detectiion of patient risk by nurses: A theoretical framework. Journal of Advanced Nursing, 66(2), 465-474.
Duffield, Christine, Diers, Donna, O'Brien-Pallas, Linda, Aisbett, Chris, Roche, Michael, King, Madeleine et al. (2011). Nursing staffing, nursing workload, the work environment and patient outcomes. Applied Nursing Research, 24, 244-255.
Institute of Medicine. (2000). To Err is Human: Building a Safer Health System. Online: National Academy Press. Retrieved 18 Apr. 2013 from http://www.iom.edu/Reports/1999/To-Err-is-Human-Building-A-Safer-Health-System.aspx.
Staffing in Nursing
Staffing and Other Nursing Issues
The main topic of this paper is staffing related to the field of nursing, here it is very important to realize a correct balance between the demand of nurses and available nurses at any medical facility. Since the duty of any medical professional like a doctor requires much assistance from a subordinate such as nurse therefore it is vital for any organization to fulfill this requirement in a way that best suits all parties involved especially the patients. This paper will focus on many different aspects related to the issues of staffing and will also shed some light on some of the difficulties of keeping a low or high number of required nurses.
The emphasis here would also be on many different aspects related to staffing such as the economical perspective, the quality perspective of any medical organization and so on. The…
Aiken, L.H., Clarke, P.S., Sloane, D.M., Sochalski, J. Silber, J.H. (2002). Hospital Nurse Staffing and Patient Mortality, Nurse Burnout and Job Dissatisfaction. Original Contribution, Vol 288, 16.
Cook, A., Gaynor, M., Stephens, M., Taylor, L. (2010). The effect of hospital nurse staffing on patient health outcomes. National bureau of economic research, 31.
Cimiotti, J., Aiken, L., Sloane, D., Evans, S. (2012).
Nurse staffing, burnout and healthcare-associated infection.
Inpatient atio and Morale
E: INPATIENT ATIO AND MOALE
Emergency oom: Nurse to Patient atio and Morale
Nurse to patient ratios in health institutions is one of the most influential factors in health providence, in any country's health sector. Two states of the aforementioned aspect would comprise of either high or low ratios. The former demonstrates poor patient outcomes that would imply high mortality rates and dissatisfied clientele. On the contrary, the latter would ensure quality patient outcome and positive feedback from patients. The ratio has an impact on cost effectiveness and also nurse turnover rates were highly influenced by the ratios that sometimes dictated the working conditions of these nurses. A recommendation to increase the number of nurses by various implementations needed to be taken sequential would be the ultimate solution. This would be despite the cost that these procedures would reflect, meaning that the budget need to be…
Related to the above is the workload at the job-level. Here the type of job is an important consideration in morale. Job-level workloads are linked to stress and low morale in nurses in multiple units (Freedman and O'Brien-Pallas, 1998). Often this comparison is made on the basis of unit, for example and ICU unit verses an ER unit, but there are probably various contextual factors within the ER unit that are related to differing perceptions of workload. The research has not looked strongly at the contextual factors with a unit that can affect morale and this would be an interesting question to address. Of course one of the factors that of concern at the patient level is the clinical condition of the patient. There is actually good research that has developed measures of workload based on the patient's clinical condition such as the Therapeutic Intervention Scoring System (Cullen, Civetta, Briggs, & Ferrara, 1974). Such measures could be employed for the current proposed question.
Nurses report that one of the biggest issues for them in an ER setting is the issue of patient centered care. Certainly, the modern healthcare professional's role is not limited to only assisting the doctor in procedures, however. Instead, the contemporary professional takes on a partnership role with both the doctor and patient as advocate caregiver, teacher, researcher, counselor, and case manager. The caregiver role includes those activities that assist the client physically, mentally, and emotionally, while still preserving the client's dignity. In order for one to be an effective caregiver, the patient must be treated in a holistic manner. Proper communication and advocacy is another role that the modern caregiver assumes when providing quality care. For the purposes of our essay, the two terms, advocacy and communication, are often interchangeable, since one is the result of the other, and vice versa (Kozier, Erb, & Blais, 1997). Therefore, it is extremely important to ascertain how the ER setting can be improved to decrease stress levels of ER Nurses and, at the same time, increase morale. The study could be targeted as finding the optimal balance of the above factors that would reduce stress and help to keep morale among the nurses at its peak.
