NURS-6053 Module 1: Discussion REVIEW OF CURRENT HEALTHCARE ISSUES

NURS-6053 Module 1: Discussion REVIEW OF CURRENT HEALTHCARE ISSUES

BY DAY 3 OF WEEK 1

Post a description of the national healthcare issue/stressor you selected for analysis, and explain how the healthcare issue/stressor may impact your work setting. Then, describe how your health system work setting has responded to the healthcare issue/stressor, including a description of what changes may have been implemented. Be specific and provide examples.

usa nursing papers

Struggling to meet your deadline?

Get your assignment on NURS-6053 Module 1: Discussion REVIEW OF CURRENT HEALTHCARE ISSUES done by certified MDs and PhDs in the USA. ORDER NOW!

BY DAY 6 OF WEEK 1

Respond to at least two of your colleagues on two different days who chose a different national healthcare issue/stressor than you selected. Explain how their chosen national healthcare issue/stressor may also impact your work setting and what (if anything) is being done to address the national healthcare issue/stressor.

15 Awesome Places to Work as a Hospital Nurse

Healthcare Problem Selected

The healthcare problem I’ve chosen to discuss is the shortage of nurses in the medical field. One of the most pressing healthcare issues today is the lack of nurses. This shortage has been widespread, especially during and after the COVID-19 pandemic. It affected various workplaces, but nursing was hit the hardest as healthcare demands increased while the number of nurses decreased. This situation had a significant impact on my workplace. We were understaffed, working long hours, and feeling completely burnt out. As COVID-19 cases surged, so did the number of patients and their needs. Before the pandemic, we typically cared for 4-5 patients at a time, which was manageable because we had enough nurses. However, during the pandemic, we often had to handle 5-7 patients, which was unsafe for both nurses and patients. This significantly compromised the quality of patient care.

Having the right number of nurses is vital for providing quality patient care and improving outcomes. Sufficient staffing ensures patient safety and allows nurses to spend quality time with patients. Inadequate staffing can lead to medication errors, which are dangerous. It also contributes to higher hospital readmission rates. In my workplace, we observed more readmissions because the hospital discharged patients quickly to make room for new admissions. The increased patient load also resulted in safety issues such as falls and pressure injuries.

As nurses, we were exhausted, irritable, and overwhelmed. It felt like we needed a week’s rest after just two days of work. Call lights were constantly ringing, we were constantly donning and doffing PPE, and the never-ending beeping of IV pump alarms haunted us. Many nurses left due to their families falling ill or because they found other facilities offering hazard pay. There was little concern for our well-being; we were expected to be there for our patients, even if we contracted COVID-19 without a fever.

It felt like a long time before the hospital finally responded to the nursing shortage. The hospital began losing money due to diversions – they had to turn patients away because there weren’t enough nurses to care for them. In response, the hospital swiftly hired traveling nurses to handle the overflow. Because of the acute nursing shortage, hospitals had to pay high rates to agencies, often using COVID-19 relief funds or money from the Federal Emergency Management Agency (AJN, American Journal of Nursing, 2022). This significantly alleviated the staffing crisis, even though we knew these nurses were temporary.

To address the crisis, our hospital offered sign-on bonuses, which attracted more long-term hires. They also established a dedicated COVID unit, offering higher pay to those willing to work there. This helped significantly because the medical floor I worked on had both COVID and non-COVID patients. Constantly donning and doffing PPE for simple tasks like giving a patient water or assisting them to the bathroom was time-consuming and stressful. The separation of patients into isolation and non-isolation rooms allowed us to keep PPE on, reducing the number of sick nurses.

Nurses are a crucial part of the 4.3 million registered nurses in the country, playing a vital role in providing care, improving healthcare systems, addressing health disparities, and enhancing the nation’s overall health (American Nurse Association, 2021). Dealing with the inadequate nursing staff took time, but things have improved since the start of the pandemic. Although we still face challenges, the number of isolated patients has significantly decreased, which has greatly helped us. Nurses, like any other professionals, deserve a safe and proper working environment, starting with adequate staffing. With sufficient staffing, we can achieve better patient and health outcomes and provide a safer environment for both staff and patients.

References

AJN, American Journal of Nursing. (2022). Ovid: Welcome to Ovid. Staffing Crisis Fueled by COVID-19 Creates Boom for Travel Nurse Industry. https://ovidsp.dc2.ovid.com/ovid-b/ovidweb.cgiLinks to an external site.?

American Nurse Association. (2021). Nurses in the Workforce. Nursing World. https://www.nursingworld.org/ErrorHandling/ErrorFallback.html?aspxerrorpath=/practice-policy/workforce/

Blouin , A., & Podjasek, K. (2019). The continuing saga of Nurse Staffing: Historical and… : Jona: The Journal of Nursing Administration. LWW. Retrieved November 28, 2022, from https://journals.lww.com/jonajournal/Abstract/2019/04000/The_Continuing_Saga_of_Nurse_Staffing__Historical.10.aspx

 

Reply to Comment

  • Collapse SubdiscussionIris Cornell 

    Response to Hannah from the Instructor:

    In your posting, you cited “Staffing Crisis Fueled by Covid-19 Creates Boom for Travel Nurse Industry” (2022), since the pandemic is subsiding, there are questions that come to mind about how quickly will nurse staffing recover. What might be a few of the challenges to addressing this issue?

    Reference

    Staffing Crisis Fueled by COVID-19 Creates Boom for Travel Nurse Industry. (2022). The American Journal of Nursing122(5), 12. https://doi.org/10.1097/01.NAJ.0000830684.40366.ef

    Edited by Iris Cornell on Nov 28, 2022 at 3:11pm

    Reply to Comment

    • Collapse SubdiscussionHannah Timmer 

      Response 1 to Dr. Conell 

      Hi Dr. Conell,

      I appreciate your question. Even as the pandemic eases, we will still encounter numerous challenges, and the nursing shortage is one that’s expected to persist until at least 2030, based on current information. However, there might be changes along the way that could prolong this shortage issue. One significant challenge that we face is the aging of the baby boomer generation. An article by Robert Rosseter (2022) on the American Association of College of Nursing website points out that healthcare demands will keep growing. As baby boomers, aged 56-76, continue to retire, we will continue to experience a considerable shortage of nurses. This challenge is unrelated to the pandemic but coincided with it, and the problem persists. As baby boomer registered nurses (RNs) continue to age, the annual retirements from the nursing field are expected to increase from 20,000 a decade ago to around 80,000 in the next ten years (Auerbach et al., 2015). This issue is inevitable and has a significant impact on patient outcomes, so finding a long-term solution is crucial.

      Another post-pandemic challenge we’ll confront is the severe burnout experienced by nurses. Given the overwhelming circumstances of COVID and the immense workload on nurses, many are leaving the medical profession in search of less stressful and mentally taxing careers. One major concern is that the pandemic’s adverse effects on the nursing profession will continue to exacerbate high turnover rates among nurses and their mental health struggles. It’s a significant worry whether the nursing field can attract enough nurses to care for future populations (Turale & Nantsupawat, 2021). We will continue to grapple with several challenges related to nurses and staffing. While there isn’t a single clear-cut solution, ongoing education and efforts to bring more individuals into the nursing workforce are essential. Additionally, taking care of the nurses we currently have is crucial to prevent further losses of these healthcare heroes.

       

        • Response #1: Discussion Week 1 (Hannah Timmer)

          Hannah, I truly appreciate your discussion on the critical topic of nursing shortages within the United States. It was heart-wrenching to read about some of the experiences you went through during the heightened nursing shortage during the COVID-19 pandemic (and possibly continue to go through).

          I work at the Department of Veterans Affairs and we have also been hit with a nursing shortage pandemic. It seems as though at one time, the VA was the place to be for work/life balance, premium pay, and job satisfaction. Similarly to your situation, these things changed during the COVID-19 pandemic and we are often short-staffed and overworked. Kime (2022) best explains the VA’s situation in regard to nursing shortages as heightened by COVID-19 but also impacted by retirements and nurse burnout. This has caused the remaining nurses in the facility to have to take on a higher caseload, and mandatory overtime, all while increasing their burnout.

          The Department of Veterans Affairs is cognizant of the fact that the nursing shortage is a crucial problem. There have been many efforts made to onboard and obtain nurses within the last couple of years. During my employment, I have seen multiple employee whole health opportunities arise such as free therapy services for work-related stress, cupping, yoga, and luncheons. Another important topic to discuss is the hype around raises and retention bonuses. Katz (2022) reports, “VA has also begun implementing the Retention and Income Security Enhancement (RAISE) Act, which President Biden signed into law in March as part of the omnibus funding package. That has led to VA approving pay increases for nearly 10,000 nurses, raising their salaries to a new cap of $203,000 per year” (para. 5). These bonuses and pay increases are allowing the VA to compete with the private sector hospitals who are currently recruiting and obtaining nurses at unbelievable rates due to their increase salary ranges, offers of student debt repayment, and increased PTO. The VA had to implement something in order to be competitive with these other facilities.

          I really enjoyed your discussion surrounding the nursing shortage, and I look forward to seeing what steps are taken in the future to ensure this problem is addressed.

           

           

           

          References:

          Kime, P. (2022, September 7). VA nurses protest staffing shortages they say pose risks to patient safety. Military.com. Retrieved November 28, 2022,

          from https://www.military.com/daily-news/2022/08/31/va-nurses-protest-staffing-shortages-they-say-pose-risks-patient-Links to an external site.

          safety.html#:~:text=In%20fiscal%20year%202022%2C%2062,shortage%2C%20according%20to%20the%20report.

           

          Katz, E. (2022, October 25). The VA gives raises to 10,000 nurses, takes more steps to boost recruiting and retention. Government Executive.

          Retrieved November 28, 2022, from https://www.govexec.com/pay-benefits/2022/10/va-gives-raises-10000-nurses-takes-more-steps-boost-Links to an external site.

          recruiting-and-retention/378906/

           Reply to Comment

        • Collapse SubdiscussionIvy Dzivenu 

          Hi Hannah,

          Great post. I enjoyed reading your post. It’s very educative and informative. The increased mortality rate is another impact of the nursing shortage in healthcare due to many errors like injuries and accidents, which the nurses make because of overworking. These mortality cases can sometimes cost the hospital (Drennan & Ross, 2019). For instance, if the family of the patient decided to sue the hospital, claiming that the patient died because of poor care, then the hospital might have a lawsuit to deal with.

          Reports from around the world tell of nurses, alongside other health professionals, being worn out. Many nurses and other healthcare providers are discouraged after a year of caring for high patient workloads with COVID-19 and seeing too many people die, as well as trying to deal with the usual caseloads of people needing interventions (Turale & Nantsupawat, 2021)

          Improving the image of the nurse is a way my hospital used to deal with a shortage of nurses. Improving their image means recognizing and appreciating what the nurses contribute to society. Most of the time, doctors are recognized in the recovery process of patients forgetting about the nurses who did most of the work. Nurses often deal with and interact with patients; they understand the patient better and do most work helping them recover. Therefore, recognizing what they do will help the nurse feel appreciated and continue doing their work without quitting or feeling like going for another occupation.

           

           

           

          References

          Drennan, V. M., & Ross, F. (2019). Global nurse shortages: The facts, the impact, and action for change. British medical bulletin130(1), 25-37. https://eprints.kingston.ac.uk/43086/6/Drennan-V-43086-AAM.pdf

          Turale, S., & Nantsupawat, A. (2021). Clinician mental health, nursing shortages and the COVID-19 pandemic: Crises within crises. International nursing review68(1), 12–14. https://doi.org/10.1111/inr.12674Links to an external site.

           

           Reply to Comment

        • Collapse SubdiscussionKatie Saletel 

          Hannah, thank you for sharing data on the overwhelming crisis we live in daily.  I come from a facility that just gave a 10-day notice to strike yesterday and several other facilities totaling approximately 15,000 nurses throughout the state.  Safety Concerns of Patients Using Health Care Organizations  (2022) speaks of the research institute publishing annual reports on the top 10 patient safety concerns and staffing shortages and COVID-19 effects on healthcare workers’ mental health we the top concerns.  Nurses are walking away from their careers due to many issues, fears, and frustrations, with staffing shortages among the top reasons.  Healthcare workers’ mental health concerns were already on the rise with exhaustion, burnout, and mental health crisis such as depression before COVID even impacted our lives; COVID only pushed this concern even further.  The US Bureau of Labor Statistics has reported our country will need 1.1 million nurses to replace nurses of the baby boomer age who are retiring, nurses leaving the profession and the expansion of nursing needs.  There’s also a severe shortage of physicians, lab technicians, and executives in safe care for patients with healthcare needs (Safety Concerns of Patients Using Health Care Organizations, 2022).

          The nursing shortage struggle is not new, as a survey was completed from December 2019 to February 2020 asking over 33,000 nurses in a  survey conducted before the pandemic, which resulted greater than 40% of RNs had reported burnout of their job, with one in four reporting dissatisfaction in their jobs/work and one in five reporting they expected to leave their job in approximately one year.  The RNs working in the nursing home reported an even worse outlook for nursing, with 56% of nursing stating they consistently worked short staff and characterizing the work environment as poor; one in three RNs reported the likelihood of leaving the nursing home within three months.  They also said their employer didn’t listen to or value the RN’s concerns reported to the administration or executive team (42%).  This shows the poor working conditions before the pandemic. Unfortunately, we are living and can imagine our reality of working conditions present day while continuing to battle COVID-19, RSV cases, the surge in mental health crisis cases, and so much more.  I’ve included a story from Minnesota Public Radio about our nurse strike.  Of note: striking is not something I want, nor do many other nurses involved in this fight for safe patient care.  It is also recognized hospitals are ‘in the red’ on their operating margins with inflation and costs in obtaining the equipment they have to purchase from other places throughout the world they hadn’t previously considered.  Thank you for writing about this critical issue throughout the US and the world.

           

          References

          Safety Concerns of Patients Using Health Care Organizations. (2022). AJN American Journal of Nursing, 122(6), 16. https://doi.org/10.1097/01.NAJ0000833880.31786.e0Links to an external site.

          French, R., Aiken, L. H., Fitzpatrick Rosenbaum, K. E., & Lasater, K. B. (2022). Conditions of Nursing Practice in Hospitals and Nursing Homes Before COVID-19: Implications for Policy Action. Journal of Nursing Regulation13(1), 45–53. https://doi.org/10.1016/S2155-8256(22)00033-3Links to an external site.

          Wiley, M., Sepic, M. (2022). Minnesota nurses set Dec. 11 strike date, plan 3-week walk out. Retrieved on December 2, 2022, from https://www.mprnews.org/story/2022/12/01/minnesota-nurses-strike-voteLinks to an external site.

           

           Reply to Comment

    • Collapse SubdiscussionDaniel Russell Wright 

      Review of the Issue

            To lead change, one must cultivate cultural competencies, foster supportive settings, and devote resources to innovation and advancement Marshall & Broome (2021); Laureate Education (2015). Unfortunately, emergency rooms serve as a primary care facility for many veterans. These facilities are unable to serve as a primary care clinic to treat chronic diseases and handle the emergencies that come through the door due to an already overburdened population. A major issue facing the US today is the national healthcare stressor of a lack of providers to offer veterans high-quality healthcare (Duerst, 2020). Longer wait times, higher prices, and ultimately lower quality of treatment come from a lack of providers to match the demand for care. Both veterans and their families experience a great deal of stress as a result of this. The lack of suppliers is caused by a number of factors, including:

      1. As the population ages, more veterans require more medical attention.
      2. There aren’t enough younger providers to step in when many providers reach retirement age.
      3. Attracting healthcare professionals to work in the VA system is difficult due to the complexity of the medical system.

      The level of treatment that veterans receive is directly impacted by the provider shortage. Veterans frequently have to wait longer for appointments when there are not enough healthcare providers to satisfy the demand. They can also encounter medical professionals that lack the qualifications or experience they would desire. This may result in less effective treatment and, ultimately, worse health outcomes for veterans.

      Implemented Changes

            Veteran Affairs (VA) is undertaking substantial changes to providing healthcare services to veterans, similar to many other healthcare systems (Pittman & Scully-Russ, 2016). Veterans now have access to the VA network, community care providers, and urgent care facilities thanks to the VA Mission Act of 2018, which replaced the VA Choice program. This gives veterans options for high-quality healthcare whenever and wherever they need it. Veterans may use community care providers (accepted non-VA providers) for their medical needs instead of the VA. In order for this to take effect,  the veteran’s primary care provider must agree that seeking treatment outside of the VA is in the patient’s best interests, the veteran’s primary care appointments are longer than 20 days, the drive to the VA medical facility is 30 minutes or longer, only a few services are offered at the VA facility, or a mix of all these (Department of Veterans Affairs, United States, 2019). Veterans can receive non-emergent care and treatment for minor injuries in urgent care centers, much like in the community. Veterans in remote places can access virtual medical treatment through the VA’s telehealth program. My health system has increased the number of healthcare providers in response to this stressor on the nation’s healthcare system. This has decreased appointment wait times and improved the standard of service. By offering additional training to healthcare professionals, my health system has likewise sought to raise the standard of treatment. In order to more readily detect and address any issues with the treatment patients receive, we have implemented a system of quality control called the patient safety net (PSN).

       

       

       

       

       

       

       

       

       

      References

      Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). New York, NY: Springer. 

      Duerst, L. (2020). The Veterans Health Administration’s Provider Shortage. Health Affairs, 39(2), 304–310. doi:10.1377/hlthaff.2019.00811 

      Laureate Education (Producer). (2015). Leading in Healthcare Organizations of the Future [Video file]. Baltimore, MD: Author.  

      Pittman, P., & Scully-Russ, E. (2016). Workforce planning and development in times of delivery system transformation. Human Resources for Health, 14(56), 1–15. doi:10.1186/s12960-016-0154-3. Retrieved from https://human-resources-health.biomedcentral.com/track/pdf/10.1186/s12960-016-0154-3Links to an external site.  

      U.S. Department of Veteran Affairs. (2019). VA mission act. Retrieved from: https://missionact.va.gov/

       

       Reply to Comment

      • Collapse SubdiscussionIris Cornell 

        Response to Daniel from the instructor:

        You mentioned that Broome and Marshall (2021) wrote  “to lead change, one must cultivate cultural competencies, foster supportive settings, and devote resources to innovation and advancement”. Therefore in the healthcare issue of a lack of providers to offer veterans, how do the Veterans Affairs monitor the lack of providers to offer veterans?

        Reference

        Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). Springer. 

        Edited by Iris Cornell on Nov 28, 2022 at 3:02pm

         Reply to Comment

        • Collapse SubdiscussionDaniel Russell Wright 

          Dr. Cornell,

          Approximately 50,000 job openings, mainly for doctors, nurses, social workers, and physician assistants are plaguing the VA healthcare system. Additionally, since 2005, the department has not seen a higher incidence of nurse turnover (Spotswood, 2022). The VA Office of Inspector General (OIG) is required by the VA Choice and Quality Employment Act of 2017 (VCQEA) to identify the Veterans Health Administration (VHA) occupations with the most significant staffing shortages within each VHA medical facility on an annual basis, at least five clinical and five nonclinical (VHA, 2022). In order to determine the acute staffing shortages per occupation, the OIG conducted a review. The OIG also assessed developments by comparing the quantity of severe occupational staffing shortages with the reports from the prior four years (VHA, 2022). Across 285 occupations, facilities reported 2,622 acute occupational staffing shortages in fiscal year 2022. Of these 285 occupations, 22 were identified as severe staffing shortages by at least 20 percent of VHA facilities. Significant nursing shortages were reported by 91% of hospitals (VHA, 2022). In an effort to uncover the true causes of the overall nursing shortage, Nurse.org surveyed over 1,500 nurses and, in short, nurses are in turmoil. Irrespective of the age, gender, or state of the practice, the answers were all the same. All nurses, NPs, and APRNs require assistance. Only 12% of the nurses questioned are content with their present situation. Notably, 36% want to stay in their current jobs but recognize that changes would need to be implemented in order for that to happen. In order to maintain their existing positions, nurses claim that they would like safe staffing levels, safer patient ratios, and more remuneration (Gaines, 2022). According to the nurse.org, survey of nurses:

          • 87% feel burnt out
          • 84% are frustrated with administrators
          • 84% feel they are underpaid
          • 83% feel their mental health has suffered
          • 77% feel unsupported at work
          • 61% feel unappreciated
          • 60% have felt uncomfortable having to work outside of their comfort zone in the past year
          • 58% have felt frustrated with their patients
          • 58% have felt unsafe at work in the past year (Gaines, 2022)

           

          The fact is that nurses need much more incentive to continue practicing clinically at the bedside. Nurses said they required:

          • Higher pay
          • Safe nurse-to-patient ratios
          • Hazard pay
          • Real mental health resources
          • Adequate staff support
          • Support programs for new nurses

          Individually, we might not be able to affect this change, but by working together, we can strengthen the voice of nurses and bring to light some of the daily problems we deal with. Together, we can bring about real, long-lasting change for nurses both now and in the future (Gaines, 2022).

           

          References

           

          Gaines, K. (2022, January 26). This is the State of Nursing. nurse.org. https://nurse.org/articles/nursing-shortage-study/Links to an external site.

          Spotswood, S. (2022, April 14). Severe Staffing Shortages Continue to Plague VA Healthcare System. U.S. Medicine. https://www.usmedicine.com/non-clinical-topics/personnel/severe-staffing-shortages-continue-to-plague-va-healthcare-system/Links to an external site.

          VETERANS HEALTH ADMINISTRATION. (2022, July 7). OIG Determination of Veterans Health Administration’s Occupational Staffing Shortages Fiscal Year 2022. VA.gov. https://www.va.gov/oig/pubs/VAOIG-22-00722-187.pdfLinks to an external site.

           Reply to Comment

    • Collapse SubdiscussionFatimah Johnson 

      Introduction

      Nursing shortages are a national healthcare issue. According to Lisa et al. (2022), lack of educators, burnout, inequitable workforce distribution, and workplace violence are some contributors to nursing shortages. These examples lead to high nurse-patient ratios and ultimately increased nurse turnover rates. In this discussion, I will reflect on the negative impact of nurse shortages in my organization and how it addresses the issue.

      Impact on the Work Setting

      The COVID-19 pandemic has increased the need for mental health services among all ages, causing a surge of patients in an already unequipped situation. When it comes to staffing, it is a matter of supply and demand. By 2025, nursing shortages are expected to exacerbate due to low rates of new nurses and patient demand, mainly due to COVID-19 (Bailey, 2022). Our organization’s supply of nurses does not meet the demand of our patients. Often, patients are stuck in the emergency department for days to weeks waiting for a bed on our unit, further affecting their mental health.

      Once on the unit, care can be compromised due to a lack of staff. Working in a psychiatric unit can be very dangerous in itself. Working on a psychiatric unit without proper staffing can be even more hazardous due to the instability and impulsiveness of our patients, who require strict monitoring. Every 15 minutes, a staff member must visualize every patient and document their status in real-time. Often, this is infeasible when there is not enough staffing for a shift and can lead to us being unaware of certain dangerous behaviors happening at that time, compromising patient safety.

