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/

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 action. https://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 Medicine, 18(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 Leader, 20(2), 145–151. https://doi.org/10.1016/j.mnl.2021.12.018Links to an external site.

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 

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/

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/

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.

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 Nursing, 122(3), 12–13.        https://doi.org/10.1097/01.naj.0000822928.16774.9a

Devi, M. K. (2022). Editorial: Mentoring New Nurses. Singapore Nursing Journal, 49(1), 1.

Foster, S. (2022). Reflecting on retention: reasons why nurses choose to stay. British Journal of Nursing, 31(7), 405–405. https://doi.org/10.12968/bjon.2022.31.7.405

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 Nurse, 42(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 Healthcare, 52(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 Research, 26(3), 371–375.

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 open, 6(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 management, 30(5), O1–O9. https://doi.org/10.1111/jonm.12928

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 health, 18(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 & safety, 28(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 Organization, 97(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 review, 66(1), 9-16. https://www.researchgate.net/profile/Joanna-Burzynska-2/publication/326584152

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.

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.

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.

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 Leader, 20(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 Open, 9(2), e023906. https://doi.org/10.1136/bmjopen-2018-023906Links to an external site.

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

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 Medicine, 2(11), 2197–2201. https://doi.org/10.1007/s42399-020-00501-yLinks to an external site.

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 Nursing, 37(4), 565–567. https://doi.org/10.1016/j.jopan.2022.05.078

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 bulletin, 130(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 Nursing, 122(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 bulletin, 130(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 Nursing, 122(5), 12. https://doi.org/10.1097/01.NAJ.0000830684.40366.efLinks to an external site.

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 Community, 9(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.

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.

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 Nursing, 8, 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 Sciences, 17, 100461. https://doi.org/10.1016/j.ijans.2022.100461