Getting back to previously stated
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
Evidence of this can be corroborated with a study conducted by the California Nurses Association, which found similar positive effects. At the same time, researchers found that reducing these ratios in various specialty environments inside the hospital (such as the ICU), improves the underlying amounts of care being provided dramatically. This is important, because it is verifying the positive effects that nurse to patient ratios are having on the industry. ("Does Mandating Nurse Patient Ratios Improve Care," 2010)
Clearly, the study that was conducted by article titled, Nursing Staff and Patient Mortality, highlights how various nurse to patient ratios, improves the quality of care being provided. The study is useful, because it examines the underlying affects of having various nurse to patient ratios at a facility or the lack of these regulations. As a result, the information that was collected and analyzed helps to highlight how hospitals can avoid the…
Does Mandating Nurse Patient Ratios Improve Care. (2010). Health Leaders Media. Retrieved from:http://www.healthleadersmedia.com/content/NRS-245408/Does-Mandating-NursePatient-Ratios-Improve-Care
Aiken, L. (2002).Hospital Nursing Staff and Patient Mortality. Journal of American Medial Association, 288 (16), 240 -- 247.
Clarke, S. (2003). Failure to Rescue. American Journal of Nursing, 103 (1), 42 -- 47.
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
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.
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.
http://www.nursingworld.org/ MainMenuCategories/' target='_blank' REL='NOFOLLOW'>
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.
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.
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 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:
The Shared Governance arrangement:
offers an apparatus for registered nurses to show guidance in the development of practice decisions authorizes all nursing staff to add to work redesign advances the quality of patient and family outcomes.
In the shared governance arrangement, the staff nurses are a big piece of the course, designated and chosen from their units to stand for an area of practice on one of many councils. it's all about shared choice making and authorizing staff nurses to affect their practice atmosphere and have a say in unit choices (Shared Governance at Henry Ford Hospital, 2011).
A new nursing deficiency is revitalizing shared governance. This pioneering organizational model gives staff nurses power over their practice and can expand their affect into administrative areas formerly controlled solely by managers. But nursing shared governance is tough to describe. Its configurations and procedures are dissimilar in every business. Shared governance, is…
Drenkard, Karen. (2010). Going for the gold: The value of attaining Magnet recognition.
Retrieved February 18, 2011, from Web site:
Estlund, Sarah. (2010). List of Nursing Labor Unions. Retrieved February 17, 2011, from Web
" (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.
The authors describe findings from a survey designed to gather baseline data about changes organizations experience after implementing the Clinical Practice Model framework, and report how the Clinical Practice Model Resource Center staff used the survey findings to build the capacity of individuals accountable for implementing this integrated, interdisciplinary professional practice framework into the organization's operations." (2002) The following model has been created for monitoring the progress of the nursing staff at the MD Anderson Cancer Center MEDVACM specifically checking progress in Years 1,3, and 5.
MD ANDERSON CANCER CENTER MEDVAMC
Job Performance Review Guide
PERFORMANCE GOALS AND OJECTIVES
ecome familiar with your department's business goals.
Work with your manager to define and document your goals. Include what you are expected to produce by your first review, activities needed to accomplish results, and success criteria.
Magnet Designation (2006) Inside UVA Online Vol. 36, Issue 14 August 26, 2006. Available at http://www.virginia.edu/insideuva/nursing_excellence.html .
Bailey, F. Amos (2000) Balm of Gilead Center, Cooper Green Hospital Pioneer Programs in Palliative Care: Nine Case Studies - Robert Wood Johnson Foundation - Milbank Memorial Fund October 2000. Online available at http://www.milbank.org/pppc/0011pppc.html#foreword .
Forrow, Lachlan (2000) Palliative Care Program, Beth Israel Deaconess Medical Center/CareGroupPioneer Programs in Palliative Care: Nine Case Studies - Robert Wood Johnson Foundation - Milbank Memorial Fund October 2000. Online available at
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.
high turnover of nursing personnel. The three main risks associated with this issue are 1) poor quality care, 2) unhealthy work environments, and 3) negative financial performance.
The first risk -- poor quality care -- is the result of a high turnover of nurses, which can lead to inadequate staffing. When there are two few nurses on any given shift, patients receive less care and attention because the nurses on shift are stretched in too many directions at once. Patients are required to wait longer, especially in the E, which can be problematic for patients requiring immediate care. Such is what happened to Edith odriguez at King-Drew hospital in L.A: she died in the E lobby waiting area because of insufficient attention given her by an over-stretched staff (AP, 2007).
The risk management solution to this first issue is to develop a temporary pool of nurses who can work on…
AP. (2007). Woman dies in ER lobby as 911 refuses to help. NBCNews. Retrieved from http://www.nbcnews.com/id/19207050/ns/health-health_care/t/woman-dies-er-lobby-refuses-help/#.V0XO57grLIU
Den, H., Deanne, N., & Belschak, F. D. (2012). When Does Transformational Leadership Enhance Employee Proactive Behavior? The Role of Autonomy and Role Breadth Self-Efficacy. Journal of Applied Psychology, 97(1), 194-202.
Geiger-Brown, J. (2010). Is it time to pull the plug on 12-hour shifts? Part 1. The evidence. Journal of Nursing Administration, 40(3): 100-102.
Ihan, M., et al. (2006). Long working hours increase the risk of sharp and needlestick injury in nurses: the need for new policy implication. Journal of Advanced Nursing, 56(5): 563-568.