      Responding to the Issue

      My organization has recently started hiring travel nurses to fill staffing gaps in our psychiatric unit. According to Hansen and Tuttas (2022), travel nurses supplement staff nurse vacancies due to attrition, leave of absences, patient surges, and newly opened units (para. 1). In our case, we hire travel nurses primarily for attrition, leave of absences, and because of unit acuity. Travel nurses are beneficial as they also relieve our staff nurses, allowing them to take more paid time off than they usually could.

      Our organization also offers bonuses as an incentive for nurses to pick up extra shifts. Bonuses are great; however, they only entice our nurses so much. Eventually, the nurses feel that the extra pay is not worth the extra work.

      Conclusion

      In conclusion, nursing shortages are a nationwide issue that does not seem to be 100% curable. Unfortunately, my organization’s strategies for responding to this issue are no more than band-aids. Nurses are not interested in temporary fixes. However, due to the many reasons for short staffing, there does not seem as though any intervention will serve as a permanent solution.

       

      References

      Bailey, V. (2022, June 28). 200k to 450k nursing shortage expected by 2025 without actionhttps://revcycleintelligence.com/news/200k-to-450k-nursing-shortage-expected-by-2025-without-actionLinks to an external site.

      Haddad, L. M., Annamaraju, P., & Toney-Butler, T. J. (2022). Nursing shortage. National Library of Medicine18(9), 10–14. https://doi.org/10.1097/00152193-198809000-00006Links to an external site.

      Hansen, A., & Tuttas, C. (2022). Professional choice 2020-2021: Travel nursing turns the tide. Nurse Leader20(2), 145–151. https://doi.org/10.1016/j.mnl.2021.12.018Links to an external site.

       

       

       

       

       Reply to Comment

      • Collapse SubdiscussionIris Cornell 

        Response from the instructor to Fatimah:

        Good posting on your healthcare issue of the negative impact of nursing shortages on organizations. Haddad et al. (2022)  reported that these shortages lead to errors, higher morbidity, and mortality rates (para. 17). In your organization what is something that could be done to resolve short staffing besides the bandaid approaches you mentioned in your posting?

         

        Reference

        Haddad, L.M., Annamaraju, P.,  & Toney-Butler, T.J. (2022, Feb 22). Nursing Shortage. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK493175/

         

        Edited by Iris Cornell on Nov 29, 2022 at 10:15am

         Reply to Comment

      • Collapse SubdiscussionPaulphielle Mcqueen 

        RESPONSE TO FATIMAH:

        I enjoyed reading your post because I feel this is a major issue nationwide and we experience this healthcare provider shortage everyday. I did not even think how bad it could be working in a psychiatric facility and not being fully staffed with nurses, how you explained how it is sounds very dangerous. I’m glad that your facility has started to obtain travel nurses to aid in your facility shortages of healthcare providers. The hospital I currently work at has started to use travel nurses but they unfortunately end their contact early because of our extreme shortage and because of the patient acuity being so high every day they come to work.

        In the article I read the author stated that with the prevalence of covid19 nationwide and the increase of older adults chronic conditions becoming worse and being hospitalized, nurses can see upwards to twelve percent in inpatient hospitalizations. Do you think that with the increase of inpatient hospitalizations even the travel nurses would stop traveling to assist other hospitals nationwide?

         

        Reference

        Odom-Forren J. Travel Nursing: Price Gouging or Supply and Demand? J Perianesth Nurs. 2022 Apr;37(2):153-154. doi: 10.1016/j.jopan.2022.01.013. PMID: 35422269; PMCID: PMC9000908.

         

         Reply to Comment

        • Collapse SubdiscussionFatimah Johnson 

          Hi Paulphielle,

          Thank you for your response back. Yes, working understaffed on a psychiatric unit can be very dangerous for the patients and staff. Travel nurses have been a huge save. For some hospitals, travel nurses are essential; therefore, they are compensated well. Whether or not they will continue to help hospitals in increased need is a personal decision to me. With the increased demand, compensation for travel nurses increase drastically. If the nurse is driven by money, I believe he or she would continue traveling to assist these hospitals. A nurse has to work in these situations no matter what, whether as a staff nurse or travel nurse, so traveling for the increased pay sounds worth it.

           Reply to Comment

      • Collapse SubdiscussionJessica Jarosky 

        RESPONSE to Fatimah from Jessica

         

        Hello Fatimah,

        I agree with you that nursing shortages are a significant problem, especially in the psychiatric setting. I also work inpatient in a psychiatric hospital and have experienced first-hand the effects of short-staffing. The unit I work in is a satellite campus, which means we are one stand unit and have no support from staff on other units. We also have no security, which means if we have an aggressive patient our floor staff cannot restrain, we resort to calling the police for backup to protect our safety and the safety of the other patients in the milieu. This, unfortunately, leads to greater healthcare costs and worse dispositions for the patients if they are taken to jail. Because of the increased safety concerns in a psychiatric unit, we experience a high turnover rate of new employees. Many nurses with no psychiatric experience severe stress and burnout from the unit’s acute conditions and leave (Rahmani et al., 2021). My hospital has also hired travel nurses to combat the nursing shortage, though these are only quick fixes to the national problem. Increasing staffing matrixes and safety on the unit will contribute to the retention of employees who feel valued and appreciated. As Chiou-Fen et al. (2020) states, “nursing managers should work to improve workplace satisfaction, support and care for nurses, and create better career advancement and teamwork opportunities through job training and career planning programs” (p. 8). I agree with you that the nursing shortage will never be 100% curable, but I do believe a safer, more appreciated work environment would contribute significantly. Thank you for your insight on the topic!

         

         

        References

        Lin, C.-F., Lai, F.-C., Huang, W.-R., Huang, C.-I., & Hsieh, C.-J. (2020). Satisfaction with the quality nursing work environment among psychiatric nurses working in acute care general hospitals. Journal of Nursing Research28(2). https://doi.org/10.1097/jnr.0000000000000350Links to an external site.

        Rahmani, N., Mohammadi, E. & Fallahi-Khoshknab, M. (2021). Nurses’ experiences of the causes of their lack of interest in working in psychiatric wards: a qualitative study. BMC Nursing, 20(1). https://doi.org/10.1186/s12912-021-00766-1Links to an external site.

         Reply to Comment

      • Collapse SubdiscussionTammy Young 

        As many healthcare professionals know, nurse staffing shortages place patients in danger. Healthcare facilities are dealing with overcrowded emergency rooms, canceled surgeries, limited support staff, the inability to open beds, and many more hurdles. Seventy-nine percent of healthcare workers reported in a recent survey that their facility was impacted by staffing shortages and expressed concerns about the care they were delivering. Although the lack of nurses is not a new concern, the COVID pandemic has highlighted and accentuated this crisis. According to one poll, nearly 20 percent of healthcare workers have quit their jobs since the pandemic, making this industry the second-highest loss of workforce (Ross, 2022).

        The local effects include closures or decreased hours of healthcare facilities; therefore, patients have been unable to obtain routine health maintenance care when needed. Operating rooms have limited the number of scheduled and canceled elective cases, so patients are not having surgeries as planned. The local hospitals have been forced to hire travel or agency nurses, placing a strain on their budgets. Fellow nurses admit to increased “near misses” in medication administration due to increased patient loads and stressors. As nurses are burdened with heavier patient assignments, they also admit to ‘cutting corners” where infection control standards are concerned, stating that it is unrealistic to follow those standards due to time restraints.

         

         

        Kentucky has utilized the national guard to assist in healthcare facilities serving a more rural population. Local businesses contributed comfort supplies, meals, and discounts to hospital employees during peak Covid times. The University of Kentucky Health System has allowed for more flexible staffing policies, increased daycare opportunities, and provided discount meals for employees.

        Moving forward, it will be necessary for healthcare institutions to look at nursing shortages differently. On a political level, investments in federal funding are needed to improve the impact of nursing shortages. Creating more accessible access to nursing education programs and providing financial reimbursement is needed to encourage student enrollment (USCSF School of Nursing, n.d.).

        On a local level, healthcare facilities need to Identify reasons nurses are dissatisfied with their current job and work toward improving job satisfaction. One study shows nurses report being most happy with their jobs when they feel valued and connected with the facility’s mission (Dotson, 2012). Working to reduce stress and increase job satisfaction should help decrease the rapid turnover of nursing staff in medical institutions.

         

         

        Dotson, M. J., Dave, D. S., & Cazier, J. A. (2012). Addressing the nursing shortage: A critical health care issue. Health Marketing Quarterly29(4), 311-328. https://pubmed.ncbi.nlm.nih.gov/23210672/

         

        Keepnews, D. (2022). Taking on the Nurse Staffing Crisis. Washington Nurse52(1), 12–14. https://web.p.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=14&sid=19f6855d-674a-4c44-a3b8-86548afb6875%40redis

        Ross, J. (2022). Nursing Shortage Creating Patient Safety Concerns. Journal of PeriAnesthesia Nursing37(4), 565-567. https://www.sciencedirect.com/science/article/pii/S1089947222002350Links to an external site.

        University of California,San Francisco School of Nursing. (n.d.). The Nursing Shortage is a National Problem. How We Can Solve It. https://nursing.ucsf.edu/news/nursing-shortage-national-problem-how-we-can-solve-it

         Reply to Comment

    • Collapse SubdiscussionPaulphielle Mcqueen 

      HealthCare Issue 

      Create settings that foster change, build cultural capabilities, and allocate resources to innovation and improvement to lead change (Laureate Education, 2015). Currently the healthcare system has struggled in many aspects over the current years. More importantly the major struggle came during COVID-19, particularly when healthcare providers began to experience burnout. Burning out health care providers remains a challenge to all organizations nationwide. 

      The heightened burn out rate of healthcare providers stems from thew nursing shortage we are currently having nationwide in healthcare providers, which in turn has more of a negative impact on patients and their hospital experiences. As the nursing shortages continue to rise, patient acuity continues to increase and nurses are forced to assume a much larger patient load with more duties that are needed to meet the high-quality care that is expected (Jiang, Li, Gu, & Lu, 2016). The continued increased patient-to- healthcare provider ratio adversely affects healthcare providers and the patient and their family. Many issues expressed at my job through our patient satisfactory survey, after a patient is discharged, the survey is sent out to see where we can improve in the hospital. The most voiced issues are the lack of time the nurse is in the room or the lack of explanation of how their experience in the hospital will go. Burn out is likely to continue to put a strain on the healthcare system and continue to worsen the already pre-existing issues surrounding nursing shortages nationwide. 

      Implemented Changes 

      At my current organization there is a significant shortage in the nurse-to-patient ratio. The strain comes from the burnout during COVID-19. The high turnover rate at my organization should distinctively tell the institution about staff satisfaction and the burn out status. Losing more experienced nurses at bedside for ten plus years has reduced quality of care and patient satisfaction. But on the other hand, and way in increasing the reduction in quality of care and patient satisfaction would be to increase staffing levels across the healthcare system (Hill & DeWitt, 2018). Understanding the needs of an organization is crucial in improving and changing the fragmented healthcare delivery system nationwide, by doing so would improve overall service quality received by the patient. My organization has already implemented hiring new healthcare workers and training them to be an asset to our units to aid in alleviating our organization in having our max acuity on the unit every day.  

      References 

      Hill, M., & DeWitt, J. (2018). Staffing Is more than a number: using workflow to 

      determine an appropriate nurse staffing ratio in a tertiary care neurocritical care unit. Journal of Neuroscience Nursing, 50(5), 268-272. doi: 10.1097/JNN.0000000000000387 

      Jiang, H., Li, C., Gu, Y., & Lu, H. (2016). Nurse Satisfaction and Burnout in Shanghai Neurology Wards. Rehabilitation Nursing, 41(2), 120-127. doi: 10.1002/rnj.174 

      Nantsupawat, A., Kunaviktikul, W., Nantsupawat, R., Wichaikhum, O., Thienthong, H., & Poghosyan, L. (2017). Effects of nurse work environment on job dissatisfaction, burnout, intention to leave. International Nursing Review, 64(1), 91-98. doi: 10.1111/inr.12342 

      Rathert, C., Williams, E., & Linhart, H. (2018). Evidence for the quadruple aim: a systematic review of the literature on physician burnout and patient outcomes. Medical Care, 56(12), 976-984. doi: 10.1097/MLR.0000000000000999 

       Reply to Comment

        • Collapse SubdiscussionPaulphielle Mcqueen 

          Response to Instructor from Paulphielle:

          The top barriers I think are high patient census at hospitals which puts a strain on nurses as well as a shortage of nurse educators what would teach new nurses that could in the future aid in the shortage of nurses.

          Reference

          President, J. C. V., Cusick, J., President, V., Manager, S. N. S. M., Nadeau, S., Manager, S. M., Shepherd Director, M., Shepherd, M., Director, Director, E. L. A., Lofgren, E., Director, A., Zhavoronkova, M., Bass, J. C., Rapfogel, N., Jarsulic, M., Hughes, S., Bedekovics, G., & McConville, D. (2022, June 7). How to ease the nursing shortage in America. Center for American Progress. Retrieved November 29, 2022, from https://www.americanprogress.org/article/how-to-ease-the-nursing-shortage-in-america/

           

           Reply to Comment

    • Collapse SubdiscussionElin Danelian 

      Introduction

      The national health care issue I chose was one I have experienced since the pandemic started, which is nursing shortages. To meet the population’s healthcare demands, the area of healthcare is constantly expanding and evolving. A substantial portion of the healthcare system is made up of nurses which makes it the nation’s largest healthcare profession (Flaubert et al., 2021). The lack of nurses is currently a problem for the country’s healthcare system. A sufficient work force is essential for improving patient outcomes.

      Description of healthcare issue/stressor and how it impacts work setting

      Within the American healthcare system, nurses are widely acknowledged to play a crucial role in the delivery of safe and high-quality treatment (Salmond & Echevarria, 2017). Nurses have been feeling overwhelmed for years, but the pandemic was the breaking point for many nurses. During the COVID-19 pandemic, nurses were working under tremendous pressure which resulted in burnouts. These burnouts led nurses to leave bedside nursing. Nursing shortages created unsafe nurse to patient staff ratios. In addition, lack of nurses resulted in inadequate patient care, low staff retention, and an increase in hospital-acquired illnesses. This healthcare issue impacted my work setting and patient experience. Nurses did not have enough time to spend with patients to provide care and compassion because our task list was long, and we were assigned more patients than were supposed to have. According to studies, patients stay longer when nurse-to-patient ratios are higher because complications arise more frequently such as hospital acquired injuries or infections and readmission’s (McHugh et al., 2022). For example, hospital acquired pressure injuries can result from inadequate staffing because it can lack proper wound care and repositioning bedridden patients every 2 hours to relieve pressure on bony prominence.

      Response and changes to the healthcare issue/stressor

      My health system work setting understood that they had to find strategies to both recruit and keep nurses. The hospital I work for provided exceptional pay for travel nurses to temporarily cover the shortages. However, that was temporary, and they were still struggling to respond to nursing shortage. When my unit was short staffed, nurses were unable to take their breaks which would cause meal break penalties, and per our union contract we would be paid an extra hour for every missed break. This problem was getting expensive for our hospital, so they started offering bonuses for extra shifts. Eventually, they opened positions for nursing staff. Even though the new staff mostly consisted of new graduates, it was helpful to have extra help and hands on the floor.

      Conclusion

      Nurses were already showing signs of burnout because of stress and understaffing before the pandemic. Stress and understaffing were only made worse by the extra exacerbating factors brought on by the COVID-19 pandemic. Help must be available to nurses so they may safely do the emotionally and physically demanding work that they are tasked with.

      References

      Flaubert, J., Le Menestrel, S., & Williams, D. (2021). The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. National Library of Medicine. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK573922/

      McHugh, M., Aiken, L., Sloane, D., Windsor, C., Douglas, C., & Yates, P. (2022). Effects of nurse-to-patient ratio legislation on nurse staffing and patient mortality, readmissions, and length of stay: a prospective study in a panel of hospitals. National Library of Medicine. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8408834/

      Salmond, S. & Echevarria, M. (2017). Healthcare Transformation and Changing Roles for Nursing. National Library of Medicine. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5266427/

       Reply to Comment

      • Collapse SubdiscussionJessica Jarosky 

        RESPONSE to Elin from Jessica

        Hello Elin,

        Thank you for your very insightful post on the increase in nursing shortages caused by the COVID-19 pandemic. I work in an inpatient psychiatric hospital, and at the height of the pandemic, we shut down an acute unit to open a COVID-19 ward to relieve the nearby emergency rooms from their influx of patients. We took in all patients with mental health issues who were medically stable, though still infected from COVID-19, compared to at the start of the pandemic when we were declining all patients who weren’t out of their quarantine period. During this time, we also had many nurses leave our work due to a variety of reasons. Many bedside nurses in all nursing settings experienced an impact from staffing shortages during and since the pandemic, with many contemplating leaving the profession for good. In 2021, 40% of nurses contemplated or intended to leave their bedside position, and in 2022, that number increased to 52%. In nurses under 35 years old, the percentage was much higher at 63%, which is more worrisome as the older generation of nurses begins to retire (American Nurses Foundation, 2022).

        As you said, there are various reasons nurses are leaving the profession, including feeling overworked, not supported by management, or having opposing views of the COVID-19 vaccine mandate. In my hospital, we had many nurses receive religious or medical exemptions for the vaccine, as well as many nurses leave the organization entirely due to the mandate. A study has shown that in 2020, 23.4% of nurses opposed receiving a COVID-19 vaccine, though the number dropped in 2021 to 18.3% (Gardner, 2022). My healthcare organization also hired travel nurses to cover the shortage of nurses leaving the profession, which in turn, caused staff nurses to leave after seeing how much money the travel nurses were receiving in compensation. Our hospital eventually stopped hiring travel nurses entirely after exceeding the budget by millions. After nearly three years since the start of the pandemic, our organization is still experiencing the effects of nursing shortages. Thank you for your insight on the topic, Elin.

         

         

        References

        American Nurses Foundation. (2022, March 1). Pulse on the Nation’s Nurses Survey Series: COVID-19 Two-Year Impact Assessment Survey. https://www.nursingworld.org/~492857/contentassets/872ebb13c63f44f6b11a1bd0c74907c9/covid-19-two-year-impact-assessment-written-report-final.pdfLinks to an external site.

        Gardner, S. (2022, July 27). The Impact of the COVID-19 Vaccine Mandate on the Nursing Profession. American Bar Association. https://www.americanbar.org/groups/health_law/publications/aba_health_esource/2021-2022/july-2022/the-impact-of-covid-19-vaccine-mandate-on-the-nursing-profession/Links to an external site.

         Reply to Comment

      • Collapse SubdiscussionTammy Young 

        Elin, I enjoyed reading your post about the national crisis of nursing shortages. I feel we have experienced some of the same difficulties when giving care to our patients.

        Healthcare professionals are becoming more aware of the nurse staffing crisis that is depleting our hospitals. The issue of limited staff was already a concern but has become increasingly more severe since the Covid 19 pandemic. Nurses have cared for acutely and critically ill patients who cannot have a loved one at their side, facing death while feeling the weight of heavier patient loads and absorbing tasks previously filled by ancillary staff. All these stressors have led to increased burnout, forcing healthcare workers to leave their jobs and even professions (Keepnews, 2022).

        At the same time, patients are becoming increasingly aware of the nursing shortage and its effects on their ability to obtain adequate healthcare (Dotson et al., 2012). Medical facilities have limited their operational hours, emergency rooms are increasingly overcrowded, planned procedures have been delayed or rescheduled, and some hospitals report closing beds or even units due to the inability to provide nursing care for patients (Ross, 2022).

        The Effect on the Workplace

        The effect of this crisis is apparent in the work setting as the clinic has been forced to decrease the number of appointment times available, limit the types of appointments and procedures offered, and limit assistance to patients who require follow-up appointments and referrals. In addition, fewer nurses available means some practitioners are without a nurse to assist with patient care. One nurse may be assigned to assist two physicians, resulting in an increased workload for the nurse and less assistance for each physician. Also, nurses and staff work without lunch breaks to meet the added demands. Restrictions have been placed on taking time off for vacations or even much-needed medical appointments. The snowball effect of placing demands that can not be met on nurses equates to a high nurse turnover rate.

        Looking to Make Improvements

        In the facility where I work, the administration addresses the shortage by encouraging nurses to make their concerns known while devising ways to foster job satisfaction. Efforts are being made to decrease the workload on nurses by employing travel nurses, offering on-site training for non-medical employees to become CMAs, and creating more in-network float pool opportunities for nurses.

        Conclusion

        Addressing this crisis requires an understanding of why the nursing shortage exists. Improving access to nursing programs, improving attitudes about the profession, developing strategies to improve work schedules, and creating a better work-life balance in medical facilities is essential. To improve on this crisis, healthcare institutions will need to continually address the nursing shortage crisis by developing strategies for recruitment and finding ways to encourage retention. as well as identifying factors that nurses feel are important for job satisfaction (Lyon et al., 2022

         

        References

        Dotson, M. J., Dave, D. S., & Cazier, J. A. (2012). Addressing the nursing shortage: A critical health care issue. Health Marketing Quarterly29(4), 311-328. https://pubmed.ncbi.nlm.nih.gov/23210672/

        Lyon, C., English, A. F., Cebuhar, K., & Emerick, J. (2022). Don’t Leave Me! Strategies for Medical Staff Retention. Family Practice Management29(3), 5–9. https://eds.p.ebscohost.com/eds/pdfviewer/pdfviewer?vid=2&sid=e59f8c94-200d-483a-825e-84bd9cb206fe%40redis

        Keepnews, D. (2022). Taking on the Nurse Staffing Crisis. Washington Nurse52(1), 12–14. https://web.p.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=14&sid=19f6855d-674a-4c44-a3b8-86548afb6875%40redis

        Ross, J. (2022). Nursing Shortage Creating Patient Safety Concerns. Journal of PeriAnesthesia Nursing37(4), 565-567. https://www.sciencedirect.com/science/article/pii/S1089947222002350Links to an external site.

         Reply to Comment

    • Collapse SubdiscussionDallas Wilcox 

      Week 1: Main Discussion Post

       

      National Healthcare Issue

      I chose to discuss the impact that the lack of mental health providers and resources has had on, not only my facility, but facilities nationwide as well. There has been a shift in how care is being given to patients experiencing mental health needs based on the attention that mental health is currently receiving. The needs are still there, but a lot more is currently being done to combat this issue.

      Impact to Current Place of Employment

      In my current role within the Department of Veterans Affairs, a large push to address mental health needs has been enacted by bills set forth by President’s in the last few elections. However, even with the growing number of interventions, lack of mental health resources is still a top priority to address. According to Weiner (2022) “Already, more than 150 million peopleLinks to an external site. live in federally designated mental health professional shortage areas. Within a few years, the country will be short between 14,280 and 31,109 psychiatristsLinks to an external site., and psychologists, social workers, and others will be overextended as well, experts say” (para. 3). The greatest impacts that this shortage has made to my current place of employment is large wait times for Veterans to see a provider. Oftentimes, the wait times are so large that the providers must send them to a provider in the community to be evaluated. This causes community providers to become overwhelmed, a risk for completion of suicide due to a wait without intervention, and staff burnout due to an overwhelming amount of Veteran’s on their waitlists.