Evidence Based Practice
University of Illinois Evidence Based Medicine Resources: Lessons Learned
From the search resources I learned that in evidence based medicine, patient values comprising of their unique concerns, preferences, and expectations introduced to the clinical encounter ought to be integrated in determining the ideal care for patient. This integration will guarantee that the individual patient’s clinical state, the clinical setting and best patient outcome prevail in ideal decisions on optimal service delivery to the patient (Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996).
The second aspect learned is that in order to integrate Evidence-Based Nursing and clinical care, there is the need for a basic comprehension of the attributes related to the inherent published evidence. Resources in Evidence-Based Practice are categorized in a hierarchy relating to the quality of the research or evidence. In Evidence-Based Practice, decisions making on best care to patient are not just basically guided by…
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.
NURN 480 Clinical Activity Plan for Nursing Fatigue Project
Meet with preceptor. (2 hours)
Determine stakeholders. (1 hour)
Develop an in-depth interview protocol and survey questionnaire regarding experience with nursing fatigue. (4 hours)
Conduct the in-depth interviews and administer the survey. (20 hours)
Analyze data using constant comparison method and triangulation. (9 hours)
Conduct member checks with select interviewees to clarify interpretation and findings. (16 hours)
Find supporting research articles from various lines of research to use when synthesizing information. (6 hours)
Correlate research related HP 2020 issues and LHIs. (2 hours)
Plan activities correlated to selected course objectives that will best highlight learnings about nursing fatigue. (6 hours)
Correlate the Living Tree of Nursing Theory with project. (2 hours)
Complete research on topic of nursing fatigue. (4)
Write the final paper on the topic of nursing fatigue (6).
Total = 78 hours (Including research and writing time)…
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.
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
One of the complexities of 21st century medicine is the evolution of nursing care theories in combination with a changing need and expectation of the stakeholder population. Nurses must be advocates and communicators, but must balance these along with an overall philosophy of ethics while still remaining mindful of budgets and the need for the medical institution to be profitable. It seems as if these issues comprise a three-part template for nursing: respect for patient value & individuality, education of patients, and cognition and respect for the realities of contemporary medicine. In many ways, too, modern technology has advanced further than societal wisdom, especially when confronting the issue of death. The modern nurse's role is to create a nurse-patient culture that encourages the individual to take responsibility for their healthcare and, in partnership with the nurse, to be involved in their recovery. The modern complexities of…
Basford, L. And O. Slevin. (2003). Theory and Practice of Nursing: An Integrated Approach to Caring Practice. New York: Nelson Thomas.
Beckstead, J. And Beckstead, L. (2004). A multidimensional analysis of the epistemic origins of nursing theories, models and frameworks. International Journal of Nursing Studies. 43
Cohen, J. (1991). Two portraits of caring: a comparison of the artists - Leininger
Perceptual and attitudinal changes are needed to motivate readiness to learn. Self-directed education is key to adult learning and especially to continuing education in the health professions (McClaran et. al, 1999, p. 184). Studies show that nurses will identify their specific needs for training and education and seek them out. They are also able to learn from previous experiences and build upon them to expand their proficiency of management skills. They seek personal mastery, vision, and team learning in order to grow as individuals and team members. These adult learners, as Knowles expressed, are motivated to learn and seek out the information they need. With education to understand the realities of healthcare management and a chance to develop management skills, nurses have both expanded opportunities and responsibilities that can impact the world of healthcare and provide safer and more satisfactory patient care.
Goddard NL. Financial management. (1987).
Goddard NL. Financial management. (1987).
In Vestal KW. Management concepts for the new nurse. Philadelphia: JB Lippincott, 127-152
Gotoh H. Continuing education changes nursing. Japanese Journal of Nursing Administration. 1992, 2 (1) 62-69.
Hiemstra, R., and Sisco, B. (1990) Individualizing Instruction: Making Learning Personal, Empowering, and Successful. San Francisco: Jossey-Bass.
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…
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.
Chief Nursing Officer in a Nursing Unit
hat is the role of today's Chief Nursing Officer (CNO) in the medical workplace? Are there issues that need resolution within the CNO purview? Is there a turnover problem in the field when it comes to the CNO position? hat leadership styles prove most effective for CNOs? These matters and others will be examined in this paper.
The Literature on Chief Nursing Officers -- Leadership Styles
As to leadership styles in nursing management, Jesus M. Casida published his dissertation for a Doctor of Philosophy at Seton Hall University on the subject of "Nurse Managers' Leadership Styles" in acute care hospitals in New Jersey. Although Casida did not use the term Chief Nursing Officer, he did employ the term "Nurse Managers" (NM) in reference to their leadership styles on "nursing units' organizational culture" (NUOC). His research included a self-administered measurement tool presented at four…
Casida, Jesus M. (2007). The Relationship of Nurse Managers' Leadership Styles and Nursing
Unit Organizational Culture in Acute Care Hospitals in New Jersey. Dissertation for Doctor of Philosophy in Health Sciences, Seton Hall University. Retrieved December 5,
2011, from http://domapp01.shu.edu.
Jones, Cheryl B., Havens, Donna S., and Thompson, Pamela A. (2008). Chief Nursing Officer
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
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.
Patients deserve as much time and attention as a nurse can possibly provide but when a nurse is in charge of eight patients at once she or he can only spend a few minutes with each one. When a patient requires additional care, nurses are unable to provide it. Therapeutic care is ultimately compromised when nurses have a high case load. Nurses can be more attentive to each patient when case loads are low. When nurses spend more time with each patient, symptoms are noticed earlier, allowing for more rapid diagnoses and recovery times.
Health care administrators should consider lowering the nurse-to-patient ratio for the best interests of both patients and nursing staff. Patient care is compromised when nurses do not have enough time or energy to devote to all patients, especially those requiring special attention or care. Employee satisfaction and patient satisfaction both suffer when nurses care for eight…
National Nurses United was founded in 2009 and has nearly 200,000 members today across the U.S. (it is the largest union of .N.s) (Gordon, 2014). It has a "democratic governing structure consisting of an N member, elected Board of Directors, all of whom are direct-care registered nurses and a presidency model called the Council of Presidents, which is a shared presidency of four Ns" (National Nurses United, 2016). Individual rights within the union consist of the right to vote for directors and on issues impacting the union such as contracts, as is standard with the democratic governmental structure of the union.
The union has achieved a number of concessions in the few short years of its existence: by setting a one-day strike date for nurses at Appalachian egional Hospital in Kentucky and Beckley Appalachian egional Hospital in West Virginia, the union managed to induce the egional hospitals to agree to…
Gordon, D. (2014). 4 of the most powerful national healthcare unions. Becker's
Hospital Review. Retrieved from http://www.beckershospitalreview.com/human-capital-and-risk/5-of-the-most-powerful-national-healthcare-unions.html
National Nurses United. (2016). NNU 101. Retrieved from http://nnumagazine.uberflip.com/i/659689-cna-nnu-101-2016-edition
Salary Inequities for Nurses in Florida
Inequities in Nurses' Salary Schedules
In the decade between 2004 and 2014, the estimated number of open positions for registered nurses was anticipated to be 2.1 million. This number reflects both attrition and the growth of the healthcare and medical fields that are responding to an aging national population. Best practices in staff recruiting in the medical arena call for an "adequate supply of nurse and high-quality patient care through competitive, transparent wage-setting, collective bargaining, and nurse/patient ratio standards" (Lovell, 2006).
An interesting phenomenon has occurred in research on the state of nursing in the U.S.: just over 20% of the nearly 50 studies conducted to analyze the nursing workforce recommended wage increases in order to attract more nurses into professional preparation programs and into the workforce. The U.S. Government Accountability Office conducted a study to look critically at the key factors that influence…
____. (2012). Florida Registered Nurse Salaries. Salary.com. Retrieved http://www1.salary.com/Florida/registered-nurse-salary.html .
____. (2002, July). Projected supply, demand, and shortages of registered nurses: 2000-2020. U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions, National Center For Health Workforce Analysis. Retrieved http://www.google.com/
____. (2012). Registered Nurse (RN) Hourly Rate. PayScale. Retrieved http://www.payscale.com/research/U.S./Job=Registered_Nurse_%28RN%29/Hourly_Rate .
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…
Healthcare Practices in Nursing Today
Over the last 50 years, health care systems all over the world have experienced rapid and significant changes. Some of these changes have been the result of innovative developments in medical science and technology that have greatly benefited patients, prolonging and saving the lives of millions. Some of these changes, however, have had the unfortunate result of limiting patient access to prescribed treatment and diminishing the overall quality of care.
Significant challenges are being faced in health care as systems restructure and reinvent themselves in a difficult and often painful effort to make more efficient use of their available resources (ICN, 2001). Since health care is such a labor-intensive industry, the stresses on these systems inexorably trickle down to affect those employed by the system. Nurses, who are the most highly trained caregivers who have ongoing, regular patient contact, stand at the very heart of…
Abramson, S. (1980). Adverse Occurrences in Intensive Care Units. Journal of the American Medical Association 244 (14): 1582-1584.
Ahmadi, M. (1989). Traditional vs. Nontraditional Work Schedules. Industrial Management 31(2), 20-23.
Bennett, M. & Hylton, J. (1990). Modular Nursing: Partners in Professional Practice. Nursing Management 21(3), 20-24.
Beauchamp, T.L. & Childress, J.F. (1994). Principles of Biomedical Ethics, 4th ed. New York: Oxford University Press.