      Response by VHA on this Healthcare Issue

      The VHA has made leaps and bounds in regard to addressing the mental health needs of Veterans. Some of the interventions the VHA have implemented are: student loan repayment for those studying Psychiatry, scholarship opportunities for those in social work, psychology, and counseling, improvements to crisis number and crisis response teams, and onboarding significantly many more mental health workers (Hester, 2017). It is also important to note the greater integration of mid-level providers, implementation of virtual or telehealth technologies, and support to primary care physicians  to address mental health needs of Veterans. Doyle & Streeter (2017) explain that broadening the scope of practice for NP’s to address certain mental health needs within the VA has been implemented as well to tackle this issue.

      Conclusion

      Although mental health services/providers are still in need, the VHA has been making adjustments to their approach on this issue. The onboarding of new mental health workers, support in student loan repayment for mental health workers, and broadening scopes of practice for mid-levels has been instrumental in providing care the Veterans who were having issues obtaining care in the past. The VHA continues to budget more for mental health needs with each passing year and continuously improves Veteran access to mental health needs. The initiative to tackle the specialized mental health needs for Veterans appears to be on the uphill trend.

       

      References:

      Weiner, S. (2022, August 9). A growing psychiatrist shortage and an enormous demand for mental health services. AAMC. Retrieved November 28, 2022, from https://www.aamc.org/news-insights/growing-psychiatrist-shortage-enormous-demand-mental-health-services

      Hester, R. D. (2017, August 18). Lack of access to mental health services contributing to the high suicide rates among veterans. International journal of mental health systems. Retrieved November 28, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5563010/

      Doyle, J. M., & Streeter, R. A. (2017, February). Veterans’ location in health professional shortage areas: Implications for access to care and workforce supply. Health services research. Retrieved November 28, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5269541/

       

       

       

       

       

       Reply to Comment

      • Collapse SubdiscussionHannah Timmer 

        Hi Dallas,

        I like the organization and topic you chose, as we are genuinely in a mental health crisis. It has been disturbing to see how we ignore mental health issues and blame everything on mental health. Everybody talks about mental health, but no one is educated about or willing to be part of the solution. The last hospital I worked at had a considerable lack of mental health providers, and when COVID hit, all these providers, like psychiatrists, only treated patients virtually. It was unfair and honestly unprofessional, in my opinion. When someone comes in due to schizophrenia with hallucination, and we wheel in a talking computer to them, do they think that is helping the situation? Can we diagnose and treat a patient over a fuzzy computer screen and distorted sound? I certainly would not want to be treated that way. Also, these people come in at all-time lows, and the only person they get to talk to is over a screen; meanwhile, our other patients are seeing in-house hospitalists. It is so infuriating that we close our eyes to mental health but then question why people do particular or why the world continues to grow scarier.

        Around 18% of the population in America, or 44.7 million adults, are estimated to have a mental disease each year, and there are only enough mental health care providers nationwide to cover around 26% of the demand for services (Behavior Health & Economic Network,2017). Providers only being able to cover 26% leaves many unspoken people who continue to struggle. This will continue to be a crisis until we acknowledge the issue and find a solution. Although not a 100% solution, I believe that nurse practitioners can be a part of the change and solution. The chance for nurse practitioners to treat patients with mental health problems effectively is significant. In addition, psychiatric mental health NPs (PMHNPs) have specialized training to provide therapy and prescribe medication-assisted treatment for patients with mental health concerns or a substance use disorder (Kays, 2022).

        As an FNP or an acute care NP, we can start the treatment and give them the proper referrals and information to get them help. As a psychiatric NP, there is a vast opportunity to care for these people and help them get the treatment they need. Doctors have treated 26% of those affected by mental health issues; I believe that nurse practitioners can start to absorb the other 74%. They can counsel, treat, and point the patient in the right direction of help and healing.

         

         

        Kays, H. (2022, June 22). Nurse Practitioners (NPS) can make a difference in mental health awareness. American Association of Nurse Practitioners. Retrieved November 30, 2022, from https://www.aanp.org/news-feed/nurse-practitioners-nps-can-make-a-difference-in-mental-health-awareness

         

         

        Behavior Health and Economic Network. (2017). Beacon’s mental health services. Beacon Health Options. Retrieved November 30, 2022, from https://www.beaconhealthoptions.com/beacons-mental-health-services/

         

         Reply to Comment

        • Collapse SubdiscussionHannah Timmer 

          RESPONSE 2 to Dallas

           

          Hi Dallas,

          I like the organization and topic you chose, as we are genuinely in a mental health crisis. It has been disturbing to see how we ignore mental health issues and blame everything on mental health. Everybody talks about mental health, but no one is educated about or willing to be part of the solution. The last hospital I worked at had a considerable lack of mental health providers, and when COVID hit, all these providers, like psychiatrists, only treated patients virtually. It was unfair and honestly unprofessional, in my opinion. When someone comes in due to schizophrenia with hallucination, and we wheel in a talking computer to them, do they think that is helping the situation? Can we diagnose and treat a patient over a fuzzy computer screen and distorted sound? I certainly would not want to be treated that way. Also, these people come in at all-time lows, and the only person they get to talk to is over a screen; meanwhile, our other patients are seeing in-house hospitalists. It is so infuriating that we close our eyes to mental health but then question why people do particular or why the world continues to grow scarier.

          Around 18% of the population in America, or 44.7 million adults, are estimated to have a mental disease each year, and there are only enough mental health care providers nationwide to cover around 26% of the demand for services (Behavior Health & Economic Network,2017). Providers only being able to cover 26% leaves many unspoken people who continue to struggle. This will continue to be a crisis until we acknowledge the issue and find a solution. Although not a 100% solution, I believe that nurse practitioners can be a part of the change and solution. The chance for nurse practitioners to treat patients with mental health problems effectively is significant. In addition, psychiatric mental health NPs (PMHNPs) have specialized training to provide therapy and prescribe medication-assisted treatment for patients with mental health concerns or a substance use disorder (Kays, 2022).

          As an FNP or an acute care NP, we can start the treatment and give them the proper referrals and information to get them help. As a psychiatric NP, there is a vast opportunity to care for these people and help them get the treatment they need. Doctors have treated 26% of those affected by mental health issues; I believe that nurse practitioners can start to absorb the other 74%. They can counsel, treat, and point the patient in the right direction of help and healing.

           

           

          Kays, H. (2022, June 22). Nurse Practitioners (NPS) can make a difference in mental health awareness. American Association of Nurse Practitioners. Retrieved November 30, 2022, from https://www.aanp.org/news-feed/nurse-practitioners-nps-can-make-a-difference-in-mental-health-awareness

           

           

          Behavior Health and Economic Network. (2017). Beacon’s mental health services. Beacon Health Options. Retrieved November 30, 2022, from https://www.beaconhealthoptions.com/beacons-mental-health-services/

           

           Reply to Comment

      • Collapse SubdiscussionMarrisa Montano-White 

        Marrisa Montano-White

        December 2, 2022

        Module 1 Discussion

        Colleague Response 2

        Hello Dallas,

        You have discussed a critical area of need in healthcare in The United States right now, the need for mental healthcare. As you have stated, there has been a shortage of mental healthcare for years that continues to deepen. The COVID-19 pandemic has highlighted the need for mental healthcare to help officials recognize the need to incentivize more people to become mental health practitioners. According to Stiles-Shields et al. (2022), before the pandemic, half of the adolescents and a quarter of adults met the criteria for one mental health disorder; since then, the majority of these people have not received mental health care due to limitations of available care, especially in rural areas due to increased demand and decreased access.

        Solutions for Increasing Mental Healthcare

        The primary solution for increasing access to mental healthcare is to increase availability. One of the solutions for increasing availability is to increase the number of primary care providers. According to Poghosyan (2018), it is estimated that there will be a shortage of 52,000 physicians by 2025; however, there will be a decrease in supply. One solution to this shortage is to increase the number of nurse practitioners to help bridge the need for more primary care providers. Poghosyan (2018) states that to improve access to care, it has been called to loosen restrictions imposed on nurse practitioners at the state level to increase their ability to provide care. It is essential to have healthcare standards, but many nurse practitioners are underutilized. If there is a shortage in the number of providers available, the only solution is to find ways to better use the providers in place to spread the scope of their capabilities for patient care in the best ways possible.

        References

        Stiles-Shields, C., Batts, K. R., Reyes, K. M., Archer, J., Crosby, S., Draxler, J. M., Lennan, N., & Held, P. (2022). Digital

        Screening and Automated Resource Identification System to Address COVID-19-Related Behavioral Health Disparities:

        Feasibility Study. JMIR Formative Research6(6), 1–12. https://doi.org/10.2196/38162Links to an external site.

        Poghosyan, L., Norful, A., & Laugesen, M. (2018). Removing restrictions on nurse practitioners’ scope of practice in New YorkLinks to an external site.

                state: Physicians’ and nurse practitioners’ perspectivesLinks to an external site.Journal of the American Association of Nurse Practitioners, 30(6),

        354–360.

         

         Reply to Comment

    • Collapse SubdiscussionJared Munoz 

      MAIN POST

      In today’s economy one major stressors nurses have, is the income compared to the cost of living and unsafe nurse/patient ratios due to nurses leaving which results in a statewide nursing shortage. I live in southeastern Idaho where the cost of living has dramatically increased but nurses pay has stayed the same. This difference has caused many nurses to leave hospitals in search of higher paying jobs. This leaves the nurses that stayed with their current employment with a nurse/patient ratio that is unsafe and can overwhelm the nurse “thus making it difficult for a single primary care professional to manage all patient care needs effectively and efficiently” (Norful et al, 2018). Nurses understand that “continual change in our work environments is a reality of life” (Broome & Marshall, 2021) and we must adapt for this change. Due to the increase of nurse/patient ratio because of low staffing from nurses leaving for better pay the burnout rate among nurses increased which then caused major stress and anxiety among all staff. It is found that “employees with poor well-being were less engaged and more negative about the workplace.” (Jacobs et al, 2018).

      The hospital I work for were slow to compensate nurses for the rising cost of living which led my hospital unable to recruit new nurses because the wages were too low. Eventually the hospital was forced to give a cost-of-living raise, this raise has kept many nurses at their current job and has also made the hospital very competitive compared to other hospital wages. As far as the nurse/patient ratio the hospital administration temporally approved unlimited overtime for a period of time for nurses from all departments to help fill in wanted needs until more nurses were hired to help decrease the nurse/patient ratio.

       

      Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). New York, NY: Springer.

      Jacobs, B., McGovern, J., Heinmiller, J., & Drenkard, K. (2018). Engaging employees in well-being: Moving from the Triple Aim to the Quadruple Aim Links to an external site. Nursing Administration Quarterly, 42(3), 231–245.

      Norful, A. A., de Jacq, K., Carlino, R., & Poghosyan, L. (2018). Nurse practitioner–physician comanagement: A theoretical model to alleviate primary care strain Links to an external site. Annals of Family Medicine, 16(3), 250–256.

       Reply to Comment

      • Collapse SubdiscussionIris Cornell 

        Response from the instructor to Jared:

        Jared thanks for sharing on the topic of the “cost of living and unsafe nurse/patient ratios due to nurses leaving which results in a statewide nursing shortage” (Munoz, 2022, para. 1). What might be a few challenges in staying on top of this issue at your organization?

        Reference

        Munoz, J. (2022). Review of current healthcare issues [Discussion board post]. Walden University. https://canvas.ecu.eduLinks to an external site.

         Reply to Comment

      • Collapse SubdiscussionJeanne Baleng Okuwobi 

        Week One.  Response I

         

        Hello Jared,

        I agree that the nursing shortage is a severe issue worldwide, and organizations are not doing much to fix this concern, leaving nurses to burn out at the bedside without assistance.  Covid 19 was a horrible event that happened to the world; however, it gave nurses the courage to ask for more compensation. In 2020 many nurses left their jobs to pursue travel nursing because their home organizations did not care about the poor conditions they were exposed to when Covid first started. We did not have proper PPE, the nurse-patient ratio was highly unsafe,  we were getting sick, and we were still expected to show up to work and others.  Our salaries remained the same, and they gave us free food and coffee to thank us for being frontline Heroes.  New York was the first state that called nurses to come to their rescue, and they were paying a very high rate, and many nurses responded. Thus, travel nurses became the new normal for many.  According to  Staffing Industry analysts, traveling nursing income tripled from $3.9 billion in 2015 to roughly $11.8 billion in 2021. And at the height of travel nursing demand, some nurses saw pay as high as $125 an hour. (Person, 2022).

        Travel/contract nursing is helping nurses make more money; however,  that does not fix the concerns that we initially had; the hardships at the bedside are still the same or even worst because the patient ratio remains unsafe. There is a severe shortage of nursing assistants, making our job challenging, and others.  According to the Journal of Nursing Management, Patients are dissatisfied with the care they receive in acute settings due to the staff shortage.  (Kim & al, 2022).

        References:

        Person. (2022, September 27). Pay for travel nurses is down-and some are suing. Advisory Board. Retrieved November 30, 2022, from https://www.advisory.com/daily-briefing/2022/09/27/travel-nurses#:~:text=According%20to%20Staffing%20Industry%20Analysts,high%20as%20%24125%20an%20hour.

        Kim, J., Lee, J. Y., & Lee, E. (2022). Risk factors for newly acquired pressure ulcer and the impact of nurse staffing on pressure ulcer incidence. Journal of nursing management30(5), O1–O9. https://doi.org/10.1111/jonm.12928

         Reply to Comment

      • Collapse SubdiscussionJan Griffin 

        Reply to Jared Munoz (response 2)

        What a great topic. Yes, the cost of living has increased in most places worldwide, from bills to gas and even groceries. I contemplated taking a travel assignment to be able to afford the increase in costs, but I have children at home that need me. The hospital I work at has begun allowing the staff to pick up additional shifts that were not originally filled and gives us an additional $50.00 an hour on top of our regular pay. They came up with this amount due to what they were offering these travel nurses and basically cutting out the middleman of the recruiter. According to Yang et al. (2021), having additional staff up to date with training, it will ultimately allow for a lower stressed work environment. The higher nurse/patient ratio you spoke of is something that needs to change. Before the pandemic, the intensive care unit in my hospital was staffed normally with two patients for every nurse. Unfortunately, that was not the case over the last few years, and unfortunately, I believe in the months and maybe even the years to come.  Hill (2020) spoke about how they had to rate each patient from zero to three based on their issues, and that would determine what the staffing ratio would be for that shift. If we cannot staff appropriately, then this seems to be one of the best options to attempt to reduce unfair treatment to the patients and even the staff.

        References:

        Hill, B. (2020). Changes to nurse-to-patient ratios in intensive care during the pandemic. British Journal of Nursing29(21), 1238–1240. https://doi.org/10.12968/bjon.2020.29.21.1238Links to an external site.

        Yang, B. K., Carter, M. W., & Nelson, H. W. (2021). Trends in COVID-19 cases, deaths, and staffing shortages in US nursing homes by rural and urban status. Geriatric Nursing42(6), 1356–1361. https://doi.org/10.1016/j.gerinurse.2021.08.016Links to an external site.

         Reply to Comment

      • Collapse SubdiscussionPamela Corona Laroya 

        Response 2 to Jared Munoz

        Hello Jared,

        Great post; I enjoyed reading your post; we both share the same topic of choice: nursing shortage. One reason nurses leave the hospital and look for another job or position in another facility is low income. According to Jacobs (2018), improvements in employee well-being will result in increased employee engagement and will be a pivotal driver in assisting the health system meet its goals. If leaders give incentives and prioritize the employee’s compensation, nurses will plan to stay in their facility. I share the same sentiments with you. I live here in Texas, and my facility offers a new graduate program to work in ICU to help solve the nursing shortage. Recent RN graduates have a low compensation rate compared to other states, so they leave the facility after a year of experience. While nursing graduates increased between 2003 to 2013, one in five left their job within the first year (Broome & Marshall, 2021). Seasonal and contractual nurses also fill the staffing shortage in ICU and hospital units. Full-time nurses are offered overtime plus incentives to work more required days than usual. According to Gaod (2019), pressures related to time, the pace of work, long hours, and the boon of information via technology have compounded abundant systematic challenges in recent years, resulting in burnout.

        References:

        Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). New York, NY: Springer.

        Jacobs, B. , McGovern, J. , Heinmiller, J. & Drenkard, K. (2018). Engaging Employees in Well-Being. Nursing Administration Quarterly, 42 (3), 231-245. doi: 10.1097/NAQ.0000000000000303.

        Waddil-Gaod.,S. (2019). Stress, fatigue, and burn-out in nursing. Journal of Radiology Nursing, Volume 38, Issue 1, pp 44-46, https://doi.org/10.1016/j.jradnu.2018.10.005Links to an external site.

         

         Reply to Comment

    • Collapse SubdiscussionKasondra Lewis 

      Main Post Week One: Nursing Shortages and Nursing Retention

            In healthcare today, it is no secret that there are significant nursing shortages and a lack of appropriate staffing. This discussion examines the link between nursing shortages and nursing retention within the workforce. According to Foster (2022), scarcity in nursing has been attributed to a decrease in nurses entering nursing and failure to retain nurses already in the field. To summarize, in the nursing field, we have fewer individuals entering the field, and more nurses are leaving the field. These two attributions led to an inevitable decrease in the nursing workforce.

      Unfortunately, this nursing shortage is something that many of my colleagues and I have faced firsthand. I work in a small rural Emergency Department that is the closest access to emergency care for many small towns. The unit consists of 13 beds; eight are for higher acuity patients (e.g., MI, trauma, complicated sepsis), and five are for lower acuity patients (e.g., sore throat, minor ankle injuries, skin rash). Staffing consists typically of four RNs, one ED tech, and one ED unit secretary. However, staffing has become increasingly shorter. For example, recently, the unit had only two RNs and one unit secretary. The shift was hectic, and several emergencies presented to the ED. This staffing shortage created many issues, such as increased wait times, decreased patient-nurse interaction, dissatisfied patients and family members, dissatisfied staff, and tension amongst staff. Most healthcare professionals would classify these working conditions as poor or unsafe. The poor working conditions created by short staffing have contributed to the decreasing number of nurses willing to work at the bedside in acute or critical care areas (American Journal of Nursing, 2022).

      Addressing staffing issues to increase nurse retention can take time to be fixed. There are, however, measures that can be taken to work towards a better work environment. As mentioned previously, fewer nurses are coming into the profession. New nurses are entering a career plagued with short staffing, making it challenging to cope with stress and develop professionally, which results in new nurses leaving the profession early on (Devi, 2022). To help retain new nurses, there needs to be a focus placed on proper mentorship. According to Davi (2022), adequate mentorship matches a more seasoned nurse, and a new nurse meant to foster growth and development, which will aid in retention. A key aspect of mentorship is ensuring that the mentor and the mentee have a good relationship where the expectations amongst each are clear.

      Recently, at my organization, new graduate orientation has changed tremendously. The recent graduate orientation timeframe has been extended, and meetings with the mentor and mentee have been implemented. There are weekly check-ins conducted by the nurse educators where the mentor and mentee can individually express needs or concerns. Because the nurse educators are not within the same department, this has helped create an unbiased environment where both individuals can reach out for help during the mentorship. This new system has helped the mentor and mentee have more self-accountability. Providing recent graduates with supportive and proper mentorship is vital to the future of nursing.

       

       

      References

      American Journal of Nursing. (2022). Nursing Shortage or Exodus? AJN, American Journal of Nursing122(3), 12–13.        https://doi.org/10.1097/01.naj.0000822928.16774.9a

      Devi, M. K. (2022). Editorial: Mentoring New Nurses. Singapore Nursing Journal49(1), 1.

      Foster, S. (2022). Reflecting on retention: reasons why nurses choose to stay. British Journal of Nursing31(7), 405–405. https://doi.org/10.12968/bjon.2022.31.7.405

       Reply to Comment

        • Collapse SubdiscussionKasondra Lewis 

          Dr. Cornell,

          My biggest concern with impacting change is that people, and from my experience, those in healthcare, do not like change. One of the biggest problems would be getting mentor staff on board and helping them to understand why these changes are essential. As a transformational leader, I want staff to understand why changes are occurring so that they believe in the cause. Thank you for the reply; this has allowed me to dive deeper into my healthcare issue.

           Reply to Comment

        • Collapse SubdiscussionKasondra Lewis 

          Week One Discussion: Peer Response #2

          Dr. Cornell, implementing changes in healthcare is often met with roadblocks. As a transformational leader, one of my biggest concerns impacting change is the reluctance staff often have to change. In research from Gürol Arslan and Özden (2018), nurses were reluctant to use a specific site for IM injections; researchers found that this reluctance was due to a lack of understanding regarding the use of this site. Once proper education occurred, nurses were less reluctant to use this site. The study from Gürol Arslan and Özden (2018) helps to identify a potential cause of reluctance and offers a solution, which is providing education to staff.

          As a transformational leader that hopes to lessen reluctance when making changes to impact staffing shortages positively, I would use education. According to research from Marufu et al. (2021), the lack of educational opportunities within the hospital decreases staff satisfaction and retention rates. Therefore, developing a mentor and mentee program with a solid educational foundation is imperative to keeping nurses already within and new to the organization. A common phrase is that education is empowerment; as a transformational leader, I hope to empower all staff through education to increase retention.

           

          References

          Gürol Arslan, G., & Özden, D. (2018). Creating a change in the use of ventrogluteal site for intramuscular injection. Patient Preference and AdherenceVolume 12, 1749–1756. https://doi.org/10.2147/ppa.s168885

          Marufu, T. C., Collins, A., Vargas, L., Gillespie, L., & Almghairbi, D. (2021). Factors influencing retention among hospital nurses: systematic review. British Journal of Nursing30(5), 302–308. https://doi.org/10.12968/bjon.2021.30.5.302

           Reply to Comment

      • Collapse SubdiscussionJessica Slavin 

        NURS 6053 WK1 Response 1

        Kasondra, I think we can all easily relate to your post due to the unfortunate state our country has gotten itself in with the nursing shortage. I hate to hear of rural communities struggling to provide optimal care because of a lack of employment support. I too spoke on this topic with the specifics of utilizing traveling nurses to help ease the burden of our loss of nurses as a whole. I agree with your statement that new nurses are entering an already high-stress industry that’s now spread thin and has lack of educational support.  RNs must take on delegable duties in the absence of support staff (nursing assistants, patient care techs, safety observers, patient/specimen transporters, monitor techs, unit clerical staff, lift teams, etc.). Doing so perpetuates a shortage syndrome by absorbing RN time at the expense of disruption to essential role functions that only RNs are educated, authorized, and required to fulfill. Such disruption yields an assault on nurses’ professional integrity when they attempt to adhere to the standard of care while simultaneously juggling delegable tasks in the absence of support staff (Hansen & Tuttas, 2022, p. 148). In taking this class we are quickly learning how to be a leader in an ever-changing industry of mandates and initiatives we may not always agree with. We must be able to manage our own time and stress when we find ourselves amid big change initiatives(Broome & Marshall, 2021, p. 51). We must stand strong in our values and resist the temptation to over-control “do all the work ourselves” and allow our team time and space to talk about changes and discuss ways to build together through the changes.

        References

        Broome, M. E., & Marshall, E. (2021). Transformational leardership in nursing: from expert clinician to influential leader (3rd ed.). New York,NY: Springer.

        Hansen, A., & Tuttas, C. (2022). Professional choice 2020-2021. Nurse Leader20(2), 145–151. https://doi.org/10.1016/j.mnl.2021.12.018Links to an external site.