Nursing Time Management Strategies
By its very nature, the profession of nursing requires effective time management. Nurses are constantly asked to balance the needs of patients and also the demands of administrators as they care for patients and attend to the bureaucratic aspects of their duties. The nursing shortage has made the need for time management particularly acute. Nurses are often overburdened with the care of many patients, whom they must attend to all at the same time while working long shifts. They must budget their time but still dispense high-quality care. With this in mind, the article by Nelson (2010) entitled "Helping new nurses set priorities" argues that time management skills must be a component of the training of all new nurses. During the first critical years of practice, the nurse develops the habits and assumptions for how she will govern her time.
In general, "orientees' time-management skills improve…
Jones, T. (2010). A holistic framework for nursing time: Implications for theory, practice, and research. Nursing Forum, 45 (30): 185-196. Retrieved from:
Nelson, J. (2010). Helping new nurses set priorities. American Nurse Today, 5.5.
Retrieved from: http://www.americannursetoday.com/article.aspx?id=6620&fid=6592
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.
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/
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
The prescriptions include wisdom, honesty, and courage, as well as human dignity, integrity, respect, health, and independence.
Part 3: Formulate possible evidence-based practices and an action plan that could work towards achieving improvement outcomes.
Provide insight into the diagnostic processes (e.g., root cause analysis) used to determine the primary causes of the problem. Consider both qualitative (cause-effect diagram, barrier analysis), and quantitative (theory testing or drill down analysis) methods.
Analyze the cost-effectiveness of your initiative and how your initiative mitigates risk and improves health care outcomes.
Countless interventions have been used for fall prevention amongst the elderly population. These include risk-assessment and management programs, I.e. Designed to screen those who are most at risk and to design interventions that will reduce their risk of falling; exercise programs slanted dot enhancing flexibility, endurance, and strength; education programs (including one-to -one counseling on methods to prevent falls); environmental modification in homes or…
ANA Nursing-Sensitive Indicators. http://www.nursingworld.org/ MainMenuCategories/' target='_blank' REL='NOFOLLOW'>
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
Nursing elated Case Study
Tom's vitals, in the emergency department, revealed an elevated respiratory rate, heart rate and blood pressure. His oxygen saturation was also considerably low. Tom's Body Mass Index (BMI) falls in the overweight category. He was also a-febrile, at presentation, indicating that infection was not a precipitating cause.
Initially the ABGs were normal, indicating an acute severe exacerbation or life threatening asthma. Later, when the ABGs were repeated, carbon dioxide levels were above normal. A raised carbon dioxide level is the differentiating bench mark between life threatening and near fatal asthma. The ABG analysis also reveals acidemia which cannot be solely attributed to a respiratory or metabolic cause alone, and hence can be safely classified as a mixed disorder.
Tom's history is typical of atopic asthma which usually begins in childhood and is triggered by antigens from the environment, such as pollen, animal dander or dust. Upper…
Brandis, K. (n.d.). The physiology viva. Retrieved from http://www.anaesthesiamcq.com/downloads/odc.pdf
Guyton, A., & Hall, J. (2011). Guyton and hall textbook of medical physiology. (12 ed.). Mississippi: Elsevier.
Kumar Abbas, & Robbins, (2007). Basic pathology. (8 ed.). London: Saunders Company.
Myron, K. (2005, May 10). Is obesity a risk factor for asthma. Retrieved from http://www.medicalnewstoday.com/releases/24118.php
Nurse Speech to Group of esidents in a Large Independent Living Facility
The information addressed today in this speech are those involving the body's regulation of the correct numbers and ratios of blood cells and how blood pressure homeostasis is achieved as well as age-related changes to the heart including coronary artery disease, congestive heart failure and myocardial infarction.
Homeostatis and the Body's Balancing Act
The work of Vikrant and Tiwan (nd) report that studies on the population indicate that blood pressure is a continuous variable and there is really not a line that divides normal and abnormal values. However, there is a point of balance also called internal equilibrium and this is known as homeostasis. This state of balance describes how the human body reacts to certain changes. This can be viewed by picturing a set of scales in which coins are poured in unevenly with one side heavier…
Vikrant, S. And Tiwan, SC (nd) Essential Hypertension -- Pathogenesis and Path physiology. Retrieved from: http://medind.nic.in/jac/t01/i3/jact01i3p140.pdf
The caregiver role includes those activities that assist the client physically, mentally, and emotionally, while still preserving the client's dignity. In order for one to be an effective caregiver, the patient must be treated in a holistic manner. Proper communication and advocacy is another role that the modern caregiver assumes when providing quality care (Carroll).
It is in the role of patient advocacy and cost-cutting that most nursing leaders are directly involved with hospital policy. Technology has increased the ease and ability for adequate communication -- there are more translators, access to databases, etc. within the field, and certainly there is more information about healthcare available for the layperson. However, the manner in which modern medicine works -- the reality that it is the nurse as opposed to the doctor who tends to follow the patient throughout their care, lends greater credibility to the use of the modern nurse as…
Carroll, T. (2005). Leadership Skills and Attributes of Women and Nurse Executives -Challenges for the 21st Century. Nursing Administration Quarterly, 29(2), 146-54.
Gershenson, Moravick, Sellman and Somerville. (n.d.). Expert to Novice: A Nuse Leader's Evolution. Nursing Management, 49-52.
Kouzes and Posner. (1994). An extension of the leadership practices inventory management systema dn individual contributors. Educational and Psychological Measurement, 54(4), 959-66.
Vesterinen, Isola and Paasivvra. (2009). Leadship Styles of Finnish Nurse Managers and Factors Influencing it. Journal of Nursing Management, 17(2), 503-9.
The chief concern of the researcher should be the safety of the research participant. This is carried out by carefully considering the risk to benefit ratio, using all available information to make an appropriate assessment and continually monitoring the research as it proceeds.
The scientific researcher must obtain informed consent from each research participant. This should be attained in writing although oral consents are sometimes acceptable after the participant has had the chance to carefully consider the risks and benefits and to ask any pertinent questions. Informed consent ought to be seen as an ongoing process, not a singular event or a mere formality.
The researcher must list how privacy and confidentiality concerns will be approached. esearchers must be receptive to not only how information is protected from unauthorized observation, but also if and how participants are to be notified of any unexpected findings from the research that they may…
American Academy of Pediatrics and American Academy of Family Physicians. (2004). Clinical
Practice Guideline: Diagnosis and Management of Acute Otitis Media. Retrieved March
20, 2010, from Web site:
Legislatively Mandated Staffing Ratios
In the nursing profession, the first job is to care for patients and that is both their physical and mental pain. The job of a nurse is to heal and care for individuals in their times of most vulnerability, when they are at their physically weakest position. Nurses and other medical professionals are tasked with taking care of their patients, of healing the body and the mind, and of saving the lives of their patients. They are life givers and life savers, often the last hope for a person's survival. Every day, nurses and doctors have to go to work knowing that they will witness some sort of despair and trauma. A nurse must be both compassionate and competent. They must feel for the patient, but they must also remain emotionally distant enough that they can still do their job accurately and efficiently, otherwise the staff…
Hale, S. & Grogan, S. (2010). Male GPs' views on men seeking medical help: a qualitative study. British Journal of Health Psychology. The British Psychological Society. 15. 697-713.
Lupton, Deborah. (2009). Toward the development of critical health communication praxis.
Health Communication. 6:1.
Shi, Leiyu (2010). Vulnerable Populations in the United States. John Wiley: San Francisco, CA.
This makes retention essential, as new nurses must stay with the hospital and become nurse specialists for CMC to continue to maintain its reputation. Nursing education is also essential.
Unfortunately, a stressed and pressured environment that is understaffed can create tension rather than foster cooperation between nurses, particularly old and young nurses. Older nurses may believe that their younger colleagues must 'pay their dues' before they are fully accepted as part of the staff. Younger nurses may find themselves given more onerous tasks and denied learning opportunities, as they assume the 'grunt work' of the nursing staff.
Sadly, no one benefits from such an adversarial culture. Younger nurses leave in greater numbers, out of frustration, further compounding the nursing shortage at CMC. Little hands-on instruction and education means that new graduates lack confidence and autonomy in their decision-making and are more prone to error and relying upon more skilled…
AACN Fact sheet. (2009, September). AACN website. Retrieved April 10, 2010 at http://www.aacn.nche.edu/Media/FactSheets/NursingShortage.htm
Addressing the nursing shortage: Background brief. (2010). Kaiser Permanente. Retrieved April
10, 2010 at http://www.kaiseredu.org/topics_im.asp?imID=1&parentID=61&id=138
Buerhaus, Peter I. (2010). Trends in the experiences of hospital-employed registered nurses:
Nursing shortage basically means the demand for nursing professionals exceeds the professional nurses, this can be in a given healthcare facility, nationally or globally. his can be measured through the number of job openings demanding high number of nurses than the ones who are available or even the disproportionate ration between qualified nurses practicing and population. his is a rampant challenge in both developing and developed countries all over the world. From the Second World War, hospitals in the U.S. have had to deal with a cyclical shortage of nurses. he national supply of nurses cannot meet the high demand nationally. With this recurrent shortage in nurses in the U.S. means that the quality of patient care will by and large continue declinig. his is a complex issue that is multifaceted and the causes are very many.
he shortage that has been observed recently is due to multiple…
These solutions require economic investments as well as contribution from the public. When addressing this issue there is need of efforts that aim to recruit as well as retain nurses and at the same time strengthen the capacity of nursing schools. These strategies call for the supply of educational facilities with ample faculty and funding, improvement of aid in terms of finances to students such as scholarship that target groups that are underrepresented like minorities and even men. Therefore many stakeholders as well as the government should invest financially to ensure that these strategies are a reality. The lay public should be involved with these efforts since they are the ones who feel the impact of nursing shortage, and it is through them that the civil sensitization mobilization of more of our citizens to enroll for the nursing courses can be achieved. The lay public must also be involved since they are the ones who own the basic, community focused solutions at the grassroots that can be converted to policies and implemented to the betterment of the healthcare.