         Reply to Comment

        • Collapse SubdiscussionKasondra Lewis 

          Week One Discussion: Peer Response #1

          Jessica, I thoroughly enjoyed your response. We relate and agree on this topic at an extraordinary level. Your response to my discussion post did not mention the current pandemic; this reminded me that nursing was already in a shortage before the pandemic. While the pandemic has worsened conditions, I cannot help but think that the pandemic also allowed both healthcare professionals and the public to see issues in healthcare that may have gone seemingly unnoticed before. For example, according to research from Norton and Myers (2021), nursing staffing shortages affect staff and patient satisfaction and outcomes. These findings were published in 2021; however, the research was conducted in 2019, before the pandemic.

          According to Griffiths et al. (2020), the COVID-19 pandemic made apparent the work burden that nurses face daily, including both physical and psychological workloads. Again, the issue I wish to shed light on is the dwindling workforce and the increased load the RN is forced to take on daily. While I believe that the pandemic worsened working conditions, the pandemic served as a source of realization that change is needed within the profession to continue to meet the growing needs of both patients and nurses.

           

          References

          Griffiths, P., Saville, C., Ball, J., Jones, J., Pattison, N., & Monks, T. (2020). Nursing workload, nurse staffing methodologies and tools: A systematic scoping review and discussion. International Journal of Nursing Studies103, 103487. https://doi.org/10.1016/j.ijnurstu.2019.103487

          Norton, L., & Myers, A. (2021). The treatment of streptococcal tonsillitis/pharyngitis in young children. World Journal of Otorhinolaryngology – Head and Neck Surgery7(3), 161–165. https://doi.org/10.1016/j.wjorl.2021.05.005

           Reply to Comment

      • Collapse SubdiscussionJared Munoz 

        Response #1

        Kasondra,

        There are many reasons there is a nursing shortage in the United States. I agree with you that nursing shortages can cause tension and dissatisfaction among patients, family and nurses. I live in Southeastern Idaho where we have experienced a mass exodus of nurses. This was caused by the cost of living and inflation. Our housing market almost doubled and to a point nurses could no longer afford rent or mortgages and a couple years ago our low cost of living is what drew in nurses from all over. This created a nurse/patient ratio that was unsafe “thus making it difficult for a single primary care professional to manage all patient care needs effectively and efficiently” (Norful et al, 2018). We had many nurses leave to find other hospitals that will offer more money or completely leave the state all together for better pay. With the nursing shortage that led to unsafe nurse/patient ratios created burnout. We all know burnout is dangerous because nurses with “poor well-being were less engaged and more negative about the workplace.” (Jacobs et al, 2018) which can ultimately lead to mistake and a hostile work environment. In my region our hospitals made cost of living adjustment raise to keep the nurses we have and hopefully recruit more coming out of college or from out of state thus providing more nurses to reduce the nurse/patient ratio, burnout and the nursing shortage so that as nurses we can have more time to focus on our patients and give them the quality of care, they deserve from us.

         

        Jacobs, B., McGovern, J., Heinmiller, J., & Drenkard, K. (2018). Engaging employees in well-being: Moving from the Triple Aim to the Quadruple Aim Links to an external site. Nursing Administration Quarterly, 42(3), 231–245.

        Norful, A. A., de Jacq, K., Carlino, R., & Poghosyan, L. (2018). Nurse practitioner–physician comanagement: A theoretical model to alleviate primary care strain Links to an external site. Annals of Family Medicine, 16(3), 250–256.

         

         Reply to Comment

        • Collapse SubdiscussionKasondra Lewis 

          Jared, like you, I have also seen staff nurses dwindle in my area. Many of the nurses I have worked alongside have left to become travel nurses. While I am happy to see other nurses making career choices that better themselves, it is hard to remain a staff nurse when fewer and fewer are showing up to work. Perhaps, one day, organizations and country leaders will recognize the need for better pay and conditions within nursing. I look forward to working with you this semester!

           Reply to Comment

    • Collapse SubdiscussionJan Griffin 

      The healthcare issue affecting the medical community is a shortage of nursing staff. The increased number of patients over the years continues to grow, significantly impacting adequate staffing levels. Why would individuals want to spend all this time and money on school when they can get a job with better benefits and pay without having someone’s life in their hands?

                 Initially, we saw many nurses hitting the road to work these travel assignments for a pay increase. According to Bourgault (2022), healthcare costs are expected to increase tremendously by 2026. One way healthcare is looking to decrease costs is to hire nurses through internal contracts, which would cut out the middleman. The facility I work in has offered full-time staff the opportunity to make extra money when shifts need covering with bonus pay. Christ (2022) stated that nurses do not want to take a decrease in revenue because they have become accustomed to a way of life. By cutting out the middleman with these nurse travel companies, the nurse’s pay can be met in the middle, and the hospital can afford to hire two nurses for the average cost of one travel assignment nurse.      

                 Another way to do this is to investigate hiring nurse externs to assist with primary nurses’ job duties. These student nurses are close to the end of their schooling and learn valuable skills while helping with daily tasks. With nursing shortage continually being an issue, patients’ needs might not all be critical, but they continue to be very important. Turale and Meechamnan (2022) stated that the population would be negatively affected if nurses do not start working together and obtaining governmental support. Not enough staff will mean poor outcomes for patients, and with this, more and more nurses will be walking away from the job feeling defeated and exhausted. The nursing community will continue to need support from all medical personnel, and hopefully, one day, the nursing shortage will be a thing of the past. 

       

      References:

      Bourgault, A. M. (2022). The Nursing Shortage and Work Expectations Are in Critical Condition: Is Anyone Listening? Critical Care Nurse42(2), 8–11. https://doi.org/10.4037/ccn2022909Links to an external site.

      Christ, G. (2022). Hospitals eye in-house staffing agencies to combat nursing shortage. Modern Healthcare52(9), 14.

      Turale, S., & Meechamnan, C. (2022). Investment in Nursing is Critical for the Health of the World: We Need 6 Million Additional Nurses. Pacific Rim International Journal of Nursing Research26(3), 371–375.

       Reply to Comment

        • Collapse SubdiscussionJan Griffin 

          Reply to Dr. Cornell

           

          Thank you, Dr. Cornell, for your comment. One way I plan on addressing the issue of the shortage of nursing staff is to look at who has been stuck within the organization during the rough times. These individuals need to be compensated for their continued support and loyalty. According to Hansen and Tuttas (2022), travel nursing has increased significantly, especially during the pandemic. We must find the best way for all nurses to work together to fulfill a sense of accomplishment and pride in their work. So many times, new nurses are hired, and their pay is based on the market.  These specific nurses could be making the same as a nurse with five or more years of experience, which creates an unhealthy work environment. This is the same instance with the travel staff coming in.  I have heard something about why must I work so much, and they sit here and barely do anything and collect a larger paycheck than I do. This is where a good leader comes into play. According to Majeed and Jamshed (2021), working to build a good team between travel nurses and nursing staff will lead to a better work environment for all. After a lengthy discussion with my manager, we concluded that if we cannot compensate the staff nurses with money, we can give them with other things, such as the first selection for shifts when scheduling. If the nurse feels like they are being respected, they will be more willing to accept help, whether from new or travel nurses. We are doing something right because travel nurses want to extend their contract due to the excellent work environment within my department.

          References:

          Hansen, A., & Tuttas, C. (2022). Professional Choice 2020-2021: Travel Nursing Turns the Tide. Nurse Leader20(2), 145–151. https://doi.org/10.1016/j.mnl.2021.12.018Links to an external site.

          Majeed, N., & Jamshed, S. (2021). Nursing turnover intentions: The role of leader emotional intelligence and team culture. Journal of Nursing Management (John Wiley & Sons, Inc.)29(2), 229–239. https://doi.org/10.1111/jonm.13144Links to an external site.

           Reply to Comment

          • Collapse SubdiscussionJulie Robinson 

            Response to Jan (Response #2)

            Hello Jan and class,

            Thank you for your post. The nurse shortage of today is quite severe and distinct from any that has existed in the past. Fewer nurses are joining the workforce, there are acute nursing shortages in some places, and there is a dearth of appropriately trained nurses to fulfill specific patient needs in a changing healthcare environment (AACN, n.d.). These factors all point to a new nursing shortage. The need for suitably trained nurses to serve a varied population is becoming increasingly apparent, and it is predicted that this shortage will only worsen over the next 20 years (AACN, n.d.).

            I agree with you completely when you stated that we, as nursing leaders, must find the best way for all nurses to work together to fulfill a sense of accomplishment and pride in their work. Not everything is about the money; do not get me wrong, it is a bonus, but other factors also take place to keep a nurse in their position. According to Drennan & Ross (2019),  an individual’s selection regarding a job is based on the perceived net advantage or disadvantage of various employment features, not only the income level: compensation, other financial benefits (such as health insurance and pensions), working hours and patterns, work types and volumes, the emotional and physically demanding nature of the work, variety of tasks, teamwork, the degree of responsibility and autonomy, managerial and clinical support, and professional help are just a few of the factors that should be considered (Drennan & Ross, 2019).

            I thoroughly enjoyed your post about nursing shortages. I hope you have a great day. I look forward to hearing more from you.

            References

            AACN. (n.d.). Strategies to reverse the new nursing shortage. Retrieved December 1, 2022, from https://www.aacnnursing.org/News-Information/Position-Statements-White-Papers/Reverse-ShortageLinks to an external site.

            Drennan, V. M., & Ross, F. (2019). Global nurse shortages—the facts, the impact, and action for change. British Medical Bulletin130(1), 25–37. https://doi.org/10.1093/bmb/ldz014Links to an external site.

             Reply to Comment

      • Collapse SubdiscussionJared Munoz 

        RESPONSE #2

        Jan,

        I agree with you that this topic of nursing shortages is a major issue the United States has. I live in Southeastern Idaho where it is one of the fastest growing areas in the nation. because of this our cost of living almost doubled without our pay going up. This caused many nurses to find travel nursing positions or leave the state for better paying jobs or leaving nursing all together because of burnout. The nursing shortage caused an unsafe nurse/patient ratio “thus making it difficult for a single primary care professional to manage all patient care needs effectively and efficiently” (Norful et al, 2018). With these unsafe ratios many nurses experienced high stress, anxiety and burnout and the hospital I work for realized quickly that “employees with poor well-being were less engaged and more negative about the workplace (Jacobs et al, 2018). This led to many a hostile work environment and an unsafe environment for the patient with high acute needs. Nurses with high nurse/patient ratios are unable to give their best quality of care their patient deserve. My hospital did give us a cost-of -living raise to satisfy the current nursing staff but in my opinion for my region it still is not enough.

        Jacobs, B., McGovern, J., Heinmiller, J., & Drenkard, K. (2018). Engaging employees in well-being: Moving from the Triple Aim to the Quadruple Aim Links to an external site. Nursing Administration Quarterly, 42(3), 231–245.

        Norful, A. A., de Jacq, K., Carlino, R., & Poghosyan, L. (2018). Nurse practitioner–physician comanagement: A theoretical model to alleviate primary care strain Links to an external site. Annals of Family Medicine, 16(3), 250–256.

         Reply to Comment

    • Collapse SubdiscussionJeanne Baleng Okuwobi 

      Week 1 Discussion:

      You will select a national healthcare issue and consider how that issue may impact your work setting. You also analyze how your organization has responded to this issue.

       

       Healthcare issue

      Low patient satisfaction is a severe issue in healthcare that is interlaced with the shortage of workers in the field. Acute healthcare settings deal with patients’ complaints and poor satisfaction surveys during and after hospital stays. Patient satisfaction is the most critical indicator of the quality of care and is considered an outcome of healthcare services (Karaca & Durna, 2019). Healthcare has always struggled with shortages of employees; however, when the pandemic hit in 2020, it worsened the problem and impacted many healthcare settings. Many workers in healthcare initially left the profession due to fear of getting sick with the Covid 19 or worry of bringing the disease home to their loved ones. According to Time magazine, It’s no mystery why about 18 percent of healthcare workers quit their jobs between Feb 2020 and Sept 2021. (Vesoulis & Abrams, 2022). This factor affected hospitals nationwide; as a result, hospitals were willing to pay higher rates to attract nurses and nursing assistants to work for them. According to Time, “Hospital administrators, facing shortages in staff nurses, spend a mint hiring contract nurses, which makes them less able or willing to increase their staff nurses’ pay. So more staff nurses quit to become contract nurses, thus further lowering nurse supply and driving demand for contract nurses. It is a vicious cycle”. (Vesoulis & Abrams, 2022).

        Impact on the work setting

      Despite these high-paying contract/travel nursing rates, hospitals are still short-staffed, compromising the quality of care rendered to the patients. There need to be more nurses at the hospital where I’m currently working as a contractor; thus, the nurse-patient ratio changes daily depending on how many nurses show up to work. We do not always have nursing assistants. As a result, there are occurrences of care delays because nurses are often busy completing tasks that techs should do. Many hospitals are dealing with hospital-acquired pressure ulcers because there is not enough staff to reposition patients every two hours, as the literature recommends. In addition, call lights are not answered promptly; thus, there is a higher rate of falls, causing patients to stay longer in hospitals and potentially worsening their condition. According to the Journal of Nursing Management, “Hospital-acquired pressure ulcers not only cause health problems but also pose an economic burden to patients” (Kim & al, 2022). Therefore, patients are not satisfied with the care they receive in acute care settings, and nurses are not happy either because they are burnt out with the assignment given due to unfair ratio, acuity of illnesses of patients, and insufficient support on the units to assist nurses.

      Conclusion

      Healthcare organizations need help fixing the issues related to short staffing, and they are constantly hiring; however, people resign from these jobs as fast as the hiring process. Thus, hospitals mainly rely on contract/travel nursing. According to Time, It is challenging to fix a problem when you have new people coming in every 12-13 weeks, orienting them to your floor, making sure they know where equipment is, where meds are, and who to call for a problem; it’s constant turnover. (Vesoulis & Abrams, 2022).  Patients are also exposed to continuous change, which affects the quality of care they receive.

       

       References

       

      Karaca, A., & Durna, Z. (2019). Patient satisfaction with the quality of nursing care. Nursing open6(2), 535–545. https://doi.org/10.1002/nop2.237

      Vesoulis, A., & Abrams, A. (2022, February 23). Hospitals say nursing agencies are ‘exploiting’ the pandemic. Time. Retrieved November 29, 2022, from https://time.com/6149467/congress-travel-nurse-pay/

      Kim, J., Lee, J. Y., & Lee, E. (2022). Risk factors for newly acquired pressure ulcer and the impact of nurse staffing on pressure ulcer incidence. Journal of nursing management30(5), O1–O9. https://doi.org/10.1111/jonm.12928

       Reply to Comment

        • Collapse SubdiscussionJeanne Baleng Okuwobi 

           

          Hello Dr. Cornell,

          I agree that hospitals are trying to address the nursing shortage issue by hiring new graduates and contract nurses to ensure they have enough staff to complete the job.  One of the challenges affecting the healthcare system is that organizations do not want to increase the base pay of their staff.  Even though one of the best approaches to fix the healthcare staff shortage is to increase the base salaries of the in-house staff to ensure retention. Instead, travel/contract nurses still make two to three times more than the staff, leading to a vicious cycle because they keep leaving their full-time job to join the travel/contract movement. According to NPR news, “In many hospitals, the only thing keeping units fully staffed is a rotating cast of traveling nurses. Hospitals have to pay them so much that their staff nurses are tempted to hit the road too.” (Farmer, 2021).  Also, we need more support at the bedside to prevent nurse burnout and other physiological and psychological issues. According to a study conducted with a sample of 3,135 nurses, fifty-four percent suffer from moderate to severe burnout, with emotional exhaustion. (Kelly et al., 2021)

          Reference

          Farmer, B. (2021, October 18). More nurses are quitting their jobs to try a lucrative stint as a traveling nurse. NPR. Retrieved November 30, 2022, from https://www.npr.org/2021/10/18/1046952444/more-nurses-are-quitting-to-try-a-lucrative-stint-as-a-traveling-nurseLinks to an external site.

          Kelly, L. A., Gee, P. M., & Butler, R. J. (2021). Impact of nurse burnout on organizational and position turnover. Nursing outlook69(1), 96–102. https://doi.org/10.1016/j.outlook.2020.06.008

           Reply to Comment

      • Collapse SubdiscussionDallas Wilcox 

        Response #2: Week 1 Discussion (Jeanne Baleng Okuwobi)

        Jeanne, thank you for an informative discussion surrounding the very critical national crisis of nursing shortages. I thought that the two other factors you discussed with this crisis, lower patient satisfaction and greater nursing shortages due to COVID-19, were a great take on how this crisis impacts more than just facilities.

        Although the nursing shortage was your main topic, I wanted to discuss a little more about how those two other topics you brought up in regard to nursing shortages has impacted the Department of Veterans Affairs. According to Heckman (2022), “The VA has seen record-high turnover among its health care workforce since the start of the COVID-19 pandemic. The agency has called on Congress to pass legislation that would raise caps for health care positions and make permanent some pandemic-era hiring authorities” (para. 8). The COVID-19 has obviously taken a great toll on the nursing profession with nurses changing career paths entirely due to burnout, fear, etc. The VA has lost many nursing professionals to career changes, nursing leaving for higher paying private-sector jobs, and some leaving to pursue travel nursing as well.

        The other aspect to the nursing shortage you discussed was decreased patient satisfaction. This has also impacted the Veterans seen within the Department of VA. The influx in medical needs due to the spread of COVID-19 in Veterans, mental health crises in Veterans, and general care has created a need for nurses that just are not available to serve within the VA. The lack of nursing then impacts the wait times for Veterans, quality nurses hired to treat Veterans, which then creates lower satisfaction regarding the treatment received by these Veterans (Fainguersch, 2022).

        The VA has made valiant attempts at onboarding nurses, and other medical professionals, to address these Veteran needs. There has been review of the salary’s of nurses with increases offered, cost of living raises, and hiring events to tackle this issue. The VA has also been offering assistance with student loan repayment in an effort to bring aboard medical professionals.

        Although the VA is attempting to tackle this issue head-on, it still remains a large issue in many areas. We are hopeful that the COVID-19 stress and fear diminishes and the fair and equitable treatment of nurses increases in order to begin the long battle of attaining more nursing to combat this crisis.

         

         

         

         

        References:

        Heckman, J. (2022, July 11). VA health staffing shortages back on the rise after years of progress. Federal News Network. Retrieved November 30,

        2022, from https://federalnewsnetwork.com/veterans-affairs/2022/07/va-health-staffing-shortages-back-on-the-rise-after-years-of-progress/Links to an external site.

         

        Fainguersch, B. A. (2022). The Impact of the Nursing Shortage on the Quality of Care of Veterans. Pace University. Retrieved November 30, 2022,

        from https://digitalcommons.pace.edu/cgi/viewcontent.cgi?article=1315&context=honorscollege_theses

         Reply to Comment

    • Collapse SubdiscussionIvy Dzivenu 

      MAIN DISCUSSION POST

      Healthcare is a broad field that is always expanding and changing to address the healthcare demands of the population. The shortage of nurses is one national healthcare issue I have chosen since I have encountered it for the five years I have worked as a nurse. The World Health Organization (WHO) estimates a 7.2 million medical professionals shortage to meet health demands. According to the United States Registered Nurse Workforce Report Card, a shortage of registered nurses is anticipated to worsen nationwide through 2030. Third Global Human Resources Forum for Health’ predicts that by 2035, the shortage of nurses will arrive at 12.9 million (Marć et al., 2019). Nurses play a very important role in healthcare systems. Nursing shortages in surgical units result in dangerous nurse-to-patient staffing ratios. In my opinion, more than merely educating and licensing is needed to address the shortage of nurses. In one year of employment, a fifth of nurses leaves their nursing jobs (Broome & Marshall, 2021). To prevent them from quitting or nurse going to other professions, serious action must be taken to keep experienced nurses in the nursing field and at the bedside.

      The nursing shortage has the following impacts on healthcare: Firstly, it leads to poor patient experiences. Nurses spend a lot of their time with their patients, and patients depend on them to provide the best and safest care possible (Larson et al., 2019). Hence, if a hospital has insufficient nurses, it will be hard for the nurses to give quality care to a patient because a lot of errors will be made as the nurse will be dealing with a lot of patients with few resources. Secondly, the shortage of nurses also leads to burnout due to the daily chronic workplace stress that nurses face while trying to meet the many patients’ demands. Due to the high patient-to-nurse ratio, the nurses are sometimes required to work extra shifts to replace the gap of the unavailability of nurses, and therefore they go home tired and fail to have time to spend with their families (Dall’Ora et al., 2020). Burnout also makes the nurses make many mistakes which can cost a patient’s life. The National Academy of Medicine reports that between 35% and 54% of American nurses and doctors experience a number of burnout-related symptoms. Lastly, a shortage of nurses can lead to an increase in cross-infection caused by the nurse forgetting to change gloves, sanitize their hands, or sterilize their tools before attending to another patient due to dealing with many patients and burnout.

      At my hospital, the medical-surgical units have a nurse-to-patient ratio of 1:6. Having six patients and the workload accompanying those patients has made me feel inadequate as a nurse and question if I want to be a nurse anymore on many occasions. Nursing is an emotionally taxing job, and I find that sometimes people forget that nurses are more than nurses; we are people. When the pandemic started, my floor transitioned to a COVID-19 medical-surgical floor. The nurse-to-patient ratio changed to 1:4, which sounds much better than 1:6, but was misleading. The staffing changes came at a cost; we often perform total care, and there is little support from other departments such as housekeeping, maintenance, lab technicians, etc. The hospital partnered with a local mental health facility and provided group and individual counseling sessions for those who wanted to attend; hence, the working environment has resulted in a high nurse turnover.

      A nursing shortage has a major adverse effect on health care; it is not only an organizational difficulty or a subject for economic analysis. Any nursing shortage, whether local, regional, national, or global, must be addressed to maintain or improve health. The followings are ways my health system work setting has responded to the shortage of nurses: Promoting career development and helping all nurses obtain the highest education is one way the hospital has helped respond to the nursing shortage. The hospital has retained more nurses because nurses will feel more satisfied and appreciated. Another way our hospital has dealt with the nursing shortage is by prioritizing nurse retention levels. Our chief nursing officer has done that by decreasing shift length and overtime, making nurses not quit working. Our chief nursing officer also offered us bonus rewards during the pandemic, which motivated our workforce because we felt our work was appreciated and noticed. Many changes were made in our healthcare system, and expanding referral bonuses was one of them.

      Using innovation to address the shortage of nurses is another healthcare method because technology is the solution to almost everything in this century. With technology, nurses can place their patients’ records on a computer. Electronic health records are very useful to nurses because they will reduce their workload as they have no paperwork to deal with. The time they could be used to arrange the papers or look for a lost file can be used to deal with patients, and time wasted can be recovered (Downing et al., 2019). Electronic health record has played an essential role in reducing the shortage of nurses because by reducing workload, many nurses do not get too tired, and the thought of quitting because of too much work disappears. It has also made communication easier and saves a lot of time, giving nurses enough time to rest.

       

       

      References

      Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). New York, NY: Springer.