KaiserEDU.org. (2012).Nursing Workforce. Retrieved February 25, 2013 from http://www.kaiseredu.org/Issue-Modules/Nursing-Workforce/Background-Brief.aspx
The comparatively simplistic provider to patient ratios and demand-based estimates cannot accurately predict need; therefore, inefficiencies in the health care system will remain. By comparison, the needs-based model provides at least the possibility of addressing most inefficiencies. This model stands out because it is essentially an iterative model that incorporates 'need' and supply data as it becomes available. Although not perfect, the model is flexible enough that it can be adjusted to include additional parameters and data to minimize the impact of unexpected developments, such as a major weather event or a severe economic downturn. Increasing the predictive accuracy of the model is also straightforward and would depend on investing into data collection efforts. As the authors discuss, the main limitation is the quality of data available; however, patient to provider ratios or demand-based models are still inferior by comparison.
A common approach used for validating predictive models such as…
Murphy, Gail Tomblin, Birch, Stephen, MacKenzie, Adrian, Alder, Rob, Lethbridge, Lynn, and Little, Lisa. Eliminating the shortage of registered nurses in Canada: An exercise in applied needs-based planning. Health Policy, 105, 192-202.
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
However, women also receive labor support even when its starts at a later stage in labor, in settings with companions of their choice, and settings with routine epidural. The supportive care provided to women during labor and birth through the one-to-one nursing includes various processes like provision of physical comfort and information and emotional support. The other processes include assisting women to communicate to caregivers and engaging members of their family as desired by the woman.
As an important part of one-to-one nursing during stages of labor and delivery, continuous support during childbirth enhances the normal labor processes while lessening the use of obstetric interventions. Therefore, this kind of support is an exceptional element of maternity care that provides well-established incentives and has no identified disadvantages.
Enhancement of Spontaneous Vaginal Birth:
Since continuous one-to-one nursing support during childbirth enables women to avoid analgesia or anesthesia and cesarean surgery, it's vital…
Barrett, S.J. & Stark, M.A. (2010). Factors Associated With Labor Support Behaviors of Nurses.
Journal of Perinatal Education, 19(1), 12-18. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2820357/
"Chapter 5 -- Care During Labour and Birth." (n.d.). Family-Centered Maternity and Newborn
Care: National Guidelines. Retrieved from Public Health Agency of Canada website: http://www.phac-aspc.gc.ca/hp-ps/dca-dea/publications/fcm-smp/fcmc-smpf-05-eng.php#careduring
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
.....clinician responses to alarms? For example: Physical barriers, physical layout of the unit, RN-pt ratio.
The observed influences include the type of alarm, such as whether it was a bed or bathroom alarm versus a technology alarm coming from something like the IV pump.
2. How, as a student, are you educated about alarms and your response to them? How might education regarding the various patient alarms be an issue associated with alarm response?
I have done some research on the clinical implications of alarms and alarm fatigue. For example, Cyach, et al. (n.d.) found that too many alarms causes alarm fatigue, and also creates a "false sense of security," (p. 5). The researchers also found that staff is sometimes not educated about the different types of alarms and what they mean.
3. Who is responsible for alarm response?
The delegation of authority for responses will vary from case to…
Importance of the Issue
Nurse need to keep the records and specific information about their patients. The services in the hospitals require that every detail of the patients be kept in the records. For patients whose conditions recur, record helps the medical practitioners understand the health history of the patient. Proper records in the hospital are helpful in patient transfers (Voyer et al. 2014). Often, patient referrals are common in hospitals and thus records help the doctors in the new hospital to attend to the needs of the patient. The family members of the patients require the health records of their patients to arrange for better treatments. The law requires the nurses to keep records of the nature of services they offer to the patients. Often, the records of each patient are permanents in the hospital where they are kept physically or electronically. Records are essential because they…
1997, the average pass rate for first time test takers on the NCLEX-RN was 93%. Since 1997, the national average pass rate on the NCLEX-RN has declined to 83.8% (National Organization for Associate Degree Nursing, 2002). The pass rate for the state of North Carolina and many other states has also declined in recent years.
Community colleges are the prime educators of new registered nurses in the United States. In 1997, 701 community colleges awarded 41,258 associate degrees in nursing (National Center for Education Statistics 1997). The combined ADN graduate pool constituted 60% of the U.S. graduates who took the NCLEX-RN exam in 2000,and these graduates represent the largest group of nurses entering the profession (National Council of State oards of Nursing 2001). On the other hand, baccalaureate programs graduated 37% of the total; and diploma or hospital-based educational programs, graduated 3%.(Teich, et al.)