      Dall’Ora, C., Ball, J., Reinius, M., & Griffiths, P. (2020). Burnout in nursing: a theoretical review. Human resources for health18(1), 1-17. https://link.springer.com/article/10.1186/s12960-020-00469-9

      Downing, N. L., Rolnick, J., Poole, S. F., Hall, E., Wessels, A. J., Heidenreich, P., & Shieh, L. (2019). Electronic health record-based clinical decision support alert for severe sepsis: a randomized evaluation. BMJ quality & safety28(9), 762-768. https://qualitysafety.bmj.com/content/28/9/762.abstract

      Larson, E., Sharma, J., Bohren, M. A., & Tunçalp, Ö. (2019). When the patient is the expert: measuring patient experience and satisfaction with care. Bulletin of the World Health Organization97(8), 563. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6653815/

      Marć, M., Bartosiewicz, A., Burzyńska, J., Chmiel, Z., & Januszewicz, P. (2019). A nursing shortage–a prospect of global and local policies. International nursing review66(1), 9-16. https://www.researchgate.net/profile/Joanna-Burzynska-2/publication/326584152

       

       

       

       

       

       Reply to Comment

        • Collapse SubdiscussionIvy Dzivenu 

          Response #2 to Dr. Cornell

          Hi Dr. Cornell

          Thank you. The hospital I work for has formed monthly meetings where we nurses get to face our manager and supervisor to voice our concerns. The meetings have worked so far because workflow has improved, nurses have more time to spend with their families, and we were given back our lunch breaks. Burnout has also been reduced; nurses are more motivated to help patients (Shamsi & Peyravi, 2020). Management not being able to address nurses’ concerns can be a challenge.

          The main challenge to face in the adoption of electronic health records is the resistance of healthcare workers and employees due to the lack of computer technology. Healthcare providers may resist adopting technologies, especially if they lack the necessary knowledge, skills, or expertise (Aguirre et al., 2019).

          Another challenge will be the lack of finances to promote career development and help all nurses obtain the highest education and also to offer bonus rewards.

           

           

           

          References

          Aguirre, R. R., Suarez, O., Fuentes, M., & Sanchez-Gonzalez, M. A. (2019). Electronic Health Record Implementation: A Review of Resources and Tools. Cureus11(9), e5649. https://doi.org/10.7759/cureus.5649Links to an external site..

           

          Shamsi, A., & Peyravi, H. (2020). Nursing shortage, a different challenge in Iran: A systematic review. Medical journal of the Islamic Republic of Iran34, 8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7139261/

           

           Reply to Comment

      • Collapse SubdiscussionJeanne Baleng Okuwobi 

        Hello Ivy,

        Your third paragraph highlights how many nurses are feeling. Many nurses I often know question themselves about this profession because of the hardships of being at the bedside. My biggest concern with nursing conditions is the lack of support, including nursing assistants. Having to care for five total care patients by myself is almost impossible. During the Pandemic, initially, nurses at my hospital had four positive patients; however, with no support, such as CNAs, going into patients’ rooms every five minutes to provide care was draining and scary. We had no phlebotomists; the rapid response team was overworked, so we had to run our codes when needed. A couple of months later, during the hot times of Covid, the ratio went back to 1-5. According to CNN news, Almost a year into the Covid-19 Pandemic, America’s nurses – who for almost 20 years have been voted the country’s most trusted professionals– are running on empty. They’ve reused PPE, canceled PTO, and worked extended shifts for employers who don’t always value their safety. (Andrew, 2021). The painful part is that nobody is coming to rescue nurses, not the organizations that we work for and not the government. According to an article in the American journal of nursing, 15 percent of nurses who responded to an American Nurses Association survey reported they regretted their career choice. What is the reason most-cited for their regret? Burnout. (6 reasons nurses quit, 2022).

        References

        Six reasons nurses quit. EveryNurse.org. (2022, June 16). Retrieved December 2, 2022, from https://everynurse.org/6-reasons-nurses-quit/

         

        Andrew, S. (2021, February 25). Traumatized and tired, nurses are quitting due to the pandemic. CNN. Retrieved December 2, 2022, from https://www.cnn.com/2021/02/25/us/nurses-quit-hospitals-covid-pandemic-trnd

         

         

         Reply to Comment

      • Collapse SubdiscussionDinorah Abigail De La Cerda 

        RESPONSE #2

        Hi Ivy,

        Thanks for your insightful post. Until recently, I worked in the ED as the weekend charge nurse and have had similar feelings to those you mentioned. Working through Covid has affected many nurses and how they feel about the profession. In an article written by Brittaney Bertagna on why nurses are quitting, she states, “Many healthcare staff are burnt out and are leaving the profession to regain their physical and mental health” (Betagna, n.d). Nursing is exhausting, and working short personally would make me so anxious before my shift that I would get to work 35 minutes earlier than required to meditate on the workday to come.

        I definitely agree with you on how shortages affect patient satisfaction. Most patients don’t realize all that the nurse is actually doing or how many other patients the nurse has; therefore, they tend to place the majority of the blame on the nursing staff when things don’t go as they want. I think the incentives your CNO placed are a great way to retain staff.

        I’ve never worked anywhere except in an ER, but my fellow colleagues have mentioned that they sometimes had to stay late to finish their charting. While the EHR is helpful and way faster than paper charting, I feel it still has a long way to go.

        Refrences:

        Bertagna , B. (n.d.). 15 Top Reasons Why Nurses Are Quitting. Nursing Process. https://www.nursingprocess.org/why-are-nurses-leaving-the-profession.html

        Clark, P. A., Leddy, K., Drain, M., & Kaldenberg, D. (2007). State nursing shortages and patient satisfaction: more RNs–better patient experiences. Journal of nursing care quality22(2), 119–129. https://doi.org/10.1097/01.NCQ.0000263100.29181.e3

         

         Reply to Comment

    • Collapse SubdiscussionSergio Aguirre 

      Hello Dr. Cornell and class,

      A national healthcare issue that has impacted the nation, and in particular the State of California, is an epidemic of psychiatric cases, homelessness, and drug abuse. These factors in combination with mental health provider shortages, and restricted access to resources, are nearing crisis levels. “Physician supply is constrained in the short run by long training times and in the longer run by medical school capacity and the number of accredited residency positions” (Auerbach et al., 2018, para.2). Similar to the business concept of supply and demand, the provider demand is not being met in our state, and this is a major problem as the State of California, has the largest population in the nation.

      In the previous emergency departments (ED) I worked for, telehealth monitors were frequently used. The two hospitals I previously worked for had no, psychiatric unit, nor psychiatrist on the hospital premises. At these facilities, tele monitors were used for patients who were going through psychiatric crisis such as acute psychosis, drug induced psychosis, suicidal ideation, and those deemed gravely disabled. Through tele monitors providers could recommend psychiatric medications, treatments, and 5150 holds. The ER doctors would work collaboratively with tele docs, up until the patient was transferred to a higher level of care, and or released when considered mentally stable. In addition, the mental health crisis has alerted members of Congress to pass policies that promote greater access to telehealth visits. In particular policies such as H.R. 4058, eliminate in person requirements that increases coverage and telehealth services regardless of geographic locations such as those who reside in rural areas (Congress.gov, 2021).

      Another strategy that my healthcare system uses to combat provider shortages are the Physician-Nurse Practitioner co-management of patient loads. This strategy not only applied to the psychiatric aspect of patient care but in cardiology specialty, and emergency services as well. In the emergency room setting, nurse practitioners, and physicians assistant are hired and concentrate on patients with less urgent matters. This helps lessen the strain on the emergency room doctors and allows them to focus on patients going through active emergencies such as CODE STEMIS, CODE Strokes, and patient arriving to the ED in a cardiac arrest. Past interviews with successful co-management duos, indicate that successful teams alleviate individual workload, prevent burnout, improve patient quality care, and improves patients access to medical services (Norfel et al., 2018).

      “One projection suggests an additional 52,000 physicians will be needed by 2025” (Poghosyan et al., 2018, para.1). By 2025, Nurse Practitioners (NP) in the role of primary care providers are supposed to increase by 93% (Poghosyan et al., 2018). However, many states have regulations that restrict a nurse practitioner scope of practice and require NP’s to work under the supervision of physicians (CA.gov, 2022). In the State of California, Assembly Bill (AB)890 is getting set to come into effect in January 1, 2023. With the passage of AB890, NP’s practicing in California must transition to practice that must include a minimum of three years practice experience or 4,600 hours (CA.gov, 2022). With these minimum requirements along with practicing under the physician without using standardized procedures, should start alleviating some of the provider shortages, regardless of specialty in the state of California.

      References

      Auerbach, D. I., Staiger, D. O., & Buerhaus, P. I. (2018). Growing ranks of advanced practice clinicians—Implications for the physician workforce Links to an external site.Links to an external site.New England Journal of Medicine, 378(25), 2358–2360.

      Congress.gov. (2021). H.R.4058 – Telemental Health Care Access Act of 2021.

      https://www.congress.gov/117/bills/hr4058/BILLS-117hr4058ih.pdfLinks to an external site.

      CA.gov. (2022). AB-890 Nurse practitioners: scope of practice: practice without standardized procedures.

      https://www.rn.ca.gov/practice/ab890.shtml

      Norful, A. A., de Jacq, K., Carlino, R., & Poghosyan, L. (2018). Nurse practitioner–physiciancomanagement: A theoretical model to alleviate primary care strain Links to an external          site.Links to an external site.Annals of Family Medicine, 16(3), 250–256.

      Poghosyan, L., Norful, A., & Laugesen, M. (2018). Removing restrictions on nurse practitioners’ scope of practice in New York state: Physicians’ and nurse practitioners’ perspectives Links to an external site.Links to an external site.Journal of the American Association of Nurse Practitioners, 30(6), 354–360.

       Reply to Comment

        • Collapse SubdiscussionSergio Aguirre 

          Hello Dr Cornell,

          Ideally advance practice registered nurses (APRNs) should be leaders in coordinating care, seeking healthcare alternatives, and providing access to care (Broome & Marshall, 2021, p.71). I’ve recently worked in an emergency room in a city that is already known to have a big segment of the community living at or below the poverty level, social issues, along with homelessness. A way to further address this issue within my organization is to act as a transformation-leader and attend multidisciplinary meetings, that can help address patient specific needs (Broome & Marshall, 2021). Working with administration, social workers, and public health, to work on strategies to reach the community is a prominent start.

          Nurse ran clinics may be an effective method to start addressing the needs of psychiatric patients and homeless on a one-to-one basis, giving patients opportunities to express themselves, and build relationships with nursing staff (Broome & Marshall, 2021). Nurse ran clinics may be a bridge between disenfranchised communities and healthcare organizations that may enhance patient compliance and adherence to treatment needed by psychiatric, and homeless patients.

           

          Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert  

               clinician to influential leader (3rd ed.). New York, NY: Springer.

           Reply to Comment

      • Collapse SubdiscussionDinorah Abigail De La Cerda 

        Hi Sergio,

        I really enjoyed reading your post. I had no idea that ED’s could use telemedicine and or collaborate with other providers to provide medical care to patients experiencing psychiatric needs. In the part of Texas I am from, there are no psychiatric in-patient hospitals. Oftentimes we hold psychiatric patients for days until placement can be found. In the case of the psychiatric holds for suicidal/homicidal patients: did your previous facility deem them a threat to themselves and then involve the police to section? How did you all manage to keep patients safe meanwhile?

         

        References:

        Betz, M. E., & Boudreaux, E. D. (2016). Managing Suicidal Patients in the Emergency Department. Annals of emergency medicine67(2), 276–282. https://doi.org/10.1016/j.annemergmed.2015.09.001

        Introduction to telehealth practices for emergency departments. Telehealth.HHS.gov. (n.d.).  https://telehealth.hhs.gov/providers/telehealth-for-emergency-departments/

         

         Reply to Comment

        • Collapse SubdiscussionSergio Aguirre 

          Hello Dinorah,

          You should see how we do Tele-stroke assessments, with neurologist on the other side of the monitor. But yes, tele health monitors is quite common for hospitals who don’t have psychiatric units. Our sister hospital has a behavioral unit, as well as the County hospital which is about a mile from my home. We also have issues with finding placements regardless if we have hospitals with behavioral units; we also have to wait days. Many times we would simply have another tele psych consult, and the psychiatrist would determine, that the patient was mentally stable enough to DC home.

          Many times, police would drop these patients off to our hospital to provide treatment. It was a tactic of theirs to relieve them of responsibility. Most of the time, they wouldn’t even write the 5150 holds, and have staff write them. As if we didn’t have enough work, as it was. If patients became a threat, we would medicate them. And if they were suicidal, we would us an ER tech, as a safety sitter.

           Reply to Comment

    • Collapse SubdiscussionJulie Robinson 

      Hello Dr. Cornell and class,

      Healthcare Issue

      The national healthcare that I have decided to select and discuss is incivility. One term for short, upsetting, intimidating, and unwelcome acts directed at another person is incivility (Asghari et al., 2017). Any behavior that disrupts the environment for learning or practicing is an example of displaying incivility. Incivility has always existed, but it appears to be a growing issue for organizations (Broome & Marshall, 2021).

      Impact on Organization

      The impact that organizations may acquire of incivility is significant. People who are the targets or witnesses of incivility may have various detrimental behavioral, psychological, and physical effects (Asghari et al., 2017). Threatening and disruptive behavior can also result in medical errors, increase risks to patient safety, decrease patient satisfaction, and raise healthcare costs (ANA, 2017).

      Response to Healthcare Issue

      This is where nursing leaders need to shine. Incivility needs to be stopped. Plain and simple. Leaders must develop and maintain a culture of respect (Broome & Marshall, 2021). It is like our required media stated in the video, “To make sure that somebody’s success in our health care industry today and to be able to adapt to the changes that are occurring, I think the number one step is to be aware” (Walden University, 2015). Nursing leaders being aware of incivility and taking the necessary steps to stop this type of behavior can make work settings for nursing less stressful. Policies are essential to control or enhance rudeness (Asghari et al., 2017). Education should also be considered. Education could be vital in helping others in preventing mistakes instead of bullying. A code of conduct should be required to define the actions that are deemed disruptive. At my organization, compassion, respect, and kindness are core values that we represent. Breaches of this behavior policy result in the use of their progressive discipline process. I love that about our organizations because bullying should not be tolerated.

      Conclusion

      Incivility, bullying, and workplace violence are obstacles to creating secure settings for healthcare practitioners. Nursing leadership is needed more than ever regarding this healthcare issue. Policies/codes of conduct and education should be required to stop behaviors that are unnecessary for the professional workplace for nurses. Teamwork could be a goal of a healthy work environment instead of incivility.

       

      References

      ANA. (2017, October 14). Violence, incivility, & bullying. American Nurses Association. Nursing World.          https://www.nursingworld.org/practice-policy/work-environment/violence-incivility-bullying/Links to an external site.

      Asghari, E., Abdollahzadeh, F., Ebrahimi, H., Rahmani, A., & Vahidi, M. (2017). How to prevent workplace incivility?: Nurses’ perspective. Iranian Journal of Nursing and Midwifery Research, 22(2), 157. https://doi.org/10.4103/1735-9066.205966Links to an external site.

      Broome, M., & Marshall, E. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). Springer Publishing Company.

      Walden University, LLC. (Producer). (2015). Leading in Healthcare Organizations of the Future [Video file]. Baltimore, MD: Author.

       Reply to Comment

        • Collapse SubdiscussionJulie Robinson 

          Hello Dr. Cornell and class,

          Response to Dr. Cornell

          Thank you for your response and question to my post. According to Broome & Marshall (2021), influential leaders must take a comprehensive view of the corporate policies, standards, and power relationships that support incivility (Broome & Marshall, 2021). An example would be overtime, a high staff turnover rate, unsuitable patient-to-nurse ratios, apparent changes in policies and procedures, and the lack of respect from other healthcare professionals (Broome & Marshall, 2021). The stress and fatigue the nurses were under could have contributed to incivility.

          When addressing some barriers to incivility, some things should be kept in mind. While nursing leaders have a crucial and direct role in combating bullying and disrespect, they also need their organization’s backing and a commitment to real change (Alberts, 2022). To ensure that obstacles are found and swiftly removed, antibullying projects must be frequently evaluated at the organizational level.

          I hope I answered your questions, Dr. Cornell. I hope that you have a great day. Let me know if I need to address any other concerns or questions you may have with my discussion.

          References

          Alberts, H. L. (2022). Addressing bullying and incivility in clinical nursing education. Teaching and Learning in Nursing17(4), 433–437. https://doi.org/10.1016/j.teln.2022.05.004Links to an external site.

          Broome, M., & Marshall, E. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). Springer Publishing Company.

           Reply to Comment

      • Collapse SubdiscussionMichele Cleary 

        Great post, Julie.

        Bullying is more common in healthcare than it should ever be. When the goal is patient care, negative words, bullying, or incivility should never come into play. Strong nursing leadership is necessary to create a positive work environment. It is helpful for a manager to have a strong leadership attitude and style. Managers manage and minimize risk, whereas leaders create opportunities; combining the two is more effective (Broome & Marshall, 2021).  Strong leaders cultivate a positive attitude in the workplace.

        Nurse bullying can occur in any care setting and at all levels, including among executives. Researchers reported in a 2018 Journal of Nursing Magazine study that 60% of nurse managers, directors, and executives experienced bullying in the workplace (St. Catherine University).

        In my outpatient infusion center, I have also seen bullying in reverse. I had a nurse report to the nursing supervisor that nurses were talking badly about her, saying she was lazy and didn’t pull her weight. She reported several nurses to Human Resources. HR thoroughly investigated and found that the nurse reporting had personal issues against the nurse outside of work. This nurse that reported constantly makes reports on everyone to management. So it would seem some of the nurses are bullied by her after she is the one who reported bullying. Leadership, in this case, should be solid and concise, respecting all the nurses and supporting all nurses. A few nurses say they feel uncomfortable working with her because she “tattles” on everything.

        It takes a positive environment with nurses working together to accomplish the critical goal of quality patient care.

        Thanks,

        Michele

         

         

        References:

        Broome, M., & Marshall, E. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). Springer

        Publishing Company.

        Nurse bullying: Why it happens and how to prevent it. Retrieved online from St. Catherine University. December 17, 2021.

         

         

         

         

         Reply to Comment

      • Collapse SubdiscussionDaniel Russell Wright 

              Julie, great post.  According to a recent AMA report, poor staffing levels, excessive workloads, poor management skills, stress, and a lack of autonomy are some of the factors that contribute to bullying in the workplace, including in healthcare (Murphy, 2021). In healthcare settings, civility is a system value that increases safety. It is not a novel idea to link decorum, workplace security, and patient care (TJC, 2021). Bullying can be direct physical assault, verbal abuse, or some indirect behavior. Bullying behavior in the workplace is rife and represents an epidemic of rudeness (TJC, 2021). Workplace bullying, according to AMA policy, is defined as persistent, emotionally or physically abusive, disrespectful, disruptive, inappropriate, insulting, intimidating, or threatening behavior directed at a single person or group of people (Murphy, 2021). It often, but not always, results from a real or perceived power imbalance and is meant to control, embarrass, undermine, threaten, or otherwise harm the target.

        The severity of the issue is highlighted by a recent Occupational Safety and Health Administration (OSHA) report on workplace violence in the healthcare industry: over 50% of registered nurses and nursing students reported verbal abuse (which included bullying) over the course of a 12-month period, compared to 21% who reported physical assault (TJC, 2021). Additionally, over the course of a week, 59% of emergency nurses reported verbal abuse and 12% reported physical abuse. According to the Workplace Bullying Institute, 65.6 million American workers are directly affected by bullying or have witnessed it (TJC, 2021). According to a 2014 Workplace Bullying Institute survey, 57% of targets and 69% of bullies are women, with women being the primary targets of bullies in 68% of cases (TJC, 2021). The overall workplace climate or culture that permits unprofessional behavior, such as bullying, to persist may be influenced by individual, organizational, and health system factors (Murphy, 2021). I very much liked the quote you chose,  “To make sure that somebody’s success in our health care industry today and to be able to adapt to the changes that are occurring, I think the number one step is to be aware” (Walden University, 2015).

        References

        Murphy, B. (2021, April 2). Why bullying happens in health care and how to stop it. AMA Association. https://www.ama-assn.org/practice-management/physician-health/why-bullying-happens-health-care-and-how-stop-it

        The Joint Commission. (2021, June). Bullying has no place in health care. Joint Commision. https://www.jointcommission.org/resources/news-and-multimedia/newsletters/newsletters/quick-safety/quick-safety-issue-24-bullying-has-no-place-in-health-care/bullying-has-no-place-in-health-care/#.Y4r

        Walden University, LLC. (Producer). (2015). Leading in Healthcare Organizations of the Future [Video file]. Baltimore, MD: Author.

         Reply to Comment

    • Collapse SubdiscussionMichele Cleary 

      Module 1 Discussion.6053N

      Health Care Issue

      One of the most significant challenges I see in nursing and healthcare is nurse burnout and compassion fatigue. Nurse burnout and compassion fatigue are especially prevalent in oncology nursing. Burnout is a state of emotional, physical, and mental exhaustion resulting in increased mental distance and low personal satisfaction in work activities. These contribute to increased tardiness, absenteeism, and presenteeism with decreased productivity and use of disability time (Qualls et al., 2022). Organizations are more successful with employees who are committed to their profession and leaders who support them. This is more important now than ever before. No longer are the days that nurses go to work, punch a time card, follow orders without thinking and go home (Walden, 2015). Nurses are on the front lines providing emotional, technological, spiritual, and precise care for their patients. It is vital for nurses to feel supported by their organizations and leaders.

      Burnout Impact on Work Setting

      Nursing burnout is characterized by a reduction in a nurse’s energy that manifests in emotional exhaustion, lack of motivation, and frustration that may lead to reduced work efficacy. Burnout affects not only individuals’ physical and mental health; its consequences are also reflected in workplace contexts involving the nursing care provided, patients’ illness and recovery, and the institution itself by increasing absenteeism and sick leave rates (Gomez-Urquiza et al., 2016). Risk factors contributing to nursing burnout and compassion fatigue are the workload, the need to cope with the death, pain, and suffering of patients and their families, and the lack of supported leadership. Due to shorter staffing, nurses who are tardy or absent due to burnout create a more significant and vigorous workload for the other nurses. Burnout can cause emotional distress, impacting all areas of nursing, including clinical, emotional, and administrative care. On the physical level, it can include weakness, fatigue, headaches, muscle aches, increased risk of infection, sleep disturbances, changes in eating habits, and a tendency to take excessive amounts of medications or stimulants (Piotrowska et al., 2022). If a nurse is not operating at their best, patient care a satisfaction will be at an all-time low.

      Response of Healthcare Organization

      Many studies evaluate the potential burnout and compassion fatigue in oncology nursing. Studies have shown that caring for cancer patients increases the risk of burnout and compassion fatigue. Organizations can help reduce the risk of burnout by supporting their staff by providing adequate staffing and support services. Some support services are counseling, a quiet room, exercise programs, group activities outside of work, oncology-related seminars, and discounts on relaxation exercises such as massage therapy and yoga. It is essential that organizations provide support and interventions for their staff to assist them in being the healthiest version of themselves physically, emotionally, and mentally.