In addition to educating the majority…
Adams, Carolyn, Valiaga, Theresa, Murdock, Jane. McGinnis, Susan & Wolfertz, Joanne (2002). Trends in Registered Nurse Education Programs: A Comparison Across Three Points in Time. In National League for Nursing (Ed.), pp. 1-10).:.
American Association of Colleges of Nursing (1999). Temporary Nurses Called A Serious Risk Threat At Hospitals. In (Ed.), p.).: American Association of Colleges of Nursing.
American Health Care Association.(1999).Facts and Trends, The Nursing Facility Sourcebook.Washington, D.C.:American Health Care Association.
American Hospital Association.1999.Trendwatch:RN Shortages in Hospitals. Washington, D.C.: American Hospital Association.
We can compare the healthcare workplace to what is seen by a person when he/she looks through a kaleidoscope: since there are numerous different patterns that appear as the moments pass by. The shortage of nurses which has been publicized widely and the high turnover rates amongst the nurses are some of the unwanted patterns which have occurred. The dependence of healthcare institutions on the nurse-managers for the retention and recruitment of nurses is steadily increasing (Contino, 2004).
There are a number of routes through which the critical care nurses have become the leaders. Most of these routes don't have any educational or managerial training as a part of the process. There is a need for effective strategies for the care leaders who provide critical care in order to inspire the staff and manage the departmental operations in an effective manner to get positive results. One of the strategies…
Adams, J., Erickson, J., Jones, D., & Paulo, L. (2009). An evidence-based structure for transformative nurse executive practice, Nursing Administration Quarterly, 33(4), 280-87
Advisory Board Web site. (2004). Available at: http://www.advisory.com .
Ales, B.J. (1995). Mastering the art of delegation. Nurs Manage. August; 26: 32A, 32E.
American Organization of Nurse Executives (2005). AONE Nurse Executive Competencies. Nurse Leader, 3(1), 15-22.
Winston Churchill once remarked that, "There is no finer investment for any community than putting milk into babies." In a similar vein, Karen Howard, the Director of Policy and Government Affairs, is a strong supporter of Nurse-Family Partnership and its programs. The Nurse-Family Partnership is a preventive effort to target first time at risk young mothers and to provide them with home visits by qualified nurses. This effort begins at early pregnancy and helps guides them rough this difficult period until their infant is two years old. Karen Howard is a strong believer that this program not only benefits mother and child but society as a whole as it reduces cost to the healthcare system and allows nurses to take direct efforts to help patients.
The concept of the Nurse-Family Partnership (NFP) emerged from the work of Professor David Olds and in particular three large randomized trials he conducted starting…
Olds. 2006. The Nurse-Family Partnership: An Evidence-Based Preventive Intervention. Infant Mental Health Journal, 27(1).
Olds, Hill, O'Brien, Racine and Moritz. 2003. Taking Preventive Intervention to Scale: The Nurse-Family Partnership. Cognitive and Behavioral Practice.
O'Brien. 2005. Translating a Research Intervention into Community Practice: The Nurse Family Partnership. Journal of Primary Prevention, 26(3).
Karoly, L.A., Kilburn, M.R., Cannon, J.S. Early Childhood Interventions: Proven Results,
The Grade Experience of Online Nurse Practitioner Students Who Took More Than One Clinical Course Per Quarter
The shortage in primary care physicians has increased the demand for nurse practitioners (NPs). Online NP programs are of interest to working students with other personal and professional life demands. This study examines grade experience differences for students of an online NP program who took more than one clinical course per quarter (OCCPQ) as compared to those who did not take more than OCCPQ. This retrospective study consisted of 3,760 NP students who graduated between fall 2013 through spring 2016. Those who took more than OCCPQ had a greater percentage of clinical course failures at first attempt as compared to those who did not take more than OCCPQ (2.1% versus 0.8%, p=0.001). Multivariate logistic regression adjusting for relevant covariates maintained these results with increased odds for clinical course failures for those…
Incidence of in-Hospital Falls in Geriatric Patients Before and After the Introduction of an Interdisciplinary Team -- Based Fall-Prevention Intervention
olfgang von Renteln-Kruse, MD, and Tom Krause, Dipl Geogr
Falls are the leading cause of hospital related injuries in the United States. There are a plethora of different factors that can be considered as possible causes of fall related incidents which cover a fairly broad range of concepts that apply to patients of all ages and over a range of different scenarios. As a result the fall incident rate has been the subject of many academic research projects as well as health care facilities due to the fact that world and professionals alike as inpatient falls are serious patient safety and quality issues. Fall prevention is an important aspect to patient safety and effective communication among staff, patients, and their families is required to mitigate potential risks. There have been…
Renteln-Kruse, W., Krause, T., & Georgr, D. (2007). Incidence of In-Hospital Falls in Geriatric Patients Before andAfter the Introduction of an Interdisciplinary Team -- BasedFall-Prevention Intervention. The American Geriatric Society, 2068-2076.