      Conclusion

      While nursing burnout can not be eliminated, there are many ways organizations and leaders can help reduce burnout and compassion fatigue. Providing nurses with education on preventing and applying interventions in their daily lives can help reduce burnout. Leaders and organizations who help support their nurses to provide balance will help to reduce burnout and compassion fatigue.

       

       

       

      References:

      Gomez-Urquiza, J., Aneas-Lopez, A., De la Fuente-Solena, E., Albendin-Garcia, L., Diaz-

      Rodriquez, L. & Canadas-De la Fuente, G. (2016). Prevalence, risk factors, and levels

      of burnout among oncology nurses: A systematic review. Oncology Nursing Forum.

                  Vol 43, No. 3. Doi: 10.1188/16.onf.e104-e120

      Qualls, B., Payton, E., Aikens, L., & Carey, M. (2022) Mindfulness for outpatient oncology

                  Nurse: A pilot study. Wolters Kluwer Health, Inc. Doi: 10.1097/hnp.0000000000000487

      Walden University, LLC. (Producer). (2105). Leading in Healthcare Organizations of the

                  Future [Video file]. Baltimore, MD: Author.

       

       Reply to Comment

        • Collapse SubdiscussionMichele Cleary 

          Module 1 Response #2 to instructor

          Dr. Cornell,

          Transformational leaders primarily motivate others through a system of rewards. They develop, innovate, focus on developing others, inspire and create trust, and hold a long-term, big-picture, futuristic view (Broome & Marshall, 2021). Transformational leaders also focus on employee satisfaction. Having leaders that focus on employee satisfaction and employees’ mental health mean they will want to help minimize compassion fatigue and burnout. Many nurse leaders concentrate on quality improvement for the patient and the employee.

          Leaders who implement interventions for the nurses on staff can help reduce compassion fatigue and burnout. Educating staff to recognize signs and symptoms of compassion fatigue and burnout is the first step in the intervention process (Gomez-Urquiza, et al., 2016). The literature recommends mindful-based interventions to combat burnout. These interventions can be simple as meditation prior or during a shit, providing a quiet room outside of work activities, seeking counseling, yoga, exercise, and self-care. Employees follow their leaders when they are solid and approachable. Leaders must create this environment so that nurses know when they need intervention and reach out to their leaders. When leaders cultivate an environment of teamwork and compassion toward others, it helps each person feel supported and noticed. It is essential for employees to feel supported by their leadership. In this day and age, leaders must support and keep their staff (Walden, 2015).

           

          References:

          Broome, M., & Marshall, E. (2021). Transformation leadership in nursing: From expert

                      Clinician to influential leader. (3rd ed.). Springer Publishing Company.

          Gomez-Urquiza, J., Aneas-Lopez, A., De la Fuente-Solena, E., Albendin-Garcia, L., Diaz-

          Rodriquez, L. & Canadas-De la Fuente, G. (2016). Prevalence, risk factors, and levels

          of burnout among oncology nurses: A systematic review. Oncology Nursing Forum.

                      Vol 43, No. 3. Doi: 10.1188/16.onf.e104-e120

           

          Walden University, LLC. (Producer). (2105). Leading in Healthcare Organizations of the

                      Future [Video file]. Baltimore, MD: Author.

           

           

           Reply to Comment

      • Collapse SubdiscussionPamela Corona Laroya 

        First response :

         

        Hello Michele,

        I enjoyed reading your post. Informative, concise, and timely. Nurse burnout and compassion fatigue are affecting healthcare workers. Caring for others, especially in nursing, has long been associated with stress due to working in challenging circumstances and conditions. According to Watts (2020), nurses are the quintessential multitaskers in healthcare. Pressures related to time, the pace of work, long hours, measured performance expectations, transparency of clinical outcomes, an aging workforce, and the boon of available information via technology have compounded abundant systematic challenges in recent years (Waddil-Gaod, 2019)

        Burnout, as you mentioned, contributes to increased tardiness, absenteeism, and presenteeism. I agree that nurses are on the front lines of providing emotional, technological, spiritual, and precise care for their patients. Multiple risk factors can contribute to burnout, such as time pressure, lack of control over work processes, role conflict, poor relationships between groups and with leadership, and our clinical nursing work’s emotional intensity (Watts, 2020). It is vital for nurses to feel supported by their organizations and leaders is a strong point in your post. According to Crabtree (2022), compassion fatigue can be prevented by education, awareness, and self-care. Healthcare settings discourage medical professionals from practicing effective self-care. Hospitals may explore alternative work schedules and lower patient loads to prevent compassion fatigue and burnout (Deyoung, 2022).

        References:

        Crabtree, N. S., DeYoung, P. M., Vincent, N. J., Myers, T. P., & Czerwinskyj, J. (2022). Compassion fatigue, compassion satisfaction, and burnout: A study of nurses in a large Texas healthcare system. Journal of Nursing Scholarship54(6), 720–727. https://doi.org/10.1111/jnu.12780Links to an external site.

        Waddill-Goad., S (2019). Stress, Fatigue, and Burnout in Nursing, Journal of Radiology Nursing, Volume 38, Issue 1, pp 44-46, https://doi.org/10.1016/j.jradnu.2018.10.005Links to an external site..

        Watts, S., Thorne-Odem, S., (2020). Nursing yourself away from burnout and compassion fatigue to resilience and joy at work. Nursing Made Incredibly Easy!: November/December 2020 – Volume 18 – Issue 6 – p 6-8 doi:10.1097/01.NME.0000717684.70292.43

         

         

         

         Reply to Comment

      • Collapse SubdiscussionJessica Slavin 

        NURS 6053 WK1 Response #2

        Michele, I enjoyed reading your post and was enlightened on this topic. Nurse burnout seems to be something lightly discussed and brushed under the rug. In an industry that seems to be losing employees faster than we can educate them, you would think burnout would be addressed in a higher manner. Workplace stress is the major source of stress for American adults, escalating over the past several decades. The outcomes speak volumes in terms of measuring: absenteeism, decreased employee productivity, employee retention, and turnover, and medical, legal, and insurance fees (Fink-Samnick 2017).  For the most part, the healthcare industry is composed of well-intentioned, highly trained, and prepared individuals, representing a variety of roles and clinical disciplines. Each person strives to perform the highest quality effort possible, toward ensuring that the expectations of patients, their caregivers, and other stakeholders are met. The service mission of people caring for people in times of their greatest vulnerability and need is a dynamic that sets the work of healthcare apart from other sectors (Fink-Samnick 2017). However, studies show widespread burnout and dissatisfaction among those employed in healthcare organizations.

        Being a nurse leader in a complex health system isn’t for the faint of heart. Leading within a complex healthcare organization requires an individual to be committed to learning, being flexible, and focusing on supporting others in their jobs and industries and how “the business of healthcare” works(Broome & Marshall, 2021, p. 40). Leaders must recognize burnout and be facile with this issue to ensure the safety and reliability of staffing conditions.

         

        References

        Broome, M. E., & Marshall, E. (2021). Transformational leardership in nursing: from expert clinician to influential leader (3rd ed.). New York,NY: Springer.

        Fink-Samnick, E. (2017). Professional Resilience Paradigm Meets the Quadruple Aim: Professional Mandate, Ethical Imperative. Professional Case Management, 22 (5), 248-253. doi: 10.1097/NCM.0000000000000238.

         

         Reply to Comment

    • Collapse SubdiscussionJessica Slavin 

      NURS 6053 Wk 1 Initial Discussion Post

      National Healthcare Issues

      It seems that the overwhelming response to this first discussion is that most of the active participants’ biggest concern is the national nursing shortage. I too agree with this concern but I’d like to hone in on the subcategory of utilizing travel agency nursing to “fix” this problem. Are travel nurses helping improve healthcare literacy and create a successful emerging healthcare team or diluting the system as a whole? I’m sure this may be a controversial topic and please don’t mistake my perspective on travel nurses as having a negative impact on our profession, I’ve been a travel nurse and done short assignments to fill temporary or seasonal needs, but the utilization of travel agencies to fill full-time positions with temporary nurses doesn’t seem to fix the burden of shortages overall.

      Travel nursing has long served as a niche profession born out of the need to supplement the permanent staff workforce. Hospitals typically turn to contingent workforce firms to help bridge temporary workforce vacancies created by occurrences such as attrition, temporary leaves of absence, seasonal patient volume surges, newly opened units, and implementation of electronic medical records. Historically, the travel RN market was characterized by a stable ratio of approximately 1 travel RN job opening per 1,000 permanent RN job openings(Hansen & Tuttas, 2022, p. 145). As we all know and experienced, COVID-19 shifted everything in healthcare, including supplemental nursing needs. In essence, travel nurses executed a national rapid response by mobilizing from one pandemic hotspot to the next, where nursing resources were most urgently needed (Hansen & Tuttas, 2022, p. 145).

      For the profession to remain strong, nurses need to be prepared by expert faculty members who are leaders in shaping health policy, generating new knowledge, promoting knowledge translation, and advancing innovative curriculum design (Broome & Marshall, 2021, p. 85). One of the biggest threats to the nursing workforce is the declining number of nursing faculty to prepare students and new graduates (Broome & Marshall, 2021, p. 85). This concern from Broome & Marshall is the exact point I’m wanting to make with hiring excessive amounts of traveling nurses, especially when it comes to an acute specialty like the one I work in. The cardiac cath lab isn’t a department that a new hire could come into without extensive orientation, most of the time it’s a minimum of a year before they are professionally prepared to work independently. Since August of 2021 my department has had the highest ratio of travelers to internal permanent staff in my facility, at one point we only had 4 core internal RN staff members, this leaves a lot of work to be done to build a strong team with limited educators.

      High turnover of health staff is costly and associated with poorer health outcomes. High reliance on agency nurses is also very likely to be cost-ineffective. Investment in a coordinated range of workforce strategies that support the recruitment and retention of resident nurses and health practitioners is needed to stabilize the workforce, minimize the risks of high staff turnover and over-reliance on agency nurses and thereby significantly reduce expenditure and improve health outcomes.(Zhao et al., 2019). The revolving door of turnover on travel nurses in our department has caused a bit of animosity but a recent new hiring model built by the department manager was created and recently accepted by hospital leadership and we hope to see changes by the end of the 2022 year.

       

      References

      Broome, M. E., & Marshall, E. (2021). Transformational leardership in nursing: from expert clinician to influential leader (3rd ed.). New York,NY: Springer.

      Hansen, A., & Tuttas, C. (2022). Professional choice 2020-2021. Nurse Leader20(2), 145–151. https://doi.org/10.1016/j.mnl.2021.12.018Links to an external site.

      Zhao, Y., Russell, D., Guthridge, S., Ramjan, M., Jones, M. P., Humphreys, J. S., & Wakerman, J. (2019). Costs and effects of higher turnover of nurses and aboriginal health practitioners and higher use of short-term nurses in remote australian primary care services: An observational cohort study. BMJ Open9(2), e023906. https://doi.org/10.1136/bmjopen-2018-023906Links to an external site.

       

       

       Reply to Comment

      • Collapse SubdiscussionMarphene Joseph 

        week 1 Response 1

         

        Hello Jessica,

        Like many of our classmates, I decided to talk on the nursing shortage, which seems to be a global problem because people in many settings have experienced and felt its effects. I also discussed the use of travel nurses by various healthcare organizations in an effort to address the nursing shortage. As you mentioned, some specialties call for additional training and experience before a nurse can work effectively in the field. I don’t believe that many travel nurses were able to fulfill this requirement because many of them worked in specialties that they were not use to due to higher travel pay rates. it’s funny because the resolution to the issues was also the problem, the fact that travel nurses were making three times more money than staff nurses many left to become travel nurses. Staffing resource demand was affected when record numbers of nurses pursued travel opportunities and again when reinstated hospital service lines opened more jobs (Hansen & Tuttas, 2022).  healthcare organizations then started hiring a lot of new graduate nurse and placing them in specialties that require more training and knowledge in that specialty. We need to create an environment in which nurses can autonomously use their nursing skills at the higher level (Bourgault, A., 2022).  So, my question is how is this safe for the patient’s.? The nursing shortage definitely cause a lapse in the quality-of-care patients are being administered. This situation can be incredibly stressful for the nurses and extremely unsafe for the patient’s (Bourgault, A., 2022). Excellent healthcare is expensive, and that money should be used at the bedside, where it is most needed.

        Reference:

        Bourgault, A. M. (2022). The nursing shortage and work expectations are in critical condition: Is anyone listening? Critical Care Nurse42(2), 8–11. https://doi.org/10.4037/ccn2022909

        Hansen, A., & Tuttas, C. (2022). Professional choice 2020-2021. Nurse Leader20(2), 145–151. https://doi.org/10.1016/j.mnl.2021.12.018

         

         

         

         Reply to Comment

    • Collapse SubdiscussionAbie Kamara 

      One of the most critical issues identified in the transformation of healthcare services is workforce planning. To improve the workforce’s efficiency, various decisions have been made to change how it is organized. Should study this issue to establish how the healthcare workforce is run and managed to deliver the best possible care.
      Some proposed changes include moving staff members to home care settings, creating new jobs related to the outreach of sick patients, developing new ways of delivering care to patients, and introducing team-based care. In addition to these, other factors, such as data collection and use, should also be considered to make informed decisions (Pittman, 2016).
      One of the most critical factors that can be considered when implementing the changes is the management of healthcare leaders. This can affect the levels of productivity and increase the demand for workers. , choosing the best workforce for a healthcare setting should also be considered to improve the well-being of its employees.
      One of the most common issues identified in this field is the need for better workforce policies that can respond to the changes needed to improve the efficiency of the healthcare workforce. This is because many workers need to plan for the political dynamics expected to affect the administrators’ decisions.
      Implementing the Affordable Care Act and other related legislation has made healthcare systems more complex. This has prompted the need for large-scale transformations in the workforce to improve their capabilities.
      Healthcare workers and union leaders can play a vital role in addressing the issues related to the workforce by bringing attention to the concerns of national and state leaders.
      Due to the Affordable Care Act, workforce planning and development have been replaced by other methods. These include the establishment of strategic growth plans, the development of new innovative teams, and the implementation of change initiatives.
      One of the most critical factors that can be considered when implementing the changes is establishing a comprehensive and integrated workforce planning and development system. We can do this by developing a set of values aligned with the healthcare system.

      References

      Drabczyk, A. L. (2019). Healthcare workforce transitioning. In (Ed.), Healthcare workforce transitioning (pp. 153–166). Productivity Press. https://doi.org/10.4324/9780429399817-9Links to an external site.

      Pittman, P. & Scully-Russ, E. (2016). Workforce planning and development in times of delivery

      system transformation. Human Resources for Health. pp. 1-15. Retrieved from

      https://human-resources-health.biomedcentral.com/track/pdf/10.1186/s12960-016-0154-3

       Reply to Comment

    • Collapse SubdiscussionFabio Anifrani 

      Initial Post:

      Staffing shortages, especially provider shortages, are the national healthcare issue this writer selected for analysis. Indeed, staffing shortages are one of the current problems facing this writer’s organization and have impacted most areas of healthcare, including the writer’s work setting, an emergency psychiatric assessment, and a healing center embedded within the emergency department.

      This writer’s health system work setting has responded to staffing shortages by attempting to recruit more nurses and cutting services at various levels of the organization. Cutting services led to multiple layoffs, which have impacted staffing and patient care. For example, the nutrition services reduced their offerings significantly due to staffing issues, citing challenges related to the novel coronavirus pandemic and supply chain issues. Such limited offerings have meant that patients have had to go without choices that would have otherwise been available.

      The response affected mainly those at a tremendous social and economic disadvantage, including the mentally ill and patients suffering from substance use disorders and homelessness who already have nowhere else to go but the emergency department. Another way the organization responded to the provider shortages is through the increased reliance on telemedicine, an evidence-based solution to the current provider shortage, given the increasing patient traffic in the emergency department. This writer believes that having the remote option would enable more providers to contribute to the solution. They can help relieve the pressure on the current providers, especially during after-hours visits. Furthermore, telehealth would help address the current provider shortage in the United States, given that the population of people aged 65 years or older is expected to grow by 45.1%, and the general population is expected to increase by 10.4% over the next 15 years (Association of American Medical Colleges, 2020).

      For example, a qualitative descriptive study conducted by Poghosyan et al. (2018) concluded that policymakers and hospital administrations should work together to remove barriers that stand in the way of provider shortages by paving the way for more nurse practitioners to practice without restrictions in the state of New York (Poghosyan et al., 2018).

      One key to understanding the changes occurring within the workforce is how policymakers and leaders in the healthcare industry choose to manage these changes and their impact on the delivery of safe patient care (Pittman & Scully-Russ, 2016).

      Another critical step in understanding staffing shortages is for leaders within organizations to understand how to interpret the traditional methods of projecting provider shortages to improve how they appropriate resources and manage their funding to expand their business. This step includes staffing to effectively meet their objective of providing safe patient care (Pittman & Scully-Russ, 2016).

      For example, several studies have demonstrated that including advanced practitioners in primary care medical homes allows practices to expand panel sizes (Pittman & Scully-Russ, 2016). Choices about staffing, therefore, can have enormous implications for productivity, assuming the demand for certain health professions is a moving target.

      Organizations ought to learn from the recent stressors brought on by the novel coronavirus pandemic, which significantly strained the healthcare infrastructure everywhere, including here at home. This writer’s organization was already burdened with human resource infrastructural deficits. Yang et at (2021) conducted a study that found some implications for policy and the practice of healthcare, suggesting that organizations need to develop effective strategies that maximize their workforce crisis resilience has never been greater. Such systems need to include creative ways to enhance recruitment and retention incentives and targeted resource allocation to prepare for short- and long-term consequences of natural disasters such as the current pandemic era upon humanity (Yang et at., 2021).

      References:

      Association of American Medical Colleges. (2020). US physician shortage growing. Retrieved

      November 30, 2022, from https://www.aamc.org/news-insights/us-physician-shortage

      Pittman, P., & Scully-Russ, E. (2016). Workforce planning and development in times of delivery

      system transformation. Human Resources for Health, 14(56), 1–15. doi:10.1186/s12960-016-0154-3.

      Poghosyan, L. , Norful, A. & Laugesen, M. (2018). Removing restrictions on nurse practitioners’

      scope of practice in New York State: Physicians’ and nurse practitioners’ perspectives. Journal of the American Association of Nurse

      Practitioners, 30 (6), 354-360. doi: 10.1097/JXX.0000000000000040.

      Yang, B. K., Carter, M., & Nelson, W. (2021). Trends in COVID‐19 Cases, Related Deaths, and

      Staffing Shortage in Nursing Homes By Rural and Urban Status. Health Services Research, 56, 6. https://doi.org/10.1111/1475-6773.13719

       Reply to Comment

      • Collapse SubdiscussionAbie Kamara 

        Response 1

        Great post and i really enjoyed reading.Staffing shortages are a significant issue in the healthcare industry and are the subject of this writer’s analysis. They have affected various areas of healthcare, such as the writer’s work setting and an emergency psychiatric assessment.
        During the COVID-19 pandemic and various other disasters, the lack of staff has been a significant issue affecting patient surges’ management. Aside from the usual factors, such as illness and school closures, other factors, such as family concerns, can also affect the ability of healthcare workers to perform their duties.
        Many healthcare workers are also reducing their hours, accepting contract positions, and leaving the field. This can further decrease the workforce and increase the stress levels of the remaining employees. A survey conducted by a group of healthcare leaders revealed that almost half of them had to reduce the inpatient capacity of their hospitals due to the nursing shortage.
        Healthcare facilities should regularly coordinate with local, state, and territorial public health agencies to ensure that their staffing levels are maintained at the appropriate classes during the pandemic and other disasters.

        References

        Hoff, T. J., Sutcliffe, K. M., & Young, G. J. (2016). The healthcare professional workforce. Oxford University Press.

        Jordan, P. (1995). Staff management in library and information work (3rd ed.). Gower Publishing Company.

         Reply to Comment

    • Collapse SubdiscussionOluwashola Adebola Adeniji 

               Module 1 Discussion – Initial Post
                                                                               Healthcare Issue
      Laureate Education (2015) suggests that in order to be ready for future healthcare difficulties, individuals and leaders should work on building cultural competency, learning to see things from many points of view, and being more familiar with the business side of healthcare. This is the best piece of advice I can think of in the midst of the global COVID-19 outbreak. The healthcare crisis has shed light on an aspect of healthcare that was previously unknown. Massive casualties in many parts of the world and a lack of once-abundant resources, such as medical supplies. Professionals in the healthcare industry are constantly expanding their horizons to learn cutting-edge techniques for diagnosing and treating patients. The latest weekly death toll in the United States is 88,243, as reported by the Centers for Disease Control and Prevention in 2020.
      Having to deal with this illness at work for the past three months has been like experiencing whiplash in slow motion. The first shock of the epidemic caused panic, and this fear prompted important policy measures. Specialized gear had to be purchased in order to safeguard the workforce once initial supplies were exhausted and could not be replaced. After shelter-in-place orders were issued, patients stopped showing up to hospitals, which exacerbated the situation. With outpatient day surgery postponed, a low census on hospital floors, and the remaining cash spent on PPE stockpiles, the money ran out rapidly. During that time, my company laid off some employees permanently and furloughed others for a month.
      The American Hospital Association (2020) reports that the COVID-19 pandemic is posing severe financial issues for hospitals and health systems across the country. The ripple effects of the infection are now felt not only by those who are ill but also by those who tend to them. My group also did a fantastic job of keeping us safe. The employees at my hospital avoided contracting the virus, and I attribute this to the extra precautions that were taken. Understanding the necessity of layoffs and furloughs is important for my future in healthcare, but it’s still hard to watch friends and coworkers lose their jobs.
      References
      American Hospital Association. (2020). Hospitals and health systems face unprecedented financial pressures due to COVID-19. Retrieved June 2, 2020, from https://www.aha.org/guidesreports/2020-05-05-hospitals-and-health-systems-face-unprecedented-financial-pressures-dueLinks to an external site.
      Centers for Disease Control and Prevention. (2020). Daily updates of totals by week and state.
      Laureate Education (Producer). (2015). Leading in Healthcare Organizations of the Future

       Reply to Comment

    • Collapse SubdiscussionJessica Jarosky 

      MAIN POST

      The healthcare issue I selected for analysis is the psychiatric provider shortage across the nation, leading to significant delays in prompt quality psychiatric care. There has been a substantial decrease in psychiatric providers providing inpatient care in the last five years for various reasons. Many psychiatric providers are nearing retirement or are experiencing burnout fatigue and decreasing hours of practice due to the strain (Butryn et al., 2017). Another factor contributing to the shortage of psychiatric providers is the lack of full practice and prescriptive authority granted by state legislatures to many states. Allowing nurse practitioners to practice independently under their full scope of practice and knowledge without being required to be under the supervision of a covering physician will allow a significant increase in mental health patients receiving timely care when in crisis (Bosse et al., 2017).

      Since the COVID-19 pandemic, many individuals are experiencing increased anxiety and depression, leading to increased self-harm and suicidal ideation. I have experienced first-hand in my hospital the rapid influx of suicidal patients in the last two years, as well as the decrease in the number of psychiatric providers in the inpatient setting. Several of our psychiatrists and psychiatric mental health nurse practitioners (PMHNP) have stepped away from inpatient care and transitioned to telehealth, leaving our hospital to cap the number of patients allowed due to insufficient providers. Psychiatric patients are now resorting to receiving mental health care from their primary care providers or via emergency room providers for a quick fix that does not encourage medication compliance or follow-up care (Kuriakose, 2020).

      There are currently many barriers to patients receiving timely psychiatric care. We currently have long waitlists for patients in emergency rooms waiting for placement in our acute psychiatric beds that wait several days before being placed. However, voluntary less-acute patients typically receive medication from the emergency room provider and may leave before a bed is available. In Washington, our largest state psychiatric hospital lost its accreditation for general population patients due to safety concerns because of unsafe staffing levels. Because of this, we house many patients in our short-term inpatient hospital awaiting placement at a long-term state facility who are court-ordered to receive 180-day, or 365-day, inpatient psychiatric care. These beds are no longer available to patients in mental health crises that are a danger to themselves, others, or are gravely disabled, and our hospital is forced to decline dozens of patients screened every day. Since the psychiatric provider shortage has increased over the last two years, my hospital has been forced to close down entire units and cap the number of patients allowed on each unit to ensure the patients are seen every day by a provider. Community resources are maxed out, and individuals with mental health disorders are not receiving the quality care they need and deserve.

      My hospital has also responded to the lack of psychiatric providers by hiring contracted telehealth providers from all across the nation. While implementing telehealth providers is a quick solution to our hospital’s provider shortage, it comes with downfalls when working with psychiatric patients. Patients on our most acute units often refuse to speak to the ‘computer doctors’ due to paranoia and delusions or simply can’t sit down for an extended interview due to mania or psychosis. The telehealth providers must rely solely on the nurse’s assessment of the patient, as they cannot see how the patient interacts within the milieu. Another downfall includes difficulty reaching the provider, as they are often in different time zones. To mitigate the psychiatric provider shortage, changes must be made at the state and organizational levels to promote recruitment to the mental health specialty.

       

      References

      Bosse, J., Simmonds, K., Hanson, C., Pulcini, J., Dunphy, L., Vanhook, P., & Poghosyan, L. (2017). Position statement: Full practice authority for advanced practice registered nurses is necessary to transform primary care. Nursing Outlook, 65(6), 761–765.

      Butryn T, Bryant L, Marchionni C, Sholevar F. (2017). The shortage of psychiatrists and other mental health providers: Causes, current state, and potential solutions. International Journal of Academic Medicine, 3(1), 5-9.

      Kuriakose, S. (2020). Pandemics and mental health: An unfortunate alliance. SN Comprehensive Clinical Medicine2(11), 2197–2201. https://doi.org/10.1007/s42399-020-00501-yLinks to an external site.

       Reply to Comment

      • Collapse SubdiscussionBeth Howell 

        Week 1 discussion response 2, Beth Howell, to Jessicas Jarosky 

        Dear Jessica, 

             Thank you for your interesting and informative post. You expand on the issues of psychiatric provider shortages and implications thoroughly. 

             I agree with your assessment of an increase in anxiety and depression since the advent of covid and the need for continuity of care in safe and

        appropriate environments.  

              A lack of providers is felt in my work setting as a corporate wellness nurse as well. Our scope is holistic, and part of our assessment includes

        stress, coping, and mental health. We rely on EAP (employee assistance program) and telehealth if further intervention is needed. On rare

        occasions, we have had mental health emergencies. We are ill-equipped for follow-up beyond the initial referrals as the earliest next follow-up is 4

        months.  

               I had not considered that in some patients the telehealth visit would be met with skepticism as you mentioned. Mental telehealth, especially in

        underserved rural areas is effective (McDougal et al.,2022). Nurse leaders like yourself using front-line experience can highlight and personalize

        issues such as this. The first step of change is figuring out what needs to be done (Broome & Marshall, 2021). Thank you for your dedication to this

        area of nursing expertise.

         

        References 

        Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert 

                    clinician to influential leader (3rd ed.). 

        McDougal Ronconi, J., Kim, S., Hackel, J., Kelly, L., & Zhang, L. (2022). Implementing Telemental Health to Improve Access to Mental Health Care in

                     Rural Vermont. Journal for Nurse Practitioners18(2), 226–231. https://doi.org/10.1016/j.nurpra.2021.10.007 

         

         Reply to Comment

      • Collapse SubdiscussionMleh Porter 

        Hello Jessica,
        I enjoyed reading your post. Thank you for choosing this important health topic. According to the National Alliance on Mental Illness (NAMI), 1 in 5 adults experiences a mental illness, and 1 in 6 youth between the ages of 6 and 17 experience a mental health disorder every year (NAMI, 2022). Every year, millions of Americans requiring mental health services struggle to find mental health care. Almost half of the 60 million adults and children who need mental health treatment go without treatment (NAMI, n.d.). A shortage of mental health providers contributes to a lack of access to mental healthcare. One of the critical reasons mental health is not screened for, recognized, and treated is the lack of mental health providers (Kuriakose, 2020).
        The lack of mental health providers has also impacted my workplace. The emergency room is packed with patients in need of mental health services. Many of these patients spend long hours waiting for inpatient psychiatric beds to become available, which can be detrimental to staff and patients. In some cases, security staff is called multiple times to address concerns. Some of these patients may require direct observation, which requires additional staff, taking away from the already short-staff issues.
        My work setting has a behavioral health psychiatric holding with beds within the emergency department for patients waiting for inpatient psychiatric beds to keep these patients away from the busy emergency room area. While in the psychiatric holding, these patients see a psychiatric provider and receive mental healthcare services. The psychiatric holding is always staffed with nurses and behavioral health technicians, reducing patient escalation and the need for more direct observation staff in the emergency room. We indeed have a mental health crisis in the United States. Many patients in need of mental health services end up in the emergency room because of the lack of access to mental healthcare services (Kuriakose, 2020).

        References

        Kuriakose, S. (2020). Pandemics and mental health: An unfortunate alliance. SN Comprehensive Clinical Medicine2(11), 2197–2201. https://doi.org/10.1007/s42399-020-00501-y

        NAMI. (2022). Mental health by the numbers.  Retrieved December 3, 2022, from https://www.nami.org/mhstats

        NAMI. (n.d.). The doctor is out. Retrieved December 3, 2022, from https://www.nami.org/support-education/publications-reports/public-policy-reports/the-doctor-is-out

         

         

         

         

         

         

         

         

         

         

         

         

         

         

         

         

         

         Reply to Comment

    • Collapse SubdiscussionMarphene Joseph 

      Healthcare Issues

      Nurse shortage have been present for some time, but when the COVID pandemic hit this made the previous shortage even more complicated and

      complex (Ross, J. 2022). Healthcare professional have found it challenging to effectively and efficiently manage all patient care demands due to the

      impending manpower shortage in the health care industry and the rise in the number of patients seeking health care services. If healthcare stakeholders

      and government authorities do not take action to address the declining workforce, the nation may experience a nursing shortfall of between 200,000 and

      450,000 registered nurses by 2025 (Bailey, V. 2022).

      Impact on healthcare setting

      The Joint Commission recorded the most sentinel events ever in 2021, which saw a substantial increase in the number of reported events (Ross, J., 2022).

      Sentinel events are unplanned occurrences that cause the patient’s death or significant damage but are unconnected to the patient’s sickness. The

      number of falls almost tripled from 2020, pressure ulcers and infection related care event doubled, wrong sited surgery and postoperative complications

      also increased (Ross, J. 2022). Lack of nurses does not change the fact that patients still require care, and care still needs to be given. The nursing

      shortage has caused issues with patient’s ability to access healthcare, medications errors and increase in healthcare associated infections. Approximately

      1.5 million people in the US suffer medication-related injuries each year, and some experts predict that number could increase by 2022 due to staffing

      shortages (Ross, J., 2022). Rural residents suffer from the nursing shortage because they are more likely to be older and sicker, and nurses there often

      make less money, making it difficult for them to recruit new nurses to the area. Due to nurses needing to make compromises to make up for the staffing

      gap, healthcare linked infections have increased as a result of the nursing shortage.  National infection rates significantly increased in 2020, with MRSA

      bacteremia, central line-associated bloodstream infections, catheter-associated urinary tract infections, and ventilator-associated events among the most

      notable increases Ross, J., 2022). More than ever, the country needs nurses to ensure its health, the stability of healthcare delivery systems, and the

      continued expansion of the nursing workforce (Buerhaus, P., 2021).

      healthcare Organization response to Issue

      In response to the nursing shortage, healthcare organizations have increased their usage of travel nurses. Three out of four nurses said they saw an increase in travel nurses in their unit during the past year. However, permanent nurses were not thrilled with this strategy, with 32 percent reporting feeling dissatisfied with the increase in travel nurses (Bailey, V.,2022). Many novice nurses have started working as travel nurses due to the increase in pay offered to them. healthcare organizations has also started hiring new graduates and placing them in high risk areas such as the emergency room and the intensive care unit. healthcare organizations have been offering sign on bonuses and increased the referral pay in order to attract new recruits. Health systems have started implementing sign-on bonuses instead of higher salaries to attract more nurses (Bailey, V., 2022). The healthcare facility where I presently work offered nurses a $1,000 bonus for every extra shift they worked. While this first seemed to help the problem, it ultimately contributed to nurse burnout. Burnout and stressful environments may exacerbate the nurse staffing shortage, as more than 30 percent of nurses plan to leave their current position by the end of the year (Bailey, V.,2022).

      conclusion

      In healthcare environments, nurses are essential, especially when it comes to assisting with patient care. However, since the start of the COVID-19 pandemic, the healthcare sector has been dealing with severe nursing staffing shortages. Even though there were staffing  concerns before COVID -19, the pandemic made the need more urgent. Health institutions need to  support their employees by creating opportunities for professional growth, more accommodating scheduling, competitive remuneration, and fostering stronger teamwork in order to help combat the nursing shortage.

      Reference

      Bailey, V. (2022, March 17). Burnout, stress fuel nurse staffing shortage, turnover rates. RevCycleIntelligence. Retrieved November 30, 2022, from https://revcycleintelligence.com/news/burnout-stress-fuel-nurse-staffing-shortage-turnover-ratesLinks to an external site.

      Bailey , V. (2022, June 8). 200k to 450k nursing shortage expected by 2025 without action. RevCycleIntelligence. Retrieved November 30, 2022, from https://revcycleintelligence.com/news/200k-to-450k-nursing-shortage-expected-by-2025-without-action

      Buerhaus, P. I. (2021). Current Nursing Shortages Could Have Long Lasting Consequences: Time to Change Our Present Course. . Nursing Economic$35(5), 247–250.

      Ross, J. (2022). Nursing shortage creating patient safety concerns. Journal of PeriAnesthesia Nursing37(4), 565–567. https://doi.org/10.1016/j.jopan.2022.05.078

       

       

       Reply to Comment

    • Collapse SubdiscussionPamela Corona Laroya 

      Module 1- Week 1: Main Post: Pamela Laroya

       

      Introduction

      According to Bourgault (2022), working conditions have worsened for many nurses and healthcare professionals across the globe during the COVID-19 pandemic. Reported critical staffing shortages in 24% of US hospitals, and military medical personnel have been deployed to assist with patients. To this date, because of the nursing shortage, healthcare workers return to work five days without significant symptoms after testing positive for COVID-19.

      Healthcare issue

      I chose to discuss the national health issue of nursing shortage/inappropriate staffing. Last year due to an increasing number of patients, nurses were working tirelessly with N-95 masks and hot PPE gowns; people called nurses the “Healthcare Heroes.”  Healthcare facilities are responsible for providing high-quality care to patients, thus improving hospital experience, patient satisfaction, and patient outcomes (Gray et al.,2018). Healthcare organizations, like our facility post-pandemic, have been struggling with a nurse shortage leading to inappropriate staffing and retention problem. The crushing and seemingly unending workload exacerbated by shortages of personal protective equipment and the psychological strain of so many deaths from COVID-19 led some nurses to quit the profession entirely (AJN, 2022). Others left their employers for positions with less stress, while some opted for more money.

      Description of healthcare issue/stressor and how it impacts work setting

      Due to the influx of patients in our facility during the Covid-19 pandemic, ICU nurses are caring for three vented patients. Nurses are responsible for all nurse duties; patients are laid on their backs and abdomen during this time. Some nurses who may have cared for two pre-pandemic patients are now being asked to care for 3 or 4 critically ill patients. According to Bourgault  (2022), nurses who have worked at the bedside in critical care know these high staffing ratios are a recipe for failure. If the unit is understaffed, nurses cannot provide optimal care if assigned to too many patients (Bourgault 2022). In my facility, if a patient is for transfer or telemetry status, the nurse gets four non-ICU patients, they are not critical, but their needs are all essential. During the pandemic’s peak months, insufficient staffing levels in the ICU were associated with poor outcomes- infection, pressure ulcers, and increased mortality.

       

      Response of health system work setting to the healthcare issue

      Our facility use travel nurses and contractual and offers financial incentives to their regular employees to help solve the staffing shortage. According to Drennan (2019), nurses comprise half the global health workforce. A nine million deficit estimated in 2014 is predicted to decrease by two million by 2030. Consequently, many nurses are working 12-hour shifts with an increased patient load, increased patient acuity, and, for some, added mandatory overtime while recovering from illness (Bourgault, 2022).

      To decompress the influx of patients, my facility has to close surgical units and limit major and minor operations so some nurses can work on the floor to help in Covid patients. Administrative leaders also helped take care of patients on the floor. In my unit, I remember seeing my CNO and directors wheeling patients from ER to ICU because of short staffing issues.

      Conclusion

      We must create an environment where nurses can autonomously use their skills at the highest level, yet our physical capacity is limited. Nurses cannot authentically refuse to help the facility if they feel guilty about saying no to working when their colleagues are short-staffed and overworked. (Gray, 2018). Many nurses are exhausted, and with a staffing shortage, nurses will burn out and may want to leave the profession. Demand for nurses is increasing in all countries. Better workforce planning in nursing is crucial to reduce health inequalities and ensuring sustainable health systems. Addressing nurse shortages requires a data-informed, country-specific model of the routes of supply and demand (Drennan, 2022).

       

      References:

      Bourgault, A. M. (2022). The Nursing Shortage and Work Expectations Are in Critical Condition: Is Anyone Listening? Critical Care Nurse, 42(2), 8–11. https://doi.org/10.4037/ccn2022909Links to an external site.

      Drennan, V. M., & Ross, F. (2019). Global nurse shortages-the facts, the impact and action for change. British medical bulletin130(1), 25–37. https://doi.org/10.1093/bmb/ldz014Links to an external site.

      Gray K, Wilde R, Shutes K. (2018). Enhancing nurse satisfaction: an exploration of specialty nurse shortage in a region of NHS England. 25:(1)26-33 https://doi.org/10.7748/nm.2018.e1695Links to an external site.

      Staffing Crisis Fueled by COVID-19 Creates Boom for Travel Nurse Industry. (2022). The American Journal of Nursing122(5), 12. https://doi.org/10.1097/01.NAJ.0000830684.40366.efLinks to an external site.

      Introduction

      According to Bourgault (2022), working conditions have worsened for many nurses and healthcare professionals across the globe during the COVID-19 pandemic. Reported critical staffing shortages in 24% of US hospitals, and military medical personnel have been deployed to assist with patients. To this date, because of the nursing shortage, healthcare workers return to work five days without significant symptoms after testing positive for COVID-19.

      Healthcare issue

      I chose to discuss the national health issue of nursing shortage/inappropriate staffing. Last year due to an increasing number of patients, nurses were working tirelessly with N-95 masks and hot PPE gowns; people called nurses the “Healthcare Heroes.”  Healthcare facilities are responsible for providing high-quality care to patients, thus improving hospital experience, patient satisfaction, and patient outcomes (Gray et al.,2018). Healthcare organizations, like our facility post-pandemic, have been struggling with a nurse shortage leading to inappropriate staffing and retention problem. The crushing and seemingly unending workload exacerbated by shortages of personal protective equipment and the psychological strain of so many deaths from COVID-19 led some nurses to quit the profession entirely (AJN, 2022). Others left their employers for positions with less stress, while some opted for more money.

      Description of healthcare issue/stressor and how it impacts work setting

      Due to the influx of patients in our facility during the Covid-19 pandemic, ICU nurses are caring for three vented patients. Nurses are responsible for all nurse duties; patients are laid on their backs and abdomen during this time. Some nurses who may have cared for two pre-pandemic patients are now being asked to care for 3 or 4 critically ill patients. According to Bourgault  (2022), nurses who have worked at the bedside in critical care know these high staffing ratios are a recipe for failure. If the unit is understaffed, nurses cannot provide optimal care if assigned to too many patients (Bourgault 2022). In my facility, if a patient is for transfer or telemetry status, the nurse gets four non-ICU patients, they are not critical, but their needs are all essential. During the pandemic’s peak months, insufficient staffing levels in the ICU were associated with poor outcomes- infection, pressure ulcers, and increased mortality.

       

      Response of health system work setting to the healthcare issue

      Our facility use travel nurses and contractual and offers financial incentives to their regular employees to help solve the staffing shortage. According to Drennan (2019), nurses comprise half the global health workforce. A nine million deficit estimated in 2014 is predicted to decrease by two million by 2030. Consequently, many nurses are working 12-hour shifts with an increased patient load, increased patient acuity, and, for some, added mandatory overtime while recovering from illness (Bourgault, 2022).

      To decompress the influx of patients, my facility has to close surgical units and limit major and minor operations so some nurses can work on the floor to help in Covid patients. Administrative leaders also helped take care of patients on the floor. In my unit, I remember seeing my CNO and directors wheeling patients from ER to ICU because of short staffing issues.

      Conclusion

      We must create an environment where nurses can autonomously use their skills at the highest level, yet our physical capacity is limited. Nurses cannot authentically refuse to help the facility if they feel guilty about saying no to working when their colleagues are short-staffed and overworked. (Gray, 2018). Many nurses are exhausted, and with a staffing shortage, nurses will burn out and may want to leave the profession. Demand for nurses is increasing in all countries. Better workforce planning in nursing is crucial to reduce health inequalities and ensuring sustainable health systems. Addressing nurse shortages requires a data-informed, country-specific model of the routes of supply and demand (Drennan, 2022).

       

      References:

      Bourgault, A. M. (2022). The Nursing Shortage and Work Expectations Are in Critical Condition: Is Anyone Listening? Critical Care Nurse, 42(2), 8–11. https://doi.org/10.4037/ccn2022909Links to an external site.

      Drennan, V. M., & Ross, F. (2019). Global nurse shortages-the facts, the impact and action for change. British medical bulletin130(1), 25–37. https://doi.org/10.1093/bmb/ldz014Links to an external site.

      Gray K, Wilde R, Shutes K. (2018). Enhancing nurse satisfaction: an exploration of specialty nurse shortage in a region of NHS England. 25:(1)26-33 https://doi.org/10.7748/nm.2018.e1695Links to an external site.

      Staffing Crisis Fueled by COVID-19 Creates Boom for Travel Nurse Industry. (2022). The American Journal of Nursing122(5), 12. https://doi.org/10.1097/01.NAJ.0000830684.40366.efLinks to an external site.

       

       

       

       

       

       

       

       

       

       

       

       

       

       

       

       

       

       Reply to Comment

    • Collapse SubdiscussionTammy Young 

       

      Lack of Access to Healthcare

      Lack of healthcare access is the inability to obtain healthcare services such as prevention, diagnosis, treatment, and management of diseases, illnesses, and disorders. Many people, even in the United States, do not have adequate access to healthcare. Healthcare must be affordable and convenient in order to be accessible. The three most significant deterrents to obtaining good healthcare are poverty, barriers to receiving services, and the allocation of resources that provide the services the University of Missouri, n.d.). To improve access for all Americans, it is essential to understand the perceived barriers to healthcare (Ahmed, 2010).

      Impact of the Lack of Access to Healthcare

      Compared to the United States, Kentucky is more rural, home to fewer minorities, and has a somewhat older population (USA Facts, 2020). The National Rural Health Association has identified that rural areas include a high proportion of seniors, higher acuity levels, and lower life expectancies. In addition, rural households have a lower median household income ($52,386 compared with $54,296 in urban households. Approximately 24% of children living in rural areas live in poverty. People in rural areas are more likely to suffer from obesity, lung cancer, COPD, and heart disease (Abell & Blankenship, 2019).

      The lack of health care access issues impacts Kentucky because the state is more rural than other states in the US. Local healthcare workers are challenged with serving a population with an average lower income, less education, disproportionate medical facilities, and an increased median age in rural counties.

      Response to the Healthcare Issue

      The University of Kentucky’s healthcare system has partnered with local and surrounding communities to provide access to good healthcare services, including education, prevention, maintenance, and research. The Kentucky Office of Rural Health (KORH), established in 1991, is a federal-state partnership charged with improving the health of rural Kentuckians by promoting access to rural health services. KORH provides a  framework for finding solutions to rural healthcare issues by linking small rural communities with local, state, and federal resources ( University of Kentucky School of Medicine, n.d.).

      The local healthcare community has organized and implemented programs to assist with free physical exams, cervical cancer screening, mammograms, colonoscopies, pediatric services, immunizations, and education for many common health concerns.

       

      Conclusion

                  To improve access to health care, medical facilities, organizations, and federal and local governments must join forces. It is essential to network with health and other community organizations to find various options to meet the needs of a state with a large rural population. Collaborating with health-related academic units in college or university settings allows access to more resources, improving access to health services.

       

      References

       

      Abell, C. & Blankenship, M. (2019). Introducing Health Ministry in a Rural American Church. Journal of Christian Nursing, 36 (4), 244-250. doi: 10.1097/CNJ.0000000000000641.

       

      Ahmed SM, Lemkau JP, Nealeigh N, & Mann B. (2010). Barriers to healthcare access in a non-elderly urban poor American population. Health & Social Care in the Community9(6), 445–453. https://doi.org/10.1046/j.1365-2524.2010.00318.xLinks to an external site.

       

      University of Missouri School of Medicine. ( n.d.). Health Care Access. https://medicine.missouri.edu/centers-institutes-labs/health-ethics/faq/health-care-access#:~:text=Health%20care%20access%20is%20the,have%20access%20to%20adequate%20healthcareLinks to an external site..

       

      USA Facts. (2020). USA Facts, Our Changing Population: Kentucky. https://usafacts.org/data/topics/people-society/population-and-demographics/our-changing-population/state/kentuckyLinks to an external site.

       

      University of Kentucky College of Medicine. (n.d.). Kentucky office of Rural Health. https://medicine.uky.edu/centers/ruralhealth/kentucky-office-rural-healthLinks to an external site.

       Reply to Comment

      • Collapse SubdiscussionFabio Anifrani 

        Response # 2

        Hello Tammy,

        I enjoyed reading your discussion post. I agree that a severe lack of access to healthcare impacts rural communities more than urban settings due to the remote nature of those communities. I appreciate your comments about Kentucky being more rustic than other states in the union.

        I acknowledge that rural healthcare workers have more unique challenges in serving their communities. I have no doubts that socioeconomic factors such as average income being lower than the state average, less education, fewer medical facilities, and an increased median age contribute to the challenges in rural patient populations.

        For example, Dickins et al. (2020) conducted a study on homeless individuals’ lived experiences through interviews and observations and recorded how certain factors, such as perceived discrimination and lack of access to stable employment and housing, often contribute to their ability to access healthcare services (Dickins et al., 2020).

        When you factor staffing shortages into the equation, it makes for an even more challenging work environment. To address the staffing shortages, healthcare organization leaders must understand the changes occurring within the workforce, how policymakers and leaders in the healthcare industry choose to manage the changes, and their impact on the delivery of safe patient care (Pittman & Scully-Russ, 2016). The solution will have to address the provider shortages at the national level, given that the population of people aged 65 years or older is expected to grow by more than 45%, and the general population is expected to increase by more than 10% over the next 15 years (Association of American Medical Colleges, 2020).

         

        References:

        Association of American Medical Colleges. (2020). U.S. physician shortage growing. Retrieved

        November 30, 2022, from https://www.aamc.org/news-insights/us-physician-shortage

        Dickins, K. A., Buchholz, S. W., Ingram, D., Braun, L. T., Hamilton, R. J., Earle, M., & Karnik,

        S. (2020). Supporting primary care access and use among homeless persons. Social Work in Public Health, 35(6), 335–357.

        https://doi.org/10.1080/19371918.2020.1809589

        Pittman, P., & Scully-Russ, E. (2016). Workforce planning and development in times of delivery

        system transformation. Human Resources for Health, 14(56), 1–15. doi:10.1186/s12960-016-0154-3.

         

         Reply to Comment

    • Collapse SubdiscussionNavtej P Singh 

      Initial Post

      Multiple things trouble the United States healthcare system, but the mental healthcare system and lack of resources are at the top in my personal experience list. I work in the mental healthcare system and have seen at least changes and challenges in the last 15 years. One of the clear and evident cases of lack of resources in Washington state was challenged in federal court, that the state is violating the patient, civil rights by not providing services and holding them in jail without due process. This case brought the state’s lack of resources and declining funding to the forefront (Find Law, (2016). Washington state is still fined monthly for not following the law and cannot address this issue.

      One of the core ideas of the US is the sovereignty of the professions and self-regulation to create the best quality service and make rules under the different professional organizations (Ricketts, T., & Fraher, E. (2013). These organizations helped to create the best quality service in their specialty and failed to develop the coordination of care among the different agencies to provide holistic wellness. With the implementation of evidence-based practices, EBP, various healthcare organizations looked inwardly to provide quality care and created processes that helped them the most but again failed in how their system will interact with other systems. EBP education revolves around the idea that managers shall look at the global evidence and then use the internal data to create the best quality care model that is efficient and effective (Melnyk, B. M., & Fineout-Overhold, E. (2022). However, these mechanisms may help create a better individual service but will not make a continuous flow of services to provide holistic care to an individual or a community.

      Mental health services in my state of Washington are sporadic and riddled with bureaucratic red tape that is difficult for the patients to navigate, who already have minimum personal resources. I am part of the team that works with the legislative team from SEIU 1199NW (Service Employees International Union) to lobby for more funding for mental health and create a compelling and diverse workforce. We are 30 people from different organizations represented by SEIU as mental health workers. We are specialists in our areas, but we are unaware of how others’ work fits or relates to creating a frictionless system. Technology was supposed to make effortless communication among providers, but EHRs evolved for specific types of service and failed to communicate with other software produced by others. Organizations fail to share information with others due to HIPPA regulations.

      If we ever have to use transformational leadership and chaos theory to find the pattern in the chaos, we must make the different systems interact freely with each other (Marshall, E. S. (2020).). Current strategies in the state of Washington for mental health cannot move the patients logically to the next level of a better state of health. Considering the current state of mental health in the country, we must start to use 4C’s model, which dictates that we use contact, comprehensiveness, coordination, and continuity to create a smooth system to provide effective and efficient care that promotes the quadruple aim (Park, B., Gold, S. B., Bazemore, A., & Liaw, W. (2018).

       

      References:

       

      Marshall, E. S. (2020). Transformational leadership in nursing: From expert clinician to influential

      leader. Springer publishing company.

      Find Law. (2016). TRUEBLOOD v. WASHINGTON STATE DEPARTMENT OF SOCIAL AND HEALTH

      SERVICES CEO (United States Court of Appeals, Ninth Circuit.). https://doi.org/https://caselaw.findlaw.com/us-9th-circuit/1734234.htmlLinks to an external site.

      Melnyk, B. M., & Fineout-Overhold, E. (2022). Evidence-based practice in nursing & healthcare: A

      guide to best practice. Lippincott Williams & Wilkins.

      Park, B., Gold, S. B., Bazemore, A., & Liaw, W. (2018). How evolving United States payment models

      influence primary care and its impact on the Quadruple Aim Links to an external site.. Journal of the American Board of Family Medicine, 31(4), 588–604.

      Ricketts, T., & Fraher, E. (2013). Reconfiguring health workforce policy so that education, training,

      and the actual delivery of care are closely connected Links to an external site.. Health Affairs, 32(11), 1874–1880.

       Reply to Comment

        • Collapse SubdiscussionNavtej P Singh 

          Hi Dr. Conell,

          Thank you for responding to my post. Healthcare, in general, and mental health, in particular, has received intense scrutiny due to covid infections and the mass shootings in the country. Increased focus on public health has made healthcare leaders rethink global strategy, how we have been doing business, and have these methods been sustainable. Current education and leadership research indicates that we must change our thinking to make our healthcare system more effective and efficient to decrease the cost of care. There are multiple things that transformational leaders shall do to change the direction of healthcare to improve the holistic health of individuals and communities.

          At first, changing the mindset from linear thinking to systems thinking (Marshall, E. S. (2020). To improve the quality of care and patient experience, healthcare leaders have focused on linear thinking to improve quality, efficiency, and effectiveness at the minimum cost. This had helped the quality but failed to connect to other providers to enhance the quality of care. Systems thinking will empower transformational leaders to develop systems that will effortlessly connect to other systems to improve the quality of the healthcare system. Due to this kind of linear thinking by leaders, patients get contraindicated care at a high cost because methods attempt to solve all the problems even when they may not be best suited to provide it (Starfield, B. (2000).

          Secondly, our current system produces the healthcare workforce to accommodate the needs of current employers and make their practice guidelines. These existing mechanisms train specialists in particular areas with minimum knowledge of how other team members work whom they have to deal with during the process of patient care. In my personal experience, I have met 30 mental healthcare workers, and most of us are very good in our own areas, but we need more information about how other members of the care system work. This kind of lack of understanding caused a lot of redundancy and added cost (Ricketts, T., & Fraher, E. (2013). As a transformational leader, I will invest in collaborative efforts to see how team care members can communicate effectively to improve larger care systems from a community perspective.

          References:

          Marshall, E. S. (2020). Transformational leadership in nursing: From expert clinician to influential

          leader. Springer publishing company.

          Ricketts, T., & Fraher, E. (2013). Reconfiguring health workforce policy so that education, training,

          and the actual delivery of care are closely connected Links to an external site. Health Affairs, 32(11), 1874–1880.

          Starfield, B. (2000). Is US health really the best in the world? Jama, 284(4), 483-485.

           Reply to Comment

      • Collapse SubdiscussionElin Danelian 

        Reponse 2

        Hello Navtej,

        Great post. Very informative regarding the mental healthcare system. You are absolutely correct about the lack of resources in the mental health system. Reaching out to patients early in their illness trajectory, assisting them in identifying their mental health requirements, and empowering them to be open about their needs are now more important than ever for maximizing patient outcomes (Alegria et al., 2018). In my hospital, we do not have a unit designed for mental health patients. This makes it difficult for nurses to focus on the patient’s mental health because we are not trained and educated well enough for it. This issue has been expressed to administrators and they have assigned nurses modules to complete to address this healthcare issue. Access and utilization of mental health services are essential for ensuring public health (Johnson & Possemato, 2019). I believe that making sure people have access to mental health services can enhance lives and communities.

        References

        Alegria, M., Nakash, O. & Nemoyer, A. (2018). Increasing equity in access to mental health care: a critical first step in improving service quality. National Library of Medicine. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5775117/

        Johnson, E. & Possemato, K. (2019). Defining the things we can change to improve access to mental health care. National Library of Medicine. Retrieved from https://pubmed.ncbi.nlm.nih.gov/31512908/

         Reply to Comment

      • Collapse SubdiscussionTiffany Johnson 

        Discussion post #2

        Hi Navtej,

        In Colorado, we also have a major mental health crisis. Three out of ten Coloradans are in need of mental health care, that is roughly 1.5 million people (Colorado Behavior Health Administration, n.d.). Unfortunately, we do not have unions here. For Coloradans to get the care they need for mental health, there is usually a waiting list of weeks or months. We have a seventy-two hour hold in our hospital systems to provide minimal relief for patients. Once they are released, there is nowhere for them to go, exasperating their crisis.

        We also have a large youth mental health crisis. We are number two in the nation for teen suicide. Our state has implemented a program named I matter. It reaches teens through social media platforms, public advertisements, and schools. “I Matter provides up to six free therapy sessions for Colorado youth ages 18 or younger or 21 or younger if receiving special education services. The program reimburses participating providers, who are licensed clinicians” (Colorado Behavior Health Administration, n.d.). This is a great service for our youth and provides relief in our hospital systems.

        I agree with your four C’s approach. We need to figure out a way to get more providers to assist in following that model. The government is attempting to help as much as possible. Mental Health Reform Reauthorization Act of 2022 is one of many bills attempting to assist with our country’s mental health crisis. The bill reauthorizes grants and other funding until 2027 for mental health as well as making sure insurance is covering the mental health needs of the people (Congress, n.d.).

        The way that the lack of progression of care for the mental health patients affects my perioperative world is that our emergency departments are full. This creates a traffic jam throughout the hospital. We are already short staffed in perioperative services, just like every other department. We often have to go pick up patients from the ED that are hours away from surgery, to create more space in the ED. This is a big nurse and patient dissatisfier. Attempting to get orders for pain meds and adequately care for the patient in holding in preop, creates frustrations for staff and patients. It is difficult to determine which doctor is caring for the patient, leaving the patient in limbo of sorts. The preop staff is often asked to stay late to assist in caring for the holding patients. I really hope as a community, we can make the right decisions to provide better care for all patients.

                                                                                References

        Colorado Behavior Health Administration. (n.d.-a). Colorado.Gov. https://www.colorado.gov/LADDERS/OBH_Mental_HealthLinks to an external site.

        Colorado Behavior Health Administration. (n.d.-b). I matter – free mental health support for colorado youthhttps://bha.colorado.gov/get-help/i-matter-free-mental-health-support-for-colorado-youthLinks to an external site.

        Congress. (n.d.). Congress.Gov. https://www.congress.gov/bill/117th-congress/house-bill/7666/all-actions?s=1&r=7Links to an external site.

         

         Reply to Comment

    • Collapse SubdiscussionMleh Porter 

      National Healthcare Issue

            The national healthcare issue/stressor selected is the recent COVID-19 pandemic. Nurses, especially in critical care areas, have always experienced a high level of physical and mental stress associated with working in this very demanding area where most patients are severely ill. The recent COVID-19 pandemic exacerbated the stress level of nurses in a critical care setting to a higher degree because of increased workloads, nursing staff shortages, and changes to patient care expectations leading to burnout (Christianson et al., 2022). 

      Impact on Work Setting

             Although hospitalization resulting from COVID-19 has declined, its impact continues to be experienced in the workplace. I work in a busy intensive care unit (ICU) where the effects of COVID-19 have led to high staff turnover and a shortage of nursing staff. Many nurses on my unit have resigned because of burnout. This year, my unit has had three different nurse managers. COVID-19 is not over, and its impact will be long-lasting. The challenges of the last two years have left the nursing profession struggling with increased shortages and many nurses reporting adverse effects on their mental health and quality of life (American Nurses Association, 2021). 

      Workplace Response to Healthcare Issues

            The health system work setting has responded to COVID-19-related stress and burnout by offering employees mental health services to meet the needs of the staff. In addition to the expanded counseling services provided to employees, staff members can call a hotline to discuss daily stressors and patient or work-related stress. There are on-site counselors, and staff members can schedule sessions with them. These on-site counselors also facilitate support groups and education on mental health issues. Employees can access counseling services once a week. My hospital setting also uses ICU float nurses and supplemental work and transition (SWAT) nurses trained in the ICU and emergency department to assist ICU nurses. These ICU floats and SWAT nurses are scheduled on every shift as helping hands to alleviate the workload for nurses in the ICU. 

           Burnout impacts not only nurses but also affects patients and the healthcare organization. Nursing burnout has been pointed out as a significant challenge in the acute care setting due to the highly stressful environment, even without the additional challenges of COVID-19. Education and a supportive environment can help improve nursing staff retention and reduce workplace stressors, contributing to patient safety and enhanced satisfaction (Olaleye et al., 2022). 

       

      References

      American Nurses Association (2021, October 26).  Nurses are still stressed, frustrated, and overwhelmed almost 2 years into COVID-19. Retrieved December 1, 2022, from https://www.nursingworld.org/news/news-releases/2021/new-survey-data-thousands-of-nurses-are-still-stressed-frustrated-and-overwhelmed-almost-2-years-into-the-pandemic/

      Christianson, J., Guttormson, J., McAndrew, N. S., & Calkins, K. (2022). Impact of covid-19 on intensive care unit nurse duty of care and professional roles: A qualitative content analysis. SAGE Open Nursing8, 237796082211135. https://doi.org/10.1177/23779608221113539

      Olaleye, T. T., Christianson, T. M., & Hoot, T. J. (2022). Nurse burnout and resiliency in critical care nurses: A scoping review. International Journal of Africa Nursing Sciences17, 100461. https://doi.org/10.1016/j.ijans.2022.100461

       Reply to Comment

      • Collapse SubdiscussionSergio Aguirre 

        Hello Mieh,
        “Nurses working on the front lines of the COVID-19 pandemic are at inherent risk of traumatic stress working in understaffed, poorly equipped, high acuity environments” (Hernandez, et al., 2021, para.1). As you mention, staff members may require mental health services, because the situation was hectic, particularly in the early days. I recall colleagues getting sick themselves, going home on oxygen and one colleague actually passing away. It was overwhelming, as I worked in the ED at the time. I remember one specific day, I had 18 COVID patients in the fast-track area, it was so much work. I will never forget that day. Similar to ICU nurses, one study found that over 30% of emergency room nurses, remained to at high risk to develop PTSD (Yang et al., 2022). With healthcare organizations running at crisis levels fueled by burnout. It makes you wonder if the joy aspect of the Quadruple Aim is even attainable.

        Resources
        Hernandez, J.M., Munyan, K., Kennedy, E. Kennedy, Patrick, Shakoor, K. & Wisser, J. (2021).
        Traumatic Stress Among Frontline American Nurses During the COVID-19 Pandemic: A Survey
        Study. Traumatology,  27 (4), 413-418.  https://doi.org/10.1037/trm0000320

        Yang, B.‐J., Yen, C.‐W., Lin, S.‐J., Huang, C.‐H., Wu, J.‐L., Cheng, Y.‐R., Hsieh, C.‐C., & Hsiao, F.‐H. (2022). Emergency nurses’ burnout levels as the mediator of the relationship between stress and posttraumatic stress disorder symptoms during COVID‐19 pandemic. Journal of Advanced Nursing, 78(9), 2861–2871. https://doi.org/10.1111/jan.15214

         Reply to Comment

      • Collapse SubdiscussionMarphene Joseph 

        week 1 Response 2

        Great post,

        healthcare challenges that the healthcare system is currently dealing with can be traced back to the COVID 19 pandemic. over the past 18 months, the COVID 19 pandemic has inflicted horrible tolls on patient’s, families, nurses, and healthcare systems (Buerhaus, P., 2021). During the COVID 19 epidemic, working conditions have gotten worse for many nurses and medical professionals around the world. Nurses and other health care workers have been saddled with the burden of the pandemic by first being asked to work in unsafe conditions without proper protective personal equipment and then asked to work in crisis mode after crisis mode, as the various waves of the pandemic hit (Bourgault, A., 2022). Some nurses who formerly provided care for two critically sick patients are now expected to provide care for three or four critically ill patients. patient’s in the intensive care unit have fluctuating requirements; they need a nurse who has flexibility in their assignments and is available to run to their room when they have a critical need (Bourgault, A., 2022).

        Reference:

        Bourgault, A. M. (2022). The nursing shortage and work expectations are in critical condition: Is anyone listening? Critical Care Nurse42(2), 8–11. https://doi.org/10.4037/ccn2022909

        Buerhaus, P. I. (2021). Current Nursing Shortages Could Have Long Lasting Consequences: Time to Change Our Present Course. . Nursing Economic$35(5), 247–250.

         

         

         Reply to Comment

      • Collapse SubdiscussionTiffany Johnson 

        Discussion Post response #1

        Hi Mleh,

        This is a great topic. “Nurses experienced high levels of burnout during the COVID-19 pandemic, and various sociodemographic, occupational, psychological, and COVID-19-related factors affected this burnout”.  (Hur et al., 2022) I work in a smaller community hospital that is bursting at the seams. We have felt the effects of nurses retiring early due to the pandemic, nurses leaving the profession, many left to go travel, and we also have the increasing population with the housing boom in our area. Our staff has been pushed to their max. We had to close one of the floors in our hospital due to lack of staff. Many of our floors are inundated with new graduate nurses training new graduate nurses. This creates an unsafe and unpredictable environment for our patients and staff.

        The burnout from the pandemic has reached providers near and far. The government is even in the mix trying to provide relief for healthcare providers. “The Dr. Lorna Breen Health Care Provider Protection Act, (HR 1667Links to an external site.) aims to reduce and prevent suicide, burnout, and mental and behavioral health conditions among health care professionals” (Dr. Lorna Breen Heroes’ Foundation, n.d.). This bill helps to provide resources for healthcare providers experiencing mental health crisis. It also helps alleviate the stigma from mental health for health care providers. I think it is great that your facility has taken action to help with burnout and mental health concerns for their staff. My facility is not there quiet yet. They have created a relaxation room with massage chairs, diffuser, warm towels, and hot tea for the staff to get a quick break from the stress of work. The problem is we do not have to enjoy it. They also do town hall meeting to address the staffing issues once a month. Again, no one is able to attend due to staffing issues. It is the hope that we catch up with many other neighboring facilities and step up our efforts to protect our staff and our patients.

                                                                                      References

        Dr. Lorna Breen Heroes’ Foundation. (n.d.). Dr. lorna breen heroes foundation. Drlornabreen. https://drlornabreen.org/Links to an external site.

        Hur, G., Cinar, N., & Suzan, O. (2022). Impact of covid-19 pandemic on nurses’ burnout and related factors: A rapid systematic review. Archives of Psychiatric Nursing41, 248–263.

         

         Reply to Comment

    • Collapse SubdiscussionTiffany Johnson 

                                                          Review of Current Health Care Issues: Initial Post

                “The United States will see a shortage of up to nearly 122,000 physicians by 2032 as demand for physicians continues to grow faster than supply, according to new data published today by the AAMC (Association of American Medical Colleges). The projected shortfall is similar to past projections and ranges from 46,900 to 121,900 physicians” (American Association of Medical Colleges, n.d.). This brings the need for nurse practitioners to the forefront. Many states have scope of practice restrictions for nurse practitioners, requiring them to have a physician overseeing their practice. The problem with this is it is outdated. We have to be able to meet healthcare where it is at. The physician shortage makes it difficult for patients to get the care they need in a safe and timely manner. Some states are seeing the relief that nurse practitioners can provide on the healthcare system and changing the way they think. In New York, the Nurse Practitioner Modernization Act was implemented (Poghosyan et al., 2018). Nurse practitioners with more than 3,600 hours are no longer required to have a written practice agreement with a physician (Poghosyan et al., 2018). This gives the NP’s more autonomy and the ability to see more patients and make clinical decisions faster by not having to wait on a physician to give the go ahead.

                “With imminent staffing shortages in the health care profession and an increase in the volume of patients seeking primary care services, patient loads are increasing rapidly, thus making it difficult for a single primary care professional to manage all patient care needs effectively and efficiently” (Norful et al., 2018). There is now a demand for the creation of new delivery of care models to meet this demand (Norful et al., 2018). In the hospital setting, it is rare to have nurse practitioners are involved in the care of patients. This puts all of the admission, plan of care and discharge on the physicians. This can lead to a delay in or missed diagnosis, delayed discharges, more expenses for facilities and patients, and physician fatigue. “One proposed care delivery model includes having more than 1 primary care professional comanaging the same patient and sharing the workload responsibilities or care management tasks” (Norful et al., 2018).

                In my current role on the perioperative areas in my facility, these two changes would make our care seamless. In my states of Colorado, Nurse Practitioners have full practice capabilities. According to the American Association of Nurse Practitioners, full practice is defined as “state practice and licensure laws permit all NPs to evaluate patients; diagnose, order and interpret diagnostic tests; and initiate and manage treatments, including prescribing medications and controlled substances, under the exclusive licensure authority of the state board of nursing” (American Association of Nurse Practitioners, n.d.). The obstacle in the way for my facility is that they do not employ NP’s in the hospital setting. The facility has an agreement with Kaiser Permanente insurance that allows their NP’s to work alongside physicians as is described above in the co-management model. Their patients are followed closely and discharged in a timely manner. The unfortunate result of this not being for every patient, is that patients end up waiting a log time for discharge orders. This increases hospital day stays, which increases the health care costs for insurance, facility, and patient. This also creates a domino effect in the perioperative world. We have to hold patients in the PACU as there are no rooms to take them to on the floor because patients are awaiting discharge orders. The PACU fills up quickly, which puts the OR on hold, meaning the patients have to stay in the OR after surgery until a PACU bay is open. This also delays surgeries as the operating rooms are on hold with patients. We must work together to get facilities to hire NP’s and states to remove outdated guidelines in order to gain some traction on the increasing demand on healthcare.

      References

      American Association of Medical Colleges. (n.d.). New findings confirm predictions on physician shortage. AAMC. https://www.aamc.org/news-insights/press-releases/new-findings-confirm-predictions-physician-shortage#:~:text=The%20United%20States%20will%20see%20a%20shortage%20of,projections%20and%20ranges%20from%2046%2C900%20to%20121%2C900%20physicians.Links to an external site.

      American Association of Nurse Practitioners. (n.d.). State practice environmenthttps://www.aanp.org/advocacy/state/state-practice-environmentLinks to an external site.

      Norful, A. A., de Jacq, K., Carlino, R., & Poghosyan, L. (2018). Nurse practitioner–physician comanagement: A theoretical model to alleviate primary care strain. The Annals of Family Medicine16(3), 250–256. https://doi.org/10.1370/afm.2230Links to an external site.

      Poghosyan, L., Norful, A. A., & Laugesen, M. J. (2018). Removing restrictions on nurse practitioners’ scope of practice in new york state: Physicians’ and nurse practitioners’ perspectives. Journal of the American Association of Nurse Practitioners30(6), 354–360. https://doi.org/10.1097/jxx.0000000000000040Links to an external site.

       

      usa nursing papers

      Dont wait until the last minute.

      Provide your requirements and let our native nursing writers deliver your assignments ASAP.

Share your love

You cannot copy content of this page

WhatsApp Us
1
www.USAnursingpapers.com
Our service is 100% Secure & Confidential.
Native USA experts will write you a Top-quality Nursing Paper from Scratch.

WhatsApp Us, We are Live!